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Casas MA, Angeramo CA, Schlottmann F, Bras Harriott C, Bun ME, Rotholtz NA. Second Laparoscopic Colorectal Resection: Safety and Feasibility. Surg Laparosc Endosc Percutan Tech 2022; 32:696-699. [PMID: 36375109 DOI: 10.1097/sle.0000000000001125] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2022] [Accepted: 10/24/2022] [Indexed: 06/16/2023]
Abstract
BACKGROUND As laparoscopic colorectal surgery continues increasing worldwide, the need of having a second laparoscopic colorectal resection (SLCR) might increase as well. Experience with this challenging procedure is scarce. The aim of this study was to evaluate the safety and feasibility of SLCR. METHODS A retrospective analysis of a prospectively collected database of patients undergoing colorectal surgery who needed an SLCR during the period 2008-2020 was performed. Demographics, operative variables, and postoperative outcomes were analyzed. A propensity score matching with a control population undergoing a first elective colorectal resection was performed. RESULTS A total of 1918 patients underwent colorectal surgery and 32 patients (1.7%) who required a SLCR were included for analysis; 17 (53.1%) were male, and the mean age was 71 (39 to 89) years. The median time between the first and second operations was 69 (6 to 230) months. At the second resection: The median operative time was 170 (90 to 380) minutes, there were 3 (9%) intraoperative complications and 2 (6%) conversions. Overall postoperative morbidity and major morbidity rates were 34% and 19%, respectively. Four patients (12.5%) required reoperation and 1 (3.1%) died of septic shock after an anastomotic leak. After propensity score matching, SLCR was more frequently performed by colorectal surgeons, and no differences in perioperative variables were observed compared with the control group. CONCLUSIONS SLCR can be safely performed without jeopardizing perioperative outcomes. Further studies are needed to confirm the benefits of the minimally invasive approach in colorectal second resection and to elucidate the long-term outcomes.
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Affiliation(s)
| | | | | | | | - Maximiliano E Bun
- Department of Surgery
- Division of Colorectal Surgery, Hospital Alemán of Buenos Aires, Argentina
| | - Nicolás A Rotholtz
- Department of Surgery
- Division of Colorectal Surgery, Hospital Alemán of Buenos Aires, Argentina
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2
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Ikeda A, Fukunaga Y, Akiyoshi T, Nagayama S, Nagasaki T, Yamaguchi T, Mukai T, Hiyoshi Y, Konishi T. Wound infection in colorectal cancer resections through a laparoscopic approach: a single-center prospective observational study of over 3000 cases. Discov Oncol 2021; 12:2. [PMID: 33844707 PMCID: PMC7878211 DOI: 10.1007/s12672-021-00396-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2021] [Accepted: 01/27/2021] [Indexed: 02/06/2023] Open
Abstract
OBJECTIVES This prospective observational study aimed to clarify the incidence and independent risk factors of wound infection after laparoscopic surgery for primary colonic and rectal cancer. METHODS A prospective surveillance of surgical site infection (SSI) was conducted in consecutive patients with primary colorectal cancer, who underwent elective laparoscopic surgery in a single comprehensive cancer center between 2005 and 2014. The outcomes of interest were the incidence and risk factors of wound infection. RESULTS In total, 3170 patients were enrolled in the study. The overall incidence of wound infection was 3.0%. The incidence of wound infection was significantly higher in rectal surgery than in colonic surgery (4.7 vs. 2.1%, p < 0.001). In rectal surgery, independent risk factors for developing wound infection included abdominoperineal resection (p < 0.001, odds ratio [OR] = 11.4, 95% confidence interval [CI]: 5.04-24.8), body mass index (BMI) ≥ 25 kg/m2 (p = 0.041, OR = 1.97, 95% CI, 1.03-3.76), and chemoradiotherapy (p = 0.032, OR = 2.18, 95% CI, 1.07-4.45). In laparoscopic colonic surgery, no significant risk factors were identified. CONCLUSIONS Laparoscopic rectal surgery has a higher risk of wound infection than colonic surgery. Laparoscopic rectal surgery involving abdominoperineal resection, patients with higher BMI, and chemoradiotherapy requires careful observation in wound care and countermeasures against wound infection.
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Affiliation(s)
- Atsushi Ikeda
- Department of Gastroenterological Surgery, Cancer Institute Hospital of Japanese Foundation for Cancer Research, Tokyo, Japan
- Department of Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Yosuke Fukunaga
- Department of Gastroenterological Surgery, Cancer Institute Hospital of Japanese Foundation for Cancer Research, Tokyo, Japan
| | - Takashi Akiyoshi
- Department of Gastroenterological Surgery, Cancer Institute Hospital of Japanese Foundation for Cancer Research, Tokyo, Japan
| | - Satoshi Nagayama
- Department of Gastroenterological Surgery, Cancer Institute Hospital of Japanese Foundation for Cancer Research, Tokyo, Japan
| | - Toshiya Nagasaki
- Department of Gastroenterological Surgery, Cancer Institute Hospital of Japanese Foundation for Cancer Research, Tokyo, Japan
| | - Tomohiro Yamaguchi
- Department of Gastroenterological Surgery, Cancer Institute Hospital of Japanese Foundation for Cancer Research, Tokyo, Japan
| | - Toshiki Mukai
- Department of Gastroenterological Surgery, Cancer Institute Hospital of Japanese Foundation for Cancer Research, Tokyo, Japan
| | - Yukiharu Hiyoshi
- Department of Gastroenterological Surgery, Cancer Institute Hospital of Japanese Foundation for Cancer Research, Tokyo, Japan
| | - Tsuyoshi Konishi
- Department of Gastroenterological Surgery, Cancer Institute Hospital of Japanese Foundation for Cancer Research, Tokyo, Japan
- Department of Surgical Oncology, The University of Texas, M.D. Anderson Cancer Center, 1400 Pressler Street Unit 1484, Houston, TX 77030 USA
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Jiang W, Mao Q, Wu X, Yu W, Chen D. Laparoscopic radical resection of gastric cancer and metachronous colon cancer-a case report. Transl Cancer Res 2020; 9:2053-2059. [PMID: 35117554 PMCID: PMC8799175 DOI: 10.21037/tcr.2020.01.44] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2019] [Accepted: 12/13/2019] [Indexed: 01/17/2023]
Abstract
Due to the favorable prognosis of gastric cancer (GC), the incidence of second primary cancer (SPC) accompanied with GC has increased. Here, we reported a case of a 69-year-old male patient with metachronous GC and colon cancer, who had undergone laparoscopic radical resection of distal GC 4 years ago. During this hospitalization, the patient underwent laparoscopic radical resection of left hemicolectomy for metachronous colon cancer. Few literatures have reported that patients with metachronous GC and colon cancer can receive laparoscopic surgery successfully. The patient recovered well and was discharged on day 10 post-operation. The pathologic specimen was identified as metachronous colon cancer. We concluded that GC patients need regular standard follow-up programs after undergoing operations. For multiple primary cancers (MPCs), treatments need to be individualized and comprehensive. Laparoscopic surgery is recommended as an appropriate option.
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Affiliation(s)
- Wenbin Jiang
- Department of General Surgery, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou 310016, China
| | - Qijiang Mao
- Department of General Surgery, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou 310016, China
| | - Xiaoli Wu
- Department of Gastroenterology, Shuanglin People's Hospital of Nanxun, Huzhou 313012, China
| | - Weihua Yu
- Department of General Surgery, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou 310016, China
| | - Dingwei Chen
- Department of General Surgery, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou 310016, China
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Ushigome H, Nishimura J, Takahashi Y, Yasui M, Ohue M, Yamada D, Yamamoto K, Wada H, Takahashi H, Omori T, Miyata H, Takiguchi S. Colorectal surgery in patients with prior pancreaticoduodenectomy. JOURNAL OF THE ANUS RECTUM AND COLON 2019; 3:121-127. [PMID: 31583327 PMCID: PMC6774738 DOI: 10.23922/jarc.2019-005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/29/2019] [Accepted: 05/16/2019] [Indexed: 01/05/2023]
Abstract
Objectives: Colorectal cancer (CRC) surgery after pancreaticoduodenectomy (PD) is difficult to perform, because PD involves dissection and complex reconstruction of the digestive tract. We evaluated the clinical outcomes of CRC surgery in patients with prior PD. Methods: Between January 2008 and March 2018, a total of 1727 patients received CRC surgery at our institution. Of these, 10 had previously undergone PD (PD group). As a control group, 280 patients were collected who had undergone resection without any history of previous abdominal surgery. The PD and control groups were further subdivided into four groups by right or left side. Outcomes of colorectal surgery were investigated in the PD and control groups. Results: The number of harvested lymph nodes was significantly lower in the PD group. In the right colectomy group, distance from the surgical margin was significantly shorter in the PD group. The rate of postoperative complications was higher in the PD group. Peritoneal dissemination originating from pancreatic cancer was found during CRC surgery for one patient, and one patient developed refractory ascites. Three patients died of pancreatic cancer, rectal cancer, and other disease. Seven patients were alive without recurrence. Conclusions: CRC surgery for patients with prior PD can involve difficulty in dissecting lymph nodes and higher postoperative morbidity rates but can provide sufficiently curative resection for CRC.
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Affiliation(s)
- Hajime Ushigome
- Department of Gastroenterological Surgery, Osaka International Cancer Institute, Osaka, Japan
| | - Junichi Nishimura
- Department of Gastroenterological Surgery, Osaka International Cancer Institute, Osaka, Japan
| | - Yusuke Takahashi
- Department of Gastroenterological Surgery, Osaka International Cancer Institute, Osaka, Japan
| | - Masayoshi Yasui
- Department of Gastroenterological Surgery, Osaka International Cancer Institute, Osaka, Japan
| | - Masayuki Ohue
- Department of Gastroenterological Surgery, Osaka International Cancer Institute, Osaka, Japan
| | - Daisaku Yamada
- Department of Gastroenterological Surgery, Osaka International Cancer Institute, Osaka, Japan
| | - Kazuyoshi Yamamoto
- Department of Gastroenterological Surgery, Osaka International Cancer Institute, Osaka, Japan
| | - Hiroshi Wada
- Department of Gastroenterological Surgery, Osaka International Cancer Institute, Osaka, Japan
| | - Hidenori Takahashi
- Department of Gastroenterological Surgery, Osaka International Cancer Institute, Osaka, Japan
| | - Takeshi Omori
- Department of Gastroenterological Surgery, Osaka International Cancer Institute, Osaka, Japan
| | - Hiroshi Miyata
- Department of Gastroenterological Surgery, Osaka International Cancer Institute, Osaka, Japan
| | - Shuji Takiguchi
- Department of Gastroenterological Surgery, Nagoya City University, Aichi, Japan
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Suzuki S, Nagasaki T, Akiyoshi T, Konishi T, Fujimoto Y, Nagayama S, Fukunaga Y, Fukuoka H, Ushigome H, Murahashi S, Miyanari S, Minami H, Ueno M. Laparoscopic right hemicolectomy for a colon cancer patient with an ileal conduit. Asian J Endosc Surg 2019; 12:114-117. [PMID: 29624907 DOI: 10.1111/ases.12486] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2018] [Revised: 02/26/2018] [Accepted: 03/05/2018] [Indexed: 11/29/2022]
Abstract
Here, we describe our experience of laparoscopic surgery in a colon cancer patient with an ileal conduit. To our knowledge, this is the second case presented in the English-language literature. A 71-year-old woman with a history of both open anterior exenteration with ileal conduit reconstruction for bladder cancer and open cholecystectomy for cholecystitis was diagnosed with ascending colon cancer (cT3N1M0). Laparoscopic right hemicolectomy with conduit preservation was planned. After adhesiolysis, complete mesocolic excision and central vascular ligation were achieved laparoscopically without injury to the conduit or other structures. Laparoscopic surgery for patients with an ileal conduit can be technically demanding. A preoperative plan based on preoperative imaging and the patient's previous operative record is crucial, especially when considering the optimal balance between oncological radicality and functional outcomes.
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Affiliation(s)
- Shinsuke Suzuki
- Gastroenterological Center, Department of Gastroenterological Surgery, Cancer Institute Hospital, Japanese Foundation for Cancer Research, Tokyo, Japan
| | - Toshiya Nagasaki
- Gastroenterological Center, Department of Gastroenterological Surgery, Cancer Institute Hospital, Japanese Foundation for Cancer Research, Tokyo, Japan
| | - Takashi Akiyoshi
- Gastroenterological Center, Department of Gastroenterological Surgery, Cancer Institute Hospital, Japanese Foundation for Cancer Research, Tokyo, Japan
| | - Tsuyoshi Konishi
- Gastroenterological Center, Department of Gastroenterological Surgery, Cancer Institute Hospital, Japanese Foundation for Cancer Research, Tokyo, Japan
| | - Yoshiya Fujimoto
- Gastroenterological Center, Department of Gastroenterological Surgery, Cancer Institute Hospital, Japanese Foundation for Cancer Research, Tokyo, Japan
| | - Satoshi Nagayama
- Gastroenterological Center, Department of Gastroenterological Surgery, Cancer Institute Hospital, Japanese Foundation for Cancer Research, Tokyo, Japan
| | - Yosuke Fukunaga
- Gastroenterological Center, Department of Gastroenterological Surgery, Cancer Institute Hospital, Japanese Foundation for Cancer Research, Tokyo, Japan
| | - Hironori Fukuoka
- Gastroenterological Center, Department of Gastroenterological Surgery, Cancer Institute Hospital, Japanese Foundation for Cancer Research, Tokyo, Japan
| | - Hajime Ushigome
- Gastroenterological Center, Department of Gastroenterological Surgery, Cancer Institute Hospital, Japanese Foundation for Cancer Research, Tokyo, Japan
| | - Satoshi Murahashi
- Gastroenterological Center, Department of Gastroenterological Surgery, Cancer Institute Hospital, Japanese Foundation for Cancer Research, Tokyo, Japan
| | - Shun Miyanari
- Gastroenterological Center, Department of Gastroenterological Surgery, Cancer Institute Hospital, Japanese Foundation for Cancer Research, Tokyo, Japan
| | - Hironori Minami
- Gastroenterological Center, Department of Gastroenterological Surgery, Cancer Institute Hospital, Japanese Foundation for Cancer Research, Tokyo, Japan
| | - Masashi Ueno
- Gastroenterological Center, Department of Gastroenterological Surgery, Cancer Institute Hospital, Japanese Foundation for Cancer Research, Tokyo, Japan
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Nagasaki T, Arai M, Chino A, Akiyoshi T, Fukunaga Y, Ueno M. Feasibility of Segmental Colectomy Followed by Endoscopic Surveillance as a Treatment Strategy for Colorectal Cancer Patients with Lynch Syndrome. Dig Surg 2017; 35:448-456. [PMID: 29017165 DOI: 10.1159/000481413] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2017] [Accepted: 09/10/2017] [Indexed: 12/28/2022]
Abstract
BACKGROUND Initial surgical procedures for colorectal cancer (CRC) patients with Lynch syndrome remain controversial. This study assessed the validity of segmental colectomy (SGC) followed by endoscopic surveillance as a treatment strategy for CRC patients with Lynch syndrome. METHODS Among consecutive patients who underwent surgery for primary CRC between April 1985 and December 2014, 49 patients were observed to have germline mutations in a mismatch repair gene, and 38 patients who underwent SGC followed by periodic endoscopic surveillance at our institution were evaluated for metachronous CRC, need for secondary surgery, and the details of endoscopic surveillance. RESULTS Of the 38 patients who underwent SGC followed by periodic endoscopic surveillance at our institution, 6 (15.8%) patients showed metachronous CRC, 3 (7.9%) patients underwent endoscopic resection, and the other 3 patients (7.9%) underwent secondary surgery. The dispersion of the endoscopic surveillance interval was significantly greater in patients with metachronous CRC (364 ± 332.9 days) than in those without metachronous CRC (370 ± 129.7 days; p < 0.001). CONCLUSIONS SGC followed by annual endoscopic surveillance was feasible as a treatment strategy for CRC patients with Lynch syndrome, because the incidence of metachronous CRC and the need for secondary surgery were low. Annual and periodic endoscopic surveillance might be essential for early detection of metachronous CRC and prevention of secondary surgery because of metachronous CRC in CRC patients with Lynch syndrome after SGC.
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Affiliation(s)
| | - Masami Arai
- Departments of Clinical Genetic Oncology, Tokyo, Japan
| | - Akiko Chino
- Departments of Gastroenterology, Cancer Institute Hospital, Japanese Foundation for Cancer Research, Tokyo, Japan
| | | | | | - Masashi Ueno
- Departments of Gastroenterological Surgery, Tokyo, Japan
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Metabolic Adaptation to Nutritional Stress in Human Colorectal Cancer. Sci Rep 2016; 6:38415. [PMID: 27924922 PMCID: PMC5141444 DOI: 10.1038/srep38415] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2016] [Accepted: 11/07/2016] [Indexed: 12/28/2022] Open
Abstract
Tumor cells respond to their microenvironment, which can include hypoxia and malnutrition, and adapt their metabolism to survive and grow. Some oncogenes are associated with cancer metabolism via regulation of the related enzymes or transporters. However, the importance of metabolism and precise metabolic effects of oncogenes in colorectal cancer remain unclear. We found that colorectal cancer cells survived under the condition of glucose depletion, and their resistance to such conditions depended on genomic alterations rather than on KRAS mutation alone. Metabolomic analysis demonstrated that those cells maintained tricarboxylic acid cycle activity and ATP production under such conditions. Furthermore, we identified pivotal roles of GLUD1 and SLC25A13 in nutritional stress. GLUD1 and SLC25A13 were associated with tumor aggressiveness and poorer prognosis of colorectal cancer. In conclusion, GLUD1 and SLC25A13 may serve as new targets in treating refractory colorectal cancer which survive in malnutritional microenvironments.
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Ikeda A, Fukunaga Y, Akiyoshi T, Konishi T, Fujimoto Y, Nagayama S, Ueno M. Laparoscopic right colectomy in patients treated with previous gastrectomy. Surg Today 2015; 46:209-13. [PMID: 25860588 DOI: 10.1007/s00595-015-1157-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2014] [Accepted: 02/24/2015] [Indexed: 01/03/2023]
Abstract
PURPOSE Laparoscopic colorectal surgery is increasingly being performed in patients treated with previous abdominal surgery. This is a retrospective study designed to evaluate the feasibility of laparoscopic right colectomy in patients with a previous history of gastrectomy. METHODS Of 838 consecutive patients who underwent elective laparoscopic right colectomy, 23 had previously undergone gastrectomy (PG group) and 516 had no history of previous abdominal surgery (NS group). The short-term surgical outcomes were retrospectively investigated in the PG and NS groups. RESULTS The median patient age was 75 years in the PG group and 67 years in the NS group (p = 0.0026), and the median body mass index in both groups was 19.2 and 22.6 kg/m(2), respectively (p = 0.0006). The mean operative time, amount of blood loss and postoperative hospital stay were similar. One patient in the PG group and five patients in the NS group required conversion to laparotomy (p = 0.1307). Three patients in the PG group experienced postoperative complications, one each with an intraperitoneal abscess, wound infection and enterocolitis; however, none of these complications were directly attributable to adhesiolysis. The rates of intraoperative and postoperative complications were similar. CONCLUSIONS Laparoscopic right colectomy is feasible in patients treated with previous gastrectomy.
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Affiliation(s)
- Atsushi Ikeda
- Department of Gastroenterological Surgery, Cancer Institute Hospital of Japanese Foundation for Cancer Research, 3-8-31 Ariake, Koto-ku, Tokyo, 135-8550, Japan
| | - Yosuke Fukunaga
- Department of Gastroenterological Surgery, Cancer Institute Hospital of Japanese Foundation for Cancer Research, 3-8-31 Ariake, Koto-ku, Tokyo, 135-8550, Japan.
| | - Takashi Akiyoshi
- Department of Gastroenterological Surgery, Cancer Institute Hospital of Japanese Foundation for Cancer Research, 3-8-31 Ariake, Koto-ku, Tokyo, 135-8550, Japan
| | - Tsuyoshi Konishi
- Department of Gastroenterological Surgery, Cancer Institute Hospital of Japanese Foundation for Cancer Research, 3-8-31 Ariake, Koto-ku, Tokyo, 135-8550, Japan
| | - Yoshiya Fujimoto
- Department of Gastroenterological Surgery, Cancer Institute Hospital of Japanese Foundation for Cancer Research, 3-8-31 Ariake, Koto-ku, Tokyo, 135-8550, Japan
| | - Satoshi Nagayama
- Department of Gastroenterological Surgery, Cancer Institute Hospital of Japanese Foundation for Cancer Research, 3-8-31 Ariake, Koto-ku, Tokyo, 135-8550, Japan
| | - Masashi Ueno
- Department of Gastroenterological Surgery, Cancer Institute Hospital of Japanese Foundation for Cancer Research, 3-8-31 Ariake, Koto-ku, Tokyo, 135-8550, Japan
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