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Zheng L, Zhou D, Lu L, Liu Z, Fang L. Effects of CO 2 pneumoperitoneum on proliferation, apoptosis, and migration of gastrointestinal stromal tumor cells. Surg Endosc 2019; 33:3384-3395. [PMID: 30604263 DOI: 10.1007/s00464-018-06633-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2018] [Accepted: 12/19/2018] [Indexed: 12/20/2022]
Abstract
BACKGROUND The purpose of the study was to investigate the proliferation and migration capability of human gastrointestinal stromal tumor line GIST-T1 after exposure to different pressures and times of CO2 pneumoperitoneum. METHODS We established simulated CO2 pneumoperitoneum environment in vitro and divided the human GIST cell GIST-T1 into open control group, 8 mmHg CO2 pneumoperitoneum treatment group and 15 mmHg CO2 pneumoperitoneum treatment group. Each group was divided into two subgroups respectively cultured for 1 h and 3 h. pH value of cell culture, cell growth curve, and cell cycle distribution of each group was measured. By application of scratch healing tests and Transwell chamber experiments, mobility ratio and number of cells through 8 µm membranes were measured to assess the migration ability of cells in each group after intervention. RESULTS Cell culture pH value of each subgroup in CO2 group decreased significantly after exposed in CO2 pneumoperitoneum (P < 0.01). The proliferation of GIST-T1 cells in 15 mmHg CO2 group was significantly inhibited early (1-2 days) (P < 0.05) and the proliferation of GIST-T1 cells in 8 mmHg CO2 1 h subgroup and 15 mmHg CO2 1 h subgroup was increased significantly late (4-6 days) (P < 0.05) after the interventions of CO2 pneumoperitoneum. The percentage of cells in G0-G1 phase increased, the percentage of S phase cells decreased (P < 0.01) in 1-h subgroup and 3-h subgroup of 15 mmHg CO2 group 24 h after exposure to CO2. The percentage of cells in S phase increased in 1-h subgroup of 8 mmHg CO2 group and decreased in 3-h subgroup of 15 mmHg CO2 group 72 h after exposure to CO2. In the Transwell chamber experiment, the cell number through 8-µm membrane increased significantly (P < 0.01) in 3-h subgroup of CO2 group compared to that in 3-h subgroup of control group. CONCLUSIONS The routine pressure and duration of CO2 pneumoperitoneum used in clinic did not promote the proliferation of gastrointestinal stromal tumors, but had a potential risk of increasing postoperative recurrence and distant metastasis.
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Affiliation(s)
- Lijun Zheng
- Department of General Surgery, Shanghai Tenth people's Hospital, Tongji University, No. 301 Middle Yanchang Road, Shanghai, 200072, People's Republic of China
| | - Donglei Zhou
- Department of General Surgery, Shanghai Tenth people's Hospital, Tongji University, No. 301 Middle Yanchang Road, Shanghai, 200072, People's Republic of China
| | - Liesheng Lu
- Department of General Surgery, Shanghai Tenth people's Hospital, Tongji University, No. 301 Middle Yanchang Road, Shanghai, 200072, People's Republic of China
| | - Zhongchen Liu
- Department of General Surgery, Shanghai Tenth people's Hospital, Tongji University, No. 301 Middle Yanchang Road, Shanghai, 200072, People's Republic of China
| | - Lin Fang
- Department of General Surgery, Shanghai Tenth people's Hospital, Tongji University, No. 301 Middle Yanchang Road, Shanghai, 200072, People's Republic of China.
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Tanis PJ, Buskens CJ, Bemelman WA. Laparoscopy for colorectal cancer. Best Pract Res Clin Gastroenterol 2014; 28:29-39. [PMID: 24485253 DOI: 10.1016/j.bpg.2013.11.017] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2013] [Revised: 10/10/2013] [Accepted: 11/23/2013] [Indexed: 01/31/2023]
Abstract
The laparoscopic approach for colorectal cancer resection has been evolved from an experimental procedure with oncological concerns to routine daily practice within a period of two decades. Numerous randomized controlled trials and meta-analyses have shown that laparoscopic resection results in faster recovery with similar oncological outcome compared to an open approach, both for colon and rectal cancer. Besides improved cosmesis, other long-term advantages seem to be less adhesion related small bowel obstruction and reduced incisional hernia rate. Adequate patient selection and surgical experience are of crucial importance. Experience can be gradually expanded step by step, by increasing the complexity of the procedure. A decision to convert should be made early in the procedure, because the outcome after a reactive conversion is worse than initial open resection or strategic conversion. The additive value of new techniques such as robotic surgery has to be proven in randomized studies including a cost-effectiveness assessment.
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Affiliation(s)
- P J Tanis
- Department of Surgery, Academic Medical Centre, Amsterdam, The Netherlands.
| | - C J Buskens
- Department of Surgery, Academic Medical Centre, Amsterdam, The Netherlands
| | - W A Bemelman
- Department of Surgery, Academic Medical Centre, Amsterdam, The Netherlands
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Mizuguchi T, Kawamoto M, Meguro M, Shibata T, Nakamura Y, Kimura Y, Furuhata T, Sonoda T, Hirata K. Laparoscopic hepatectomy: a systematic review, meta-analysis, and power analysis. Surg Today 2010; 41:39-47. [PMID: 21191689 DOI: 10.1007/s00595-010-4337-6] [Citation(s) in RCA: 48] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2009] [Accepted: 03/16/2010] [Indexed: 12/15/2022]
Abstract
PURPOSE A previous meta-analysis study demonstrated that bleeding and the duration of the hospital stay following laparoscopic hepatectomy (Lap) were significantly smaller and shorter, respectively, than for patients undergoing an open approach (Op). The aim of the present study was to re-evaluate perioperative variables and adverse outcomes in patients undergoing Lap versus (vs) Op after 2000. METHODS A PubMed and Ovid Medline search identified clinical studies that compared the outcomes of Lap vs Op patients after 2000. A meta-analysis and power analysis were performed. RESULTS Operative time was not significantly different between the two approaches (95% confidence interval [CI]: -0.063 to 0.992). Patient bleeding in the Lap group was significantly lower than in the Op group (95% CI: -1.027 to -0.390). Complications with Lap patients were significantly less frequent (95% CI: 0.231-0.642), and the duration of the hospital stay for Lap patients was significantly shorter (95% CI: -0.950 to -0.530) than for Op patients. Only one paper presented 80% power with 0.05 α-errors in all four outcomes, whereas four studies did not have sufficient statistical power. CONCLUSIONS The clinical benefits of Lap include a smaller incidence of complications and a shorter duration of hospital stay at the current time. Several studies had too few cases to sufficiently evaluate these factors, although other studies were appropriately analyzed.
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Affiliation(s)
- Toru Mizuguchi
- Department of Surgery I, Sapporo Medical University, S-1, W-16, Chuo-ku, Sapporo, Hokkaido 060-8543, Japan
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Varlotto JM, Recht A, Flickinger JC, Medford-Davis LN, Dyer AM, DeCamp MM. Varying recurrence rates and risk factors associated with different definitions of local recurrence in patients with surgically resected, stage I nonsmall cell lung cancer. Cancer 2010; 116:2390-400. [PMID: 20225332 DOI: 10.1002/cncr.25047] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
BACKGROUND The objective of this study was to examine the effects of different definitions of local recurrence on the reported patterns of failure and associated risk factors in patients who undergo potentially curative resection for stage I nonsmall cell lung cancer (NSCLC). METHODS The study included 306 consecutive patients who were treated from 2000 to 2005 without radiotherapy. Local recurrence was defined either as 'radiation' (r-LR) (according to previously defined postoperative radiotherapy fields), including the bronchial stump, staple line, ipsilateral hilum, and ipsilateral mediastinum; or as 'comprehensive' (c-LR), including the same sites plus the ipsilateral lung and contralateral mediastinal and hilar lymph nodes. All recurrences that were not classified as "local" were considered to be distal. RESULTS The median follow-up was 33 months. The proportions of c-LR and r-LR at 2 years, 3 years, and 5 years were 14%, 21%, and 29%, respectively, and 7%, 12%, and 16%, respectively. Significant risk factors for c-LR on multivariate analysis were diabetes, lymphatic vascular invasion, and tumor size; and significant factors for r-LR were resection of less than a lobe and lymphatic vascular invasion. The proportions of distant (non-local) recurrence using these definitions at 2 years, 3 years, and 5 years were 10%, 12%, and 18%, respectively, and 14%, 19%, and 29%, respectively. Significant risk factors for distant failure were histology when using the c-LR definition and tumor size when using the r-LR definition. CONCLUSIONS Local recurrence increased nearly 2-fold when a broad definition was used instead of a narrow definition. The definition also affected which factors were associated significantly with both local and distant failure on multivariate analysis. Comparable definitions must be used when analyzing different series.
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Affiliation(s)
- John M Varlotto
- Division of Radiation Oncology, Penn State Hershey Cancer Institute, Hershey, Pennsylvania 17033, USA.
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Laparoscopic versus open left lateral segmentectomy. BMC Surg 2009; 9:14. [PMID: 19735573 PMCID: PMC2742511 DOI: 10.1186/1471-2482-9-14] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2009] [Accepted: 09/07/2009] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND Laparoscopic liver surgery is becoming increasingly common. This cohort study was designed to directly compare perioperative outcomes of the left lateral segmentectomy via laparoscopic and open approach. METHODS Between 2002 and 2006 43 left lateral segmentectomies were performed at King's College Hospital. Those excluded from analysis included previous liver resections, polycystic liver disease, liver cirrhosis and synchronous operations. Of 20 patients analysed, laparoscopic (n = 10) were compared with open left lateral segmentectomy (n = 10). Both groups had similar patient characteristics. RESULTS Morbidity rates were similar with no wound or chest infection in either group. The conversion rate was 10% (1/10). There was no difference in operating time between the groups (median time 220 minutes versus 179 minutes, p = 0.315). Surgical margins for all lesions were clear. Less postoperative opiate analgesics were required in the laparoscopic group (median 2 days versus 5 days, p = 0.005). The median postoperative in-hospital stay was less in the laparoscopic group (6 days vs 9 days, p = 0.005). There was no mortality. CONCLUSION Laparoscopic left lateral segmentectomy is safe and feasible. Laparoscopic patients may benefit from requiring less postoperative opiate analgesia and a shorter post-operative in-hospital stay.
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Laparoscopic liver resection assisted by the laparoscopic Habib Sealer. Surgery 2008; 144:770-4. [PMID: 19081019 DOI: 10.1016/j.surg.2008.08.005] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2008] [Accepted: 08/04/2008] [Indexed: 01/22/2023]
Abstract
BACKGROUND Radiofrequency has been used as a tool for liver resection since 2002. A new laparoscopic device is reported in this article that assists liver resection laparoscopically. METHODS From October 2006 to the present, patients suitable for liver resection were assessed carefully for laparoscopic resection with the laparoscopic Habib Sealer (LHS). Detailed data of patients resected laparoscopically with this device were collected prospectively and analyzed. RESULTS In all, 28 patients underwent attempted laparoscopic liver resection. Four cases had to be converted to an open approach because of extensive adhesions from previous colonic operations. Twenty-four patients completed the procedure comprising tumorectomy (n = 7), multiple tumoretcomies (n = 5), segmentectomy (n = 3), and bisegmentectomies (n = 9). Vascular clamping of portal triads was not used. The mean resection time was 60 +/- 23 min (mean +/- SD), and blood loss was 48 +/- 54 mL. None of the patients received any transfusion of blood or blood products perioperatively or postoperatively. Postoperatively, 1 patient developed severe exacerbation of asthma that required steroid therapy, and 1 other patient had a transient episode of liver failure that required supportive care. The mean duration of hospital stay was 5.6 +/- 2 days (mean +/- SD). At a short-term follow up, no recurrence was detected in patients with liver cancer. CONCLUSION Laparoscopic liver resection can be performed safely with this new laparoscopic liver resection device with a significantly low risk of intraoperative bleeding or postoperative complications.
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Pai M, Navarra G, Ayav A, Sommerville C, Khorsandi SK, Damrah O, Jiao LR, Habib NA. Laparoscopic Habib 4X: a bipolar radiofrequency device for bloodless laparoscopic liver resection. HPB (Oxford) 2008; 10:261-4. [PMID: 18773100 PMCID: PMC2518296 DOI: 10.1080/13651820802167862] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2008] [Indexed: 12/12/2022]
Abstract
BACKGROUND In recent years the progress of laparoscopic procedures and the development of new and dedicated technologies have made laparoscopic hepatic surgery feasible and safe. In spite of this laparoscopic liver resection remains a surgical procedure of great challenge because of the risk of massive bleeding during liver transection and the complicated biliary and vascular anatomy in the liver. A new laparoscopic device is reported here to assist liver resection laparoscopically. METHODS The laparoscopic Habib 4X is a bipolar radiofrequency device consisting of a 2 x 2 array of needles arranged in a rectangle. It is introduced perpendicularly into the liver, along the intended transection line. It produces coagulative necrosis of the liver parenchyma sealing biliary radicals and blood vessels and enables bloodless transection of the liver parenchyma. RESULTS Twenty-four Laparoscopic liver resections were performed with LH4X out of a total of 28 attempted resections over 12 months. Pringle manoeuvre was not used in any of the patients. None of the patients required intraoperative transfusion of red cells or blood products. CONCLUSION Laparoscopic liver resection can be safely performed with laparoscopic Habib 4X with a significantly low risk of intraoperative bleeding or postoperative complications.
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Affiliation(s)
- M. Pai
- HPB unit, Division of Surgery, Hammersmith Hospital, Imperial College London, Oncology, Reproductive Biology and AnaesthesiaLondonUK
| | - G. Navarra
- Department of Surgical Sciences, G. Martino University Hospital, Faculty of Medicine, University of Messina, V. Cons.Valeria MEItaly
| | - A. Ayav
- Department of Digestive Surgery, University Hospital Nancy-Brabois, Rue du MorvanVandoeuvre les NancyFrance
| | - C. Sommerville
- HPB unit, Division of Surgery, Hammersmith Hospital, Imperial College London, Oncology, Reproductive Biology and AnaesthesiaLondonUK
| | - S. K. Khorsandi
- HPB unit, Division of Surgery, Hammersmith Hospital, Imperial College London, Oncology, Reproductive Biology and AnaesthesiaLondonUK
| | - O. Damrah
- HPB unit, Division of Surgery, Hammersmith Hospital, Imperial College London, Oncology, Reproductive Biology and AnaesthesiaLondonUK
| | - L. R. Jiao
- HPB unit, Division of Surgery, Hammersmith Hospital, Imperial College London, Oncology, Reproductive Biology and AnaesthesiaLondonUK
| | - N. A. Habib
- HPB unit, Division of Surgery, Hammersmith Hospital, Imperial College London, Oncology, Reproductive Biology and AnaesthesiaLondonUK
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Hao YX, Zhong H, Zhang C, Zeng DZ, Shi Y, Tang B, Yu PW. Effects of simulated carbon dioxide and helium peumoperitoneum on proliferation and apoptosis of gastric cancer cells. World J Gastroenterol 2008; 14:2241-5. [PMID: 18407602 PMCID: PMC2703853 DOI: 10.3748/wjg.14.2241] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2007] [Revised: 02/05/2008] [Indexed: 02/06/2023] Open
Abstract
AIM To investigate the effects of carbon dioxide (CO(2)) and helium insufflation administered at different pressures on the growth and apoptosis of cultured human gastric cancer cells. METHODS The gastric cancer cells MKN-45 were exposed to a CO(2) and helium environment maintained at different pressures (0, 5, 10 and 15 mmHg). The cells were exposed to simulated pneumoperitoneum environment for 4 h, and pH of the culture media was measured after it was moved to normal conditions for 0, 2, 4, 6 and 8 h. Proliferation viability of MKN-45 was examined by 3-[4,5Dimethylthiazol-2-yl],5-diphenyltetrazolium bromide or triazolyl blue (MTT) assay after it was moved to normal conditions. Apoptotic ratio was measured by Annexin V-FITC/PI double labelled staining. RESULTS The pH of media was acid and recovered to normal after 4 h in the CO(2) group while it was basic in the helium group. There was no difference between CO(2) groups (under 10 mmHg ) and control group (P > 0.05) in the proliferative viability of the cells. The cultured cells exposed to 15 mmHg CO(2) environment grew more slowly than control group from 4 to 7 d (P < 0.01 ) while there was no difference from 1 to 3 d (P > 0.05). The proliferative viability in helium group was not obviously different from the control group (P > 0.05). The apoptotic ratio of the cultured cells was markedly higher than that of the control group (P < 0.01) at 10 and 15 mmHg CO(2) insufflation pressure. In helium group, the apoptotic ratio was not obviously different from the control group (P > 0.05). CONCLUSION There is no obvious effect in the proliferation and apoptosis of MKN-45 cells under 10 mmHg CO(2) insufflation pressure and helium in any pressure. Fifteen mmHg CO(2) insufflation pressure can inhibit the proliferation of the cells and improve apoptosis.
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Ayres BE, Thomas F, Zacharowski K, Lightman SL, Persad RA. The stress response in laparoscopic urological surgery. BJU Int 2007; 99:1331-2. [PMID: 17419702 DOI: 10.1111/j.1464-410x.2007.06847.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Benjamin E Ayres
- Department of Urology, Bristol Royal Infirmary, University of Bristol, Bristol, UK.
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Bachellier P, Ayav A, Pai M, Weber JC, Rosso E, Jaeck D, Habib NA, Jiao LR. Laparoscopic liver resection assisted with radiofrequency. Am J Surg 2007; 193:427-30. [PMID: 17368282 DOI: 10.1016/j.amjsurg.2006.06.046] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2006] [Revised: 06/28/2006] [Accepted: 06/28/2006] [Indexed: 01/22/2023]
Abstract
BACKGROUND Radiofrequency-assisted laparoscopic liver resection is reported. METHODS Patients suitable for liver resection were carefully assessed for laparoscopic resection. Patient and intraoperative and postoperative data were prospectively collected and analyzed. RESULTS Eighteen patients underwent laparoscopic liver resection. All operations were performed without vascular clamping and consisting of tumorectomy (n = 9), multiple tumoretcomies (n = 2), segmentectomy (n = 2), and bisegmentectomies (n = 2). Mean blood loss was 121 +/- 68 mL, and mean resection was time 167 +/- 45 minutes. There was no need for perioperative or postoperative transfusion of blood or blood products. One patient developed pneumothorax during surgery as a result of direct puncture of pleura with the radiofrequency probe, and 1 patient had transient liver failure and required supportive care after surgery. The mean length of hospital stay was 6.0 +/-1.5 days. At follow-up, those with liver cancer had no recurrence. CONCLUSIONS Radiofrequency-assist laparoscopic liver resection can decrease the risk of intraoperative bleeding and blood transfusion.
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Affiliation(s)
- Philippe Bachellier
- HPB Unit, Hammersmith Hospital, Division of Surgery, Anaesthetics and Intensive Care, Imperial College School of Medicine, Du Cane Rd., London W120NN, UK
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Tobalina Aguirrezábal E, Múgica Alcorta I, Portugal Porras V, Sarabia García S. Implantación de la cirugía laparoscópica de colon en un servicio de cirugía general. Cir Esp 2007; 81:134-8. [PMID: 17349237 DOI: 10.1016/s0009-739x(07)71284-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
OBJECTIVE To evaluate the viability, safety and short-term results of laparoscopic colon surgery during the first few years after its introduction in our department. METHOD Between January 2002 and December 2005, laparoscopic surgery was performed in patients with surgical indication for benign colon disease. After 2003, patients with malignant disease were also included. A database was created and demographic data, surgical indication, technique, conversion rate, morbidity and postoperative length of stay were recorded. All patients were operated on by the same team of three surgeons. RESULTS Ninety consecutive patients, with a mean age of 59.2 years (20-88) underwent laparoscopic surgery. Of these, 53 were men (59%). In total, 32 patients had previously undergone one or more open laparotomies (35.5%). Surgery was indicated for benign disease in 60 patients (66%). Distribution was left colon in 79 patients and right colon in 11 patients. The most frequent technique was sigmoidectomy (67.7%). The conversion rate was 12.2%. Operating time was 199 min. (120-340) and length of postoperative stay was 7.5 days (4-57). Morbidity was 18.8% and mortality was 1.1%. CONCLUSIONS Laparoscopic surgery of the colon is safe and reproducible. Our short-term results are similar to those of previous studies. We believe that prior experience of laparoscopic surgery is important and that a stable surgical team minimizes the effect of the learning curve.
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Stocchi L, Nelson H. Minimally Invasive Surgery for Colorectal Carcinoma. Ann Surg Oncol 2005; 12:960-70. [PMID: 16244804 DOI: 10.1245/aso.2005.02.017] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2005] [Accepted: 07/17/2005] [Indexed: 01/29/2023]
Affiliation(s)
- Luca Stocchi
- Division of Colon and Rectal Surgery, Gonda 9S, Mayo Clinic and Mayo Foundation, 200 First Street SW, Rochester, MN 55905, USA
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Abstract
Unlike laparoscopic cholecystectomy, laparoscopic hepatectomy has been slow to gain acceptance because of its association with technical difficulties. Many surgeons feel there are few advantages in laparoscopic hepatectomy when compared to open surgery. The liver is the organ most susceptible to bleeding while dissecting the parenchyma and the resected liver usually requires a wide abdominal incision to deliver the resected specimen. Both the improvement of surgeons' skills and the development of technology have improved results, however, the indication of laparoscopic hepatectomy for malignancy is still controversial. This article focuses on the current status of minimally invasive treatment for liver malignancy.
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Affiliation(s)
- Fumihiko Fujita
- Department of Transplantation and Digestive Surgery, Nagasaki University Graduate School of Biomedical Science, Nagasaki, Japan.
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Bacal D. Experience with laparoscopic medial and lateral dissection of the rectosigmoid for cancer. World J Surg 2003; 27:1337-8; author reply 1338. [PMID: 14574481 DOI: 10.1007/s00268-003-1028-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Cho J, Harrop J, Veznadaroglu E, Andrews DW. Concomitant use of computer image guidance, linear or sigmoid incisions after minimal shave, and liquid wound dressing with 2-octyl cyanoacrylate for tumor craniotomy or craniectomy: analysis of 225 consecutive surgical cases with antecedent historical control at one institution. Neurosurgery 2003; 52:832-40; discussion 840-1. [PMID: 12657178 DOI: 10.1227/01.neu.0000054219.35102.b4] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2002] [Accepted: 12/05/2002] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVE Recent neurosurgical literature reflects rapidly evolving, technically enhanced methods that promise to improve neurosurgical outcomes. We review our experience with computer image guidance, linear or sigmoid incisions after minimal shaving, and liquid wound dressing with 2-octyl cyanoacrylate (Dermabond; Ethicon, Inc., Somerville, NJ) for tumor craniotomy or craniectomy in our attempt to optimize craniotomy or craniectomy for tumor. METHODS After institutional review board approval, we retrospectively reviewed patients who underwent craniotomy or craniectomy for tumor with or without the combination of techniques specified above. A prior cohort of patients who underwent craniotomy or craniectomy with traditional techniques served as a retrospective basis of comparison. Analysis included in- and outpatient chart reviews, which included the operative notes, pathology reports, discharge summaries, outpatient office records, and intraoperative nursing records. Data were entered into a statistical spreadsheet for analysis and comparison. RESULTS A total of 225 consecutive patients underwent a combination of less invasive techniques from July 2000 through October 2001. These patients were matched with 225 patients in a standard neurosurgical cohort that included patients who underwent operations from July 1994 through July 2000. Age, tumor type, radiation, reoperation rate, tumor location, and extent of resection were comparable for both groups. The overall wound complication rate was significantly lower in the minimally invasive group when compared with the control cohort of patients (0.9% versus 6.2%; P = 0.0298), even for early follow-up (0.9% versus 3.5%; P = 0.0427). Pedicle flap design was a variable that was significantly associated with wound complication. CONCLUSION Modern neurosurgical techniques are beneficial for patients undergoing craniotomy or craniectomy for tumor and seem to be superior to standard techniques. Although the study is multifactorial and retrospective, this conclusion is further supported by the enhanced self-image patients have during the postoperative period.
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Affiliation(s)
- Joon Cho
- Department of Neurosurgery, Konkuk University, Seoul, South Korea
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Polliand C, Barrat C, Raselli R, Elizalde A, Champault G. [Colorectal cancer: 74 patients treated by laparoscopic resection with a mean follow-up of 5 years]. ANNALES DE CHIRURGIE 2002; 127:690-6. [PMID: 12658828 DOI: 10.1016/s0003-3944(02)00865-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
OBJECTIVE The aims of this study were to analyse the results and long term outcome in a prospective non randomised trial of 74 patients treated by laparoscopic colo-rectal resection for cancer, and to determine wether survival and recurrence are or are not compromised by an initial laparoscopic approach. PATIENTS AND METHODS Seventy-four patients with colo-rectal carcinoma were included in a prospective trial and treated by laparoscopic resection. All patients were reviewed at 1, 3, and 6 months interval. A median of 5 years follow up was available. Forty-eight patients (65%) had more than 3 years of follow up. RESULTS Six conversions (8.1%) were necessary: 2 for tumor invasion of adjacent organs, 2 for limited margin resection in lower rectal tumors, 1 for small bowel injury and 1 for obesity. After surgery, passing flatus occurred at 34.3 +/- 16.7 h and oral intake could be reinstaured at 42.6 +/- 22 h. Mean postoperative stay was 8.2 +/- 3.4 days. No death occurred. The overall morbidity was about 13.5%. The rate of late complications was 5.4%. Two port site metastasis (2.6%) were seen in locally advanced carcinoma. Recurrence rate at 5 years was 0% for Dukes A, 20% for Dukes B, 39.2% for Dukes C. Survival rate at 5 years was 100% for Dukes A, 80% for Dukes B, and 60.7% for Dukes C. These results are similar to those of conventional open surgery. CONCLUSION Laparoscopic colorectal resection for cancer can be performed safely, with a low morbidity and rare late complications. Long term follow up (5 years) assessment shows similar outcome compared with conventional surgery.
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Affiliation(s)
- C Polliand
- Université Paris XIII, service de chirurgie digestive, CHU Jean-Verdier, AP-HP, avenue du 14-juillet, 93140 Bondy, France
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Champault GG, Barrat C, Raselli R, Elizalde A, Catheline JM. Laparoscopic Versus Open Surgery For Colorectal Carcinoma. Surg Laparosc Endosc Percutan Tech 2002; 12:88-95. [PMID: 11948293 DOI: 10.1097/00129689-200204000-00003] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
The role of laparoscopic resection in the management of colorectal cancer is still unclear. It has been shown that laparoscopic colectomies can be accomplished with acceptable morbidity. Major concerns are port-site recurrences and neoplastic dissemination. The aims of this study were to compare perioperative results and long-term outcomes in a prospective, nonrandomized study of patients treated by laparoscopic versus open colorectal resection for cancer. In particular, the effects of an initial laparoscopic approach on survival and recurrence were examined. One hundred fifty-seven patients with colorectal carcinoma were included in the prospective trial: 74 underwent laparoscopic resection and 83 underwent conventional open surgery. The two groups were comparable in terms of characteristics, demographic data, stage of disease, and use of adjuvant or palliative chemoradiotherapy. All patients were observed at 1.3- and 6-month intervals. The median duration of follow-up was 60 months (range, 10-125 months). The mean operating time was significantly longer in the laparoscopic group. Six conversions (8.1%) were necessary. The passage of flatus and the restarting of oral intake (P = 0.0001) occurred earlier in the laparoscopic surgery group than in the open conventional surgery group. The mean postoperative stay was significantly shorter in the former group (P = 0.005), as was the length of the scar (P = 0.001). There were no deaths in either group. The overall morbidity was significantly lower (13% versus 33.7%; P = 0.001) in patients treated laparoscopically. No significant differences were observed between the groups in the length of specimens, the size of the tumor, or the number of nodes removed. Late complications were more frequent after open resection (12% versus 5.4%; P = 0.01). Two port-site metastases (2.6%) were seen in stage III and IV locally advanced carcinoma. There was no significant difference in recurrent disease between the groups (24.3% versus 25%) during the 60-month follow-up. Stage-for-stage comparisons showed that disease recurrence rates and crude death rates were comparable.
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Affiliation(s)
- Gerard G Champault
- Department of Digestive Surgery, Paris University Hopital J. Verdier, Paris, France.
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Canis M, Mage G, Botchorishvili R, Wattiez A, Rabischong B, Houlle C, Pouly JL, Bruhat MA. [Laparoscopy and gynecologic cancer: is it still necessary to debate or only convince the incredulous?]. GYNECOLOGIE, OBSTETRIQUE & FERTILITE 2001; 29:913-8. [PMID: 11802556 DOI: 10.1016/s1297-9589(01)00243-0] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Many papers suggested that laparoscopic treatment of cancer could be achieved and taught safely. Although cases reports about trocar site metastasis and national survey about inadequate management of early ovarian cancer suggested that laparoscopic management of cancer may be dangerous. The current literature may be summarized as follows. An inadequate surgical management performed by laparoscopy as well as by laparotomy may worsen the prognosis of an early ovarian cancer. If the abdominal wall is protected with a bag and the tumour is not morcellated, the incidence of trocar site site metastasis is about 1%. Animal studies demonstrated that the laparoscopic management of cancer has both advantages and disadvantages. Preliminary results from prospective randomised trials in the treatment of colon cancer suggested that the survival rate is similar after laparoscopy and after laparotomy. The risk of dissemination appears high when a large number of malignant cells are present in patients operated using an increased abdominal pressure and a CO2 pneumoperitoneum. These data suggest that laparoscopic treatment of gynaecologic cancer is not dangerous if an adequate surgical technique is used. However morcellation of suspicious solid tumours, treatment of adnexal tumours with external vegetations but without peritoneal dissemination and of bulky lymph nodes should be considered as contra-indications to CO2 laparoscopy, puncture of an ovarian tumour with intracystic vegetations is a high risk situation which should be avoided whenever possible.
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Affiliation(s)
- M Canis
- Département de gynécologie obstétrique et médecine de la reproduction, CHU, boulevard Léon-Malfreyt, 63033 Clermont Ferrand, France.
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