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Ishizuka M, Shibuya N, Hachiya H, Nishi Y, Kono T, Takayanagi M, Nemoto T, Ihara K, Shiraki T, Matsumoto T, Mori S, Nakamura T, Aoki T, Mizushima T. Robotic surgery is associated with a decreased risk of circumferential resection margin positivity compared with conventional laparoscopic surgery in patients with rectal cancer undergoing mesorectal excision: A systematic review and meta-analysis. EUROPEAN JOURNAL OF SURGICAL ONCOLOGY 2024; 50:108538. [PMID: 39053042 DOI: 10.1016/j.ejso.2024.108538] [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: 04/26/2024] [Revised: 06/14/2024] [Accepted: 07/07/2024] [Indexed: 07/27/2024]
Abstract
OBJECTIVE To investigate whether robotic surgery (RS) decreases the risk of circumferential resection margin (CRM) positivity compared with conventional laparoscopic surgery (LS) in patients with rectal cancer (RC) undergoing mesorectal excision (ME). BACKGROUND Although it is well known that CRM positivity affects postoperative outcomes in patients with RC undergoing ME, few studies have investigated whether RS is superior to conventional LS for the risk of CRM positivity. METHODS We performed a comprehensive electronic search of the literature up to December 2022 to identify studies that compared the risk of CRM positivity between patients with RC undergoing robotic and conventional laparoscopic surgery. A meta-analysis was performed using random-effects models to calculate risk ratios (RRs) and 95 % confidence intervals (CIs), and heterogeneity was analyzed using I2 statistics. RESULTS Eighteen studies, consisting of 4 randomized controlled trials (RCTs) and 14 propensity score matching (PSM) studies, involved a total of 9203 patients with RC who underwent ME were included in this meta-analysis. The results demonstrated that RS decreased the overall risk of CRM positivity (RR, 0.82; 95 % CI, 0.73-0.92; P = 0.001; I2 = 0 %) compared with conventional LS. Results of a meta-analysis of the 4 selected RCTs also showed that RS decreased the risk of CRM positivity (RR, 0.62; 95 % CI, 0.43-0.91; P = 0.01; I2 = 0 %) compared with conventional LS. CONCLUSIONS This meta-analysis revealed that RS is associated with a decreased risk of CRM positivity compared with conventional LS in patients with RC undergoing ME.
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Affiliation(s)
- Mitsuru Ishizuka
- Department of Colorectal Surgery, Dokkyo Medical University, Tochigi, Japan.
| | - Norisuke Shibuya
- Department of Colorectal Surgery, Dokkyo Medical University, Tochigi, Japan
| | - Hiroyuki Hachiya
- Department of Colorectal Surgery, Dokkyo Medical University, Tochigi, Japan
| | - Yusuke Nishi
- Department of Colorectal Surgery, Dokkyo Medical University, Tochigi, Japan
| | - Takahiro Kono
- Department of Colorectal Surgery, Dokkyo Medical University, Tochigi, Japan
| | - Masashi Takayanagi
- Department of Colorectal Surgery, Dokkyo Medical University, Tochigi, Japan
| | - Tetsutaro Nemoto
- Department of Colorectal Surgery, Dokkyo Medical University, Tochigi, Japan
| | - Keisuke Ihara
- Department of Colorectal Surgery, Dokkyo Medical University, Tochigi, Japan
| | - Takayuki Shiraki
- Department of Hepato-Biliary-Pancreatic Surgery, Dokkyo Medical University, Tochigi, Japan
| | - Takatsugu Matsumoto
- Department of Hepato-Biliary-Pancreatic Surgery, Dokkyo Medical University, Tochigi, Japan
| | - Shozo Mori
- Department of Hepato-Biliary-Pancreatic Surgery, Dokkyo Medical University, Tochigi, Japan
| | - Takatoshi Nakamura
- Department of Colorectal Surgery, Dokkyo Medical University, Tochigi, Japan
| | - Taku Aoki
- Department of Hepato-Biliary-Pancreatic Surgery, Dokkyo Medical University, Tochigi, Japan
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Lin S, Wei J, Lai H, Zhu Y, Gong H, Wei C, Wei B, Luo Y, Liu Y, Mo X, Zuo H, Lin Y. Determining the optimal distal resection margin in rectal cancer patients by imaging of large pathological sections: An experimental study. Medicine (Baltimore) 2024; 103:e38083. [PMID: 38787988 PMCID: PMC11124751 DOI: 10.1097/md.0000000000038083] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2024] [Accepted: 04/11/2024] [Indexed: 05/26/2024] Open
Abstract
OBJECTIVE To determine the distal resection margin in sphincter-sparing surgery in patients with low rectal cancer based on imaging of large pathological sections. METHODS Patients who underwent sphincter-sparing surgery for ultralow rectal cancer at Guangxi Medical University Cancer Hospital within the period from January 2016 to March 2022 were tracked and observed. The clinical and pathological data of the patients were collected and analyzed. The EVOS fluorescence automatic cell imaging system was used for imaging large pathological sections. Follow-up patient data were acquired mainly by sending the patients letters and contacting them via phone calls, and during outpatient visits. RESULTS A total of 46 patients (25 males, 21 females) aged 27 to 86 years participated in the present study. Regarding clinical staging, there were 9, 10, 16, and 10 cases with stages I, II, III, and IV low rectal cancer, respectively. The surgical time was 273.82 ± 111.51 minutes, the blood loss was 123.78 ± 150.91 mL, the postoperative exhaust time was 3.67 ± 1.85 days, and the postoperative discharge time was 10.36 ± 5.41 days. There were 8 patients with complications, including 3 cases of pulmonary infection, 2 cases of intestinal obstruction, one case of pleural effusion, and one case of stoma necrosis. The longest and shortest distal resection margins (distances between the cutting edges and the tumor edges) were 3 cm and 1 cm, respectively. The minimum length of the extension areas of the tumor lesions in the 46 images of large pathological sections was 0.1 mm, and the maximum length was 15 mm. Among the tumor lesions, 91.30% (42/46) had an extension area length of ≤5 mm, and 97.83% (45/46) had an extension area length of ≤10 mm. The length of the extension zone was not related to clinical pathological parameters (P > .05). CONCLUSION In the vast majority of cases, the distal resection margin was at least 1 cm; thus, "No Evidence of Disease" could have been achieved. Additional high-powered randomized trials are needed to confirm the results of the present study.
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Affiliation(s)
- Shuhan Lin
- Hepatological Surgery Department, Guangxi Guigang People Hospital, Guigang City, Guangxi Autonomous Region, China
| | - Jie Wei
- Colorectal Surgery, Guangxi Medical University Cancer Hospital, Nanning, Guangxi Zhuang Autonomous Region, China
- Guangxi Clinical Research Center for Colorectal Cancer, Nanning, Guangxi Zhuang Autonomous Region, China
| | - Hao Lai
- Colorectal Surgery, Guangxi Medical University Cancer Hospital, Nanning, Guangxi Zhuang Autonomous Region, China
- Guangxi Clinical Research Center for Colorectal Cancer, Nanning, Guangxi Zhuang Autonomous Region, China
| | - Yazhen Zhu
- Experimental Research Department, Guangxi Cancer Hospital, Nanning, Guangxi Autonomous Region, China
| | - Han Gong
- Colorectal Surgery, Guangxi Medical University Cancer Hospital, Nanning, Guangxi Zhuang Autonomous Region, China
- Guangxi Clinical Research Center for Colorectal Cancer, Nanning, Guangxi Zhuang Autonomous Region, China
| | - Chengjiang Wei
- Colorectal Surgery, Guangxi Medical University Cancer Hospital, Nanning, Guangxi Zhuang Autonomous Region, China
- Guangxi Clinical Research Center for Colorectal Cancer, Nanning, Guangxi Zhuang Autonomous Region, China
| | - Binglin Wei
- Colorectal Surgery, Guangxi Medical University Cancer Hospital, Nanning, Guangxi Zhuang Autonomous Region, China
- Guangxi Clinical Research Center for Colorectal Cancer, Nanning, Guangxi Zhuang Autonomous Region, China
| | - Yinxiang Luo
- Colorectal Surgery, Guangxi Medical University Cancer Hospital, Nanning, Guangxi Zhuang Autonomous Region, China
- Guangxi Clinical Research Center for Colorectal Cancer, Nanning, Guangxi Zhuang Autonomous Region, China
| | - Yi Liu
- Hepatological Surgery Department, Guangxi Guigang People Hospital, Guigang City, Guangxi Autonomous Region, China
| | - Xianwei Mo
- Colorectal Surgery, Guangxi Medical University Cancer Hospital, Nanning, Guangxi Zhuang Autonomous Region, China
- Guangxi Clinical Research Center for Colorectal Cancer, Nanning, Guangxi Zhuang Autonomous Region, China
| | - Hongqun Zuo
- Colorectal Surgery, Guangxi Medical University Cancer Hospital, Nanning, Guangxi Zhuang Autonomous Region, China
- Guangxi Clinical Research Center for Colorectal Cancer, Nanning, Guangxi Zhuang Autonomous Region, China
| | - Yuan Lin
- Colorectal Surgery, Guangxi Medical University Cancer Hospital, Nanning, Guangxi Zhuang Autonomous Region, China
- Guangxi Clinical Research Center for Colorectal Cancer, Nanning, Guangxi Zhuang Autonomous Region, China
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Li X, Zhou Z, Zhu B, Wu Y, Xing C. Development and validation of machine learning models and nomograms for predicting the surgical difficulty of laparoscopic resection in rectal cancer. World J Surg Oncol 2024; 22:111. [PMID: 38664824 PMCID: PMC11044303 DOI: 10.1186/s12957-024-03389-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2024] [Accepted: 04/14/2024] [Indexed: 04/29/2024] Open
Abstract
BACKGROUND The objective of this study is to develop and validate a machine learning (ML) prediction model for the assessment of laparoscopic total mesorectal excision (LaTME) surgery difficulty, as well as to identify independent risk factors that influence surgical difficulty. Establishing a nomogram aims to assist clinical practitioners in formulating more effective surgical plans before the procedure. METHODS This study included 186 patients with rectal cancer who underwent LaTME from January 2018 to December 2020. They were divided into a training cohort (n = 131) versus a validation cohort (n = 55). The difficulty of LaTME was defined based on Escal's et al. scoring criteria with modifications. We utilized Lasso regression to screen the preoperative clinical characteristic variables and intraoperative information most relevant to surgical difficulty for the development and validation of four ML models: logistic regression (LR), support vector machine (SVM), random forest (RF), and decision tree (DT). The performance of the model was assessed based on the area under the receiver operating characteristic curve(AUC), sensitivity, specificity, and accuracy. Logistic regression-based column-line plots were created to visualize the predictive model. Consistency statistics (C-statistic) and calibration curves were used to discriminate and calibrate the nomogram, respectively. RESULTS In the validation cohort, all four ML models demonstrate good performance: SVM AUC = 0.987, RF AUC = 0.953, LR AUC = 0.950, and DT AUC = 0.904. To enhance visual evaluation, a logistic regression-based nomogram has been established. Predictive factors included in the nomogram are body mass index (BMI), distance between the tumor to the dentate line ≤ 10 cm, radiodensity of visceral adipose tissue (VAT), area of subcutaneous adipose tissue (SAT), tumor diameter >3 cm, and comorbid hypertension. CONCLUSION In this study, four ML models based on intraoperative and preoperative risk factors and a nomogram based on logistic regression may be of help to surgeons in evaluating the surgical difficulty before operation and adopting appropriate responses and surgical protocols.
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Affiliation(s)
- Xiangyong Li
- Department of Gastrointestinal Surgery, The Second Affiliated Hospital of Soochow University, Suzhou, Jiangsu province, China
| | - Zeyang Zhou
- Department of Gastrointestinal Surgery, The Second Affiliated Hospital of Soochow University, Suzhou, Jiangsu province, China
| | - Bing Zhu
- Department of Anesthesiology, Dongtai People's Hospital, Yancheng, Jiangsu Province, China
| | - Yong Wu
- Department of Gastrointestinal Surgery, The Second Affiliated Hospital of Soochow University, Suzhou, Jiangsu province, China.
| | - Chungen Xing
- Department of Gastrointestinal Surgery, The Second Affiliated Hospital of Soochow University, Suzhou, Jiangsu province, China.
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Gachabayov M, Lee H, Kajmolli A, Felsenreich DM, Bergamaschi R. Impact of robotic total mesorectal excision upon pathology metrics in overweight males with low rectal cancer: a pooled analysis of 836 cases. Updates Surg 2024; 76:505-512. [PMID: 38147292 DOI: 10.1007/s13304-023-01733-y] [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: 08/25/2023] [Accepted: 12/12/2023] [Indexed: 12/27/2023]
Abstract
The aim of this pooled analysis was to evaluate the impact of robotic total mesorectal excision (TME) on pathology metrics in Male Overweight patients with Low rectal cancer (MOL). This was a multicenter retrospective pooled analysis of data. Two groups were defined: MOL (Male, Overweight, Low rectal cancer) and non-MOL. Overweight was defined as BMI ≥ 25 kg/m2. Low rectal cancer was defined as cancer within 6 cm from the anal verge. The primary endpoints of this study were histopathological metrics, namely circumferential resection margin (CRM) (mm), CRM involvement rate (%), and the quality of TME. Circumferential resection margin (CRM) was involved if < 1 mm. 836 (106 MOL and 730 non-MOL) patients that underwent robotic TME by six surgeons over 3 years were compared. No significant differences in demographics and perioperative variables were found, except for operating time, distal margin, and number of lymph nodes harvested. CRM involvement rate did not significantly differ (7.5% vs. 5.5%, p = 0.395). Mean CRM was statistically significantly narrower in MOL patients (6.6 vs. 7.7 mm, p = 0.04). Quality of TME did not differ. Distance of tumor from the anal verge was the only independent predictor of CRM involvement. Robotic TME may provide optimal pathology metrics in overweight males with low rectal cancer. Although CRM was a few millimeters narrower in MOL, the values were within the range of uninvolved margins making the difference statistically significant, but not clinically. Being MOL was not a risk factor for involvement of circumferential resection margin.
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Affiliation(s)
- Mahir Gachabayov
- Section of Colorectal Surgery, Westchester Medical Center, New York Medical College, Taylor Pavilion, Suite D-365, 100 Woods Road, Valhalla, NY, 10595, USA
| | - Hanjoo Lee
- Division of Colon and Rectal Surgery, Harbor-UCLA Medical Center, Torrence, CA, USA
| | - Agon Kajmolli
- Section of Colorectal Surgery, Westchester Medical Center, New York Medical College, Taylor Pavilion, Suite D-365, 100 Woods Road, Valhalla, NY, 10595, USA
| | - Daniel M Felsenreich
- Division of Visceral Surgery, Department of General Surgery, Medical University of Vienna, Vienna, Austria
| | - Roberto Bergamaschi
- Section of Colorectal Surgery, Westchester Medical Center, New York Medical College, Taylor Pavilion, Suite D-365, 100 Woods Road, Valhalla, NY, 10595, USA.
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Jin Y, Yin H, Zhang H, Wang Y, Liu S, Yang L, Song B. Predicting tumor deposits in rectal cancer: a combined deep learning model using T2-MR imaging and clinical features. Insights Imaging 2023; 14:221. [PMID: 38117396 PMCID: PMC10733230 DOI: 10.1186/s13244-023-01564-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2023] [Accepted: 11/05/2023] [Indexed: 12/21/2023] Open
Abstract
BACKGROUND Tumor deposits (TDs) are associated with poor prognosis in rectal cancer (RC). This study aims to develop and validate a deep learning (DL) model incorporating T2-MR image and clinical factors for the preoperative prediction of TDs in RC patients. METHODS AND METHODS A total of 327 RC patients with pathologically confirmed TDs status from January 2016 to December 2019 were retrospectively recruited, and the T2-MR images and clinical variables were collected. Patients were randomly split into a development dataset (n = 246) and an independent testing dataset (n = 81). A single-channel DL model, a multi-channel DL model, a hybrid DL model, and a clinical model were constructed. The performance of these predictive models was assessed by using receiver operating characteristics (ROC) analysis and decision curve analysis (DCA). RESULTS The areas under the curves (AUCs) of the clinical, single-DL, multi-DL, and hybrid-DL models were 0.734 (95% CI, 0.674-0.788), 0.710 (95% CI, 0.649-0.766), 0.767 (95% CI, 0.710-0.819), and 0.857 (95% CI, 0.807-0.898) in the development dataset. The AUC of the hybrid-DL model was significantly higher than the single-DL and multi-DL models (both p < 0.001) in the development dataset, and the single-DL model (p = 0.028) in the testing dataset. Decision curve analysis demonstrated the hybrid-DL model had higher net benefit than other models across the majority range of threshold probabilities. CONCLUSIONS The proposed hybrid-DL model achieved good predictive efficacy and could be used to predict tumor deposits in rectal cancer. CRITICAL RELEVANCE STATEMENT The proposed hybrid-DL model achieved good predictive efficacy and could be used to predict tumor deposits in rectal cancer. KEY POINTS • Preoperative non-invasive identification of TDs is of great clinical significance. • The combined hybrid-DL model achieved good predictive efficacy and could be used to predict tumor deposits in rectal cancer. • A preoperative nomogram provides gastroenterologist with an accurate and effective tool.
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Affiliation(s)
- Yumei Jin
- Department of Medical Imaging Center, Qujing First People's Hospital, Qujing, 655000, Yunnan Province, China.
- Department of Radiology, West China Hospital of Sichuan University, Chengdu, 610041, Sichuan Province, China.
| | - Hongkun Yin
- Beijing Infervision Technology Co.Ltd, Beijing, China
| | - Huiling Zhang
- Beijing Infervision Technology Co.Ltd, Beijing, China
| | - Yewu Wang
- Department of Joint and Sports Medicine, Qujing First People's Hospital, Qujing, 655000, Yunnan Province, China
| | - Shengmei Liu
- Department of Radiology, West China Hospital of Sichuan University, Chengdu, 610041, Sichuan Province, China
| | - Ling Yang
- Department of Radiology, West China Hospital of Sichuan University, Chengdu, 610041, Sichuan Province, China
| | - Bin Song
- Department of Radiology, West China Hospital of Sichuan University, Chengdu, 610041, Sichuan Province, China.
- Functional and Molecular Imaging Key Laboratory of Sichuan Province, West China Hospital of Sichuan University, Chengdu, 610041, Sichuan Province, China.
- Department of Radiology, Sanya People's Hospital, Sanya, Hainan Province, 572000, China.
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