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Keller DS, Qiu J, Kiran RP. A National study on the adoption of laparoscopic colorectal surgery in the elderly population: current state and value proposition. Tech Coloproctol 2019; 23:965-972. [PMID: 31598786 DOI: 10.1007/s10151-019-02082-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2019] [Accepted: 09/07/2019] [Indexed: 12/19/2022]
Abstract
BACKGROUND The economic and clinical benefits of laparoscopic colorectal surgery are proven, yet may be underutilized in appropriate cases, especially in the elderly. Since the elderly constitute the greatest colorectal surgical volume, our goal was to identify trends in utilization and impact of laparoscopy in this cohort. METHODS A national review of elective inpatient colorectal resections from the Premier Inpatient Database between 2010 and 2015 was performed. Patients were included if elderly (≥ 65 years), then grouped into open or laparoscopic procedures. The main outcome measures were trends in utilization by approach and total costs for the episode of care, length of stay (LOS), readmission, and complications by approach in the elderly. Multivariable regression models controlled for differences across platforms, adjusting for patient demographic, comorbidities and hospital characteristics. RESULTS In 70,655 elderly patients evaluated, laparoscopic adoption remained lower than open throughout the study period. Rates increased until 2013, then declined, with increasing rates of open surgery. Laparoscopy was associated with significantly lower mean total costs ($4012 less/case), complications and readmissions (36% and 33% less, respectively), and shorter LOS (2.6 less days) than open cases (all p < 0.0001). When complications occurred, they were less severe and the readmission episodes were less costly with laparoscopy than open colorectal surgery. CONCLUSION The adoption of laparoscopy in the elderly has lagged behind open surgery and even declined in recent years despite being associated with improved clinical outcomes and reduced cost. With this tremendous value proposition to increase use of laparoscopic surgery in the elderly, further work needs to evaluate root causes of the disparity.
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Affiliation(s)
- D S Keller
- Division of Colon and Rectal Surgery, Department of Surgery, NewYork-Presbyterian, Columbia University Medical Center, Herbert Irving Pavilion, 161 Fort Washington Avenue, 8th Floor, New York, NY, 10032, USA.
| | - J Qiu
- Minimally Invasive Therapies Group, Medtronic, Inc., Boulder, CO, USA
| | - R P Kiran
- Division of Colorectal Surgery, Department of Surgery, Columbia University Medical Center, New York, NY, USA
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Port site metastases after minimally invasive resection for colorectal cancer: A retrospective study of 13 patients. Surg Oncol 2019; 29:20-24. [DOI: 10.1016/j.suronc.2019.02.008] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2018] [Revised: 01/10/2019] [Accepted: 02/11/2019] [Indexed: 01/27/2023]
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Halicek M, Fabelo H, Ortega S, Callico GM, Fei B. In-Vivo and Ex-Vivo Tissue Analysis through Hyperspectral Imaging Techniques: Revealing the Invisible Features of Cancer. Cancers (Basel) 2019; 11:E756. [PMID: 31151223 PMCID: PMC6627361 DOI: 10.3390/cancers11060756] [Citation(s) in RCA: 96] [Impact Index Per Article: 19.2] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2019] [Revised: 05/20/2019] [Accepted: 05/24/2019] [Indexed: 12/27/2022] Open
Abstract
In contrast to conventional optical imaging modalities, hyperspectral imaging (HSI) is able to capture much more information from a certain scene, both within and beyond the visual spectral range (from 400 to 700 nm). This imaging modality is based on the principle that each material provides different responses to light reflection, absorption, and scattering across the electromagnetic spectrum. Due to these properties, it is possible to differentiate and identify the different materials/substances presented in a certain scene by their spectral signature. Over the last two decades, HSI has demonstrated potential to become a powerful tool to study and identify several diseases in the medical field, being a non-contact, non-ionizing, and a label-free imaging modality. In this review, the use of HSI as an imaging tool for the analysis and detection of cancer is presented. The basic concepts related to this technology are detailed. The most relevant, state-of-the-art studies that can be found in the literature using HSI for cancer analysis are presented and summarized, both in-vivo and ex-vivo. Lastly, we discuss the current limitations of this technology in the field of cancer detection, together with some insights into possible future steps in the improvement of this technology.
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Affiliation(s)
- Martin Halicek
- Department of Bioengineering, The University of Texas at Dallas, 800 W. Campbell Road, Richardson, TX 75080, USA.
- Department of Biomedical Engineering, Emory University and The Georgia Institute of Technology, 1841 Clifton Road NE, Atlanta, GA 30329, USA.
| | - Himar Fabelo
- Department of Bioengineering, The University of Texas at Dallas, 800 W. Campbell Road, Richardson, TX 75080, USA.
- Institute for Applied Microelectronics (IUMA), University of Las Palmas de Gran Canaria (ULPGC), 35017 Las Palmas de Gran Canaria, Spain.
| | - Samuel Ortega
- Institute for Applied Microelectronics (IUMA), University of Las Palmas de Gran Canaria (ULPGC), 35017 Las Palmas de Gran Canaria, Spain.
| | - Gustavo M Callico
- Institute for Applied Microelectronics (IUMA), University of Las Palmas de Gran Canaria (ULPGC), 35017 Las Palmas de Gran Canaria, Spain.
| | - Baowei Fei
- Department of Bioengineering, The University of Texas at Dallas, 800 W. Campbell Road, Richardson, TX 75080, USA.
- Advanced Imaging Research Center, University of Texas Southwestern Medical Center, 5323 Harry Hine Blvd, Dallas, TX 75390, USA.
- Department of Radiology, University of Texas Southwestern Medical Center, 5323 Harry Hine Blvd, Dallas, TX 75390, USA.
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Osagiede O, Spaulding AC, Cochuyt JJ, Naessens J, Merchea A, Colibaseanu DT. Trends in the Use of Laparoscopy and Robotics for Colorectal Cancer in Florida. J Laparoendosc Adv Surg Tech A 2019; 29:926-933. [PMID: 31094645 DOI: 10.1089/lap.2019.0016] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Background: Laparoscopy and more recently robotics are increasingly used for colorectal cancer surgery in the United States. We examined the current trends of minimally invasive surgical resections for colorectal cancer in Florida. Methods: The Florida Inpatient Discharge Dataset was used to examine the clinical data of patients who underwent elective surgery for colorectal cancer during 2013-2015. Multivariate analyses were performed to compare patient characteristics associated with the use of open and minimally invasive surgeries. Results: A total of 10,513 patients were analyzed; 5451 (52%) had open surgery, 4403 (42%) laparoscopy, and 659 (6%) robotic surgery. The rates of minimally invasive surgery (MIS) increased from 46.95% in 2013 to 48.72% in 2015. Among minimally invasive surgical procedures, the use of robotics increased from 9.82% in 2013 to 15.48% in 2015. Metastatic cancer (odds ratio [OR] 0.61, confidence interval [CI] 0.55-0.67), Elixhauser score of 3-5 (OR 0.85, CI 0.76-0.95) or more than 5 (OR 0.78, CI 0.63-0.97), Medicaid insurance (OR 0.73, CI 0.6-0.89), Black race (OR 0.88, CI 0.77-0.99), and rural residence (OR 0.83, CI 0.69-0.99) were associated with lower odds of MIS than open surgery. Conclusions: This study demonstrates that the overall rates of MIS for colorectal cancer in Florida increased from 2013 to 2015. Socially deprived and very sick patient populations with colorectal cancer are less likely to undergo MIS.
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Affiliation(s)
| | - Aaron C Spaulding
- 2 Department of Health Sciences Research, Mayo Clinic, Jacksonville, Florida
| | - Jordan J Cochuyt
- 2 Department of Health Sciences Research, Mayo Clinic, Jacksonville, Florida
| | - James Naessens
- 2 Department of Health Sciences Research, Mayo Clinic, Jacksonville, Florida
| | - Amit Merchea
- 1 Department of Surgery and Mayo Clinic, Jacksonville, Florida
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Hoshino N, Fukui Y, Hida K, Sakai Y. Short-term outcomes of laparoscopic surgery for colorectal cancer in the elderly versus non-elderly: a systematic review and meta-analysis. Int J Colorectal Dis 2019; 34:377-386. [PMID: 30649570 DOI: 10.1007/s00384-019-03234-0] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/04/2019] [Indexed: 02/04/2023]
Abstract
PURPOSE Laparoscopic surgery for colorectal cancer has spread globally. The usefulness of laparoscopic surgery for elderly patients was initially indicated by comparison with open surgery. However, whether the procedure is safe for elderly as well as non-elderly patients with colorectal cancer remains unclear. METHODS In this review, patients aged ≥ 75 were defined as elderly. We conducted literature searches using PubMed, Scopus, and the Cochrane Central Register of Clinical Trials. Two authors independently reviewed resultant articles to identify relevant observational studies. Data synthesis was performed with a random-effects model. Heterogeneity was investigated by using forest plots and I2 statistics. Risk of bias of included studies was assessed by the Risk of Bias Assessment Tool for Nonrandomized Studies. Publication bias was assessed by funnel plots. RESULTS Twenty-two studies were included. The incidence of overall complications was slightly higher in elderly patients than in non-elderly patients, with statistical significance (risk ratio (RR) 1.20, 95% confidence interval (CI) 1.08-1.34). There was no difference between them in the incidence of anastomotic leakage (RR 1.24, 95% CI 0.86-1.80) and mortality (risk difference 0.00, 95% CI - 0.01 to 0.01). CONCLUSIONS Laparoscopic surgery for colorectal cancer is mostly safe for elderly patients as well as non-elderly patients. Preoperative comorbidities or poor physical capacity should be cared for in the elderly.
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Affiliation(s)
- Nobuaki Hoshino
- Department of Surgery, Kyoto University Graduate School of Medicine, 54 Shogoin-Kawahara-cho, Sakyo-ku, Kyoto, 606-8507, Japan.
| | - Yudai Fukui
- Department of Surgery, Kyoto University Graduate School of Medicine, 54 Shogoin-Kawahara-cho, Sakyo-ku, Kyoto, 606-8507, Japan
| | - Koya Hida
- Department of Surgery, Kyoto University Graduate School of Medicine, 54 Shogoin-Kawahara-cho, Sakyo-ku, Kyoto, 606-8507, Japan
| | - Yoshiharu Sakai
- Department of Surgery, Kyoto University Graduate School of Medicine, 54 Shogoin-Kawahara-cho, Sakyo-ku, Kyoto, 606-8507, Japan
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Baltussen EJM, Kok END, Brouwer de Koning SG, Sanders J, Aalbers AGJ, Kok NFM, Beets GL, Flohil CC, Bruin SC, Kuhlmann KFD, Sterenborg HJCM, Ruers TJM. Hyperspectral imaging for tissue classification, a way toward smart laparoscopic colorectal surgery. JOURNAL OF BIOMEDICAL OPTICS 2019; 24:1-9. [PMID: 30701726 PMCID: PMC6985687 DOI: 10.1117/1.jbo.24.1.016002] [Citation(s) in RCA: 57] [Impact Index Per Article: 11.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/17/2018] [Accepted: 01/11/2019] [Indexed: 05/07/2023]
Abstract
In the last decades, laparoscopic surgery has become the gold standard in patients with colorectal cancer. To overcome the drawback of reduced tactile feedback, real-time tissue classification could be of great benefit. In this ex vivo study, hyperspectral imaging (HSI) was used to distinguish tumor tissue from healthy surrounding tissue. A sample of fat, healthy colorectal wall, and tumor tissue was collected per patient and imaged using two hyperspectral cameras, covering the wavelength range from 400 to 1700 nm. The data were randomly divided into a training (75%) and test (25%) set. After feature reduction, a quadratic classifier and support vector machine were used to distinguish the three tissue types. Tissue samples of 32 patients were imaged using both hyperspectral cameras. The accuracy to distinguish the three tissue types using both hyperspectral cameras was 0.88 (STD = 0.13) on the test dataset. When the accuracy was determined per patient, a mean accuracy of 0.93 (STD = 0.12) was obtained on the test dataset. This study shows the potential of using HSI in colorectal cancer surgery for fast tissue classification, which could improve clinical outcome. Future research should be focused on imaging entire colon/rectum specimen and the translation of the technique to an intraoperative setting.
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Affiliation(s)
- Elisabeth J. M. Baltussen
- Antoni van Leeuwenhoek Hospital, The Netherlands Cancer Institute, Department of Surgery, Amsterdam, The Netherlands
- Address all correspondence to Elisabeth J. M. Baltussen, E-mail:
| | - Esther N. D. Kok
- Antoni van Leeuwenhoek Hospital, The Netherlands Cancer Institute, Department of Surgery, Amsterdam, The Netherlands
| | - Susan G. Brouwer de Koning
- Antoni van Leeuwenhoek Hospital, The Netherlands Cancer Institute, Department of Surgery, Amsterdam, The Netherlands
| | - Joyce Sanders
- Antoni van Leeuwenhoek Hospital, The Netherlands Cancer Institute, Department of Pathology, Amsterdam, The Netherlands
| | - Arend G. J. Aalbers
- Antoni van Leeuwenhoek Hospital, The Netherlands Cancer Institute, Department of Surgery, Amsterdam, The Netherlands
| | - Niels F. M. Kok
- Antoni van Leeuwenhoek Hospital, The Netherlands Cancer Institute, Department of Surgery, Amsterdam, The Netherlands
| | - Geerard L. Beets
- Antoni van Leeuwenhoek Hospital, The Netherlands Cancer Institute, Department of Surgery, Amsterdam, The Netherlands
| | - Claudie C. Flohil
- Slotervaart Medical Centre, Department of Pathology, Amsterdam, The Netherlands
| | - Sjoerd C. Bruin
- Slotervaart Medical Centre, Department of Surgery, Amsterdam, The Netherlands
| | - Koert F. D. Kuhlmann
- Antoni van Leeuwenhoek Hospital, The Netherlands Cancer Institute, Department of Surgery, Amsterdam, The Netherlands
| | - Henricus J. C. M. Sterenborg
- Antoni van Leeuwenhoek Hospital, The Netherlands Cancer Institute, Department of Surgery, Amsterdam, The Netherlands
- Amsterdam University Medical Centre, University of Amsterdam, Department of Biomedical Engineering and Physics, Amsterdam, The Netherlands
| | - Theo J. M. Ruers
- Antoni van Leeuwenhoek Hospital, The Netherlands Cancer Institute, Department of Surgery, Amsterdam, The Netherlands
- Technical University Twente, MIRA Institute, Enschede, The Netherlands
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Magge DR, Zenati MS, Hamad A, Rieser C, Zureikat AH, Zeh HJ, Hogg ME. Comprehensive comparative analysis of cost-effectiveness and perioperative outcomes between open, laparoscopic, and robotic distal pancreatectomy. HPB (Oxford) 2018; 20:1172-1180. [PMID: 31217087 DOI: 10.1016/j.hpb.2018.05.014] [Citation(s) in RCA: 40] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2018] [Revised: 05/08/2018] [Accepted: 05/18/2018] [Indexed: 02/06/2023]
Abstract
BACKGROUND NSQIP data show that half of distal pancreatectomies (DP) are performed by a minimally invasive approach (MIS). Advantages have been demonstrated for MIS DP, yet comparative cost data are limited. Outcomes and cost were compared in patients undergoing open (ODP), laparoscopic (LDP), and robotic (RDP) approaches at a single institution. METHODS A retrospective review was performed on patients undergoing DP between 1/2010-5/2016. Analysis was intention-to-treat, and cost was available after 1/2013. RESULTS DP was performed in 374 patients: ODP = 85, LDP = 93, and RDP = 196. Operating time was lowest in the RDP cohort (p < 0.0001). ODP had higher estimated blood loss (p < 0.0001) and transfusions (p < 0.0001) than LDP and RDP. LDP had greater conversions to open procedures than RDP (p = 0.001). Postoperative outcomes were similar between groups. Length of stay was higher in the ODP group (p = 0.0001) than LDP and RDP. Overall cost for the ODP was higher than the RDP and LDP group (p = 0.002). On multivariate analysis, RDP reduced LOS (ODP: Odds = 6.5 [p = 0.0001] and LDP: Odds = 2.1 [p = 0.036]) and total cost (ODP: Odds = 5.7 [p = 0.002] and LDP: Odds = 2.8 [p = 0.042]) independently of all demographics and illness covariates. CONCLUSIONS A robotic approach is associated with reduced length of stay and cost compared to open and laparoscopic procedures.
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Affiliation(s)
- Deepa R Magge
- Division of GI Surgical Oncology, University of Pittsburgh Medical Center, USA
| | - Mazen S Zenati
- Division of GI Surgical Oncology, University of Pittsburgh Medical Center, USA
| | - Ahmad Hamad
- Department of Surgery, Ohio State University, USA
| | - Caroline Rieser
- Division of GI Surgical Oncology, University of Pittsburgh Medical Center, USA
| | - Amer H Zureikat
- Division of GI Surgical Oncology, University of Pittsburgh Medical Center, USA
| | | | - Melissa E Hogg
- Division of GI Surgical Oncology, University of Pittsburgh Medical Center, USA
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Osagiede O, Spaulding AC, Cochuyt JJ, Naessens JM, Merchea A, Kasi PM, Crandall M, Colibaseanu DT. Disparities in minimally invasive surgery for colorectal cancer in Florida. Am J Surg 2018; 218:293-301. [PMID: 30503514 DOI: 10.1016/j.amjsurg.2018.11.019] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2018] [Revised: 11/07/2018] [Accepted: 11/15/2018] [Indexed: 02/08/2023]
Abstract
BACKGROUND The cost of minimally invasive surgery (MIS) raises potential for racial and social disparities. The aim of this study was to identify the racial, socioeconomic and geographic disparities associated with MIS for colorectal cancer (CRC) in Florida. METHODS Using the Florida Inpatient Discharge Dataset, we examined the clinical data of patients who underwent elective resections for CRC during 2013-2015. Multivariable analysis was performed to identify differences in gender, age, race, urbanization, region, insurance and clinical characteristics associated with the surgical approach. RESULTS Of the 10,224 patients identified, 5308 (52%) had open surgery and 4916 (48%) had MIS. Females (p = 0.012), Medicare-insured patients (p = 0.001) and residents of South Florida were more likely to undergo MIS. Patients with Medicaid (p = 0.008), metastasis (p < 0.001) or 3-5 comorbidities (p = 0.004) had reduced likelihood of MIS. Hispanic patients in Southwest Florida had reduced likelihood of receiving MIS than whites (p < 0.017). Patients who underwent MIS had significantly reduced LOS (p < 0.001). CONCLUSIONS Consistent with national studies, MIS for CRC in Florida is associated with insurance status and geographic location. There are patient-level regional differences for racial disparities in MIS for CRC in Florida.
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Affiliation(s)
| | - Aaron C Spaulding
- Department of Health Sciences Research, Mayo Clinic, Jacksonville, FL, USA
| | - Jordan J Cochuyt
- Department of Health Sciences Research, Mayo Clinic, Jacksonville, FL, USA
| | - James M Naessens
- Department of Health Sciences Research, Mayo Clinic, Jacksonville, FL, USA
| | - Amit Merchea
- Department of Surgery, Mayo Clinic, Jacksonville, FL, USA
| | - Pashtoon M Kasi
- Department of Medical Oncology, Mayo Clinic, Jacksonville, FL, USA
| | - Marie Crandall
- Department of Surgery, University of Florida, Jacksonville, FL, USA
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Quah GS, Eslick GD, Cox MR. Laparoscopic versus open surgery for adhesional small bowel obstruction: a systematic review and meta-analysis of case-control studies. Surg Endosc 2018; 33:3209-3217. [PMID: 30460502 DOI: 10.1007/s00464-018-6604-3] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2018] [Accepted: 11/13/2018] [Indexed: 02/08/2023]
Abstract
BACKGROUND Small bowel obstruction (SBO) due to adhesions is a common acute surgical presentation. Laparoscopic adhesiolysis is being performed more frequently. However, the clear benefits of laparoscopic adhesiolysis (LA) compared with traditional open adhesiolysis (OA) remain uncertain. The aim of this study was to compare the outcomes of LA versus OA for SBO due to adhesions. METHODS A systemic literature review was conducted using PRISMA guidelines. A search was conducted using MEDLINE, EMBASE, PubMed and Cochrane Databases of all randomised controlled trials (RCT) and case-controlled studies (CCS) that compared LA with OA for SBO. Data were extracted using a standardised form and subsequently analysed. RESULTS There were no RCT. Data from 18 CCS on 38,927 patients (LA = 5,729 and OA = 33,389) were analysed. A meta-analysis showed that LA for SBO has decreased overall mortality (LA = 1.6% vs. OA = 4.9%, p < 0.001) and morbidity (LA = 11.2% vs. OA = 30.9%, p < 0.001). Similarly, the incidences of specific complications are significantly lower in the LA group. There are significantly lower reoperation rate (LA = 4.5% vs. OA = 6.5%, p = 0.017), shorter average operating time (LA = 89 min vs. OA = 104 min, p < 0.001) and a shorter length of stay (LOS) (LA = 6.7 days vs. OA = 11.6 days, p < 0.001) in the LA group. In the CCS, there is likely to be a selection bias favouring less complex adhesions in the LA group that may contribute to the better outcomes in this group. CONCLUSIONS Although there is a probable selection bias, these results suggest that LA for SBO in selected patients has a reduced mortality, morbidity, reoperation rate, average operating time and LOS compared with OA. LA should be considered in appropriately selected patients with acute SBO due to adhesions.
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Affiliation(s)
- Gaik S Quah
- Discipline of Surgery, The Whiteley-Martin Research Centre, Nepean Hospital, The University of Sydney, Penrith, NSW, Australia
| | - Guy D Eslick
- Discipline of Surgery, The Whiteley-Martin Research Centre, Nepean Hospital, The University of Sydney, Penrith, NSW, Australia
| | - Michael R Cox
- Discipline of Surgery, The Whiteley-Martin Research Centre, Nepean Hospital, The University of Sydney, Penrith, NSW, Australia. .,Discipline of Surgery, The University of Sydney Nepean Hospital, Level 5, South Block, P.O. Box 63, Penrith, NSW, 2751, Australia.
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Suprapubic single-port approach for complicated diverticulitis. Tech Coloproctol 2018; 22:657-662. [PMID: 30219934 DOI: 10.1007/s10151-018-1843-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2018] [Accepted: 09/03/2018] [Indexed: 10/28/2022]
Abstract
BACKGROUND Laparoscopic sigmoidectomy is the gold standard for elective surgical treatment of diverticulitis. A periumbilical single-port technique reduces the size of the access wound, usually to 3-4 cm. However, in the presence of large phlegmon or fistulae, the risk of conversion is higher and the extraction site might be enlarged. A suprapubic Pfannenstiel incision reduces the risk of incisional hernia compared to umbilical access and might provide the possibility to perform sigmoidectomy with a hybrid technique. The aim of the present study was to investigate the feasibility of laparoscopic sigmoidectomy through a single suprapubic transverse access for large diverticular phlegmon. METHODS Consecutive patients with a diverticular inflammatory mass ≥ 5 cm, with or without sigmoid-vesical fistula, were considered candidates for laparoscopic sigmoidectomy through a 5-cm single-port suprapubic (SPSP) access, extended (if required) to match the size of the inflammatory mass. RESULTS Twenty patients underwent SPSP sigmoidectomy at our institution in April 2014-April 2017. All procedures were completed by SPSP access, with no intraoperative complications or need for additional trocar placement. Eight patients had a sigmoid-vesical fistula (bladder sutured in three patients). The splenic flexure was mobilized in nine patients. Median operative time was 178 min and median hospital stay was 5.5 days (iqr 4-6). Postoperative complications occurred in four patients and included one subcutaneous hematoma, one urinary tract infection, and two superficial wound infections. After a median follow-up time of 25 months (interquartile range 15-38), all patients experienced complete resolution of symptoms, with no incisional hernias reported. CONCLUSIONS SPSP sigmoidectomy for diverticulitis is feasible and effective, minimizing the size of the access wound and avoiding increased risk of hernia. This approach might be especially valuable for the management of large diverticular phlegmon and sigmoid-vesical fistula.
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Meta-analysis of short- and long-term outcomes after pure laparoscopic versus open liver surgery in hepatocellular carcinoma patients. Surg Endosc 2018; 33:1491-1507. [PMID: 30203210 PMCID: PMC6484823 DOI: 10.1007/s00464-018-6431-6] [Citation(s) in RCA: 50] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2018] [Accepted: 09/05/2018] [Indexed: 12/17/2022]
Abstract
Background The advantages of laparoscopy are widely known. Nevertheless, its legitimacy in liver surgery is often questioned because of the uncertain value associated with minimally invasive methods. Our main goal was to compare the outcomes of pure laparoscopic (LLR) and open liver resection (OLR) in patients with hepatocellular carcinoma. Methods We searched EMBASE, MEDLINE, Web of Science, and The Cochrane Library databases to find eligible studies. The most recent search was performed on December 1, 2017. Studies were regarded as suitable if they reported morbidity in patients undergoing LLR versus OLR. Extracted data were pooled and subsequently used in a meta-analysis with a random-effects model. Clinical applicability of results was evaluated using predictive intervals. Review was reported following the PRISMA guidelines. Results From 2085 articles, forty-three studies (N = 5100 patients) were included in the meta-analysis. Our findings showed that LLR had lower overall morbidity than OLR (15.59% vs. 29.88%, p < 0.001). Moreover, major morbidity was reduced in the LLR group (3.78% vs. 8.69%, p < 0.001). There were no differences between groups in terms of mortality (1.58% vs. 2.96%, p = 0.05) and both 3- and 5-year overall survival (68.97% vs. 68.12%, p = 0.41) and disease-free survival (46.57% vs. 44.84%, p = 0.46). Conclusions The meta-analysis showed that LLR is beneficial in terms of overall morbidity and non-procedure-specific complications. That being said, these results are based on non-randomized trials. For these reasons, we are calling for randomization in upcoming studies. Systematic review registration: PROSPERO registration number CRD42018084576. Electronic supplementary material The online version of this article (10.1007/s00464-018-6431-6) contains supplementary material, which is available to authorized users.
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Abstract
BACKGROUND Colorectal surgery outcomes must be accurately assessed and aligned with patient priorities. No study to date has investigated the patient's subjective assessment of outcomes most important to them during and following their surgical recovery. Although surgeons greatly value the benefits of laparoscopy, patient priorities remain understudied. OBJECTIVE This study aimed to assess what aspects of patients' perioperative care and recovery they value most when queried in the postoperative period. DESIGN This study is an exploratory cross-sectional investigation of a defined retrospective patient population. Enrollees were stratified into subcategories and analyzed, with statistical analysis performed via χ test and unpaired t test. SETTINGS This study was conducted at a single academic medical center in New England. PATIENTS Patients who underwent a colorectal surgical resection between 2009 and 2015 were selected. INTERVENTIONS Patients within a preidentified population were asked to voluntarily complete a 32-item questionnaire regarding their surgical care. MAIN OUTCOME MEASURES The primary outcomes measured were patient perioperative and postoperative quality of life and satisfaction on selected areas of functioning. RESULTS Of 167 queried respondents, 92.2% were satisfied with their recovery. Factors considered most important included being cured of colorectal cancer (76%), not having a permanent stoma (78%), and avoiding complications (74%). Least important included length of stay (13%), utilization of laparoscopy (14%), and incision appearance and length (2%, 4%). LIMITATIONS The study had a relatively low response rate, the study is susceptible to responder's bias, and there is temporal variability from surgery to questionnaire within the patient population. CONCLUSIONS Overall, patients reported high satisfaction with their care. Most important priorities included being free of cancer, stoma, and surgical complications. In contrast, outcomes traditionally important to surgeons such as laparoscopy, incision appearance, and length of stay were deemed less important. This research helps elucidate the outcomes patients truly consider valuable, and surgeons should focus on these outcomes when making surgical decisions. See Video Abstract at http://links.lww.com/DCR/A596. See Visual Abstract at https://tinyurl.com/yb25xl66.
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Quintana JM, Antón-Ladisla A, González N, Lázaro S, Baré M, Fernández de Larrea N, Redondo M, Briones E, Escobar A, Sarasqueta C, García-Gutierrez S. Outcomes of open versus laparoscopic surgery in patients with colon cancer. Eur J Surg Oncol 2018; 44:1344-1353. [PMID: 29921557 DOI: 10.1016/j.ejso.2018.05.030] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2017] [Revised: 02/07/2018] [Accepted: 05/24/2018] [Indexed: 02/07/2023] Open
Abstract
OBJECTIVE There is limited information on health service use or patient-reported outcomes when comparing the effectiveness of laparoscopic with that of open surgery. The aim was to compare the effectiveness of laparoscopic with that of open surgery up to 2 years after intervention in patients with colon cancer. METHODS Prospective cohort study of patients with colon cancer who underwent surgery (laparoscopic or open surgery) between June 2010 and December 2012, at 22 hospitals. Main outcomes of the study were mortality, complications, reoperation, readmission, and patient-reported outcome measures (PROMs), as measured using the Hospital Anxiety and Depression Scale, Duke-UNC, EuroQol-5D, and European Organisation for Research and Treatment of Cancer-Q30 and Q29 at baseline, and 30 days and 1 and 2 years after surgery. Multivariable multilevel logistic regression and generalized linear models were used in analyses after adjusting for specific propensity scores developed for each outcome and time point. RESULTS In the multivariable analysis, the complication rates up to 30 days (infectious, surgical, and medical) and 1 year (surgical), and readmission rate at 30 days and at 2 years were higher among patients who underwent open surgery than among those who underwent laparoscopic surgery. There were no differences between the two surgical approaches in all other parameters assessed and in changes of all PROMs. CONCLUSIONS Though in most outcomes both surgical approaches provide similar results up to 2 years after intervention, still the rates of some complications and readmission, mainly up to 30 days, are higher in open surgery. CLINICALTRIALS. GOV IDENTIFIER NCT02488161.
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Affiliation(s)
- José M Quintana
- Unidad de Investigación, Hospital Galdakao-Usansolo, Galdakao, Bizkaia, Spain; Red de Investigación en Servicios Sanitarios y Enfermedades Crónicas (REDISSEC).
| | - Ane Antón-Ladisla
- Unidad de Investigación, Hospital Galdakao-Usansolo, Galdakao, Bizkaia, Spain; Red de Investigación en Servicios Sanitarios y Enfermedades Crónicas (REDISSEC)
| | - Nerea González
- Unidad de Investigación, Hospital Galdakao-Usansolo, Galdakao, Bizkaia, Spain; Red de Investigación en Servicios Sanitarios y Enfermedades Crónicas (REDISSEC)
| | - Santiago Lázaro
- Servicio de Cirugía General, Hospital Galdakao-Usansolo, Galdakao, Bizkaia, Spain
| | - Marisa Baré
- Unidad de Epidemiología Clínica, Corporació Parc Taulí, Sabadell, Barcelona, Spain; Red de Investigación en Servicios Sanitarios y Enfermedades Crónicas (REDISSEC)
| | - Nerea Fernández de Larrea
- Centro Nacional de Epidemiología, ISCIII, Madrid, Spain; CIBER Epidemiología y Salud Pública (CIBERESP)
| | - Maximino Redondo
- Unidad de Investigación, Hospital Costa del Sol, Málaga, Spain; Red de Investigación en Servicios Sanitarios y Enfermedades Crónicas (REDISSEC)
| | - Eduardo Briones
- Unidad de Epidemiología. Distrito Sanitario Sevilla, Sevilla, Spain
| | - Antonio Escobar
- Unidad de Investigación, Hospital U. Basurto, Bilbao, Bizkaia, Spain; Red de Investigación en Servicios Sanitarios y Enfermedades Crónicas (REDISSEC)
| | - Cristina Sarasqueta
- Unidad de Investigación, Hospital U. Donostia/BIODONOSTIA, Donostia-San Sebastian, Gipuzkoa, Spain; Red de Investigación en Servicios Sanitarios y Enfermedades Crónicas (REDISSEC)
| | - Susana García-Gutierrez
- Unidad de Investigación, Hospital Galdakao-Usansolo, Galdakao, Bizkaia, Spain; Red de Investigación en Servicios Sanitarios y Enfermedades Crónicas (REDISSEC)
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Khalilov ZB, Kalinichenko AY, Azimov RK, Chinikov MA, Panteleeva IS, Kurbanov FS. [Minimally invasive surgery for colorectal cancer in advanced age patients]. Khirurgiia (Mosk) 2018:76-81. [PMID: 29560964 DOI: 10.17116/hirurgia2018376-81] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
AIM To evaluate the role of laparoscopic surgery for colorectal cancer in advanced age patients. MATERIAL AND METHODS 290 patients with colorectal cancer were enrolled including 121 patients with rectal cancer and 169 patients with colon cancer. Main group consisted of 171 patients over 60 years old, control group - 119 patients younger 60 years old. RESULTS Radical advanced procedures on different parts of colon including laparoscopic approach were performed in the majority of advanced age patients. Outcomes were considered as good, we did not notice serious complications (5.4% after rectal surgery, 3.9% after colon surgery). Differences were not significant compared with younger patients including laparoscopic interventions for emergency indications. Nevertheless, surgical treatment of advanced age patients with colorectal cancer makes special demands for equipping of the clinic and physicians' qualification. CONCLUSION Advanced age is not a serious limitation in choice of laparoscopic access in both elective and emergency surgery in patients with colorectal cancer.
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Affiliation(s)
| | - A Yu Kalinichenko
- Department of Hospital Surgery with the course of pediatric surgery, Russian Peoples' Friendship University, Central Clinical Hospital of RAS, Moscow, Russia
| | - R Kh Azimov
- Department of Hospital Surgery with the course of pediatric surgery, Russian Peoples' Friendship University, Central Clinical Hospital of RAS, Moscow, Russia
| | - M A Chinikov
- Department of Hospital Surgery with the course of pediatric surgery, Russian Peoples' Friendship University, Central Clinical Hospital of RAS, Moscow, Russia
| | - I S Panteleeva
- Department of Hospital Surgery with the course of pediatric surgery, Russian Peoples' Friendship University, Central Clinical Hospital of RAS, Moscow, Russia
| | - F S Kurbanov
- Department of Hospital Surgery with the course of pediatric surgery, Russian Peoples' Friendship University, Central Clinical Hospital of RAS, Moscow, Russia
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Implementation of laparoscopic approach in colorectal surgery - a single center's experience. Wideochir Inne Tech Maloinwazyjne 2018; 13:27-32. [PMID: 29643955 PMCID: PMC5890849 DOI: 10.5114/wiitm.2018.72748] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2017] [Accepted: 09/02/2017] [Indexed: 01/31/2023] Open
Abstract
Introduction Implementation of the laparoscopic approach in colorectal surgery has not happened as rapidly as in cholecystectomy, because of concerns about oncological safety. The results of controlled trials in multiple centers showed the method to be safe. Consequently, surgeons decided to try the approach with colorectal surgery. This process, in our clinic, began in earnest about four years ago. Aim To analyze and present the clinical outcomes of applying the laparoscopic approach to colorectal surgery in a single center. Material and methods We retrospectively identified patients from a hospital database who underwent colorectal surgery – laparoscopic and open – between 2013 and 2016. Our focus was on laparoscopic cases. Study points included operative time, duration of the hospital stay, postoperative mortality and rates of complications, conversion, reoperation and readmission. Results Of 534 cases considered, the results showed that the relation between open and laparoscopic procedures had reversed, in favor of the latter method (2013: open: 82% vs. laparoscopic: 18%; 2016: open: 22.4% vs. laparoscopic: 77.6%). The most commonly performed procedure was right hemicolectomy. The total complication rate was 22%. The total rate of conversion to open surgery was 9.3%. The postoperative mortality rate was 3%. Conclusions Use of the laparoscopic approach in colorectal surgery has increased in recent years world-wide – including in Poland – but the technique is still underused. Rapid implementation of the miniinvasive method in colorectal surgery, in centers with previous laparoscopic experience, is not only safe and feasible, but also highly recommended.
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Gibor U, Perry Z, Domchik S, Mizrahi S, Kirshtein B. Single Port and Conventional Laparoscopy in Colorectal Surgery: Comparison of Two Techniques. J Laparoendosc Adv Surg Tech A 2017; 28:65-70. [PMID: 28976805 DOI: 10.1089/lap.2017.0331] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
Abstract
BACKGROUND Single-incision laparoscopic surgery (SILS) was introduced to further the enhanced outcome of conventional multiport laparoscopy (CML). We compared their short- and long-term outcomes in colorectal surgery. MATERIALS AND METHODS Retrospective review of patients who underwent elective laparoscopic colorectal surgery during 3-year period. Patients' data, surgery outcomes, and oncological results were compared. RESULTS Sixty-one patients (33 male, 28 female), mean age 67.4 years, underwent laparoscopic colonic resections: 28 SILS and 33 CML. Twenty-three (37.7%) patients had previous abdominal surgery. There were 19 (31.2%) right, 9 (14.7%) left, and 2 (3.3%) total colectomies, 16 (26.2%) sigmoidectomies, 13 (21.3%) anterior and 2 (3.3%) abdominoperineal resections. Colonic malignancy was a main indication for the surgery in 51 (83.6%) patients. Mean surgery time and postoperative stay were 92.0 minutes and 9 days, respectively. Pathological examination revealed stage I colon cancer in 16 (32%), stage II in 22 (44%), stage III in 10 (20%), and stage IV in 2 (4%) patients. Mean number of retrieved lymph nodes was 19 ± 13.5. No differences were found between groups in demographic data, type of surgery, surgery time and hospital stay, pathological results and tumor staging, and disease-free and overall survivals. In the SILS group, placement of additional trocar was required in 7 (25%) and conversion in 3 (10.7%) cases compared with 1 (3%) case of conversion to formal laparotomy in the CML group. Overall postoperative morbidity was 16.4%. There was no mortality in both the groups. During the study period, 3 patients from the CML group had cancer recurrence. CONCLUSIONS SILS is a feasible and safe technique compared with CML in terms of surgical and oncological outcomes.
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Affiliation(s)
- Udit Gibor
- Department of Surgery A, Soroka University Medical Center, Ben-Gurion University of the Negev , Beer-Sheva, Israel
| | - Zvi Perry
- Department of Surgery A, Soroka University Medical Center, Ben-Gurion University of the Negev , Beer-Sheva, Israel
| | - Sergey Domchik
- Department of Surgery A, Soroka University Medical Center, Ben-Gurion University of the Negev , Beer-Sheva, Israel
| | - Solly Mizrahi
- Department of Surgery A, Soroka University Medical Center, Ben-Gurion University of the Negev , Beer-Sheva, Israel
| | - Boris Kirshtein
- Department of Surgery A, Soroka University Medical Center, Ben-Gurion University of the Negev , Beer-Sheva, Israel
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Sánchez-García S, Padilla-Valverde D, Villarejo-Campos P, García-Santos EP, Martín-Fernández J. Hyperthermic chemotherapy intra-abdominal laparoscopic approach: development of a laparoscopic model using CO 2 recirculation system and clinical translation in peritoneal carcinomatosis. Int J Hyperthermia 2017; 33:684-689. [PMID: 28540790 DOI: 10.1080/02656736.2017.1302100] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
INTRODUCTION Hyperthermic intraperitoneal chemotherapy (HIPEC) is an effective treatment for peritoneal carcinomatosis (PC). Laparoscopic surgery is performed in the treatment of colorectal and appendiceal cancer, and PC from diverse origin in selected patients. HIPEC management by laparoscopic approach after cytoreductive surgery (CRS) completed locoregional treatment of PC, and may be feasible and safe after appropriate patient selection. OBJECTIVE Development of an experimental model of HIPEC by laparoscopic approach, with CO2 recirculation. Clinical translation in two patients with PC and low peritoneal cancer index. MATERIAL AND METHODS We performed CRS in a porcine model of 5 pigs (35-38 kg) by laparoscopic approach. Laparoscopic HIPEC by CO2 recirculation system was performed; laparoscopic access was used for catheter input and output placement (Paclitaxel 175 mg/m2 for 60 min at 42 °C). The experimental variables were: blood gases, haemodynamic and intra-abdominal and central temperature. Clinical model application was performed in three cases with PC from colorectal origin. RESULTS No statistically significant differences was found in blood gases, haemodynamic or temperature in the experimental study. In clinical study, there were no technical complications during laparoscopic-HIPEC approach, and we observed no changes in haemodynamic variables during the procedure. CONCLUSIONS CRS and HIPEC laparoscopic model by CO2 recirculation system is safe and feasible technique in selected patients, that include low PC index, local and accessible tumour recurrences or high-risk of PC tumours.
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Affiliation(s)
- Susana Sánchez-García
- a Department of General Surgery , University General Hospital, Medicine School, University of Castilla la Mancha , Ciudad Real , Spain
| | - David Padilla-Valverde
- a Department of General Surgery , University General Hospital, Medicine School, University of Castilla la Mancha , Ciudad Real , Spain
| | - Pedro Villarejo-Campos
- a Department of General Surgery , University General Hospital, Medicine School, University of Castilla la Mancha , Ciudad Real , Spain
| | - Esther P García-Santos
- a Department of General Surgery , University General Hospital, Medicine School, University of Castilla la Mancha , Ciudad Real , Spain
| | - Jesús Martín-Fernández
- a Department of General Surgery , University General Hospital, Medicine School, University of Castilla la Mancha , Ciudad Real , Spain
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Current Status of Laparoscopic Surgery in Colorectal Cancer. CURRENT COLORECTAL CANCER REPORTS 2017. [DOI: 10.1007/s11888-017-0345-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Khalilov ZB, Kalinichenko AY, Azimov RK, Panteleeva IS, Chinnikov MA, Kurbanov FS. [Emergency endoscopic surgery of colon cancer]. Khirurgiia (Mosk) 2017:22-27. [PMID: 29186092 DOI: 10.17116/hirurgia20171122-27] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
AIM To assess the role of endoscopic technologies in treatment of complicated forms of colorectal cancer. MATERIAL AND METHODS Our trial included patients after endoscopic intervention (n=18) and open surgery (n=11). RESULTS Mean time of surgery in this group was 158.8±10.7 minutes. In elective surgery group this value was 161.3 minutes (p>0.05). Mean blood loss was not great (near 122.5±17.9 ml). Overall and postoperative hospital-stay was 23.1±2.4 and 8.6±0.5 days, respectively. There were no intraoperative and postoperative complications. CONCLUSION Endoscopic interventions may be performed for colon cancer for emergency indications including patients with severe complications.
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Affiliation(s)
| | - A Yu Kalinichenko
- Chair of Hospital Surgery with the course of pediatric surgery of Peoples' Friendship University of Russia, Central Hospital of Russian Academy of Sciences, Moscow, Russia
| | - R Kh Azimov
- Chair of Hospital Surgery with the course of pediatric surgery of Peoples' Friendship University of Russia, Central Hospital of Russian Academy of Sciences, Moscow, Russia
| | - I S Panteleeva
- Chair of Hospital Surgery with the course of pediatric surgery of Peoples' Friendship University of Russia, Central Hospital of Russian Academy of Sciences, Moscow, Russia
| | - M A Chinnikov
- Chair of Hospital Surgery with the course of pediatric surgery of Peoples' Friendship University of Russia, Central Hospital of Russian Academy of Sciences, Moscow, Russia, Baku Central Hospital, Azerbaijan Republic
| | - F S Kurbanov
- Chair of Hospital Surgery with the course of pediatric surgery of Peoples' Friendship University of Russia, Central Hospital of Russian Academy of Sciences, Moscow, Russia
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SUGIMOTO KIICHI, SAKAMOTO KAZUHIRO, ICHIKAWA RYOSUKE, KURE KAZUMASA, HONJO KUMPEI, RO HISASHI, TAKAHASHI RINA, KAWANO SHINGO, NIWA KOICHIRO, ISHIYAMA SHUN, KAMIYAMA HIROHIKO, KOMIYAMA HIROMITSU, TAKAHASHI MAKOTO, KOJIMA YUTAKA, GOTO MICHITOSHI, OKUZAWA ATSUSHI, ISHIBIKI YOSHIRO, TOMIKI YUICHI. Propensity Score Analysis in the Comparison of Long-Term Outcomes for Locally Advanced Colon Cancer Between Laparoscopic Colectomy and Open Colectomy. JUNTENDO MEDICAL JOURNAL 2017. [DOI: 10.14789/jmj.63.264] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Affiliation(s)
- KIICHI SUGIMOTO
- Department of Coloproctological Surgery, Juntendo University Faculty of Medicine
| | - KAZUHIRO SAKAMOTO
- Department of Coloproctological Surgery, Juntendo University Faculty of Medicine
| | - RYOSUKE ICHIKAWA
- Department of Coloproctological Surgery, Juntendo University Faculty of Medicine
| | - KAZUMASA KURE
- Department of Coloproctological Surgery, Juntendo University Faculty of Medicine
| | - KUMPEI HONJO
- Department of Coloproctological Surgery, Juntendo University Faculty of Medicine
| | - HISASHI RO
- Department of Coloproctological Surgery, Juntendo University Faculty of Medicine
| | - RINA TAKAHASHI
- Department of Coloproctological Surgery, Juntendo University Faculty of Medicine
| | - SHINGO KAWANO
- Department of Coloproctological Surgery, Juntendo University Faculty of Medicine
| | - KOICHIRO NIWA
- Department of Coloproctological Surgery, Juntendo University Faculty of Medicine
| | - SHUN ISHIYAMA
- Department of Coloproctological Surgery, Juntendo University Faculty of Medicine
| | - HIROHIKO KAMIYAMA
- Department of Coloproctological Surgery, Juntendo University Faculty of Medicine
| | - HIROMITSU KOMIYAMA
- Department of Coloproctological Surgery, Juntendo University Faculty of Medicine
| | - MAKOTO TAKAHASHI
- Department of Coloproctological Surgery, Juntendo University Faculty of Medicine
| | - YUTAKA KOJIMA
- Department of Coloproctological Surgery, Juntendo University Faculty of Medicine
| | - MICHITOSHI GOTO
- Department of Coloproctological Surgery, Juntendo University Faculty of Medicine
| | - ATSUSHI OKUZAWA
- Department of Coloproctological Surgery, Juntendo University Faculty of Medicine
| | - YOSHIRO ISHIBIKI
- Department of Coloproctological Surgery, Juntendo University Faculty of Medicine
| | - YUICHI TOMIKI
- Department of Coloproctological Surgery, Juntendo University Faculty of Medicine
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Jian-Cheng T, Shu-Sheng W, Bo Z, Jian F, Liang Z. Total laparoscopic right hemicolectomy with 3-step stapled intracorporeal isoperistaltic ileocolic anastomosis for colon cancer: An evaluation of short-term outcomes. Medicine (Baltimore) 2016; 95:e5538. [PMID: 27902621 PMCID: PMC5134775 DOI: 10.1097/md.0000000000005538] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2016] [Revised: 10/01/2016] [Accepted: 11/10/2016] [Indexed: 12/22/2022] Open
Abstract
Laparoscopic right hemicolectomy with extracorporeal anastomosis is a widely used procedure; several authors have published their approach to intracorporeal anastomosis. In this paper, we present an approach developed by us and compare short-term outcomes with those of extracorporeal anastomosis in colon cancer patients.Retrospective review of colon cancer patients treated with laparoscopic right hemicolectomy either with intracorporeal anastomosis (TLG group) or extracorporeal anastomosis (LG group) at the Zhangjiagang Hospital Affiliated to Soochow University between January 2011 and October 2015. Operative and postoperative data are compared.Around 85 patients underwent laparoscopic hemicolectomy (56 TLG and 29 LG) during the reference period for this study. Age, gender, body mass index (BMI), stage of cancer, operation time, number of lymph nodes harvested, and length of hospital stay were comparable between the 2 groups. In the TLG group, the ileocolic anastomosis time was significantly shorter (9.9-15.5 minutes vs 13.5-18.2 minutes in LG; P < 0.001), the mean intraoperative blood loss was lower (83.2 mL [range, 56.5-100.5 mL] vs 93.3 mL [range, 75.8 - 110.3 mL]; P < 0.001), the recovery of bowel function was faster (P < 0.001), and the postoperative pain score was lower (P < 0.001) as compared to that in the LG group. Complications in the LG group included wound infection (4 patients), obstruction (1), and postoperative bleeding complications (1); however, only 1 patient developed complication (wound infection) in the TLG group.Total laparoscopic right hemicolectomy with 3-step stapled intracorporeal anastomosis for colon cancer is a safe and reliable procedure. Its advantages include short anastomosis time, less intraoperative blood loss, less postoperative pain, and early bowel function recovery.
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Fabozzi M, Cirillo P, Corcione F. Surgical approach to right colon cancer: From open technique to robot. State of art. World J Gastrointest Surg 2016; 8:564-573. [PMID: 27648160 PMCID: PMC5003935 DOI: 10.4240/wjgs.v8.i8.564] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2016] [Revised: 05/04/2016] [Accepted: 05/27/2016] [Indexed: 02/06/2023] Open
Abstract
This work is a topic highlight on the surgical treatment of the right colon pathologies, focusing on the literature state of art and comparing the open surgery to the different laparoscopic and robotic procedures. Different laparoscopic procedures have been described for the treatment of right colon tumors: Totally laparoscopic right colectomy, laparoscopic assisted right colectomy, laparoscopic facilitated right colectomy, hand-assisted right colectomy, single incision laparoscopic surgery colectomy, robotic right colectomy. Two main characteristics of these techniques are the different type of anastomosis: Intracorporeal (for totally laparoscopic right colectomy, single incision laparoscopic surgery colectomy, laparoscopic assisted right colectomy and robotic technique) or extracorporeal (for laparoscopic assisted right colectomy, laparoscopic facilitated right colectomy, hand-assisted right colectomy and open right colectomy) and the different incision (suprapubic, median or transverse on the right side of abdomen). The different laparoscopic techniques meet the same oncological criteria of radicalism as the open surgery for the right colon. The totally laparoscopic right colectomy with intracorporeal anastomosis and even more the single incision laparoscopic surgery colectomy, remain a technical challenge due to the complexity of procedures (especially for the single incision laparoscopic surgery colectomy) and the particular right colon vascular anatomy but they seem to have some theoretical advantages compared to the other laparoscopic and open procedures. Data reported in literature while confirming the advantages of laparoscopic approach, do not allow to solve controversies about which is the best laparoscopic technique (Intracorporeal vs Extracorporeal Anastomosis) to treat the right colon cancer. However, the laparoscopic techniques with intracorporeal anastomosis for the right colon seem to show some theoretical advantages (functional, technical, oncological and cosmetic advantages) even if all studies conclude that further prospective randomized trials are necessary. Robotic technique may be useful to overcome the problems related to inexperience in laparoscopy in some surgical centers.
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Chen YJ, Huynh D, Nguyen S, Chin E, Divino C, Zhang L. Outcomes of robot-assisted versus laparoscopic repair of small-sized ventral hernias. Surg Endosc 2016; 31:1275-1279. [PMID: 27450207 DOI: 10.1007/s00464-016-5106-4] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2016] [Accepted: 07/09/2016] [Indexed: 01/08/2023]
Abstract
INTRODUCTION The aim of the study is to investigate the outcomes of the da Vinci robot-assisted laparoscopic hernia repair of small-sized ventral hernias with circumferential suturing of the mesh compared to the traditional laparoscopic repair with trans-fascial suturing. METHODS A retrospective review was conducted of all robot-assisted umbilical, epigastric and incisional hernia repairs performed at our institution between 2013 and 2015 compared to laparoscopic umbilical or epigastric hernia repairs. Patient characteristics, operative details and postoperative complications were collected and analyzed using univariate analysis. Three primary minimally invasive fellowship trained surgeons performed all of the procedures included in the analysis. RESULTS 72 patients were identified during the study period. 39 patients underwent robot- assisted repair (21 umbilical, 14 epigastric, 4 incisional), and 33 patients laparoscopic repair (27 umbilical, 6 epigastric). Seven had recurrent hernias (robot: 4, laparoscopic: 3). There were no significant differences in preoperative characteristics between the two groups. Average operative time was 156 min for robot-assisted repair and 65 min for laparoscopic repair (p < 0.0001). The average defect size was significantly larger for the robot group [3.07 cm (1-9 cm)] than that for the laparoscopic group [2.02 cm (0.5-5 cm)] (p < 0.0001), although there was no significant difference in the average size of mesh used (13 vs. 13 cm). There was no difference in patients requiring postoperative admission or length of stay between the two groups. The mean duration of follow-up was 47 days. There was no difference in complication rate during this time, and no recurrences were reported. CONCLUSION There are no significant differences in terms of safety and early efficacy when comparing small-sized ventral hernias repaired using the robot-assisted technique versus the standard laparoscopic repair.
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Affiliation(s)
- Y Julia Chen
- Department of Surgery, Mount Sinai Medical Center, 1 Gustave L. Levy Place, Box 1259, New York, NY, 10029, USA
| | - Desmond Huynh
- Department of Surgery, Mount Sinai Medical Center, 1 Gustave L. Levy Place, Box 1259, New York, NY, 10029, USA
| | - Scott Nguyen
- Department of Surgery, Mount Sinai Medical Center, 1 Gustave L. Levy Place, Box 1259, New York, NY, 10029, USA
| | - Edward Chin
- Department of Surgery, Mount Sinai Medical Center, 1 Gustave L. Levy Place, Box 1259, New York, NY, 10029, USA
| | - Celia Divino
- Department of Surgery, Mount Sinai Medical Center, 1 Gustave L. Levy Place, Box 1259, New York, NY, 10029, USA
| | - Linda Zhang
- Department of Surgery, Mount Sinai Medical Center, 1 Gustave L. Levy Place, Box 1259, New York, NY, 10029, USA.
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