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Wang L, Zhao J, Shi L, Wang B, Zhang X. The effect of combined head and tail approach during laparoscopic D3 lymph node dissection on pain severity and complications in patients with right colon cancer. Clin Transl Oncol 2024:10.1007/s12094-024-03585-3. [PMID: 38967738 DOI: 10.1007/s12094-024-03585-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2024] [Accepted: 06/23/2024] [Indexed: 07/06/2024]
Abstract
OBJECTIVE To examine the impact of a combined craniocaudal approach on pain and complications during laparoscopic D3 lymph node dissection in clients diagnosed with right colon cancer (RCC). METHODS 100 RCC patients were divided into Group A and Group B. Both groups underwent laparoscopic D3 lymph node dissection, with Group A undergoing an intermediate approach and Group B undergoing a combined head and tail approach. Two groups of patients' perioperative (surgical time, intraoperative blood loss, number of lymph node dissection) indicators, postoperative recovery (postoperative exhaust time, postoperative hospital stay, drainage tube removal time) indicators, perioperative pain level (VAS scores 1, 3, and 5 days following surgery), and incidence of complications (vascular injury, intestinal obstruction, anastomotic bleeding, incision infection), and the therapeutic efficacy [CEA, CA19-9] indicators were compared. RESULTS Clients in the B team had substantially shorter operating times and considerably fewer intraoperative hemorrhage than those in the A team. The VAS grades of clients in the B team were considerably lower than those in the A team the day following surgery. Clients in the B team experienced vascular injury at a substantially lower rate than those in the A team. The overall incidence rate of problems did not differ statistically significantly between the A team and the B team. Following therapy, teams A and B's CEA and CA19-9 levels were considerably lower than those of the same team prior to therapy. CONCLUSION Combined craniocaudal technique can significantly reduce intraoperative bleeding, postoperative pain, and the risk of sequelae from vascular injuries.
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Affiliation(s)
- Liang Wang
- Department of Gastrointestinal Surgery, First Affiliated Hospital of Wannan Medical College, No. 2, Zheshan West Road, Jinghu District, Wuhu, 241000, Anhui, China
| | - Jun Zhao
- Department of Gastrointestinal Surgery, First Affiliated Hospital of Wannan Medical College, No. 2, Zheshan West Road, Jinghu District, Wuhu, 241000, Anhui, China
| | - Lianghui Shi
- Department of Gastrointestinal Surgery, First Affiliated Hospital of Wannan Medical College, No. 2, Zheshan West Road, Jinghu District, Wuhu, 241000, Anhui, China
| | - Bing Wang
- Department of Gastrointestinal Surgery, First Affiliated Hospital of Wannan Medical College, No. 2, Zheshan West Road, Jinghu District, Wuhu, 241000, Anhui, China
| | - Xiaofeng Zhang
- Department of Gastrointestinal Surgery, First Affiliated Hospital of Wannan Medical College, No. 2, Zheshan West Road, Jinghu District, Wuhu, 241000, Anhui, China.
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Huynh Thanh L, Nguyen Manh K, Nguyen Thi M, Nguyen Tri Trung A, Nguyen Trung K, Le Viet T, Vu Huy N. Results of Laparoscopic Surgery and D3 Lymph Node Dissection Combined With Chemotherapy for the Radical Treatment of Advanced-Stage Right Colon Cancer: A Single-Center Observational Study in Vietnam. Cureus 2023; 15:e43243. [PMID: 37577279 PMCID: PMC10420333 DOI: 10.7759/cureus.43243] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/07/2023] [Indexed: 08/15/2023] Open
Abstract
AIM To describe the results of laparoscopic surgery and D3 lymph node dissection combined with adjuvant chemotherapy (ACT) for the treatment of advanced-stage right colon cancer (stages II and III). METHODS A total of 172 right colon cancer patients (with tumour, node, and metastasis (TNM) stage II and III; mean age of 59.30±14.27 years; 58.1% male, 41.9% female) who had undergone complete mesocolic excision (CME) with D3 lymph node dissection at Nguyen Tri Phuong Hospital, Ho Chi Minh City, Vietnam, were included in this study. They were divided into two groups: group 1 (n=34) without ACT and group 2 (n=138) with ACT. We collected clinical and laboratory data twice (before and after one year of performing laparoscopic surgery). Rates of recurrence and mortality were obtained during a five-year follow-up. RESULTS After one year of surgery, the rate of anemia and the increase in serum carcinoembryonic antigen (CEA) levels in group 1 were significantly higher than those in group 2 (p<0.001). After five years of follow-up, the recurrence rate was 11.6% (that of group 1 was 41.2%, which is higher than that of group 2, i.e., 4.3%; p<0.001), and the mortality rate was 8.7% (that of group 1 was 32.4%, which is higher than that of group 2, i.e., 2.9%; p<0.001). Preoperative serum CEA levels were predictive of recurrence and mortality, with an area under the curve (AUC) of 0.729 and 0.805, respectively (p<0.001). CONCLUSIONS Laparoscopic CME surgery and D3 lymph node dissection combined with ACT reduced the five-year recurrence and mortality rates for advanced-stage right colon cancer patients.
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Affiliation(s)
| | | | - Minh Nguyen Thi
- Oncology, Cancer Institute, 108 Military Central Hospital, Hanoi, VNM
| | | | - Kien Nguyen Trung
- Hematology and Blood Transfusion, Military Hospital 103, Hanoi, VNM
- Hematology and Blood Transfusion, Vietnam Military Medical University, Hanoi, VNM
| | - Thang Le Viet
- Nephrology and Hemodialysis, Military Hospital 103, Hanoi, VNM
- Nephrology and Hemodialysis, Vietnam Military Medical University, Hanoi, VNM
| | - Nung Vu Huy
- Surgery, Vietnam Military Medical University, Hanoi, VNM
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Mazzola M, Ripamonti L, Giani A, Carnevali P, Origi M, Alampi B, Giusti I, Achilli P, Bertoglio CL, Magistro C, Ferrari G. Should Laparoscopic Complete Mesocolic Excision Be Offered to Elderly Patients to Treat Right-Sided Colon Cancer? Curr Oncol 2023; 30:4979-4989. [PMID: 37232834 DOI: 10.3390/curroncol30050376] [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: 03/25/2023] [Revised: 05/06/2023] [Accepted: 05/09/2023] [Indexed: 05/27/2023] Open
Abstract
BACKGROUND Despite its potential oncologic benefit, complete mesocolic excision (CME) has rarely been offered to elderly patients. The present study evaluated the effect of age on postoperative outcomes among patients undergoing laparoscopic right colectomies with CME for right-sided colon cancer (RCC). METHODS Data of patients undergoing laparoscopic right colectomies with CME for RCC between 2015 and 2018 were retrospectively analyzed. Selected patients were divided into two groups: the under-80 group and the over-80 group. Surgical, pathological, and oncological outcomes among the groups were compared. RESULTS A total of 130 patients were selected (95 in the under-80 group and 35 in the over-80 group). No difference was found between the groups in terms of postoperative outcomes, except for median length of stay and adjuvant chemotherapy received, which were in favor of the under-80 group (5 vs. 8 days, p < 0.001 and 26.3% vs. 2.9%, p = 0.003, respectively). No difference between the groups was found regarding overall survival and disease free survival. Using multivariate analysis, only the ASA score > 2 (p = 0.01) was an independent predictor of overall complications. CONCLUSIONS laparoscopic right colectomy with CME for RCC was safely performed in elderly patients ensuring similar oncological outcomes compared to younger patients.
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Affiliation(s)
- Michele Mazzola
- Division of Minimally-Invasive Surgical Oncology, ASST Grande Ospedale Metropolitano Niguarda, 20162 Milano, Italy
| | - Lorenzo Ripamonti
- Department of General Surgery, IRCCS san Gerardo dei Tintori, 20900 Monza, Italy
| | - Alessandro Giani
- Division of Minimally-Invasive Surgical Oncology, ASST Grande Ospedale Metropolitano Niguarda, 20162 Milano, Italy
| | - Pietro Carnevali
- Division of Minimally-Invasive Surgical Oncology, ASST Grande Ospedale Metropolitano Niguarda, 20162 Milano, Italy
| | - Matteo Origi
- Division of Minimally-Invasive Surgical Oncology, ASST Grande Ospedale Metropolitano Niguarda, 20162 Milano, Italy
| | - BrunocDomenico Alampi
- Division of Minimally-Invasive Surgical Oncology, ASST Grande Ospedale Metropolitano Niguarda, 20162 Milano, Italy
| | - Irene Giusti
- Division of Minimally-Invasive Surgical Oncology, ASST Grande Ospedale Metropolitano Niguarda, 20162 Milano, Italy
| | - Pietro Achilli
- Division of Minimally-Invasive Surgical Oncology, ASST Grande Ospedale Metropolitano Niguarda, 20162 Milano, Italy
| | | | - Carmelo Magistro
- Division of General Surgery, ASST Melegnano e Martesana, Hospital of Vizzolo Predabissi, 20070 Vizzolo Predabissi, Italy
| | - Giovanni Ferrari
- Division of Minimally-Invasive Surgical Oncology, ASST Grande Ospedale Metropolitano Niguarda, 20162 Milano, Italy
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Nguyen NH, Vu XV, Nguyen VQ, Nguyen TH, Du Nguyen H, Luong TH, Nguyen TK, Nguyen HH. Bach Mai Procedure for complete mesocolic excision, central vascular ligation, and D3 lymphadenectomy in total laparoscopic right hemicolectomy: a prospective study. World J Surg Oncol 2023; 21:140. [PMID: 37147674 PMCID: PMC10161467 DOI: 10.1186/s12957-023-03026-5] [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: 04/03/2023] [Accepted: 04/29/2023] [Indexed: 05/07/2023] Open
Abstract
PURPOSE Total laparoscopic right hemicolectomy with complete mesocolic excision (CME), central vascular ligation (CVL), and D3 lymphadenectomy is still the most challenging colon procedures for gastrointestinal surgeons. We herein report the technical details and our preliminary experience of Bach Mai Procedure - a novel-combining (cranial, medial to lateral, and caudal) approach with early resection of the terminal ileum. METHODS The dissection stage was central vascular isolation and ligation by a combined multiple approaches in the following four steps: cranial approach, dissecting along the inferior aspect of pancreatic isthmus to reveal the middle colic vessels and the anterior aspect of the superior mesentery vein and then exposed the right gastroepiploic vein and the trunk of Henle; medial-to-lateral approach, exposing the surgical axis - the superior mesenteric vascular axis and then early resection of the terminal ileum to open the dissection from the bottom up; and caudal approach, radical ligation of the ileocecal artery and right colic artery (central vascular ligation), lymph node dissection (D3 lymphadenectomy), and resecting the Toldt fascia of the colon to release the entire right colon from the abdominal wall. RESULTS In 12 months, there were 32 cases of primary right-sided colon malignancies that have undergone tLRHD3, CME/CVL based on the Bach Mai Procedure. In 3 cases (9.4%), the tumor site was hepatic flexure. The median of lymph node number (LNN) was 38, with the maximum number which was 101. No serious postoperative complications (grade 3 or higher) neither inhospital mortality was detected. CONCLUSION This Bach Mai procedure, a novel-combining approach with early resection of the terminal ileum, is technically feasible and safe for tLRHD3, CME/CVL. Further investigations and follow-up must be proceeded to evaluate the long-term outcomes of our technique.
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Affiliation(s)
- Ngoc Hung Nguyen
- Department of Gastrointestinal and Hepato-Pancreato-Biliary Surgery, Bach Mai Hospital, Hanoi, Vietnam
| | - Xuan Vinh Vu
- Department of Gastrointestinal and Hepato-Pancreato-Biliary Surgery, Bach Mai Hospital, Hanoi, Vietnam
- Department of Surgery, Hanoi Medical University, Hanoi, Vietnam
| | - Vu Quang Nguyen
- Department of Gastrointestinal and Hepato-Pancreato-Biliary Surgery, Bach Mai Hospital, Hanoi, Vietnam
| | - The Hiep Nguyen
- Department of Gastrointestinal and Hepato-Pancreato-Biliary Surgery, Bach Mai Hospital, Hanoi, Vietnam
- Department of Surgery, Hanoi Medical University, Hanoi, Vietnam
| | - Huy Du Nguyen
- Department of Gastrointestinal and Hepato-Pancreato-Biliary Surgery, Bach Mai Hospital, Hanoi, Vietnam
| | - Tuan Hiep Luong
- Department of Gastrointestinal and Hepato-Pancreato-Biliary Surgery, Bach Mai Hospital, Hanoi, Vietnam.
| | - Thanh Khiem Nguyen
- Department of Gastrointestinal and Hepato-Pancreato-Biliary Surgery, Bach Mai Hospital, Hanoi, Vietnam
| | - Ham Hoi Nguyen
- Department of Gastrointestinal and Hepato-Pancreato-Biliary Surgery, Bach Mai Hospital, Hanoi, Vietnam
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Cuk P, Jawhara M, Al-Najami I, Helligsø P, Pedersen AK, Ellebæk MB. Robot-assisted versus laparoscopic short- and long-term outcomes in complete mesocolic excision for right-sided colonic cancer: a systematic review and meta-analysis. Tech Coloproctol 2023; 27:171-181. [PMID: 36001164 DOI: 10.1007/s10151-022-02686-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2021] [Accepted: 08/10/2022] [Indexed: 02/07/2023]
Abstract
BACKGROUND Complete mesocolic excision (CME) surgery is increasingly implemented for the resection of right-sided colonic cancer, possibly resulting in improved 5-year overall and disease-free survival compared to non-CME surgery. However, it is not clear what surgical platform should be used. The aim of this study was to compare the following outcomes between robot-assisted and laparoscopic CME-surgery for right-sided colonic cancer: (i) short-term clinical outcomes, (ii) pathological specimen quality, and (iii) long-term oncological outcomes. METHODS Medline, Embase, and Cochrane Database of Systematic Reviews were searched from inception until August 2021. Pooled proportions were calculated by applying the inverse variance method. Heterogeneity was explored by I-square and supplemented by sensitivity- and meta-regression analyses. The risk of bias was evaluated by either MINORS or Cochrane's risk-of-bias tool (RoB 2). RESULTS Fifty-five studies with 5.357 patients (740 robot-assisted and 4617 laparoscopic) were included in the meta-analysis. Overall postoperative morbidity was 17% [95% CI (14-20%)] in the robot-assisted group and 13% [95%CI (12-13%)] in the laparoscopic group. Robot-assisted CME was associated with a shorter hospital stay, lower intraoperative blood loss, a higher amount of harvested lymph nodes, and better 3-year oerall and disease-free survival. MINORS and RoB2 indicated a serious risk of bias across studies included. CONCLUSIONS This review which includes predominantly non-randomized studies suggests a possible advantage of the robot-assisted CME compared with a laparoscopic technique for several short-term outcomes.
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Affiliation(s)
- Pedja Cuk
- Surgical Department, Hospital of Southern Jutland, Kresten Philipsens Vej 15, 6200, Aabenraa, Denmark. .,Institute of Regional Health Research, University of Southern Denmark, Odense, Denmark.
| | - Mohamad Jawhara
- Surgical Department, Hospital of Southern Jutland, Kresten Philipsens Vej 15, 6200, Aabenraa, Denmark
| | - Issam Al-Najami
- Research Unit for Surgery, Odense University Hospital, Odense, Denmark
| | - Per Helligsø
- Surgical Department, Hospital of Southern Jutland, Kresten Philipsens Vej 15, 6200, Aabenraa, Denmark
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Zheng HD, Liu YR, Chen ZZ, Sun YF, Xu CH, Xu JH. Nomogram for predicting chylous ascites after right colectomy. World J Gastrointest Surg 2021; 13:1361-1371. [PMID: 34950426 PMCID: PMC8649560 DOI: 10.4240/wjgs.v13.i11.1361] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2021] [Revised: 07/01/2021] [Accepted: 09/17/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Chylous ascites following right colectomy has a high incidence which is a critical challenge. At present, there are few studies on the factors affecting chylous ascites after right colectomy and especially after D3 Lymphadenectomy. A predictive model for chylous ascites has not yet been established. Therefore, we created the first nomogram to predict the incidence of chylous ascites after right hemicolectomy.
AIM To analyze the risk factors for chylous ascites after right colectomy and establish a nomogram to predict the incidence of chylous ascites.
METHODS We retrospectively collected patients who underwent right hemicolectomy between January 2012 and May 2021 and were pathologically diagnosed with cancer. Multivariate logistic regression was used to analyze the influencing factors of chylous ascites and a nomogram was established. The predictive ability was assessed by the area under the receiver operating characteristic (ROC) curve.
RESULTS Operative time, the type of operation (standard or extended), the number of lymph nodes retrieved, and somatostatin administration were considered important risk factors. Multivariate logistic regression and nomograms can be used to accurately predict whether chylous ascites occurs. The area under the ROC curve of the model is 0.770. The C-statistic of this model is 0.770 which indicates that it has a relatively moderate ability to predict the risk of chylous ascites.
CONCLUSION We found a novel set of risk factors, created a nomogram, and validated it. The nomogram had a relatively accurate forecasting ability for chylous ascites after right hemicolectomy and can be used as a reference for risk assessment of chylous ascites and whether to prevent it after surgery.
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Affiliation(s)
- Hui-Da Zheng
- Department of Gastrointestinal Surgery, The Second Affiliated Hospital of Fujian Medical University, Quanzhou 362000, Fujian Province, China
| | - Yu-Rong Liu
- Department of Gastrointestinal Surgery, The Second Affiliated Hospital of Fujian Medical University, Quanzhou 362000, Fujian Province, China
| | - Zhen-Ze Chen
- Department of Gastrointestinal Surgery, The Second Affiliated Hospital of Fujian Medical University, Quanzhou 362000, Fujian Province, China
| | - Ya-Feng Sun
- Department of Gastrointestinal Surgery, The Second Affiliated Hospital of Fujian Medical University, Quanzhou 362000, Fujian Province, China
| | - Chun-Hao Xu
- Department of Gastrointestinal Surgery, The Second Affiliated Hospital of Fujian Medical University, Quanzhou 362000, Fujian Province, China
| | - Jian-Hua Xu
- Department of Gastrointestinal Surgery, The Second Affiliated Hospital of Fujian Medical University, Quanzhou 362000, Fujian Province, China
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Reduced port versus open right hemicolectomy for colorectal cancer: a retrospective comparison study of two centers. Int J Colorectal Dis 2021; 36:1469-1477. [PMID: 33825027 DOI: 10.1007/s00384-021-03923-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/01/2021] [Indexed: 02/04/2023]
Abstract
PURPOSE The concept of complete mesocolic excision (CME) in right-sided colorectal cancer is well known for open and laparoscopic surgery. The aim of this study was to evaluate and compare perioperative and oncological outcomes of reduced port and open surgery for right-sided colorectal cancer. METHODS One hundred forty-one patients received elective surgery for right-sided colonic cancer between January 2015 and December 2019 and were included in a retrospective database. RESULTS We observed longer operation time in the RP-CME group (145 min vs. 119.43 min, p<0.01). Hospital stay (8 days vs. 14 days, p<0.01) and time to first intestinal passage (42 h. vs. 59 h, p<0.01) were significantly shorter in the reduced port group. Postoperative complications were more likely to be observed in the O-CME group (7.2% vs. 14.1%, p=0.28); anastomotic leakage rate was low in both groups (1.8% vs. 2.4%, p=1.00). Specimen scores (score 1= good: 93.8% vs. 91.7%, p=1.00) and average number of retrieved lymph nodes were comparable (24 vs. 23 p=0.69). In O-CME patients, we observed more advanced tumor stages (UICC III: 21.4% vs. 45.9%, p<0.01). CONCLUSION To our knowledge, this is the first study comparing reduced port to open surgery for right-sided colorectal cancer. We could demonstrate that this technique is feasible for oncological right hemicolectomy with observation of shorter hospital stay and lower morbidity rates compared to open surgery. The oncological outcome did not differ in the present study.
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