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Kuliavas J, Marcinkevičiūtė K, Baušys A, Bičkaitė K, Baušys R, Abeciūnas V, Degutytė AE, Kryžauskas M, Stratilatovas E, Dulskas A, Poškus T, Strupas K. Short- and long-term outcome differences between patients undergoing left and right colon cancer surgery: cohort study. Int J Colorectal Dis 2024; 39:66. [PMID: 38702488 PMCID: PMC11068684 DOI: 10.1007/s00384-024-04623-w] [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] [Accepted: 03/27/2024] [Indexed: 05/06/2024]
Abstract
PURPOSE Since the literature currently provides controversial data on the postoperative outcomes following right and left hemicolectomies, we carried out this study to examine the short- and long-term treatment outcomes. METHODS This study included consecutive patients who underwent right or left-sided colonic resections from year 2014 to 2018 and then they were followed up. The short-term outcomes such as postoperative morbidity and mortality according to Clavien-Dindo score, duration of hospital stay, and 90-day readmission rate were evaluated as well as long-term outcomes of overall survival and disease-free survival. Multivariable Cox regression analysis was performed of overall and progression-free survival. RESULTS In total, 1107 patients with colon tumors were included in the study, 525 patients with right-sided tumors (RCC) and 582 cases with tumors in the left part of the colon (LCC). RCC group patients were older (P < 0.001), with a higher ASA score (P < 0.001), and with more cardiovascular comorbidities (P < 0.001). No differences were observed between groups in terms of postoperative outcomes such as morbidity and mortality, except 90-day readmission which was more frequent in the RCC group. Upon histopathological analysis, the RCC group's patients had more removed lymph nodes (29 ± 14 vs 20 ± 11, P = 0.001) and more locally progressed (pT3-4) tumors (85.4% versus 73.4%, P = 0.001). Significantly greater 5-year overall survival and disease-free survival (P = 0.001) were observed for patients in the LCC group, according to univariate Kaplan-Meier analysis. CONCLUSIONS Patients with right-sided colon cancer were older and had more advanced disease. Short-term surgical outcomes were similar, but patients in the LCC group resulted in better long-term outcomes.
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Affiliation(s)
- Justas Kuliavas
- Clinic of Gastroenterology, Nephrourology and Surgery, Institute of Clinical Medicine, Faculty of Medicine, Vilnius University, LT-03101, Vilnius, Lithuania
- Department of Abdominal and General Surgery and Oncology, National Cancer Institute, 1 Santariskiu str., LT-08406, Vilnius, Lithuania
| | - Kristina Marcinkevičiūtė
- Faculty of Medicine, Vilnius University, 21/27 M. K. Ciurlionio str., LT-03101, Vilnius, Lithuania.
| | - Augustinas Baušys
- Department of Abdominal and General Surgery and Oncology, National Cancer Institute, 1 Santariskiu str., LT-08406, Vilnius, Lithuania
- Faculty of Medicine, Vilnius University, 21/27 M. K. Ciurlionio str., LT-03101, Vilnius, Lithuania
| | - Klaudija Bičkaitė
- Faculty of Medicine, Vilnius University, 21/27 M. K. Ciurlionio str., LT-03101, Vilnius, Lithuania
| | - Rimantas Baušys
- Department of Abdominal and General Surgery and Oncology, National Cancer Institute, 1 Santariskiu str., LT-08406, Vilnius, Lithuania
| | - Vilius Abeciūnas
- Faculty of Medicine, Vilnius University, 21/27 M. K. Ciurlionio str., LT-03101, Vilnius, Lithuania
| | | | - Marius Kryžauskas
- Clinic of Gastroenterology, Nephrourology and Surgery, Institute of Clinical Medicine, Faculty of Medicine, Vilnius University, LT-03101, Vilnius, Lithuania
| | - Eugenijus Stratilatovas
- Department of Abdominal and General Surgery and Oncology, National Cancer Institute, 1 Santariskiu str., LT-08406, Vilnius, Lithuania
| | - Audrius Dulskas
- Department of Abdominal and General Surgery and Oncology, National Cancer Institute, 1 Santariskiu str., LT-08406, Vilnius, Lithuania
- Faculty of Medicine, Vilnius University, 21/27 M. K. Ciurlionio str., LT-03101, Vilnius, Lithuania
| | - Tomas Poškus
- Clinic of Gastroenterology, Nephrourology and Surgery, Institute of Clinical Medicine, Faculty of Medicine, Vilnius University, LT-03101, Vilnius, Lithuania
| | - Kęstutis Strupas
- Clinic of Gastroenterology, Nephrourology and Surgery, Institute of Clinical Medicine, Faculty of Medicine, Vilnius University, LT-03101, Vilnius, Lithuania
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Pinto RA, Soares DFM, Gerbasi L, Nahas CSR, Marques CFS, Bustamante-Lopes LA, de Camargo MGM, Nahas SC. LAPAROSCOPIC RIGHT AND LEFT COLECTOMY: WHICH PROVIDES BETTER POSTOPERATIVE RESULTS FOR ONCOLOGY PATIENTS? ARQUIVOS BRASILEIROS DE CIRURGIA DIGESTIVA : ABCD = BRAZILIAN ARCHIVES OF DIGESTIVE SURGERY 2024; 36:e1792. [PMID: 38324853 PMCID: PMC10841488 DOI: 10.1590/0102-672020230074e1792] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/27/2023] [Accepted: 10/25/2023] [Indexed: 02/09/2024]
Abstract
BACKGROUND The laparoscopic approach considerably reduced the morbidity of colorectal surgery when compared to the open approach. Among its benefits, we can highlight less intraoperative bleeding, early oral intake, lower rates of surgical site infection, incisional hernia, and postoperative pain, and earlier hospital discharge. AIMS To compare the perioperative morbidity of right versus left colectomy for cancer and the quality of laparoscopic oncologic resection. METHODS Retrospective analysis of patients submitted to laparoscopic right and left colctomy between 2006 and 2016. Postoperative complications were classified using the Clavien-Dindo scale, 30 days after surgery. RESULTS A total of 293 patients were analyzed, 97 right colectomies (33.1%) and 196 left colectomies (66.9%). The averageage was 62.8 years. The groups were comparable in terms of age, comorbidities, body mass index, and the American Society of Anesthesiology (ASA) classification. Preoperative transfusion was higher in the right colectomy group (5.1% versus 0.4%, p=0.004, p<0.05). Overall, 233 patients (79.5%) had no complications. Complications found were grade I and II in 62 patients (21.1%) and grade III to V in 37 (12.6%). Twenty-three patients (7.8%) underwent reoperation. The comparison between left and right colectomy was not statistically different for operative time, conversion, reoperation, severe postoperative complications, and length of stay. The anastomotic leak rate was comparable in both groups(5.6% versus 2.1%, p=0.232, p>0.05). The oncological results were similar in both surgeries. In multiple logistic regression, ASA statistically influenced the worst results (≥ III; p=0.029, p<0.05). CONCLUSIONS The surgical and oncological results of laparoscopic right and left colectomies are similar, making this the preferred approach for both procedures.
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Affiliation(s)
- Rodrigo Ambar Pinto
- Universidade de São Paulo, Faculty of Medicine, Department of Gastroenterology, Coloproctology Unit - São Paulo (SP), Brazil
| | - Diego Fernandes Maia Soares
- Universidade de São Paulo, Faculty of Medicine, Department of Gastroenterology, Coloproctology Unit - São Paulo (SP), Brazil
| | - Lucas Gerbasi
- Universidade de São Paulo, Faculty of Medicine, Department of Gastroenterology, Coloproctology Unit - São Paulo (SP), Brazil
| | - Caio Sérgio Rizkallah Nahas
- Universidade de São Paulo, Faculty of Medicine, Department of Gastroenterology, Coloproctology Unit - São Paulo (SP), Brazil
| | | | | | | | - Sérgio Carlos Nahas
- Universidade de São Paulo, Faculty of Medicine, Department of Gastroenterology, Coloproctology Unit - São Paulo (SP), Brazil
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Solis-Pazmino P, Oka K, La K, Termeie O, Ponce O, Figueroa L, Weston A, Machry M, Cohen J, Barnajian M, Nasseri Y. Robotic right versus left colectomy for colorectal neoplasia: a systemic review and meta-analysis. J Robot Surg 2023; 17:1907-1915. [PMID: 37310528 DOI: 10.1007/s11701-023-01649-0] [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: 04/16/2023] [Accepted: 05/31/2023] [Indexed: 06/14/2023]
Abstract
Previous studies comparing right and left colectomies have shown variable short-term outcomes. Despite the rapid adoption of robotics in colorectal operations, few studies have addressed outcome differences between robotic right (RRC) and left (RLC) colectomies. Therefore, we sought to compare the short-term outcomes of RRC and RLC for neoplasia. This is a systematic review and meta-analysis of articles published from the time of inception of the datasets to May 1, 2022. The electronic databases included English publications in Ovid MEDLINE In-Process and Other Non-Indexed Citations, Ovid MEDLINE, Ovid EMBASE, and Scopus. A total of 13,514 patients with colon neoplasia enrolled in 9 comparative studies were included. The overall mean age was 64.1 years (standard deviation [SD] ± 9.8), and there was a minor female predominance (52% female vs. 48% male). 8656 (64.0%) underwent RRC and 4858 (36.0%) underwent RLC. The ASA score 1 of - 2 in the LRC group was 37% vs. 21% in the R. Whereas the ASA score 3-4 was 62% in the LRC vs. 76% in RRC. Moreover, the mean of the Charlson Comorbidity Score in the LRC was 4.3 (SD 1.9) vs. 3.1 (SD 2.3) in the RRC. Meta-analysis revealed a significantly higher rate of ileus in RRC (10%) compared to RLC (7%) (OR 1.46, 95% CI 1.27-1.67). Additionally, operative time was significantly shorter by 22.6 min in RRC versus LRC (95% CI - 37.4-7.8; p < 0.001). There were no statistically significant differences between RRC and RLC in conversion to open operation, estimated blood loss, wound infection, anastomotic leak, reoperation, readmission, and hospital length of stay. In this only meta-analysis comparing RRC and LRC for colon neoplasia, we found that RRC was independently associated with a shorter operative time but increased risk of ileus.
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Affiliation(s)
- Paola Solis-Pazmino
- Surgery Group Los Angeles, Los Angeles, CA, USA.
- Surgery Department, Santa Casa de Porto Alegre, Porto Alegre, RS, Brazil.
- Knowledge and Evaluation Research Unit, Mayo Clinic, Rochester, MN, 55905, USA.
- CaTaLiNA-Cancer de Tiroides en Latino America, Quito, Ecuador.
| | | | - Kristina La
- Surgery Group Los Angeles, Los Angeles, CA, USA
| | | | - Oscar Ponce
- Knowledge and Evaluation Research Unit, Mayo Clinic, Rochester, MN, 55905, USA
- CaTaLiNA-Cancer de Tiroides en Latino America, Quito, Ecuador
| | - Luis Figueroa
- CaTaLiNA-Cancer de Tiroides en Latino America, Quito, Ecuador
- Facultad de Ciencias Médicas, Universidad Central del Ecuador, Quito, Ecuador
| | - Antonio Weston
- Surgery Department, Santa Casa de Porto Alegre, Porto Alegre, RS, Brazil
| | - Mayara Machry
- Surgery Department, Santa Casa de Porto Alegre, Porto Alegre, RS, Brazil
| | - Jason Cohen
- Surgery Group Los Angeles, Los Angeles, CA, USA
| | | | - Yosef Nasseri
- Surgery Group Los Angeles, Los Angeles, CA, USA
- Cedars-Sinai Medical Center, Los Angeles, CA, USA
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Zarnescu EC, Zarnescu NO, Sanda N, Costea R. Risk Factors for Severe Postoperative Complications after Oncologic Right Colectomy: Unicenter Analysis. MEDICINA (KAUNAS, LITHUANIA) 2022; 58:1598. [PMID: 36363555 PMCID: PMC9697206 DOI: 10.3390/medicina58111598] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/07/2022] [Revised: 10/26/2022] [Accepted: 11/01/2022] [Indexed: 08/30/2023]
Abstract
Background and Objectives: This study aimed to investigate the potential risk factors for severe postoperative complications after oncologic right colectomy. Materials and Methods: All consecutive patients with right colon cancer who underwent right colectomy in our department between 2016 and 2021 were retrospectively included in this study. The Clavien-Dindo grading system was used to evaluate postoperative complications. Univariate and multivariate logistic regression analyses were used to investigate risk factors for postoperative severe complications. Results: Of the 144 patients, there were 69 males and 75 females, with a median age of 69 (IQR 60-78). Postoperative morbidity and mortality rates were 41.7% (60 patients) and 11.1% (16 patients), respectively. The anastomotic leak rate was 5.3% (7 patients). Severe postoperative complications (Clavien-Dindo grades III-V) were present in 20 patients (13.9%). Univariate analysis showed the following as risk factors for postoperative severe complications: Charlson score, lack of mechanical bowel preparation, level of preoperative proteins, blood transfusions, and degree of urgency (elective/emergency right colectomy). In the logistic binary regression, the Charlson score (OR = 1.931, 95% CI = 1.077-3.463, p = 0.025) and preoperative protein level (OR = 0.049, 95% CI = 0.006-0.433, p = 0.007) were found to be independent risk factors for postoperative severe complications. Conclusions: Severe complications after oncologic right colectomy are associated with a low preoperative protein level and a higher Charlson comorbidity index.
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Affiliation(s)
- Eugenia Claudia Zarnescu
- Department of General Surgery, “Carol Davila” University of Medicine and Pharmacy, 050474 Bucharest, Romania
- Second Department of Surgery, University Emergency Hospital Bucharest, 050098 Bucharest, Romania
| | - Narcis Octavian Zarnescu
- Department of General Surgery, “Carol Davila” University of Medicine and Pharmacy, 050474 Bucharest, Romania
- Second Department of Surgery, University Emergency Hospital Bucharest, 050098 Bucharest, Romania
| | - Nicoleta Sanda
- Department of General Surgery, “Carol Davila” University of Medicine and Pharmacy, 050474 Bucharest, Romania
- Second Department of Surgery, University Emergency Hospital Bucharest, 050098 Bucharest, Romania
| | - Radu Costea
- Department of General Surgery, “Carol Davila” University of Medicine and Pharmacy, 050474 Bucharest, Romania
- Second Department of Surgery, University Emergency Hospital Bucharest, 050098 Bucharest, Romania
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Cram P, Cohen ME, Ko C, Landon BE, Hall B, Jackson TD. Surgical Outcomes in Canada and the United States: An Analysis of the ACS-NSQIP Clinical Registry. World J Surg 2022; 46:1039-1050. [PMID: 35102437 PMCID: PMC9929717 DOI: 10.1007/s00268-022-06444-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/19/2021] [Indexed: 11/28/2022]
Abstract
BACKGROUND There has been longstanding uncertainty over whether lower healthcare spending in Canada might be associated with inferior outcomes for hospital-based care. We hypothesized that mortality and surgical complication rates would be higher for patients who underwent four common surgical procedures in Canada as compared to the US. DESIGN, SETTING, AND PARTICIPANTS We conducted a retrospective cohort study of all adults who underwent hip fracture repair, colectomy, pancreatectomy, or spine surgery in 96 Canadian and 585 US hospitals participating in the American College of Surgeons National Surgical Quality Improvement Project (ACS-NSQIP) between January 1, 2015 and December 31, 2019. We compared patients with respect to demographic characteristics and comorbidity. We then compared unadjusted and adjusted outcomes within 30-days of surgery for patients in Canada and the US including: (1) Mortality; (2) A composite constituting 1-or-more of the following complications (cardiac arrest; myocardial infarction; pneumonia; renal failure/; return to operating room; surgical site infection; sepsis; unplanned intubation). RESULTS Our hip fracture cohort consisted of 21,166 patients in Canada (22.3%) and 73,817 in the US (77.7%), for colectomy 21,279 patients in Canada (8.9%) and 218,307 (91.1%), for pancreatectomy 873 (7.8%) in Canada and 12,078 (92.2%) in the US, and for spine surgery 14,088 (5.3%) and 252,029 (94.7%). Patient sociodemographics and comorbidity were clinically similar between jurisdictions. In adjusted analyses odds of death was significantly higher in Canada for two procedures (colectomy (OR 1.22; 95% CI 1.044-1.424; P = .012) and pancreatectomy (OR 2.11; 95% CI 1.26-3.56; P = .005)) and similar for hip fracture and spine surgery. Odds of the composite outcome were significantly higher in Canada for all 4 procedures, largely driven by higher risk of cardiac events and post-operative infections. CONCLUSIONS We found evidence of higher rates of mortality and surgical complications within 30-days of surgery for patients in Canada as compared to the US.
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Affiliation(s)
- Peter Cram
- Department of Medicine, University of Toronto, Toronto, ON, Canada. .,Division of General Internal Medicine and Geriatrics, Sinai Health System and University Health Network, Toronto, ON, Canada. .,ICES, Toronto, ON, Canada. .,University of Texas Medical Branch, Galveston, TX, USA.
| | | | - Clifford Ko
- American College of Surgeons, Chicago, IL, USA,UCLA Department of Surgery, Los Angeles, CA, USA,Los Angeles VA Medical Center, Los Angeles, CA, USA
| | - Bruce E. Landon
- Department of Health Care Policy, Harvard Medical School and Division of General Medicine, Beth Israel Deaconess Medical Center, Boston, USA
| | - Bruce Hall
- American College of Surgeons, Chicago, IL, USA,Department of Surgery, School of Medicine, Washington University, St Louis, MO, USA,St Louis VA Medical Center, St Louis, MO, USA,BJC Healthcare, St Louis, MO, USA
| | - Timothy D. Jackson
- Department of Surgery, University of Toronto, Toronto, Canada,Division of General Surgery, University Health Network, Toronto, ON, Canada
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Mayo JS, Brazer ML, Bogenberger KJ, Tavares KB, Conrad RJ, Lustik MB, Gillern SM, Park CW, Richards CR. Ureteral injuries in colorectal surgery and the impact of laparoscopic and robotic-assisted approaches. Surg Endosc 2021; 35:2805-2816. [PMID: 32591939 DOI: 10.1007/s00464-020-07714-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2019] [Accepted: 06/09/2020] [Indexed: 10/24/2022]
Abstract
BACKGROUND Ureteral injury is a feared complication in colorectal surgery that has been increasing over the past decade. Some have attributed this to an increased adoption of minimally invasive surgery (MIS), but the literature is hardly conclusive. In this study we aim to further assess the overall trend of ureteral injuries in colorectal surgery, and investigate propensity adjusted contributions from open and MIS to include robotic-assisted surgery. METHODS This is a retrospective analysis of colorectal surgeries from 2006 to 2016 using the Nationwide Inpatient Sample (NIS) database. Multivariable logistic regression was performed to identify predisposing and protective factors. Demographics, hospital factors, and case-mix differences for open and MIS were accounted for via propensity analysis. The NIS coding structure changed in 2015, which could introduce a potential source of incongruity in complication rates over time. As a result, all statistical analyses included only the first nine years of data, or were conducted before and after the change for comparison. RESULTS Of 514,162 colorectal surgeries identified there were 1598 ureteral injuries (0.31%). Ureteral injuries were found to be increasing through 2015 (2.3/1000 vs 3.3/1000; p < 0.001) and through the coding transition to 2016 (4.8/1000; p < 0.001). This trend was entirely accounted for by injuries made during open surgery, with decreasing injury rates for MIS over time. Adjusted odds ratio (OR) for ureteral injury with all MIS vs. open cases was 0.81 (95% CI 0.70-0.93, p = 0.003) and for robotic-assisted surgery alone versus open cases was 0.50 (95% CI 0.33-0.77, p = 0.001). CONCLUSIONS The incidence rate of ureteral injuries during open colorectal surgery is increasing over time, but have been stable or decreasing for MIS cases. These findings hold even after using propensity score analysis. More research is needed to further delineate the impact of MIS and robotic-assisted surgery on ureteral injuries.
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Affiliation(s)
- John S Mayo
- Department of Surgery, Tripler Army Medical Center, 1 Jarrett White Rd., Honolulu, HI, 96859, USA.
| | - Miriam L Brazer
- Department of Surgery, Tripler Army Medical Center, 1 Jarrett White Rd., Honolulu, HI, 96859, USA
| | - Kenneth J Bogenberger
- Department of Surgery, Tripler Army Medical Center, 1 Jarrett White Rd., Honolulu, HI, 96859, USA
| | - Kelli B Tavares
- Department of Surgery, Tripler Army Medical Center, 1 Jarrett White Rd., Honolulu, HI, 96859, USA
| | - Robert J Conrad
- Department of Surgery, Tripler Army Medical Center, 1 Jarrett White Rd., Honolulu, HI, 96859, USA
| | - Michael B Lustik
- Department of Clinical Investigation, Tripler Army Medical Center, Honolulu, HI, USA
| | - Suzanne M Gillern
- Department of Surgery, Tripler Army Medical Center, 1 Jarrett White Rd., Honolulu, HI, 96859, USA
| | - Chan W Park
- Department of Surgery, Tripler Army Medical Center, 1 Jarrett White Rd., Honolulu, HI, 96859, USA
| | - Carly R Richards
- Department of Surgery, Tripler Army Medical Center, 1 Jarrett White Rd., Honolulu, HI, 96859, USA
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Mok HT, Ong ZH, Yaow CYL, Ng CH, Buan BJL, Wong NW, Chong CS. Indocyanine green fluorescent imaging on anastomotic leakage in colectomies: a network meta-analysis and systematic review. Int J Colorectal Dis 2020; 35:2365-2369. [PMID: 32845390 DOI: 10.1007/s00384-020-03723-7] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/21/2020] [Indexed: 02/06/2023]
Abstract
PURPOSE The usage of indocyanine green (ICG) dye is commonly associated with decreased anastomotic leakage rates in colectomies. This study aims to perform a network meta-analysis to assess the usage of ICG fluorescence imaging in right-sided colectomies. METHODS Medline, Embase, Cochrane Trials, CNKI, and WanFang electronic databases were reviewed, and meta-analysis of proportions, comparative meta-analysis, and network meta-analysis were conducted in this review. Studies comparing ICG usage with conventional approaches of anastomosis were selected, with postoperative anastomotic leak rate being the primary outcome. RESULTS Ten articles were included, with a total of 675 patients involved, of which 515 patients underwent colorectal surgery with ICG. Anastomotic leak rates with ICG were estimated to be 1% (CI 0.00-0.04) and 3% (CI 0.01-0.06) for right and left procedures, respectively. No significant difference was observed in left-sided colectomies (OR 0.587; 95% CI 0.218-1.582; p = 0.292). There were nearly half the odds of anastomotic leakage when ICG was used in right-sided colectomies (OR 0.524; 95% CI 0.128-2.137). CONCLUSION With the ability to potentially avert postoperative anastomotic leakage, coupled with its minimal costs and side effects, administration of ICG in colectomies in centers where equipment is available should be encouraged.
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Affiliation(s)
- Hao Ting Mok
- Yong Loo Lin School of Medicine, National University of Singapore, 10 Medical Dr, Singapore, 117597, Singapore
| | - Zhi Hao Ong
- Yong Loo Lin School of Medicine, National University of Singapore, 10 Medical Dr, Singapore, 117597, Singapore
| | - Clyve Yu Leon Yaow
- Yong Loo Lin School of Medicine, National University of Singapore, 10 Medical Dr, Singapore, 117597, Singapore
| | - Cheng Han Ng
- Yong Loo Lin School of Medicine, National University of Singapore, 10 Medical Dr, Singapore, 117597, Singapore
| | - Bryan Jun Liang Buan
- Division of Colorectal Surgery, Department of Surgery, University Surgical Cluster, National University Health System, 1E Kent Ridge Road, Singapore, 119228, Singapore
| | - Neng Wei Wong
- Department of General Surgery, National University Health System, 1E Kent Ridge Road, Singapore, 119228, Singapore
| | - Choon Seng Chong
- Division of Colorectal Surgery, Department of Surgery, University Surgical Cluster, National University Health System, 1E Kent Ridge Road, Singapore, 119228, Singapore.
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Hunt ME, Yates JR, Vega H, Heidel RE, Buehler JM. Effects on Postoperative Gastrointestinal Motility After Neuromuscular Blockade Reversal With Sugammadex Versus Neostigmine/Glycopyrrolate in Colorectal Surgery Patients. Ann Pharmacother 2020; 54:1165-1174. [DOI: 10.1177/1060028020929061] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Background: Neuromuscular blockers (NMBs) used during surgery have historically been reversed with acetylcholinesterase inhibitors and anticholinergic agents, which can slow gastrointestinal motility. Sugammadex (SUG) provides NMB reversal with minimal effects on gastrointestinal motility. Objective: The purpose of this study was to determine if SUG for reversal of NMB is associated with decreased time to first bowel movement (BM) following laparoscopic colorectal surgery. Methods: A retrospective cohort analysis divided 224 patients undergoing laparoscopic colorectal surgeries based on whether they received SUG or a combination of neostigmine and glycopyrrolate (NG) for NMB reversal. The primary outcome was time (in hours) from NMB reversal until first recorded BM. Secondary end points were postoperative ileus, postoperative nausea and vomiting, prevalence of residual NMB, and hospital length of stay. The relationship between NMB reversal agent and outcomes were analyzed using multivariable linear regression and Cox proportional hazards model. Results: There were 128 patients who received NG and 96 who received SUG. Time to first BM was faster in the SUG group by 11.7 hours ( P = 0.004). SUG maintained the effect in a multiple regression model ( P = 0.012). A Cox Proportional Hazards regression model found 50% increased odds of a BM across time for the SUG group ( P = 0.003). No adverse effects were noted. Conclusion and Relevance: This represents the first report demonstrating faster return of BM following colorectal surgery with SUG when compared with NG. Application of these data may add another tool to enhance recovery after colorectal surgery.
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Affiliation(s)
- Molly E. Hunt
- The University of Tennessee Medical Center, Knoxville, TN, USA
| | - John R. Yates
- The University of Tennessee Medical Center, Knoxville, TN, USA
| | - Hannah Vega
- The University of Tennessee Medical Center, Knoxville, TN, USA
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Tankel J, Yellinek S, Vainberg E, David Y, Greenman D, Kinross J, Reissman P. Sarcopenia defined by muscle quality rather than quantity predicts complications following laparoscopic right hemicolectomy. Int J Colorectal Dis 2020; 35:85-94. [PMID: 31776699 DOI: 10.1007/s00384-019-03423-x] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/29/2019] [Indexed: 02/04/2023]
Abstract
PURPOSE While sarcopenia has prognostic value in elective colorectal surgery for predicting peri-operative morbidity and mortality, its role in elective laparoscopic surgery is poorly defined. METHODS A retrospective single-center analysis of patients undergoing elective laparoscopic right hemicolectomy for adenocarcinoma between January 2010 and December 2016. Univariate analysis compared the robustness of total psoas index (TPI) with Hounsfield unit average calculation (HUAC) calculated from pre-operative CT imaging in predicting post-operative complications. Multivariate analysis compared these measures with American Society of Anesthesiologists (ASA) grade and Charlson scores in predicting post-operative complications. RESULTS Of the 580 patients identified, 185 met the inclusion criteria (91 males and 94 females, with a median age of 68). Using TPI and HUAC, 46 and 44 patients respectively were identified as sarcopenic, including 18 patients that were identified by both measures. HUAC-defined sarcopenia was significantly associated with pre-operative comorbidities, peri-operative mortality, and a greater incidence of respiratory, cardiac, and serious post-operative complications (Clavien-Dindo ≥ 3). Those with HUAC-defined sarcopenia aged > 75 were at particular risk of morbidity (OR 5.52, p = 0.002). No such relationships were found with TPI-defined sarcopenia. Only HUAC remained predictive of post-operative complications on multivariate analysis. CONCLUSION Sarcopenia is a novel methodology for stratifying surgical risk in elective colorectal cancer surgery. HUAC has a high prognostic accuracy for the prediction of complications following laparoscopic colorectal surgery compared with TPI, ASA grade, and Charlson score.
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Affiliation(s)
- James Tankel
- Department of General Surgery, Shaare Zedek Medical Center, The Hebrew University School of Medicine, 12 Shmeul Bait Street, 9103102, Jerusalem, Israel. .,Department of Surgery and Cancer, Imperial College Healthcare Trust, St Mary's Hospital, Praed Street, London, W2 1NY, UK.
| | - Shlomo Yellinek
- Department of General Surgery, Shaare Zedek Medical Center, The Hebrew University School of Medicine, 12 Shmeul Bait Street, 9103102, Jerusalem, Israel
| | - Elena Vainberg
- Department of Radiology, Shaare Zedek Medical Center, The Hebrew University School of Medicine, 12 Shmeul Bait Street, 9103102, Jerusalem, Israel
| | - Yotam David
- Department of General Surgery, Shaare Zedek Medical Center, The Hebrew University School of Medicine, 12 Shmeul Bait Street, 9103102, Jerusalem, Israel
| | - Dmitry Greenman
- Department of General Surgery, Shaare Zedek Medical Center, The Hebrew University School of Medicine, 12 Shmeul Bait Street, 9103102, Jerusalem, Israel.,Department of Anesthesiology, Perioperative Medicine and Pain Treatment, Shaare Zedek Medical Center, The Hebrew Univeristy School of Medicine, 12 Shmeul Bait Street, 9103102, Jerusalem, Israel
| | - James Kinross
- Department of Surgery and Cancer, Imperial College Healthcare Trust, St Mary's Hospital, Praed Street, London, W2 1NY, UK
| | - Petachia Reissman
- Department of General Surgery, Shaare Zedek Medical Center, The Hebrew University School of Medicine, 12 Shmeul Bait Street, 9103102, Jerusalem, Israel
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Eisenstein S, Stringfield S, Holubar SD. Using the National Surgical Quality Improvement Project (NSQIP) to Perform Clinical Research in Colon and Rectal Surgery. Clin Colon Rectal Surg 2019; 32:41-53. [PMID: 30647545 DOI: 10.1055/s-0038-1673353] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
The American College of Surgeons' National Surgical Quality Improvement Project (ACS-NSQIP) is probably the most well-known surgical database in North American and worldwide. This clinical database was first proposed by Dr. Clifford Ko, a colorectal surgeon, to the ACS, and NSQIP first started collecting data ca. 2005 with the intent of comparing hospitals (benchmarking) and for hospital-level quality improvement projects. Since then, its popularity has grown from just a few participating hospitals in the United States to more than 708 participating hospitals worldwide, and collaboration allows regional or disease-specific data sharing. Importantly, from a methodological perspective, as the number of hospitals has grown so has the hospital heterogeneity and thus generalizability of the results and conclusions of the individual studies. In this article, we will first briefly present the structure of the database (aka the Participant User File) and other important methodological considerations specific to performing clinical research. We will then briefly review and summarize the approximately 60 published colectomy articles and 30 published articles on proctectomy. We will conclude with future directions relevant to colorectal clinical research.
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Affiliation(s)
- Samuel Eisenstein
- Section of Colon and Rectal Surgery, Rebecca and John Moores Cancer Center, University of California San Diego Health, La Jolla, California
| | - Sarah Stringfield
- Section of Colon and Rectal Surgery, Rebecca and John Moores Cancer Center, University of California San Diego Health, La Jolla, California
| | - Stefan D Holubar
- Department of Colon & Rectal Surgery, Cleveland Clinic, Cleveland, Ohio
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Al-Temimi MH, Trujillo CN, Mahlberg S, Ruan J, Nguyen P, Yuhan R, Carmichael JC. Surgical Intervention for Right-Side Diverticulitis: A Case-Matched Comparison with Left-Side Diverticulitis. Am Surg 2018. [DOI: 10.1177/000313481808401014] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Right-side diverticulitis (RSD) is an uncommon disease in Western countries. We conducted a case-matched comparison of surgically managed right-side and left-side diverticulitis (LSD) from the Southern California Kaiser Permanente database (2007–2014). Of 995 patients undergoing emergent surgery for diverticulitis, 33 RSD (3.3%) met our inclusion criteria and were matched (1:1) to LSD based on age, gender, year of diagnosis, and Hinchey class. Mean age of the RSD group was 56 ± 13.9 years, and 24.2 per cent were Asian. RSD was classified as Hinchey class III or IV in 28.1 per cent and 9.4 per cent of cases, respectively. Right hemicolectomy was performed in 87.9 per cent and laparoscopy was used in 24.2 per cent of the cases. Surgically managed RSD patients were more likely to be Asian (25% vs 3.1%, P = 0.03) and have body mass index < 25 (31.3% vs 6.3%, P = 0.02) compared with LSD patients. Diverting stoma was less common in the RSD (6.3% vs 62.5%) ( P < 0.001). Hospital stay was shorter in RSD (7.6 ± 4.2 vs 12.8 ± 9.4 days, P = 0.006) and more common in the RSD group ( P < 0.01). Open surgery (90.6% vs 71.9%) and postoperative complications (37.5% vs 25%) were more common in the LSD group, but that was not statistically significant ( P > 0.05). Surgery for complicated RSD was associated with shorter hospital stay and decreased likelihood of diverting ostomy.
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Affiliation(s)
- Mohammed H. Al-Temimi
- Department of General Surgery, Arrowhead Regional Medical Center, Colton, California
- Department of General Surgery, Kaiser Permanente (Fontana) Medical Center, Fontana, California
| | - Charles N. Trujillo
- Department of General Surgery, Arrowhead Regional Medical Center, Colton, California
- Department of General Surgery, Kaiser Permanente (Fontana) Medical Center, Fontana, California
| | - Scott Mahlberg
- College of Osteopathic Medicine of the Pacific, Western University of Health Sciences, Pomona, California
| | - Joseph Ruan
- Department of General Surgery, Kaiser Permanente (Fontana) Medical Center, Fontana, California
| | - Patrick Nguyen
- Department of General Surgery, Kaiser Permanente (Fontana) Medical Center, Fontana, California
| | - Robert Yuhan
- Department of General Surgery, Kaiser Permanente (Fontana) Medical Center, Fontana, California
| | - Joseph C. Carmichael
- Division of Colon and Rectal Surgery, University of California at Irvine, Orange, California
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What have we learned in minimally invasive colorectal surgery from NSQIP and NIS large databases? A systematic review. Int J Colorectal Dis 2018; 33:663-681. [PMID: 29623415 DOI: 10.1007/s00384-018-3036-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/25/2018] [Indexed: 02/06/2023]
Abstract
BACKGROUND "Big data" refers to large amount of dataset. Those large databases are useful in many areas, including healthcare. The American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) and the National Inpatient Sample (NIS) are big databases that were developed in the USA in order to record surgical outcomes. The aim of the present systematic review is to evaluate the type and clinical impact of the information retrieved through NISQP and NIS big database articles focused on laparoscopic colorectal surgery. METHODS A systematic review was conducted using The Meta-Analysis Of Observational Studies in Epidemiology (MOOSE) guidelines. The research was carried out on PubMed database and revealed 350 published papers. Outcomes of articles in which laparoscopic colorectal surgery was the primary aim were analyzed. RESULTS Fifty-five studies, published between 2007 and February 2017, were included. Articles included were categorized in groups according to the main topic as: outcomes related to surgical technique comparisons, morbidity and perioperatory results, specific disease-related outcomes, sociodemographic disparities, and academic training impact. CONCLUSIONS NSQIP and NIS databases are just the tip of the iceberg for the potential application of Big Data technology and analysis in MIS. Information obtained through big data is useful and could be considered as external validation in those situations where a significant evidence-based medicine exists; also, those databases establish benchmarks to measure the quality of patient care. Data retrieved helps to inform decision-making and improve healthcare delivery.
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Cai X, Gu D, Chen M, Liu L, Chen D, Lu L, Gao M, Ye X, Jin X, Xie C. The effect of the primary tumor location on the survival of colorectal cancer patients after radical surgery. Int J Med Sci 2018; 15:1640-1647. [PMID: 30588187 PMCID: PMC6299419 DOI: 10.7150/ijms.27834] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2018] [Accepted: 02/09/2018] [Indexed: 12/18/2022] Open
Abstract
Background and Objectives: Colorectal cancer is one of the most common cancers and the leading cause of cancer-related death worldwide. The impact of the primary tumor location on the prognosis of patients with colorectal cancer has long been a concern, but studies have led to conflicting conclusions. Methods: In total, 465 colorectal cancer patients who received radical surgery were reviewed in this study. Enrolled patients were divided into two groups according to the tumor location. Disease-free survival (DFS) and overall survival (OS) were analyzed via the Kaplan-Meier method. A Cox regression model was employed to evaluate the independent prognostic factors for DFS and OS. Results: The right colorectal cancer (RCC) and left colorectal cancer (LCC) groups comprised 202 and 140 patients, respectively. Univariate and multivariate analyses revealed that the tumor location and TNM stage were independent predictors of DFS and OS. Subgroup analyses by stage demonstrated that there were significant differences in DFS and OS between patients with stage II and III RCC and LCC, but not for those with stage I colorectal cancer. Conclusions: Patients with stage II and III LCC had better survival than those with RCC. However, this improvement in DFS and OS was not observed in patients with stage I colorectal cancer.
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Affiliation(s)
- Xiaona Cai
- Department of Radiation and Medical Oncology, the First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China, 325000
| | - Dianna Gu
- Department of Radiation and Medical Oncology, the First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China, 325000
| | - Mengfeng Chen
- Department of Oncology Medicine, Yueqing Third People's Hospital, Wenzhou, China, 325000
| | - Linger Liu
- Department of Radiation and Medical Oncology, the First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China, 325000
| | - Didi Chen
- Department of Radiation and Medical Oncology, the First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China, 325000
| | - Lihuai Lu
- Department of Radiation and Medical Oncology, the First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China, 325000
| | - Mengdan Gao
- Department of Radiation and Medical Oncology, the First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China, 325000
| | - Xuxue Ye
- Department of Radiation and Medical Oncology, the First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China, 325000
| | - Xiance Jin
- Department of Radiation and Medical Oncology, the First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China, 325000
| | - Congying Xie
- Department of Radiation and Medical Oncology, the First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China, 325000
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Dolejs SC, Waters JA, Ceppa EP, Zarzaur BL. Laparoscopic versus robotic colectomy: a national surgical quality improvement project analysis. Surg Endosc 2016; 31:2387-2396. [PMID: 27655383 DOI: 10.1007/s00464-016-5239-5] [Citation(s) in RCA: 61] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2016] [Accepted: 09/01/2016] [Indexed: 12/17/2022]
Abstract
INTRODUCTION Robotic colorectal surgery is being increasingly adopted. Our objective was to compare early postoperative outcomes between robotic and laparoscopic colectomy in a nationally representative sample. METHODS The American College of Surgeons National Surgical Quality Improvement Project Colectomy Targeted Dataset from 2012 to 2014 was used for this study. Adult patients undergoing elective colectomy with an anastomosis were included. Patients were stratified based on location of colorectal resection (low anterior resection (LAR), left-sided resection, or right-sided resection). Bivariate data analysis was performed, and logistic regression modeling was conducted to calculate risk-adjusted 30-day outcomes. RESULTS There were a total of 25,998 laparoscopic colectomies (30 % LAR's, 45 % left-sided, and 25 % right-sided) and 1484 robotic colectomies (54 % LAR's, 28 % left-sided, and 18 % right-sided). The risk-adjusted overall morbidity, serious morbidity, and mortality were similar between laparoscopic and robotic approaches in all anastomotic groups. Patients undergoing robotic LAR had a lower conversion rate (OR 0.47, 95 % CI 1.20-1.76) and postoperative sepsis rate (OR 0.49, 95 % CI 0.29-0.85) but a higher rate of diverting ostomies (OR 1.45, 95 % CI 1.20-1.76). Robotic right-sided colectomies had significantly lower conversion rates (OR 0.58, 95 % CI 0.34-0.96). Robotic colectomy in all groups was associated with a longer operative time (by 40 min) and a decreased length of stay (by 0.5 days). CONCLUSIONS In a nationally representative sample comparing laparoscopic and robotic colectomies, the overall morbidity, serious morbidity, and mortality between groups are similar while length of stay was shorter by 0.5 days in the robotic colectomy group. Robotic LAR was associated with lower conversion rates and lower septic complications. However, robotic LAR is also associated with a significantly higher rate of diverting ostomy. The reason for this relationship is unclear. Surgeon factors, patient factors, and technical factors should be considered in future studies.
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Affiliation(s)
- Scott C Dolejs
- Department of Surgery, Indiana University School of Medicine, 545 Barnhill Drive #202, Indianapolis, IN, 46202, USA.
| | - Joshua A Waters
- Department of Surgery, Indiana University School of Medicine, 545 Barnhill Drive #202, Indianapolis, IN, 46202, USA
| | - Eugene P Ceppa
- Department of Surgery, Indiana University School of Medicine, 545 Barnhill Drive #202, Indianapolis, IN, 46202, USA
| | - Ben L Zarzaur
- Department of Surgery, Indiana University School of Medicine, 545 Barnhill Drive #202, Indianapolis, IN, 46202, USA
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