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Ma L, Yu H, Zhu Y, Li W, Xu K, Zhao A, Ding L, Gao H. Laparoscopy is non-inferior to open surgery for rectal cancer: A systematic review and meta-analysis. Cancer Med 2024; 13:e7363. [PMID: 38970275 PMCID: PMC11226727 DOI: 10.1002/cam4.7363] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2023] [Revised: 05/19/2024] [Accepted: 05/27/2024] [Indexed: 07/08/2024] Open
Abstract
BACKGROUND Laparoscopic surgery has been endorsed by clinical guidelines for colon cancer, but not for rectal cancer on account of unapproved oncologic equivalence with open surgery. AIMS We started this largest-to-date meta-analysis to comprehensively evaluate the safety and efficacy of laparoscopy in the treatment of rectal cancer compared with open surgery. MATERIALS & METHODS Both randomized and nonrandomized controlled trials comparing laparoscopic proctectomy and open surgery between January 1990 and March 2020 were searched in PubMed, Cochrane Library and Embase Databases (PROSPERO registration number CRD42020211718). The data of intraoperative, pathological, postoperative and survival outcomes were compared between two groups. RESULTS Twenty RCTs and 93 NRCTs including 216,615 patients fulfilled the inclusion criteria, with 48,888 patients received laparoscopic surgery and 167,727 patients underwent open surgery. Compared with open surgery, laparoscopic surgery group showed faster recovery, less complications and decreased mortality within 30 days. The positive rate of circumferential margin (RR = 0.79, 95% CI: 0.72 to 0.85, p < 0.0001) and distal margin (RR = 0.75, 95% CI: 0.66 to 0.85 p < 0.0001) was significantly reduced in the laparoscopic surgery group, but the completeness of total mesorectal excision showed no significant difference. The 3-year and 5-year local recurrence, disease-free survival and overall survival were all improved in the laparoscopic surgery group, while the distal recurrence did not differ significantly between the two approaches. CONCLUSION Laparoscopy is non-inferior to open surgery for rectal cancer with respect to oncological outcomes and long-term survival. Moreover, laparoscopic surgery provides short-term advantages, including faster recovery and less complications.
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Affiliation(s)
- Ling Ma
- Department of Gastrointestinal Tumor SurgeryBeijing Shijitan Hospital Affiliated to Capital Medical UniversityBeijingPeople's Republic of China
| | - Hai‐jiao Yu
- Department of Gastrointestinal Tumor SurgeryBeijing Shijitan Hospital Affiliated to Capital Medical UniversityBeijingPeople's Republic of China
| | - Yu‐bing Zhu
- Department of Gastrointestinal Tumor SurgeryBeijing Shijitan Hospital Affiliated to Capital Medical UniversityBeijingPeople's Republic of China
| | - Wen‐xia Li
- Department of Gastrointestinal Tumor SurgeryBeijing Shijitan Hospital Affiliated to Capital Medical UniversityBeijingPeople's Republic of China
| | - Kai‐yu Xu
- Department of Gastrointestinal Tumor SurgeryBeijing Shijitan Hospital Affiliated to Capital Medical UniversityBeijingPeople's Republic of China
| | - Ai‐min Zhao
- Department of Gastrointestinal Tumor SurgeryBeijing Shijitan Hospital Affiliated to Capital Medical UniversityBeijingPeople's Republic of China
| | - Lei Ding
- Department of Gastrointestinal Tumor SurgeryBeijing Shijitan Hospital Affiliated to Capital Medical UniversityBeijingPeople's Republic of China
| | - Hong Gao
- Department of Gastrointestinal Tumor SurgeryBeijing Shijitan Hospital Affiliated to Capital Medical UniversityBeijingPeople's Republic of China
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Li J, Kong XX, Zhou JJ, Song YM, Huang XF, Li GH, Ying XJ, Dai XY, Lu M, Jiang K, Fu DL, Li XL, He JJ, Wang JW, Sun LF, Xu D, Xu JY, Chen M, Tian Y, Li JS, Yan M, Yuan Y, Ding KF. Fast-track multidisciplinary treatment versus conventional treatment for colorectal cancer: a multicenter, open-label randomized controlled study. BMC Cancer 2019; 19:988. [PMID: 31647032 PMCID: PMC6806550 DOI: 10.1186/s12885-019-6188-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2018] [Accepted: 09/23/2019] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Laparoscopic surgery, fast-track perioperative treatment and XELOX chemotherapy are effective strategies for shortening the duration of hospital stay for cancer patients. This trial aimed to clarify the safety and efficacy of the fast-track multidisciplinary treatment (FTMDT) model compared to conventional surgery combined with chemotherapy in Chinese colorectal cancer patients. METHODS This trial was a prospective randomized controlled study with a 2 × 2 balanced factorial design and was conducted at six hospitals. Patients in group 1 (FTMDT) received fast-track perioperative treatment and XELOX adjuvant chemotherapy. Patients in group 2 (conventional treatment) received conventional perioperative treatment and mFOLFOX6 adjuvant chemotherapy. Subgroups 1a and 2a had laparoscopic surgery and subgroups 1b and 2b had open surgery. The primary endpoint was total length of hospital stay during treatment. RESULTS A total of 374 patients were randomly assigned to the four subgroups, and 342 patients were finally analyzed, including 87 patients in subgroup 1a, 85 in subgroup 1b, 86 in subgroup 2a, and 84 in subgroup 2b. The total hospital stay of group 1 was shorter than that of group 2 [13 days, (IQR, 11-17 days) vs. 23.5 days (IQR, 15-42 days), P = 0.0001]. Compared to group 2, group 1 had lower surgical costs, fewer in-hospital complications and faster recovery (all P < 0.05). Subgroup 1a showed faster surgical recovery than that of subgroup 1b (all P < 0.05). There was no difference in 5-year overall survival between groups 1 and 2 [87.1% (95% CI, 80.7-91.5%) vs. 87.1% (95% CI, 80.8-91.4%), P = 0.7420]. CONCLUSIONS The FTMDT model, which integrates laparoscopic surgery, fast-track treatment, and XELOX chemotherapy, was the superior model for enhancing the recovery of Chinese patients with colorectal cancer. TRIAL REGISTRATION ClinicalTrials.gov: NCT01080547 , registered on March 4, 2010.
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Affiliation(s)
- Jun Li
- Department of Colorectal Surgery and Cancer Institute (Key Laboratory of Cancer Prevention and Intervention, China National Ministry of Education; Key Laboratory of Molecular Biology in Medical Sciences, Zhejiang Province, China), the Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, China
| | - Xiang-Xing Kong
- Department of Colorectal Surgery and Cancer Institute (Key Laboratory of Cancer Prevention and Intervention, China National Ministry of Education; Key Laboratory of Molecular Biology in Medical Sciences, Zhejiang Province, China), the Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, China
| | - Jiao-Jiao Zhou
- Department of Colorectal Surgery and Cancer Institute (Key Laboratory of Cancer Prevention and Intervention, China National Ministry of Education; Key Laboratory of Molecular Biology in Medical Sciences, Zhejiang Province, China), the Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, China
| | - Yong-Mao Song
- Department of Colorectal Surgery and Cancer Institute (Key Laboratory of Cancer Prevention and Intervention, China National Ministry of Education; Key Laboratory of Molecular Biology in Medical Sciences, Zhejiang Province, China), the Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, China
| | - Xue-Feng Huang
- Department of Anus and Large Intestine, Sir Run Shaw Hospital, Zhejiang University College of Medicine, No. 3 East Qingchun Road, Hangzhou, 310016, Zhejiang Province, China
| | - Gen-Hai Li
- Department of Anus and Large Intestine, People's Hospital of Yuyao, 800 City Road East, Yuyao, 315400, Zhejiang Province, China
| | - Xiao-Jiang Ying
- Department of Anorectum, People's Hospital of Shaoxing, 568 Zhong-Xing North Rd, Shaoxing, 312000, Zhejiang Province, China
| | - Xiao-Yu Dai
- Department of Anus and Large Intestine, Ningbo No. 2 Hospital, No. 41 Northwest Road, Ningbo, 315010, Zhejiang Province, China
| | - Min Lu
- Department of Anus and Large Intestine, Second Affiliated Hospital, Wenzhou Medicine College, 109 Xue-Yuan West Rd, Wenzhou, 325027, Zhejiang Province, China
| | - Kai Jiang
- Department of Colorectal Surgery and Cancer Institute (Key Laboratory of Cancer Prevention and Intervention, China National Ministry of Education; Key Laboratory of Molecular Biology in Medical Sciences, Zhejiang Province, China), the Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, China
| | - Dong-Liang Fu
- Department of Colorectal Surgery and Cancer Institute (Key Laboratory of Cancer Prevention and Intervention, China National Ministry of Education; Key Laboratory of Molecular Biology in Medical Sciences, Zhejiang Province, China), the Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, China
| | - Xin-Lin Li
- Department of Colorectal Surgery and Cancer Institute (Key Laboratory of Cancer Prevention and Intervention, China National Ministry of Education; Key Laboratory of Molecular Biology in Medical Sciences, Zhejiang Province, China), the Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, China
| | - Jin-Jie He
- Department of Colorectal Surgery and Cancer Institute (Key Laboratory of Cancer Prevention and Intervention, China National Ministry of Education; Key Laboratory of Molecular Biology in Medical Sciences, Zhejiang Province, China), the Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, China
| | - Jian-Wei Wang
- Department of Colorectal Surgery and Cancer Institute (Key Laboratory of Cancer Prevention and Intervention, China National Ministry of Education; Key Laboratory of Molecular Biology in Medical Sciences, Zhejiang Province, China), the Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, China
| | - Li-Feng Sun
- Department of Colorectal Surgery and Cancer Institute (Key Laboratory of Cancer Prevention and Intervention, China National Ministry of Education; Key Laboratory of Molecular Biology in Medical Sciences, Zhejiang Province, China), the Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, China
| | - Dong Xu
- Department of Colorectal Surgery and Cancer Institute (Key Laboratory of Cancer Prevention and Intervention, China National Ministry of Education; Key Laboratory of Molecular Biology in Medical Sciences, Zhejiang Province, China), the Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, China
| | - Jing-Yan Xu
- Department of Anesthesiology, Second Affiliated Hospital, Zhejiang University School of Medicine, No. 88 Jiefang Road, Hangzhou, 310009, Zhejiang Province, China
| | - Min Chen
- Department of Anus and Large Intestine, Sir Run Shaw Hospital, Zhejiang University College of Medicine, No. 3 East Qingchun Road, Hangzhou, 310016, Zhejiang Province, China
| | - Yu Tian
- Engineering Research Center of EMR and Intelligent Expert System, Ministry of Education, Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, College of Biomedical Engineering and Instrument Science, Zhejiang University, No. 38 Zheda Road, Hangzhou, 310027, Zhejiang, China
| | - Jing-Song Li
- Engineering Research Center of EMR and Intelligent Expert System, Ministry of Education, Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, College of Biomedical Engineering and Instrument Science, Zhejiang University, No. 38 Zheda Road, Hangzhou, 310027, Zhejiang, China
| | - Min Yan
- Department of Anesthesiology, Second Affiliated Hospital, Zhejiang University School of Medicine, No. 88 Jiefang Road, Hangzhou, 310009, Zhejiang Province, China
| | - Ying Yuan
- Department of Medical Oncology, Second Affiliated Hospital, and The Key Laboratory of Cancer Prevention and Intervention, China National Ministry of Education, Zhejiang University School of Medicine, No. 88 Jiefang Road, Hangzhou, 310009, Zhejiang Province, China
| | - Ke-Feng Ding
- Department of Colorectal Surgery and Cancer Institute (Key Laboratory of Cancer Prevention and Intervention, China National Ministry of Education; Key Laboratory of Molecular Biology in Medical Sciences, Zhejiang Province, China), the Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, China.
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Cleary RK, Morris AM, Chang GJ, Halverson AL. Controversies in Surgical Oncology: Does the Minimally Invasive Approach for Rectal Cancer Provide Equivalent Oncologic Outcomes Compared with the Open Approach? Ann Surg Oncol 2018; 25:3587-3595. [DOI: 10.1245/s10434-018-6740-y] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2018] [Indexed: 12/15/2022]
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Li J, Yi CH, Hu YT, Li JS, Yuan Y, Zhang SZ, Zheng S, Ding KF. TNM Staging of Colorectal Cancer Should be Reconsidered According to Weighting of the T Stage: Verification Based on a 25-Year Follow-Up. Medicine (Baltimore) 2016; 95:e2711. [PMID: 26871810 PMCID: PMC4753906 DOI: 10.1097/md.0000000000002711] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
The gradient monotonicity of existing tumor, node, metastases staging systems for colorectal cancer is unsatisfactory. Our proposed T-plus staging system strengthens weighting of the T stage. In this study, applicability of the T-plus staging system was verified with data of a Chinese colorectal cancer center.Records of 2080 nonmetastatic, advanced cancer patients undergoing colorectal cancer surgery from 1985 to 2011 were reviewed for T, N stage pathology and follow-up information. Using overall and disease-specific survival data, the 7th edition tumor, node, metastases staging system and the T-plus staging system were compared for stage homogeneity and discrimination and gradient monotonicity.For gradient monotonicity, the T-plus staging system was superior for both colon and rectal cancer. With Kaplan-Meier survival curves, the T-plus staging system discriminated among different stages, and the corresponding survival was inversely associated with the stage. However, for the 7th edition tumor, node, metastases staging system, stage IIIa had a better prognosis than stage II for rectal cancer and stage I for colon cancer. For homogeneity within the same stage and discrimination between different stages, the 2 staging systems were similar for colorectal cancer, but the T-plus system was clearly better for colon cancer.The T-plus staging system provides good gradient monotonicity. For future colorectal cancer staging systems, we propose replacement of lymph node status as the criterion to discriminate colorectal cancer stage II and stage III with greater weighting of the T stage.
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Affiliation(s)
- Jun Li
- From the Department of Surgical Oncology (JL, S-ZZ, K-FD), Second Affiliated Hospital, Zhejiang University School of Medicine; Zhejiang University Cancer Institute and the Key Laboratory of Cancer Prevention and Intervention (JL, C-HY, Y-TH, YY, S-ZZ, SZ, K-FD), China National Ministry of Education; EMR and Intelligent Expert System Engineering Research Center (J-SL), the Key Laboratory of Biomedical Engineering, China National Ministry of Education, Zhejiang University College of Biomedical Engineering and Instrument Science; and Department of Medical Oncology (YY), Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang Province, China
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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]
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Li J, Liu Y, Wang JW, Gao Y, Hu YT, He JJ, Yu XY, Hu HG, Yuan Y, Zhang SZ, Ding KF. Oxaliplatin-based adjuvant chemotherapy without radiotherapy can improve the survival of locally-advanced rectal cancer. PLoS One 2014; 9:e107872. [PMID: 25243406 PMCID: PMC4171483 DOI: 10.1371/journal.pone.0107872] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2014] [Accepted: 08/21/2014] [Indexed: 12/18/2022] Open
Abstract
Objective To assess the impact of oxaliplatin-containing adjuvant chemotherapy on the survival of patients with locally-advanced rectal cancer. Methods Data on patients with pathologically-confirmed T3/4 or N1/2 rectal cancer who accepted radical surgery at our center from January 2002 to June 2009 were reviewed retrospectively. The patients' 5-year overall survival (OS), disease-specific survival (DSS), and recurrence-free survival (RFS) were analyzed by comparing those who accepted radical surgery only (Group S) with those who accepted radical surgery and oxaliplatin-containing adjuvant chemotherapy (Group SO). Results A total of 236 patients were analyzed (Group S 135; Group SO 101). Group S patients were older and had a higher proportion with stage II disease and more perioperative complications than those in Group SO (P<0.05). The OS and DSS of patients with stage III disease under 50 years of age or with mucinous adenocarcinoma were higher in Group SO than Group S (P<0.05). In addition, the OS of patients with stage N2b disease was higher in Group SO than Group S (P = 0.016), and the OS of patients with stage N1a or N2b disease who received more than 8 weeks of oxaliplatin-containing chemotherapy was also higher in Group SO than Group S (P<0.05). Although the OS and DSS of patients with stage II disease in Group SO showed a tendency towards improvement, the differences between the groups were not statistically significant. Conclusion Adjuvant oxaliplatin-containing chemotherapy can improve the survival of patients with locally-advanced low and middle rectal cancers in comparison with observation. Randomized, prospective trials are warranted to confirm this benefit of oxaliplatin for rectal cancer.
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Affiliation(s)
- Jun Li
- Department of Surgical Oncology, Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang Province, China
- The Key Laboratory of Cancer Prevention and Intervention, China National Ministry of Education, Hangzhou, Zhejiang Province, China
| | - Yue Liu
- The Key Laboratory of Cancer Prevention and Intervention, China National Ministry of Education, Hangzhou, Zhejiang Province, China
| | - Jian-Wei Wang
- Department of Surgical Oncology, Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang Province, China
- The Key Laboratory of Cancer Prevention and Intervention, China National Ministry of Education, Hangzhou, Zhejiang Province, China
| | - Yang Gao
- The Key Laboratory of Cancer Prevention and Intervention, China National Ministry of Education, Hangzhou, Zhejiang Province, China
| | - Ye-Ting Hu
- The Key Laboratory of Cancer Prevention and Intervention, China National Ministry of Education, Hangzhou, Zhejiang Province, China
| | - Jin-Jie He
- Department of Surgical Oncology, Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang Province, China
- The Key Laboratory of Cancer Prevention and Intervention, China National Ministry of Education, Hangzhou, Zhejiang Province, China
| | - Xiu-Yan Yu
- Department of Surgical Oncology, Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang Province, China
- The Key Laboratory of Cancer Prevention and Intervention, China National Ministry of Education, Hangzhou, Zhejiang Province, China
| | - Han-Guang Hu
- The Key Laboratory of Cancer Prevention and Intervention, China National Ministry of Education, Hangzhou, Zhejiang Province, China
- Department of Medical Oncology, Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang Province, China
| | - Ying Yuan
- The Key Laboratory of Cancer Prevention and Intervention, China National Ministry of Education, Hangzhou, Zhejiang Province, China
- Department of Medical Oncology, Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang Province, China
| | - Su-Zhan Zhang
- Department of Surgical Oncology, Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang Province, China
- The Key Laboratory of Cancer Prevention and Intervention, China National Ministry of Education, Hangzhou, Zhejiang Province, China
| | - Ke-Feng Ding
- Department of Surgical Oncology, Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang Province, China
- The Key Laboratory of Cancer Prevention and Intervention, China National Ministry of Education, Hangzhou, Zhejiang Province, China
- * E-mail:
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Gu J, Chen N. Current status of rectal cancer treatment in China. Colorectal Dis 2013; 15:1345-50. [PMID: 23651350 DOI: 10.1111/codi.12269] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2012] [Accepted: 01/17/2013] [Indexed: 12/13/2022]
Abstract
AIM Colorectal cancer (CRC) is the fourth most common carcinoma in China. For economic reasons, a national CRC registry has not been established and a large-scale screening programme has not been implemented. METHOD Clinical studies (since 2000) of CRC epidemiology which originated from China were summarized, and data was analyzed. RESULTS In China, the majority of hospitals in central cities and even in county hospitals are able to provide medical care for CRC patients. Due to socio-economic disparities, medical conditions and skill level, there is a wide variation in the treatment. Most oncologists make their clinical decisions based on the National Comprehensive Cancer Network (NCCN) guidelines, although some domestic guidelines are now available. On 11 October 2011, the China Ministry of Health released national guidelines for CRC treatment. Owing to language difficulties, research on CRC in China has only had a limited exposure in the international literature, due in some part to lack of understanding of the current position in the country. CONCLUSION The national guidelines for CRC treatment will give a degree of standardization of the treatment of CRC nationwide and will ensure that higher quality care will be available, especially in rural areas. Chinese colorectal surgeons urgently need to exchange their knowledge and experience with international colleagues.
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Affiliation(s)
- J Gu
- Department of Colorectal Surgery, Peking University Cancer Hospital and Beijing Institute of Cancer Research, Beijing, China
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Vendramini DL, Albuquerque MMD, Schmidt EM, Rossi-Junior EE, Gerent WDA, Cunha VJLD. Laparoscopic and open colorectal resections for colorectal cancer. ABCD-ARQUIVOS BRASILEIROS DE CIRURGIA DIGESTIVA 2013; 25:81-7. [PMID: 23381748 DOI: 10.1590/s0102-67202012000200004] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/08/2011] [Accepted: 02/13/2012] [Indexed: 11/21/2022]
Abstract
BACKGROUND Surgical resection is the mainstay of treatment for colorectal cancer with curative intent. AIM To evaluate the postoperative results of laparoscopic and laparotomic colorectal resections for colorectal cancer. METHODS A retrospective study of a series of 189 patients. The descriptive variables were age and gender, and for outcome were type of resection, number of lymph nodes resected, free margins, the need for colostomy, complications, operative time and hospital stay. They were analyzed using the chi-square, Student t and Mann-Whitney test, with significance level <0.05. RESULTS Of the 189 operated patients, 110 met the inclusion criteria, 75 (68.2%) operated by open surgery and 35 (31.8%) by laparoscopic. The sigmoid colon was the most common site presented by neoplasia and rectosigmoidectomy was performed more by open colorectal resection (p = 0.042). The conversion rate was 7.9% (3/38). The patients were operated by open surgery in 81.5% of time less than 180 minutes (p <0.001). In both pathways, the average number of removed lymph nodes was greater than 12, but laparotomy enabled, more frequently, the resection of 12 or more nodes (p = 0.012). No patient had surgical margins involved, but laparotomy allowed a greater number of patients with a margin greater than 5 cm from the tumor (p = 0.036). Increased number of patients treated by open surgery were hospitalized for more than seven days (p <0.001). There were no statistically significant differences regarding the need for ostomies, complications and mortality. CONCLUSIONS The laparoscopic approach was as safe and effective as laparotomy in the treatment of colorectal cancer, and was associated with increased operative time, shorter hospital stay and less morbidity.
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Zhou JJ, Li J, Ying XJ, Song YM, Chen R, Chen G, Yan M, Ding KF. Fast track multi-discipline treatment (FTMDT trial) versus conventional treatment in colorectal cancer--the design of a prospective randomized controlled study. BMC Cancer 2011; 11:494. [PMID: 22111914 PMCID: PMC3254142 DOI: 10.1186/1471-2407-11-494] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2011] [Accepted: 11/24/2011] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Laparoscopy-assisted surgery, fast-track perioperative treatment are both increasingly used in colorectal cancer treatment, for their short-time benefits of enhanced recovery and short hospital stays. However, the benefits of the integration of the Laparoscopy-assisted surgery, fast-track perioperative treatment, and even with the Xelox chemotherapy, are still unknown. In this study, the three treatments integration is defined as "Fast Track Multi-Discipline Treatment Model" for colorectal cancer and this model extends the benefits to the whole treatment process of colorectal cancer. The main purpose of the study is to explore the feasibility of "Fast Track Multi-Discipline Treatment" model in treatment of colorectal cancer. METHODS The trial is a prospective randomized controlled study with 2 × 2 balanced factorial design. Patients eligible for the study will be randomized to 4 groups: (I) Laparoscopic surgery with fast track perioperative treatment and Xelox chemotherapy; (II) Open surgery with fast track perioperative treatment and Xelox chemotherapy; (III) Laparoscopic surgery with conventional perioperative treatment and mFolfox6 chemotherapy; (IV) Open surgery with conventional perioperative treatment and mFolfox6 chemotherapy. The primary endpoint of this study is the hospital stays. The secondary endpoints are the quality of life, chemotherapy related adverse events, surgical complications and hospitalization costs. Totally, 340 patients will be enrolled with 85 patients in each group. CONCLUSIONS The study initiates a new treatment model "Fast Track Multi-Discipline Treatment" for colorectal cancer, and will provide feasibility evidence on the new model "Fast Track Multi-Discipline Treatment" for patients with colorectal cancer. TRIAL REGISTRATION ClinicalTrials.gov: NCT01080547.
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Affiliation(s)
- Jiao-Jiao Zhou
- Department of Surgical Oncology, Second Affiliated Hospital, and The Key Laboratory of Cancer Prevention and Intervention, China National Ministry of Education, Zhejiang University College of Medicine, 88 Jie-Fang Rd, Hangzhou, Zhejiang 310009, China
| | - Jun Li
- Department of Surgical Oncology, Second Affiliated Hospital, and The Key Laboratory of Cancer Prevention and Intervention, China National Ministry of Education, Zhejiang University College of Medicine, 88 Jie-Fang Rd, Hangzhou, Zhejiang 310009, China
| | - Xiao-Jiang Ying
- Department of Anorectum, People's Hospital of Shaoxing, 568 Zhong-Xing North Rd, Shaoxing, Zhejiang 312000, China
| | - Yong-Mao Song
- Department of Surgical Oncology, Second Affiliated Hospital, and The Key Laboratory of Cancer Prevention and Intervention, China National Ministry of Education, Zhejiang University College of Medicine, 88 Jie-Fang Rd, Hangzhou, Zhejiang 310009, China
| | - Rong Chen
- Department of Anus and Large Intestine, Second Affiliated Hospital, Wenzhou Medicine College, 109 Xue-Yuan West Rd, Wenzhou, Zhejiang 325027, China
| | - Gang Chen
- Department of Anesthesiology, Second Affiliated Hospital, Zhejiang University College of Medicine, 88 Jie-Fang Rd, Hangzhou, Zhejiang 310009, China
| | - Min Yan
- Department of Anesthesiology, Second Affiliated Hospital, Zhejiang University College of Medicine, 88 Jie-Fang Rd, Hangzhou, Zhejiang 310009, China
| | - Ke-Feng Ding
- Department of Surgical Oncology, Second Affiliated Hospital, and The Key Laboratory of Cancer Prevention and Intervention, China National Ministry of Education, Zhejiang University College of Medicine, 88 Jie-Fang Rd, Hangzhou, Zhejiang 310009, China
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Hotta T, Yamaue H. Laparoscopic surgery for rectal cancer: review of published literature 2000-2009. Surg Today 2011; 41:1583-91. [PMID: 21969189 DOI: 10.1007/s00595-010-4555-y] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2010] [Accepted: 12/08/2010] [Indexed: 12/19/2022]
Abstract
We reviewed seven reports of laparoscopic low anterior resection (LAR) alone for rectal cancer and 18 reports of laparoscopic surgery, including LAR. We examined the length of surgery, blood loss during surgery, conversion rate to open surgery, incidence of anastomotic leakage, morbidity, mortality, and local recurrence, and the 5-year overall survival rates. The values were as follows (range): length of surgery, 107-540 min vs 23-780 min; blood loss, 0-600 ml vs 0-1800 ml; conversion to open surgery, 0%-14.0% vs 1.0%-21.9%; anastomotic leakage, 0%-23.0% vs 3.0%-17.0%; morbidity, 6.1%-38.6% vs 5.8%-40.0%; mortality, 0%-2.0% vs 05-5.8%; and local recurrence, 1.4%-6.8% vs 0.95%-20.8%, respectively, in the LAR alone vs laparoscopic surgery groups. The 5-year overall survival rates of patients with stage I, II, III, and IV disease were 92%-98%, 79%-81%, 67%-89%, and 0%-15%, respectively, in the LAR alone group versus 85.4%-100%, 61.7%-94.4%, 53.7%-78%, and 0%-44.6%, respectively, in the laparoscopic surgery group. Thus, we demonstrated the safety and efficacy of laparoscopic surgery for rectal cancer.
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Affiliation(s)
- Tsukasa Hotta
- Second Department of Surgery, Wakayama Medical University, School of Medicine, 811-1 Kimiidera, Wakayama, 641-8510, Japan
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Greenblatt DY, Rajamanickam V, Pugely AJ, Heise CP, Foley EF, Kennedy GD. Short-term outcomes after laparoscopic-assisted proctectomy for rectal cancer: results from the ACS NSQIP. J Am Coll Surg 2011; 212:844-54. [PMID: 21414814 DOI: 10.1016/j.jamcollsurg.2011.01.005] [Citation(s) in RCA: 75] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2010] [Revised: 01/03/2011] [Accepted: 01/04/2011] [Indexed: 12/22/2022]
Abstract
BACKGROUND Although numerous studies have demonstrated improved short-term outcomes after laparoscopic resection of colon cancer, the benefits of laparoscopic-assisted proctectomy (LAP) for rectal cancer are less clear. The current report addresses the need for a large multi-institutional study on early outcomes after proctectomy for cancer. STUDY DESIGN Patients who underwent elective LAP or open proctectomy for cancer during 2005 to 2009 were identified from the American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP) database. The frequency of postoperative complications and other early outcomes was determined. Multivariate logistic regression identified predictors of 30-day morbidity. Propensity scores, stratified by quintiles, were included in all multivariable models to partially adjust for nonrandom assignment of treatment. RESULTS Of 5,420 patients who underwent surgery for rectal cancer, 4,380 underwent open proctectomy and 1,040 (19.2%) LAP. The LAP group had a lower frequency of blood transfusion (12.3% versus 4.3%; p < 0.0001) and a longer mean operative time (242 versus 219 minutes; p < 0.0001). Median length of stay was 5 days after LAP and 7 days after open resection (p < 0.0001). Although no difference in 30-day mortality was detected, the frequency of complications was less after LAP (20.5% versus 28.8%; p < 0.0001). Specifically, the frequencies of superficial surgical site infection, sepsis, respiratory complications, renal failure, and venous thromboembolism were each lower in the LAP group. After adjusting for potential confounders, the likelihood of 30-day morbidity was significantly greater in open versus laparoscopic proctectomy (odds ratio = 1.41; 95% CI, 1.19-1.68). CONCLUSIONS Compared with open proctectomy, LAP is associated with decreased length of stay and 30-day morbidity. If ongoing randomized clinical trials confirm oncologic equivalency, LAP might eventually replace open resection as the standard of care for the treatment of patients with resectable rectal cancer.
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Affiliation(s)
- David Yu Greenblatt
- Section of Colorectal Surgery, Department of Surgery, University of Wisconsin, Madison, WI, USA.
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Li J, Chen R, Xu YQ, Wang XC, Zheng S, Zhang SZ, Ding KF. Impact of a laparoscopic resection on the quality of life in rectal cancer patients: results of 135 patients. Surg Today 2010; 40:917-22. [PMID: 20872193 DOI: 10.1007/s00595-009-4156-9] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2009] [Accepted: 07/23/2009] [Indexed: 12/20/2022]
Abstract
PURPOSE To investigate the impact of a laparoscopic resection on the quality of life in rectal cancer patients. METHODS This study included 135 patients (laparoscopic resection [LR] 65 cases and open resection [OR] 70 cases). The European Organization for Research and Treatment of Cancer QLQ-C30 and QLQ-CR38 questionnaires were used to measure the quality of life before the operation, then 1 week, 3 months, and 1 year after the operation. RESULTS Eleven (16.9%) patients underwent a conversion from laparoscopic to open surgery. The incision length and blood loss both decreased significantly in the LR group in comparison to the OR group (P < 0.05). Recovery of the gastrointestinal function, bladder function, and ambulation was more rapid in the LR group (P < 0.05). The patients in the LR group reported better global health status (33.3 vs 25.0, P < 0.001), body image (77.8 vs 66.7, P = 0.008), and less pain (33.3 vs 50. 0, P = 0.009) 1 week after operation. Better body image was reported in the LR group even 1 year after the operation (P < 0.05). Fewer financial difficulties were reported by patients in the LR group (P < 0.001). No significant differences were found between two groups on other scales. CONCLUSIONS This study showed that the quality of life benefits due to minimally invasive laparoscopic surgery were evident only in the immediate postoperative period. A laparoscopic rectal resection therefore provided only better cosmetic benefit over the longer term.
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Affiliation(s)
- Jun Li
- Department of Surgical Oncology, Second Affiliated Hospital, and The Key Laboratory of Cancer Prevention and Intervention, China National Ministry of Education, Zhejiang University College of Medicine, No 88 Jiefang Road, Hangzhou, 310009 Zhejiang Province, PR China
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Laparoscopic total mesorectal excision for rectal cancer: experience of a single center with a series of 174 patients. Surg Endosc 2010; 25:508-14. [PMID: 20607560 DOI: 10.1007/s00464-010-1202-z] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2010] [Accepted: 06/15/2010] [Indexed: 12/16/2022]
Abstract
BACKGROUND Laparoscopic total mesorectal excision for low rectal cancer is not considered a gold standard treatment due to the high conversion rate and the long operation time. METHODS A retrospective review examined a surgical series of 174 laparoscopic low rectal resections involving total mesorectal excision (1995-2006), with particular reference to technical points as well as surgical and oncologic outcomes. Miles operations and partial mesorectal excisions were excluded. RESULTS The cancer affected the low rectum in 110 cases and the medium rectum in 64 cases. A total of 68 patients were subjected to neoadjuvant radiochemotherapy. The anastomosis was mechanical for 83.3% of the cases and intersphinteric through the perineum for 16.6% of the cases. Protective ileostomy was performed in 112 cases. The conversion rate was 4.6%. The mesorectum remained intact in 91.6% of the cases and was partially interrupted in 15 of the cases. In no case was it totally discontinued. The postoperative morbidity rate was 16.7%, and the mortality rate was 0.57%. The incidence of anastomotic fistulas was 14.4%. The percentage was higher for males (18.6 vs 8.3%) and correlated with the low distance of the tumor from the anal verge (18.2 vs 7.8%) and the absence of a protection ileostomy (20.9 vs 10.7%). After an average follow-up period of 48.6 months (range, 24-149 months), six patients (3.44%) experienced a pelvic recurrence. The 5-year overall survival rate was 75.4%, and the disease-free survival rate was 61.9%. CONCLUSION Laparoscopic total mesorectal excision for low rectal cancer is safe and effective, allowing surgical and oncologic outcomes similar to those reported for open surgery.
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da Luz Moreira A, Mor I, Geisler DP, Remzi FH, Kiran RP. Laparoscopic resection for rectal cancer: a case-matched study. Surg Endosc 2010; 25:278-83. [PMID: 20585962 DOI: 10.1007/s00464-010-1174-z] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2009] [Accepted: 04/10/2010] [Indexed: 02/07/2023]
Abstract
INTRODUCTION The field of laparoscopic rectal cancer surgery is expanding. We compare short-term and early oncological outcomes after laparoscopic versus open resection in carefully matched rectal cancer patients. METHODS All consecutive patients undergoing elective laparoscopic resection for rectal cancer were reviewed. Laparoscopic resections were matched 1:1 to open resections by age, gender, American Society of Anesthesiologists class, body mass index, neoadjuvant chemoradiation, and type of surgery. Data were analyzed using Fisher's exact, chi-square, Wilcoxon rank-sum tests, and Kaplan-Meier estimates. P-value <0.05 was considered statistically significant. RESULTS Ninety-one rectal cancer patients with laparoscopic resection were included, 59% were male, and median age was 62 years. Conversion rate was 18.7%. Laparoscopic and open surgery had similar 30-day morbidity and mortality except wound infection, which was lower for the laparoscopic group (p = 0.02). Laparoscopic surgery had similar 30-day readmissions but shorter total length of hospital stay (5 versus 7 days, p < 0.01), time to first flatus (3 versus 4.5 days, p = 0.001), and time to first bowel movement (4 versus 5 days, p = 0.05) when compared with open surgery. The 3-year disease-free survival, local recurrence, and distant recurrence rates were also similar between the two groups. CONCLUSION Laparoscopic surgery can be safely performed for rectal cancer, with better postoperative recovery and acceptable early oncological outcomes. Results from large ongoing randomized trials with longer follow-up time are pending to better define oncologic outcomes.
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Affiliation(s)
- Andre da Luz Moreira
- Department of Colorectal Surgery, Digestive Disease Institute, Cleveland Clinic, A30, 9500 Euclid Avenue, Cleveland, OH 44195, USA.
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Sambasivan CN, Deveney KE, Morris KT. Oncologic outcomes after resection of rectal cancer: Laparoscopic versus open approach. Am J Surg 2010; 199:599-603. [DOI: 10.1016/j.amjsurg.2010.01.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2009] [Revised: 01/19/2010] [Accepted: 01/19/2010] [Indexed: 01/12/2023]
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Abstract
BACKGROUND The improvement of renal allograft survival by pre-transplantation transfusions alerted the medical community to the potential detrimental effect of transfusions in patients being treated for cancer. OBJECTIVES The present meta-analysis aims to evaluate the role of perioperative blood transfusions (PBT) on colorectal cancer recurrence. This is accomplished by validating the results of a previously published meta-analysis (Amato 1998); and by updating it to December 2004. SEARCH STRATEGY Published papers were retrieved using Medline, EMBASE, the Cochrane Library, controlled trials web-based registries, or the CCG Trial Database. The search strategy used was: {colon OR rectal OR colorectal} WITH {cancer OR tumor OR neoplasm} AND transfusion. The tendency not to publish negative trials was balanced by inspecting the proceedings of international congresses. SELECTION CRITERIA Patients undergoing curative resection of colorectal cancer (classified either as Dukes stages A-C, Astler-Coller stages A-C2, or TNM stages T1-3a/N0-1/M0) were included if they had received any amount of blood products within one month of surgery. Excluded were patients with distant metastases at surgery, and studies with short follow-up or with no data. DATA COLLECTION AND ANALYSIS A specific form was developed for data collection. Data extraction was cross-checked, using the most recent publication in case of repetitive ones. Papers' quality was ranked using the method by Evans and Pollock. Odds ratios (OR, with 95% confidence intervals) were computed for each study, and pooled estimates were generated by RevMan (version 4.2). When available, data were stratified for risk factors of cancer recurrence. MAIN RESULTS The findings of the 1998 meta-analysis were confirmed, with small variations in some estimates. Updating it through December 2004 led to the identification of 237 references. Two-hundred and one of them were excluded because they analyzed survival (n=22), were repetitive (n=26), letters/reviews (n=66) or had no data (n=87). Thirty-six studies on 12,127 patients were included: 23 showed a detrimental effect of PBT; 22 used also multivariable analyses, and 14 found PBT to be an independent prognostic factor. Pooled estimates of PBT effect on colorectal cancer recurrence yielded overall OR of 1.42 (95% CI, 1.20 to 1.67) against transfused patients in randomized controlled studies. Stratified meta-analyses confirmed these findings, also when stratifying patients by site and stage of disease. The PBT effect was observed regardless of timing, type, and in a dose-related fashion, although heterogeneity was detected. Data on surgical techniques was not available for further analysis. AUTHORS' CONCLUSIONS This updated meta-analysis confirms the previous findings. All analyses support the hypothesis that PBT have a detrimental effect on the recurrence of curable colorectal cancers. However, since heterogeneity was detected and conclusions on the effect of surgical technique could not be drawn, a causal relationship cannot still be claimed. Carefully restricted indications for PBT seems necessary.
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Affiliation(s)
- A Amato
- Sigma Tau Research, Inc., 10101 Grosvenor Place, apartment#1415, Rockville, Maryland 20852, USA.
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