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Akagi T, Suzuki K, Kono Y, Ninomiya S, Shibata T, Ueda Y, Shiroshita H, Etoh T, Shiomi A, Ito M, Watanabe J, Murata K, Hirano Y, Shimomura M, Tsukamoto S, Kanemitsu Y, Inomata M. Success rate of acquiring informed consent and barriers to participation in a randomized controlled trial of laparoscopic versus open surgery for non-curative stage IV colon cancer in Japan (JCOG1107). Jpn J Clin Oncol 2022; 52:1270-1275. [PMID: 35863012 DOI: 10.1093/jjco/hyac112] [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: 04/24/2022] [Accepted: 06/24/2022] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Successful achievement of randomized controlled trials (RCTs) is dependent on the acquisition of informed consent (IC) from patients. The aim of this study was to prospectively calculate the proportion of participation in a surgical RCT and to identify the reasons for failed acquisition of IC. METHODS A 50-insitution RCT was conducted to evaluate oncological outcomes of open and laparoscopic surgery for stage IV colon cancer (JCOG1107: UMIN-CTR 000000105). The success rate of obtaining IC was evaluated in eight periods between January 2013 and January 2021. In addition, reasons for failed acquisition of IC were identified from questionnaires. RESULTS In total, 391 patients were informed of their eligibility for the trial, and 168 (42%) were randomly assigned to either the laparoscopic surgery group (n = 84) or open surgery group (n = 84). The success rate of IC acquisition ranged from 33 to 58% in three periods. The most common reasons for failed IC acquisition were the patients' preference for one approach of surgery based on recommendations from referring doctors and family members, and anxiety/unhappiness about randomization. CONCLUSIONS The success rate of acquiring IC from patients for an RCT of laparoscopic versus open surgery for stage IV colon cancer was lower than the expected rate planned in the protocol. To obtain the planned rate, investigators should make efforts to inform patients and their families about the medical contributions a surgical RCT can make and recognize that the period in equipoise may be limited.
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Affiliation(s)
- Tomonori Akagi
- Department of Gastroenterological and Pediatric Surgery, Oita University Faculty of Medicine, Oita, Japan
| | - Kosuke Suzuki
- Department of Gastroenterological and Pediatric Surgery, Oita University Faculty of Medicine, Oita, Japan
| | - Yohei Kono
- Department of Gastroenterological and Pediatric Surgery, Oita University Faculty of Medicine, Oita, Japan
| | - Shigeo Ninomiya
- Department of Gastroenterological and Pediatric Surgery, Oita University Faculty of Medicine, Oita, Japan
| | - Tomotaka Shibata
- Department of Gastroenterological and Pediatric Surgery, Oita University Faculty of Medicine, Oita, Japan
| | - Yoshitake Ueda
- Department of Gastroenterological and Pediatric Surgery, Oita University Faculty of Medicine, Oita, Japan
| | - Hidefumi Shiroshita
- Department of Gastroenterological and Pediatric Surgery, Oita University Faculty of Medicine, Oita, Japan
| | - Tsuyoshi Etoh
- Department of Gastroenterological and Pediatric Surgery, Oita University Faculty of Medicine, Oita, Japan
| | - Akio Shiomi
- Division of Colon and Rectal Surgery, Shizuoka Cancer Center Hospital, Shizuoka, Japan
| | - Masaaki Ito
- Department of Colorectal Surgery, National Cancer Center Hospital East, Chiba, Japan
| | - Jun Watanabe
- Department of Surgery, Gastroenterological Center, Yokohama City University Medical Center, Kanagawa, Japan
| | - Kohei Murata
- Department of Surgery, Kansai Rosai Hospital, Hyogo, Japan
| | - Yasumitsu Hirano
- Department of Gastroenterological Surgery, Saitama Medical University International Medical Center, Saitama, Japan
| | - Manabu Shimomura
- Department of Surgery, Hiroshima City Asa Citizens Hospital, Hiroshima, Japan
| | - Shunsuke Tsukamoto
- Department of Colorectal Surgery, National Cancer Center Hospital, Tokyo, Japan
| | - Yukihide Kanemitsu
- Department of Colorectal Surgery, National Cancer Center Hospital, Tokyo, Japan
| | - Masafumi Inomata
- Department of Gastroenterological and Pediatric Surgery, Oita University Faculty of Medicine, Oita, Japan
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Laitamäki M, Alamylläri I, Kalliomäki M, Laukkarinen J, Ukkonen M, Junttila E. Scoring Systems May be Effective in Predicting Mortality Associated with Palliative Emergency Gastrointestinal Surgery: A Retrospective Observational Study. World J Surg 2021; 45:2694-2702. [PMID: 34059930 PMCID: PMC8322013 DOI: 10.1007/s00268-021-06170-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/24/2021] [Indexed: 11/30/2022]
Abstract
Background Palliative emergency gastrointestinal surgery is associated with significant morbidity and mortality and weighing up the benefits and harms during the decision-making may be challenging. There are very few studies on surgery in palliative patient population. The aim of this retrospective study was to evaluate morbidity and mortality after palliative emergency gastrointestinal surgery and the usability of scoring systems in predicting the outcome. Methods Consecutive adult patients undergoing palliative emergency surgery at a tertiary hospital during the period 2015 to 2016 were included. Pre- and post-operative functional status, morbidity and mortality of patients were assessed. The predictive value of the American Society of Anesthesiologists (ASA) classification, the American College of Surgeons National Surgical Quality Improvement Program Surgical Risk Calculator (ACS NSQIP SRC) and Palliative index (PI) in estimating morbidity and mortality were determined. Results A total of 93 patients (age 69 [28–92] years, 51% female) were included. Typical indications for surgery were bowel obstruction (52%) and securing food intake (30%). Pre-operatively two patients (2.2%) were totally dependent in daily activities, while post-operatively the respective share was 34% at discharge from hospital. The incidence of post-operative complications was 37% and 14% died during the hospital stay. One-, three-month and one-year mortality rates were 41%, 63% and 87%, respectively. While ASA score, PI score and ACS NSQIP did not predict post-operative morbidity, both ASA score and ACS NSQIP SRC predicted post-operative mortality. Conclusions Palliative emergency laparotomy is associated with significant post-operative mortality and morbidity. Scorings, such as ASA score and ACS NSQIP SRC predict mortality in this patient population.
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Affiliation(s)
- M Laitamäki
- Department of Gastroenterology and Alimentary Tract Surgery, Tampere University Hospital, Tampere, Finland
| | - I Alamylläri
- Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
| | - M Kalliomäki
- Department of Anaesthesiology and Intensive Care Medicine, Tampere University Hospital, Tampere, Finland
| | - J Laukkarinen
- Department of Gastroenterology and Alimentary Tract Surgery, Tampere University Hospital, Tampere, Finland.,Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
| | - M Ukkonen
- Department of Gastroenterology and Alimentary Tract Surgery, Tampere University Hospital, Tampere, Finland. .,Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland.
| | - E Junttila
- Department of Anaesthesiology and Intensive Care Medicine, Tampere University Hospital, Tampere, Finland
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Nishizawa Y, Akagi T, Inomata M, Katayama H, Mizusawa J, Yamamoto S, Ito M, Masaki T, Watanabe M, Shimada Y, Kitano S. Risk factors for early postoperative complications after D3 dissection for stage II or III colon cancer: Supplementary analysis of a multicenter randomized controlled trial in Japan (JCOG0404). Ann Gastroenterol Surg 2019; 3:310-317. [PMID: 31131360 PMCID: PMC6524116 DOI: 10.1002/ags3.12246] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/25/2018] [Revised: 02/25/2019] [Accepted: 03/04/2019] [Indexed: 01/24/2023] Open
Abstract
OBJECTIVE To determine risk factors for early postoperative complications after D3 dissection for stage II/III colon cancer. BACKGROUND Identification of risk factors for postoperative complications is essential in patients surgically treated for colon cancer. The Japan Clinical Oncology Group (JCOG) conducted a randomized controlled trial, JCOG0404, to confirm the non-inferiority of laparoscopic surgery (LAP) to open surgery (OP) with D3 dissection for stage II/III colon cancer. This supplementary analysis was made to assess risk factors for surgery requiring D3 dissection using data from JCOG0404. METHODS Proportion of postoperative complications of any grade (CTCAE ver. 3.0) until first discharge and risk factors for the most frequent complications were analyzed by univariable and multivariable analysis. RESULTS Among 1057 randomized patients treated between October 2004 and March 2009, 520 patients with OP and 525 patients with LAP were analyzed. Overall postoperative complications of all grades occurred in 190 patients (18.2%). Multivariable analysis showed that the risk factors for overall early postoperative complications were OP itself (odds ratio [OR] 2.01, 95% confidence interval [CI]: 1.38-2.91, P = 0.0003) and operation time of >240 minutes (OR 1.94, 95% CI: 1.24-3.02, P = 0.0036). The most frequent adverse event was wound complication (50/1045, 4.8%). In the univariable analysis, reconstruction, greater blood loss, OP, and higher body mass index were significantly associated with wound complication. CONCLUSION Open surgery and longer operation time of >240 minutes were significant risk factors for postoperative complications. LAP surgery and shorter operation time could contribute to fewer postoperative complications in patients undergoing colectomy with D3 dissection. (Japan Clinical Oncology Group study JCOG 0404: NCT00147134/UMIN-CTR: C000000105.).
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Affiliation(s)
- Yusuke Nishizawa
- Division of Gastroenterological SurgerySaitama Cancer CenterKitaadachi‐gunSaitamaJapan
| | - Tomonori Akagi
- Faculty of Medicine, Gastroenterological and Pediatric SurgeryOita UniversityYufuOitaJapan
| | - Masafumi Inomata
- Faculty of Medicine, Gastroenterological and Pediatric SurgeryOita UniversityYufuOitaJapan
| | | | - Junki Mizusawa
- JCOG Data CenterNational Cancer Center HospitalTokyoJapan
| | | | - Masaaki Ito
- Department of Colorectal SurgeryNational Cancer Center Hospital EastKashiwaChibaJapan
| | | | - Masahiko Watanabe
- Department of SurgeryKitasato University School of MedicineSagamiharaKanagawaJapan
| | - Yasuhiro Shimada
- Department of Medical OncologyKochi Health Sciences CenterKochiJapan
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4
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Numata M, Sawazaki S, Aoyama T, Tamagawa H, Godai T, Sato T, Saeki H, Saigusa Y, Taguri M, Mushiake H, Oshima T, Yukawa N, Shiozawa M, Masuda M, Rino Y. Laparoscopic surgery in patients diagnosed with clinical N2 colon cancer. Surg Today 2019; 49:507-512. [PMID: 30666418 DOI: 10.1007/s00595-019-1762-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2018] [Accepted: 12/20/2018] [Indexed: 01/08/2023]
Abstract
PURPOSE The benefits of laparoscopic surgery for colorectal cancer have been well established. Several randomized controlled trials have demonstrated similar oncological outcomes between laparoscopic and open surgery for colon cancer. However, whether or not laparoscopic surgery is acceptable in patients with clinical N2 colon cancer is unclear. Therefore, the present study aimed to evaluate the safety and oncological outcomes of laparoscopic surgery for clinical N2 colon cancer. METHODS This retrospective study assessed a prospective database and identified 262 consecutive patients with clinical N2 colon cancer who underwent either laparoscopic or open primary resection between 2000 and 2016. After propensity-score matching, 162 patients were analyzed. The primary outcome of interest was the 3-year recurrence-free survival rate, and the secondary outcome of interest was the postoperative complication rate. RESULTS The 3-year recurrence-free survival rate did not differ markedly between the laparoscopic and open surgery groups (77.4% vs. 76.5%, p = 0.620). In addition, the incidence of postoperative complications did not differ markedly between the laparoscopic and open surgery groups (16.6% vs. 24.0%, p = 0.317). CONCLUSIONS Our findings suggest that laparoscopic surgery is safe and effective for clinical N2 colon cancer. Laparoscopic resection can be considered in patients diagnosed with clinical N2 colon cancer.
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Affiliation(s)
- Masakatsu Numata
- Department of Surgery, Yokohama City University, 3-9 Fukuura, Kanazawa-ku, Yokohama, Kanagawa, 236-0004, Japan.
| | - Sho Sawazaki
- Department of Surgery, Yokohama City University, 3-9 Fukuura, Kanazawa-ku, Yokohama, Kanagawa, 236-0004, Japan
| | - Toru Aoyama
- Department of Surgery, Yokohama City University, 3-9 Fukuura, Kanazawa-ku, Yokohama, Kanagawa, 236-0004, Japan
| | - Hiroshi Tamagawa
- Department of Surgery, Yokohama City University, 3-9 Fukuura, Kanazawa-ku, Yokohama, Kanagawa, 236-0004, Japan
| | - Teni Godai
- Department of Surgery, Fujisawa Shounandai Hospital, Fujisawa, Japan
| | - Tsutomu Sato
- Department of Surgery, Yokohama City University, 3-9 Fukuura, Kanazawa-ku, Yokohama, Kanagawa, 236-0004, Japan
| | - Hiroyuki Saeki
- Department of Surgery, Yokohama Minami Kyosai Hospital, Yokohama, Japan
| | - Yusuke Saigusa
- Department of Biostatistics, Yokohama City University, Yokohama, Japan
| | - Masataka Taguri
- Department of Biostatistics, Yokohama City University, Yokohama, Japan
| | - Hiroyuki Mushiake
- Department of Surgery, Yokohama City University, 3-9 Fukuura, Kanazawa-ku, Yokohama, Kanagawa, 236-0004, Japan
| | - Takashi Oshima
- Department of Gastroenterological Surgery, Kanagawa Cancer Hospital, Yokohama, Japan
| | - Norio Yukawa
- Department of Surgery, Yokohama City University, 3-9 Fukuura, Kanazawa-ku, Yokohama, Kanagawa, 236-0004, Japan
| | - Manabu Shiozawa
- Department of Gastroenterological Surgery, Kanagawa Cancer Hospital, Yokohama, Japan
| | - Munetaka Masuda
- Department of Surgery, Yokohama City University, 3-9 Fukuura, Kanazawa-ku, Yokohama, Kanagawa, 236-0004, Japan
| | - Yasushi Rino
- Department of Surgery, Yokohama City University, 3-9 Fukuura, Kanazawa-ku, Yokohama, Kanagawa, 236-0004, Japan
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5
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Harji DP, Vallance A, Selgimann J, Bach S, Mohamed F, Brown J, Fearnhead N. A systematic analysis highlighting deficiencies in reported outcomes for patients with stage IV colorectal cancer undergoing palliative resection of the primary tumour. EUROPEAN JOURNAL OF SURGICAL ONCOLOGY 2018; 44:1469-1478. [PMID: 30007475 DOI: 10.1016/j.ejso.2018.06.012] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2018] [Revised: 05/24/2018] [Accepted: 06/11/2018] [Indexed: 02/07/2023]
Abstract
BACKGROUND Management of the primary tumour in the presence of unresectable metastatic colorectal cancer (mCRC) is controversial. The role of primary tumour resection (PTR) has been investigated by a number of retrospective cohort studies, with a number on going randomised controlled trials. The aim of this study was to identify the clinical and patient-reported outcomes currently reported in studies that evaluate the role of PTR in mCRC. METHODS Literature searches were performed in MEDLINE (via OvidSP) (1966-June 2017), EMBASE (via OvidSP) and the Cochrane Library using terms related to colorectal cancer and primary tumour resection. All studies documenting outcomes following palliative PTR were included. Eligible articles were assessed using the Risk of Bias In Non-Randomised Studies of Intervention (ROBINS-I) tool. RESULTS Of 11,209 studies screened, 59 non-randomised studies reporting outcomes on 331,157 patients were included. Patient characteristics regarding performance status and co-morbidity were recorded in 26 (44.1%) and 17 (28.8%) studies. The chemotherapy regime used was reported in 27 (45.8%) studies. The operative setting and the operative approach was reported in 42 (71%) and 14 (23.7%) studies. Post-operative mortality and morbidity were reported in 33 (55.9%) and 35 (59.3%) studies. Overall survival was reported in 49 (83.1%) studies, with 5 different definitions identified. Quality of life was only reported in 1 (1.7%) study. CONCLUSION This study demonstrates significant heterogeneity in the selection and definition of outcomes reported following PTR in mCRC. There is significant heterogeneity with a significant under-reporting of important outcomes such as treatment related adverse events and patient reported outcomes.
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Affiliation(s)
- Deena P Harji
- Newcastle Centre of Bowel Disease, Royal Victoria Infirmary, Newcastle upon Tyne, UK; Clinical Trials Research Unit, University of Leeds, UK.
| | - Abigail Vallance
- Clinical Effectiveness Unit, Royal College of Surgeons, London, UK
| | - Jenny Selgimann
- Leeds Institute of Cancer and Pathology, University of Leeds, Leeds, UK
| | - Simon Bach
- Department of Surgery, University Hospitals Birmingham, Birmingham, UK
| | - Faheez Mohamed
- Peritoneal Malignancy Institute, North Hampshire Hospital, Hampshire Hospital Foundation Trust, Basingstoke, UK
| | - Julia Brown
- Clinical Trials Research Unit, University of Leeds, UK
| | - Nicola Fearnhead
- Department of Colorectal Surgery, Addenbrooke's Hospital, Cambridge, UK
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6
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Akagi T, Inomata M, Hasegawa S, Kinjo Y, Ito M, Fukunaga Y, Kanazawa A, Idani H, Yamamoto S, Otsuka K, Endo S, Watanabe M. Short- and long-term outcomes following laparoscopic palliative resection for patients with incurable, asymptomatic stage IV colorectal cancer: A multicenter study in Japan. JOURNAL OF THE ANUS RECTUM AND COLON 2018; 1:125-130. [PMID: 31583312 PMCID: PMC6768683 DOI: 10.23922/jarc.2017-012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/24/2017] [Accepted: 07/20/2017] [Indexed: 11/30/2022]
Abstract
OBJECTIVE This retrospective multicenter study compared short- and long-term results between Japanese patients with asymptomatic stage IV colorectal cancer who underwent palliative laparoscopic surgery (LS) versus those who underwent conventional open surgery (OS). METHODS Among 968 patients treated for stage IV colorectal cancer from January 2006 to December 2007 in 41 surgical units that were participating in the Japan Society of Laparoscopic Colorectal Surgery group, we studied 398 patients who received palliative resection of their asymptomatic primary colorectal tumor. RESULTS We analyzed data from patients undergoing LS (LS group, n=106) and OS (OS group, n=292). Fourteen (13.2%) LS group patients were converted to OS. Although the differences between groups for postoperative complications were not significant, the mean time to solid food intake and postoperative length of hospital stay for the LS group were significantly shorter than those for the OS group (2 vs. 3 days, p<0.0001; 13 vs. 16 days, p<0.0001, respectively). The LS group patients experienced a longer median survival time than that of the OS group (24.5 vs. 23.9 months, p=0.0357). CONCLUSIONS Laparoscopic palliative resection (LS) offers advantages for short-term outcomes and no disadvantages for long-term outcomes. The use of laparoscopic procedures to treat asymptomatic, incurable stage IV colorectal cancer appears to be acceptable.
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Affiliation(s)
- Tomonori Akagi
- Department of Gastroenterological & Pediatric Surgery, Oita University Faculty of Medicine, Oita, Japan
| | - Masafumi Inomata
- Department of Gastroenterological & Pediatric Surgery, Oita University Faculty of Medicine, Oita, Japan
| | | | - Yousuke Kinjo
- Department of Surgery, Kyoto University, Kyoto, Japan
| | - Masaaki Ito
- Department of Colorectal and Pelvic Surgery, National Cancer Center Hospital East, Chiba, Japan
| | - Yosuke Fukunaga
- Department of Gastroenterological Surgery, Cancer Institute Hospital, Tokyo, Japan
| | - Akiyoshi Kanazawa
- Department of Gastroenterology, Osaka Red Cross Hospital, Osaka, Japan
| | - Hitoshi Idani
- Department of Surgery, Fukuyama City Hospital, Fukuyama, Japan
| | - Seiichiro Yamamoto
- Division of Colorectal Surgery, National Cancer Center Hospital, Tokyo, Japan
| | - Koki Otsuka
- Department of Surgery, Iwate Medical University, Iwate, Japan
| | - Shungo Endo
- Department of Surgery, Showa University School of Medicine, Yokohama Northern Hospital, Yokohama, Japan
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7
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Otani T, Isohata N, Kumamoto K, Endo S, Utano K, Nemoto D, Aizawa M, Lefor AK, Togashi K. An evidence-based medicine approach to the laparoscopic treatment of colorectal cancer. Fukushima J Med Sci 2016; 62:74-82. [PMID: 27477991 DOI: 10.5387/fms.2016-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
During the 1990s, laparoscopic resection was established as a treatment for gastrointestinal malignant tumors. A number of randomized controlled trials comparing laparoscopic-assisted colorectal surgery with conventional open colorectal surgery for colon cancer have been conducted. These trials have shown short-term benefits, and the vast majority demonstrated no significant difference in long-term outcomes. Laparoscopic-assisted colorectal surgery is widely performed for the treatment of colon cancer, whereas laparoscopic-assisted colorectal surgery for rectal cancer is less commonly performed. In recent years, there have been an increasing number of reports of laparoscopic-assisted colorectal surgery for rectal cancer, where improving short-term outcomes was shown, but no definitive effect on long-term survival has been shown to date. Randomized controlled trials focusing on long-term survival are currently ongoing.
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Affiliation(s)
- Taisuke Otani
- Department of Coloproctology, Aizu Medical Center, Fukushima Medical University
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8
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Tei M, Wakasugi M, Akamatsu H. Short-term outcomes of single-port surgery for palliative resection of the primary tumor in patients with incurable stage IV colon cancer. Asian J Endosc Surg 2016; 9:258-264. [PMID: 27113950 DOI: 10.1111/ases.12289] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2015] [Revised: 02/18/2016] [Accepted: 02/25/2016] [Indexed: 11/29/2022]
Abstract
INTRODUCTION The aim of this study was to evaluate the short-term outcomes of single-port surgery (SPS) for palliative resection of the primary tumor in patients with incurable stage IV colon cancer. METHODS We studied 66 consecutive patients who underwent SPS or multiport surgery (MPS) for palliative resection of their primary tumor in our department from January 2008 to December 2013. Short-term outcomes and the postoperative course were analyzed between groups retrospectively. RESULTS Of the 66 patients, 32 underwent SPS, and 34 underwent MPS. The groups did not differ significantly in terms of preoperative evaluation and short-term outcomes. In the SPS group, one patient was converted to MPS (3.1%); no patients were converted to open surgery. Oncological resection, the proportion of patients who received postoperative chemotherapy, and time to the beginning of postoperative chemotherapy was similar in both groups. The 1-year overall survival rates were 76.7% in the SPS group and 79.4% in the MPS group (P = 0.711). CONCLUSIONS SPS is safe and feasible for palliative resection of the primary tumor in patients with incurable stage IV colon cancer.
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Affiliation(s)
- Mitsuyoshi Tei
- Department of Surgery, Osaka Police Hospital, Osaka, Japan.
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9
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Yamada T, Okabayashi K, Hasegawa H, Tsuruta M, Yoo JH, Seishima R, Kitagawa Y. Meta-analysis of the risk of small bowel obstruction following open or laparoscopic colorectal surgery. Br J Surg 2016; 103:493-503. [DOI: 10.1002/bjs.10105] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2015] [Revised: 12/13/2015] [Accepted: 12/14/2015] [Indexed: 12/17/2022]
Abstract
Abstract
Background
One of the potential advantages of laparoscopic compared with open colorectal surgery is a reduction in postoperative bowel obstruction events. Early reports support this proposal, but accumulated evidence is lacking.
Methods
A systematic review and meta-analysis was performed of randomized clinical trials and observational studies by searching the PubMed and Cochrane Library databases from 1990 to August 2015. The primary outcomes were early and late postoperative bowel obstruction following laparoscopic and open colorectal surgery. Both ileus and bowel obstruction were defined as a postoperative bowel obstruction. Subgroup and sensitivity analyses were performed, and a random-effects model was used to account for the heterogeneity among the studies.
Results
Twenty-four randomized clinical trials and 88 observational studies were included in the meta-analysis; 106 studies reported early outcome and 12 late outcome. Collectively, these studies reported on the outcomes of 148 392 patients, of whom 58 133 had laparoscopic surgery and 90 259 open surgery. Compared with open surgery, laparoscopic surgery was associated with reduced rates of early (odds ratio 0·62, 95 per cent c.i. 0·54 to 0·72; P < 0·001) and late (odds ratio 0·61, 0·41 to 0·92; P = 0·019) postoperative bowel obstruction. Weighted mean values for early postoperative bowel obstruction were 8 (95 per cent c.i. 6 to 10) and 5 (3 to 7) per cent for open and laparoscopic surgery respectively, and for late bowel obstruction were 4 (2 to 6) and 3 (1 to 5) per cent respectively.
Conclusion
The reduction in postoperative bowel obstruction demonstrates an advantage of laparoscopic surgery in patients with colorectal disease.
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Affiliation(s)
- T Yamada
- Department of Surgery, Keio University School of Medicine, Tokyo, Japan
| | - K Okabayashi
- Department of Surgery, Keio University School of Medicine, Tokyo, Japan
| | - H Hasegawa
- Department of Surgery, Keio University School of Medicine, Tokyo, Japan
| | - M Tsuruta
- Department of Surgery, Keio University School of Medicine, Tokyo, Japan
| | - J-H Yoo
- Department of Surgery, National Hospital Organization Saitama National Hospital, 2–1 Suwa Wako, Saitama, Japan
| | - R Seishima
- Department of Surgery, Keio University School of Medicine, Tokyo, Japan
| | - Y Kitagawa
- Department of Surgery, Keio University School of Medicine, Tokyo, Japan
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10
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Kim IY, Kim BR, Kim HS, Kim YW. Differences in clinical features between laparoscopy and open resection for primary tumor in patients with stage IV colorectal cancer. Onco Targets Ther 2015; 8:3441-8. [PMID: 26640384 PMCID: PMC4657796 DOI: 10.2147/ott.s93420] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
Abstract
PURPOSE To identify differences in clinical features between laparoscopy and open resection for primary tumor in patients with stage IV colorectal cancer. We also evaluated short-term and oncologic outcomes after laparoscopy and open surgery. METHODS A total of 100 consecutive stage IV patients undergoing open (n=61) or laparoscopic (n=39) major resection were analyzed. There were four cases (10%) of conversion to laparotomy in the laparoscopy group. RESULTS Pathological T4 tumors (56% vs 26%), primary colon cancers (74% vs 51%), and larger tumor diameter (6 vs 5 cm) were more commonly managed with open surgery. Right colectomy was more common in the open surgery group (39%) and low anterior resection was more common in the laparoscopy group (39%, P=0.002). Hepatic metastases in segments II, III, IVb, V, and VI were more frequently resected with laparoscopy (100%) than with open surgery (56%), although the difference was not statistically significant. In colon and rectal cancers, mean operative time and 30-day complication rates of laparoscopy and open surgery did not differ. In both cancers, mean time to soft diet and length of hospital stay were shorter in the laparoscopy group. Mean time from surgery to chemotherapy commencement was significantly shorter with laparoscopy than with open surgery. In colon and rectal cancers, 2-year cancer-specific and progression-free survival rates were similar between the laparoscopy and open surgery groups. CONCLUSION Based on our findings, laparoscopy can be selected as an initial approach in patients with a primary tumor without adjacent organ invasion and patients without primary tumor-related symptoms. In selected stage IV patients, tumor factors such as primary rectal tumor, peritoneal carcinomatosis, or liver metastasis may not be absolute contraindications for a laparoscopic approach.
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Affiliation(s)
- Ik Yong Kim
- Department of Surgery, Division of Colorectal Surgery, Yonsei University Wonju College of Medicine, Wonju, Gangwon-do, Korea
| | - Bo Ra Kim
- Department of Internal Medicine, Division of Gastroenterology, Yonsei University Wonju College of Medicine, Wonju, Gangwon-do, Korea
| | - Hyun Soo Kim
- Department of Internal Medicine, Division of Gastroenterology, Yonsei University Wonju College of Medicine, Wonju, Gangwon-do, Korea
| | - Young Wan Kim
- Department of Surgery, Division of Colorectal Surgery, Yonsei University Wonju College of Medicine, Wonju, Gangwon-do, Korea
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Ishizaki H, Nakashima S, Hamada T, Nishida T, Maehara N, Ikeda T, Tsukino H, Mukai S, Kamoto T, Kondo K. Laparoscopic anterior pelvic exenteration for locoregionally advanced rectal cancer directly invading the urinary bladder: A case report of low anterior resection with en bloc cystectomy for sphincter preservation. Asian J Endosc Surg 2015; 8:343-6. [PMID: 26303734 PMCID: PMC5049648 DOI: 10.1111/ases.12196] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/24/2014] [Revised: 04/06/2015] [Accepted: 04/15/2015] [Indexed: 01/07/2023]
Abstract
Laparoscopic multi-visceral resection in patients with T4 colorectal cancer remains controversial. A 73-year-old man was admitted to the hospital for rectosigmoid cancer directly invading the urinary bladder trigone without distant metastasis. We successfully performed complete resection by laparoscopic anterior pelvic exenteration while preserving the anus. After laparoscopic mobilization of the rectum, urinary bladder, and prostate, the urethra and urethral catheter were dissected to reveal the lower rectum. By pulling the urethral catheter toward the head, the prostate was excised retrogradely from the lower rectum anterior wall. The lower rectum was resected and anastomosed by the double stapling technique with a safe distal margin from the tumor. Pathological findings of the resected specimen indicated no residual tumor in the surgical margin. There was no evidence of recurrence 34 months after surgery. En bloc, R0, laparoscopic anterior pelvic exenteration for T4 rectal cancer is feasible. However, further studies with long-term follow-up are required to resolve oncological outcomes.
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Affiliation(s)
- Hidenobu Ishizaki
- Department of Surgical Oncology and Regulation of Organ FunctionMiyazaki University School of MedicineMiyazakiJapan
| | - Shinya Nakashima
- Department of Surgical Oncology and Regulation of Organ FunctionMiyazaki University School of MedicineMiyazakiJapan
| | - Takeomi Hamada
- Department of Surgical Oncology and Regulation of Organ FunctionMiyazaki University School of MedicineMiyazakiJapan
| | - Takahiro Nishida
- Department of Surgical Oncology and Regulation of Organ FunctionMiyazaki University School of MedicineMiyazakiJapan
| | - Naoki Maehara
- Department of Surgical Oncology and Regulation of Organ FunctionMiyazaki University School of MedicineMiyazakiJapan
| | - Takuto Ikeda
- Department of Surgical Oncology and Regulation of Organ FunctionMiyazaki University School of MedicineMiyazakiJapan
| | - Hiromasa Tsukino
- Department of UrologyMiyazaki University School of MedicineMiyazakiJapan
| | - Shoichiro Mukai
- Department of UrologyMiyazaki University School of MedicineMiyazakiJapan
| | - Toshiyuki Kamoto
- Department of UrologyMiyazaki University School of MedicineMiyazakiJapan
| | - Kazuhiro Kondo
- Department of Surgical Oncology and Regulation of Organ FunctionMiyazaki University School of MedicineMiyazakiJapan
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12
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Manceau G, Dubreuil O, Karoui M. Forme métastatique non résécable : quid du primitif ? ONCOLOGIE 2014. [DOI: 10.1007/s10269-014-2470-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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13
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Inomata M, Akagi T, Katayama H, Kimura A, Mizusawa J, Etoh T, Yamaguchi S, Ito M, Kinugasa Y, Saida Y, Hasegawa H, Ota M, Kanemitsu Y, Shimada Y, Kitano S. A randomized controlled trial comparing laparoscopic surgery with open surgery in palliative resection of primary tumor in incurable Stage IV colorectal cancer: Japan Clinical Oncology Group Study JCOG 1107 (ENCORE trial). Jpn J Clin Oncol 2014; 44:1123-6. [PMID: 25156683 DOI: 10.1093/jjco/hyu115] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
A randomized controlled trial was started in Japan to evaluate the non-inferiority of overall survival of laparoscopic surgery to open surgery for palliative resection of primary tumor in incurable Stage IV colorectal cancer. Symptomatic, Stage IV colorectal cancer patients with non-curable metastasis are pre-operatively randomized to either open or laparoscopic colorectal resection. Surgeons in 56 specialized institutions will recruit 450 patients. The primary endpoint is overall survival. Secondary endpoints are progression-free survival, the proportion of conversion from laparoscopic surgery to open surgery, the proportion of patients who fulfill the criteria of starting chemotherapy by 6 weeks after operation, intraoperative and post-operative complications, adverse events during chemotherapy and serious adverse events.
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Affiliation(s)
- Masafumi Inomata
- Department of Gastroenterological and Pediatric Surgery, Oita University Faculty of Medicine, Oita
| | - Tomonori Akagi
- Department of Gastroenterological and Pediatric Surgery, Oita University Faculty of Medicine, Oita
| | - Hiroshi Katayama
- JCOG Data Center/Operations Office, Center for Research Administration and Support, National Cancer Center, Tokyo
| | - Aya Kimura
- JCOG Data Center/Operations Office, Center for Research Administration and Support, National Cancer Center, Tokyo
| | - Junki Mizusawa
- JCOG Data Center/Operations Office, Center for Research Administration and Support, National Cancer Center, Tokyo
| | - Tsuyoshi Etoh
- Department of Gastroenterological and Pediatric Surgery, Oita University Faculty of Medicine, Oita
| | - Shigeki Yamaguchi
- Department of Gastroenterological Surgery, Comprehensive Cancer Center, Saitama International Medical Center, Saitama Medical University, Saitama
| | | | | | | | | | - Mitsuyoshi Ota
- Department of Surgery, Gastroenterological Center, Yokohama City University, Kanagawa
| | - Yukihide Kanemitsu
- Department of Colorectal Surgery Division, National Cancer Center Hospital, Tokyo
| | - Yasuhiro Shimada
- Department of Gastrointestinal Medical Oncology, National Cancer Center Hospital, Tokyo, Japan
| | - Seigo Kitano
- Department of Gastroenterological and Pediatric Surgery, Oita University Faculty of Medicine, Oita
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14
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Mestier LD, Manceau G, Neuzillet C, Bachet JB, Spano JP, Kianmanesh R, Vaillant JC, Bouché O, Hannoun L, Karoui M. Primary tumor resection in colorectal cancer with unresectable synchronous metastases: A review. World J Gastrointest Oncol 2014; 6:156-69. [PMID: 24936226 PMCID: PMC4058723 DOI: 10.4251/wjgo.v6.i6.156] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2013] [Revised: 04/08/2014] [Accepted: 05/13/2014] [Indexed: 02/05/2023] Open
Abstract
At the time of diagnosis, 25% of patients with colorectal cancer (CRC) present with synchronous metastases, which are unresectable in the majority of patients. Whether primary tumor resection (PTR) followed by chemotherapy or immediate chemotherapy without PTR is the best therapeutic option in patients with asymptomatic CRC and unresectable metastases is a major issue, although unanswered to date. The aim of this study was to review all published data on whether PTR should be performed in patients with CRC and unresectable synchronous metastases. All aspects of the management of CRC were taken into account, especially prognostic factors in patients with CRC and unresectable metastases. The impact of PTR on survival and quality of life were reviewed, in addition to the characteristics of patients that could benefit from PTR and the possible underlying mechanisms. The risks of both approaches are reported. As no randomized study has been performed to date, we finally discussed how a therapeutic strategy's trial should be designed to provide answer to this issue.
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15
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Reply to letter: "Open versus laparoscopic resection of primary tumor for incurable stage IV colorectal cancer: a large multicenter consecutive patients cohort study". Ann Surg 2014; 261:e71. [PMID: 24441824 DOI: 10.1097/sla.0000000000000528] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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