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Sibia US, Klune JR, Saiolghalam S, Bilchik A. Early Experiences With Bundled Payments for Care Improvement for Major Bowel Surgery. Am Surg 2024:31348241241618. [PMID: 38523411 DOI: 10.1177/00031348241241618] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/26/2024]
Abstract
BACKGROUND Bundled Payment (BP) models are becoming more common in surgery. We share our early experiences with Bundled Payments for Care Improvement for major bowel surgery. METHODS Patients undergoing major bowel surgery between January and October 2021 were identified using Medicare Severity-Diagnosis Related Group (MS-DRG) codes. Major drivers of cost in a BP model are reported and compared to the Fee-For-Service (FFS) payment model. RESULTS A total of 202 cases (173 FFS vs 29 BP) were analyzed. The mean BP cost per Clinical Episode was $28,340. Eleven patients (38%) in the BP model had costs greater than the Target Price. The drivers of cost in the BP model were 59% acute care facility, 17% physician services, 9% post-acute care facilities, 8% other, and 7% readmissions. Clinical Episode of care costs varied considerably by MS-DRG case complexity. Robotic surgery increased costs by 35% (mean increase $3724, P < .01). The 90-day readmission rate was 17% for a mean cost of $11,332 per readmission. Three patients (10%) were discharged to a skilled nursing facility at an average cost of $11,009, while fifteen patients (52%) received home health services at a mean cost of $2947. Acute care facility costs were similar in the BP vs FFS groups (mean difference $1333, P = .22). CONCLUSIONS Patients undergoing major bowel surgery are a heterogeneous population. Physicians are ideally positioned to deliver high-value, patient-centered care and are crucial to the success of a BP model. The post-acute care setting is a key component of improving efficiency and quality of care.
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Affiliation(s)
- Udai S Sibia
- Providence Health System, Saint John's Cancer Institute, Santa Monica, CA, USA
| | - John R Klune
- Department of Surgery, Anne Arundel Medical Center, Luminis Health, Annapolis, MD, USA
| | - Said Saiolghalam
- Business Intelligence Analytics, Providence Health System, Renton, WA, USA
| | - Anton Bilchik
- Providence Health System, Saint John's Cancer Institute, Santa Monica, CA, USA
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Rodriguez-Silva JA, Doyle W, Alden A, Poonja S, Martinez C, Chudzinski A, Marcet J, Bennett RD. Laparoscopic vs. robotic colectomy for left-sided diverticulitis. J Robot Surg 2023; 17:2823-2830. [PMID: 37743399 DOI: 10.1007/s11701-023-01719-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2023] [Accepted: 09/06/2023] [Indexed: 09/26/2023]
Abstract
Diverticulitis is a prevalent gastrointestinal disease that often warrants surgical intervention. However, the optimal approach between traditional laparoscopy (LC) and robotic-assisted laparoscopy (RAC) for diverticulitis remains unclear. Our research compares these techniques in patients diagnosed with left-sided diverticulitis treated at a single, tertiary referral center from 2019 to 2022. Among the 134 patients, 86 underwent laparoscopic and 48 robotic-assisted surgeries. The surgeries included in this analysis are left colectomy, sigmoid colectomy, low anterior resection, and Hartmann's procedure. Primary outcomes were major morbidity and 30-day mortality. Secondary outcomes were operative time, conversion to open, length of stay, unplanned return to the operating room, 30-day readmission rate, and overall morbidity. While demographics and comorbidities were similar for both groups, the robotic-assisted group displayed a statistically significant longer operative time (198.0 ± 84.4 LC vs. 264.8 ± 78.5 min RAC, p < 0.001). When investigated further, there was a significant difference in operative time for uncomplicated diverticulitis cases favoring the LC approach (169.17 ± 58.1 LC vs. 244.82 ± 58.79 min RAC, p < 0.001). This significant difference, however, was not present in complicated diverticulitis cases. Other factors, such as overall and major morbidity, rate of conversion to open approach, ostomy creation, estimated blood loss, time to return of bowel function, length of stay, and 30-day readmission rate, did not significantly differ between the groups. There was no 30-day mortality in either group. Favorable patient outcomes, lack of significant difference in operative time compared with traditional laparoscopy, and absence of differences in morbidities or efficacy, raises an interesting question in the world of minimally invasive surgery: is the robotic-assisted approach emerging as the advantageous approach for complicated diverticulitis cases? We encourage additional, multi-center analysis of specifically complicated diverticulitis managed with both surgical approaches to investigate if these findings are replicated outside of our institution.
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Affiliation(s)
- Jetsen A Rodriguez-Silva
- Division of Colon and Rectal Surgery, Department of Surgery, University of South Florida Morsani College of Medicine/Tampa General Hospital, 5 Tampa General Circle, Suite 740, Tampa, FL, 33606, USA
| | - William Doyle
- University of South Florida Morsani College of Medicine, Tampa, FL, USA
| | - Ashley Alden
- Department of Surgery, University of South Florida Morsani College of Medicine, Tampa, FL, USA
| | - Sharan Poonja
- University of South Florida Morsani College of Medicine, Tampa, FL, USA
| | - Carolina Martinez
- Division of Colon and Rectal Surgery, Department of Surgery, University of South Florida Morsani College of Medicine/Tampa General Hospital, 5 Tampa General Circle, Suite 740, Tampa, FL, 33606, USA
| | - Allen Chudzinski
- Division of Colon and Rectal Surgery, Department of Surgery, University of South Florida Morsani College of Medicine/Tampa General Hospital, 5 Tampa General Circle, Suite 740, Tampa, FL, 33606, USA
| | - Jorge Marcet
- Division of Colon and Rectal Surgery, Department of Surgery, University of South Florida Morsani College of Medicine/Tampa General Hospital, 5 Tampa General Circle, Suite 740, Tampa, FL, 33606, USA
| | - Robert D Bennett
- Division of Colon and Rectal Surgery, Department of Surgery, University of South Florida Morsani College of Medicine/Tampa General Hospital, 5 Tampa General Circle, Suite 740, Tampa, FL, 33606, USA.
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Cooper LE, Morant L, Anderson M, Bedra M, Boutros CN. Analysis of 10 years of open, laparoscopic, and robotic rectal surgeries in the community setting. Surg Open Sci 2023; 16:165-170. [PMID: 38026827 PMCID: PMC10656262 DOI: 10.1016/j.sopen.2023.10.011] [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: 07/15/2023] [Revised: 10/10/2023] [Accepted: 10/24/2023] [Indexed: 12/01/2023] Open
Abstract
Background Colorectal cancer is the fourth most common cancer in the US. Many of these patients will require operations. Although there is significant data in the literature that supports minimally invasive colorectal operations in the academic setting, few studies have examined their performance in community hospitals. Methods Data was collected from a high-volume, university-affiliated, community center. Our Cancer Registry Database was queried to include any patients that had rectal surgery at our institution from 2010 to 2020. One hundred-twenty-two patients were identified and reviewed retrospectively. Main outcome measures include estimated blood loss (EBL), blood transfusion, time to first bowel movement, oncologic resection, length of stay (LOS), survival, and cost analysis. Results Both robotic and laparoscopic operations resulted in lower average EBL, less blood transfusions, and less time to first bowel movement (p = 0.003, 0.006, 0.003, respectively). There was no significant difference in ability to achieve R0 resection, adequate lymph node retrieval, and adequate total mesorectal excision (TME, p = 0.856, 0.489, 0.500, respectively). LOS was significantly shorter for minimally invasive operations, 4.35 vs 8.48 days, and average survival was longest for laparoscopic operations at 7.19 years as compared to 5.55 years for open operations (p < 0.001, 0.026, respectively). Cost was lowest for robotic operations (0.003). Conclusions Minimally invasive rectal operations, especially robotic, lead to better short- and long-term outcomes, equivalent oncologic resection, and are more cost-effective as compared to open operations even in the community setting, supporting continued performance and growth of robotic colorectal operations in the community setting. Key message Although there is significant data in the literature that supports minimally invasive colorectal operations in the academic setting, few studies have examined their performance in community hospitals as this study does. This study found that minimally invasive rectal operations, especially robotic, lead to better short- and long-term outcomes, equivalent oncologic resection, and are more cost-effective as compared to open operations even in the community setting, supporting continued performance and growth of robotic colorectal operations in the community setting.
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Affiliation(s)
- Laura E. Cooper
- Department of Surgery, University of Maryland Medical Center, 22 S. Greene Street, Baltimore, MD 21201, United States of America
| | - Lena Morant
- Department of Surgery, University of Maryland Baltimore Washington Medical Center, 305 Hospital Drive, Tate Center, Suite 304, Glen Burnie, MD 21061, United States of America
| | - Maribeth Anderson
- Department of Surgery, University of Maryland Baltimore Washington Medical Center, 305 Hospital Drive, Tate Center, Suite 304, Glen Burnie, MD 21061, United States of America
| | - McKenzie Bedra
- Department of Surgery, University of Maryland Baltimore Washington Medical Center, 305 Hospital Drive, Tate Center, Suite 304, Glen Burnie, MD 21061, United States of America
| | - Cherif N. Boutros
- Department of Surgery, University of Maryland Medical Center, 22 S. Greene Street, Baltimore, MD 21201, United States of America
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Zheng H, Wang Q, Fu T, Wei Z, Ye J, Huang B, Li C, Liu B, Zhang A, Li F, Gao F, Tong W. Robotic versus laparoscopic left colectomy with complete mesocolic excision for left-sided colon cancer: a multicentre study with propensity score matching analysis. Tech Coloproctol 2023:10.1007/s10151-023-02788-0. [PMID: 37014449 DOI: 10.1007/s10151-023-02788-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2023] [Accepted: 03/14/2023] [Indexed: 04/05/2023]
Abstract
PURPOSE Robotic surgery for right-sided colon and rectal cancer has rapidly increased; however, there is limited evidence in the literature of advantages of robotic left colectomy (RLC) for left-sided colon cancer. The purpose of this study was to compare the outcomes of RLC versus laparoscopic left colectomy (LLC) with complete mesocolic excision (CME) for left-sided colon cancer. METHODS Patients who had RLC or LLC with CME for left-sided colon cancer at five hospitals in China between January 2014 and April 2022 were included. A one-to-one propensity score matched analysis was performed to decrease confounding. The primary outcome was postoperative complications occurring within 30 days of surgery. Secondary outcomes were disease-free survival, overall survival and the number of harvested lymph nodes. RESULTS A total of 292 patients (187 male; median age 61.0 [20.0-85.0] years) were eligible for this study, and propensity score matching yielded 102 patients in each group. The clinicopathological characteristics were well-matched between groups. The two groups did not differ in estimated blood loss, conversion to open rate, time to first flatus, reoperation rate, or postoperative length of hospital stay (p > 0.05). RLC was associated with a longer operation time (192.9 ± 53.2 vs. 168.9 ± 52.8 min, p = 0.001). The incidence of postoperative complications did not differ between the RLC and LLC groups (18.6% vs. 17.6%, p = 0.856). The total number of lymph nodes harvested in the RLC group was higher than that in the LLC group (15.7 ± 8.3 vs. 12.1 ± 5.9, p < 0.001). There were no significant differences in 3-year and 5-year overall survival or 3-year and 5-year disease-free survival. CONCLUSION Compared to laparoscopic surgery, RLC with CME for left-sided colon cancer was found to be associated with higher numbers of lymph nodes harvested and similar postoperative complications and long-term survival outcomes.
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Affiliation(s)
- Huichao Zheng
- Gastric and Colorectal Surgery Division, Department of General Surgery, Army Medical Center (Daping Hospital), Army Medical University, Chongqing, China
| | - Quan Wang
- Department of Gastrocolorectal Surgery, The First Hospital of Jilin University, Changchun, China
| | - Tao Fu
- Department of Gastrointestinal Surgery II, Renmin Hospital of Wuhan University, Wuhan, China
| | - Zhengqiang Wei
- Department of Gastrointestinal Surgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Jingwang Ye
- Department of Gastrointestinal Surgery, The People's Hospital of Shapingba District, Chongqing, China
| | - Bin Huang
- Gastric and Colorectal Surgery Division, Department of General Surgery, Army Medical Center (Daping Hospital), Army Medical University, Chongqing, China
| | - Chunxue Li
- Gastric and Colorectal Surgery Division, Department of General Surgery, Army Medical Center (Daping Hospital), Army Medical University, Chongqing, China
| | - Baohua Liu
- Gastric and Colorectal Surgery Division, Department of General Surgery, Army Medical Center (Daping Hospital), Army Medical University, Chongqing, China
| | - Anping Zhang
- Gastric and Colorectal Surgery Division, Department of General Surgery, Army Medical Center (Daping Hospital), Army Medical University, Chongqing, China
| | - Fan Li
- Gastric and Colorectal Surgery Division, Department of General Surgery, Army Medical Center (Daping Hospital), Army Medical University, Chongqing, China.
| | - Feng Gao
- Department of Colorectal Surgery, 940th Hospital of Joint Logistics Support Force of PLA, Lanzhou, China.
| | - Weidong Tong
- Gastric and Colorectal Surgery Division, Department of General Surgery, Army Medical Center (Daping Hospital), Army Medical University, Chongqing, China.
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5
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Zheng H, Wang Q, Fu T, Wei Z, Ye J, Huang B, Li C, Liu B, Zhang A, Li F, Gao F, Tong W. Robotic versus laparoscopic left colectomy with complete mesocolic excision for left-sided colon cancer: a multicentre study with propensity score matching analysis. Tech Coloproctol 2023:10.1007/s10151-023-02781-7. [PMID: 36964884 DOI: 10.1007/s10151-023-02781-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2023] [Accepted: 02/28/2023] [Indexed: 03/26/2023]
Abstract
BACKGROUND Robotic surgery for right-sided colon and rectal cancer has rapidly increased; however, there is limited evidence in the literature of advantages of robotic left colectomy (RLC) for left-sided colon cancer. The purpose of this study was to compare the outcomes of RLC versus laparoscopic left colectomy (LLC) with complete mesocolic excision (CME) for left-sided colon cancer. METHODS Patients who had RLC or LLC with CME for left-sided colon cancer at 5 hospitals in China between January 2014 and April 2022 were included. A one-to-one propensity score matched analysis was performed to decrease confounding. The primary outcome was postoperative complications occurring within 30 days of surgery. Secondary outcomes were disease-free survival, overall survival and the number of harvested lymph nodes. RESULTS A total of 292 patients (187 males; median age 61.0 [20.0-85.0] years) were eligible for this study, and propensity score matching yielded 102 patients in each group. The clinical-pathological characteristics were well-matched between groups. The two groups did not differ in estimated blood loss, conversion to open rate, time to first flatus, reoperation rate, or postoperative length of hospital stay (p > 0.05). RLC was associated with a longer operation time (192.9 ± 53.2 vs. 168.9 ± 52.8 minutes, p=0.001). The incidence of postoperative complications did not differ between the RLC and LLC groups (18.6% vs. 17.6%, p = 0.856). The total number of lymph nodes harvested in the RLC group was higher than that in the LLC group (15.7 ± 8.3 vs. 12.1 ± 5.9, p< 0.001). There were no significant differences in 3-year and 5-year overall survival or 3-year and 5-year disease-free survival. CONCLUSIONS Compared to laparoscopic surgery, RLC with CME for left-sided colon cancer was found to be associated with higher numbers of lymph nodes harvested and similar postoperative complications and long-term survival outcomes.
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Affiliation(s)
- H Zheng
- Gastric and Colorectal Surgery Division, Department of General Surgery, Army Medical Center (Daping Hospital), Army Medical University, No. 10, Changjiang Branch Road, Daping, Yuzhong District, Chongqing, China
| | - Q Wang
- Department of Gastrocolorectal Surgery, The First Hospital of Jilin University, Changchun, China
| | - T Fu
- Department of Gastrointestinal Surgery II, Renmin Hospital of Wuhan University, Wuhan, China
| | - Z Wei
- Department of Gastrointestinal Surgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - J Ye
- Department of Gastrointestinal Surgery, The People's Hospital of Shapingba District, Chongqing, China
| | - B Huang
- Gastric and Colorectal Surgery Division, Department of General Surgery, Army Medical Center (Daping Hospital), Army Medical University, No. 10, Changjiang Branch Road, Daping, Yuzhong District, Chongqing, China
| | - C Li
- Gastric and Colorectal Surgery Division, Department of General Surgery, Army Medical Center (Daping Hospital), Army Medical University, No. 10, Changjiang Branch Road, Daping, Yuzhong District, Chongqing, China
| | - B Liu
- Gastric and Colorectal Surgery Division, Department of General Surgery, Army Medical Center (Daping Hospital), Army Medical University, No. 10, Changjiang Branch Road, Daping, Yuzhong District, Chongqing, China
| | - A Zhang
- Gastric and Colorectal Surgery Division, Department of General Surgery, Army Medical Center (Daping Hospital), Army Medical University, No. 10, Changjiang Branch Road, Daping, Yuzhong District, Chongqing, China
| | - F Li
- Gastric and Colorectal Surgery Division, Department of General Surgery, Army Medical Center (Daping Hospital), Army Medical University, No. 10, Changjiang Branch Road, Daping, Yuzhong District, Chongqing, China.
| | - F Gao
- Department of Colorectal Surgery, 940th Hospital of Joint Logistics Support force of PLA, Lanzhou, China.
| | - W Tong
- Gastric and Colorectal Surgery Division, Department of General Surgery, Army Medical Center (Daping Hospital), Army Medical University, No. 10, Changjiang Branch Road, Daping, Yuzhong District, Chongqing, China.
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6
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Ngu JCY, Shannon NB, Eu EW, Lee LS, Tan SS, Lim SKT, Ng FC, Chiow AKH. Technical insights to multivisceral resections using the da Vinci Xi. ANZ J Surg 2023; 93:166-172. [PMID: 36129451 DOI: 10.1111/ans.18064] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2022] [Revised: 09/05/2022] [Accepted: 09/11/2022] [Indexed: 11/30/2022]
Abstract
BACKGROUND There have been few reports on the feasibility and safety of robotic multivisceral surgeries. The da Vinci Xi boasts significant upgrades that improve its applicability in combined resections. We report our early experience of multivisceral, multi-quadrant resections with the Xi system. METHODS Between May 2015 and August 2019, 13 multivisceral resections were performed. Patient demographics, procedural data, and perioperative outcomes were evaluated. RESULTS The procedures were completed at a median operative time of 290 (range, 210-535) minutes. The median postoperative length of hospital stay was 3.5 (range, 2-7) days. There was one case of readmission for anastomotic leak, but no positioning injuries, external robot arm collisions or issues arising from trocar position. There were no cases of perioperative mortality. CONCLUSION Multivisceral resections can be safely accomplished using the Xi. Further studies are necessary to ascertain whether there are benefits of the robotic approach over conventional laparoscopy in these complex cases.
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Affiliation(s)
| | | | | | - Lip Seng Lee
- Department of General Surgery, Changi General Hospital, Singapore
| | - Siong San Tan
- Department of General Surgery, Changi General Hospital, Singapore
| | | | - Foo Cheong Ng
- Department of Urology, Changi General Hospital, Singapore
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7
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Giesen LJX, Dekker JWT, Verseveld M, Crolla RMPH, van der Schelling GP, Verhoef C, Olthof PB. Implementation of robotic rectal cancer surgery: a cross-sectional nationwide study. Surg Endosc 2023; 37:912-920. [PMID: 36042043 PMCID: PMC9945537 DOI: 10.1007/s00464-022-09568-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2022] [Accepted: 08/14/2022] [Indexed: 11/30/2022]
Abstract
AIM An increasing number of centers have implemented a robotic surgical program for rectal cancer. Several randomized controls trials have shown similar oncological and postoperative outcomes compared to standard laparoscopic resections. While introducing a robot rectal resection program seems safe, there are no data regarding implementation on a nationwide scale. Since 2018 robot resections are separately registered in the mandatory Dutch Colorectal Audit. The present study aims to evaluate the trend in the implementation of robotic resections (RR) for rectal cancer relative to laparoscopic rectal resections (LRR) in the Netherlands between 2018 and 2020 and to compare the differences in outcomes between the operative approaches. METHODS Patients with rectal cancer who underwent surgical resection between 2018 and 2020 were selected from the Dutch Colorectal Audit. The data included patient characteristics, disease characteristics, surgical procedure details, postoperative outcomes. The outcomes included any complication within 90 days after surgery; data were categorized according to surgical approach. RESULTS Between 2018 and 2020, 6330 patients were included in the analyses. 1146 patients underwent a RR (18%), 3312 patients a LRR (51%), 526 (8%) an open rectal resection, 641 a TaTME (10%), and 705 had a local resection (11%). The proportion of males and distal tumors was higher in the RR compared to the LRR. Over time, the proportion of robotic procedures increased from 15% (95% confidence intervals (CI) 13-16%) in 2018 to 22% (95% CI 20-24%) in 2020. Conversion rate was lower in the robotic group [4% (95% CI 3-5%) versus 7% (95% CI 6-8%)]. Anastomotic leakage rate was similar with 16%. Defunctioning ileostomies were more common in the RR group [42% (95% CI 38-46%) versus 29% (95% CI 26-31%)]. CONCLUSION Rectal resections are increasingly being performed through a robot-assisted approach in the Netherlands. The proportion of males and low rectal cancers was higher in RR compared to LRR. Overall outcomes were comparable, while conversion rate was lower in RR, the proportion of defunctioning ileostomies was higher compared to LRR.
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Affiliation(s)
- L J X Giesen
- Department of Surgery, Erasmus MC Cancer Institute, Rotterdam, The Netherlands.
- Department of Surgery, Franciscus Gasthuis & Vlietland, Rotterdam, The Netherlands.
| | - J W T Dekker
- Department of Surgery, Reinier de Graaf Gasthuis, Delft, The Netherlands
| | - M Verseveld
- Department of Surgery, Erasmus MC Cancer Institute, Rotterdam, The Netherlands
- Department of Surgery, Franciscus Gasthuis & Vlietland, Rotterdam, The Netherlands
| | - R M P H Crolla
- Department of Surgery, Amphia Hospital, Breda, The Netherlands
| | | | - C Verhoef
- Department of Surgery, Erasmus MC Cancer Institute, Rotterdam, The Netherlands
| | - P B Olthof
- Department of Surgery, Erasmus MC Cancer Institute, Rotterdam, The Netherlands
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Soliman SS, Flanagan J, Wang YH, Stopper PB, Rolandelli RH, Nemeth ZH. Comparison of Robotic and Laparoscopic Colectomies Using the 2019 ACS NSQIP Database. South Med J 2022; 115:887-892. [DOI: 10.14423/smj.0000000000001479] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/29/2023]
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9
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Davidoff AJ, Akif K, Halpern MT. Research on the Economics of Cancer-Related Health Care: An Overview of the Review Literature. J Natl Cancer Inst Monogr 2022; 2022:12-20. [PMID: 35788372 DOI: 10.1093/jncimonographs/lgac011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2021] [Accepted: 03/21/2022] [Indexed: 01/16/2023] Open
Abstract
We reviewed current literature reviews regarding economics of cancer-related health care to identify focus areas and gaps. We searched PubMed for systematic and other reviews with the Medical Subject Headings "neoplasms" and "economics" published between January 1, 2010, and April 1, 2020, identifying 164 reviews. Review characteristics were abstracted and described. The majority (70.7%) of reviews focused on cost-effectiveness or cost-utility analyses. Few reviews addressed other types of cancer health economic studies. More than two-thirds of the reviews examined cancer treatments, followed by screening (15.9%) and survivorship or end-of-life (13.4%). The plurality of reviews (28.7%) cut across cancer site, followed by breast (20.7%), colorectal (11.6%), and gynecologic (8.5%) cancers. Specific topics addressed cancer screening modalities, novel therapies, pain management, or exercise interventions during survivorship. The results indicate that reviews do not regularly cover other phases of care or topics including financial hardship, policy, and measurement and methods.
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Affiliation(s)
- Amy J Davidoff
- Healthcare Assessment Research Branch, Healthcare Delivery Research Program, Division of Cancer Control and Population Sciences, National Cancer Institute, Rockville, MD, USA
| | - Kaitlin Akif
- Office of the Associate Director, Surveillance Research Program, Division of Cancer Control and Population Sciences, National Cancer Institute, Rockville, MD, USA
| | - Michael T Halpern
- Healthcare Assessment Research Branch, Healthcare Delivery Research Program, Division of Cancer Control and Population Sciences, National Cancer Institute, Rockville, MD, USA
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Tschann P, Szeverinski P, Weigl MP, Rauch S, Lechner D, Adler S, Girotti PNC, Clemens P, Tschann V, Presl J, Schredl P, Mittermair C, Jäger T, Emmanuel K, Königsrainer I. Short- and Long-Term Outcome of Laparoscopic- versus Robotic-Assisted Right Colectomy: A Systematic Review and Meta-Analysis. J Clin Med 2022; 11:jcm11092387. [PMID: 35566512 PMCID: PMC9103048 DOI: 10.3390/jcm11092387] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2022] [Revised: 04/15/2022] [Accepted: 04/21/2022] [Indexed: 12/17/2022] Open
Abstract
Background: There is a rapidly growing literature available on right hemicolectomy comparing the short- and long-term outcomes of robotic right colectomy (RRC) to that of laparoscopic right colectomy (LRC). The aim of this meta-analysis is to revise current comparative literature systematically. Methods: A systematic review of comparative studies published between 2000 to 2021 in PubMed, Scopus and Embase was performed. The primary endpoint was postoperative morbidity, mortality and long-term oncological results. Secondary endpoints consist of blood loss, conversion rates, complications, time to first flatus, hospital stay and incisional hernia rate. Results: 25 of 322 studies were considered for data extraction. A total of 16,099 individual patients who underwent RRC (n = 1842) or LRC (n = 14,257) between 2002 and 2020 were identified. Operative time was significantly shorter in the LRC group (LRC 165.31 min ± 43.08 vs. RRC 207.38 min ± 189.13, MD: −42.01 (95% CI: −51.06−32.96), p < 0.001). Blood loss was significantly lower in the RRC group (LRC 63.57 ± 35.21 vs. RRC 53.62 ± 34.02, MD: 10.03 (95% CI: 1.61−18.45), p = 0.02) as well as conversion rate (LRC 1155/11,629 vs. RRC 94/1534, OR: 1.65 (1.28−2.13), p < 0.001) and hospital stay (LRC 6.15 ± 31.77 vs. RRC 5.31 ± 1.65, MD: 0.84 (95% CI: 0.29−1.38), p = 0.003). Oncological long-term results did not differ between both groups. Conclusion: The advantages of robotic colorectal procedures were clearly demonstrated. RRC can be regarded as safe and feasible. Most of the included studies were retrospective with a limited level of evidence. Further randomized trials would be suitable.
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Affiliation(s)
- Peter Tschann
- Department of General and Thoracic Surgery, Academic Teaching Hospital Feldkirch, 6800 Feldkirch, Austria; (M.P.W.); (S.R.); (D.L.); (S.A.); (P.N.C.G.); (I.K.)
- Correspondence: ; Tel.: +43-(0)-5522-303-2400; Fax: +43-(0)-5522-303-7505
| | - Philipp Szeverinski
- Institute of Medical Physics, Academic Teaching Hospital Feldkirch, 6800 Feldkirch, Austria;
- Private University in the Principality of Liechtenstein, 9495 Triesen, Liechtenstein
| | - Markus P. Weigl
- Department of General and Thoracic Surgery, Academic Teaching Hospital Feldkirch, 6800 Feldkirch, Austria; (M.P.W.); (S.R.); (D.L.); (S.A.); (P.N.C.G.); (I.K.)
| | - Stephanie Rauch
- Department of General and Thoracic Surgery, Academic Teaching Hospital Feldkirch, 6800 Feldkirch, Austria; (M.P.W.); (S.R.); (D.L.); (S.A.); (P.N.C.G.); (I.K.)
| | - Daniel Lechner
- Department of General and Thoracic Surgery, Academic Teaching Hospital Feldkirch, 6800 Feldkirch, Austria; (M.P.W.); (S.R.); (D.L.); (S.A.); (P.N.C.G.); (I.K.)
| | - Stephanie Adler
- Department of General and Thoracic Surgery, Academic Teaching Hospital Feldkirch, 6800 Feldkirch, Austria; (M.P.W.); (S.R.); (D.L.); (S.A.); (P.N.C.G.); (I.K.)
| | - Paolo N. C. Girotti
- Department of General and Thoracic Surgery, Academic Teaching Hospital Feldkirch, 6800 Feldkirch, Austria; (M.P.W.); (S.R.); (D.L.); (S.A.); (P.N.C.G.); (I.K.)
| | - Patrick Clemens
- Department of Radio-Oncology, Academic Teaching Hospital Feldkirch, 6800 Feldkirch, Austria;
| | - Veronika Tschann
- Department of Internal Medicine II, Academic Teaching Hospital Feldkirch, 6800 Feldkirch, Austria;
| | - Jaroslav Presl
- Department of Surgery, Paracelsus Medical University, 5020 Salzburg, Austria; (J.P.); (P.S.); (T.J.); (K.E.)
| | - Philipp Schredl
- Department of Surgery, Paracelsus Medical University, 5020 Salzburg, Austria; (J.P.); (P.S.); (T.J.); (K.E.)
| | - Christof Mittermair
- Department of Surgery, St. John of God Hospital, Teaching Hospital of Paracelsus Medical University, 5020 Salzburg, Austria;
| | - Tarkan Jäger
- Department of Surgery, Paracelsus Medical University, 5020 Salzburg, Austria; (J.P.); (P.S.); (T.J.); (K.E.)
| | - Klaus Emmanuel
- Department of Surgery, Paracelsus Medical University, 5020 Salzburg, Austria; (J.P.); (P.S.); (T.J.); (K.E.)
| | - Ingmar Königsrainer
- Department of General and Thoracic Surgery, Academic Teaching Hospital Feldkirch, 6800 Feldkirch, Austria; (M.P.W.); (S.R.); (D.L.); (S.A.); (P.N.C.G.); (I.K.)
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11
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Solaini L, Bocchino A, Avanzolini A, Annunziata D, Cavaliere D, Ercolani G. Robotic versus laparoscopic left colectomy: a systematic review and meta-analysis. Int J Colorectal Dis 2022; 37:1497-1507. [PMID: 35650261 PMCID: PMC9262793 DOI: 10.1007/s00384-022-04194-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/25/2022] [Indexed: 02/04/2023]
Abstract
BACKGROUND This study aimed to review the new evidence to understand whether the robotic approach could find some clear indication also in left colectomy. METHODS A systematic review of studies published from 2004 to 2022 in the Web of Science, PubMed, and Scopus databases and comparing laparoscopic (LLC) and robotic left colectomy (RLC) was performed. All comparative studies evaluating robotic left colectomy (RLC) versus laparoscopic (LLC) left colectomy with at least 20 patients in the robotic arm were included. Abstract, editorials, and reviews were excluded. The Newcastle-Ottawa Scale for cohort studies was used to assess the methodological quality. The random-effect model was used to calculate pooled effect estimates. RESULTS Among the 139 articles identified, 11 were eligible, with a total of 52,589 patients (RLC, n = 13,506 versus LLC, n = 39,083). The rate of conversion to open surgery was lower for robotic procedures (RR 0.5, 0.5-0.6; p < 0.001). Operative time was longer for the robotic procedures in the pooled analysis (WMD 39.1, 17.3-60.9, p = 0.002). Overall complications (RR 0.9, 0.8-0.9, p < 0.001), anastomotic leaks (RR 0.7, 0.7-0.8; p < 0.001), and superficial wound infection (RR 3.1, 2.8-3.4; p < 0.001) were less common after RLC. There were no significant differences in mortality (RR 1.1; 0.8-1.6, p = 0.124). There were no differences between RLC and LLC with regards to postoperative variables in the subgroup analysis on malignancies. CONCLUSIONS Robotic left colectomy requires less conversion to open surgery than the standard laparoscopic approach. Postoperative morbidity rates seemed to be lower during RLC, but this was not confirmed in the procedures performed for malignancies.
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Affiliation(s)
- Leonardo Solaini
- grid.6292.f0000 0004 1757 1758Department of Medical and Surgical Sciences (DIMEC), University of Bologna, Bologna, Italy ,grid.415079.e0000 0004 1759 989XGeneral and Oncologic Surgery, Morgagni-Pierantoni Hospital, Ausl Romagna, Forlì, Italy
| | - Antonio Bocchino
- grid.6292.f0000 0004 1757 1758Department of Medical and Surgical Sciences (DIMEC), University of Bologna, Bologna, Italy
| | - Andrea Avanzolini
- grid.415079.e0000 0004 1759 989XGeneral and Oncologic Surgery, Morgagni-Pierantoni Hospital, Ausl Romagna, Forlì, Italy
| | - Domenico Annunziata
- grid.415079.e0000 0004 1759 989XGeneral and Oncologic Surgery, Morgagni-Pierantoni Hospital, Ausl Romagna, Forlì, Italy
| | - Davide Cavaliere
- grid.415079.e0000 0004 1759 989XGeneral and Oncologic Surgery, Morgagni-Pierantoni Hospital, Ausl Romagna, Forlì, Italy
| | - Giorgio Ercolani
- grid.6292.f0000 0004 1757 1758Department of Medical and Surgical Sciences (DIMEC), University of Bologna, Bologna, Italy ,grid.415079.e0000 0004 1759 989XGeneral and Oncologic Surgery, Morgagni-Pierantoni Hospital, Ausl Romagna, Forlì, Italy
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12
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Giuliani G, Guerra F, Coletta D, Giuliani A, Salvischiani L, Tribuzi A, Caravaglios G, Genovese A, Coratti A. Robotic versus conventional laparoscopic technique for the treatment of left-sided colonic diverticular disease: a systematic review with meta-analysis. Int J Colorectal Dis 2022; 37:101-109. [PMID: 34599362 DOI: 10.1007/s00384-021-04038-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/21/2021] [Indexed: 02/04/2023]
Abstract
PURPOSE Minimally invasive surgery has been universally accepted as a valid option for the treatment of diverticular disease, provided specific expertise is available. Over the last decade, there has been a growing interest in the application of robotic approaches for diverticular disease. We aimed at evaluating whether robotic colectomy may offer some advantages over the laparoscopic approach for surgical treatment of diverticular disease by meta-analyzing the available data from the medical literature. METHODS The PubMed/Medline, EMBASE, and Web Of Sciences electronic databases were searched for literature up to December 2020. Inclusion criteria considered all comparative studies evaluating robotic versus laparoscopic colectomy for diverticulitis eligible. The conversion rate to the open approach was evaluated as the primary outcome. RESULTS The data of 4177 patients from nine studies were included in the analysis. There were no significant differences in the baseline characteristics. Patients undergoing laparoscopic colectomy compared to those who underwent surgery with a robotic approach had a significantly higher risk of conversion into an open procedure (12.5% vs. 7.4%, p < 0.00001) and abbreviated hospital stay (p < 0.0001) at the price of a longer operating time (p < 0.00001). CONCLUSION Compared with conventional laparoscopic surgery, the robotic approach offers significant advantages in terms of conversion rate and shortened hospital stay for the treatment of diverticular disease. However, because of the lack of available evidence, it is impossible to draw definitive conclusions.
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Affiliation(s)
- Giuseppe Giuliani
- Department of General and Urgency Surgery, Misericordia Hospital, Via Senese, 161, 58100, Grosseto, Italy.
| | - Francesco Guerra
- Department of General and Urgency Surgery, Misericordia Hospital, Via Senese, 161, 58100, Grosseto, Italy
| | - Diego Coletta
- Department of Surgical Sciences, Emergency Department - Emergency and Trauma Surgery Unit, Umberto I University Hospital, Sapienza University of Rome, Rome, Italy.,Department of General Surgery, Ospedali Riuniti Marche Nord, Pesaro, Italy
| | - Antonio Giuliani
- Department of Biotechnological and Applied Clinical Sciences, Department of General Surgery, University of L'Aquila, San Salvatore Hospital, L'Aquila, Italy
| | - Lucia Salvischiani
- Department of General and Urgency Surgery, Misericordia Hospital, Via Senese, 161, 58100, Grosseto, Italy
| | - Angela Tribuzi
- Department of General and Urgency Surgery, Misericordia Hospital, Via Senese, 161, 58100, Grosseto, Italy
| | - Giuseppe Caravaglios
- Department of General and Urgency Surgery, Misericordia Hospital, Via Senese, 161, 58100, Grosseto, Italy
| | - Alfredo Genovese
- Department of General and Urgency Surgery, Misericordia Hospital, Via Senese, 161, 58100, Grosseto, Italy
| | - Andrea Coratti
- Department of General and Urgency Surgery, Misericordia Hospital, Via Senese, 161, 58100, Grosseto, Italy
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13
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Mueller AN, Vossler JD, Yim NH, Harbison GJ, Murayama KM. Predictors and Consequences of Unplanned Conversion to Open During Robotic Colectomy: An ACS-NSQIP Database Analysis. HAWAI'I JOURNAL OF HEALTH & SOCIAL WELFARE 2021; 80:3-9. [PMID: 34820629 PMCID: PMC8609196] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
Robotic-assisted surgery has become a desired modality for performing colectomy; however, unplanned conversion to an open procedure may be associated with worse outcomes. The purpose of this study is to examine predictors and consequences of unplanned conversion to open in a large, high fidelity data set. A retrospective analysis of 11 061 robotic colectomies was conducted using the American College of Surgeons - National Surgical Quality Improvement Program (ACS-NSQIP) 2012-2017 database. Predictors of conversion and the effect of conversion on outcomes were analyzed by multivariate logistic regression resulting in risk-adjusted odds ratios of conversion and morbidity/mortality. Overall, 10 372 (93.8%) patients underwent successful robotic colectomy, and 689 (6.2%) had an unplanned conversion. Predictors of conversion included age ≥ 65 years, male gender, obesity, functional status not independent, American Society of Anesthesia (ASA) classification IV-V, non-oncologic indication, emergency case, smoking, recent weight loss, bleeding disorder, and preoperative organ space infection. Conversion is an independent risk factor for mortality, overall morbidity, cardiac morbidity, pulmonary morbidity, renal morbidity, venous thromboembolism morbidity, wound morbidity, sepsis, bleeding, readmission, return to the operating room, and extended length of stay (LOS). Unplanned conversion to open during robotic colectomy is an independent predictor of morbidity and mortality.
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Affiliation(s)
- Andrew N. Mueller
- Department of Surgery, John A. Burns School of Medicine, University of Hawai‘i, Honolulu, HI (ANM, JDV, KMM)
| | - John D. Vossler
- Department of Surgery, John A. Burns School of Medicine, University of Hawai‘i, Honolulu, HI (ANM, JDV, KMM)
| | - Nicholas H. Yim
- John A. Burns School of Medicine, University of Hawai‘i, Honolulu, HI (NHY, GJH)
| | - Gregory J. Harbison
- John A. Burns School of Medicine, University of Hawai‘i, Honolulu, HI (NHY, GJH)
| | - Kenric M. Murayama
- Department of Surgery, John A. Burns School of Medicine, University of Hawai‘i, Honolulu, HI (ANM, JDV, KMM)
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Ahmadi N, Mor I, Warner R. Comparison of outcome and costs of robotic and laparoscopic right hemicolectomies. J Robot Surg 2021; 16:429-436. [PMID: 34081291 DOI: 10.1007/s11701-021-01246-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2021] [Accepted: 04/26/2021] [Indexed: 12/22/2022]
Abstract
To compare the outcomes of patients undergoing right hemicolectomy using laparoscopic or robotic approaches and perform a cost analysis. Retrospective review of all patients undergoing elective laparoscopic and robotic right hemicolectomies at a public and private hospital in NSW/QLD from January 2015 to June 2018. Cost analysis was calculated using actual and estimated costs by the local health district. A total of 101 patients were identified. 59 (58%) had Robotic resection, of which 44 (75%) had an intra-corporeal anastomosis. There were no demographic or oncological differences between the two groups. The robotic group had a significantly earlier time to bowels opening (2 vs 4 days, p < 0.001) and shorter length of stay (3 vs 5 days, p < 0.001). The robotic group had a lower rate of ileus (2% vs 14%, p = 0.02) and complications (5% vs 33%, p = 0.006). The mean lymph node harvest was higher in the robotic group (18 vs 14, p = 0.001). The operative time was longer in the robotic group (110 vs 97 min, p = 0.021). The total instrument costs of robotic surgery were A$2565.37 compared with $1507.50 for laparoscopic surgery. The cost of bed days was A$1167.00/day. The average difference in cost of care was calculated as A$1276.13 and A$464.43 less in the robotic with intra-corporeal and extra-corporeal anastomosis, respectively. Patients have significantly faster return to bowel function and shorter length of stay after Robotic vs laparoscopic right hemicolectomy and experience fewer complications. This difference in length of stay may make robotic right hemicolectomies more cost effective.
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Affiliation(s)
- Nima Ahmadi
- Department of Colorectal Surgery, The Tweed Hospital, Powell St, Tweed Heads, NSW, 2485, Australia
| | - Isabella Mor
- Department of Colorectal Surgery, The Tweed Hospital, Powell St, Tweed Heads, NSW, 2485, Australia.,Department of Colorectal Surgery, John Flynn Private Hospital, Tugun, QLD, 4224, Australia
| | - Ross Warner
- Department of Colorectal Surgery, The Tweed Hospital, Powell St, Tweed Heads, NSW, 2485, Australia. .,Department of Colorectal Surgery, John Flynn Private Hospital, Tugun, QLD, 4224, Australia.
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15
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Complete mesocolic excision versus conventional hemicolectomy in patients with right colon cancer: a systematic review and meta-analysis. Int J Colorectal Dis 2021; 36:881-892. [PMID: 33170319 DOI: 10.1007/s00384-020-03797-3] [Citation(s) in RCA: 33] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/05/2020] [Indexed: 02/08/2023]
Abstract
PURPOSE Complete mesocolic excision (CME) has introduced a promising surgical approach for treatment of right colon cancer. However, benefits of CME are still a matter of debate. We conducted a systematic review and meta-analysis to assess safety and long-term outcomes of CME versus conventional right hemicolectomy (CRH). METHODS We systematically searched MEDLINE, the Cochrane Database of Systematic Reviews, Scopus, Web of Science, and Embase for retrieving studies comparing CME with CRH in right colon cancer. After data extraction from the included studies, meta-analysis was performed to compare postoperative complications, anastomotic leakage, 30-day mortality, number of lymph node yield, disease-free survival (DFS), and overall survival (OS). RESULTS Eight studies met the inclusion criteria with a total of 1871 patients enrolled. No difference was observed in postoperative complications (OR 1.13, 95% CI 0.88-1.47, p = 0.34). CME was associated with significantly higher number of lymph nodes retrieved (MD 9.17, CI 4.67-13.68, p < 0.001). CME also improved 3-year OS (OR 1.57, 95% CI 1.17-2.11, p = 0.003), 5-year OS (OR 1.41, 95% CI 1.06-1.89, p = 0.02), and 5-year DFS (OR 1.99, 95% CI 1.29-3.07, p = 0.002). A sub-group analysis for patients with stage III colon cancer showed no significant impact of CME on 3-year and 5-year OS (OR 2.47, 95% CI 0.86-7.06, p = 0.09; OR 1.23, 95% CI 0.78-1.94, p = 0.38). CONCLUSION Although with limited evidence, CME shows similar postoperative complication rates and an improved survival outcome compared with CRH.
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16
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Lorenzon L, Bini F, Landolfi F, Quinzi S, Balducci G, Marinozzi F, Biondi A, Persiani R, D’Ugo D, Tirelli F, Iannicelli E. 3D pelvimetry and biometric measurements: a surgical perspective for colorectal resections. Int J Colorectal Dis 2021; 36:977-986. [PMID: 33230658 PMCID: PMC8026460 DOI: 10.1007/s00384-020-03802-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/11/2020] [Indexed: 02/04/2023]
Abstract
PURPOSE Male sex, high BMI, narrow pelvis, and bulky mesorectum were acknowledged as clinical variables correlated with a difficult pelvic dissection in colorectal surgery. This paper aimed at comparing pelvic biometric measurements in female and male patients and at providing a perspective on how pelvimetry segmentation may help in visualizing mesorectal distribution. METHODS A 3D software was used for segmentation of DICOM data of consecutive patients aged 60 years, who underwent elective abdominal CT scan. The following measurements were estimated: pelvic inlet, outlet, and depth; pubic tubercle height; distances from the promontory to the coccyx and to S3/S4; distance from S3/S4 to coccyx's tip; ischial spines distance; pelvic tilt; offset angle; pelvic inlet angle; angle between the inlet/sacral promontory/coccyx; angle between the promontory/coccyx/pelvic outlet; S3 angle; and pelvic inlet to pelvic depth ratio. The measurements were compared in males and females using statistical analyses. RESULTS Two-hundred patients (M/F 1:1) were analyzed. Out of 21 pelvimetry measurements, 19 of them documented a significant mean difference between groups. Specifically, female patients had a significantly wider pelvic inlet and outlet but a shorter pelvic depth, and promontory/sacral/coccyx distances, resulting in an augmented inlet/depth ratio when comparing with males (p < 0.0001). The sole exceptions were the straight conjugate (p = 0.06) and S3 angle (p = 0.17). 3D segmentation provided a perspective of the mesorectum distribution according to the pelvic shape. CONCLUSION Significant differences in the structure of pelvis exist in males and females. Surgeons must be aware of the pelvic shape when approaching the rectum.
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Affiliation(s)
- Laura Lorenzon
- grid.8142.f0000 0001 0941 3192General Surgery Unit, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Catholic University, Rome, Italy ,grid.417007.5Surgical and Medical Department of Translational Medicine, Sant’Andrea Hospital, Faculty of Medicine and Psychology, “Sapienza” University of Rome, 00185 Rome, RM Italy
| | - Fabiano Bini
- grid.7841.aDepartment of Mechanical and Aerospace Engineering, “Sapienza” University of Rome, via Eudossiana 18, 00184 Rome, Italy
| | - Federica Landolfi
- grid.417007.5Surgical and Medical Department of Translational Medicine, Sant’Andrea Hospital, Faculty of Medicine and Psychology, “Sapienza” University of Rome, 00185 Rome, RM Italy
| | - Serena Quinzi
- grid.7841.aDepartment of Mechanical and Aerospace Engineering, “Sapienza” University of Rome, via Eudossiana 18, 00184 Rome, Italy
| | - Genoveffa Balducci
- grid.417007.5Surgical and Medical Department of Translational Medicine, Sant’Andrea Hospital, Faculty of Medicine and Psychology, “Sapienza” University of Rome, 00185 Rome, RM Italy
| | - Franco Marinozzi
- grid.7841.aDepartment of Mechanical and Aerospace Engineering, “Sapienza” University of Rome, via Eudossiana 18, 00184 Rome, Italy
| | - Alberto Biondi
- grid.8142.f0000 0001 0941 3192General Surgery Unit, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Catholic University, Rome, Italy
| | - Roberto Persiani
- grid.8142.f0000 0001 0941 3192General Surgery Unit, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Catholic University, Rome, Italy
| | - Domenico D’Ugo
- grid.8142.f0000 0001 0941 3192General Surgery Unit, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Catholic University, Rome, Italy
| | - Flavio Tirelli
- grid.8142.f0000 0001 0941 3192General Surgery Unit, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Catholic University, Rome, Italy
| | - Elsa Iannicelli
- grid.417007.5Surgical and Medical Department of Translational Medicine, Sant’Andrea Hospital, Faculty of Medicine and Psychology, “Sapienza” University of Rome, 00185 Rome, RM Italy
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17
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Chen H, Cheng Y, Wang X, Wang J, Shi X, Li X, Tan W, Tan Z. 3D printed in vitro tumor tissue model of colorectal cancer. Theranostics 2020; 10:12127-12143. [PMID: 33204333 PMCID: PMC7667682 DOI: 10.7150/thno.52450] [Citation(s) in RCA: 35] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2020] [Accepted: 10/15/2020] [Indexed: 12/13/2022] Open
Abstract
Rationale: The tumor microenvironment (TME) determines tumor progression and affects clinical therapy. Its basic components include cancer-associated fibroblasts (CAFs) and tumor-associated endothelial cells (TECs), both of which constitute the tumor matrix and microvascular network. The ability to simulate interactions between cells and extracellular matrix in a TME in vitro can assist the elucidation of cancer growth and evaluate the efficiency of therapies. Methods: In the present study, an in vitro 3D model of tumor tissue that mimicked in vivo cell physiological function was developed using tumor-associated stromal cells. Colorectal cancer cells, CAFs, and TECs were co-cultured on 3D-printed scaffolds so as to constitute an extracellular matrix (ECM) that allowed cell processes such as adhesion, stemness, proliferation, and vascularization to take place. Normal stromal cells were activated and reprogrammed into tumor-related stromal cells to construct a TME of tumor tissues. Results: The activated stromal cells overexpressed a variety of tumor-related markers and remodeled the ECM. Furthermore, the metabolic signals and malignant transformation of the in vitro 3D tumor tissue was substantially similar to that observed in tumors in vivo. Conclusions: The 3D tumor tissue exhibited physiological activity with high drug resistance. The model is suitable for research studies of tumor biology and the development of personalized treatments for cancer.
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Affiliation(s)
- Haoxiang Chen
- College of Biology, Hunan University, Changsha, Hunan, 410082, China
- Shenzhen Institute, Hunan University, Shenzhen, Guangdong, 518000, China
| | - Yanxiang Cheng
- Department of Gynecology, Renmin Hospital of Wuhan University, Wuhan 430060, China
| | - Xiaocheng Wang
- College of Biology, Hunan University, Changsha, Hunan, 410082, China
| | - Jian Wang
- College of Biology, Hunan University, Changsha, Hunan, 410082, China
- Shenzhen Institute, Hunan University, Shenzhen, Guangdong, 518000, China
| | - Xuelei Shi
- College of Biology, Hunan University, Changsha, Hunan, 410082, China
- Shenzhen Institute, Hunan University, Shenzhen, Guangdong, 518000, China
| | - Xinghuan Li
- College of Biology, Hunan University, Changsha, Hunan, 410082, China
| | - Weihong Tan
- College of Biology, Hunan University, Changsha, Hunan, 410082, China
| | - Zhikai Tan
- College of Biology, Hunan University, Changsha, Hunan, 410082, China
- Shenzhen Institute, Hunan University, Shenzhen, Guangdong, 518000, China
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18
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Alharthi S, Reilly M, Arishi A, Ahmed AM, Chulkov M, Qu W, Ortiz J, Nazzal M, Pannell S. Robotic versus Laparoscopic Sigmoid Colectomy: Analysis of Healthcare Cost and Utilization Project Database. Am Surg 2020. [DOI: 10.1177/000313482008600337] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Minimally invasive sigmoid colectomy via the laparoscopic approach (LA) has numerous benefits. We seek to compare outcomes between laparoscopic and robotic sigmoid colectomies. We analyzed the data using the National Inpatient Sample database between 2008 and 2014. Utilization and outcome measures were compared. The seven-year average number of patients who underwent elective sigmoid colectomy in the United States from 2008 to 2014 was estimated to be 197,053. Of these, 95.1 per cent were conducted using the LA. The mean age was 58.33 + 13.6 years and 58.23 + 12.8 years in laparoscopic and robotic approaches, respectively. No significant differences existed in respect to morbidities. Postoperative complications were comparable with respect to other complications. Length of hospital stay was statistically significantly shorter in the robot-assisted approach compared with the LA (mean 4.8 + 4 vs 5.7 + 5 days, respectively, P < 0.001). Patients who underwent robotic surgery had significantly higher total hospital charges than those who underwent laparoscopic surgery (median $45,057 vs $57,871 USD, P < 0.001). The advent of robot-assisted surgery has provided more options for patients and surgeons. Compared with laparoscopy, robot-assisted sigmoid colectomy has no clinical advantages in morbidity and mortality. However, the robotic approach has a significantly higher total charge to the patient.
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Affiliation(s)
- Samer Alharthi
- From the Department of Surgery, University of Toledo College of Medicine, Toledo, Ohio
| | - Margaret Reilly
- From the Department of Surgery, University of Toledo College of Medicine, Toledo, Ohio
| | - Abdulaziz Arishi
- From the Department of Surgery, University of Toledo College of Medicine, Toledo, Ohio
| | - Amin Mohamed Ahmed
- From the Department of Surgery, University of Toledo College of Medicine, Toledo, Ohio
| | - Maria Chulkov
- From the Department of Surgery, University of Toledo College of Medicine, Toledo, Ohio
| | - Weikai Qu
- From the Department of Surgery, University of Toledo College of Medicine, Toledo, Ohio
| | - Jorge Ortiz
- From the Department of Surgery, University of Toledo College of Medicine, Toledo, Ohio
| | - Munier Nazzal
- From the Department of Surgery, University of Toledo College of Medicine, Toledo, Ohio
| | - Stephanie Pannell
- From the Department of Surgery, University of Toledo College of Medicine, Toledo, Ohio
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Robotically Assisted Omentum Flap Harvest: A Novel, Minimally Invasive Approach for Vascularized Lymph Node Transfer. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2020; 8:e2505. [PMID: 32440389 PMCID: PMC7209865 DOI: 10.1097/gox.0000000000002505] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2019] [Accepted: 08/28/2019] [Indexed: 01/11/2023]
Abstract
Background: The omentum provides abundant lymphatic tissue with reliable vascular anatomy, representing an ideal donor for vascularized lymph node transfer without risk for donor site lymphedema. We describe a novel, robotically assisted approach for omental flap harvest. Methods: All patients undergoing robotically assisted omentum harvest for vascularized lymph node transfer from 2017 to 2019 were identified. Patient demographics, intraoperative variables, and postoperative outcomes were reviewed. Results: Five patients underwent robotically assisted omentum flap harvest for vascularized lymph node transfer. The average patient age and body mass index were 51.2 years and 29.80 kg/m2, respectively. Indications for lymph node transfer were upper extremity lymphedema following mastectomy, radiation, and lymphadenectomy (60.0%); congenital unilateral lower extremity lymphedema (20.0%); and bilateral lower extremity/scrotal lymphedema following partial penectomy and bilateral inguinal/pelvic lymphadenectomy (20.0%). Four patients (80.0%) underwent standard robotic harvest, whereas 1 patient underwent single-port robotic harvest. The average number of port sites was 4.4. All patients underwent omentum flap transfer to 2 sites; in 2 cases, the flap was conjoined, and in 3 cases, the flap was segmented. The average overall operative time was 9:19. The average inpatient hospitalization was 5.2 days. Two patients experienced cellulitis, which is resolved with oral antibiotics. There were no major complications. All patients reported subjective improvement in swelling and softness of the affected extremity. The average follow-up was 8.8 months. Conclusions: Robotically assisted omental harvest for vascularized lymph node transfer is a novel, safe, and viable minimally invasive approach offering improved intra-abdominal visibility and maneuverability for flap dissection.
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Guachi R, Bini F, Bici M, Campana F, Marinozzi F, Guachi L. Finite element analysis in colorectal surgery: non-linear effects induced by material model and geometry. COMPUTER METHODS IN BIOMECHANICS AND BIOMEDICAL ENGINEERING: IMAGING & VISUALIZATION 2019. [DOI: 10.1080/21681163.2019.1679669] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Affiliation(s)
- Robinson Guachi
- Department of Mechatronics, Universidad Internacional del Ecuador, Quito, Ecuador
- Dipartimento di ingegneria Meccanica e Aerospaziale, Universita degli Studi di Roma La Sapienza, Roma, Italy
| | - Fabiano Bini
- Dipartimento di ingegneria Meccanica e Aerospaziale, Universita degli Studi di Roma La Sapienza, Roma, Italy
| | - Michele Bici
- Dipartimento di ingegneria Meccanica e Aerospaziale, Universita degli Studi di Roma La Sapienza, Roma, Italy
| | - Francesca Campana
- Dipartimento di ingegneria Meccanica e Aerospaziale, Universita degli Studi di Roma La Sapienza, Roma, Italy
| | - Franco Marinozzi
- Dipartimento di ingegneria Meccanica e Aerospaziale, Universita degli Studi di Roma La Sapienza, Roma, Italy
| | - Lorena Guachi
- Mathematical and Computational Sciences, Yachay University, Urcuquí, Ecuador
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Robot-Assisted Removal of a Broken Scalpel Blade following Discectomy. Case Rep Surg 2019; 2019:8609246. [PMID: 31281708 PMCID: PMC6589283 DOI: 10.1155/2019/8609246] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2018] [Accepted: 05/19/2019] [Indexed: 12/26/2022] Open
Abstract
The risk of a broken scalpel blade during discectomy is considered extremely rare, while no guidelines exist regarding this complication. We report a case of a robotic broken blade removal following lumbar discectomy. A 52-year-old female was subjected to L4-L5 discectomy. During the annulus resection, the scalpel blade broke and was retained within the disc space. The broken blade migrated towards the abdominal cavity and viscera. Emergency CT angiography scan revealed that the main vessels were intact, while the broken surgical knife was located anterior to the lumbar spine at the L4/L5 level, to the left of the aorta and superiorly of the left common iliac artery. At that point, robot-assisted laparoscopy was performed. The broken instrument was located and carefully removed. It seems more proper that such foreign bodies should be removed, while robotic surgery may play a significant role in cases that the foreign body is near major vessels.
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Grass F, Crippa J, Mathis KL, Kelley SR, Larson DW. Feasibility and safety of robotic resection of complicated diverticular disease. Surg Endosc 2019; 33:4171-4176. [PMID: 30868321 DOI: 10.1007/s00464-019-06727-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2018] [Accepted: 03/01/2019] [Indexed: 01/17/2023]
Abstract
This study aimed to assess intra- and postoperative outcomes of robotic resection of left-sided complicated diverticular disease. Retrospective analysis of a prospectively maintained institutional database on consecutive patients undergoing elective robotic resection for diverticular disease (2014-2018). All procedures were performed within an enhanced recovery pathway (ERP). Demographic, surgical and ERP-related items were compared between patients with simple and complicated diverticular disease according to intra-operative presentation. Postoperative complications and length of stay were compared between the two groups. Out of 150 patients, 78 (52%) presented with complicated and the remaining 72 (48%) with uncomplicated disease. Both groups were comparable regarding demographic baseline characteristics and overall ERP compliance. Surgery for complicated disease was longer (288 ± 96 vs. 258 ± 72 min, p = 0.04) and more contaminated (≥ class 3: 57.7 vs. 23.6%, p < 0.001) with a trend to higher conversion rates (10.3 vs. 2.8%, p = 0.1). While postoperative overall complications tended to occur more often after resections for complicated disease (28.2 vs. 15.3%, p = 0.075), major, surgical and medical complications did not differ between the two groups, and median length of stay was 3 days in both settings (p = 0.19). Robotic resection of diverticular disease was feasible and safe regardless of disease presentation by the time of surgery.
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Affiliation(s)
- Fabian Grass
- Division of Colon and Rectal Surgery, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA
| | - Jacopo Crippa
- Division of Colon and Rectal Surgery, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA
| | - Kellie L Mathis
- Division of Colon and Rectal Surgery, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA
| | - Scott R Kelley
- Division of Colon and Rectal Surgery, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA
| | - David W Larson
- Division of Colon and Rectal Surgery, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA.
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Abstract
PURPOSE OF REVIEW Despite the growth in laparoscopic surgery, comparable oncological outcomes, and reduced complication rates, the majority of colorectal surgery is still performed via an open approach. Reasons for this may include technical difficulties associated with operating in narrow spaces such as in the pelvis and inadequate experience. Robotic surgery provides potential solutions to some of these challenges. This review will summarize the state of the literature regarding robotic colorectal surgery. RECENT FINDINGS The most consistent benefit of robotic surgery is decreasing operative conversions, specifically in rectal cancer. In partial colectomies, there is evidence to support quicker return to bowel function. Oncologic outcomes compared to the laparoscopic approach are equivalent. Robotic surgery provides solutions to the challenges posed by laparoscopy, including wristed instruments, ease of intracorporeal suturing, and ergonomic advantages. Randomized trials to evaluate peri-operative outcomes will be important. If robotics is able to facilitate conversion of open colectomies to their minimally invasive equivalent, robotics may end up proving to be advantageous in the peri-operative and post-operative period. Continued studies are warranted.
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Affiliation(s)
- Harith H Mushtaq
- General Surgery, McGovern Medical School at UT Health, 6431 Fannin Street, MSB 4.331, Houston, TX, 77030, USA
| | - Shinil K Shah
- Minimally Invasive and Elective General Surgery, McGovern Medical School at UT Health, 6431 Fannin Street, MSB 4.156, Houston, TX, 77030, USA
| | - Amit K Agarwal
- Colon and Rectal Surgery, McGovern Medical School at UT Health, 6431 Fannin Street, MSB 4.158, Houston, TX, 77030, USA.
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Liu WH, Yan PJ, Hu DP, Jin PH, Lv YC, Liu R, Yang XF, Yang KH, Guo TK. Short-Term Outcomes of Robotic versus Laparoscopic Total Mesorectal Excision for Rectal Cancer: A Cohort Study. Am Surg 2019. [DOI: 10.1177/000313481908500336] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
The aim of this study was to evaluate and compare the intestinal function recovery time and other short-term outcomes between robotic-assisted total mesorectal excision (R-TME) and laparoscopic total mesorectal excision (L-TME) for rectal cancer. This is a retrospective study using a prospectively collected database. Patients’ records were obtained from Gansu Provincial Hospital between July 2015 and October 2017. Eighty patients underwent R-TME, and 116 with the same histopathological stage of the tumor underwent an L-TME. Both operations were performed by the same surgeon, comparing intra- and postoperative outcomes intergroups. The time to the first passage of flatus ( P < 0.001), the time to the first postoperative oral fluid intake ( P < 0.001), and the length of hospital stay ( P < 0.01) of the R-TME group were about three days faster than those in the L-TME group. The rate of conversion to open laparotomy ( P = 0.038) and postoperative urinary retention ( P = 0.016) were significantly lower in the R-TME group than in the L-TME group. Intraoperative blood loss of the R-TME group was more than that of the L-TME group ( P < 0.01).The operation time, number of lymph nodes harvested, and rate of positive circumferential resection margin were similar intergroup. The total cost of the R-TME group was higher than that of the L-TME group, but with a lack of statistical significance (85,623.91 ± 13,310.50 vs 67,356.79 ± 17,107.68 CNY, P = 0.084). The R-TME is safe and effective and has better postoperative short-term outcomes and faster intestinal function recovery time, contrasting with the L-TME. The large, multicenter, prospective studies were needed to validate the advantages of robotic surgery system used in rectal cancer.
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Affiliation(s)
- Wen-Han Liu
- Department of colorectal surgery, Gansu Provincial Hospital, Lanzhou, China
- Department of Clinical Medicine, Gansu University of Traditional Chinese Medicine, Lanzhou, China
| | - Pei-Jing Yan
- Evidence-Based Medicine Center, School of Basic Medical Sciences, Lanzhou University, Lanzhou, China
- Institution of Clinical Research and Evidence Based Medicine, Gansu Provincial Hospital, Lanzhou, China; and
| | - Dong-Ping Hu
- Department of colorectal surgery, Gansu Provincial Hospital, Lanzhou, China
| | - Peng-Hui Jin
- Department of colorectal surgery, Gansu Provincial Hospital, Lanzhou, China
- Department of Clinical Medicine, Gansu University of Traditional Chinese Medicine, Lanzhou, China
| | - Yao-Chun Lv
- Department of colorectal surgery, Gansu Provincial Hospital, Lanzhou, China
| | - Rong Liu
- The Second Department of Hepatobiliary surgery, Chinese PLA General Hospital, Beijing, China
| | - Xiong-Fei Yang
- Department of colorectal surgery, Gansu Provincial Hospital, Lanzhou, China
| | - Ke-Hu Yang
- Department of Clinical Medicine, Gansu University of Traditional Chinese Medicine, Lanzhou, China
| | - Tian-Kang Guo
- Department of colorectal surgery, Gansu Provincial Hospital, Lanzhou, China
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Hoshino N, Sakamoto T, Hida K, Sakai Y. Robotic versus laparoscopic surgery for rectal cancer: an overview of systematic reviews with quality assessment of current evidence. Surg Today 2019; 49:556-570. [DOI: 10.1007/s00595-019-1763-y] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2018] [Accepted: 12/20/2018] [Indexed: 12/17/2022]
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Ma S, Chen Y, Chen Y, Guo T, Yang X, Lu Y, Tian J, Cai H. Short-term outcomes of robotic-assisted right colectomy compared with laparoscopic surgery: A systematic review and meta-analysis. Asian J Surg 2018; 42:589-598. [PMID: 30503268 DOI: 10.1016/j.asjsur.2018.11.002] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2018] [Revised: 10/27/2018] [Accepted: 11/02/2018] [Indexed: 12/22/2022] Open
Abstract
To assess the clinical efficacy and safety of robotic-assisted right colectomy (RRC) with conventional laparoscopic right colectomy (LRC) by performing a systematic review and meta-analysis of the published studies. All published literature for comparative studies reporting preoperative outcomes of RRC and LRC were searched. We searched the databases included Cochrane Library of Clinical Comparative Trials, MEDLINE, Embase, Web of Science and Chinese Biomedical Database (CBM) from 1973 to 2018. The censor date was up to January 2018. Operative time, estimated blood loss, length of hospital stay, conversion rates to open surgery, postoperative complications, and related outcomes were evaluated. All calculations and statistical tests were performed using Stata 12.0 software. A total of 7769 patients with colon cancer enrolled in 13 trials were divided into a study group (n = 674) and a control group (n = 7095). Meta-analysis suggested significantly greater length of hospital stay in the LRC group [MD = -0.85; 95% CI: -1.07 to -0.63; P < 0.00001]. Robotic surgery was also associated with a significantly lower complication rate [OR = 0.73; 95% CI: 0.52 to 1.01; P = 0.05]. There were statistically significant differences between the groups in estimated blood loss [MD = -16.89; 95% CI: -24.80 to -8.98; P < 0.00001] and the rate of intraoperative conversion to open surgery [OR = 0.34, 95% CI: 0.15 to 0.75; P = 0.008)], but these differences were not clinically relevant. The recovery of bowel function in two groups is no significant differences [MD = -0.58, 95% CI: -0.96 to -0.20, P = 0.0008]. However, operation times [MD = 43.61, 95% CI: 39.11 to 48.10, P < 0.00001] were longer for RRC than for LRC. Compared to LRC, RRC was associated with reduced estimated blood loss, reduced postoperative complications, longer operation times. Recovery of bowel function and other perioperative outcomes were equivalent between the two surgeries.
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Affiliation(s)
- Shixun Ma
- Gansu Province Hospital, Lanzhou, China.
| | - Yan Chen
- The First Affiliated Hospital of Soochow University, Jiangsu, China.
| | | | | | | | - Yufeng Lu
- Gansu Province Hospital, Lanzhou, China.
| | | | - Hui Cai
- Gansu Province Hospital, Lanzhou, China.
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Abstract
Treatment of locally advanced rectal cancer is evolving through surgical innovation and paradigm shifts in neoadjuvant treatment. Whereas local recurrence was a significant concern before the systematic implementation of neoadjuvant chemoradiation therapy and surgery according to total mesorectal excision principles, distant relapse remains a major drawback. Hence, efforts in recent years have focused on delivering preoperative chemotherapy regimens to overcome compliance issues with adjuvant administration. In parallel, new surgical techniques, including transanal video-assisted total mesorectal excision and robot-assisted surgery, emerged to face the challenge to navigate in the deep and narrow spaces of the pelvis. Furthermore, patients experiencing a complete response after neoadjuvant treatment might even escape surgery within a close surveillance strategy. This novel "watch and wait" concept has gained interest to improve quality of life in highly selected patients. This review summarizes recent evidence and controversies and provides an overview on timely and innovative aspects in the treatment of locally advanced rectal cancer.
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Affiliation(s)
- Fabian Grass
- Department of Surgery, Division of Colon and Rectal Surgery, Mayo Clinic, Rochester, MN, USA
| | - Kellie Mathis
- Department of Surgery, Division of Colon and Rectal Surgery, Mayo Clinic, Rochester, MN, USA
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Felder SI, Ramanathan R, Russo AE, Jimenez-Rodriguez RM, Hogg ME, Zureikat AH, Strong VE, Zeh HJ, Weiser MR. Robotic gastrointestinal surgery. Curr Probl Surg 2018; 55:198-246. [PMID: 30470267 DOI: 10.1067/j.cpsurg.2018.07.001] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2018] [Accepted: 07/26/2018] [Indexed: 12/11/2022]
Affiliation(s)
- Seth I Felder
- Department of Gastrointestinal Surgery, Moffitt Cancer Center, Tampa, Florida
| | - Rajesh Ramanathan
- Division of Surgical Oncology, University of Pittsburgh Medical Center, Pittsburgh, PA
| | - Ashley E Russo
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY
| | | | - Melissa E Hogg
- Division of Surgical Oncology, University of Pittsburgh Medical Center, Pittsburgh, PA
| | - Amer H Zureikat
- Division of Surgical Oncology, University of Pittsburgh Medical Center, Pittsburgh, PA
| | - Vivian E Strong
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Herbert J Zeh
- Division of Surgical Oncology, University of Pittsburgh Medical Center, Pittsburgh, PA
| | - Martin R Weiser
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY.
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Mangano A, Gheza F, Bustos R, Masrur M, Bianco F, Fernandes E, Valle V, Giulianotti PC. Robotic right colonic resection. Is the robotic third arm a game-changer? MINERVA CHIR 2018; 75:1-10. [PMID: 29860773 DOI: 10.23736/s0026-4733.18.07814-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
BACKGROUND Minimally invasive surgery (MIS) approaches have produces relevant advancements in the pre/intra/postoperative outcomes. The conventional laparoscopic approach presents similar oncological results in comparison to laparotomic approaches. Despite these evidences, a considerable part of the colorectal operations are still being performed in an open way. This is in part because traditional laparoscopy may have some hurdles and a long learning curve to reach mastery. The robotic technology may help in increasing the MIS penetrance in colorectal surgery. The use of the R3 can potentially increase the number of surgical options available. METHODS In this retrospective case series, after a long robotic colorectal experience connected to a robotic program started by Giulianotti et al. in October 2000, we present our results regarding a subset of colorectal patients who underwent robotic right colonic resections performed, all by a single surgeon (P.C.G.), using the R3 according to our standardized technique. RESULTS Out of all the robotic colorectal operations performed, this sub-sample sample included 33 patients: 21 males and 12 females. The age range was between 51 and 95 years old. The Body Mass Index (BMI) was between 21.6 to 43.1. The conversion rate to laparoscopy or to open surgery has been 0%. No intraoperative complications have been registered. The postoperative complications rates are reported in this manuscript. The perfusion check of the anastomosis by Near-infrared ICG (Indocyanine Green) enhanced fluorescence has been used. In 11.2% of the sample, the site of the anastomosis has been changed after ICG-Test. Moreover, when the ICG perfusion test has been performed no leakage occurred. CONCLUSIONS This subset of patients suggests the potential role of R3 and the benefits correlated to robotic surgery. In fact, the laparoscopic approach uses mostly a medial to lateral mobilization. Indeed, during laparoscopic surgery an early right colon mobilization may create problems in the surgical field visualization. In robotic surgery, R3 can lift upwards the cecum/ascending colon/hepatic flexure exposing, in doing so, the anatomical structures. Hence, we can use also the same approach of the open surgery (where the first step is usually the mobilization of the ascending colon mesentery). In other words, the R3 offers more operative options in terms of surgical pathways maintaining at the same time good perioperative outcomes. However, more studies are needed to confirm our findings.
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Affiliation(s)
- Alberto Mangano
- Division of General, Minimally Invasive and Robotic Surgery, University of Illinois at Chicago, Chicago, IL, USA -
| | - Federico Gheza
- Division of General, Minimally Invasive and Robotic Surgery, University of Illinois at Chicago, Chicago, IL, USA
| | - Roberto Bustos
- Division of General, Minimally Invasive and Robotic Surgery, University of Illinois at Chicago, Chicago, IL, USA
| | - Mario Masrur
- Division of General, Minimally Invasive and Robotic Surgery, University of Illinois at Chicago, Chicago, IL, USA
| | - Francesco Bianco
- Division of General, Minimally Invasive and Robotic Surgery, University of Illinois at Chicago, Chicago, IL, USA
| | - Eduardo Fernandes
- Division of General, Minimally Invasive and Robotic Surgery, University of Illinois at Chicago, Chicago, IL, USA
| | - Valentina Valle
- Division of General, Minimally Invasive and Robotic Surgery, University of Illinois at Chicago, Chicago, IL, USA
| | - Pier C Giulianotti
- Division of General, Minimally Invasive and Robotic Surgery, University of Illinois at Chicago, Chicago, IL, USA
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30
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Jimenez-Rodriguez RM, Weiser MR. In Brief. Curr Probl Surg 2018. [DOI: 10.1067/j.cpsurg.2018.08.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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31
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Crolla RMPH, Mulder PG, van der Schelling GP. Does robotic rectal cancer surgery improve the results of experienced laparoscopic surgeons? An observational single institution study comparing 168 robotic assisted with 184 laparoscopic rectal resections. Surg Endosc 2018; 32:4562-4570. [DOI: 10.1007/s00464-018-6209-x] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2017] [Accepted: 05/09/2018] [Indexed: 12/24/2022]
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Kulaylat AS, Mirkin KA, Puleo FJ, Hollenbeak CS, Messaris E. Robotic versus standard laparoscopic elective colectomy: where are the benefits? J Surg Res 2018; 224:72-78. [DOI: 10.1016/j.jss.2017.11.059] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2017] [Revised: 11/13/2017] [Accepted: 11/21/2017] [Indexed: 01/09/2023]
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Palmeri M, Gianardi D, Guadagni S, Di Franco G, Bastiani L, Furbetta N, Simoncini T, Zirafa C, Melfi F, Buccianti P, Moglia A, Cuschieri A, Mosca F, Morelli L. Robotic Colorectal Resection With and Without the Use of the New Da Vinci Table Motion: A Case-Matched Study. Surg Innov 2018; 25:251-257. [PMID: 29577830 DOI: 10.1177/1553350618765540] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
BACKGROUND The da Vinci Table Motion (dVTM) is a new device that enables patients to be repositioned with instruments in place within the abdomen, and without undocking the robot. The present study was designed to compare operative and short-term outcomes of patients undergoing colorectal cancer surgery with the da Vinci Xi system, with or without use of the dVTM. METHODS Ten patients underwent robotic colorectal resection for cancer with the use of dVTM (Xi-dVTM group) between May 2015 and October 2015 at our center. The intraoperative and short-term clinical outcome were compared, using a case-control methodology (propensity scores approach to create 1:2 matched pairs), with a similar group of patients who underwent robotic colorectal surgery for cancer without the use of the dVTM device (Xi-only group). RESULTS Overall robotic operative time was shorter in the Xi-dVTM group ( P = .04). Operations were executed fully robotic in all Xi-dVTM cases, while 2 cases of the Xi-only group required conversion to open surgery because of bulky tumors and difficult exposure. Postoperative medical complications were higher in the Xi-only group ( P = .024). CONCLUSIONS In this preliminary experience, the use of the new dVTM with the da Vinci Xi in colorectal surgery, by overcoming the limitations of the fixed positions of the patient, enhanced the workflow and resulted in improved exposure of the operative field. Further studies with a greater number of patients are needed to confirm these benefits of the dVTM-da Vinci Xi robotically assisted colorectal surgery.
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Affiliation(s)
- Matteo Palmeri
- 1 General Surgery Unit, Department of Surgery, Translational and new Technologies in Medicine, University of Pisa, Pisa, Italy
| | - Desirée Gianardi
- 1 General Surgery Unit, Department of Surgery, Translational and new Technologies in Medicine, University of Pisa, Pisa, Italy
| | - Simone Guadagni
- 1 General Surgery Unit, Department of Surgery, Translational and new Technologies in Medicine, University of Pisa, Pisa, Italy
| | - Gregorio Di Franco
- 1 General Surgery Unit, Department of Surgery, Translational and new Technologies in Medicine, University of Pisa, Pisa, Italy
| | - Luca Bastiani
- 2 Institute of Clinical Physiology, National Council of Research, Pisa, Italy
| | - Niccolò Furbetta
- 1 General Surgery Unit, Department of Surgery, Translational and new Technologies in Medicine, University of Pisa, Pisa, Italy
| | - Tommaso Simoncini
- 3 Division of Obstetrics and Gynecology, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Cristina Zirafa
- 4 Multidisciplinary Robotic Center, Azienda Ospedaliero-Universitaria Pisana, Pisa, Italy
| | - Franca Melfi
- 4 Multidisciplinary Robotic Center, Azienda Ospedaliero-Universitaria Pisana, Pisa, Italy
| | - Piero Buccianti
- 5 General Surgery Unit, Department of Surgery, Azienda Ospedaliero-Universitaria Pisana, Pisa, Italy
| | - Andrea Moglia
- 6 EndoCAS (Center for Computer Assisted Surgery), University of Pisa, Pisa, Italy
| | - Alfred Cuschieri
- 7 Institute for Medical Science and Technology, University of Dundee, Dundee, Scotland
| | - Franco Mosca
- 6 EndoCAS (Center for Computer Assisted Surgery), University of Pisa, Pisa, Italy
| | - Luca Morelli
- 1 General Surgery Unit, Department of Surgery, Translational and new Technologies in Medicine, University of Pisa, Pisa, Italy.,6 EndoCAS (Center for Computer Assisted Surgery), University of Pisa, Pisa, Italy
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Guachi R, Bini F, Bici M, Campana F, Marinozzi F. Finite Element Model Set-up of Colorectal Tissue for Analyzing Surgical Scenarios. VIPIMAGE 2017 2018. [DOI: 10.1007/978-3-319-68195-5_65] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
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Robotic versus laparoscopic right colectomy: an updated systematic review and meta-analysis. Surg Endosc 2017; 32:1104-1110. [PMID: 29218671 DOI: 10.1007/s00464-017-5980-4] [Citation(s) in RCA: 53] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2017] [Accepted: 11/05/2017] [Indexed: 12/17/2022]
Abstract
BACKGROUND In the right colon surgery, there is a growing literature comparing the safety of robotic right colectomy (RRC) to that of laparoscopic right colectomy (LRC). With this paper we aim to systematically revise and meta-analyze the latest comparative studies on these two minimally invasive procedures. METHODS A systematic review of studies published from 2000 to 2017 in the PubMed, Scopus, and Embase databases was performed. Primary endpoints were postoperative morbidity and mortality. Secondary endpoints were blood loss, conversion to open surgery, harvested lymph node anastomotic leak, postoperative hemorrhage, abdominal abscess, postoperative ileus, time to first flatus, non-surgical complications, wound infections, hospital stay, and incisional hernia and costs. A subgroup analysis was performed on those series presenting only extracorporeal anastomosis in both arms. RESULTS After screening 355 articles, 11 articles with a total of 8257 patients were eligible for inclusion. Operative time was found to be significantly shorter for the laparoscopic procedures in the pooled analysis (SMD - 0.99 95% CI - 1.4 to - 0.6, p < 0.001). Conversion to open surgery was more common during laparoscopic procedures than during the robotic ones (RR 1.7; 95% CI 1.1-2.6, p = 0.02). No significant differences in mortality (RR 0.47; 95% CI 0.18-1.23, p = 0.124) and postoperative complications (RR 1.05; 95% CI 0.9-1.2, p = 0.5) were found between LRC versus RRC. The pooled mean time to first flatus was higher in the laparoscopic group (SMD 0.85 days; 95% CI 0.16-1.54, p = 0.016). Hospital costs were significantly higher in RRCs (SMD - 0.52; 95% CI - 0.52 to - 0.04, p = 0.035). CONCLUSIONS RRC can be regarded as a feasible and safe technique. Its superiority in terms of postoperative recovery must be confirmed by further large prospective series comparing RRC and LRC performed with the same anastomotic technique. RRC seemed to be associated with higher costs than LRC.
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Holmer C, Kreis ME. Systematic review of robotic low anterior resection for rectal cancer. Surg Endosc 2017; 32:569-581. [DOI: 10.1007/s00464-017-5978-y] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2017] [Accepted: 11/05/2017] [Indexed: 01/30/2023]
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Robotic versus laparoscopic versus open colorectal surgery: towards defining criteria to the right choice. Surg Endosc 2017; 32:24-38. [PMID: 28812154 DOI: 10.1007/s00464-017-5796-2] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2017] [Accepted: 07/28/2017] [Indexed: 12/28/2022]
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38
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Schootman M, Hendren S, Loux T, Ratnapradipa K, Eberth J, Davidson N. Differences in Effectiveness and Use of Robotic Surgery in Patients Undergoing Minimally Invasive Colectomy. J Gastrointest Surg 2017; 21:1296-1303. [PMID: 28567574 PMCID: PMC5576564 DOI: 10.1007/s11605-017-3460-8] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2017] [Accepted: 05/17/2017] [Indexed: 01/31/2023]
Abstract
BACKGROUND We compared patient outcomes of robot-assisted surgery (RAS) and laparoscopic colectomy without robotic assistance for colon cancer or nonmalignant polyps, comparing all patients, obese versus nonobese patients, and male versus female patients. METHODS We used the 2013-2015 American College of Surgeons National Surgical Quality Improvement Program data to examine a composite outcome score comprised of mortality, readmission, reoperation, wound infection, bleeding transfusion, and prolonged postoperative ileus. We used propensity scores to assess potential heterogeneous treatment effects of RAS by patient obesity and sex. RESULTS In all, 17.1% of the 10,844 of patients received RAS. Males were slightly more likely to receive RAS. Obese patients were equally likely to receive RAS as nonobese patients. In comparison to nonRAS, RAS was associated with a 3.1% higher adverse composite outcome score. Mortality, reoperations, wound infections, sepsis, pulmonary embolisms, deep vein thrombosis, myocardial infarction, blood transfusions, and average length of hospitalization were similar in both groups. Conversion to open surgery was 10.1% lower in RAS versus nonRAS patients, but RAS patients were in the operating room an average of 52.4 min longer. We found no statistically significant differences (p > 0.05) by obesity status and gender. CONCLUSIONS Worse patient outcomes and no differential improvement by sex or obesity suggest more cautious adoption of RAS.
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Affiliation(s)
- M. Schootman
- Saint Louis University, College for Public Health and Social Justice, Department of Epidemiology, 3545 Lafayette Avenue, Saint Louis, MO 63104,Alvin J. Siteman Cancer Center at Barnes-Jewish Hospital and Washington University, School of Medicine, Saint Louis, MO
| | - S. Hendren
- University of Michigan, Department of Surgery, Ann Arbor, MI
| | - T. Loux
- Saint Louis University, College for Public Health and Social Justice, Department of Biostatistics, 3545 Lafayette Avenue, Saint Louis, MO 63104
| | - K. Ratnapradipa
- Saint Louis University, College for Public Health and Social Justice, Department of Epidemiology, 3545 Lafayette Avenue, Saint Louis, MO 63104
| | - J.M. Eberth
- University of South Carolina, Arnold School of Public Health, Department of Epidemiology and Biostatistics, Columbia, SC
| | - N.O. Davidson
- Alvin J. Siteman Cancer Center at Barnes-Jewish Hospital and Washington University, School of Medicine, Saint Louis, MO,Washington University School of Medicine, Department of Medicine, Division of Gastroenterology, Saint Louis, MO
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São Julião GP, Habr-Gama A, Vailati BB, Araujo SEA, Fernandez LM, Perez RO. New Strategies in Rectal Cancer. Surg Clin North Am 2017; 97:587-604. [PMID: 28501249 DOI: 10.1016/j.suc.2017.01.008] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
In recent years, our understanding of rectal cancer has improved, including how locally advanced disease responds to chemotherapy and radiation. This has led to new innovations and advances in the treatment of rectal cancer, which includes organ-preserving strategies for responsive disease, and minimally invasive approaces for the performance of total mesorectal excision/protectomyh for persistently advanced disease. This article discusses new strategies for rectal cancer therapy, including Watch and Wait, local excision, minimally invasive proctectomy, and transanal total mesorectal excision particularly in the setting of preoperative multimodality treatment.
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Affiliation(s)
- Guilherme Pagin São Julião
- Department of Colorectal Surgery, Angelita & Joaquim Gama Institute, Rua Manoel da Nóbrega 1564, São Paulo 04001, Brazil
| | - Angelita Habr-Gama
- Department of Colorectal Surgery, Angelita & Joaquim Gama Institute, Rua Manoel da Nóbrega 1564, São Paulo 04001, Brazil
| | - Bruna Borba Vailati
- Department of Colorectal Surgery, Angelita & Joaquim Gama Institute, Rua Manoel da Nóbrega 1564, São Paulo 04001, Brazil
| | - Sergio Eduardo Alonso Araujo
- Department of Colorectal Surgery, Hospital Israelita Albert Einstein, Avenida Albert Einstein 627, Suite 219, São Paulo 05652, Brazil
| | - Laura Melina Fernandez
- Department of Colorectal Surgery, Angelita & Joaquim Gama Institute, Rua Manoel da Nóbrega 1564, São Paulo 04001, Brazil
| | - Rodrigo Oliva Perez
- Department of Colorectal Surgery, Angelita & Joaquim Gama Institute, Rua Manoel da Nóbrega 1564, São Paulo 04001, Brazil.
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Abstract
It is evident that the use of laparoscopy in the management of rectal cancer has gained popularity in the last few years. It is still, however, not widely accepted as the standard of care. Multiple randomized trials have shown that short-term outcomes and perioperative morbidity and mortality of laparoscopic proctectomy are equivalent to open surgery. However, data regarding long-term oncologic outcomes are still scarce, with only a few randomized trials reporting similar outcomes in both laparoscopic and open group. A more recent trial failed to replicate those results in patients with locally advanced rectal cancer. In this article, we will look at the most recent evidence regarding the use of laparoscopy for patients with rectal cancer. We will also briefly discuss the different approaches and new minimally invasive techniques used in this field, and we will talk about the challenges facing the widespread adoption of laparoscopic surgery in the management of rectal cancer.
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Affiliation(s)
- Chady Atallah
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Jonathan E Efron
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
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Morelli L, Di Franco G, Guadagni S, Palmeri M, Gianardi D, Bianchini M, Moglia A, Ferrari V, Caprili G, D'Isidoro C, Melfi F, Di Candio G, Mosca F. Full Robotic Colorectal Resections for Cancer Combined With Other Major Surgical Procedures: Early Experience With the da Vinci Xi. Surg Innov 2017; 24:321-327. [PMID: 28498018 DOI: 10.1177/1553350617697183] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
BACKGROUND The da Vinci Xi has been developed to overcome some of the limitations of the previous platform, thereby increasing the acceptance of its use in robotic multiorgan surgery. METHODS Between January 2015 and October 2015, 10 patients with synchronous tumors of the colorectum and others abdominal organs underwent robotic combined resections with the da Vinci Xi. Trocar positions respected the Universal Port Placement Guidelines provided by Intuitive Surgical for "left lower quadrant," with trocars centered on the umbilical area, or shifted 2 to 3 cm to the right or to the left, depending on the type of combined surgical procedure. RESULTS All procedures were completed with the full robotic technique. Simultaneous procedures in same quadrant or left quadrant and pelvis, or left/right and upper, were performed with a single docking/single targeting approach; in cases of left/right quadrant or right quadrant/pelvis, we performed a dual-targeting operation. No external collisions or problems related to trocar positions were noted. No patient experienced postoperative surgical complications and the mean hospital stay was 6 days. CONCLUSIONS The high success rate of full robotic colorectal resection combined with other surgical interventions for synchronous tumors, suggest the efficacy of the da Vinci Xi in this setting.
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Affiliation(s)
- Luca Morelli
- 1 General Surgery Unit, Department of Surgery, University of Pisa, Pisa, Italy.,2 EndoCAS (Center for Cumputer Assisted Surgery), University of Pisa, Pisa, Italy
| | - Gregorio Di Franco
- 1 General Surgery Unit, Department of Surgery, University of Pisa, Pisa, Italy
| | - Simone Guadagni
- 1 General Surgery Unit, Department of Surgery, University of Pisa, Pisa, Italy
| | - Matteo Palmeri
- 1 General Surgery Unit, Department of Surgery, University of Pisa, Pisa, Italy
| | - Desirée Gianardi
- 1 General Surgery Unit, Department of Surgery, University of Pisa, Pisa, Italy
| | - Matteo Bianchini
- 1 General Surgery Unit, Department of Surgery, University of Pisa, Pisa, Italy
| | - Andrea Moglia
- 2 EndoCAS (Center for Cumputer Assisted Surgery), University of Pisa, Pisa, Italy
| | - Vincenzo Ferrari
- 2 EndoCAS (Center for Cumputer Assisted Surgery), University of Pisa, Pisa, Italy
| | - Giovanni Caprili
- 1 General Surgery Unit, Department of Surgery, University of Pisa, Pisa, Italy
| | - Cristiano D'Isidoro
- 1 General Surgery Unit, Department of Surgery, University of Pisa, Pisa, Italy
| | - Franca Melfi
- 3 Multidisciplinary Center of Robotic Surgery, Azienda Ospedaliero-Universitaria Pisana, Pisa, Italy
| | - Giulio Di Candio
- 1 General Surgery Unit, Department of Surgery, University of Pisa, Pisa, Italy
| | - Franco Mosca
- 2 EndoCAS (Center for Cumputer Assisted Surgery), University of Pisa, Pisa, Italy
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Lorenzon L, Montebelli F, Mercantini P, Sebastiani S, Ziparo V, Ferri M. Right Colectomy for Cancer: A Matched Comparison of Three Different Surgical Approaches. J INVEST SURG 2016; 29:405-412. [DOI: 10.1080/08941939.2016.1183735] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Affiliation(s)
- Laura Lorenzon
- Surgical and Medical Department of Translational Medicine, University of Rome “La Sapienza”, St. Andrea Hospital, Rome, Italy
| | - Francesco Montebelli
- Surgical and Medical Department of Translational Medicine, University of Rome “La Sapienza”, St. Andrea Hospital, Rome, Italy
| | - Paolo Mercantini
- Surgical and Medical Department of Translational Medicine, University of Rome “La Sapienza”, St. Andrea Hospital, Rome, Italy
| | - Simone Sebastiani
- Surgical and Medical Department of Translational Medicine, University of Rome “La Sapienza”, St. Andrea Hospital, Rome, Italy
| | - Vincenzo Ziparo
- Surgical and Medical Department of Translational Medicine, University of Rome “La Sapienza”, St. Andrea Hospital, Rome, Italy
| | - Mario Ferri
- Surgical and Medical Department of Translational Medicine, University of Rome “La Sapienza”, St. Andrea Hospital, Rome, Italy
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