1
|
Saia M, Buja A, Mantoan D, Sartor G, Agresta F, Baldo V. Isolated rectal cancer surgery: a 2007-2014 population study based on a large administrative database. Updates Surg 2017; 69:367-373. [PMID: 28409441 DOI: 10.1007/s13304-017-0445-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2016] [Accepted: 04/03/2017] [Indexed: 12/11/2022]
Abstract
Rectal resection is technically one of the most demanding laparoscopic procedures, requiring additional training and expertise of both surgeons and institutions. The literature has shown that laparoscopic procedures can be appropriate for the treatment of rectal cancer (RC), in terms of safety, outcome and efficiency, but results may not always be directly transferable to the general population. This study aimed to investigate the use of laparoscopic rectal cancer resections in a north-eastern Italian region (the Veneto) and to see how the characteristics of patients and hospitals are associated with the use of laparoscopy. This was a retrospective cohort study based on administrative data collected from 2007 to 2014 in the Veneto region (north-east Italy). In the period considered (2007-2014), 4953 rectal resections were performed for RC in Veneto hospitals, accounting for 35% of the total 14,243 surgical procedures involving the rectum, and resulting in 76,739 days in hospital [mean length of stay-post-operative (MLOS) 15.5 ± 11.1 days]. Patients were a mean 67.9 ± 11.7 years old (68 ± 12.7 for women, 67.9 ± 11 for men), while the subgroup of patients undergoing laparoscopic procedures was on average 2 years younger (66.5 ± 11.8 vs 68.8 ± 11.5; p < 0.05). The four main findings of this study are: (1) the increasing rates of laparoscopic procedures for RC resection at all the hospitals in our geographical area, rising up to 52% in 2014. This is probably related to not only to availability of better equipment but surely to a growing expertise of surgeons; (2) the esteem of proportion of laparoscopically treated RC; (3) the significant difference between the laparoscopic and open surgical approach in terms of mean length of hospital stay after RC resection, making the laparoscopic approach cost-effective generally speaking; and (4) the disparities in hospitals' use of laparoscopy by patients' age group: Laparoscopic surgery is safe also in the elderly population but it is not so widely offers in Veneto Region hospitals, and it's probably due to the lack of experience about this approach in frail/old patients.
Collapse
Affiliation(s)
- Mario Saia
- Veneto Region Health Directorate, Venice, Italy
| | - Alessandra Buja
- Department of Molecular Medicine, Laboratory of Public Health and Population StudiesUniversity of Padua, Padua, Italy
| | | | - Gino Sartor
- Department of Molecular Medicine, Laboratory of Public Health and Population StudiesUniversity of Padua, Padua, Italy
| | - Ferdinando Agresta
- Department of General Surgery, ULSS 5 Polesana del Veneto, Adria, RO, Italy.
| | - Vincenzo Baldo
- Department of Molecular Medicine, Laboratory of Public Health and Population StudiesUniversity of Padua, Padua, Italy
| |
Collapse
|
2
|
Sikorszki L, Temesi R, Liptay-Wagner P, Bezsilla J, Botos A, Vereczkei A, Horvath ÖP. Case–matched comparison of short and middle term survival after laparoscopic versus open rectal and rectosigmoid cancer surgery. Eur Surg 2015. [DOI: 10.1007/s10353-015-0358-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
|
3
|
Li S, Jiang F, Tu J, Zheng X. Long-Term Oncologic Outcomes of Laparoscopic versus Open Surgery for Middle and Lower Rectal Cancer. PLoS One 2015; 10:e0135884. [PMID: 26335944 PMCID: PMC4559379 DOI: 10.1371/journal.pone.0135884] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2015] [Accepted: 07/27/2015] [Indexed: 02/07/2023] Open
Abstract
Background Laparoscopic surgery for middle and lower rectal cancer remain controversial because anatomical and complex surgical procedures specifically influence oncologic outcomes. This study analyzes the long-term outcomes of laparoscopic versus open surgery for middle and lower rectal cancer. Methods Patients (laparoscopic: n = 129, open: n = 152) who underwent curative resection for middle and lower rectal cancer from 2003 to 2008 participated in the study. The same surgical team performed all operations. The mean follow up time of all patients was 74.3 months. Results No statistical difference in local recurrence rate (7.8% vs. 7.2%; log-rank = 0.024; P = 0.876) and distant recurrence rate (20.9% vs.16.4%; log-rank = 0.699; P = 0.403) between laparoscopic and open groups were observed within 5 years. The 5-year overall survival rates of the laparoscopic and open groups were 72.9% and 75.7%, respectively; no significant statistical difference was observed between them (log-rank = 0.163; P = 0.686). The 5-year survival rates between groups were not different between stages: Stage I (92.6% vs. 86.7%; log-rank = 0.533; P = 0.465); stage II (75.8% vs. 80.5%; log-rank = 0.212; P = 0.645); and Stage III (63.8% vs. 69.1%, log-rank = 0272;P = 0.602). However, significant statistical difference amongst different stages were observed (log-rank = 1.802; P = 0.003). Conclusion Laparoscopic and open surgery for middle and lower rectal cancer offer equivalent long-term oncologic outcomes. Laparoscopic surgery is feasible in these patients.
Collapse
Affiliation(s)
- Shaotang Li
- Department of General Surgery, the First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejian, People’s Republic of China
| | - Feizhao Jiang
- Department of General Surgery, the First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejian, People’s Republic of China
| | - Jingfu Tu
- Department of General Surgery, the First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejian, People’s Republic of China
| | - Xiaofeng Zheng
- Department of General Surgery, the First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejian, People’s Republic of China
- * E-mail:
| |
Collapse
|
4
|
Swaid F, Sroka G, Madi H, Shteinberg D, Somri M, Matter I. Totally laparoscopic versus laparoscopic-assisted left colectomy for cancer: a retrospective review. Surg Endosc 2015; 30:2481-8. [DOI: 10.1007/s00464-015-4502-5] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2015] [Accepted: 08/03/2015] [Indexed: 12/20/2022]
|
5
|
Musselman RP, Gomes T, Chan BP, Auer RC, Moloo H, Mamdani M, Al-Omran M, Al-Obeed O, Boushey RP. Changing trends in rectal cancer surgery in Ontario: 2002-2009. Colorectal Dis 2012; 14:1467-72. [PMID: 22487101 DOI: 10.1111/j.1463-1318.2012.03044.x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
AIM The safety and efficacy of laparoscopic surgery for colon cancer have been demonstrated in large, multicentre clinical trials. The study aimed to determine the use of laparoscopic surgery for rectal cancer in Ontario over a 7-year period. METHOD We conducted a retrospective study examining rates of elective rectal cancer surgery among 10.5 million adults in Ontario, Canada, from 1 April 2002 to 31 March 2009. We linked the Canadian Institute for Health Information Discharge Abstract Database, the Registered Persons Database and the database of the Ontario Cancer Registry to assess procedures used over the period. Data on demographics were collected. Trends were assessed using time series analysis. RESULTS Over the 7-year period, 8189 open and 1079 laparoscopic elective operations for rectal cancer were identified. The annual rate of laparoscopic rectal cancer procedures increased from 0.60 per 100,000 population in 2003 to 2.24 per 100,000 population in 2008 (P < 0.01). Laparoscopic patients were similar to open with respect to age (66.5 ± 11.8 vs 66.2 ± 12.1 years; standardized difference 0.02), gender (63.2%vs 59.4%; standardized difference 0.08), Charlson Comorbidity Index score (standardized difference < 0.1) and socioeconomic status (standardized difference < 0.1). CONCLUSION Laparoscopic rectal cancer surgery rates are increasing in Ontario. Ongoing research regarding the long-term safety and effectiveness of the laparoscopic approach for rectal cancer surgeries may lead to greater increases in its utilization.
Collapse
Affiliation(s)
- R P Musselman
- Department of Surgery, University of Ottawa, Ottawa, Ontario, Canada.
| | | | | | | | | | | | | | | | | |
Collapse
|
6
|
Westerholm J, Garcia-Osogobio S, Farrokhyar F, Cadeddu M, Anvari M. Midterm outcomes of laparoscopic surgery for rectal cancer. Surg Innov 2012; 19:81-8. [PMID: 22604576 DOI: 10.1177/1553350611415868] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
In this study, the authors examine midterm survival and recurrence after laparoscopic and open surgery for rectal cancer. This is a retrospective review of a prospective database for rectal cancer surgeries performed at the authors' institution, with follow-up data obtained through chart review. In all, 74 patients in this study had open surgery, and 93 had laparoscopic surgery. The 5-year overall survival was 73.6% ± 12.0% in the open group and 80.0% ± 12.8% in the laparoscopic group (P = .159). Disease-free survival at 5 years was better in the laparoscopic group (71.0% ± 13.4%) than in the open group (50.3% ± 12.7%), with a P value of .01. Laparoscopic surgery remained an independent predictor of disease-free survival in the multivariate analysis. Results of prospective randomized trials are awaited, and the authors expect that the laparoscopic approach will be shown to be a safe and effective option for the management of rectal cancer.
Collapse
|
7
|
Roscio F, Bertoglio C, De Luca A, Frattini P, Scandroglio I. Totally laparoscopic versus laparoscopic assisted right colectomy for cancer. Int J Surg 2012; 10:290-5. [PMID: 22564829 DOI: 10.1016/j.ijsu.2012.04.020] [Citation(s) in RCA: 50] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2012] [Revised: 04/28/2012] [Accepted: 04/28/2012] [Indexed: 12/31/2022]
Abstract
INTRODUCTION Colorectal cancer (CRC) is one of the leading causes of cancer death all over the world and right-sided colon cancer represents approximately 15% of all cases of CRC. Laparoscopic colectomies produce advantages in short-term outcome compared to open procedures and have recently benefited by a long term oncologic validation. This study was designed to compare the short- and medium-term surgical outcomes of totally laparoscopic (TLRC) and laparoscopic-assisted right colectomy (LARC) for neoplasia, hypothesizing they may be at least similar. METHODS A consecutive unselected series of 72 patients undergone elective surgery for right-sided colon cancer from April 2006 to April 2011 was retrospectively evaluated. All patients were treated by laparoscopic medial-to-lateral right colectomy. In 42 patients a TLRC was performed, in 30 a LARC. Perioperative care plan, operative steps and surgical instrumentations were standardized. All the operations were performed or supervised by the same Surgeon (I.S.). Data on the patients' demographics, disease features, operative details and follow up were recorded and analyzed. Complications were classified using the Clavien-Dindo classification system. Continuous variables were expressed as mean ± standard deviation and analyzed with the Student t test. Categorical ones were expressed as percent value and analyzed with Fischer test or Chi-square test, where appropriate. P < 0.05 were considered statistically significant. RESULTS There was no significant difference in term of age, sex, body mass index and American Society of Anesthesiology score between the two groups. Comorbidities, site of tumor and stage of disease were similar too. No conversion to laparotomy was registered. Median operative time (186.3 ± 40.1 min vs 176.5 ± 40.0 min; not significant (NS)) and estimated blood loss (43.3 ± 89.8 ml vs 31.2 ± 51.3 ml; NS) were statistically comparable in both groups. Timing of first defecation (3.4 ± 0.9 dd vs 2.9 ± 0.9; P = 0.023) and length of hospital stay (7.2 ± 1.3 dd vs 6.2 ± 1.1 dd; P < 0.001) were statistically lower in TLRC cohort. A significantly longer length of skin incision characterized LARC group compared with TLRC group (71.0 ± 13.5 mm vs 48.2 ± 10.2 mm; P < 0.001). Both groups achieved an adequate number of lymph nodes harvested (22.0 ± 8.2 vs 25.9 ± 9.0; P = 0.036) and oncological resection of the tumor (proximal margin 7.6 ± 7.7 vs 6.1 ± 3.8; NS - distal margin 13.3 ± 7.7 vs 13.6 ± 5.8; NS). Post-operative complications according to Clavien-Dindo classification were statistically comparable in both cohorts. No readmission within 60 days of discharge was observed. The mean follow-up recorded was 27.7 ± 16.6 months. Late complications consisted in 1 case of incisional hernia (3.8%) in LARC group. CONCLUSIONS Although more appropriate indications must be set by future studies, we encourage the choice of a TLRC for the treatment of cancer of the right colon. TLRC is actually a feasible and safe technique, which has resulted in an encouraging short-term outcome, low incidence of major complications and preservation of oncologic principles, without affecting operative times.
Collapse
Affiliation(s)
- Francesco Roscio
- Department of General Surgery, Galmarini Hospital, Tradate, Italy.
| | | | | | | | | |
Collapse
|
8
|
Li S, Chi P, Lin H, Lu X, Huang Y. Long-term outcomes of laparoscopic surgery versus open resection for middle and lower rectal cancer: an NTCLES study. Surg Endosc 2011; 25:3175-82. [PMID: 21487864 DOI: 10.1007/s00464-011-1683-4] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2010] [Accepted: 03/11/2011] [Indexed: 12/23/2022]
Abstract
BACKGROUND Prognoses for treatment of middle and lower rectal cancer remain unclear because anatomical and complex surgical procedures specifically influence long-term outcomes. This study analyzes the long-term outcomes of laparoscopic versus open resection for middle and lower rectal cancer. METHODS Patients (laparoscopic, n = 113; open, n = 123) who underwent curative resection for middle and lower rectal cancer from 2000 to 2005 participated in the study. All operations were performed by the same surgical team with extensive experience in laparoscopic and open procedures. The mean follow-up time of all patients was 74.8 months. RESULTS No statistical differences in local recurrence rate (9.1% vs. 6.4%; log-rank = 0.432; p = 0.511) and in distant recurrence rate (19.7% vs. 15.5%; log-rank = 0.505; p = 0.477) between laparoscopic and open groups were observed within 5 years. The 5-year overall survival rates of the laparoscopic and open groups were 77.9 and 78.9%, respectively; no significant statistical difference was observed between them (log-rank = 0.012; p = 0.913). The 5-year survival rates between groups were not different between stages: stage I (91.7% vs. 92.0%; p = 0.950), stage II (82.8% vs. 79.4%; p = 0.643), and stage III (66.7% vs. 70.3%; p = 0.850). However, significant statistical differences between different stages were observed (log-rank = 11.156; p = 0.004). CONCLUSION Laparoscopic and open surgery for middle and lower rectal cancer offer similar long-term outcomes. The continued use of laparoscopic surgery in these patients can be supported.
Collapse
Affiliation(s)
- Shaotang Li
- Department of Colorectal and Anal Surgery, Fujian Medical University Union Hospital, Fuzhou, Fujian, People's Republic of China
| | | | | | | | | |
Collapse
|
9
|
Kahokehr A, Sammour T, Zargar-Shoshtari K, Srinivasa S, Hill AG. Recovery after open and laparoscopic right hemicolectomy: a comparison. J Surg Res 2010; 162:11-6. [PMID: 20452623 DOI: 10.1016/j.jss.2010.02.008] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2009] [Revised: 01/17/2010] [Accepted: 02/08/2010] [Indexed: 01/04/2023]
Abstract
BACKGROUND Enhanced Recovery after Surgery (ERAS) programs have gained popularity with potential to accelerate recovery and reduce morbidity after colectomy. We were interested in comparing recovery after open right colectomy within an ERAS program compared with laparoscopic right colectomy in a standard care perioperative environment. METHODS Between October 2005 and June 2009, prospective data were collected on consecutive patients undergoing elective open right colectomy within an established ERAS setting (OpERAS). Similarly, between March 2008 and June 2009, data were collected on consecutive patients undergoing laparoscopic right hemicolectomy with conventional care (LapCon). Exclusion criteria for both groups were: ASA >or= 4, formation of a stoma, and dementia or mental illness rendering the patient unable to comply with instructions. Perioperative variables were collected. The surgical recovery score (SRS) was used as a validated means to measure convalescence on d 1, 3, 7, 30, and 60 postoperatively. RESULTS There were 74 patients in the OpERAS and 39 patients in the LapCon groups. At baseline, there were no significant demographic differences except that more patients had malignancy in OpERAS group. Mean operating time was longer in the LapCon group. Median day stay was 4 (3-28) in OpERAS and 5 (2-18) in LapCon (P = 0.032). There was no statistical difference in the incidence of complications or the severity of complications. There were no significant differences in SRS after surgery at any time point. CONCLUSION When perioperative care is optimized, recovery after elective open right hemicolectomy is comparable with laparoscopic resection. Studies looking at the combination of laparoscopy and ERAS are warranted.
Collapse
Affiliation(s)
- Arman Kahokehr
- Department of Surgery, University of Auckland, Middlemore Hospital, Otahuhu, Auckland, New Zealand.
| | | | | | | | | |
Collapse
|
10
|
|
11
|
Laparoscopic surgery for the curative treatment of rectal cancer: results of a Chinese three-center case–control study. Surg Endosc 2008; 23:854-61. [DOI: 10.1007/s00464-008-9990-0] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2008] [Revised: 05/02/2008] [Accepted: 05/05/2008] [Indexed: 01/10/2023]
|