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Hayashi K, Passera R, Meroni C, Dallorto R, Marafante C, Ammirati CA, Arezzo A. Complete mesocolic excision (CME) impacts survival only for Stage III right-sided colon cancer: a systematic review and meta-analysis. MINIM INVASIV THER 2024:1-11. [PMID: 39323111 DOI: 10.1080/13645706.2024.2405544] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2024] [Accepted: 07/30/2024] [Indexed: 09/27/2024]
Abstract
INTRODUCTION Complete mesocolic excision (CME) is widely adopted for its assumed superior oncological outcome. However, it's unclear if all right-sided colon cancer patients benefit from CME. The aim of this systematic review is to investigate whether CME contributes to postoperative outcomes and to determine the surgical indications for CME. MATERIAL AND METHODS We searched eligible articles about CME versus non-CME procedures for right-sided colon cancer in the OVID Medline, Embase, and Cochrane CENTRAL databases, and a meta-analysis was conducted. RESULTS Twenty-two articles and seven abstracts involving 8088 patients were included in this study. Among them, 3803 underwent CME and 4285 non-CME procedures. The analysis showed that CME was favoured for three-year disease-free survival (DFS) and overall survival (OS), for local, systemic, and total recurrence, and for hospital stay durations. However, increased vascular injury and longer surgery time were observed in CME. Regarding the three-year OS, the superiority of CME was observed only in Stage III. Additionally, no significant differences were observed between CME and non-CME groups regarding overall complications, 30-day readmission rates, reoperation, or postoperative mortality rates. CONCLUSIONS CME for right-sided colon cancer should be considered, particularly in Stage III patients, to contribute to improved oncological outcomes. However, careful attention must be paid to the increased risk of vascular injury.
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Affiliation(s)
- Kengo Hayashi
- Department of Gastrointestinal Surgery, Kanazawa University, Kanazawa, Japan
| | - Roberto Passera
- Department of Medical Sciences, University of Turin, Turin, Italy
| | - Chiara Meroni
- Department of Surgical Sciences, University of Turin, Turin, Italy
| | - Rebecca Dallorto
- Department of Surgical Sciences, University of Turin, Turin, Italy
| | - Chiara Marafante
- Department of Surgical Sciences, University of Turin, Turin, Italy
| | | | - Alberto Arezzo
- Department of Surgical Sciences, University of Turin, Turin, Italy
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Catarci M, Guadagni S, Masedu F, Ruffo G, Viola MG, Scatizzi M. Bowel preparation before elective right colectomy: Multitreatment machine-learning analysis on 2,617 patients. Surgery 2024:S0039-6060(24)00675-5. [PMID: 39322486 DOI: 10.1016/j.surg.2024.08.039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2024] [Revised: 08/13/2024] [Accepted: 08/29/2024] [Indexed: 09/27/2024]
Abstract
BACKGROUND In the worldwide, real-life setting, some candidates for right colectomy still receive no bowel preparation, some receive oral antibiotics alone, some receive mechanical bowel preparation alone, and some receive mechanical bowel preparation with oral antibiotics, with varying degrees of compliance to preoperative intravenous antibiotic prophylaxis. Previous studies mainly focused on left-sided colorectal anastomoses while less attention has been devoted to right-sided ileocolic anastomoses. When high-level evidence from randomized clinical trials is lacking, multiple-treatment propensity score weighting analysis of prospective data on the basis of generalized boosted model is superior to a simple propensity score-matching analysis and to an inverse probability weighting in terms of external validity and bias reduction. METHODS This is an analysis on the basis of machine-learning procedures of 2,617 patients who underwent elective right colectomies. RESULTS The risk of surgical-site infections (5.0% after no bowel preparation) was significantly lower after mechanical bowel preparation with oral antibiotics (4.0%, P = .017), significantly greater after mechanical bowel preparation alone (8.6%, P = .019), and comparable after oral antibiotics alone (3.9%). The risk of anastomotic leakage (3.2% after no bowel preparation) was significantly greater after oral antibiotics alone (4.8%, P = .013). Concerning secondary outcomes, no significant differences were recorded for the risk of overall morbidity and reoperation. The risk of readmission (3.0% after no bowel preparation) was significantly reduced after mechanical bowel preparation with oral antibiotics (1.5%, P = .046), and the risk of major morbidity (5.1% after no bowel preparation) was significantly greater after oral antibiotics alone (6.7%, P = .007). CONCLUSION This multitreatment machine-learning analysis, despite some limitations, showed that mechanical bowel preparation with oral antibiotics is associated with a decrease in surgical-site infections after elective right colectomy compared with no bowel preparation.
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Affiliation(s)
- Marco Catarci
- General Surgery Unit, Sandro Pertini Hospital, Roma, Italy
| | - Stefano Guadagni
- General Surgery Unit, Università degli Studi dell'Aquila, L'Aquila, Italy.
| | - Francesco Masedu
- Department of Biotechnological and Applied Clinical Sciences, Università degli Studi dell'Aquila, L'Aquila, Italy
| | - Giacomo Ruffo
- General Surgery Unit, IRCCS Sacro Cuore Don Calabria Hospital, Negrar di Valpolicella, Province of Verona, Italy
| | | | - Marco Scatizzi
- General Surgery Unit, Santa Maria Annunziata & Serristori Hospital, Florence, Italy
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Lu CC, Lu CT, Chang KY, Chun-Li W, Wu CY. Robot-assisted vs. laparoscopic right hemicolectomy in octogenarians and nonagenarians: an analysis of the US nationwide inpatient sample 2005-2018. Aging Clin Exp Res 2024; 36:193. [PMID: 39311977 PMCID: PMC11420325 DOI: 10.1007/s40520-024-02833-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2024] [Accepted: 08/09/2024] [Indexed: 09/26/2024]
Abstract
BACKGROUND Colorectal cancer (CRC) is a significant health concern, particularly among older adults. Outcomes between laparoscopic and robot-assisted surgeries for right-sided colon cancers in the oldest old population have yet to be evaluated despite increased use of these surgeries. AIM This study aimed to compare clinical outcomes after robot-assisted right hemicolectomy (RARH) versus laparoscopic right hemicolectomy (LRH) in octogenarian and nonagenarian patients. METHODS This population-based, retrospective and observational study analyzed the data of adults ≥ 80 years old diagnosed with right-side colon cancer who received RARH or LRH. All data were extracted from the US National Inpatient Sample (NIS) database 2005-2018. Associations between type of surgery and in-hospital outcomes were determined using univariate and multivariable logistic regression and linear regression analysis. RESULTS Data of 7,550 patients (representing 37,126 hospitalized patients in the U.S.) were analyzed. Mean age of the study population was 84.8 years, 61.4% were females, and 79.1% were non-smokers. After adjusting for relevant confounders, regression analysis showed that patients undergoing RARH had a significantly shorter LOS (adjusted Beta (aBeta), -0.24, 95% CI: -0.32, -0.15) but greater total hospital costs (aBeta, 26.54, 95% CI: 24.64, 28.44) than patients undergoing LRH. No significant differences in mortality, perioperative complications, and risk of unfavorable discharge were observed between the two procedures (p > 0.05). Stratified analyses by frailty status revealed consistent results. CONCLUSIONS RARH is associated with a significantly shorter LOS but higher total hospital costs than LRH among octogenarians and nonagenarians. Other short-term outcomes for this population are similar between the two procedures, including in-hospital mortality, perioperative complications, and unfavorable discharge. These findings also apply to frail patients.
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Affiliation(s)
- Chien-Chang Lu
- Department of Colorectal Surgery, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, No. 123, Dapi Road, Niaosong District, Kaohsiung City, Taiwan.
| | - Chi-Tung Lu
- Department of Colorectal Surgery, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, No. 123, Dapi Road, Niaosong District, Kaohsiung City, Taiwan
| | - Kai-Yen Chang
- Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan
| | - Wang Chun-Li
- Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan
| | - Chien-Ying Wu
- Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan
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Inamoto S, Nomura A, Okada T, Kanaya S, Sakai Y. Seamless solely medially approached robotic right hemicolectomy utilizing the double bipolar method excluding patient repositioning and instrument exchange. Tech Coloproctol 2024; 28:103. [PMID: 39138710 DOI: 10.1007/s10151-024-02987-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2024] [Accepted: 07/16/2024] [Indexed: 08/15/2024]
Affiliation(s)
- S Inamoto
- Department of Gastroenterological Surgery, Japanese Red Cross Osaka Hospital, 5-30 Fudegasaki-chou, Tennoji-ku, Osaka, 543-8555, Japan.
| | - A Nomura
- Department of Gastroenterological Surgery, Japanese Red Cross Osaka Hospital, 5-30 Fudegasaki-chou, Tennoji-ku, Osaka, 543-8555, Japan
| | - T Okada
- Department of Gastroenterological Surgery, Japanese Red Cross Osaka Hospital, 5-30 Fudegasaki-chou, Tennoji-ku, Osaka, 543-8555, Japan
| | - S Kanaya
- Department of Gastroenterological Surgery, Japanese Red Cross Osaka Hospital, 5-30 Fudegasaki-chou, Tennoji-ku, Osaka, 543-8555, Japan
| | - Y Sakai
- Department of Gastroenterological Surgery, Japanese Red Cross Osaka Hospital, 5-30 Fudegasaki-chou, Tennoji-ku, Osaka, 543-8555, Japan
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Soltesz T, Müller DT, Dieplinger G, Fuchs HF. [Minimally Invasive Techniques for Anastomosis in the Gastrointestinal Tract]. Zentralbl Chir 2024; 149:157-160. [PMID: 38565164 DOI: 10.1055/a-2284-6536] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/04/2024]
Abstract
ZusammenfassungAufgrund des zunehmenden Einsatzes der Robotik im Bereich der Chirurgie des Gastrointestinaltraktes bietet dieser Beitrag einen Leitfaden zu unterschiedlichen Anastomosentechniken bei der robotisch assistierten transthorakalen Ivor-Lewis-Ösophagektomie (RAMIE), der robotisch assistierten onkologischen Gastrektomie (RAMIG) sowie der robotischen Hemikolektomie rechts. Es werden die relevanten Operationsschritte dargestellt mit Fokus auf die verschiedenen Rekonstruktionen mittels robotisch assistierter Naht oder Verwendung eines Stapler Devices.Die onkologische Entscheidungsfindung und insbesondere die Wahl der chirurgischen Therapie und das Ausmaß der Resektion hängen immer von der Lokalisation des Tumors, der Histologie und den individuellen Risikofaktoren des Patienten ab. Beim Magenkarzinom im Stadium ≥ IB wird ein multimodales Vorgehen empfohlen, das eine perioperative Chemotherapie in Kombination mit einer chirurgischen Resektion mit kurativer Absicht umfasst. Für Patienten mit lokal fortgeschrittenen Adenokarzinomen oder Plattenepithelkarzinomen des Ösophagus ist die multimodale Behandlung heute ebenfalls der Goldstandard. Nach Abschluss der neoadjuvanten Vorbehandlung sowie Durchführung eines Re-Stagings erfolgt komplettierend die operative Resektion.Bei dem nicht metastasierten Kolonkarzinom ist eine primäre radikale onkologische Resektion im Sinne eines kurativen Therapiekonzeptes durchzuführen, gefolgt von einer adjuvanten Therapie bei fortgeschrittenem Befund.Dieses Manuskript sowie das begleitende Video erläutern die Rekonstruktionstechnik nach RAMIG sowohl als robotisch genähte Technik mittels V-Lock-3–0-Nähten als auch die Rekonstruktion mittels Linearstapler als alternative Technik. Für die RAMIE wird die Rekonstruktion mittels Zirkularstapler und intrathorakaler Anastomose als Standard gezeigt. Für die robotische Hemikolektomie wird eine Rekonstruktion mittels Linearstapler gezeigt.Verschiedene Möglichkeiten der robotischen Rekonstruktion sowohl nach robotischer Gastrektomie, nach robotischer Hemikolektomie als auch nach robotischer Ösophagektomie beinhalten robotisch genähte Techniken sowie die Anwendung von Stapler Devices. Eine Evidenz zum Vergleich der verschiedenen Techniken, insbesondere in der robotischen Chirurgie im Gastrointestinaltrakt, fehlt bislang, die Methoden zeigen sich in der klinischen Anwendung jedoch sicher durchführbar mit guten postoperativen Ergebnissen. Kommende Studien werden sich einem Vergleich der unterschiedlichen Rekonstruktionsmethoden in der robotischen Chirurgie widmen.
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Affiliation(s)
- Tim Soltesz
- Klinik und Poliklinik für Allgemein-, Viszeral-, Tumor- und Transplantationschirurgie, Universitätsklinikum Köln, Köln, Deutschland
| | - Dolores Thea Müller
- Klinik und Poliklinik für Allgemein-, Viszeral-, Tumor- und Transplantationschirurgie, Universitätsklinikum Köln, Köln, Deutschland
| | - Georg Dieplinger
- Klinik und Poliklinik für Allgemein-, Viszeral-, Tumor- und Transplantationschirurgie, Universitätsklinikum Köln, Köln, Deutschland
| | - Hans Friedrich Fuchs
- Klinik und Poliklinik für Allgemein-, Viszeral-, Tumor- und Transplantationschirurgie, Universitätsklinikum Köln, Köln, Deutschland
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Liu S, Huang N, Wei C, Wu Y, Zeng L. Is mechanical bowel preparation mandatory for elective colon surgery? A systematic review and meta-analysis. Langenbecks Arch Surg 2024; 409:99. [PMID: 38504007 DOI: 10.1007/s00423-024-03286-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2023] [Accepted: 03/09/2024] [Indexed: 03/21/2024]
Abstract
BACKGROUND Growing evidence demonstrates minimal impact of mechanical bowel preparation (MBP) on reducing postoperative complications following elective colectomy. This study investigated the necessity of MBP prior to elective colonic resection. METHOD A systematic literature review was conducted across PubMed, Ovid, and the Cochrane Library to identify studies comparing the effects of MBP with no preparation before elective colectomy, up until May 26, 2023. Surgical-related outcomes were compiled and subsequently analyzed. The primary outcomes included the incidence of anastomosis leakage (AL) and surgical site infection (SSI), analyzed using Review Manager Software (v 5.3). RESULTS The analysis included 14 studies, comprising seven RCTs with 5146 participants. Demographic information was consistent across groups. No significant differences were found between the groups in terms of AL ((P = 0.43, OR = 1.16, 95% CI (0.80, 1.68), I2 = 0%) or SSI (P = 0.47, OR = 1.20, 95% CI (0.73, 1.96), I2 = 0%), nor were there significant differences in other outcomes. Subgroup analysis on oral antibiotic use showed no significant changes in results. However, in cases of right colectomy, the group without preparation showed a significantly lower incidence of SSI (P = 0.01, OR = 0.52, 95% CI (0.31, 0.86), I2 = 1%). No significant differences were found in other subgroup analyses. CONCLUSION The current evidence robustly indicates that MBP before elective colectomy does not confer significant benefits in reducing postoperative complications. Therefore, it is justified to forego MBP prior to elective colectomy, irrespective of tumor location.
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Affiliation(s)
- Sheng Liu
- Department of General Surgery, Jiangyou Fourth People's Hospital, Jiangyou, China
| | - Ning Huang
- Department of Stomatology, Jiangyou Fourth People's Hospital, Jiangyou, China
| | - Changcheng Wei
- Department of General Surgery, Jiangyou Fourth People's Hospital, Jiangyou, China
| | - Yuehong Wu
- Department of General Surgery, Jiangyou Fourth People's Hospital, Jiangyou, China
| | - Lin Zeng
- Department of General Surgery, Jiangyou Fourth People's Hospital, Jiangyou, China.
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Kossenas K, Karamatzanis I, Moutzouri O, Catalli B, Biris AI, Dimaki D, Kokkofiti I, Georgopoulos F. Precision Versus Practicality: A Comprehensive Analysis of Robotic Right Colectomy Versus Laparoscopic Right Colectomy, Future Directions, Biases, Research Gaps, and Their Implications. Cureus 2024; 16:e52904. [PMID: 38406010 PMCID: PMC10892367 DOI: 10.7759/cureus.52904] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/25/2024] [Indexed: 02/27/2024] Open
Abstract
Colorectal cancer is the third most commonly diagnosed cancer in the world and second in cancer-related mortality. It is most prevalent in the developed world and is often associated with lifestyle factors along with age and genetics. The inclusion criteria comprised high-level evidence, such as randomized clinical trials, meta-analyses, and systematic reviews, conducted between 2012 and 2023, that directly compared the two approaches. The review reveals mixed outcomes between robotic right colectomy (RRC) and laparoscopic right colectomy (LRC). The robotic approach was associated with longer operative duration and higher costs but with decreased blood loss and quicker recovery compared to laparoscopy. On the other hand, no major differences were observed regarding lymph node retrieval, duration of hospitalization, and surgical complications. Regarding future directions, it is evident that the focus needs to shift beyond the operative parameters and to patient-centered outcomes, which are underreported. Also, more randomized clinical trials are required, focusing on safety, efficacy, and long-term quality of life. Costs-benefit analyses are required to weigh the benefits of robotic surgery against the implementation and practice costs. Additionally, improvements in surgeons' training may be necessary to reduce the operative duration and potentially decrease operational costs. Finally, standardization of research protocols may be necessary to reduce biases.
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Affiliation(s)
| | | | - Olga Moutzouri
- Medicine, University of Nicosia Medical School, Nicosia, CYP
| | | | | | - Dimitra Dimaki
- Medicine, University of Nicosia Medical School, Nicosia, CYP
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