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Kobayashi T, Miyazaki H, Yagyu T, Hatta M, Miki H, Sekimoto M. Single-incision laparoscopic surgery for benign peritoneal cystic mesothelioma-A Video Vignette. Colorectal Dis 2024; 26:1482-1483. [PMID: 38693771 DOI: 10.1111/codi.17013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2024] [Accepted: 03/09/2024] [Indexed: 05/03/2024]
Affiliation(s)
| | | | - Takuki Yagyu
- Department of Surgery, Kansai Medical University, Osaka, Japan
| | - Masahiko Hatta
- Department of Surgery, Kansai Medical University, Osaka, Japan
| | - Hisanori Miki
- Department of Surgery, Kansai Medical University, Osaka, Japan
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Taylor JC, Burke D, Iversen LH, Birch RJ, Finan PJ, Iles MM, Quirke P, Morris EJA. Minimally Invasive Surgery for Colorectal Cancer: Benchmarking Uptake for a Regional Improvement Programme. Clin Colorectal Cancer 2024:S1533-0028(24)00061-6. [PMID: 39004595 DOI: 10.1016/j.clcc.2024.05.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2023] [Revised: 05/15/2024] [Accepted: 05/28/2024] [Indexed: 07/16/2024]
Abstract
BACKGROUND The uptake of minimally invasive surgery (MIS) for patients with colorectal cancer has progressed at differing rates, both across countries, and within countries. This study aimed to investigate uptake for a regional colorectal cancer improvement programme in England. METHOD We calculated the proportion of patients receiving elective laparoscopic and robot-assisted surgery amongst those diagnosed with colorectal cancer over 3 time periods (2007-2011, 2012-2016 and 2017-2021) in hospitals participating in the Yorkshire Cancer Research Bowel Cancer Improvement Programme (YCR BCIP). These were benchmarked against national rates. Regression analysis and funnel plots were used to develop a data driven approach for analysing trends in the use of MIS at hospitals in the programme. RESULTS In England, resections performed by MIS increased from 34.9% to 72.9% for colon cancer and from 28.8% to 72.5% for rectal cancer. Robot-assisted surgery increased from 0.1% to 2.7% for colon cancer and from 0.2% to 7.9% for rectal cancer. Wide variation in the uptake of MIS was observed at a hospital level. Detailed analysis of the YCR BCIP region identified a decreasing number of surgical departments, since the start of the programme, as potential outliers for MIS when compared to the English national average. CONCLUSION Wide variation in use of MIS for colorectal cancer exists within the English National Health Service and a data-driven approach can help identify outlying hospitals. Addressing some of the challenges behind the uptake of MIS, such as ensuring adequate provision of surgical training and equipment, could help increase its use.
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Affiliation(s)
- John C Taylor
- Leeds Institute of Medical Research at St James's, University of Leeds, Leeds, United Kingdom; Leeds Institute for Data Analytics, University of Leeds, Leeds, United Kingdom.
| | - Dermot Burke
- Leeds Institute of Medical Research at St James's, University of Leeds, Leeds, United Kingdom
| | - Lene H Iversen
- Department of Surgery, Aarhus University Hospital, and Danish Colorectal Cancer Group, Aarhus, Denmark
| | - Rebecca J Birch
- Leeds Institute of Medical Research at St James's, University of Leeds, Leeds, United Kingdom; Leeds Institute for Data Analytics, University of Leeds, Leeds, United Kingdom
| | - Paul J Finan
- Leeds Institute of Medical Research at St James's, University of Leeds, Leeds, United Kingdom; Leeds Institute for Data Analytics, University of Leeds, Leeds, United Kingdom
| | - Mark M Iles
- Leeds Institute for Data Analytics, University of Leeds, Leeds, United Kingdom; NIHR Leeds Biomedical Research Centre, Leeds Teaching Hospitals NHS Trust, Leeds, United Kingdom
| | - Philip Quirke
- Leeds Institute of Medical Research at St James's, University of Leeds, Leeds, United Kingdom
| | - Eva J A Morris
- Nuffield Department of Population Health, Big Data Institute, University of Oxford, Oxford, United Kingdom
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Suzuki Y, Tei M, Wakasugi M, Ohtsuka M, Hagihara K, Ikenaga M, Yanagimoto Y, Yamashita M, Shimizu J, Akamatsu H, Tomita N, Imamura H. Single-incision Laparoscopic Colonic Surgery: A Systemic Review, Meta-analysis, and Future Prospect. J Anus Rectum Colon 2024; 8:48-60. [PMID: 38689785 PMCID: PMC11056536 DOI: 10.23922/jarc.2023-078] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/26/2023] [Accepted: 01/11/2024] [Indexed: 05/02/2024] Open
Abstract
Although single-incision laparoscopic surgery (SILS) has gained some attention as a feasible alternative to conventional multiport laparoscopic surgery (MPLS) in colonic surgery, it became less prevalent than expected. Hence, we conducted this systematic review to evaluate the feasibility, safety, and oncological outcomes of single-incision laparoscopic colectomy (SILC) with meta-analysis and discussion of the future prospect of SILS. The search was conducted from September to October 2023 using PubMed and the Cochrane Central Register of Controlled Trials. Articles on colorectal cancer comparing SILC with multiport laparoscopic colectomy (MPLC) from all randomized controlled trials and comparative studies with 50 patients or more per arm were examined. The primary outcomes were the intra- and postoperative complication rates, and the secondary outcomes were the perioperative and oncological outcomes. The trends of the SILS number in Japan and the trends of the number of articles on SILS in PubMed were also reviewed. There were no significant differences in perioperative complication rates, operative factors, and oncological outcomes between SILC and MPLC, although heterogeneity was observed mainly in operative factors and the total length of the skin incision was significantly shorter in SILC. Therefore, SILC is technically and oncologically feasible and safe when performed by experienced laparoscopic surgeons. The case number of SILS was gradually increasing but the rate of SILS was decreasing in Japan. The number of articles on SILS was also decreasing. SILS has gained foothold to some extent but has plateaued. The emerging new robotic platform may reappraise the concept of SILS.
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Affiliation(s)
- Yozo Suzuki
- Department of Gastroenterological Surgery, Toyonaka Municipal Hospital, Osaka, Japan
| | - Mitsuyoshi Tei
- Department of Gastroenterological Surgery, Osaka Rosai Hospital, Osaka, Japan
| | - Masaki Wakasugi
- Department of Gastroenterological Surgery, Ibaraki Prefectural Central Hospital, Ibaraki, Japan
| | - Masahisa Ohtsuka
- Department of Gastroenterological Surgery, Kindai Nara Hospital, Nara, Japan
| | - Kiyotaka Hagihara
- Department of Gastroenterological Surgery, Toyonaka Municipal Hospital, Osaka, Japan
| | - Masakazu Ikenaga
- Department of Gastroenterological Surgery, Toyonaka Municipal Hospital, Osaka, Japan
| | - Yoshitomo Yanagimoto
- Department of Gastroenterological Surgery, Toyonaka Municipal Hospital, Osaka, Japan
| | - Masafumi Yamashita
- Department of Gastroenterological Surgery, Toyonaka Municipal Hospital, Osaka, Japan
| | - Junzo Shimizu
- Department of Gastroenterological Surgery, Toyonaka Municipal Hospital, Osaka, Japan
| | - Hiroki Akamatsu
- Department of Surgery, Japan Community Health Care Organization Osaka Minato Central Hospital, Osaka, Japan
| | - Naohiro Tomita
- Department of Gastroenterological Surgery, Toyonaka Municipal Hospital, Osaka, Japan
- Cancer Treatment Center, Toyonaka Municipal Hospital, Osaka, Japan
| | - Hiroshi Imamura
- Department of Gastroenterological Surgery, Toyonaka Municipal Hospital, Osaka, Japan
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Lirk P, Badaoui J, Stuempflen M, Hedayat M, Freys SM, Joshi GP. PROcedure-SPECific postoperative pain management guideline for laparoscopic colorectal surgery: A systematic review with recommendations for postoperative pain management. Eur J Anaesthesiol 2024; 41:161-173. [PMID: 38298101 DOI: 10.1097/eja.0000000000001945] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2024]
Abstract
Colorectal cancer is the second most common cancer diagnosed in women and third most common in men. Laparoscopic resection has become the standard surgical technique worldwide given its notable benefits, mainly the shorter length of stay and less postoperative pain. The aim of this systematic review was to evaluate the current literature on postoperative pain management following laparoscopic colorectal surgery and update previous procedure-specific pain management recommendations. The primary outcomes were postoperative pain scores and opioid requirements. We also considered study quality, clinical relevance of trial design, and a comprehensive risk-benefit assessment of the analgesic intervention. We performed a literature search to identify randomised controlled studies (RCTs) published before January 2022. Seventy-two studies were included in the present analysis. Through the established PROSPECT process, we recommend basic analgesia (paracetamol for rectal surgery, and paracetamol with either a nonsteroidal anti-inflammatory drug or cyclo-oxygenase-2-specific inhibitor for colonic surgery) and wound infiltration as first-line interventions. No consensus could be achieved either for the use of intrathecal morphine or intravenous lidocaine; no recommendation can be made for these interventions. However, intravenous lidocaine may be considered when basic analgesia cannot be provided.
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Affiliation(s)
- Philipp Lirk
- From the Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women's Hospital (PL, JB, MS), Department of Anesthesiology, Critical Care and Pain Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA (MH), Department of Surgery, DIAKO Ev. Diakonie-Krankenhaus, Bremen, Germany (SMF) and Department of Anesthesiology, UT Southwestern Medical Center, Dallas, Texas, USA (GPJ)
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Miyasaka M, Kitashiro S, Takahashi M, Okawa Y, Sekiya S, Saikawa D, Teramura K, Hayashi S, Suzuki Y, Matsumoto J, Kawada M, Kawarada Y, Kaga K, Okushiba S, Hirano S. Long-term outcomes of single-incision laparoscopic colectomy for right-sided colon cancer utilising a craniocaudal approach. J Minim Access Surg 2024:01413045-990000000-00026. [PMID: 38214348 DOI: 10.4103/jmas.jmas_191_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Accepted: 09/27/2023] [Indexed: 01/13/2024] Open
Abstract
INTRODUCTION This study aimed to evaluate the short- and long-term outcomes of single-incision laparoscopic colectomy (SILC) for right-sided colon cancer (CC) using a craniocaudal approach. PATIENTS AND METHODS The data of patients who underwent SILC for right-sided CC at our hospital between January 2013 and December 2022 were retrospectively collected. Surgery was performed using a craniocaudal approach. Short- and long-term operative outcomes were analysed. RESULTS In total, 269 patients (127 men, 142 women; median age 74 years) underwent SILC for right-sided CC. The cases included ileocaecal resection (n = 138) and right hemicolectomy (n = 131). The median operative time was 154 min, and the median operative blood loss was 0 ml. Twenty-seven cases (10.0%) required an additional laparoscopic trocar, and 9 (3.3%) were converted to open surgery. The Clavien-Dindo classification Grade III post-operative complications were detected in 7 (2.6%) cases. SILC was performed by 25 surgeons, including inexperienced surgeons, with a median age of 34 years. The 5-year cancer-specific survival (CSS) was 96.1% (95% confidence interval [CI] 91.3%-98.2%), and CSS per pathological disease stage was 100% for Stages 0-I and II and 86.2% (95% CI 71.3%-93.7%) for Stage III. The 5-year recurrence-free survival (RFS) was 90.6% (95% CI 85.7%-93.9%), and RFS per pathological disease stage was 100% for Stage 0-I, 91.7% (95% CI 80.5%-96.6%) for Stage II and 76.1% (95% CI 63.0%-85.1%) for Stage III. CONCLUSIONS SILC for right-sided CC can be safely performed with a craniocaudal approach, with reasonable short- and long-term outcomes.
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Affiliation(s)
- Mamoru Miyasaka
- Department of Surgery, Tonan Hospital, Sapporo, Hokkaido, Japan
| | - Shuji Kitashiro
- Department of Surgery, Tonan Hospital, Sapporo, Hokkaido, Japan
| | | | - Yuki Okawa
- Department of Surgery, Tonan Hospital, Sapporo, Hokkaido, Japan
| | - Sho Sekiya
- Department of Surgery, Tonan Hospital, Sapporo, Hokkaido, Japan
| | - Daisuke Saikawa
- Department of Surgery, Tonan Hospital, Sapporo, Hokkaido, Japan
| | - Koichi Teramura
- Department of Surgery, Tonan Hospital, Sapporo, Hokkaido, Japan
| | - Satoshi Hayashi
- Department of Surgery, Tonan Hospital, Sapporo, Hokkaido, Japan
| | | | - Joe Matsumoto
- Department of Surgery, Tonan Hospital, Sapporo, Hokkaido, Japan
| | - Masaya Kawada
- Department of Surgery, Tonan Hospital, Sapporo, Hokkaido, Japan
| | - Yo Kawarada
- Department of Surgery, Tonan Hospital, Sapporo, Hokkaido, Japan
| | - Kichizo Kaga
- Department of Surgery, Tonan Hospital, Sapporo, Hokkaido, Japan
| | | | - Satoshi Hirano
- Department of Gastroenterological Surgery II, Faculty of Medicine, Hokkaido University, Sapporo, Hokkaido, Japan
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Jiang F, Ji M, Jin F, Liu J, Liu X. Clinical application of two-port laparoscopic surgery in sigmoid colon and upper rectal cancer resection. Front Oncol 2023; 13:1248280. [PMID: 38023157 PMCID: PMC10658933 DOI: 10.3389/fonc.2023.1248280] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2023] [Accepted: 10/16/2023] [Indexed: 12/01/2023] Open
Abstract
Background In the field of minimally invasive surgery, the two-port laparoscopic surgery is on the rise. This study investigated the safety and efficacy of two-port laparoscopic surgery (TLS) for resecting sigmoid colon and upper rectal cancers compared with conventional laparoscopic surgery (CLS). Methods The clinical data of patients undergoing laparoscopic sigmoid colon cancer and upper rectal cancer resection at the Department of General Surgery of the First Affiliated Hospital of Gannan Medical College between July 2019 and January 2022 were retrospectively collected. Grouped according to different laparoscopic surgery. Based on the inclusion and exclusion criteria,A total of 81 patients were enrolled, of the 25 patients from the TLS group,and of the 56 patients from the CLS group. We mainly compared whether there were statistical differences between the two groups in terms of operative time, intraoperative bleeding, incision length, time to first ambulation, time to first flatus, time to first defecation, postoperative complication rate, and other surgical outcomes. Results There was no statistical difference between the two groups in terms of baseline clinical characteristics (P > 0.05). In terms of the surgical outcomes, there were statistical differences in the total incision length (TLS: 6.21 ± 0.67 cm, CLS: 8.64 ± 1.08 cm, P < 0.001)), time to first ambulation (TLS: 2.0 ± 0.7 d, CLS:3.1 ± 0.9 d, P < 0.001), time to first flatus (TLS: 2.5 ± 0.8 d, CLS: 3.0 ± 0.8 d, P = 0.028), time to first defecation (TLS: 3.8 ± 1.3 d, CLS: 5.1 ± 2.1 d, P = 0.010), and time for liquid diet (TLS: 4.3 ± 1.4 d, CLS: 5.3 ± 1.9 d, P = 0.021). There was no statistical difference between the two groups in terms of the pathology (P > 0.05). Conclusion In terms of safety, TLS in sigmoid colon and upper rectal cancer resection is comparable to CLS. However, its incision is smaller and more aesthetic, and it causes lesser trauma than CLS. Additionally, it is also superior to CLS in postoperative recovery.
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Affiliation(s)
- Feng Jiang
- Department of General Surgery, The First Affiliated Hospital of Gannan Medical University, Ganzhou, China
- Ganzhou City Key Laboratory of Colorectal and Anal Diseases Research, Ganzhou, China
| | - Mengmeng Ji
- Department of General Surgery, The First Affiliated Hospital of Gannan Medical University, Ganzhou, China
- Ganzhou City Key Laboratory of Colorectal and Anal Diseases Research, Ganzhou, China
| | - Fangtong Jin
- Ganzhou City Key Laboratory of Colorectal and Anal Diseases Research, Ganzhou, China
- Gannan Medical University, Ganzhou, China
| | - Junfeng Liu
- Ganzhou City Key Laboratory of Colorectal and Anal Diseases Research, Ganzhou, China
- Gannan Medical University, Ganzhou, China
| | - Xiaoping Liu
- Department of General Surgery, The First Affiliated Hospital of Gannan Medical University, Ganzhou, China
- Ganzhou City Key Laboratory of Colorectal and Anal Diseases Research, Ganzhou, China
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ElSherbiney M, Khawaja AH, Noureldin K, Issa M, Varma A. Single incision laparoscopy versus conventional multiport laparoscopy for colorectal surgery: a systematic review and meta-analysis. Ann R Coll Surg Engl 2023; 105:709-720. [PMID: 37843129 PMCID: PMC10618036 DOI: 10.1308/rcsann.2022.0132] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2023] Open
Abstract
INTRODUCTION There has been an increase in colorectal cancer resections worldwide and in the UK. Initially conducted as an open procedure, this was replaced with the conventional multiport technique. Laparoscopic colectomy became the standard surgical technique in 1991. With innovation in surgical technology, single incision laparoscopy (SIL) has attracted more attention as the possible next step in colorectal resection. The aim of this review was to compare outcomes between SIL and conventional laparoscopy (CL). METHODS A literature search was carried out in accordance with the PRISMA (Preferred Reporting Items for Systematic reviews and Meta-Analyses) guidelines. The PubMed®, MEDLINE®, Embase®, Google Scholar™ and Cochrane Library databases were used to extract randomised controlled trials (RCTs) published between January 2000 and May 2021. Statistical analysis was performed with RevMan software. RESULTS A total of 11 RCTs were extracted with 1,370 patients (686 SIL, 684 CL). There was no significant difference between SIL and CL for operative time (standardised mean difference [SMD]: 0.01, 95% confidence interval [CI]: -0.19 to 0.22, z=0.11, p=0.91), length of hospital stay (SMD: -0.10, 95% CI: 0.22 to 0.02, z=1.61, p=0.11) or overall complications (odds ratio [OR]: 0.99, 95% CI: 0.75 to 1.30, z=0.09, p=0.93). SIL had a shorter mean incision (SMD: -0.99, 95% CI: -1.35 to -0.62, z=5.25, p<0.00001). Patients undergoing SIL had a higher conversion rate to CL or an open approach (OR: 3.10, 95% CI: 0.95 to 10.14, z=1.87, p=0.06) but this just missed statistical significance. CONCLUSIONS SIL can be considered a safe alternative to CL if performed by experienced surgeons.
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Affiliation(s)
| | - A H Khawaja
- Nottingham University Hospitals NHS Trust, UK
| | - K Noureldin
- Wirral University Teaching Hospital NHS Foundation Trust, UK
| | - M Issa
- Dudley Group NHS Foundation Trust, UK
| | - A Varma
- United Lincolnshire Hospitals NHS Trust, UK
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Lai J, Ye P, Yang J, Feng Y, Qiu K, Wei S. A propensity score matching investigation of short-term results of single-incision laparoscopic low anterior rectal resection via ileostomy site. J Minim Access Surg 2023; 19:371-377. [PMID: 36695238 PMCID: PMC10449036 DOI: 10.4103/jmas.jmas_163_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2022] [Revised: 07/29/2022] [Accepted: 08/05/2022] [Indexed: 01/22/2023] Open
Abstract
Aims The study was performed to verify the results of single-incision laparoscopic surgery (SILS) through the ileostomy site for low rectal cancer compared with conventional laparoscopic surgery (CLS). Materials and Methods From January 2019 to November 2021, 133 patients with low rectal cancer underwent single-incision (n = 27) or conventional (n = 106) methods of low anterior rectal resection surgery with ileostomy. All patients were balanced by propensity score matching for basic information in a ratio of 1:2, resulting in 27 and 54 in SILS and CLS groups, respectively. Results Relative to the CLS group, the SILS group exhibited fewer leucocyte changes, shorter time to first exhaust and first bowel sounds, shorter length of hospital stay and lower Visual Analogue Score on post-operative days (POD2) and POD3. Intraoperative or post-operative complications or readmissions were comparable between the two groups. The oncologic results remained consistent between the two groups other than the number of lymph nodes dissected in group no. 253. Conclusions Single-incision laparoscopic low rectal resection surgery through the ileostomy site has advantages in terms of reduced post-operative pain, shorter post-operative exhaust time and length of hospital stay while also achieving oncologic outcomes similar to those of conventional laparoscopy. It can be an alternative procedure for patients with low rectal cancer who require ileostomy.
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Affiliation(s)
- Jianxiong Lai
- Department of General Surgery, Affiliated Hospital of North Sichuan Medical College, Nanchong, Sichuan Province, China
- Department of General Surgery, The Third Hospital of Mianyang, Sichuan Mental Health Center, Mianyang, Sichuan Province, China
| | - Pengcheng Ye
- Department of General Surgery, Affiliated Hospital of North Sichuan Medical College, Nanchong, Sichuan Province, China
| | - Junsong Yang
- Department of General Surgery, Affiliated Hospital of North Sichuan Medical College, Nanchong, Sichuan Province, China
| | - Yanchao Feng
- Department of General Surgery, The Third Hospital of Mianyang, Sichuan Mental Health Center, Mianyang, Sichuan Province, China
| | - Kai Qiu
- Department of General Surgery, Affiliated Hospital of North Sichuan Medical College, Nanchong, Sichuan Province, China
| | - Shoujiang Wei
- Department of General Surgery, Affiliated Hospital of North Sichuan Medical College, Nanchong, Sichuan Province, China
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Carrillo Montenegro AF, Aristizabal Rojas S, Pulido Segura JA, Pedraza M, Padilla L, Lozada-Martinez ID, Rafael Narvaez-Rojas A, Cabrera-Vargas LF. Single incision laparoscopic appendectomy with surgical-glove port is cost-effective and reliable in complicated acute appendicitis: A casecontrol multicenter study in Colombia. Heliyon 2023; 9:e12972. [PMID: 36747929 PMCID: PMC9898640 DOI: 10.1016/j.heliyon.2023.e12972] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2022] [Revised: 01/05/2023] [Accepted: 01/10/2023] [Indexed: 01/20/2023] Open
Abstract
Background The single-port (SPL) and multi-port (MPL) laparoscopic approach are the gold standard of management of acute appendicitis, due to its multiple advantages over open surgery, mainly because of its direct effects on recovery, esthetics and costs of the procedure. However, in third-world countries, the laparoscopic approach is not yet fully reproducible due to the costs of the technique. The surgical-glove port single incision laparoscopic appendectomy (SGP-SILA) has been proposed as a viable option. However, it has never been studied in Colombia. Objective To evaluate the cost-effectiveness and reliability of SGP-SILA in the management of complicated acute appendicitis, compared to traditional MPL approach. Materials and methods A retrospective case control study was carried out comparing patients undergoing laparoscopic appendectomy by SGP-SILA vs. MPL, evaluating operating costs associated with intraoperative and postoperative variables in two tertiary centers in Bogota, Colombia. The data were analyzed and expressed according to their nature and distribution. Results 116 patients were included (SGP-SILA: 62 and MPL: 54). The median surgical time for SGP-SILA was 60 min vs. 39 min for MPL. SGP-SILA was shown to cause lower frequency of surgical site infection (4 vs. 8 patients; p = 0.047). It was found a significant correlation between Grade III surgical site infection and surgery time (p = 0.047) in the MPL group; also, with hospital stay (p < 0.001). Also, a lower risk of surgical site infection was found with the SGP-SILA technique (22% vs. 31%). SGP-SILA generated a reduction in both direct and indirect operating costs of approximately 10% (616 USD vs. 683 USD). Conclusion SGP-SILA and MPL are feasible and comparable procedures in the resolution of complicated acute appendicitis. SGP-SILA turns out to be more cost-effective compared to MPL, due to the use of more easily accessible instruments. This may be a reproducible technique in low- and middle-income countries.
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Affiliation(s)
| | | | | | - Mauricio Pedraza
- Department of General Surgery, Universidad El Bosque, Bogotá, Colombia
| | - Laura Padilla
- Department of General Surgery, Universidad El Bosque, Bogotá, Colombia
| | - Ivan David Lozada-Martinez
- Medical and Surgical Research Center, Future Surgeons Chapter, Colombian Surgery Association, Bogotá, Colombia
- International Coalition on Surgical Research, Universidad Nacional Autónoma de Nicaragua, Managua, Nicaragua
| | - Alexis Rafael Narvaez-Rojas
- International Coalition on Surgical Research, Universidad Nacional Autónoma de Nicaragua, Managua, Nicaragua
- Breast Surgical Oncology Division, DeWitt Daughtry Family Department of Surgery. Jackson Health System/University of Miami Miller School of Medicine, Florida, USA
- Corresponding author. International Coalition on Surgical Research, Universidad Nacional Autónoma de Nicaragua, Managua, Nicaragua.
| | - Luis Felipe Cabrera-Vargas
- Department of General Surgery, Universidad El Bosque, Bogotá, Colombia
- Medical and Surgical Research Center, Future Surgeons Chapter, Colombian Surgery Association, Bogotá, Colombia
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Tei M, Suzuki Y, Sueda T, Iwamoto K, Naito A, Nomura M, Yoshikawa Y, Ohtsuka M, Imasato M, Mizushima T, Akamatsu H. Comparison of clinical outcomes of single-incision versus multi-port laparoscopic surgery for descending colon cancer: a propensity score-matched analysis. BMC Gastroenterol 2022; 22:511. [PMID: 36494780 PMCID: PMC9738018 DOI: 10.1186/s12876-022-02597-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2022] [Accepted: 11/28/2022] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND The clinical impact of single-incision laparoscopic surgery (SILS) for descending colon cancer (DCC) is unclear. The aim of this study was to evaluate the clinical outcomes of SILS for DCC compared with multi-port laparoscopic surgery (MPLS). METHODS We retrospectively analyzed 137 consecutive patients with stage I-III DCC who underwent SILS or MPLS at two high-volume multidisciplinary tertiary hospitals between April 2008 and December 2018, using propensity score-matched analysis. RESULTS After propensity score-matching, we enrolled 88 patients (n = 44 in each group). SILS was successful in 97.7% of the matched cohort. Compared with the MPLS group, the SILS group showed significantly less blood loss and a greater number of harvested lymph nodes. Morbidity rates were similar between groups. Recurrence pattern did not differ between groups. No significant differences were found between groups in terms of 3-year disease-free and overall survivals. CONCLUSION SILS appears safe and feasible and can provide satisfactory oncological outcomes for patients with DCC.
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Affiliation(s)
- Mitsuyoshi Tei
- grid.417001.30000 0004 0378 5245Department of Surgery, Osaka Rosai Hospital, 1179-3 Nagasone-cho, Kita-ku, Sakai, 591-8025 Japan
| | - Yozo Suzuki
- grid.417245.10000 0004 1774 8664Department of Surgery, Toyonaka Municipal Hospital, Toyonaka, Japan
| | - Toshinori Sueda
- grid.417001.30000 0004 0378 5245Department of Surgery, Osaka Rosai Hospital, 1179-3 Nagasone-cho, Kita-ku, Sakai, 591-8025 Japan
| | - Kazuya Iwamoto
- grid.416980.20000 0004 1774 8373Department of Surgery, Osaka Police Hospital, Osaka, Japan
| | - Atsushi Naito
- grid.416980.20000 0004 1774 8373Department of Surgery, Osaka Police Hospital, Osaka, Japan
| | - Masatoshi Nomura
- grid.417001.30000 0004 0378 5245Department of Surgery, Osaka Rosai Hospital, 1179-3 Nagasone-cho, Kita-ku, Sakai, 591-8025 Japan
| | - Yukihiro Yoshikawa
- grid.417001.30000 0004 0378 5245Department of Surgery, Osaka Rosai Hospital, 1179-3 Nagasone-cho, Kita-ku, Sakai, 591-8025 Japan
| | - Masahisa Ohtsuka
- grid.416980.20000 0004 1774 8373Department of Surgery, Osaka Police Hospital, Osaka, Japan
| | - Mitsunobu Imasato
- grid.416980.20000 0004 1774 8373Department of Surgery, Osaka Police Hospital, Osaka, Japan
| | - Tsunekazu Mizushima
- grid.416980.20000 0004 1774 8373Department of Surgery, Osaka Police Hospital, Osaka, Japan
| | - Hiroki Akamatsu
- Department of Surgery, Osaka Minato Central Hospital, Osaka, Japan
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Li FH, Zeng DX, Chen L, Xu CF, Tan L, Zhang P, Xiao JW. Comparison of clinical efficacy of single-incision and traditional laparoscopic surgery for colorectal cancer: A meta-analysis of randomized controlled trials and propensity-score matched studies. Front Oncol 2022; 12:997894. [PMID: 36324593 PMCID: PMC9621120 DOI: 10.3389/fonc.2022.997894] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2022] [Accepted: 09/22/2022] [Indexed: 12/24/2022] Open
Abstract
Background Single-incision laparoscopy surgery (SILS) is a new laparoscopic technique that has emerged in the past decade. Whether it has advantages over conventionl laparoscopy surgery (CLS) is inconclusive. This article aimed to compare the short- and long-term outcomes of single-incision laparoscopic surgery and conventional laparoscopic surgery for colorectal cancer through high-quality literature text mining and meta-analysis. Methods Relevant articles were searched on the PubMed, Embase, and Cochrane Library databases from January 2012 to November 2021. All data was from randomized controlled trials (RCTs) in order to increase the confidence of the analytical results.The main outcomes were intraoperative and postoperative complications. Results A total of 10 RCTs were included, involving 1609 patients. The quality of the included studies was generally high. No significant difference was found between SILS and CLS in the postoperative complications, operation time, postoperative hospital stay, number of lymph nodes removed, readmission, reoperation, complication level I- II, complication level IIIa, complication level IIIb, prolonged Ileus, blood loss, infection, anastomotic leakage and operation time. The results showed that SILS group had a higher rate of intraoperative complications, but it had lower incision length and better cosmetic effects. Conclusion These results indicate that SILS did not have a comprehensive and obvious advantage over the CLS. On the contrary, SILS has higher intraoperative complications, which may be related to the more difficulty of SILS operation, but SILS still has better cosmetic effects, which is in line with the concept of surgical development. Therefore, the SILS needs to be selected in patients with higher cosmetic requirements and performed by more experienced surgeons.
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12
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Tei M, Suzuki Y, Ohtsuka M, Iwamoto K, Naito A, Imasato M, Mizushima T, Akamatsu H. Clinical outcomes of single incision laparoscopic surgery for colorectal cancer: A propensity score-matched analysis between well-experienced and novice surgeons. Ann Gastroenterol Surg 2022; 7:102-109. [PMID: 36643373 PMCID: PMC9831886 DOI: 10.1002/ags3.12607] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2022] [Accepted: 07/14/2022] [Indexed: 01/18/2023] Open
Abstract
Background Single incision laparoscopic surgery (SILS) is a recent advancement in minimally invasive techniques for colorectal cancer (CRC). However, SILS is a technically challenging procedure for novice surgeons. The aim of this study was to evaluate clinical outcomes of SILS for CRC performed by novice surgeons compared with those performed by well-experienced surgeons. Methods We retrospectively analyzed 1004 consecutive patients with stage I-IV CRC who underwent SILS between May 2009 and December 2018, using propensity score-matched analysis. Results After propensity score-matching, we enrolled 344 patients (n = 172 in each group). Before matching, significant group-dependent differences were observed in terms of age (P = 0.034) and tumor location (P < 0.001). After matching, preoperative clinical factors were similar between groups, but operative time was longer in the Novice group (213 vs 171 min, P < 0.001). Other operative factors and morbidity rates did not differ significantly between groups. The number of harvested lymph nodes was smaller in the Novice group (23 vs 25, P = 0.040), and the number of patients with lymph node metastases was smaller in the Novice group (57 vs 86, P = 0.002). The 3-year disease-free survival rate was 85.8% in the Novice group and 89.9% in the Experienced group (P = 0.512). Three-year overall survival rate was 92.2% in the Novice group and 90.0% in the Experienced group (P = 0.899). Conclusion SILS for CRC was safely performed by novice surgeons under the guidance of well-experienced surgeons, and could provide satisfactory oncological outcomes.
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Affiliation(s)
| | - Yozo Suzuki
- Department of SurgeryToyonaka Municipal HospitalToyonakaJapan
| | | | | | - Atsushi Naito
- Department of SurgeryOsaka Police HospitalOsakaJapan
| | | | | | - Hiroki Akamatsu
- Department of SurgeryOsaka Minato Central HospitalOsakaJapan
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13
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Oncologic outcomes of single-incision laparoscopic surgery versus conventional laparoscopic surgery for colorectal cancer (CSILS): study protocol for a multicentre, prospective, open-label, noninferiority, randomized controlled trial. BMC Cancer 2022; 22:743. [PMID: 35799145 PMCID: PMC9264567 DOI: 10.1186/s12885-022-09821-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2022] [Accepted: 06/24/2022] [Indexed: 12/24/2022] Open
Abstract
Background In most previous studies, single-incision laparoscopic surgery (SILS) for colorectal cancer (CRC) was feasible and safe in the short term. However, long-term oncologic outcomes remain uncertain, as only a few studies contained long-term survival data. SILS for CRC is still in the early stages of research. Further studies, particularly large-scale, prospective randomized controlled trials, are necessary to assess the value of SILS for CRC. Methods This study is a prospective, multicentre, open-label, noninferiority, parallel-group randomized controlled trial that investigates the long-term oncologic outcomes of SILS compared to conventional laparoscopic surgery (CLS) for CRC. A total of 710 eligible patients will be randomly assigned to the SILS group or the CLS group at a 1:1 ratio using a central, dynamic, and stratified block randomization method. Patients with ages ranging from 18 to 85 years old, of both sexes, with CRC above the peritoneal reflection diagnosed as cT1-4aN0-2M0 and a tumour size no larger than 5 cm will be considered for the study. The primary endpoint is 3-year disease-free survival (DFS). The secondary endpoints include: intraoperative outcomes, postoperative recovery, postoperative pain assessment, pathological outcomes, early morbidity and mortality rate, cosmetic effects, quality of life, 3-year overall survival (OS), incidence of incisional hernia, 5-year DFS and 5-year OS. The first two follow-up visits will be scheduled at one month and three months postoperatively, then every three months for the first two years and every six months for the next three years. Discussion Currently, no randomized controlled trials (RCTs) have been designed to investigate the long-term oncologic outcomes of SILS for CRC. This study is expected to provide clinical evidence of the oncologic outcomes of SILS compared to CLS for CRC to promote its widespread use. Trial registration ClinicalTrials.gov: NCT 04527861 (registered on August 27, 2020).
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Tominaga T, Nonaka T, Shiraishi T, Sumida Y, Takeshita H, Hisanaga M, Fukuoka H, Hashimoto S, To K, Tanaka K, Sawai T, Nagayasu T. Short- and long-term outcomes of single-incision laparoscopic surgery for right colon cancer: A multicenter propensity score-matched analysis. Asian J Endosc Surg 2022; 15:547-554. [PMID: 35229473 DOI: 10.1111/ases.13045] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/27/2021] [Revised: 02/13/2022] [Accepted: 02/15/2022] [Indexed: 01/22/2023]
Abstract
INTRODUCTION Single-incision laparoscopic surgery (SILS) for colon cancer is a recent innovation in minimally invasive surgery that can improve short-term outcome. However, several biases exist in current favorable comparisons of SILS with conventional laparoscopic (CL) surgery. Moreover, the oncological outcomes in SILS remain unclear. The aim of this study was to identify outcomes following SILS and CL for right colectomy using a propensity score-matched analysis. METHODS A total of 553 patients underwent curative resection for right colon cancer (58 SILS and 495 CL). After propensity score matching, 58 patients in each group were matched. RESULTS Before matching, median age was younger (p = 0.037) and clinical stage was lower (p < 0.001) in the SILS group. After matching, operation time was shorter (172 versus 193 min, p = 0.007) and blood loss was less (12 versus 20 mL, p = 0.037) in the SILS group. Most of the SILS cases were performed (43.1%) or supervised (51.7%) by an expert surgeon. Median follow-up duration was 30 and 37 mo in the SILS and CL groups, respectively. Three-year relapse-free survival was 92.5% and 92.4% (p = 0.781); and overall survival was 100% versus 98.1% (p = 0.177). CONCLUSIONS Under the control of expert surgeons, SILS appeared to be a safe and feasible approach and had similar oncological outcomes compared with CL in a propensity score-matched cohort of patients with right-sided colon cancer.
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Affiliation(s)
- Tetsuro Tominaga
- Department of Surgical Oncology, Nagasaki University Graduate School of Biomedical Science, Nagasaki, Japan
| | - Takashi Nonaka
- Department of Surgical Oncology, Nagasaki University Graduate School of Biomedical Science, Nagasaki, Japan
| | - Toshio Shiraishi
- Department of Surgery, Sasebo City General Hospital, Sasebo, Japan
| | - Yorihisa Sumida
- Department of Surgery, Sasebo City General Hospital, Sasebo, Japan
| | - Hiroaki Takeshita
- Department of Surgery, National Hospital Organization Nagasaki Medical Center, Ōmura, Japan
| | - Makoto Hisanaga
- Department of Surgery, Isahaya General Hospital, Isahaya, Japan
| | | | | | - Kazuo To
- Department of Surgery, Ureshino Medical Center, Ureshino, Japan
| | - Kenji Tanaka
- Department of Surgery, Saiseikai Nagasaki Hospital, Nagasaki, Japan
| | - Terumitsu Sawai
- Department of Surgical Oncology, Nagasaki University Graduate School of Biomedical Science, Nagasaki, Japan
| | - Takeshi Nagayasu
- Department of Surgical Oncology, Nagasaki University Graduate School of Biomedical Science, Nagasaki, Japan
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Tei M, Suzuki Y, Ohtsuka M, Iwamoto K, Naito A, Imasato M, Mizushima T, Akamatsu H. Comparison of clinical outcomes of single-incision versus multi-port laparoscopic surgery for rectosigmoid or upper rectal cancer. Int J Colorectal Dis 2022; 37:1553-1560. [PMID: 35639124 DOI: 10.1007/s00384-022-04166-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/22/2022] [Indexed: 02/04/2023]
Abstract
BACKGROUND Single-incision laparoscopic surgery (SILS) for rectal cancer is technically challenging, and its clinical impact is unclear. The aim of this study was to evaluate clinical outcomes of SILS for rectal cancer compared with multi-port laparoscopic surgery (MPLS). PATIENTS AND METHODS We retrospectively analyzed 357 consecutive patients with stage I-III rectal cancer located in the rectosigmoid or upper rectum who underwent SILS or MPLS between January 2012 and December 2016, using propensity score-matched analysis. RESULTS After propensity score-matching, we enrolled 204 patients (n = 102 per group). Before matching, significant group-dependent differences were observed in tumor location (p < 0.001). After matching, preoperative clinical factors were similar between groups. SILS was successful in 73.5% of cases, an additional port was required in 23.5%, and 2.9% were converted to open surgery. Compared to the MPLS group, the SILS group showed shorter operative time (192 vs. 211 min, p = 0.015) and shorter postoperative hospital stay (9 vs. 11 days, p = 0.038). Other operative factors and morbidity rates did not differ significantly between groups. The number of harvested lymph nodes was smaller in the SILS group (24) than in the MPLS group (27, p = 0.008). Postoperative recurrence did not differ between groups, either before or after matching. No significant differences in 3-year disease-free, 3-year local recurrence-free, or 5-year overall survival were found between groups. CONCLUSIONS SILS is safe, is feasible, and offers satisfactory oncological outcomes in selected patients with rectosigmoid or upper rectal cancer.
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Affiliation(s)
- Mitsuyoshi Tei
- Department of Surgery, Osaka Rosai Hospital, Sakai, Japan.
| | - Yozo Suzuki
- Department of Surgery, Toyonaka Municipal Hospital, Toyonaka, Japan
| | | | - Kazuya Iwamoto
- Department of Surgery, Osaka Police Hospital, Osaka, Japan
| | - Atsushi Naito
- Department of Surgery, Osaka Police Hospital, Osaka, Japan
| | | | | | - Hiroki Akamatsu
- Department of Surgery, Osaka Minato Central Hospital, Osaka, Japan
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Nishimura A, Kawahara M, Kawachi Y, Hasegawa J, Makino S, Kitami C, Nakano T, Otani T, Nemoto M, Hattori S, Nikkuni K. Totally laparoscopic resection of right-sided colon cancer using transvaginal specimen extraction with a 10-mm-long abdominal incision. Tech Coloproctol 2022; 26:755-760. [DOI: 10.1007/s10151-022-02636-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2022] [Accepted: 05/01/2022] [Indexed: 11/24/2022]
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Zhang X, Li G, Li X, Liang Z, Lan X, Mou T, Xu Z, Fu J, Wu M, Li G, Wang Y. Effect of single-incision plus one port laparoscopic surgery assisted with enhanced recovery after surgery on colorectal cancer: study protocol for a single-arm trial. Transl Cancer Res 2022; 10:5443-5453. [PMID: 35116390 PMCID: PMC8799928 DOI: 10.21037/tcr-21-1361] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2021] [Accepted: 11/05/2021] [Indexed: 12/20/2022]
Abstract
Background Studies have proved that the enhanced recovery after surgery (ERAS) protocol can significantly improve the recovery course of patients during the perioperative period. The application of minimally invasive surgery is a critical component of ERAS protocol. Single-incision plus one port laparoscopic surgery (SILS plus one) could achieve further minimally invasive surgical results than conventional laparoscopic surgery (CLS). The objective of this trial is to evaluate the safety and feasibility of SILS plus one with ERAS protocol in colorectal cancer. Methods This is a prospective, single-center, open-label, single-arm trial. A total of 120 eligible patients with colorectal cancer will receive SILS plus one followed by the ERAS management during the perioperative period. The primary endpoint is postoperative hospital stay. The secondary endpoints include rehabilitative rate of the fourth postoperative day, postoperative medical cost, postoperative pain score, postoperative recovery indexes, inflammatory immune response indexes, compliance with ERAS measures, 6 min postoperative walking test (6MWT), hospital readmissions, and early postoperative complications. Discussion This trial will be the first to evaluate the short-term outcomes of SILS plus one assisted with ERAS protocol for patients with colorectal cancer and will provide valuable clinical evidence on the benefit of the combination of these two techniques, hopefully, to provide patients with more safe, economic, feasible, and rapid surgery and perioperative strategies. Trial Registration Clinical Trial Registry, NCT0426829. Registered February 15, 2020 (https://clinicaltrials.gov/ct2/show/NCT04268290).
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Affiliation(s)
- Xuehua Zhang
- Department of General Surgery, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Gaohua Li
- Department of General Surgery, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Xiaojing Li
- The First School of Clinical Medicine, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Zhenye Liang
- Department of General Surgery, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Xiaoliang Lan
- Department of General Surgery, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Tingyu Mou
- Department of General Surgery, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Zhenzhao Xu
- Department of General Surgery, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Jie Fu
- Department of General Surgery, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Mingyi Wu
- Department of General Surgery, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Guoxin Li
- Department of General Surgery, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Yanan Wang
- Department of General Surgery, Nanfang Hospital, Southern Medical University, Guangzhou, China
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Vogel JD, Felder SI, Bhama AR, Hawkins AT, Langenfeld SJ, Shaffer VO, Thorsen AJ, Weiser MR, Chang GJ, Lightner AL, Feingold DL, Paquette IM. The American Society of Colon and Rectal Surgeons Clinical Practice Guidelines for the Management of Colon Cancer. Dis Colon Rectum 2022; 65:148-177. [PMID: 34775402 DOI: 10.1097/dcr.0000000000002323] [Citation(s) in RCA: 108] [Impact Index Per Article: 54.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Affiliation(s)
| | | | | | | | | | | | - Amy J Thorsen
- Colon and Rectal Surgery Associates, Minneapolis, Minnesota
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Wang C, Feng H, Zhu X, Song Z, Li Y, Shi Y, Jiang Y, Chen X, Zhang T, Zhao R, Liu K. Comparative Effectiveness of Enhanced Recovery After Surgery Program Combined With Single-Incision Laparoscopic Surgery in Colorectal Cancer Surgery: A Retrospective Analysis. Front Oncol 2022; 11:768299. [PMID: 35096576 PMCID: PMC8790242 DOI: 10.3389/fonc.2021.768299] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2021] [Accepted: 12/20/2021] [Indexed: 02/04/2023] Open
Abstract
BACKGROUND Recently, enhanced recovery after surgery (ERAS) has been widely used in the perioperative management of colorectal cancer (CRC). This study aimed to evaluate the safety and feasibility of ERAS combined with single-incision laparoscopic surgery (SILS) in CRC surgery. METHODS This was a retrospective study of patients with CRC who underwent surgery between April 2018 and April 2020 in Ruijin Hospital(North), Shanghai Jiaotong University School of Medicine. The patients were divided into three groups: group A (n=138), patients who underwent traditional multiport laparoscopic colectomy with conventional perioperative management; group B (n=63), patients who underwent SILS; and group C (n=51), patients who underwent SILS with ERAS. RESULTS Overall, 252 participants were included in the retrospective study. The median operation time (min) in group B and group C was shorter than that in group A (group A 134.0 ± 42.5; group B 117 ± 38.9; group C 111.7 ± 35.4, p=0.004). The estimated surgical blood loss (ml) was lower in groups B and C than in group A (group A 165.1 ± 142.2; group B 122.0 ± 79.4; group C 105.2 ± 55.8, p=0.011). The length of surgical incision (cm) was shorter in groups B and C than in group A (group A 7.34 ± 1.05; group B 5.60 ± 0.80; group C 5.28 ± 0.52, p<0.001). The time before first flatus (hours) in group C was shorter than in groups A and B (group A 61.85 ± 21.14; group B 58.30 ± 20.08; group C 42.06 ± 23.72; p<0.001). The days prior to the administration of free oral fluids in group C was shorter than in groups A and B (group A 4.79 ± 1.28; group B 4.67 ± 1.11; group C 2.62 ± 0.64; p<0.001). The days of prior solid diet was less in group C than in groups A and B (group A 7.22 ± 3.87; group B 7.08 ± 3.18; group C 5.75 ± 1.70; p=0.027). The postoperative length of stay (LOS) was less in group C compared with that in groups A and B (group A 9.46 ± 4.84 days; group B 9.52 ± 7.45 days; group C 7.20 ± 2.37 days; p=0.023). The visual analog scale (VAS) scores on day 0, 1, and 2 in groups B and C were lower than those in group A (day 0, p<0.001; day 1, p<0.001; day 2, p=0.002), while the VAS score on day 3 showed no differences in the three groups (group A 1.29 ± 1.38; group B 0.98 ± 1.24; group C 0.75 ± 0.64, p=0.018). CONCLUSION The findings suggest that SILS combined with ERAS may be a feasible and safe procedure for CRC surgery because it provides favorable cosmetic results, early dietary resumption, shorter hospital stays, and appropriate control of postoperative pain without increases in complications or readmission rates compared to conventional perioperative care with SILS or conventional laparoscopic surgery(CLS) of CRC. Further prospective randomized controlled studies are needed to enhance evidence-based medical evidence.
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Affiliation(s)
- Changgang Wang
- Department of General Surgery, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Haoran Feng
- Department of General Surgery, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Xiaoning Zhu
- Department of Neurology Department, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Zijia Song
- Department of General Surgery, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - You Li
- Department of General Surgery, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Yiqing Shi
- Department of General Surgery, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Yimei Jiang
- Department of General Surgery, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Xianze Chen
- Department of General Surgery, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Tao Zhang
- Department of General Surgery, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Ren Zhao
- Department of General Surgery, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Kun Liu
- Department of General Surgery, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
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Al-Taher M, Okamoto N, Mutter D, Stassen LPS, Marescaux J, Diana M, Dallemagne B. International survey among surgeons on laparoscopic right hemicolectomy: the gap between guidelines and reality. Surg Endosc 2022; 36:5840-5853. [PMID: 35064320 PMCID: PMC8782220 DOI: 10.1007/s00464-022-09044-w] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2021] [Accepted: 01/08/2022] [Indexed: 12/14/2022]
Abstract
Introduction To assess the current approaches and perioperative treatments of laparoscopic right hemicolectomy (LRHC) and to highlight similarities and differences with international guidelines and scientific evidence, we conducted a survey for surgeons across the globe. Methods All digestive and colorectal surgeons registered with the database of the Research Institute against Digestive Cancer (IRCAD) were invited to take part in the survey via email and through the social media networks of IRCAD. Results There were a total of 440 respondents from 78 countries. Most surgeons worked in the European region (38.6%) followed by the Americas (34.1%), the Eastern Mediterranean region (13.0%), the South-East Asian region (5.9%), the Western Pacific region (4.8%), and Africa (3.2%) respectively. Over half of the respondents performed less than 25% of right hemicolectomies laparoscopically where 4 ports are usually used by 68% of the surgeons. The medial-to-lateral, vessel-first approach is the approach most commonly used (74.1%). The most common extraction site was through a midline incision (53%) and an abdominal drain tube is routinely used by 52% of the surgeons after surgery. A total of 68.6% of the responding surgeons perform the majority of the anastomoses extracorporeally. Finally, we found that the majority of responders (60.7%) routinely used mechanical bowel preparations prior to LRHC. Conclusion Regarding several topics related to LRHC care, a discrepancy was observed between the current medical practice and the recommendations from RCTs and international guidelines and significant regional differences were observed. Supplementary Information The online version contains supplementary material available at 10.1007/s00464-022-09044-w.
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Jiang H, Lin L, Xu Q, Xu F, Zhou C, Huang X, Chen R. Comparison of short-term surgical outcomes and post-operative recovery between single-incision and multi-port laparoscopic distal gastrectomy for gastric cancer: A systematic review and meta-analysis. J Minim Access Surg 2022; 18:578-584. [PMID: 35899917 PMCID: PMC9632719 DOI: 10.4103/jmas.jmas_219_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
Background: To summarise data from previous reports and perform a meta-analysis to compare the short-term surgical outcomes and post-operative recovery between single-incision and multi-port laparoscopic distal gastrectomy (MLDG) for gastric cancer. Methods: A systematic literature search was performed using PubMed and Embase databases and relevant data were extracted. Short-term surgical outcomes and post-operative recovery of single-incision laparoscopic distal gastrectomy (SLDG) and MLDG for gastric cancer were compared using a fixed or random-effect model. Results: In total, we identified five relevant studies involving 983 participants for this systematic review and meta-analysis, and 45.8% (450/983) of patients underwent SLDG. The results demonstrated that mean operation time (weighted mean difference [WMD]:-3.22, 95% confidence interval [CI]: 14.64,8.19, P = 0.580; I2 = 75.6%), intra-operative blood loss (WMD:-19.77, 95% CI: 40.20,0.65, P = 0.058; I2 = 85.0%) and lymph node yield (WMD:-0.71, 95% CI: 1.47, 0.05, P = 0.068; I2 = 0%) of SLDG were comparable to those of MLDG for gastric cancer. In addition, SLDG had a similar incidence of post-operative complications compared with MLDG (odds ratio: 0.82, 95% CI: 0.55-1.22, P = 0.326; I2 = 0%). There was no significant difference between the two surgical procedures for the conversion to open surgery (OR: 0.32, 95%CI: 0.03-3.15, P = 0.331; I2 = 0%), the length of hospital stay (WMD:-0.05, 95% CI: 0.65, 0.55, P = 0.876; I2 = 44.1%), the time to first flatus (WMD:-0.24, 95% CI: 0.58, 0.10, P = 0.169; I2 = 85.3%) and the time to oral intake (WMD:-0.05, 95% CI: 0.20, 0.10, P = 0.500; I2 = 0%). Conclusion: Single-incision laparoscopic gastrectomy may be technically feasible and safe for gastric cancer. However, it did not show a more obvious advantage over MLDG.
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Wang C, Su C, Chen C, Tang X, Wang H, Li W, Li Y, Liu Q, Chen P, Li Y, Luo Y. Single-incision laparoscopic splenectomy in children with massive splenomegaly: A prospective, monocentric pilot study. Front Pediatr 2022; 10:1097416. [PMID: 36704139 PMCID: PMC9871812 DOI: 10.3389/fped.2022.1097416] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2022] [Accepted: 12/22/2022] [Indexed: 01/11/2023] Open
Abstract
BACKGROUND Single-incision laparoscopic splenectomy (SILS) remains a challenging procedure because of the technical difficulty. In this prospective study, we aimed to evaluate the efficacy and safety of SILS in children with massive splenomegaly. METHODS Pediatric patients with massive splenomegaly were recruited for SILS in a university-affiliated hospital. The data on patient demographics, clinical features, operative variables, and perioperative outcomes were collected prospectively and analyzed. According to the different surgical instruments, the patients were randomly assigned into two groups: the SILS with straight surgical instrument (SILS-S) group and the SILS with curved surgical instrument (SILS-C) group. A two-group comparative analysis was conducted using perioperative data from the different surgical instrumentation systems. RESULTS A total of 120 patients were included, of which 103 patients (success group, 85.83%) had complete SILS, the other 17 (failure group, 14.17%) patients were converted to open (n = 4, 3.33%) or multi-incision laparoscopic surgery (n = 13, 10.83%). The major cause for surgical failure is uncontrollable bleeding (n = 14, 82.35%), and age, height, and weight were the risk factors for failure of SILS, but none of the parameters were independent risk factors. The blood loss in the success group was less than that in the failure group, but no significant differences in other operative and outcome indicators. For SILS, the mean (±SD) operative time was 188 (±48.70) minutes, the median intraoperative blood loss (min, max) was 20 (5, 290) ml, the mean (±SD) time of first anal exhaust was 23.9 (±7.73) hours, and the mean (±SD) postoperative hospital stay was 4.72 (±1.03) days. The median pain score was 3 on 1 day, and 1 on 3 days after the operation. Postoperative complications were identified in 8 (7.77%) cases. However, there were no peri-operative deaths in this series. The SILS-C group had a significantly shorter operation time than the SILS-S group (mean ± SD, 172 ± 44.21 vs. 205 ± 47.90 min). There were no significant differences between the two groups in other perioperative data (P < 0.05). CONCLUSION SILS is a safe and feasible treatment in pediatric patients with massive splenomegaly, and curved surgical instrumentation has contributed to developing surgical manipulation.
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Affiliation(s)
- Congjun Wang
- Department of Pediatric Surgery, The First Affiliated Hospital of Guangxi Medical University, Guangxi Medical University, Nanning, China
| | - Cheng Su
- Department of Pediatric Surgery, The First Affiliated Hospital of Guangxi Medical University, Guangxi Medical University, Nanning, China
| | - Chao Chen
- Department of Pediatric Surgery, The First Affiliated Hospital of Guangxi Medical University, Guangxi Medical University, Nanning, China
| | - Xianming Tang
- Department of Pediatric Surgery, The First Affiliated Hospital of Guangxi Medical University, Guangxi Medical University, Nanning, China
| | - Hong Wang
- Department of Pediatric Surgery, The First Affiliated Hospital of Guangxi Medical University, Guangxi Medical University, Nanning, China
| | - Wei Li
- Department of Pediatric Surgery, The First Affiliated Hospital of Guangxi Medical University, Guangxi Medical University, Nanning, China
| | - Yanqiang Li
- Department of Pediatric Surgery, The First Affiliated Hospital of Guangxi Medical University, Guangxi Medical University, Nanning, China
| | - Qiang Liu
- Department of Pediatric Surgery, The First Affiliated Hospital of Guangxi Medical University, Guangxi Medical University, Nanning, China
| | - Peng Chen
- Department of Pediatric Surgery, The First Affiliated Hospital of Guangxi Medical University, Guangxi Medical University, Nanning, China
| | - Yong Li
- Department of Pediatric Surgery, The First Affiliated Hospital of Guangxi Medical University, Guangxi Medical University, Nanning, China
| | - Yige Luo
- Department of Pediatric Surgery, The First Affiliated Hospital of Guangxi Medical University, Guangxi Medical University, Nanning, China
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Song Z, Liu K, Li Y, Shi Y, Jiang Y, Wang C, Chen X, Zhang T, Ji X, Zhao R. Short-Term Outcomes of Single-Incision Laparoscopic Surgery for Colorectal Cancer: A Single-Center, Open-Label, Non-Inferiority, Randomized Clinical Trial. Front Oncol 2021; 11:762147. [PMID: 34760706 PMCID: PMC8573253 DOI: 10.3389/fonc.2021.762147] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2021] [Accepted: 10/05/2021] [Indexed: 12/17/2022] Open
Abstract
Objective To date, well-designed randomized controlled trials examining the safety, efficacy, and long-term outcomes of single-incision laparoscopic surgery (SILS) for colorectal cancer are scarce. The aim of the current study was to compare short-term outcomes of SILS for colorectal cancer with conventional laparoscopic surgery (CLS). Methods Between June 28, 2017, and June 29, 2019, a single-center, open-label, non-inferiority, randomized clinical trial was conducted at the Department of General Surgery, Ruijin Hospital (North), Shanghai Jiaotong University School of Medicine in Shanghai, China. In total, 200 patients diagnosed or suspected of colorectal cancer (cT1-4aN0-2M0) were randomly assigned to either the SILS or CLS group in a 1:1 ratio. The primary outcome was early morbidity rate. Secondary outcomes included intraoperative outcomes, pain intensity, postoperative recovery, pathologic outcomes, and long-term outcomes. Results In total, 193 participants (SILS, 97; CLS, 96) were analyzed in the modified intention-to-treat (MITT) population. Among them, 48 underwent right hemicolectomy (SILS n = 23, 23.7% and MLS n = 25, 26%), 15 underwent left hemicolectomy (SILS n = 6, 6.2% and MLS n = 9, 9.4%), 1 underwent transverse colectomy (MLS n = 1, 1%), 57 underwent sigmoidectomy (SILS n = 32, 33% and MLS n = 25, 26%), and 72 underwent anterior resection (SILS n = 36, 37.1% and MLS n = 36, 37.5%). No significant differences were observed in the baseline characteristics. The intraoperative complication was comparable between the two groups [5 (5.2%) vs. 4 (4.2%); difference, 1%; 95% CI, -5.8% to 7.8%; p > 0.999) and so was postoperative complication rates [10 (10.3%) vs. 14 (14.6%); difference, -4.3%; 95% CI, -13.9% to 5.3%; p = 0.392]. The SILS group showed shorter incision length [median (IQR), 4 (3.5-5) vs. 6.6 (6-7.5), p < 0.001] and lower VAS scores on the first [median (IQR), 4 (3-5) vs. 4 (4-5), p = 0.002] and the second day [median (IQR), 2 (1.5-3) vs. 3 (2-4), p < 0.001] after surgery. No statistically significant difference was found in other measured outcomes. Conclusions Compared with CLS, SILS performed by experienced surgeons for selected colorectal cancer patients is non-inferior with good short-term safety and has the advantage of reducing postoperative pain. Clinical Trial Registration ClinicalTrials.gov, identifier NCT03151733.
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Affiliation(s)
- Zijia Song
- Department of General Surgery, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Kun Liu
- Department of General Surgery, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - You Li
- Department of General Surgery, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Yiqing Shi
- Department of General Surgery, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Yimei Jiang
- Department of General Surgery, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Changgang Wang
- Department of General Surgery, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Xianze Chen
- Department of General Surgery, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Tao Zhang
- Department of General Surgery, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Xiaopin Ji
- Department of General Surgery, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Ren Zhao
- Department of General Surgery, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
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Yuan Y, Jian J, Jing H, Yan R, You F, Fu X, Du L, Li W. Single-Incision vs. Conventional Laparoscopic Surgery for Colorectal Cancer: An Update of a Systematic Review and Meta-Analysis. Front Surg 2021; 8:704986. [PMID: 34497828 PMCID: PMC8419430 DOI: 10.3389/fsurg.2021.704986] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2021] [Accepted: 07/19/2021] [Indexed: 12/28/2022] Open
Abstract
Background: Although the advantages of single-incision laparoscopic surgery have been reported in several meta-analyses, the low quality of studies included in the meta-analyses limits the reliability of such a conclusion. In recent years, the number of randomized controlled trials on the efficacy of SILS in colorectal cancer has been on the rise. This update systematic review and meta-analysis of RCTs aims to compare efficacy and safety of SILS and CLS in the patients with colorectal cancer. Methods: Relevant data was searched on the CNKI, Wanfang, VIP, Sinomed, PubMed, Embase, and Cochrane CENTRAL databases from inception until February 5th, 2021. All RCTs comparing SILS and CLS were included. The main outcomes were 30 days of mortality, postoperative complications, intraoperative complications, whereas secondary outcomes were the number of lymph nodes removed, duration of hospital stay, intraoperative blood loss, abdominal incision length, reoperation, readmission, conversion to laparotomy, operation time and anastomotic leakage. Results: A total of 10 RCTs were included, involving 1,133 participants. The quality of the included studies was generally high. No significant difference was found between SILS and CLS in the 30 days mortality rate. The results showed that SILS group had a lower rate of postoperative complications (RR = 0.67, 95% CI: 0.49-0.92), higher rate of intraoperative complications (RR = 2.26, 95%CI: 1.00-5.10), shorter length of abdominal incision (MD = -2.01, 95% CI:-2.42-1.61) (cm), longer operation time (MD = 11.90, 95% CI: 5.37-18.43) (minutes), shorter hospital stay (MD = -1.12, 95% CI: -1.89-0.34) (days) compared with CLS group. However, intraoperative blood loss (MD = -8.23, 95% CI: -16.75-0.29) (mL), number of lymph nodes removed (MD = -0.17, 95% CI: -0.79-0.45), conversion to laparotomy (RR=1.31, 95% CI: 0.48-3.60), reoperation (RR = 1.00, 95% CI: 0.30-3.33) and readmission (RR =1.15, 95% CI: 0.12-10.83) and anastomotic leakage were not significantly different between the two groups. Conclusion: These results indicate that SILS did not has a comprehensive and obvious advantage over the CLS. Surgeons and patients should carefully weigh the pros and cons of the two surgical procedures. Further RCTs are needed to prove long-term outcomes of SILS in colorectal cancer.
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Affiliation(s)
- Ye Yuan
- Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Jianing Jian
- Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Hailiang Jing
- Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Ran Yan
- Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Fengming You
- Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Xi Fu
- Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Linke Du
- Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Wenyuan Li
- Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, China.,Sichuan Evidence-Based Medicine Center of Traditional Chinese Medicine, Chengdu, China.,TCM Regulating Metabolic Diseases Key Laboratory of Sichuan Province, Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, China
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Long-term oncologic outcomes of single-incision laparoscopic surgery for colon cancer. Surg Endosc 2021; 36:3200-3208. [PMID: 34463871 DOI: 10.1007/s00464-021-08629-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2020] [Accepted: 07/05/2021] [Indexed: 10/20/2022]
Abstract
BACKGROUND Studies find similar perioperative outcomes between single-incision laparoscopic surgery (SILS) and conventional laparoscopic surgery (CLS) for colon cancer. However, few have reported long-term outcomes of SILS versus CLS. We aimed to compare long-term postoperative and oncologic outcomes as well as perioperative outcomes between SILS and CLS for colon cancer. METHODS A total of 641 consecutive patients who underwent laparoscopic surgery for colon cancer from July 2009 to September 2014 were eligible for the study. Data from 300 of these patients were used for analysis after propensity score-matching (n = 150 per group). Variables associated with short- and long-term outcomes were analyzed. RESULTS The SILS group had a shorter mean total incision length, less postoperative pain, and a similar mean rate of incisional hernia (2.7% versus 3.3%) compared with the CLS group. The 7-year overall and disease-free survival rates were 92.7% versus 94% (p = 0.673) and 85.3% versus 84.7% (p = 0.688) in the SILS and CLS groups, respectively. CONCLUSIONS Compared with CLS, SILS for colon cancer appeared to be safe in terms of perioperative and long-term postoperative and oncologic outcomes. The results suggested that SILS is a reasonable treatment option for colon cancer for a selected group of patients.
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Long-term Outcomes of a Randomized Controlled Trial of Single-incision Versus Multi-port Laparoscopic Colectomy for Colon Cancer. Ann Surg 2021; 273:1060-1065. [PMID: 33630448 DOI: 10.1097/sla.0000000000004252] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
OBJECTIVE The aim of this study was to evaluate the long-term outcomes that were the secondary endpoints of a RCT of multi-port laparoscopic colectomy (MPC) versus SILC in colon cancer surgery. SUMMARY OF BACKGROUND DATA The actual long-term outcomes, such as the 5-year RFS, OS, and recurrence patterns after surgery, have not been evaluated by a RCT. METHODS Patients with histologically proven colon carcinoma located in the cecum, ascending, sigmoid or rectosigmoid colon clinically diagnosed as stage 0-III were eligible for this study. Patients were preoperatively randomized and underwent complete mesocolic excision. The 5-year RFS, OS, and recurrence patterns were analyzed (UMIN-CTR 000007220). RESULTS Between March 1, 2012, and March 31, 2015, a total of 200 patients were randomly assigned to either the MPC arm (n = 100) or SILC arm (n = 100). The median follow-up for all patients was 61.0 months. An intention-to-treat analysis showed that the 5-year RFS was 91.0% [95% confidence interval (CI) 85.1%-96.9%] in the MPC arm and 88.0% (95% CI 82.1%-93.9%) in the SILC arm (hazard ratio: 1.37; 95% CI 0.58-3.24; P = 0.479). The 5-year OS was 95.0% (95% CI 91.1%-98.9%) in the MPC arm and 93.0% (87.1%-98.9%) in the SILC arm (hazard ratio: 1.39; 95% CI 0.44-4.39; P = 0.568). There were no significant differences in the recurrence patterns between the 2 arms. CONCLUSIONS Even though the results of the 5-year OS and RFS in this trial were exploratory and underpowered, there were no statistically significant differences between the SILC and MPC arms. SILC may be an acceptable treatment option for select patients with colon cancer.
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Rink AD, Golubev V, Vestweber B, Paul C, Lang H, Vestweber KH. Oncologic long-term outcome of single-incision laparoscopic surgery (SILS) for colorectal cancer. Int J Colorectal Dis 2021; 36:1751-1758. [PMID: 33723635 PMCID: PMC8279984 DOI: 10.1007/s00384-021-03902-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/02/2021] [Indexed: 02/04/2023]
Abstract
PURPOSE Single-incision laparoscopic surgery (SILS) has been introduced as a less invasive alternative to multi-port laparoscopic surgery (MLS). MLS is widely accepted for the treatment of colorectal cancer, but there remains minimal evidence for the use of SILS. Thus, we compared both short- and long-term outcomes of SILS and open surgery (OS) in matched cohorts of colorectal cancer patients. METHODS Some 910 patients had colorectal resections for cancer between 2006 and 2013, and 134 of them were operated on using SILS. Eighty of these SILS patients were compared to a cohort of patients who had open surgery that were matching in tumour stage and location, type of resection, sex, age and ASA Score. Disease-free survival at 5 years (5y-DFS) was the primary endpoint; morbidity and hospitalization were secondary parameters. The role of surgical training in SILS was also investigated. RESULTS Clavien Dindo ≥ IIIb complications occurred in 13.8% in both groups. 5y-DSF were 82% after SILS and 70% after OS (p = 0.11). Local recurrence after rectal cancer tended to be lower after SILS (0/43 (SILS) vs. 4/35 (OS), p = 0.117). Length of stay was significantly shorter after SILS (10 vs. 14 days, p = 0.0004). The rate of operations performed by surgical residents was equivalent in both groups (44/80 (SILS) vs. 46/80 (OS), p = 0.75). CONCLUSION The data demonstrates that SILS results in similar long-term oncological outcomes when compared to open surgery as well as morbidity rates. The hospital stay in the SILS group was shorter. SILS can also be incorporated in surgical training programmes.
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Affiliation(s)
- Andreas D Rink
- Department of General, Visceral and Transplant Surgery, University Medicine of Johannes Gutenberg-University, Langenbeckstr 1, 55131, Mainz, Germany.
- Department of General, Visceral and Thoracic Surgery, Leverkusen General Hospital, Am Gesundheitspark 11, 51375, Leverkusen, Germany.
| | - Vitaly Golubev
- Department of General, Visceral and Thoracic Surgery, Leverkusen General Hospital, Am Gesundheitspark 11, 51375, Leverkusen, Germany
| | - Boris Vestweber
- Department of Surgery, King Edwards VII Memorial Hospital, 7 Point Finger Rd,, Paget DV 04, Hamilton, HM DX, Bermuda
| | - Claudia Paul
- Department of General, Visceral and Thoracic Surgery, Leverkusen General Hospital, Am Gesundheitspark 11, 51375, Leverkusen, Germany
| | - Hauke Lang
- Department of General, Visceral and Transplant Surgery, University Medicine of Johannes Gutenberg-University, Langenbeckstr 1, 55131, Mainz, Germany
| | - Karl-Heinz Vestweber
- Department of General, Visceral and Thoracic Surgery, Leverkusen General Hospital, Am Gesundheitspark 11, 51375, Leverkusen, Germany
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A learning curve in using organ retractor for single-incision laparoscopic right colectomy. Sci Rep 2021; 11:6546. [PMID: 33753808 PMCID: PMC7985516 DOI: 10.1038/s41598-021-86168-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2020] [Accepted: 02/25/2021] [Indexed: 12/26/2022] Open
Abstract
Single-incision laparoscopic surgery (SILS) has the potential to improve perioperative outcomes, including less postoperative pain, shorter operation time, less blood loss, and shorter hospital stay. However, SILS is technically difficult and needs a longer learning curve. Between April 2016 and September 2019, a total of 198 patients with clinical stage I/II right colon cancer underwent curative resection. In the case of the SILS approach, an organ retractor was usually used to overcome SILS-specific restrictions. The patients were divided into two groups by surgical approach: the SILS with organ retractor group (SILS-O, n = 33) and the conventional laparoscopic surgery group (LAC, n = 165). Clinical T status was significantly higher in the LAC group (p = 0.016). Operation time was shorter and blood loss was lower in the SILS-O group compared to the LAC group (117 vs. 197 min, p = 0.027; 10 vs. 25 mL, p = 0.024, respectively). In the SILS-O group, surgical outcomes including operation time, blood loss, number of retrieved lymph nodes, and postoperative complications were not significantly different between those performed by experts and by non-experts. Longer operation time (p = 0.041) was significantly associated with complications on univariate and multivariate analyses (odds ratio 2.514, 95%CI 1.047–6.035, p = 0.039). SILS-O was safe and feasible for right colon cancer. There is a potential to shorten the learning curve of SILS using an organ retractor.
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Comparison of Survival between Single-Access and Conventional Laparoscopic Surgery in Rectal Cancer. Minim Invasive Surg 2021; 2021:6684527. [PMID: 33815842 PMCID: PMC7994082 DOI: 10.1155/2021/6684527] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2020] [Revised: 01/28/2021] [Accepted: 03/10/2021] [Indexed: 11/18/2022] Open
Abstract
Introduction Innovative laparoscopic surgery for rectal cancer can be classified into 2 types: firstly, new instruments such as robotic surgery and secondly, new technique such as single-access laparoscopic surgery (SALS) and transanal total mesorectal excision (TaTME). Most reports of SALS for rectal cancer have shown pathologic outcomes comparable to those of conventional laparoscopic surgery (CLS); however, SALS is considered to be superior to CLS in terms of lower levels of discomfort and faster recovery rates. This study aimed to compare the survival outcomes of the two approaches. Methods From 2011 to 2014, 84 cases of adenocarcinoma of the rectum and anal canal were enrolled. The operations were anterior, low anterior, intersphincteric, and abdominoperineal resections. Data collected included postoperative outcomes. The oncological outcomes recorded included 3-year and 5-year survival, local recurrence, and metastasis. Results SALS was performed on 41 patients, and CLS was utilized in 43 cases. The demographic data of the two groups were similar. Intraoperative volumes of blood loss and conversion rates were similar, but operative time was longer in the SALS group. There were no significant differences in postoperative complications or pathological outcomes. The oncologic results were similar in terms of 3-year survival (100% and 97.7%; p = 1.00), 5-year survival (78.0% and 86.0%; p = 0.401), local recurrence rates (19.5% vs 11.6%, p = 0.376), and metastasis rates (19.5% vs 11.6%; p = 0.376) for SALS and CLS, respectively. Conclusion SALS and CLS for rectal and anal cancer had comparable pathological and survival results, but SALS showed some superior benefits in the early postoperative period.
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Suzuki Y, Tei M, Wakasugi M, Nakahara Y, Naito A, Mikamori M, Furukawa K, Ohtsuka M, Moon JH, Imasato M, Asaoka T, Kishi K, Akamatsu H. Long-term outcomes of single-incision versus multiport laparoscopic colectomy for colon cancer: results of a propensity score-based analysis. Surg Endosc 2021; 36:1027-1036. [PMID: 33638106 DOI: 10.1007/s00464-021-08367-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2020] [Accepted: 02/09/2021] [Indexed: 01/07/2023]
Abstract
BACKGROUND Long-term outcomes of single-incision laparoscopic colectomy (SILC) for colon cancer (CC), as practiced in real-world settings, especially in relation to disease stage, have not been established. We examined, retrospectively, both short- and long-term outcomes of SILC versus those of multiport laparoscopic colectomy (MPLC) performed for CC in a propensity-score-matched cohort. METHODS The study involved 263 patient pairs matched 1:1 from among 691 patients who, between January 2008 and May 2014, underwent either SILC or MPLC for a primary solitary CC at our hospital. Short-term and long-term operative outcomes were compared between the two groups. RESULTS Operation time was the only surgical outcome that varied significantly between the two groups (p = 0.0004). Overall 5-year cancer-specific survival (CSS) in the SILC group was 93.7 (95% CI 89.6-96.2)%, and CSS per pathological stage (I, II and III) was 98.5 (90.0-99.8)%, 96.0 (88.2-98.7)%, and 88.3 (79.6-93.6)%, respectively, whereas overall 5-year CSS in the MPLC group was 93.3 (89.4-95.9)%, and CSS per pathological stage was 100%, 95.4 (88.3-98.3)%, and 84.1 (74.1-90.8)% (p = 0.5278, 0.2679, 0.7666, and 0.9073), respectively. Overall 3-year disease-free survival (DFS) in the SILC group was 94.0 (90.2-96.4)%, and 3-year DFS per pathological stage was 98.6 (90.4-99.8)%, 90.1 (81.4-95.0)%, and 79.0 (69.4-86.2)%, respectively, whereas overall 3-year DFS in the MPLC group was 93.2 (89.4-95.7)%, and 3-year DFS per pathological disease stage was 100%, 94.5 (87.4-97.7)% and 75.5 (64.7-83.8)% (p = 0.2829, 0.7401, 0.4335 and 0.8518), respectively. Thus, oncological outcomes did not differ significantly between groups. Incisional hernia occurred in 21 (8.0%) SILC group patients and 17 (6.5%) MPLC group patients, without a significant between-group difference (p = 0.6139). CONCLUSION Our data indicate that perioperative and oncological outcomes of SILC performed for CC are comparable to those of MPLC performed for CC.
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Affiliation(s)
- Yozo Suzuki
- Department of Gastroenterological Surgery, Osaka Police Hospital, 10-31 Kitayama-cho, Tennoji-Ku, Osaka, Osaka, 543-0035, Japan. .,Department of Gastroenterological Surgery, Toyonaka Municipal Hospital, 4-14-1, Shibahara-cho, Toyonaka, Osaka, 560-8565, Japan.
| | - Mitsuyoshi Tei
- Department of Gastroenterological Surgery, Osaka Rosai Hospital, 1179-3 Nagasone-cho, Kita-ku, Sakai, Osaka, 591-8025, Japan
| | - Masaki Wakasugi
- Department of Gastroenterological Surgery, Osaka Rosai Hospital, 1179-3 Nagasone-cho, Kita-ku, Sakai, Osaka, 591-8025, Japan
| | - Yujiro Nakahara
- Department of Gastroenterological Surgery, Osaka Police Hospital, 10-31 Kitayama-cho, Tennoji-Ku, Osaka, Osaka, 543-0035, Japan
| | - Atsushi Naito
- Department of Gastroenterological Surgery, Osaka Police Hospital, 10-31 Kitayama-cho, Tennoji-Ku, Osaka, Osaka, 543-0035, Japan
| | - Manabu Mikamori
- Department of Gastroenterological Surgery, Osaka Police Hospital, 10-31 Kitayama-cho, Tennoji-Ku, Osaka, Osaka, 543-0035, Japan
| | - Kenta Furukawa
- Department of Gastroenterological Surgery, Osaka Police Hospital, 10-31 Kitayama-cho, Tennoji-Ku, Osaka, Osaka, 543-0035, Japan
| | - Masahisa Ohtsuka
- Department of Gastroenterological Surgery, Osaka Police Hospital, 10-31 Kitayama-cho, Tennoji-Ku, Osaka, Osaka, 543-0035, Japan
| | - Jeong Ho Moon
- Department of Gastroenterological Surgery, Osaka Police Hospital, 10-31 Kitayama-cho, Tennoji-Ku, Osaka, Osaka, 543-0035, Japan
| | - Mitsunobu Imasato
- Department of Gastroenterological Surgery, Osaka Police Hospital, 10-31 Kitayama-cho, Tennoji-Ku, Osaka, Osaka, 543-0035, Japan
| | - Tadafumi Asaoka
- Department of Gastroenterological Surgery, Osaka Police Hospital, 10-31 Kitayama-cho, Tennoji-Ku, Osaka, Osaka, 543-0035, Japan
| | - Kentaro Kishi
- Department of Gastroenterological Surgery, Osaka Police Hospital, 10-31 Kitayama-cho, Tennoji-Ku, Osaka, Osaka, 543-0035, Japan
| | - Hiroki Akamatsu
- Department of Gastroenterological Surgery, Osaka Police Hospital, 10-31 Kitayama-cho, Tennoji-Ku, Osaka, Osaka, 543-0035, Japan
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Tominaga T, Nonaka T, Fukuda A, Moriyama M, Oyama S, Ishii M, Sawai T, Ueki N, Nagayasu T. Epidermoid cyst of the cecum resected by single-incision laparoscopic colectomy: a case report. Surg Case Rep 2021; 7:57. [PMID: 33630182 PMCID: PMC7907325 DOI: 10.1186/s40792-021-01138-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2021] [Accepted: 02/11/2021] [Indexed: 12/11/2022] Open
Abstract
Background Epidermoid cyst arising from the cecum is extremely rare. Single-incision laparoscopic surgery is the latest innovation in minimally invasive surgery, and shortens incisions, improves cosmesis, and reduces postoperative pain. We report here the first description of a patient with epidermoid cyst of the cecum treated by ileocecal resection by single-incision laparoscopic surgery. Case presentation A 20-year-old woman presented to our hospital with abdominal pain in the right lower quadrant. Abdominal contrast-enhanced computed tomography showed a 56 × 35-mm cystic mass in the ileocecal area. Magnetic resonance imaging revealed a 56 × 43-mm, T1-hypointense, T2-hyperintense mass attached to the cecum. Gastrointestinal tumor or duplication cyst was suspected, and ileocecal resection was performed using single-incision laparoscopic surgery. Intraoperative examination showed the tumor as a round, whitish mass arising from the cecum. Operation time was 162 min, and intraoperative blood loss was 10 ml. Macroscopic examination showed a 56 × 45-mm elastic-hard, whitish, round mass arising from the cecal wall. Microscopic examination revealed the cyst wall lined by keratinized stratified squamous epithelium. No malignant findings were identified. The final diagnosis was epidermoid cyst of the cecum. The postoperative course was uneventful and she was discharged on postoperative day 5. Conclusions A rare case of cecal epidermoid cyst is reported. Single-incision laparoscopic colectomy using an organ retractor represents a promising option for treating cecal epidermoid cyst.
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Affiliation(s)
- Tetsuro Tominaga
- Departments of Surgical Oncology, Nagasaki University Graduate School of Biomedical Science, 1-7-1 Sakamoto, Nagasaki, 852-8501, Japan.
| | - Takashi Nonaka
- Departments of Surgical Oncology, Nagasaki University Graduate School of Biomedical Science, 1-7-1 Sakamoto, Nagasaki, 852-8501, Japan
| | - Akiko Fukuda
- Departments of Surgical Oncology, Nagasaki University Graduate School of Biomedical Science, 1-7-1 Sakamoto, Nagasaki, 852-8501, Japan
| | - Masaaki Moriyama
- Departments of Surgical Oncology, Nagasaki University Graduate School of Biomedical Science, 1-7-1 Sakamoto, Nagasaki, 852-8501, Japan
| | - Shosaburo Oyama
- Departments of Surgical Oncology, Nagasaki University Graduate School of Biomedical Science, 1-7-1 Sakamoto, Nagasaki, 852-8501, Japan
| | - Mitsuhisa Ishii
- Departments of Surgical Oncology, Nagasaki University Graduate School of Biomedical Science, 1-7-1 Sakamoto, Nagasaki, 852-8501, Japan
| | - Terumitsu Sawai
- Departments of Cardiopulmonary Rehabilitation Science, Nagasaki University Graduate School of Biomedical Science, 1-7-1 Sakamoto, Nagasaki, 852-8501, Japan
| | - Nozomi Ueki
- Department of Tumor and Diagnostic Pathology, Atomic Bomb Disease Institute, Nagasaki University Graduate School of Biomedical Sciences, 1-12-4 Sakamoto, Nagasaki, 852-8523, Japan
| | - Takeshi Nagayasu
- Departments of Surgical Oncology, Nagasaki University Graduate School of Biomedical Science, 1-7-1 Sakamoto, Nagasaki, 852-8501, Japan
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Short-term Outcomes of Single-port Versus Multiport Laparoscopic Surgery for Colon Cancer: The SIMPLE Multicenter Randomized Clinical Trial. Ann Surg 2021; 273:217-223. [PMID: 32209897 DOI: 10.1097/sla.0000000000003882] [Citation(s) in RCA: 30] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
OBJECTIVE To compare short-term perioperative outcomes of single-port laparoscopic surgery (SPLS) and multiport laparoscopic surgery (MPLS) for colon cancer. SUMMARY BACKGROUND DATA Although many studies reported short- and long-term outcomes of SPLS for colon cancer compared with MPLS, few have reported results of randomized controlled trials. METHODS This was a multicenter, prospective, randomized controlled trial with a noninferiority design. It was conducted between August 2011 and June 2017 at 7 sites in Korea. A total of 388 adults (aged 19-85 yrs) with clinical stage I, II, or III adenocarcinoma of the ascending or sigmoid colon were enrolled and randomized. The primary endpoint was 30-day postoperative complication rates. Secondary endpoints were the number of harvested lymph nodes, length of the resection margin, postoperative pain, and time to functional recovery (bowel movement and diet). Patients were followed for 30 days after surgery. RESULTS Among 388 patients, 359 (92.5%) completed the study (SPLS, n = 179; MPLS, n = 180). The 30-day postoperative complication rate was 10.6% in the SPLS group and 13.9% in the MPLS group (95% confidence interval, -10.05 to 3.05 percentage points; P < 0.0001). Total incision length was shorter in the SPLS group than in the MPLS group (4.6 cm vs 7.2 cm, P < 0.001), whereas the length of the specimen extraction site did not differ (4.4 cm vs 4.6 cm, P = 0.249). There were no significant differences between groups for all secondary endpoints and all other outcomes. CONCLUSIONS Even though there was no obvious benefit to SPLS over MPLS when performing colectomy for cancer, our data suggest that SPLS is noninferior to MPLS and can be considered an option in selected patients, when performed by experienced surgeons.Trial registration: ClinicalTrials.gov Identifier: NCT01480128.
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Natural orifice versus conventional mini-laparotomy for specimen extraction after reduced-port laparoscopic surgery for colorectal cancer: propensity score-matched comparative study. Surg Endosc 2021; 36:155-166. [PMID: 33532930 DOI: 10.1007/s00464-020-08250-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2020] [Accepted: 12/16/2020] [Indexed: 02/07/2023]
Abstract
BACKGROUND Although reduced port laparoscopic surgery (RPLS), defined as laparoscopic surgery performed with the minimum possible number of ports and/or small-sized ports, is less invasive than conventional laparoscopic surgery by reducing the number of surgical wounds, an extension of the incision is still needed for specimen extraction, which can undermine the merits of RPLS. OBJECTIVE To determine the impact of natural orifice specimen extraction (NOSE) in patients undergoing RPLS for colorectal cancer. The endpoints were perioperative outcome and oncologic safety at 3 years. SETTING Single-center experience (2013-2019). PATIENTS We retrospectively analyzed our prospectively collected patient records (American Joint Committee on Cancer (AJCC) stage I-III sigmoid or upper rectal cancer (tumor diameter ≤ 5 cm) who underwent curative anterior resection via RPLS. We excluded patients who did not undergo intestinal anastomosis. INTERVENTIONS Perioperative and oncologic outcomes were compared between patients undergoing natural orifice (RPLS-NOSE) or conventional (mini-laparotomy) specimen extraction (RPLS-CSE). Patients were matched by propensity scores 1:1 for tumor diameter, AJCC stage, American Society of Anesthesiologists score and tumor location. RESULTS Of 119 eligible patients, 104 were matched (52 RPLS-NOSE; 52 RPLS-CSE) by propensity scores. Compared with RPLS-CSE, RPLS-NOSE was associated with longer operative time (223.9 vs. 188.7 min; p = 0.003), decreased use of analgesics (morphine dose 33.9 vs. 43.4 mg; p = 0.011) and duration of hospital stay (4.2 vs. 5.1 days; p = 0.001). No statistically significant difference was found in morbidity or wound-related complication rates between the two groups. After a median follow-up of 34.3 months, no local recurrence was observed in RPLS-NOSE. The 3-year disease-free survival did not differ statistically significantly between groups (90.9 vs. 90.5%; p = 0.610). CONCLUSION NOSE enhances the advantages of RPLS by avoiding the need for abdominal wall specimen extraction in patients with tumor diameter ≤ 5 cm. Surgical and oncologic safety are comparable to RPLS with CSE.
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Chang TC, Lin EK, Lu YJ, Huang MT, Chen CH. Single-incision robotic colectomy versus single-incision laparoscopic colectomy: A matched case control study. Asian J Surg 2021; 44:749-754. [PMID: 33468374 DOI: 10.1016/j.asjsur.2020.12.017] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2020] [Revised: 09/20/2020] [Accepted: 12/20/2020] [Indexed: 01/06/2023] Open
Abstract
BACKGROUND Single incision laparoscopic colectomy (SILC) and single incision robotic colectomy (SIRC) are both advanced minimally invasive operative techniques. However, studies comparing these two surgical methods have not been published. The purpose of this study is to compare and evaluate the short-term outcomes of SIRC with those of SILC. METHODS A total of 21 consecutive patients underwent SIRC and 136 consecutive patients underwent SILC in separate institutes between January 2013 and December 2019. We used retrospective cohort matching to analyze these patients. RESULTS Prior to matching, patients who underwent SIRC had a lower percentage of American Society of Anesthesiologists (ASA) grades III-IV (5% vs. 19%, P = 0.11) compared with patients who underwent SILC. The SIRC group revealed a higher proportion of sigmoid colon lesions and anterior resections than the SILC group (61% vs. 45%, P = 0.16). After 1:4 cohort matching, 21 patients were enrolled in the SIRC group and 84 patients were enrolled in the SILC group. No statistically significant difference in terms of operative time (SIRC: 185 ± 46 min, SILC: 208 ± 53 min; P = 0.51), estimated blood loss (SIRC: 12 ± 22 ml, SILC: 85 ± 234 ml; P = 0.12), and complications (SIRC: 4.7%, SIRC: 7.1%; P = 0.31) was observed between these groups. Length of postoperative hospital stay (SIRC: 8.3 ± 1.7 days, SILC: 9.3 ± 6.5; P = 0.10) and number of harvested lymph nodes (SIRC: 21.3 ± 10.3, SILC: 21.3 ± 9.5; P = 0.77) were also similar between the two groups. In subgroup analysis, numbers of harvested lymph node is less in SIRC than SILC (SIRC: 18.1 ± 4.7 vs. SILC: 18.9 ± 8.1, P = 0.04) in anterior resection. CONCLUSION SIRC and SILC are safe and feasible procedures with similar surgical and pathological outcomes for right- and left-side colectomy.
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Affiliation(s)
- Tung-Cheng Chang
- Division of Colorectal Surgery, Department of Surgery, Taipei Medical University Shuang-Ho Hospital, Number 291 Zhongzheng Road, Zhonghe District, Taipei, Taiwan; Department of Surgery, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan.
| | - En-Kwang Lin
- Division of Colorectal Surgery, Department of Surgery, WanFang Hospital, Taipei Medical University, No.111 Sec. 3 Xinglong Rd., Wenshan Dist., Taipei, Taiwan.
| | - Yen-Jung Lu
- Division of Colorectal Surgery, Department of Surgery, WanFang Hospital, Taipei Medical University, No.111 Sec. 3 Xinglong Rd., Wenshan Dist., Taipei, Taiwan.
| | - Ming-Te Huang
- Department of Surgery, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan; Division of General Surgery, Department of Surgery, Taipei Medical University Shuang-Ho Hospital, Number 291 Zhongzheng Road, Zhonghe District, Taipei, Taiwan.
| | - Chien-Hsin Chen
- Division of Colorectal Surgery, Department of Surgery, WanFang Hospital, Taipei Medical University, No.111 Sec. 3 Xinglong Rd., Wenshan Dist., Taipei, Taiwan.
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Ohya H, Watanabe J, Suwa Y, Suwa H, Ozawa M, Ishibe A, Fujii S, Kubota K, Kunisaki C, Endo I. The comparison of health-related quality of life and patient satisfaction between single-incision and multiport laparoscopic colectomy for cancer: A sub-study of a randomized, prospective clinical trial. Ann Gastroenterol Surg 2020; 4:684-692. [PMID: 33319159 PMCID: PMC7726688 DOI: 10.1002/ags3.12378] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2020] [Revised: 06/17/2020] [Accepted: 06/30/2020] [Indexed: 12/24/2022] Open
Abstract
AIM The present study clarified the effect on the health-related quality of life and patient satisfaction of single-incision laparoscopic colectomy compared with multiport laparoscopic colectomy for colorectal cancer. METHODS We conducted a multicenter, randomized, control trial comparing single-incision and multiport laparoscopic colectomy for colon cancer. We performed a pre-planned secondary analysis of health-related quality of life and patient satisfaction data of 200 patients. Health-related quality of life was evaluated using the Japanese 36-item Short Form Health Survey (SF-36) version 2.0 before surgery and at 1 month after surgery. Patient satisfaction was compared using seven questionnaires at 1 month after surgery. RESULTS One hundred patients were assigned to each group. After excluding 18 patients (9.0%) who did not complete the SF-36, 182 patients (91.0%) were included in the analysis (92 cases of single-incision laparoscopic colectomy and 90 cases of multiport laparoscopic colectomy). The SF-36 scores at 1 month after surgery were not significantly different between the two arms. The role physical, bodily pain, vitality and physical component summary were significantly lower at 1 month after surgery than before in both groups. However, the role emotional was significantly lower after surgery than before only in the single-incision laparoscopic colectomy group. In terms of patient satisfaction at 1 month after surgery, there were no significant differences in any of the seven items on the questionnaire. CONCLUSIONS Single-incision laparoscopic colectomy was similar to multiport laparoscopic colectomy in terms of health-related quality of life and patient satisfaction. However, single-incision laparoscopic colectomy may be inferior than multiport laparoscopic colectomy in terms of the role emotional.
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Affiliation(s)
- Hiroki Ohya
- Department of Gastroenterological SurgeryGraduate School of MedicineYokohama City UniversityYokohamaJapan
| | - Jun Watanabe
- Department of Gastroenterological SurgeryGraduate School of MedicineYokohama City UniversityYokohamaJapan
- Department of SurgeryGastroenterological CenterYokohama City University Medical CenterYokohamaJapan
| | - Yusuke Suwa
- Department of SurgeryGastroenterological CenterYokohama City University Medical CenterYokohamaJapan
| | - Hirokazu Suwa
- Department of SurgeryYokosuka Kyosai HospitalYokosukaJapan
| | - Mayumi Ozawa
- Department of Gastroenterological SurgeryGraduate School of MedicineYokohama City UniversityYokohamaJapan
| | - Atsushi Ishibe
- Department of Gastroenterological SurgeryGraduate School of MedicineYokohama City UniversityYokohamaJapan
| | - Shoichi Fujii
- Department of SurgeryGastroenterological CenterYokohama City University Medical CenterYokohamaJapan
| | - Kazumi Kubota
- Department of BiostatisticsYokohama City University School of MedicineYokohamaJapan
| | - Chikara Kunisaki
- Department of SurgeryGastroenterological CenterYokohama City University Medical CenterYokohamaJapan
| | - Itaru Endo
- Department of Gastroenterological SurgeryGraduate School of MedicineYokohama City UniversityYokohamaJapan
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Watanabe J, Ishibe A, Suwa Y, Suwa H, Ota M, Kubota K, Yamanaka T, Kunisaki C, Endo I. Hernia incidence following a randomized clinical trial of single-incision versus multi-port laparoscopic colectomy. Surg Endosc 2020; 35:2465-2472. [PMID: 32435960 DOI: 10.1007/s00464-020-07656-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2019] [Accepted: 05/15/2020] [Indexed: 01/07/2023]
Abstract
BACKGROUND The short-term results of single-incision laparoscopic colectomy (SILC) showed the safety, feasibility, and effectiveness when performed by skilled laparoscopic surgeons. However, the long-term complications, such as SILC-associated incisional hernia, have not been evaluated. The aim of this study was to determine the incidence of incisional hernia after SILC compared with multi-port laparoscopic colectomy (MPC) for colon cancer. METHODS From March 2012, to March 2015, a total of 200 patients were enrolled in this study. The patients were randomized to the MPC arm and SILC arm. A total of 200 patients (MPC arm; 100 patients, SILC arm; 100 patients) were therefore analyzed. In all cases the specimen was extracted through the umbilical port, which was extended according to the size of the specimen. A diagnosis of incisional hernia was made either based on a physical examination or computed tomography. RESULTS The baseline factors were well balanced between the arms. The median follow-up period was 42.4 (range 9.4-70.0) months. Twenty-one patients were diagnosed with incisional hernia, giving an incidence rate of 12.1% in the MPC arm and 9.0% in the SILC arm at 36 months (P = 0.451). In the multivariate analysis, the body mass index (≥ 25 kg/m2) (hazard ratio [HR] 3.03; 95% confidence interval [CI] 1.03-8.92; P = 0.044), umbilical incision (≥ 5.0 cm) (HR 3.22; 95% CI 1.16-8.93; P = 0.025), and history of umbilical hernia (HR 3.16; 95% CI 1.02-9.77; P = 0.045) were shown to be correlated with incisional hernia. CONCLUSIONS We found no significant difference in the incidence of incisional hernia after SILC arm versus MPC arm with a long-term follow-up. However, this result may be biased because all specimens were harvested through the umbilical port. The study was registered with the Japanese Clinical Trials Registry as UMIN000007220.
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Affiliation(s)
- Jun Watanabe
- Department of Gastroenterological Surgery, Yokohama City University Graduate School of Medicine, 3-9, Fukuura, Kanazawa-ku, Yokohama, 236-0004, Japan.
- Department of Surgery, Gastroenterological Center, Yokohama City University Medical Center, Yokohama, Japan.
| | - Atsushi Ishibe
- Department of Gastroenterological Surgery, Yokohama City University Graduate School of Medicine, 3-9, Fukuura, Kanazawa-ku, Yokohama, 236-0004, Japan
| | - Yusuke Suwa
- Department of Surgery, Gastroenterological Center, Yokohama City University Medical Center, Yokohama, Japan
| | - Hirokazu Suwa
- Department of Surgery, Yokosuka Kyosai Hospital, Yokosuka, Japan
| | - Mitsuyoshi Ota
- Department of Surgery, Gastroenterological Center, Yokohama City University Medical Center, Yokohama, Japan
| | - Kazumi Kubota
- Department of Biostatistics, Yokohama City University School of Medicine, Yokohama, Japan
| | - Takeharu Yamanaka
- Department of Biostatistics, Yokohama City University School of Medicine, Yokohama, Japan
| | - Chikara Kunisaki
- Department of Surgery, Gastroenterological Center, Yokohama City University Medical Center, Yokohama, Japan
| | - Itaru Endo
- Department of Gastroenterological Surgery, Yokohama City University Graduate School of Medicine, 3-9, Fukuura, Kanazawa-ku, Yokohama, 236-0004, Japan
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Ishimaru K, Tominaga T, Nonaka T, Hisanaga M, Fukuda A, Yoshimoto T, Takei D, Hidaka S, Sawai T, Nagayasu T. Single-incision laparoscopic total colectomy using an organ retractor: A case report. Ann Med Surg (Lond) 2020; 55:101-105. [PMID: 32477505 PMCID: PMC7248583 DOI: 10.1016/j.amsu.2020.04.032] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2020] [Revised: 04/22/2020] [Accepted: 04/27/2020] [Indexed: 02/07/2023] Open
Abstract
Introduction Single-incision laparoscopic surgery (SILS) has benefits, including less postoperative pain, a shorter incision, and improved cosmesis. However, SILS is technically difficult because of the limited movement. An organ retractor is an instrument that has the potential to overcome these limitations. Presentation of case An 85-year-old woman with hematochezia was referred to our hospital. Emergency endoscopy showed diverticulosis of the entire colon and active bleeding from the ascending colon. Despite endoscopic clipping, the bleeding continued. SILS total colectomy using an organ retractor was performed due to uncontrollable diverticular bleeding. A 3-cm incision was placed in the umbilicus, and three conventional ports were inserted into the single umbilical incision. An organ retractor was used for hepatocolic ligament transection, transection of the ileocolic vessels, and transection of the mesentery of the sigmoid colon. For each transection, the tension was adjusted to provide a good operative view. The patient's postoperative course was uneventful. Conclusion An organ retractor was effective for SILS total colectomy to maintain an adequate operative view, which enabled safe dissection.
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Affiliation(s)
- Kazuhide Ishimaru
- Departments of Surgical Oncology, Nagasaki University Graduate School of Biomedical Sciences, 1-7-1 Sakamoto, Nagasaki, 852-8501, Japan
| | - Tetsuro Tominaga
- Departments of Surgical Oncology, Nagasaki University Graduate School of Biomedical Sciences, 1-7-1 Sakamoto, Nagasaki, 852-8501, Japan
| | - Takashi Nonaka
- Departments of Surgical Oncology, Nagasaki University Graduate School of Biomedical Sciences, 1-7-1 Sakamoto, Nagasaki, 852-8501, Japan
| | - Makoto Hisanaga
- Departments of Surgical Oncology, Nagasaki University Graduate School of Biomedical Sciences, 1-7-1 Sakamoto, Nagasaki, 852-8501, Japan
| | - Akiko Fukuda
- Departments of Surgical Oncology, Nagasaki University Graduate School of Biomedical Sciences, 1-7-1 Sakamoto, Nagasaki, 852-8501, Japan
| | - Takafumi Yoshimoto
- Departments of Surgical Oncology, Nagasaki University Graduate School of Biomedical Sciences, 1-7-1 Sakamoto, Nagasaki, 852-8501, Japan
| | - Daiki Takei
- Departments of Surgical Oncology, Nagasaki University Graduate School of Biomedical Sciences, 1-7-1 Sakamoto, Nagasaki, 852-8501, Japan
| | - Shigekazu Hidaka
- Departments of Surgical Oncology, Nagasaki University Graduate School of Biomedical Sciences, 1-7-1 Sakamoto, Nagasaki, 852-8501, Japan
| | - Terumitsu Sawai
- Cardiopulmonary Rehabilitation Science, Nagasaki University Graduate School of Biomedical Sciences, 1-7-1 Sakamoto, Nagasaki, 852-8501, Japan
| | - Takeshi Nagayasu
- Departments of Surgical Oncology, Nagasaki University Graduate School of Biomedical Sciences, 1-7-1 Sakamoto, Nagasaki, 852-8501, Japan
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Puckett Y, Mitchell D, Pham T. Laparoscopic colectomies associated with decreased retrieval of 12 or more lymph nodes compared to open in elective colon cancer surgery. Ecancermedicalscience 2020; 13:968. [PMID: 31921339 PMCID: PMC6834383 DOI: 10.3332/ecancer.2019.968] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2019] [Indexed: 12/21/2022] Open
Abstract
Background Colorectal cancer is the third most commonly diagnosed cancer worldwide. Lymph node (LN) retrieval is a key factor for pathologic staging and prognosis of colorectal cancer. Increase in number of LNs removal suggests improvement in tumour clearance and decrease in metastatic spread. Studies have suggested that excising 12 or more LNs during colectomy in patients with colon cancer is associated with improved survival. To date, there have been no studies to determine whether minimally invasive surgery affects the ability to retrieve 12+ LNs in elective colon cancer surgery. Therefore, we elected to determine whether a difference exists on the ability to retrieve 12+ nodes in elective colon cancer colectomies performed open versus laparoscopic. Methods The National Surgical Quality Improvement Program (NSQIP) Procedure Specific Colectomy database was analysed for the year 2014–2015. Inclusion criteria were colon cancer (ICD-9 Code 153.9), age greater than 18 years. Exclusion criteria were missing data. Data abstracted included patient demographics, type of operation performed and number of LNs retrieved. The patients were categorised based on their elective colon cancer colectomies such as laparoscopic or open. Binary logistic regression was used to identify confounding variables in the retrieval of 12+ LNs. Results After accounting for missing cases, a total of 18,792 patients with a diagnosis of colon cancer were analysed. Twelve or more LNs were retrieved in 88% (16,538) of patients, Among them, 2,516 patients underwent laparoscopic colectomy and 5,284 patients underwent open colectomy. The difference was not statistically significant for the average number of LNs retrieved among both the groups. Open operative approach compared to the laparoscopic approach was associated with 15% greater odds of retrieval of >12 LNs (OR 1.148; 95% CI (1.035–1.272); p = 0.008). Conclusion The majority of colectomies such as open or laparoscopic are able to retrieve 12 or more LNs. However, there are greater odds of retrieving more than 12 LNs with the open approach compared to the laparoscopic approach. By allowing for more LN retrieval, open colectomies suggest improvement in tumour clearance and decrease metastatic spread. Additional research is needed to further investigate the specific factors influencing the ability to retrieve an adequate number of LNs, such as viewing angles provided with an open approach versus laparoscopic approach.
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Affiliation(s)
- Yana Puckett
- Department of General Surgery, Texas Tech University Health Sciences Center, Lubboc, TX 79430, USA
| | - Diana Mitchell
- Department of General Surgery, Texas Tech University Health Sciences Center, Lubboc, TX 79430, USA
| | - Theophilus Pham
- Department of General Surgery, Texas Tech University Health Sciences Center, Lubboc, TX 79430, USA
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Athanasiou C, Pitt J, Malik A, Crabtree M, Markides GA. A Systematic Review and Meta-Analysis of Single-Incision Versus Multiport Laparoscopic Complete Mesocolic Excision Colectomy for Colon Cancer. Surg Innov 2019; 27:235-243. [PMID: 31854262 DOI: 10.1177/1553350619893232] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Background. Our aim was to compare the emerging technique of single-incision laparoscopic surgery complete mesocolic excision (SILS CME) colectomy with the standard multiport laparoscopic CME (MPL CME) colectomy. Methods. MEDLINE (PubMed), Scopus, EMBASE, Ovid, and the Cochrane library were searched. Studies comparing the SILS CME with MPL CME in adults with colon adenocarcinoma were included. The Jadad and Newcastle Ottawa Scales were used to critically appraise the studies. The presence of statistical heterogeneity or publication bias was examined. Results. Seven studies (3 randomized) with a total number of 1344 patients were included (546 SILS CME and 798 MPL CME). No difference was found in anastomotic leakage (odds ratio [OR] = 0.79 [0.31 to 2.03]; P = .63), number of lymph nodes (weighted mean difference [WMD] = 0.85 [-0.97 to 2.66]; P = .36), hospital stay (WMD = 0.01 [-0.19 to 0.20]; P = .96), overall survival (hazard ratio [HR] = 1.19 [0.29 to 4.80]; P = .81), and disease-free survival (HR = 1.30 [0.30 to 5.61]; P = .72). Skin incision was shorter in SILS CME group (WMD = -3.02 [-3.25 to -2.80]; P < .00001) but with no difference in pain reported in postoperative day 1 (standardized mean difference [SMD] = -0.21 [-0.50 to 0.09]; P = .17) or day 2 (SMD = 0.16 [-0.52 to 0.84]; P = .64). Conclusions. SILS CME, although technically more demanding, has equivalent short- and long-term outcomes when compared with MPL CME. Potential benefits in cosmesis or postoperative pain need to be further explored by high-quality randomized controlled trials.
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Affiliation(s)
- Christos Athanasiou
- Ipswich Hospital, East Suffolk and North Essex NHS Foundation Trust, Ipswich, UK
| | - James Pitt
- Ipswich Hospital, East Suffolk and North Essex NHS Foundation Trust, Ipswich, UK
| | - Arshad Malik
- Ipswich Hospital, East Suffolk and North Essex NHS Foundation Trust, Ipswich, UK
| | - Michael Crabtree
- Ipswich Hospital, East Suffolk and North Essex NHS Foundation Trust, Ipswich, UK
| | - Georgios A Markides
- Royal Blackburn Teaching Hospital, East Lancashire Teaching Hospitals, Blackburn, UK
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Ezzedine W, Frontali A, Panis Y. Controversies and future of minimally invasive surgery for inflammatory bowel disease. Cir Esp 2019; 98:503-506. [PMID: 31679740 DOI: 10.1016/j.ciresp.2019.07.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2019] [Accepted: 07/21/2019] [Indexed: 11/29/2022]
Affiliation(s)
- Walid Ezzedine
- Departamento de Cirugía Colorrectal, Pôle des Maladies de l'Appareil Digestif (PMAD), Hôpital Beaujon, Assistance Publique des Hôpitaux de Paris (APHP), Université Paris VII (Denis Diderot), Clichy, Francia
| | - Alice Frontali
- Departamento de Cirugía Colorrectal, Pôle des Maladies de l'Appareil Digestif (PMAD), Hôpital Beaujon, Assistance Publique des Hôpitaux de Paris (APHP), Université Paris VII (Denis Diderot), Clichy, Francia
| | - Yves Panis
- Departamento de Cirugía Colorrectal, Pôle des Maladies de l'Appareil Digestif (PMAD), Hôpital Beaujon, Assistance Publique des Hôpitaux de Paris (APHP), Université Paris VII (Denis Diderot), Clichy, Francia.
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Single-incision Laparoscopy Versus Multiport Laparoscopy for Colonic Surgery: A Multicenter, Double-blinded, Randomized Controlled Trial. Ann Surg 2019; 268:740-746. [PMID: 30303873 DOI: 10.1097/sla.0000000000002836] [Citation(s) in RCA: 42] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
OBJECTIVE To compare outcome of single-port laparoscopy (SPL) and multiport laparoscopy (MPL) laparoscopy for colonic surgery. SUMMARY OF BACKGROUND DATA Benefits of SPL over MPL are yet to be demonstrated in large randomized trials. METHODS In this prospective, double-blinded, superiority trial, patients undergoing laparoscopic colonic resection for benign or malignant disease were randomly assigned to SPL or MPL (NCT01959087). Primary outcome was length of theoretical hospital stay (LHS). RESULTS One hundred twenty-eight patients were randomized and 125 analyzed: 62 SPL and 63 MPL, including 91 right (SPL: n = 44, 71%; MPL: n = 47, 75%) and 34 left (SPL: n = 18, 29%; MPL: n = 16, 25%) colectomies, performed for Crohn disease (n = 53, 42%), cancer (n = 36, 29%), diverticulitis (n = 21, 17%), or benign neoplasia (n = 15, 12%). Additional port insertion was required in 5 (8%) SPL patients and conversion to laparotomy occurred in 7 patients (SPL: n = 3, 5%; MPL: n = 4, 7%; P = 1.000). Total length of skin incision was significantly shorter in the SPL group [SPL: 56 ± 41 (range, 30-300) mm; MPL: 87 ± 40 (50-250) mm; P < 0.001]. Procedure duration, intraoperative complication rate, postoperative 30-day morbidity, postoperative pain, and time to first bowel movement were similar between the groups, leading to similar theoretical LHS (SPL: 6 ± 3 days; MPL: 6 ± 2; P = 0.298). At 6 months, quality of life was similar between groups, but patients from the SPL group were significantly more satisfied with their scar aspect than patients from the MPL group (P = 0.003). CONCLUSION SPL colectomy does not confer any additional benefit other than cosmetic result, as compared to MPL.
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Famiglietti F, Wolthuis AM, De Coster J, Vanbrabant K, D'Hoore A, de Buck van Overstraeten A. Impact of single-incision laparoscopic surgery on postoperative analgesia requirements after total colectomy for ulcerative colitis: a propensity-matched comparison with multiport laparoscopy. Colorectal Dis 2019; 21:953-960. [PMID: 31058400 DOI: 10.1111/codi.14668] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2018] [Accepted: 03/16/2019] [Indexed: 12/17/2022]
Abstract
AIM To compare the requirements for postoperative analgesia in patients with ulcerative colitis after single-incision versus multiport laparoscopic total colectomy. METHOD All patients undergoing single-incision or multiport laparoscopic total colectomy as a first stage in the surgical treatment of ulcerative colitis between 2010 and 2016 at the University Hospital of Leuven were included. The cumulative dose of postoperative patient-controlled analgesia was used as the primary end-point. A Z-transformation was performed combining values for patient-controlled epidural analgesia and patient-controlled intravenous analgesia, resulting in one hybrid outcome variable. The two groups were matched using propensity scores. Subgroup analysis was performed to analyse the impact of extraction site on postoperative pain. RESULTS A total of 81 patients underwent total colectomy for ulcerative colitis (median age 35 years). Thirty patients underwent single-incision laparoscopy, while 51 patients had a multiport approach. The mean normalized patient-controlled analgesia dose was significantly lower in patients undergoing single-incision laparoscopy (-0.33 vs 0.46, P < 0.001). This difference was no longer significant in subgroup analysis for patients with stoma site specimen extraction (P = 0.131). The odds of receiving tramadol postoperatively was 3.66 times lower after single-incision laparoscopy (P = 0.008). The overall morbidity rate was 32.1% (26/81). The mean Comprehensive Complication Index in single-incision and multiport laparoscopy group was 18.33 and 21.39, respectively (P = 0.506). Hospital stay was significantly shorter after single-incision laparoscopic surgery (6.3 days vs 7.6 days, P = 0.032). CONCLUSION Single-incision total colectomy was associated with lower postoperative analgesia requirements and shorter hospital stay, with comparable morbidity. However, the specimen extraction site played a significant role in postoperative pain control.
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Affiliation(s)
- F Famiglietti
- Department of Abdominal Surgery, University Hospital Leuven, KU Leuven, Leuven, Belgium
| | - A M Wolthuis
- Department of Abdominal Surgery, University Hospital Leuven, KU Leuven, Leuven, Belgium
| | - J De Coster
- Department of Anesthesiology, University Hospital Leuven, KU Leuven, Leuven, Belgium
| | - K Vanbrabant
- Interuniversity Institute for Biostatistics and Statistical Bioinformatics, KU Leuven and University of Hasselt, University Hospital Leuven, KU Leuven, Leuven, Belgium
| | - A D'Hoore
- Department of Abdominal Surgery, University Hospital Leuven, KU Leuven, Leuven, Belgium
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Hirano Y, Shimada M, Kato K, Hiranuma C, Douden K, Hattori M, Taniguchi K. Single-Incision Laparoscopic Colectomy for Descending Colon Cancer: a Single Institutional Experience. Indian J Surg 2019. [DOI: 10.1007/s12262-018-1818-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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Morales-Conde S, Peeters A, Meyer YM, Antoniou SA, Del Agua IA, Arezzo A, Arolfo S, Yehuda AB, Boni L, Cassinotti E, Dapri G, Yang T, Fransen S, Forgione A, Hajibandeh S, Hajibandeh S, Mazzola M, Migliore M, Mittermair C, Mittermair D, Morandeira-Rivas A, Moreno-Sanz C, Morlacchi A, Nizri E, Nuijts M, Raakow J, Sánchez-Margallo FM, Sánchez-Margallo JA, Szold A, Weiss H, Weiss M, Zorron R, Bouvy ND. European association for endoscopic surgery (EAES) consensus statement on single-incision endoscopic surgery. Surg Endosc 2019; 33:996-1019. [PMID: 30771069 PMCID: PMC6430755 DOI: 10.1007/s00464-019-06693-2] [Citation(s) in RCA: 38] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2019] [Accepted: 02/06/2019] [Indexed: 12/14/2022]
Abstract
BACKGROUND Laparoscopic surgery changed the management of numerous surgical conditions. It was associated with many advantages over open surgery, such as decreased postoperative pain, faster recovery, shorter hospital stay and excellent cosmesis. Since two decades single-incision endoscopic surgery (SIES) was introduced to the surgical community. SIES could possibly result in even better postoperative outcomes than multi-port laparoscopic surgery, especially concerning cosmetic outcomes and pain. However, the single-incision surgical procedure is associated with quite some challenges. METHODS An expert panel of surgeons has been selected and invited to participate in the preparation of the material for a consensus meeting on the topic SIES, which was held during the EAES congress in Frankfurt, June 16, 2017. The material presented during the consensus meeting was based on evidence identified through a systematic search of literature according to a pre-specified protocol. Three main topics with respect to SIES have been identified by the panel: (1) General, (2) Organ specific, (3) New development. Within each of these topics, subcategories have been defined. Evidence was graded according to the Oxford 2011 Levels of Evidence. Recommendations were made according to the GRADE criteria. RESULTS In general, there is a lack of high level evidence and a lack of long-term follow-up in the field of single-incision endoscopic surgery. In selected patients, the single-incision approach seems to be safe and effective in terms of perioperative morbidity. Satisfaction with cosmesis has been established to be the main advantage of the single-incision approach. Less pain after single-incision approach compared to conventional laparoscopy seems to be considered an advantage, although it has not been consistently demonstrated across studies. CONCLUSIONS Considering the increased direct costs (devices, instruments and operating time) of the SIES procedure and the prolonged learning curve, wider acceptance of the procedure should be supported only after demonstration of clear benefits.
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Affiliation(s)
- Salvador Morales-Conde
- Unit of Innovation in Minimally Invasive Sugery, Department of General and Digestive Surgery, University Hospital "Virgen del Rocio", Sevilla, Spain
| | - Andrea Peeters
- Department of Clinical Epidemiology and Medical Technology Assessment, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Yannick M Meyer
- Department of Surgery, Maastricht University Medical Center, Maastricht, The Netherlands.
| | - Stavros A Antoniou
- Colorectal Department, Royal Devon & Exeter NHS Foundation Trust, Exeter, UK
| | - Isaías Alarcón Del Agua
- Unit of Innovation in Minimally Invasive Sugery, Department of General and Digestive Surgery, University Hospital "Virgen del Rocio", Sevilla, Spain
| | - Alberto Arezzo
- Department of Surgical Sciences, University of Torino, Torino, Italy
| | - Simone Arolfo
- Department of Surgical Sciences, University of Torino, Torino, Italy
| | - Amir Ben Yehuda
- Surgery division, Assaf Harofe medical center, Zeriffin, Israel
| | - Luigi Boni
- Department of Surgery, Fondazione IRCCS Ca' Granda - Ospedale Maggiore Policlinico, University of Milan, Milan, Italy
| | - Elisa Cassinotti
- Department of Surgery, Fondazione IRCCS Ca' Granda - Ospedale Maggiore Policlinico, University of Milan, Milan, Italy
| | | | - Tao Yang
- Unit of Innovation in Minimally Invasive Sugery, Department of General and Digestive Surgery, University Hospital "Virgen del Rocio", Sevilla, Spain
| | - Sofie Fransen
- Department of Surgery, Laurentius Ziekenhuis Roermond, Roermond, The Netherlands
| | | | | | - Shahin Hajibandeh
- Department of General Surgery, Stepping Hill Hospital, Stockport, UK
| | | | - Marco Migliore
- Department of Surgical Sciences, University of Torino, Torino, Italy
| | | | | | - Antonio Morandeira-Rivas
- Department of Surgery, "La Mancha Centro" General Hospital, Alcázar de San Juan, Ciudad Real, Spain
| | - Carlos Moreno-Sanz
- Department of Surgery, "La Mancha Centro" General Hospital, Alcázar de San Juan, Ciudad Real, Spain
| | | | - Eran Nizri
- Surgery division, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - Myrthe Nuijts
- Department of Surgery, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Jonas Raakow
- Center for Innovative Surgery- ZIC, Charité - Universitätsmedizin, Chirurgische Klinik, Campus Charité Mitte/ Campus Virchow-Klinikum, Berlin, Germany
| | | | | | | | - Helmut Weiss
- SJOG Hospital - PMU Teaching Hospital, Salzburg, Austria
| | - Michael Weiss
- SJOG Hospital - PMU Teaching Hospital, Salzburg, Austria
| | - Ricardo Zorron
- Department of Surgery, University of Insubria, Varese, Italy
| | - Nicole D Bouvy
- Department of Surgery, Maastricht University Medical Center, Maastricht, The Netherlands
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Hirano Y, Hiranuma C, Hattori M, Douden K, Yamaguchi S. Long-term oncological outcomes of single-port laparoscopic surgery for colon cancer. ANZ J Surg 2019; 89:408-411. [PMID: 30873699 DOI: 10.1111/ans.15076] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2018] [Revised: 12/25/2018] [Accepted: 12/27/2018] [Indexed: 12/14/2022]
Abstract
BACKGROUND We retrospectively reviewed our consecutive experience from the introduction of single-port laparoscopic surgery (SPS) for colon cancer, and its 5-year oncological outcomes are evaluated. METHODS A total of 288 patients (140 males) with a mean age of 71.5 years were treated with the single-port laparoscopic colectomy for stage I, II and III colon cancers. Exclusion criteria of SPS were patients with unresolved bowel obstruction, T4b tumour, tumour perforation and severe medical illness. RESULTS In 20 patients (6.9%), we inserted an extra port mainly to transect the rectum. The median follow-up period was 52 months. The 5-year relapse-free survival rates in stage I, II and III patients were 95.8%, 80.2% and 61.6%, respectively. The 5-year overall survival rates for stage I, II and III patients were 97.4%, 85.3% and 72.9%, respectively. The 5-year cancer-specific survival rates in patients diagnosed pathologically T1, T2, T3 and T4 were 100%, 100%, 92.1% and 73.9%, respectively. CONCLUSIONS SPS colectomy can be applied to the treatment of colon cancer with good long-term oncological outcomes. However, we should pay more attention when we treat the pathologically diagnosed T4 tumours.
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Affiliation(s)
- Yasumitsu Hirano
- Department of Gastroenterological Surgery, Saitama Medical University International Medical Center, Hidaka, Japan
| | | | | | - Kenji Douden
- Department of Surgery, Fukui Prefectural Hospital, Fukui, Japan
| | - Shigeki Yamaguchi
- Department of Gastroenterological Surgery, Saitama Medical University International Medical Center, Hidaka, Japan
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Abstract
BACKGROUND Laparoscopy is a common procedure in many surgical specialties. Complications arising from laparoscopy are often related to initial entry into the abdomen. Life-threatening complications include injury to viscera (e.g. bowel, bladder) or to vasculature (e.g. major abdominal and anterior abdominal wall vessels). No clear consensus has been reached as to the optimal method of laparoscopic entry into the peritoneal cavity. OBJECTIVES To evaluate the benefits and risks of different laparoscopic entry techniques in gynaecological and non-gynaecological surgery. SEARCH METHODS We searched the Cochrane Gynaecology and Fertility (CGF) Group trials register, CENTRAL, MEDLINE, Embase, PsycINFO, and trials registers in January 2018. We also checked the references of articles retrieved. SELECTION CRITERIA We included randomised controlled trials (RCTs) that compared one laparoscopic entry technique versus another. Primary outcomes were major complications including mortality, vascular injury of major vessels and abdominal wall vessels, visceral injury of bladder or bowel, gas embolism, solid organ injury, and failed entry (inability to access the peritoneal cavity). Secondary outcomes were extraperitoneal insufflation, trocar site bleeding, trocar site infection, incisional hernia, omentum injury, and uterine bleeding. DATA COLLECTION AND ANALYSIS Two review authors independently selected studies, assessed risk of bias, and extracted data. We expressed findings as Peto odds ratios (Peto ORs) with 95% confidence intervals (CIs). We assessed statistical heterogeneity using the I² statistic. We assessed the overall quality of evidence for the main comparisons using GRADE methods. MAIN RESULTS The review included 57 RCTs including four multi-arm trials, with a total of 9865 participants, and evaluated 25 different laparoscopic entry techniques. Most studies selected low-risk patients, and many studies excluded patients with high body mass index (BMI) and previous abdominal surgery. Researchers did not find evidence of differences in major vascular or visceral complications, as would be anticipated given that event rates were very low and sample sizes were far too small to identify plausible differences in rare but serious adverse events.Open-entry versus closed-entryTen RCTs investigating Veress needle entry reported vascular injury as an outcome. There was a total of 1086 participants and 10 events of vascular injury were reported. Four RCTs looking at open entry technique reported vascular injury as an outcome. There was a total of 376 participants and 0 events of vascular injury were reported. This was not a direct comparison. In the direct comparison of Veress needle and Open-entry technique, there was insufficient evidence to determine whether there was a difference in rates of vascular injury (Peto OR 0.14, 95% CI 0.00 to 6.82; 4 RCTs; n = 915; I² = N/A, very low-quality evidence). Evidence was insufficient to show whether there were differences between groups for visceral injury (Peto OR 0.61, 95% CI 0.06 to 6.08; 4 RCTs; n = 915: I² = 0%; very low-quality evidence), or failed entry (Peto OR 0.45, 95% CI 0.14 to 1.42; 3 RCTs; n = 865; I² = 63%; very low-quality evidence). Two studies reported mortality with no events in either group. No studies reported gas embolism or solid organ injury.Direct trocar versus Veress needle entryTrial results show a reduction in failed entry into the abdomen with the use of a direct trocar in comparison with Veress needle entry (OR 0.24, 95% CI 0.17 to 0.34; 8 RCTs; N = 3185; I² = 45%; moderate-quality evidence). Evidence was insufficient to show whether there were differences between groups in rates of vascular injury (Peto OR 0.59, 95% CI 0.18 to 1.96; 6 RCTs; n = 1603; I² = 75%; very low-quality evidence), visceral injury (Peto OR 2.02, 95% CI 0.21 to 19.42; 5 RCTs; n = 1519; I² = 25%; very low-quality evidence), or solid organ injury (Peto OR 0.58, 95% Cl 0.06 to 5.65; 3 RCTs; n = 1079; I² = 61%; very low-quality evidence). Four studies reported mortality with no events in either group. Two studies reported gas embolism, with no events in either group.Direct vision entry versus Veress needle entryEvidence was insufficient to show whether there were differences between groups in rates of vascular injury (Peto OR 0.39, 95% CI 0.05 to 2.85; 1 RCT; n = 186; very low-quality evidence) or visceral injury (Peto OR 0.15, 95% CI 0.01 to 2.34; 2 RCTs; n = 380; I² = N/A; very low-quality evidence). Trials did not report our other primary outcomes.Direct vision entry versus open entryEvidence was insufficient to show whether there were differences between groups in rates of visceral injury (Peto OR 0.13, 95% CI 0.00 to 6.50; 2 RCTs; n = 392; I² = N/A; very low-quality evidence), solid organ injury (Peto OR 6.16, 95% CI 0.12 to 316.67; 1 RCT; n = 60; very low-quality evidence), or failed entry (Peto OR 0.40, 95% CI 0.04 to 4.09; 1 RCT; n = 60; very low-quality evidence). Two studies reported vascular injury with no events in either arm. Trials did not report our other primary outcomes.Radially expanding (STEP) trocars versus non-expanding trocarsEvidence was insufficient to show whether there were differences between groups in rates of vascular injury (Peto OR 0.24, 95% Cl 0.05 to 1.21; 2 RCTs; n = 331; I² = 0%; very low-quality evidence), visceral injury (Peto OR 0.13, 95% CI 0.00 to 6.37; 2 RCTs; n = 331; very low-quality evidence), or solid organ injury (Peto OR 1.05, 95% CI 0.07 to 16.91; 1 RCT; n = 244; very low-quality evidence). Trials did not report our other primary outcomes.Other studies compared a wide variety of other laparoscopic entry techniques, but all evidence was of very low quality and evidence was insufficient to support the use of one technique over another. AUTHORS' CONCLUSIONS Overall, evidence was insufficient to support the use of one laparoscopic entry technique over another. Researchers noted an advantage of direct trocar entry over Veress needle entry for failed entry. Most evidence was of very low quality; the main limitations were imprecision (due to small sample sizes and very low event rates) and risk of bias associated with poor reporting of study methods.
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Affiliation(s)
- Gaity Ahmad
- Pennine Acute Hospitals NHS TrustDepartment of Obstetrics and GynaecologyManchesterUK
| | - Jade Baker
- Pennine Acute Hospitals NHS TrustDepartment of Obstetrics and GynaecologyManchesterUK
| | | | - Kevin Phillips
- Castle Hill HospitalObstetrics and GynaecologyCastle RoadCottinghamNorth HumbersideUKHU16 5JQ
| | - Andrew Watson
- Tameside & Glossop Acute Services NHS TrustDepartment of Obstetrics and GynaecologyFountain StreetAshton‐Under‐LyneLancashireUKOL6 9RW
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Yamamoto M, Asakuma M, Tanaka K, Masubuchi S, Ishii M, Osumi W, Hamamoto H, Okuda J, Uchiyama K. Clinical impact of single-incision laparoscopic right hemicolectomy with intracorporeal resection for advanced colon cancer: propensity score matching analysis. Surg Endosc 2019; 33:3616-3622. [PMID: 30643984 DOI: 10.1007/s00464-018-06647-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2018] [Accepted: 12/21/2018] [Indexed: 02/08/2023]
Abstract
BACKGROUND Laparoscopic right hemicolectomy has become an acceptable treatment for right-sided colon cancer. Most centers use multiport laparoscopic right hemicolectomy extracorporeally (MRHE), whereas single-incision laparoscopic right hemicolectomy intracorporeally (SRHI) remains controversial. The aim of this study was to compare these two techniques using propensity score matching analysis. METHODS We analyzed the data from 111 patients who underwent laparoscopic right hemicolectomy between December 2015 and December 2016. The propensity score was calculated according to age, gender, body mass index, the American Society of Anesthesiologists score, previous abdominal surgery, and D3 lymph node dissection. Postoperative pain was evaluated using a visual analogue scale (VAS) and postoperative analgesic use was an outcome measure. RESULTS The length of skin incision in SRHI was significantly shorter than in MRHE [3 (3.5-6) versus 4 (3-6) cm, respectively; P = 0.007]. The VAS score on day 1 and day 2 after surgery was significantly less in SRHI than in MRHE [30 (10-50) versus 50 (20-69) on day 1, P = 0.037; 10 (0-50) versus 30 (0-70) on day 2, P = 0.029]. Significantly fewer patients required analgesia after SRHI on day 1 and day 2 after surgery [1 (0-3) versus 2 (0-4) on day 1, P = 0.024; 1 (0-2) versus 1 (0-4) on day 2, P = 0.035]. There were no significant differences in operative time, intraoperative blood loss, number of lymph nodes removed, and postoperative course between groups. CONCLUSIONS SRHI appears to be safe and technically feasible. Moreover, SRHI reduces the length of the skin incision and postoperative pain compared with MRHE.
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Affiliation(s)
- Masashi Yamamoto
- Departments of General and Gastroenterological Surgery, Osaka Medical College, 2-7 Daigakumachi, Takatsuki, Osaka, 569-8686, Japan
| | - Mitsuhiro Asakuma
- Departments of General and Gastroenterological Surgery, Osaka Medical College, 2-7 Daigakumachi, Takatsuki, Osaka, 569-8686, Japan
| | - Keitaro Tanaka
- Departments of General and Gastroenterological Surgery, Osaka Medical College, 2-7 Daigakumachi, Takatsuki, Osaka, 569-8686, Japan
| | - Shinsuke Masubuchi
- Departments of General and Gastroenterological Surgery, Osaka Medical College, 2-7 Daigakumachi, Takatsuki, Osaka, 569-8686, Japan
| | - Masatsugu Ishii
- Departments of General and Gastroenterological Surgery, Osaka Medical College, 2-7 Daigakumachi, Takatsuki, Osaka, 569-8686, Japan
| | - Wataru Osumi
- Departments of General and Gastroenterological Surgery, Osaka Medical College, 2-7 Daigakumachi, Takatsuki, Osaka, 569-8686, Japan
| | - Hiroki Hamamoto
- Departments of General and Gastroenterological Surgery, Osaka Medical College, 2-7 Daigakumachi, Takatsuki, Osaka, 569-8686, Japan
| | - Junji Okuda
- Departments of General and Gastroenterological Surgery, Osaka Medical College, 2-7 Daigakumachi, Takatsuki, Osaka, 569-8686, Japan
| | - Kazuhisa Uchiyama
- Departments of General and Gastroenterological Surgery, Osaka Medical College, 2-7 Daigakumachi, Takatsuki, Osaka, 569-8686, Japan.
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Ohmura Y, Suzuki H, Kotani K, Teramoto A. Comparative effectiveness of human scope assistant versus robotic scope holder in laparoscopic resection for colorectal cancer. Surg Endosc 2018; 33:2206-2216. [PMID: 30334160 DOI: 10.1007/s00464-018-6506-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2018] [Accepted: 10/11/2018] [Indexed: 12/23/2022]
Abstract
BACKGROUND Several types of robotic scope holders have been developed to date, but there are only some experimental reports or the results of small clinical cases. The Soloassist® system is a unique robotic scope holder with which the surgeon can control the field of view by a joystick. We evaluated the efficacy of Soloassist in laparoscopic resection for colorectal cancer. MATERIALS AND METHODS We investigated operative time, blood loss, setup time, length of hospital stay, and the number of participating surgeons in 273 laparoscopic colorectal resections, including 130 cases with human assistant (HA group) and 143 cases with Soloassist (SA group). Additionally, we also used logistic regression of the perioperative factors for the propensity score calculation to balance the bias. RESULTS The number of participating surgeons was apparently less in the SA group (HA group: 3.3 vs. SA group: 2.5, p < 0.01). The average operative time was shorter in the SA group, but there was no statistical difference (HA group: 287.0 min vs. SA group: 268.5 min, p = 0.07). No significant difference was found in setup time, conversion rate, perioperative complications, and length of hospital stay. There was no conversion case to human scope assistant and no system-specific adverse event. Similar results were observed between two groups after propensity score matching. CONCLUSION Laparoscopic colorectal resection with Soloassist is safe and feasible. The present study demonstrated that Soloassist system provided the possibilities of saving human resources in laparoscopic colorectal resection without prolonged operative time or system-specific morbidity. Soloassist is an effective robot-assisted surgical instrument for colorectal surgery.
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Affiliation(s)
- Yasushi Ohmura
- Department of Cancer Treatment Support Center, Okayama City Hospital, 1-20-3 Kitanagase-omotemachi, Kita-ku, Okayama, Okayama, 700-8557, Japan. .,Department of Surgery, Okayama City Hospital, 1-20-3 Kitanagase-omotemachi, Kita-ku, Okayama, Okayama, 700-8557, Japan.
| | - Hiromitsu Suzuki
- Department of Surgery, Yakage Hospital, 2695 Yakage, Yakage-chou, Oda, Okayama, 714-1201, Japan
| | - Kazutoshi Kotani
- Department of Surgery, Kasaoka Daiichi Hospital, 1945 Yokoshima, Kasaoka, Okayama, 714-0043, Japan
| | - Atsushi Teramoto
- Department of Surgery, Okayama City Hospital, 1-20-3 Kitanagase-omotemachi, Kita-ku, Okayama, Okayama, 700-8557, Japan
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Clinical and oncologic outcomes of single-incision laparoscopic surgery for right colon cancer: a propensity score matching analysis. Surg Endosc 2018; 33:1117-1123. [PMID: 30043168 DOI: 10.1007/s00464-018-6370-2] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2018] [Accepted: 07/20/2018] [Indexed: 01/28/2023]
Abstract
BACKGROUND Single-incision laparoscopic surgery (SILS) for right colon cancer is going to be considered as a new option. The potential benefits, clinical, and oncologic outcomes are still controversial. The aim of this study was to investigate clinical and oncologic outcomes of single-incision laparoscopic surgery (SILS) compared to conventional laparoscopic surgery (CLS) for right colon cancer using propensity score matching analysis. METHODS From December 2013 to June 2017, 174 patients underwent laparoscopic radical right hemicolectomy through a single-incision (n = 32) or a conventional (n = 142) approach. The data were prospectively collected and the patients were matched at a radio of 1:1 according to age, sex, body mass index (BMI), previous abdominal surgeries, comorbidities, ASA score (≤ 2/> 2), and pathologic stage. RESULTS No significant differences were observed in estimated blood loss, time to diet, postoperative pain score, length of hospital stay between the SILS and CLS groups. However, the SILS group showed longer operation time (175 (40) vs 145 (52.5), p = 0.011) and shorter incision length (4 (1.4) vs 7 (1.9), p < 0.001). There were 2 (6.3%) postoperative complications in the SILS group and 5 (15.6%) in the CLS group (p = 0.426). The pathologic outcomes were similar between two groups. The median follow-up period was 26.5 months in the SILS group and 34.9 months in the CLS group (p = 0.002). There were 3 recurrences (9.4%) in the SILS group and 3 (9.4%) in the CLS group. The 3-year disease-free survival rates were 92.4 and 93.8% (p = 0.984), and overall survival rates were 92.3 and 93.0% (p = 0.884) in the SILS and the CLS groups, respectively. No incisional hernia was observed during the follow-up period. CONCLUSIONS Though single-incision laparoscopic surgery for right colon cancer showed longer operation time in this study, it appears to be a safe and feasible option with comparable clinical and oncologic outcomes to conventional laparoscopic surgery.
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Wang Y, Deng H, Mou T, Li J, Liu H, Zhou H, Li G. Short-term outcomes of single-incision plus one-port laparoscopic versus conventional laparoscopic surgery for rectosigmoid cancer: a randomized controlled trial. Surg Endosc 2018; 33:840-848. [PMID: 30006846 DOI: 10.1007/s00464-018-6350-6] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2018] [Accepted: 07/06/2018] [Indexed: 12/22/2022]
Abstract
OBJECTIVE The objective of the study is to evaluate the short-term outcomes of single-incision plus one-port surgery (SILS + 1) compared with conventional laparoscopic surgery (CLS) for colonic cancer. BACKGROUND At present, single-incision laparoscopic colectomy remains technically challenging. The use of SILS + 1 as an alternative has gained increasing attention; however, its safety and efficacy remain controversial. METHODS AND PATIENTS Between April 2014 and July 2016, 198 patients with clinical stage T1-4aN0-2 M0 rectosigmoid cancer were enrolled. The participants were randomly assigned to either SILS + 1 (n = 99) or CLS (n = 99). The morbidity and mortality within 30 days, operative and pathologic outcomes, postoperative recovery course, inflammation and immune responses, and pain intensity were compared. RESULTS There was no significant difference in overall complications between the two groups (17.2 vs. 16.3%, P = 1.000). The total operating time for the SILS + 1 group was significantly shorter (100.8 ± 30.4 vs. 116.6 ± 36.6, P = 0.002). Blood loss was significantly greater in the CLS group (20 vs. 50, P < 0.001). Thirteen patients (14%) in the CLS group required additional postoperative analgesics, which was significantly more than four patients in the SILS + 1 group. Notably, on postoperative day three, the visual analogue scale score of the CLS group was greater than that of the SILS + 1 group (1.3 ± 1.1 vs. 1.7 ± 1.3, P = 0.023). Tumor diameter, pathologic stage, length of the proximal and distal margins, and number of lymph nodes harvested were similar, other values were also similar between the two groups. CONCLUSION Our findings suggest that SILS + 1 might be safe and feasible for rectosigmoid cancer when performed by experienced surgeons. It offers minimal invasiveness without compromising oncologic treatment principles. Trial Registration This trial was registered on ClinicalTrials.gov (NCT02117557).
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Affiliation(s)
- Yanan Wang
- Department of General Surgery, Nanfang Hospital, Southern Medical University, 1838 North Guangzhou Avenue, Guangzhou, 510-515, China
| | - Haijun Deng
- Department of General Surgery, Nanfang Hospital, Southern Medical University, 1838 North Guangzhou Avenue, Guangzhou, 510-515, China
| | - Tingyu Mou
- Department of General Surgery, Nanfang Hospital, Southern Medical University, 1838 North Guangzhou Avenue, Guangzhou, 510-515, China
| | - Junmeng Li
- Department of General Surgery, Nanfang Hospital, Southern Medical University, 1838 North Guangzhou Avenue, Guangzhou, 510-515, China
| | - Hao Liu
- Department of General Surgery, Nanfang Hospital, Southern Medical University, 1838 North Guangzhou Avenue, Guangzhou, 510-515, China
| | - Haipeng Zhou
- Department of General Surgery, Nanfang Hospital, Southern Medical University, 1838 North Guangzhou Avenue, Guangzhou, 510-515, China
| | - Guoxin Li
- Department of General Surgery, Nanfang Hospital, Southern Medical University, 1838 North Guangzhou Avenue, Guangzhou, 510-515, China.
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