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Tominaga T, Yamaguchi T, Nagasaki T, Akiyoshi T, Nagayama S, Fukunaga Y, Ueno M, Konishi T. Improved oncologic outcomes with increase of laparoscopic surgery in modified complete mesocolic excision with D3 lymph node dissection for T3/4a colon cancer: results of 1191 consecutive patients during a 10-year period: a retrospective cohort study. Int J Clin Oncol 2021; 26:893-902. [PMID: 33481157 DOI: 10.1007/s10147-021-01870-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2020] [Accepted: 01/03/2021] [Indexed: 01/03/2023]
Abstract
BACKGROUND Laparoscopic modified complete mesocolic excision (mCME) with D3 lymph node dissection has been performed with increasing frequency, but the oncological safety remains unclear. This study investigated the oncological safety of laparoscopic modified CME with D3 dissection for pT3/4a M0 colon cancer. PATIENTS Consecutive patients with pT3/4a M0 colon cancer undergoing curative colectomy at a comprehensive cancer center between 2004 and 2013 were included. Outcomes were compared between early (2004-2008, n = 450) and late (2009-2014, n = 741) periods. Prognostic factors were investigated by multivariate analysis. RESULTS A total of 1191 patients were eligible. Median follow-up was 57 months. Laparoscopic surgeries were more common in the late period (early vs late: 53.6% vs. 91.8%, p < 0.01). Patients in the late period showed lower blood loss (20 mL vs. 10 mL, p < 0.01), higher number of harvested lymph nodes (18.1 vs. 21.6, p < 0.01) and fewer patients with < 12 harvested nodes (13.6% vs. 5.8%, p < 0.01). Postoperative complication rates were similar between periods (2.7% vs. 2.7%, p = 0.97). Five-year relapse-free survival rate (RFS) (75.3% vs. 82.7%, p < 0.01) and overall survival rate (OS) (86.9% vs. 91.7%, p = 0.01) were higher in the late period. Multivariate analysis revealed laparoscopic surgery as an independent favorable prognostic factor for both RFS (hazard ratio (HR) = 0.73, 95% confidence interval (CI) 0.54-0.99, p = 0.03) and OS (HR = 0.56, 95% CI 0.37-0.83, p < 0.01). CONCLUSION Improved oncologic outcomes and more frequent laparoscopic surgery during the 10-year period of the study were demonstrated for modified CME with D3 dissection, suggesting the safety of this procedure performed by experienced surgeons for pT3/4a M0 colon cancer.
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Affiliation(s)
- Tetsuro Tominaga
- Department of Gastroenterological Surgery, Cancer Institute Hospital of the Japanese Foundation for Cancer Research, Tokyo, Japan
| | - Tomohiro Yamaguchi
- Department of Gastroenterological Surgery, Cancer Institute Hospital of the Japanese Foundation for Cancer Research, Tokyo, Japan
| | - Toshiya Nagasaki
- Department of Gastroenterological Surgery, Cancer Institute Hospital of the Japanese Foundation for Cancer Research, Tokyo, Japan
| | - Takashi Akiyoshi
- Department of Gastroenterological Surgery, Cancer Institute Hospital of the Japanese Foundation for Cancer Research, Tokyo, Japan
| | - Satoshi Nagayama
- Department of Gastroenterological Surgery, Cancer Institute Hospital of the Japanese Foundation for Cancer Research, Tokyo, Japan
| | - Yosuke Fukunaga
- Department of Gastroenterological Surgery, Cancer Institute Hospital of the Japanese Foundation for Cancer Research, Tokyo, Japan
| | - Masashi Ueno
- Department of Gastroenterological Surgery, Cancer Institute Hospital of the Japanese Foundation for Cancer Research, Tokyo, Japan
| | - Tsuyoshi Konishi
- Department of Gastroenterological Surgery, Cancer Institute Hospital of the Japanese Foundation for Cancer Research, Tokyo, Japan.
- Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, 1400 Pressler Street Unit 1484, Houston, TX, 77030, USA.
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Qin M, Siyi L, Huang HF, Li Y, Gu Y, Wang W, Shan Y, Yin J, Wang YX, Cai Y, Chen JY, Jin Y, Pan LY. A Comparison of Laparoscopies and Laparotomies for Radical Hysterectomy in Stage IA1-IB1 Cervical Cancer Patients: A Single Team With 18 Years of Experience. Front Oncol 2020; 10:1738. [PMID: 32984056 PMCID: PMC7485394 DOI: 10.3389/fonc.2020.01738] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2020] [Accepted: 08/04/2020] [Indexed: 12/13/2022] Open
Abstract
Objective To investigate the safety and efficacy of abdominal radical hysterectomy (ARH) and laparoscopic radical hysterectomy (LRH) in managing early-stage cervical cancer. Methods This retrospective study comprised patients with FIGO stage IA1 with lymphovascular space invasion (LVSI), IA2, and IB1 cervical cancer who underwent radical hysterectomy performed by a single gynecologic oncology team at Peking Union Medical College Hospital from 2000–2018. The clinicopathological characteristics, surgical outcomes, and survival outcomes were compared between the two groups. Results The ARH and LRH groups consisted of 84 and 172 patients, respectively. The 5-year progression-free survival (PFS) rates were 89.3 and 95.9% in the ARH and LRH groups (P = 0.122, adjusted HR = 0.449, 95% CI: 0.162–1.239), respectively, while the 5-year overall survival (OS) rates were 95.2 and 98.8%, respectively (P = 0.578, adjusted HR = 0.650, 95% CI: 0.143–2.961). The presence of more than two comorbidities led to poor OS (P = 0.011). For patients with a BMI greater than 24 kg/m2, LRH was associated with better PFS (P = 0.039). Compared with ARH, LRH was associated with a shorter operation time (248.8 vs. 176.9 min, P < 0.001), less blood loss (670.2 vs. 200.9 ml, P < 0.001), and lower postoperative ileus rates (2.4% vs. 0%, P = 0.042). No significant differences were observed in PFS and OS between 2006–2012, 2013–2015, and 2016–2018 in the LRH group (P = 0.126 and P = 0.583). Conclusion Compared with ARH, LRH yields similar survival and improved surgical outcomes in patients with early-stage cervical cancer. LRH is not inferior to ARH for select cervical cancer patients treated by a single team with adequate laparoscopy experience.
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Affiliation(s)
- Meng Qin
- Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Li Siyi
- Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Hui-Fang Huang
- Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Yan Li
- Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Yu Gu
- Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Wei Wang
- Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Ying Shan
- Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Jie Yin
- Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Yong-Xue Wang
- Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Yan Cai
- Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Jia-Yu Chen
- Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Ying Jin
- Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Ling-Ya Pan
- Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
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Peng Y, Yang H, Ye Q, Zhou H, Zheng M, Shi Y. Inhibition of peritoneal dissemination of colon cancer by hyperthermic CO2 insufflation: A novel approach to prevent intraperitoneal tumor spread. PLoS One 2017; 12:e0172097. [PMID: 28207849 PMCID: PMC5313196 DOI: 10.1371/journal.pone.0172097] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2016] [Accepted: 01/31/2017] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND The increasing use of laparoscopic surgery for advanced gastrointestinal cancer raises concerns about intra-peritoneal tumor spread. Prevention of peritoneal dissemination is extremely important but a preventive modality is lacking. The aim of this study was to examine a novel approach (hyperthermic CO2 insufflation, HT-CO2) for preventing peritoneal dissemination during laparoscopic surgery. METHODS A peritoneal dissemination model was established in Balb/c nu/nu mice by intraperitoneal injection of human colon cancer cells (SW1116, 1×106). The mice (n = 48) were subsequently randomized into two groups and subjected to hyperthermic CO2 (43°C, >95% humidity, HT-CO2 group) or standard normothermic CO2 (21°C, <1% relative humidity, NT-CO2 group) insufflation for 3 hours. The mice were sacrificed 28 days later. The peritoneal dissemination was quantitatively analyzed by counting and weighing the peritoneal nodules. The port sites and ascites volume were measured. The peritoneal damage of HT-CO2 was histologically examined with light microscopy and scanning electron microscopy. Intra-abdominal adhesions were evaluated 4 weeks later. RESULTS The number of peritoneal nodules in the HT-CO2 group was significantly less than that in the NT-CO2 group (10.21±3.72 vs. 67.12±5.49, P<0.01). The mean weight of metastatic tumors in the HT-CO2 group was significantly lower than that in the NT-CO2 group (0.31±0.10g vs. 2.16±0.31g, P<0.01). Massive ascites were found in the NT-CO2 group while significantly less ascites developed in HT-CO2- treated mice (8.26±0.31ml vs. 1.27±0.28ml, P<0.01). No port-site metastases were detected in the HT-CO2 group while the incidence of the NT-CO2 group was 12.5% (3/24). HT-CO2 subjection resulted in slight peritoneal damage; the peritoneum returned to normal within five days. No adhesions formed after HT-CO2 treatment. CONCLUSIONS HT-CO2 can suppress peritoneal dissemination of colon cancer cells and only causes slight and transient peritoneal damage. HT-CO2 may serve as a promising adjuvant treatment for preventing peritoneal dissemination in laparoscopic resection of advanced colorectal cancer.
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Affiliation(s)
- Yuanfei Peng
- Department of Liver Surgery, Liver Cancer Institute, Zhongshan Hospital, Fudan University; Key Laboratory of Carcinogenesis and Cancer Invasion of Ministry of Education, Shanghai, China
| | - Hua Yang
- Department of Liver Surgery, Liver Cancer Institute, Zhongshan Hospital, Fudan University; Key Laboratory of Carcinogenesis and Cancer Invasion of Ministry of Education, Shanghai, China
| | - Qing Ye
- Department of Gastrointestinal Tumor Surgery, Fujian Provincial Tumor Hospital of Fujian Medical University, Fujian, China
| | - Houming Zhou
- Department of General Surgery, Shanghai Minimally Invasive Surgery Center, Institute of Digestive Surgery, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Minhua Zheng
- Department of General Surgery, Shanghai Minimally Invasive Surgery Center, Institute of Digestive Surgery, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Yinghong Shi
- Department of Liver Surgery, Liver Cancer Institute, Zhongshan Hospital, Fudan University; Key Laboratory of Carcinogenesis and Cancer Invasion of Ministry of Education, Shanghai, China
- * E-mail:
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Lingohr P, Dohmen J, Matthaei H, Schwandt T, Hong GS, Konieczny N, Bölke E, Wehner S, Kalff JC. Development of a standardized laparoscopic caecum resection model to simulate laparoscopic appendectomy in rats. Eur J Med Res 2014; 19:33. [PMID: 24934381 PMCID: PMC4094547 DOI: 10.1186/2047-783x-19-33] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2013] [Accepted: 05/20/2014] [Indexed: 01/08/2023] Open
Abstract
Background Laparoscopic appendectomy (LA) has become one of the most common surgical procedures to date. To improve and standardize this technique further, cost-effective and reliable animal models are needed. Methods In a pilot study, 30 Wistar rats underwent laparoscopic caecum resection (as rats do not have an appendix vermiformis), to optimize the instrumental and surgical parameters. A subsequent test study was performed in another 30 rats to compare three different techniques for caecum resection and bowel closure. Results Bipolar coagulation led to an insufficiency of caecal stump closure in all operated rats (Group 1, n = 10). Endoloop ligation followed by bipolar coagulation and resection (Group 2, n = 10) or resection with a LigaSure™ device (Group 3, n = 10) resulted in sufficient caecal stump closure. Conclusions We developed a LA model enabling us to compare three different caecum resection techniques in rats. In conclusion, only endoloop closure followed by bipolar coagulation proved to be a secure and cost-effective surgical approach.
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Affiliation(s)
- Philipp Lingohr
- Department of General, Visceral, Thoracic and Vascular Surgery, University of Bonn, Sigmund-Freud-Strasse 25, 53127 Bonn, Germany.
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Nakagawa M, Kojima K, Inokuchi M, Kato K, Sugita H, Kawano T, Sugihara K. Patterns, timing and risk factors of recurrence of gastric cancer after laparoscopic gastrectomy: reliable results following long-term follow-up. Eur J Surg Oncol 2014; 40:1376-82. [PMID: 24915857 DOI: 10.1016/j.ejso.2014.04.015] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2013] [Revised: 03/24/2014] [Accepted: 04/30/2014] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND To clarify the patterns, timing and risk factors of recurrence of gastric cancer after laparoscopic gastrectomy. METHODS From January 1999 to March 2012, 577 patients underwent laparoscopic or laparoscopy-assisted gastrectomy for curative resection of gastric cancer. Recurrence patterns were classified as locoregional, hematogenous, peritoneal, distant lymph node and mixed. Recurrence patterns and time to recurrence were retrospectively examined and risk factors for recurrence were analyzed. RESULTS Recurrence occurred in 28 (4.9%) cases with patterns as follows: locoregional in 2 patients (7.1%), hematogenous in seven (25.0%), peritoneal in nine (32.1%), distant lymph node in four (14.3%), and mixed in 6 (21.4%). There was no recurrence pattern peculiar to laparoscopic surgery. Recurrence occurred at one site in 21 patients (78.6%), two in 4 patients (14.3%), and three in 2 patients (7.1%). The median time to recurrence was 384 days (range 83-1497 days). Recurrence was detected within a year in 13 cases (46.4%), within two years in 21 (75%), and within three years in 25 (89.3%). Univariate analysis revealed tumor location, tumor size, type of operation, tumor depth, and lymph node classification as risk factors for recurrence. Multivariate analysis indicated tumor depth and lymph node classification as risk factors of recurrence. CONCLUSIONS Patterns, timing and risk factors of recurrence of gastric cancer after laparoscopic gastrectomy are similar to those after open gastrectomy, with no peculiarities specific to laparoscopic gastrectomy. Thus, as long as laparoscopic gastrectomy is performed according to the present inclusion criteria, follow-up can be similarly performed as for open gastrectomy.
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Affiliation(s)
- M Nakagawa
- Department of Esophagogastric Surgery, Tokyo Medical Dental University, Japan.
| | - K Kojima
- Center for Minimally Invasive Surgery, Tokyo Medical Dental University, Japan
| | - M Inokuchi
- Department of Esophagogastric Surgery, Tokyo Medical Dental University, Japan
| | - K Kato
- Department of Esophagogastric Surgery, Tokyo Medical Dental University, Japan
| | - H Sugita
- Department of Esophagogastric Surgery, Tokyo Medical Dental University, Japan
| | - T Kawano
- Department of Esophagogastric Surgery, Tokyo Medical Dental University, Japan
| | - K Sugihara
- Department of Surgical Oncology, Graduate School, Tokyo Medical Dental University, Japan
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Han C, Ding Z, Fan J, Sun J, Qian Y. Comparison of the Stress Response in Patients Undergoing Gynecological Laparoscopic Surgery Using Carbon Dioxide Pneumoperitoneum or Abdominal Wall-Lifting Methods. J Laparoendosc Adv Surg Tech A 2012; 22:330-5. [PMID: 22423956 DOI: 10.1089/lap.2011.0412] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Chuanbao Han
- Department of Anaesthesiology, Nanjing Medical University, Nanjing, China
| | - Zhengnian Ding
- Department of Anaesthesiology, Nanjing Medical University, Nanjing, China
| | - Jin Fan
- Department of Orthopaedics, The First Affiliated Hospital, Nanjing Medical University, Nanjing, China
| | - Jie Sun
- Department of Anaesthesiology, Nanjing Medical University, Nanjing, China
| | - Yanning Qian
- Department of Anaesthesiology, Nanjing Medical University, Nanjing, China
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Sun J, Jiang T, Qiu Z, Cen G, Cao J, Huang K, Pu Y, Liang H, Huang R, Chen S. Short-term and medium-term clinical outcomes of laparoscopic-assisted and open surgery for colorectal cancer: a single center retrospective case-control study. BMC Gastroenterol 2011; 11:85. [PMID: 21794159 PMCID: PMC3160957 DOI: 10.1186/1471-230x-11-85] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2010] [Accepted: 07/27/2011] [Indexed: 01/30/2023] Open
Abstract
Background Laparoscopic procedure is a rapid developed technique in colorectal surgery. In this investigation we aim at assessing the diversities of short-term and medium-term clinical outcomes of laparoscopic-assisted versus open surgery for colorectal cancer. Methods A total number of 519 patients with non-metastatic colorectal cancer were enrolled for this study. The patients underwent either laparoscopic-assisted surgery (LAP) (n = 254) or open surgery (OP) (n = 265). Surgical techniques, perioperative managements and clinical follow-ups were standardized. Short-term perioperative data and medium-term recurrence and survival were compared and analyzed between the two groups. Results There were no differences in perioperative parameters between the two groups except in regards to a trend of faster recovery in laparoscopic procedures. There was no statistically significant difference in postoperative complications, reoperation rate, or perioperative mortality. Statistically significant differences in a faster return of gastrointestinal function and shorter hospital stay were identified in favor of laparoscopic-assisted resection. In colon and rectal cancer cases separately, the overall survival, cancer-free survival and recurrence rate were similar in two groups. There was also no tendency of significant differences in overall survival, cancer-free survival and recurrence in stage I-II and stage III patients in two cancer categories between the two groups, respectively. pT, lymph node metastasis, and clinical stage were independent predictors of overall death risk, while pT, pN, lymph node metastasis and clinical stage were found to be the independent predictors of recurrence risk in enrolled patients database. Conclusions Laparoscopic-assisted procedure has more benefits on postoperative recovery, while has the same effects on medium-term recurrence and survival compared with open surgery in the treatment of non-metastatic colorectal cancer.
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Affiliation(s)
- Jing Sun
- Department of General Surgery, Rui Jin Hospital, Shanghai Jiao Tong University School of Medicine, 197 Rui Jin Er Road, Shanghai, 200025, China
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Fuganti PE, Rodrigues Júnior AJ, Rodrigues CJ, Sato M. A comparison of the effects of pneumoperitoneum and laparotomy on natural killer cell mediated cytotoxicity and Walker tumor growth in Wistar rats. Surg Endosc 2008; 20:1858-61. [PMID: 17031748 DOI: 10.1007/s00464-005-0189-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2005] [Accepted: 07/06/2005] [Indexed: 11/27/2022]
Abstract
BACKGROUND Surgical stress promotes impaired immunological function, which contributes to tumor growth. Natural killer activity (NKA) has a protective role in immunity to tumors. So, the aim of this experimental study was to assess tumor growth and (NKA) after pneumoperitoneum and laparotomy. METHODS; Sixty male Wistar rats were divided into three groups (anesthesia, CO2 pneumoperitoneum and laparotomy) plus ten controls. All experimental animals were inoculated subcutaneously with 8 x 105 Walker carcinosarcoma 256 cells. Animals were sacrificed on 1st(POD1) and 8th (POD8) postoperative day. Tumors were excised and weighed. RESULTS On POD1 all animals had diminished NKA when compared to controls; NKA after pneumoperitoneum was significantly greater than after laparotomy. On POD8 all animals, except after laparotomy, reached NKA at controls levels. Tumor weight was significantly greater after laparotomy when compared to pneumoperitoneum. CONCLUSIONS Pneumoperitoneum causes a less depressed NKA and less tumor growth when compared to laparotomy.
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Canis M, Farina M, Jardon K, Rabischong B, Rivoire C, Nohuz E, Botchorishvili R, Pouly JL, Mage G. Cœlioscopie et cancer en gynécologie : le point en 2005. ACTA ACUST UNITED AC 2006; 35:117-35. [PMID: 16575358 DOI: 10.1016/s0368-2315(06)76386-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
All the surgical procedures, which may be required to treat a gynecologic cancer, can be performed endoscopically. However prospective randomized studies required to confirm the oncologic efficacy of the technique are still lacking in gynecology, whereas such studies are available in digestive surgery. Animal studies suggested that the risk of tumor dissemination in non traumatized peritoneum is higher after a pneumoperitoneum than after a laparotomy. Experimental studies also emphasized two points: the surgeon and the surgical technique are essential, all the parameters of the pneumoperitoneum may influence the postoperative dissemination. Changing these parameters we may, in the future, be able to create a peritoneal environment adapted to oncologic patients in order to prevent or to decrease the risks of peritoneal dissemination and/or of postoperative tumor growth. Until the results of prospective randomized studies become available, the preoperative selection of the patients and the surgical technique should be very strict. In patients with endometrial cancer, the laparoscopic approach should be reserved to clinical stage I disease, if the vaginal extraction is anticipated to be easy accounting for the volume of the uterus and the local conditions. In cervical cancer, the laparoscopic approach should be reserved to patients with favorable prognostic factors: stage IB of less than 2 cm in diameter. Laparoscopy is the gold standard for the surgical diagnosis of adnexal masses. But the puncture should be avoided whenever possible. The surgical treatment of invasive ovarian cancer should be performed by laparotomy whatever the stage. In contrast restaging of an early ovarian cancer initially managed as a benign mass, is a good indication of the laparoscopic approach. The laparoscopic management of low malignant potential tumors should include a complete staging of the peritoneum. Knowledge of the principles of endoscopy and of oncologic surgery is required. Teaching and diffusion of endoscopic oncological techniques are among the major challenges of gynecologic surgery within the next few years.
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Affiliation(s)
- M Canis
- Département de Gynécologie Obstétrique et Médecine de la Reproduction, CHU de Clermont-Ferrand, Polyclinique de l'Hôtel-Dieu, boulevard Léon-Malfreyt, 63058 Clermont-Ferrand
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Ng CSH, Whelan RL, Lacy AM, Yim APC. Is minimal access surgery for cancer associated with immunologic benefits? World J Surg 2005; 29:975-81. [PMID: 15981046 DOI: 10.1007/s00268-005-0029-6] [Citation(s) in RCA: 50] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Minimal-access surgical techniques have been shown to be beneficial to patients in terms of shorter convalescence, reduced pain, and improved cosmesis. Although systemic immune function is better preserved following laparoscopic procedures when compared with their respective open approaches, CO2 pneumoperitoneum may significantly affect local (i.e., infra-abdominal) cellular immunity by reducing regional macrophage function. Results to date are conflicting with regard to the impact of closed and open methods on intraabdominal immunity. Impaired cellular immunity after CO2 pneumoperitoneum may have significant undesirable intra-abdominal effects on tumor surveillance after oncological surgery; however, at present, there is no clinical evidence to support this position. The VATS techniques avoid the use of CO2 insufflation, which may offer some advantages from the immune function perspective over laparoscopic procedures accomplished with CO2 pneumoperitoneum. Better preservation of early postoperative cellular immune function and attenuated disturbance in the inflammatory mediators are likely contributing factors to the clinical benefits that follow laparoscopic surgery and VATS. Larger multi-center randomized trials are needed to confirm the potential benefits of minimal-access surgery on patient survival after cancer surgery. Future research should focus on the effects of minimal-access surgery on other mediators (such as MMP-9, IGFBP-3, IL-12, IL-17, and IL-23) that may be important in tumor cell dissemination, deposition, and propagation in the early postoperative period. Furthermore, additional searches for other factors or mediators, heretofore unrecognized, should be carried out. Such studies will, we hope, increase our knowledge and understanding of the impact of surgery on immune and other physiologic functions.
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Affiliation(s)
- Calvin S H Ng
- Division of Cardiothoracic Surgery, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, N.T., Hong Kong
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