Safety and feasibility of single-incision laparoscopic cholecystectomy in obese patients

Background

Current literature frequently indicates that experienced laparoscopic surgeons can safely perform single-incision laparoscopic cholecystectomy, but there have been few reports evaluating the feasibility and safety of performing single-incision laparoscopic cholecystectomy for obese patients. Therefore, a large single-center database was retrospectively reviewed to evaluate the feasibility and safety of single-incision laparoscopic cholecystectomy for obese patients by comparing the outcomes of normal-weight and obese patients undergoing single-incision laparoscopic cholecystectomy.

Methods

A retrospective analysis of 608 patients undergoing SILC between May 2009 and May 2015 at Osaka Police Hospital was performed, and the outcomes of obese [body mass index (BMI) ≥ 30 kg/m²] and normal-weight patients (18.5 ≤ BMI < 25 kg/m²) were compared.

Results

Thirty-eight obese patients (mean BMI 32.5 kg/m²) were compared to 362 normal-weight patients (mean BMI 22.0 kg/m²). The American Society of Anesthesiologists (ASA) scores of the obese patients were significantly higher than those of normal-weight patients. The mean operative times in the normal-weight and the obese groups were 110 min vs. 127 min, respectively (p < 0.05). There were no significant differences in the bleeding volume and the conversion rate to a different operative procedure. Perioperative complications were seen in 6% (23/362) of the patients in the normal-weight group and 8% (3/38) of the patients in the obese group (p = 0.7). The mean postoperative hospital stay was 4.5 days for the normal-weight group and 4.4 days for the obese group (p = 0.8).

Conclusions

Single-incision laparoscopic cholecystectomy, which offers good cosmetic outcomes, seems feasible and safe in obese patients.

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Single-incision laparoscopic cholecystectomy offers good cosmetic outcomes.

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Single-incision laparoscopic cholecystectomy seems feasible and safe in obese patients.

[A Case of Surgical Resection for Liver Metastasis of Gastric Cancer Treated with Neoadjuvant Chemotherapy]

The patient was a 73-year-old man. Upper gastrointestinal endoscopy revealed a type 3 tumor in the antrum of the stomach. Preoperative CT imaging showed multiple liver metastases(S2, S3, S4, S6, S7). We administered 2 courses of chemotherapy( XP therapy)for the unresectable gastric cancer; the impact of the neoadjuvant therapy was PR. We performed distal gastrectomy and D2 dissection. After gastric resection, we administered an additional 3 courses of XP therapy. Unfortunately, new lesions of liver metastases were recurrent at S5 and S8. The patient was treated with 3 courses of S-1 chemotherapy. However, abdominal CT and EOB-MRI revealed significant tumor growth despite S-1 therapy. We performed S5 sub-segment resection and S8 partial resection due to the absence of new lesions. Histopathological findings revealed that the well-differentiated adenocarcinoma had metastasized to the liver, with Grade 1a tumor destruction. Two years after the initial gastrectomy, no recurrence of gastric cancer was observed.

Short-term outcomes of single-port surgery for palliative resection of the primary tumor in patients with incurable stage IV colon cancer

INTRODUCTION

The aim of this study was to evaluate the short-term outcomes of single-port surgery (SPS) for palliative resection of the primary tumor in patients with incurable stage IV colon cancer.

METHODS

We studied 66 consecutive patients who underwent SPS or multiport surgery (MPS) for palliative resection of their primary tumor in our department from January 2008 to December 2013. Short-term outcomes and the postoperative course were analyzed between groups retrospectively.

RESULTS

Of the 66 patients, 32 underwent SPS, and 34 underwent MPS. The groups did not differ significantly in terms of preoperative evaluation and short-term outcomes. In the SPS group, one patient was converted to MPS (3.1%); no patients were converted to open surgery. Oncological resection, the proportion of patients who received postoperative chemotherapy, and time to the beginning of postoperative chemotherapy was similar in both groups. The 1-year overall survival rates were 76.7% in the SPS group and 79.4% in the MPS group (P = 0.711).

CONCLUSIONS

SPS is safe and feasible for palliative resection of the primary tumor in patients with incurable stage IV colon cancer.

Single-incision totally extraperitoneal inguinal hernia repair is safe and feasible in elderly patients: A single-center experience of 365 procedures

The aim of this study was to evaluate the feasibility and safety of SILS for totally extraperitoneal inguinal hernia repair in elderly patients. A retrospective analysis of 365 patients who underwent of SILS for totally extraperitoneal inguinal hernia repair from January 2012 to November 2015 at Osaka Police Hospital was performed, and the outcomes of patients aged <80 years and those aged ≥80 years were compared. There was a greater proportion of patients with an ASA score ≥3 among those ≥80 years than among those <80 years. The mean operative time for unilateral inguinal hernia was 94 min in patients <80 years and 98 min in patients ≥80 years. The mean operative time for bilateral inguinal hernia was 133 min in patients <80 years and 130 min in patients ≥80. Intraoperative bleeding was minimal in all patients. Conversion to a different operative procedure occurred in 3% (10/322) of patients <80 years and in 5% (2/43) of patients ≥80 years (P = 0.6). The mean postoperative hospital stay was 2.2 days for patients <80 years and 2.2 days for patients ≥80 years. The mean follow-up period 21 ± 14 months (range, 3-50 months) for patients <80 years and 17 ± 14 months (range, 3-50 months) for patients ≥80 years (P = 0.3). Postoperative complications were seen in 12% (38/322) of patients <80 years and in 14% (6/43) of patients ≥80 years (P = 0.7). A seroma was seen in 9% (28/322) of patients <80 years and in 12% (5/43) of patients ≥80 years (P = 0.6). A wound infection occurred in 2% (8/322) of patients <80 years. These seromas and wound infections were managed conservatively. Pulmonary embolism was seen in one patient <80 years (0.3%). There was no mortality or recurrence in either group. SILS for totally extraperitoneal inguinal hernia repair has good cosmesis and can be performed in elderly patients with acceptable morbidity and mortality.

[Curative Resection for Chemorefractory Advanced Gastric Cancer with Pancreatic Invasion by Pancreatoduodenectomy - A Case Report]

A 37-year-old woman was diagnosed with advanced gastric cancer. Pancreatic invasion of the tumor and positive cytology from peritoneal washing was found on staging laparoscopy. The patient received chemotherapy consisting of S-1 and CDDP, but the tumor size increased after 5 courses. The patient then received 2 courses of second line chemotherapy consisting of biweekly CPT-11; however, the tumor progressed and caused stenosis of the stomach. After gastrojejunostomy for the stenosis, negative cytology of intraperitoneal lavage was found. The patient underwent pancreatoduodenectomy with right hemicolectomy and wedge resection of the portal vein as curative resection. The patient was alive without recurrence 10 months after the surgery.

[A Case of Pathological Complete Response after SOX Chemotherapy in Advanced Gastric Cancer]

The patient was a 78-year-old woman. She was referred to our hospital and diagnosed with advanced gastric cancer with para-aortic lymph node(#16)metastasis. She received the SOX regimen(L-OHP 100mg/m2)chemotherapy and developed fatigue, anorexia, and neutropenia. After 4 courses of the SOX regimen, the #16 metastasis was reduced remarkably. A curative operation was performed and histological evaluation of the primary and lymphatic lesion after chemotherapy showed Grade 3 findings. The SOX regimen is tolerable in the outpatient clinic and is useful as part of multidisciplinary treatment for advanced gastric cancer.

The Effect of Fexofenadine on Pruritus in a Mouse Model (HR-ADf) of Atopic Dermatitis

Fexofenadine, a histamine H1-receptor antagonist, is approved for the treatment of pruritus associated with atopic dermatitis. The effects of fexofenadine on scratching behaviour, and plasma levels of histamine and eotaxin were assessed in a new model of atopic dermatitis. Mice fed a diet low in Mg2+ and Zn2+ (special diet S) were compared with mice on a normal diet (N) or diet S plus fexofenadine HCl for weeks 0-10 (S + F0-10), 0-5 (S + F0-5) or 6-10 (S + F6-10) (seven mice per group). Compared with group N, group S mice showed significantly greater scratching frequency, and plasma histamine and eotaxin concentrations; these three variables were significantly lower in group S + F0-10 than in group S. Scratching frequency increased when fexofenadine was discontinued. Fexofenadine significantly reduced mast cell and eosinophil numbers. Histamine may be important in the pathological changes seen in this model of atopic dermatitis, suggesting that it might aid future development of antihistamines for the treatment of atopic dermatitis.

Measurement and comparison of individual external doses of high-school students living in Japan, France, Poland and Belarus-the 'D-shuttle' project

Twelve high schools in Japan (of which six are in Fukushima Prefecture), four in France, eight in Poland and two in Belarus cooperated in the measurement and comparison of individual external doses in 2014. In total 216 high-school students and teachers participated in the study. Each participant wore an electronic personal dosimeter 'D-shuttle' for two weeks, and kept a journal of his/her whereabouts and activities. The distributions of annual external doses estimated for each region overlap with each other, demonstrating that the personal external individual doses in locations where residence is currently allowed in Fukushima Prefecture and in Belarus are well within the range of estimated annual doses due to the terrestrial background radiation level of other regions/countries.

Incidence and risk factors of postoperative delirium in elderly patients who underwent laparoscopic surgery for colorectal cancer

BACKGROUND

The reported incidence of postoperative delirium (POD) in elderly patients ranges from 6 to 53 %. Several preoperative and operative factors have been reported as risk factors of POD.

AIM

The aim of this study was to determine the incidence of and risk factors for POD in patients with colorectal cancer who had undergone laparoscopic colorectal resection.

METHODS

A total of 311 consecutive patients aged 75 years and older who underwent laparoscopic surgery for colorectal cancer at our department from January 2008 to December 2013 were classified as delirious group (n = 44) and nondelirious group (n = 267). Short-term outcomes and risk factors for POD were analyzed.

RESULTS

POD was diagnosed in 14.1 % of elderly patients with colorectal cancer. Univariate analysis showed that older age, high American Society of Anesthesiology (ASA) score, performance status >2, low prognostic nutrition index (PNI), past history of delirium or dementia, operative approach, Organ/Space SSI, and cardiac or pulmonary disease were significantly associated with POD. Multivariate logistic regression analysis identified older age, past history of delirium or dementia, operative approach, and Organ/Space SSI as four independent risk factors for POD.

CONCLUSIONS

Our results suggest that the risk of POD is associated with older age, past history of delirium or dementia, operative approach, Organ/Space SSI.

Comparison of bleeding risks related to venous thromboembolism prophylaxis in laparoscopic vs open colorectal cancer surgery: a multicenter study in Japanese patients

BACKGROUND

Venous thromboembolism is the most common preventable cause of hospital death. The objective of this study was to clarify risk factors for postoperative bleeding related to thromboprophylaxis after laparoscopic colorectal cancer surgery.

METHODS

The study was conducted at 23 Japanese institutions and included patients with colorectal cancer who underwent laparoscopic or open surgery followed by fondaparinux treatment. We performed a retrospective analysis from a prospectively maintained database. We used multivariate analyses to evaluate clinical risk factors for prophylaxis-related bleeding events.

RESULTS

After multivariate analysis, male gender, intraoperative blood loss of less than 25 mL, and a preoperative platelet count below 15 × 10⁴/μL were found to be independent risk factors in the laparoscopic surgery group. Only the preoperative platelet count was an independent risk factor in the open surgery group.

CONCLUSIONS

Different prophylactic treatments for postoperative venous thromboembolism may be necessary in laparoscopic vs open surgery for colorectal cancer.

Single-incision totally extraperitoneal inguinal hernia repair as a teaching procedure: one center's experience of more than 300 procedures

PURPOSE

To evaluate resident doctors' proficiency in performing single-incision laparoscopic surgery for totally extraperitoneal inguinal hernia repair (SILS-TEP), and assess patient outcomes by comparing procedures performed by resident surgeons vs. those performed by staff surgeons.

METHODS

We analyzed retrospectively 301 patients who underwent SILS-TEP between January 2011 and May 2015 at Osaka Police Hospital.

RESULTS

The mean operative times for unilateral and bilateral hernia repairs in the resident-surgeon and the staff-surgeon groups were 99 vs. 88 min, respectively (p < 0.05), and 130 vs. 137 min, respectively. There was no significant difference in the incidence of conversion to a different procedure between the groups. The mean postoperative hospital stay was 2.0 days for patients from the resident-surgeon group vs. 2.8 days for those from the staff-surgeon group (p < 0.05). Seromas and wound infections developed in 8 % (12/148) of patients from the resident-surgeon group vs. 12 % (19/153) of those from the staff-surgeon group. No other major complications or hernia recurrence were noted in either group.

CONCLUSIONS

SILS-TEP was performed safely, with low morbidity and no recurrence, by the resident surgeons under appropriate guidance by staff surgeons.

Evaluation of postoperative pain at the stoma site in patients who underwent a single-port Hartmann's procedure

INTRODUCTION

The aims of this retrospective study were to evaluate postoperative pain at the stoma site in patients who underwent a single-port Hartmann's procedure (SPH) and to compare the SPH to the multiport Hartmann's procedure (MPH) in terms of postoperative pain.

METHODS

We studied 17 consecutive patients who underwent SPH or MPH for left colon cancer. Postoperative pain was evaluated from postoperative day 1 to 7 with the Numeric Rating Scale.

RESULTS

The postoperative pain score at the stoma site was highest on postoperative day 2 (Numeric Rating Scale score = 3.6). The duration of narcotics use was significantly shorter in the SPH group than in the MPH group (2.1 vs 3.3 days; P = 0.012). The rescue analgesia was administered fewer times in the SPH group than in the MPH group (1.3 vs 4.6; P = 0.012), and the duration of rescue analgesia use was shorter (1.1 vs 3.7 days; P = 0.013). The worst Numeric Rating Scale score in the SPH group was significantly lower than that in the MPH group on postoperative day 3 (1.9 vs 4.1; P = 0.031).

CONCLUSIONS

Postoperative pain at the stoma site was highest on postoperative day 2. The SPH was associated with less postoperative pain than the MPH.

Cancer immunotherapy for pancreatic cancer utilizing α-gal epitope/natural anti-Gal antibody reaction

Pancreatic ductal adenocarcinoma (PDAC) has the poorest prognosis of all malignancies and is largely resistant to standard therapy. Novel treatments against PDAC are desperately needed. Anti-Gal is the most abundant natural antibody in humans, comprising about 1% of immunoglobulins and is also naturally produced in apes and Old World monkeys. The anti-Gal ligand is a carbohydrate antigen called “α-gal epitopes” with the structure Galα1-3Galβ1-4GlcNAc-R. These epitopes are expressed as major carbohydrate antigens in non-primate mammals, prosimians, and New World monkeys. Anti-Gal is exploited in cancer vaccines to increase the immunogenicity of antigen-presenting cells (APCs). Cancer cells or PDAC tumor lysates are processed to express α-gal epitopes. Vaccination with these components results in in vivo opsonization by anti-Gal IgG in PDAC patients. The Fc portion of the vaccine-bound anti-Gal interacts with Fcγ receptors of APCs, inducing uptake of the vaccine components, transport of the vaccine tumor membranes to draining lymph nodes, and processing and presentation of tumor-associated antigens (TAAs). Cancer vaccines expressing α-gal epitopes elicit strong antibody production against multiple TAAs contained in PDAC cells and induce activation of multiple tumor-specific T cells. Here, we review new areas of clinical importance related to the α-gal epitope/anti-Gal antibody reaction and the advantages in immunotherapy against PDAC.

Abstract 556: The detection of viable human circulating tumor cells (v-hCTCs) in resectable pancreatic cancer induced by neoadjuvant chemoradiotherapy (NACRT) using gemcitabine, S-1 and intensity-modulated radiotherapy (IMRT)

Circulating tumor cells (CTCs) are thought to be “metastatic intermediates”. Recently, we reported encouraging survival rates following neoadjuvant therapy using gemcitabine (Gem) and S-1 concurrently with radiotherapy (NACRT) in patients (pts) with resectable pancreatic cancer (PC). However, NACRT may have disadvantages. We hypothesized that NACRT in PC may induce epithelial to mesenchymal transition (EMT), which is associated with metastasis followed by the increase of CTCs. To extend our assessment of EMT during NACRT, we investigate the results of the v-hCTC detection in the pts treated with NACRT. This study was a single institution trial, approved by the Kure Medical Center IRB. Pts with resectable cytologically or histologically proven ductal adenocarcinoma of the pancreas were enrolled. Treatment consisted of an intervenous infusion of Gem 800 mg/m2 on day 1, 8, 22, and 29; and S-1 80 mg/m2 orally on day 1-5, 8-12, 22-26, and 29-33 given concurrently with IMRT to 60 Gy (2 Gy/day, 5 times per week, 30 fractions). Surgical exploration was scheduled 4-7 weeks after the final radiation fraction. To detect v-hCTCs, we employed a telomerase-specific replication-selective adenovirous expressing GFP (TelomeScan F35). 7.5 ml of blood samples were obtained from the pts included in this clinical study before NACRT, after 1 month of NACRT, and after 2 months of surgical resection. To distinguish between leucocyte and cells with epithelial origin, cells were stained with anti-CD45 and anti-Cytokeratin Abs. To distinguish cells with mesenchymal origin, cells were labeled with anti-Vimentin Ab. GFP-positive and CD45-negative cells were counted as v-hCTC. 12 pts aged 44-77 years (2 males and 10 females) were enrolled. No treatment-related deaths occurred. CA19-9 was reduced to &lt;50% of baseline values in 7 of 9 measureable pts. 11 of 12 enrolled pts successfully underwent surgical resection. Only 4 out of 12 pts had one or two v-hCTCs detected before NACRT. After NACRT, 6 of 12 pts without tumor progression had v-hCTCs detected, which expressed Vimentin (1-56 CTCs). Among them, 3 pts had v-hCTCs detected at baseline. These 3 CTC-positive pts still had two or more Vimentin-positive CTCs detected (2-27 CTCs) after surgery, whereas remaining 9 pts had no detectable v-hCTCs. 1 of these 3 CTC-positive pts early developed liver metastasis and died, despite R0 resection. For the remaining 2 CTC-positive pts after surgery, one pt with postoperative therapy had no detectable CTCs at 1 year after surgery, however another pt without postoperative therapy still had 7 v-hCTCs detected (Vimentin[+]). We believe that our NACRT is feasible. However, we may consider “surgery first” for CTC-positive PC pts at baseline. In conclusion, v-hCTCs may become useful for prognosis assessment or stratification, especially when radiotherapy is considered.

Citation Format: Masahiro Tanemura, Toshimitsu Irei, Masashi Inoue, Shinya Yamashita, Kenta Furukawa, Masaki Wakasugi, Kentaro Kishi, Hiroaki Nagano, Hiroki Akamatsu, Yasuo Urata, Nobuyoshi Hatanaka, Masaki Mori, Yuichiro Doki. The detection of viable human circulating tumor cells (v-hCTCs) in resectable pancreatic cancer induced by neoadjuvant chemoradiotherapy (NACRT) using gemcitabine, S-1 and intensity-modulated radiotherapy (IMRT). [abstract]. In: Proceedings of the 106th Annual Meeting of the American Association for Cancer Research; 2015 Apr 18-22; Philadelphia, PA. Philadelphia (PA): AACR; Cancer Res 2015;75(15 Suppl):Abstract nr 556. doi:10.1158/1538-7445.AM2015-556

Abstract 2512: Novel immunotherapy using a tumor lysate vaccine with α-gal epitopes against pancreatic cancer

Pancreatic cancer (PC) is a lethal disease that remains one of the most resistant to traditional therapies, so we are in urgent need of other therapies. Immunotherapies act differently than chemotherapy or radiotherapy and might be an alternative treatment modality to this deadly disease with significantly less toxicity. Immunotherapy designed to target tumor-associated antigens (TAAs) is a promising treatment approach for PC. But vaccination against a single TAA seems to be insufficient. In our previous study, we showed effectiveness vaccination by whole PC cells engineered to express α-gal epitopes (Cancer Res, 2010). Subsequently we showed effectiveness of tumor lysate vaccine engineered to α-gal epitopes (Int J Oncol, 2015). For clinical development of more effective immunotherapy, we proposed that human tumor lysate originated from resected PC is more suitable because it contains several TAAs that could elicit a marked anti-tumor response. The present study addresses the effectiveness of elicitation of both antibody production and in vivo destruction against PC by vaccination with human tumor lysate with α-gal epitopes enzymatically.

Tumor specimens were obtained from 11 patients at the time of surgical resection. To express α-gal epitopes, we cloned the α1,3galactosyltransferas (α1,3GT) from a New World Monkey and expressed it in a soluble form in the yeast expression system of Pichia pastoris. α1,3GT KO mice were immunized with pig tissue to generate anti-Gal Ab in their sera. These mice were vaccinated intraperitoneally by either unsynthesized (control group; group C) or α-gal tumor lysate (α-gal group; group A).

Production of anti-PC cell Ab in group A was 8∼16-fold higher than that of group C. Also production of anti-TAA Ab in group A was 8∼16-fold higher than that of group C. Expansion of TAAs-specific B cells was significantly higher [number of spots at 1×106 splenocytes: MUC1: group A vs. C; 151±33 vs. 28±13 (p&lt;0.001), Mesothelin: 97±26 vs. 36±19 (p = 0.03)]. In group A, we detected 828±180 spots of IFN-γ secreting T cells in the presence of the MUC1, and 988±232 spots were detected in the presence of the Mesothelin. In group C, 146±59 spots by the MUC1 and 384±219 spots by the Mesothelin were detected. The number of spots in the presence of TAA stimulation was significantly higher in group A than in group C. To demonstrate in vivo tumor destruction, an animal experiment was performed. Splenocytes from vaccinated KO mice were prepared, and then transferred intraperitoneally (90×106 cells) into NOD/SCID mice. Followed by transferring, mice were challenged with 1×107 of live PANC-1 cells. In mice from group A, regrowth of tumors was significantly prevented and survival period was significantly prolonged [group A vs. C: 91.5 vs. 47.0 days (p&lt;0.01)].

We conclude that immunotherapy with α-gal tumor lysate obtained from PC patients with enzymatic engineering could be more effective and practicable methods for PC treatment.

Citation Format: Kenta Furukawa, Masahiro Tanemura, Eiji Miyoshi, Hiroaki Nagano, Masaki Wakasugi, Toru Masuzawa, Mitsuyoshi Tei, Kentaro Kishi, Hiroki Akamatsu, Hidetoshi Eguchi, Katsuyoshi Matsunami, Masaki Mori, Yuichiro Doki. Novel immunotherapy using a tumor lysate vaccine with α-gal epitopes against pancreatic cancer. [abstract]. In: Proceedings of the 106th Annual Meeting of the American Association for Cancer Research; 2015 Apr 18-22; Philadelphia, PA. Philadelphia (PA): AACR; Cancer Res 2015;75(15 Suppl):Abstract nr 2512. doi:10.1158/1538-7445.AM2015-2512

Comparison of perioperative and short-term oncological outcomes after single- or multiport surgery for colorectal cancer

AIM

The aim of this retrospective study was to compare the short-term surgical results of single-port surgery (SPS) with those of multiport surgery (MPS) for colorectal cancer.

METHOD

We studied 673 consecutive patients who underwent SPS or MPS for colorectal cancer in our department from January 2008 to December 2013. The operative parameters and oncological outcome were analysed and compared between the SPS and the MPS groups retrospectively.

RESULTS

The SPS and MPS groups did not differ significantly in terms of preoperative evaluation. The median operative time was significantly shorter with SPS than with MPS (176 min vs 193 min; P < 0.001). The two groups did not differ significantly in terms of postoperative complications. Length of hospital stay was significantly shorter with SPS than with MPS (8 days vs 10 days; P < 0.001). Oncological resection was similar in the two groups. The disease-free survival rates at 2 years according to the TNM stage did not differ significantly between the two groups (Stage I, 98.5% vs 94.7%; Stage II, 93.4% vs 90.7%; and Stage III, 70.8% vs 68.4%).

CONCLUSION

Our experience demonstrates that SPS is safe and can provide oncological outcomes equal to those of MPS in patients with colorectal cancer.

Comparison of short-term surgical results of single-port and multi-port laparoscopic rectal resection for rectal cancer

BACKGROUND

Single-port surgery is a recent advancement in minimally invasive techniques for colon disease. However, single-port laparoscopic rectal resection (SPLR) is rare. The aim of this study was to compare the short-term results of SPLR with those of multi-port laparoscopic rectal resection (MPLR) for rectal cancer.

METHODS

Patients who underwent SPLR (n = 50) or MPLR (n = 50) for rectal cancer from July 2010 to March 2014 were analyzed. Patients with tumor diameter less than 40 mm and body mass index less than 30 kg/m(2) were matched for age, sex, tumor location, and preoperative evaluation. Operative parameters and outcomes were compared between groups. Patients with lower rectal cancer were excluded.

RESULTS

SPLR was successful in 98.0% of cases. Operative procedure, operative time, blood loss, field of lymph node dissection, and rate of postoperative complications did not differ significantly. Length of hospital stay was shorter with SPLR than with MPLR (8 vs 10 days, respectively; P = .018). Oncological outcomes did not differ significantly between the 2 groups.

CONCLUSION

SPLR is safe and feasible in selected patients with rectal cancer.

New approaches in laparoscopic surgery for colorectal diseases: The totally laparoscopic and single-incision approaches

More than 20 years have passed since the first report of laparoscopic colectomy in 1991. Thereafter, laparoscopic surgery for the management of colorectal diseases has been widely accepted as a prevailing option because of improved cosmetic outcomes, less postoperative pain, and shorter hospital stay in comparison with open surgery. To further the principle of minimally invasive surgery, two new approaches have been developed in this rapidly evolving field. The first is the totally laparoscopic approach. Currently most of standard techniques inevitably involve an abdominal incision for retrieval of the specimen and preparation for anastomosis, which might compromise the benefits of laparoscopic surgery. The totally laparoscopic approach dispenses with this incision by combining completely intraperitoneal anastomosis with retrieval of the specimen via a natural orifice, such as the anus or the vagina. Our new and reliable technique for intraperitoneal anastomosis is also described in detail in this article. The second is the single-incision approach. While three to six ports are needed in standard laparoscopic surgery, the single-incision approach uses the umbilicus as the sole access to the abdominal cavity. All of the laparoscopic procedures are performed entirely through the umbilicus, in which the surgical scar eventually becomes hidden, achieving virtually scarless surgery. This article reviews the current status of these two approaches and discusses the future of minimally invasive surgery for colorectal diseases.