1
|
Serra-Aracil X, Gómez-Torres I, Torrecilla-Portoles A, Serracant-Barrera A, García-Nalda A, Pallisera-Lloveras A. Minimally invasive left colectomy with total intracorporeal anastomosis versus extracorporeal anastomosis. A single center cohort study. Stage 2b IDEAL framework for evaluating surgical innovation. Langenbecks Arch Surg 2024; 409:225. [PMID: 39028427 PMCID: PMC11271420 DOI: 10.1007/s00423-024-03387-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2023] [Accepted: 06/17/2024] [Indexed: 07/20/2024]
Abstract
PURPOSE Performing intracorporeal anastomoses in minimally invasive colon surgery appears to provide better short-term outcomes for patients with colon cancer. The aim of the study is to compare surgical aspects and short-term outcomes between intracorporeal and extracorporeal techniques in left colectomies with both laparoscopic and robotic approaches and evaluate advantages and disadvantages of intracorporeal anastomosis according to IDEAL framework (Exploration, stage 2b). METHODS This is a single center, ambispective cohort study comparing total intracorporeal anastomosis (TIA) and standard surgery with extracorporeal anastomosis (EA). Patients with colon cancer treated by left colectomy, sigmoidectomy and high anterior resection by total intracorporeal anastomosis between May 2020 and January 2023 without exclusion criteria were prospectively included in a standardized database. Short-term outcomes in the group undergoing TIA were compared with a historical EA cohort. The main assessment outcomes were intraoperative complications, postoperative morbidity according to the Clavien-Dindo scale and the comparison of pathological. We conducted a preliminary comparative study within the TIA group between approaches, a primary analysis between the two anastomotic techniques, and a propensity score matched analysis including only the laparoscopic approach, between both anastomotic techniques. RESULTS Two hundred and forty-six patients were included: 103 who underwent TIA, 35 of them with laparoscopic approach and 68 with robotic approach, and a comparison group comprising another 103 eligible consecutive patients who underwent laparoscopic EA. There were no statistically significant differences between the two groups in terms of demographic variables. No statistically significant differences were observed in anastomotic dehiscence. Intraoperative complications are fewer in the TIA group, with a higher C-Reactive Protein levels. Relevant anastomotic bleeding and the number of retrieved lymph nodes were higher in EA group. Nevertheless, no differences were observed in terms of overall morbidity. CONCLUSION Minimally invasive left colectomy with intracorporeal resection and anastomosis is technically feasible and safe suing either a laparoscopic or a robotic approach. Clinical data from this cohort demonstrate outcomes comparable to those achieved through the conventional EA procedure in relation to postoperative morbidity and oncological efficacy, with indications suggesting that the utilization of robotic-assisted techniques may play a contributing role in enhancing overall treatment outcomes.
Collapse
Affiliation(s)
- Xavier Serra-Aracil
- Department of Surgery, Autonomous University of Barcelona, Parc Tauli s/n, Sabadell, Barcelona, 08208, Spain.
- Coloproctology Unit, General and Digestive Surgery Service, Parc Tauli Institute for Research and Innovation I3PT, Parc Tauli University Hospital, Sabadell, Spain.
| | - Irene Gómez-Torres
- Department of Surgery, Autonomous University of Barcelona, Parc Tauli s/n, Sabadell, Barcelona, 08208, Spain.
| | - Andrea Torrecilla-Portoles
- Department of Surgery, Autonomous University of Barcelona, Parc Tauli s/n, Sabadell, Barcelona, 08208, Spain
- Coloproctology Unit, General and Digestive Surgery Service, Parc Tauli Institute for Research and Innovation I3PT, Parc Tauli University Hospital, Sabadell, Spain
| | - Anna Serracant-Barrera
- Department of Surgery, Autonomous University of Barcelona, Parc Tauli s/n, Sabadell, Barcelona, 08208, Spain
- Coloproctology Unit, General and Digestive Surgery Service, Parc Tauli Institute for Research and Innovation I3PT, Parc Tauli University Hospital, Sabadell, Spain
| | - Albert García-Nalda
- Department of Surgery, Autonomous University of Barcelona, Parc Tauli s/n, Sabadell, Barcelona, 08208, Spain
- Coloproctology Unit, General and Digestive Surgery Service, Parc Tauli Institute for Research and Innovation I3PT, Parc Tauli University Hospital, Sabadell, Spain
| | - Anna Pallisera-Lloveras
- Department of Surgery, Autonomous University of Barcelona, Parc Tauli s/n, Sabadell, Barcelona, 08208, Spain
- Coloproctology Unit, General and Digestive Surgery Service, Parc Tauli Institute for Research and Innovation I3PT, Parc Tauli University Hospital, Sabadell, Spain
| |
Collapse
|
2
|
Wu HB, Liu DF, Liu YL, Wang XF, Cao YP. Influence of reduced-port laparoscopic surgery on perioperative indicators, postoperative recovery, and serum inflammation in patients with colorectal carcinoma. World J Gastrointest Surg 2024; 16:1734-1741. [PMID: 38983325 PMCID: PMC11230031 DOI: 10.4240/wjgs.v16.i6.1734] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2024] [Revised: 05/08/2024] [Accepted: 05/11/2024] [Indexed: 06/27/2024] Open
Abstract
BACKGROUND Conventional five-port laparoscopic surgery, the current standard treatment for colorectal carcinoma (CRC), has many disadvantages. AIM To assess the influence of reduced-port laparoscopic surgery (RPLS) on perioperative indicators, postoperative recovery, and serum inflammation indexes in patients with CRC. METHODS The study included 115 patients with CRC admitted between December 2019 and May 2023, 52 of whom underwent conventional five-port laparoscopic surgery (control group) and 63 of whom underwent RPLS (research group). Comparative analyses were performed on the following dimensions: Perioperative indicators [operation time (OT), incision length, intraoperative blood loss (IBL), and rate of conversion to laparotomy], postoperative recovery (first postoperative exhaust, bowel movement and oral food intake, and bowel sound recovery time), serum inflammation indexes [high-sensitivity C-reactive protein (hs-CRP), tumor necrosis factor-α (TNF-α), and interleukin-6 (IL-6)], postoperative complications (anastomotic leakage, incisional infection, bleeding, ileus), and therapeutic efficacy. RESULTS The two groups had comparable OTs and IBL volumes. However, the research group had a smaller incision length; lower rates of conversion to laparotomy and postoperative total complication; and shorter time of first postoperative exhaust, bowel movement, oral food intake, and bowel sound recovery; all of which were significant. Furthermore, hs-CRP, IL-6, and TNF-α levels in the research group were significantly lower than the baseline and those of the control group, and the total effective rate was higher. CONCLUSION RPLS exhibited significant therapeutic efficacy in CRC, resulting in a shorter incision length and a lower conversion rate to laparotomy, while also promoting postoperative recovery, effectively inhibiting the inflammatory response, and reducing the risk of postoperative complications.
Collapse
Affiliation(s)
- Hong-Biao Wu
- Department of Colorectal Surgery, The First Affiliated Hospital of Ningbo University, Ningbo 315000, Zhejiang Province, China
| | - Dong-Fang Liu
- Department of Colorectal Surgery, The First Affiliated Hospital of Ningbo University, Ningbo 315000, Zhejiang Province, China
| | - Ye-Lei Liu
- Department of Colorectal Surgery, The First Affiliated Hospital of Ningbo University, Ningbo 315000, Zhejiang Province, China
| | - Xiao-Feng Wang
- Department of Colorectal Surgery, The First Affiliated Hospital of Ningbo University, Ningbo 315000, Zhejiang Province, China
| | - Yue-Peng Cao
- Department of Colorectal Surgery, The First Affiliated Hospital of Ningbo University, Ningbo 315000, Zhejiang Province, China
| |
Collapse
|
3
|
Ivascu R, Torsin LI, Hostiuc L, Nitipir C, Corneci D, Dutu M. The Surgical Stress Response and Anesthesia: A Narrative Review. J Clin Med 2024; 13:3017. [PMID: 38792558 PMCID: PMC11121777 DOI: 10.3390/jcm13103017] [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: 04/05/2024] [Revised: 04/28/2024] [Accepted: 05/16/2024] [Indexed: 05/26/2024] Open
Abstract
The human physiological response "to stress" includes all metabolic and hormonal changes produced by a traumatic event at the micro or macro cellular levels. The main goal of the body's first response to trauma is to keep physiological homeostasis. The perioperative non-specific adaptation response can sometimes be detrimental and can produce systemic inflammatory response syndrome (SIRS), characterized by hypermetabolism and hyper catabolism. We performed a narrative review consisting of a description of the surgical stress response's categories of changes (neurohormonal and immunological response) followed by reviewing methods found in published studies to modulate the surgical stress response perioperatively. We described various preoperative measures cited in the literature as lowering the burden of surgical trauma. This article revises the anesthetic drugs and techniques that have an impact on the surgical stress response and proven immune-modulatory effects. We also tried to name present knowledge gaps requiring future research. Our review concludes that proper preoperative measures, adequate general anesthetics, multimodal analgesia, early postoperative mobilization, and early enteral nutrition can decrease the stress response to surgery and ease patient recovery. Anesthetics and analgesics used during the perioperative period may modulate the innate and adaptive immune system and inflammatory system, with a consecutive impact on cancer recurrence and long-term outcomes.
Collapse
Affiliation(s)
- Robert Ivascu
- Department of Anesthesiology and Intensive Care, Carol Davila University of Medicine and Pharmacy, 0200021 Bucharest, Romania; (R.I.); (D.C.)
- Department of Anesthesiology and Intensive Care, Dr. Carol Davila Central Military Emergency University Hospital, 010242 Bucharest, Romania; (L.I.T.); (L.H.)
| | - Ligia I. Torsin
- Department of Anesthesiology and Intensive Care, Dr. Carol Davila Central Military Emergency University Hospital, 010242 Bucharest, Romania; (L.I.T.); (L.H.)
| | - Laura Hostiuc
- Department of Anesthesiology and Intensive Care, Dr. Carol Davila Central Military Emergency University Hospital, 010242 Bucharest, Romania; (L.I.T.); (L.H.)
| | - Cornelia Nitipir
- Department of Oncology, Carol Davila University of Medicine and Pharmacy, 020021 Bucharest, Romania;
- Department of Oncology, Elias University Emergency Hospital, 011461 Bucharest, Romania
| | - Dan Corneci
- Department of Anesthesiology and Intensive Care, Carol Davila University of Medicine and Pharmacy, 0200021 Bucharest, Romania; (R.I.); (D.C.)
- Department of Anesthesiology and Intensive Care, Dr. Carol Davila Central Military Emergency University Hospital, 010242 Bucharest, Romania; (L.I.T.); (L.H.)
| | - Madalina Dutu
- Department of Anesthesiology and Intensive Care, Carol Davila University of Medicine and Pharmacy, 0200021 Bucharest, Romania; (R.I.); (D.C.)
- Department of Anesthesiology and Intensive Care, Dr. Carol Davila Central Military Emergency University Hospital, 010242 Bucharest, Romania; (L.I.T.); (L.H.)
| |
Collapse
|
4
|
Rathod PR, Bhoi D, Kumar A, Ray BR, Mohan VK, Kashyap L. Effect of ultrasound-guided quadratus lumborum block on neuroendocrine stress response and postoperative analgesia in paediatric patients undergoing elective open pyeloplasty - A randomised clinical trial. Indian J Anaesth 2024; 68:467-472. [PMID: 38764955 PMCID: PMC11100651 DOI: 10.4103/ija.ija_608_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2023] [Revised: 03/02/2024] [Accepted: 03/05/2024] [Indexed: 05/21/2024] Open
Abstract
Background and Aims Quadratus lumborum block (QLB) is a compartmental block of the anterior abdominal wall. Surgical trauma produces neuroendocrine surgical stress responses, which are modified by anaesthetic blocks. The aim of this study was to evaluate the effect of ultrasound (US)-guided QLB on analgesia and surgical neuroendocrine stress response in paediatric patients undergoing pyeloplasty. Methods A randomised trial was conducted in 60 children aged 1-7 years undergoing elective open pyeloplasty. Patients were randomised into Group QLB [US-guided QLB with 0.5 ml/kg of 0.25% ropivacaine after induction of general anaesthesia (GA)], and Group GA, which received only GA. Perioperative haemodynamic parameters, serum cortisol, blood glucose, analgesic consumption and postoperative FLACC scores were recorded. Unpaired t-test, Wilcoxon rank-sum test or Mann-Whitney U test was used to compare variables between the two groups. Two-way analysis of variance or the Friedmann test was used to compare quantitative variables at various points within a group. Results A decrease in serum cortisol and blood glucose values was observed in Group QLB at 30 min after surgical incision and 24 h after surgery compared to the preoperative value and compared to Group GA (P < 0.05). The quality of analgesia assessed by the FLACC scale was significantly better in group QLB. Dose of fentanyl consumption (µg/kg) was higher in Group GA compared to Group QLB in the intraoperative and postoperative period (P < 0.05). Conclusion QLB is effective as part of multimodal analgesia and attenuates the neuroendocrine stress in paediatric patients undergoing open pyeloplasty.
Collapse
Affiliation(s)
- Pyarelal Ramsing Rathod
- Department of Anaesthesiology, Pain Medicine and Critical Care, All India Institute of Medical Sciences, New Delhi, India
| | - Debesh Bhoi
- Department of Anaesthesiology, Pain Medicine and Critical Care, All India Institute of Medical Sciences, New Delhi, India
| | - Ajeet Kumar
- Department of Anaesthesiology, Pain Medicine and Critical Care, All India Institute of Medical Sciences, New Delhi, India
| | - Bikash Ranjan Ray
- Department of Anaesthesiology, Pain Medicine and Critical Care, All India Institute of Medical Sciences, New Delhi, India
| | - Virender Kumar Mohan
- Department of Anaesthesiology, Pain Medicine and Critical Care, All India Institute of Medical Sciences, New Delhi, India
| | - Lokesh Kashyap
- Department of Anaesthesiology, Pain Medicine and Critical Care, All India Institute of Medical Sciences, New Delhi, India
| |
Collapse
|
5
|
Liu S, Huang H, Zhang C, Chen L, Feng X, Wu Y, Xia Q, Huang X. Postoperative leukocyte counts as a surrogate for surgical stress response in matched robot- and video-assisted thoracoscopic surgery cohorts of patients: A preliminary report. J Robot Surg 2024; 18:176. [PMID: 38630145 PMCID: PMC11024030 DOI: 10.1007/s11701-024-01939-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2024] [Accepted: 03/31/2024] [Indexed: 04/19/2024]
Abstract
The objective is to preliminary evaluated postoperative leukocyte counts as a surrogate for the surgical stress response in NSCLC patients who underwent RATS or VATS for further prospective analyses with proper assessment of surgical stress response and tissue trauma. We retrospectively analyzed patients with stageI-IIIA NSCLC who underwent RATS or VATS at a hospital between 8 May 2020 and 31 December 2021. Analysis of leukocytes (including neutrophils and lymphocytes) and albumin on postoperative days (PODs) 1 and 3 in patients with NSCLC treated with RATS or VATS after propensity score matching (PSM). In total, 1824 patients (565 RATS and 1259 VATS) were investigated. The two MIS groups differed significantly with regard to operative time (p < 0.001), chronic lung disease (p < 0.001), the type of pulmonary resection (p < 0.001), the excision site of lobectomy (p = 0.004), and histology of the tumor (p = 0.028). After PSM, leukocyte and neutrophil levels in the RATS group were lower than those in the VATS group on PODs 1 and 3, with those on POD 3 (p < 0.001) being particularly notable. While lymphocyte levels in the RATS group were significantly lower than those in the VATS group only at POD 1 (p = 0.016). There was no difference in albumin levels between the RATS and VATS groups on PODs 1 and 3. The surgical stress response and tissue trauma was less severe in NSCLC patients who underwent RATS than in those who underwent VATS, especially reflected in the neutrophils of leukocytes.
Collapse
Affiliation(s)
- Sidi Liu
- Infection Control Center, Xiangya Hospital of Central South University, 87 Xiangya Road, Changsha, 410008, China
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital of Central South University, Changsha, China
| | - Huichao Huang
- Department of Infectious Diseases, Xiangya Hospital of Central South University, Changsha, China
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital of Central South University, Changsha, China
| | - Chunfang Zhang
- Department of Thoracic Surgery, Xiangya Hospital of Central South University, Changsha, China
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital of Central South University, Changsha, China
| | - Letao Chen
- Infection Control Center, Xiangya Hospital of Central South University, 87 Xiangya Road, Changsha, 410008, China
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital of Central South University, Changsha, China
| | - Xuelian Feng
- Operating Room Department, Xiangya Hospital of Central South University, Changsha, China
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital of Central South University, Changsha, China
| | - Yaling Wu
- Infection Control Center, Xiangya Hospital of Central South University, 87 Xiangya Road, Changsha, 410008, China
- Disease Prevention and Control Section, Anfu People's Hospital, Jian, China
| | - Qing Xia
- Infection Control Center, Xiangya Hospital of Central South University, 87 Xiangya Road, Changsha, 410008, China
- Disease Prevention and Control Section, 921 Hospital of Joint Logistics Support Force, Changsha, China
| | - Xun Huang
- Infection Control Center, Xiangya Hospital of Central South University, 87 Xiangya Road, Changsha, 410008, China.
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital of Central South University, Changsha, China.
| |
Collapse
|
6
|
Kayano H, Mamuro N, Kamei Y, Ogimi T, Miyakita H, Nakagohri T, Koyanagi K, Mori M, Yamamoto S. Evaluation of bacterial contamination and medium-term oncological outcomes of intracorporeal anastomosis for colon cancer: A propensity score matching analysis. World J Gastrointest Surg 2024; 16:670-680. [PMID: 38577098 PMCID: PMC10989348 DOI: 10.4240/wjgs.v16.i3.670] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2023] [Revised: 01/06/2024] [Accepted: 02/04/2024] [Indexed: 03/22/2024] Open
Abstract
BACKGROUND Although intracorporeal anastomosis (IA) for colon cancer requires longer operative time than extracorporeal anastomosis (EA), its short-term postoperative results, such as early recovery of bowel movement, have been reported to be equal or better. As IA requires opening the intestinal tract in the abdominal cavity under pneumoperitoneum, there are concerns about intraperitoneal bacterial infection and recurrence of peritoneal dissemination due to the spread of bacteria and tumor cells. However, intraperitoneal bacterial contamination and medium-term oncological outcomes have not been clarified. AIM To clarify the effects of bacterial and tumor cell contamination of the intra-abdominal cavity in IA. METHODS Of 127 patients who underwent laparoscopic colon resection for colon cancer from April 2015 to December 2020, 75 underwent EA (EA group), and 52 underwent IA (IA group). After propensity score matching, the primary endpoint was 3-year disease-free survival rates, and secondary endpoints were 3-year overall survival rates, type of recurrence, surgical site infection (SSI) incidence, number of days on antibiotics, and postoperative biological responses. RESULTS Three-year disease-free survival rates did not significantly differ between the IA and EA groups (87.2% and 82.7%, respectively, P = 0.4473). The 3-year overall survival rates also did not significantly differ between the IA and EA groups (94.7% and 94.7%, respectively; P = 0.9891). There was no difference in the type of recurrence between the two groups. In addition, there were no significant differences in SSI incidence or the number of days on antibiotics; however, postoperative biological responses, such as the white blood cell count (10200 vs 8650/mm3, P = 0.0068), C-reactive protein (6.8 vs 4.5 mg/dL, P = 0.0011), and body temperature (37.7 vs 37.5 °C, P = 0.0079), were significantly higher in the IA group. CONCLUSION IA is an anastomotic technique that should be widely performed because its risk of intraperitoneal bacterial contamination and medium-term oncological outcomes are comparable to those of EA.
Collapse
Affiliation(s)
- Hajime Kayano
- Department of Gastroenterological Surgery, Tokai University School of Medicine, Isehara 259-1193, Kanagawa, Japan
| | - Nana Mamuro
- Department of Gastroenterological Surgery, Tokai University School of Medicine, Isehara 259-1193, Kanagawa, Japan
| | - Yutaro Kamei
- Department of Gastroenterological Surgery, Tokai University School of Medicine, Isehara 259-1193, Kanagawa, Japan
| | - Takashi Ogimi
- Department of Gastroenterological Surgery, Tokai University School of Medicine, Isehara 259-1193, Kanagawa, Japan
| | - Hiroshi Miyakita
- Department of Gastroenterological Surgery, Tokai University School of Medicine, Isehara 259-1193, Kanagawa, Japan
| | - Toshio Nakagohri
- Department of Gastroenterological Surgery, Tokai University School of Medicine, Isehara 259-1193, Kanagawa, Japan
| | - Kazuo Koyanagi
- Department of Gastroenterological Surgery, Tokai University School of Medicine, Isehara 259-1193, Kanagawa, Japan
| | - Masaki Mori
- Department of Gastroenterological Surgery, Tokai University School of Medicine, Isehara 259-1193, Kanagawa, Japan
| | - Seiichiro Yamamoto
- Department of Gastroenterological Surgery, Tokai University School of Medicine, Isehara 259-1193, Kanagawa, Japan
| |
Collapse
|
7
|
Ivascu R, Dutu M, Corneci D, Nitipir C. Energy Expenditure, a New Tool for Monitoring Surgical Stress in Colorectal Oncological Patients: A Prospective, Monocentric Study. Cureus 2024; 16:e56822. [PMID: 38654802 PMCID: PMC11037290 DOI: 10.7759/cureus.56822] [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: 03/24/2024] [Indexed: 04/26/2024] Open
Abstract
BACKGROUND Surgical stress response in colorectal surgery consists of a neurohormonal and an immunological response and influences oncological outcomes. The intensity of surgical trauma influences mortality, morbidity, and metastasis' occurrence in colorectal neoplasia. Energy expenditure (EE) stands for the body's energy consumed to keep its homeostasis and can be either calculated or measured by direct or indirect calorimetry. AIM The present study attempted to evaluate surgical stress response using EE measurement and compare it to the postoperative cortisol dynamic. METHODS A prospective, monocentric study was conducted over a period of one year in the Anesthesiology Department including 21 patients from whom serum cortisol values were collected in the preoperative period and on the first postoperative day, and EE was measured and recorded every 15 minutes throughout surgery using the indirect calorimetry method. The study compared EE values' dynamic registered 30 minutes after intubation and 30 minutes before extubating (after abdominal closure) to cortisol perioperative dynamic. RESULTS We enrolled 21 patients and 84 measurements were recorded, 42 probes of serum cortisol and 42 measurements of EE. The mean value of the first measurement of serum cortisol was 13.60±3.6 µg and the second was 16.21±6.52 µg. The average value of the first EE recording was 1273.9±278 kcal and 1463.4±398.2 kcal of the second recording. The bivariate analysis performed showed a good correlation between cortisol variation and EE's variation (Spearman coefficient=0.666, p<0.001, CI=0.285, 0.865). In nine cases (42.85%), cortisol value at 24 hours reached the baseline or below the baselines preoperative value. In eight cases (38.09%), patients' EE at the end of the surgery was lower than that recorded at the beginning of the surgery. CONCLUSIONS Intraoperative EE variation correlated well with cortisol perioperative dynamic and stood out in this study as a valuable and accessible predictor of surgical stress in colorectal surgery.
Collapse
Affiliation(s)
- Robert Ivascu
- Anesthesia and Critical Care, Dr. Carol Davila University Emergency Central Military Hospital, Bucharest, ROU
| | - Madalina Dutu
- Anesthesia and Critical Care, Dr. Carol Davila University Emergency Central Military Hospital, Bucharest, ROU
- Anesthesia and Critical Care, Carol Davila University of Medicine and Pharmacy, Bucharest, ROU
| | - Dan Corneci
- Anesthesia and Critical Care, Dr. Carol Davila University Emergency Central Military Hospital, Bucharest, ROU
- Anesthesia and Critical Care, Carol Davila University of Medicine and Pharmacy, Bucharest, ROU
| | - Cornelia Nitipir
- Oncology, Elias University Emergency Hospital, Bucharest, ROU
- Oncology, Carol Davila University of Medicine and Pharmacy, Bucharest, ROU
| |
Collapse
|
8
|
Liu J, Tian JM, Liu GZ, Sun JN, Gao PF, Zhang YQ, Yue XQ. Application of remimazolam transversus abdominis plane block in gastrointestinal tumor surgery. World J Gastrointest Oncol 2023; 15:2101-2110. [PMID: 38173426 PMCID: PMC10758652 DOI: 10.4251/wjgo.v15.i12.2101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2023] [Revised: 10/26/2023] [Accepted: 11/25/2023] [Indexed: 12/14/2023] Open
Abstract
BACKGROUND Transversus abdominis plane block (TAPB) is a block of the abdominal afferent nerve fibers between the internal oblique muscle and the transverse abdominal muscle achieved with local anesthetics. It can effectively block the conduction of the anterior nerve of the abdominal wall and exert a good analgesic effect. However, the effect of combining the block with remimazolam on anesthesia in patients undergoing gastrointestinal tumor surgery is still unclear. AIM To examine the effects of combining TAPB with remimazolam on the stress response and postoperative recovery of gastrointestinal tumor surgery patients. METHODS A retrospective analysis was conducted on the clinical data of 102 individuals diagnosed with gastrointestinal malignancies who underwent laparoscopic surgery under general anesthesia between April 2020 and June 2023. The patients were categorized into a control group (n = 51), receiving remimazolam for general anesthesia, and an observation group (n = 51), receiving TAPB combined with remimazolam for general anesthesia. A comparison was made between both groups in terms of hemodynamic parameters, stress markers, pain levels, recovery quality, analgesic effects, and adverse reactions during the perioperative period. RESULTS The observation group had significantly higher heart rates at time points 1 min after induction and upon leaving the operating room than the control group (P < 0.05). The mean arterial pressure at time point T1 in the observation group was significantly higher than that in the control group (P < 0.05). Five minutes after extubation, the levels of the hormones adrenaline and noradrenaline in the observation group were considerably lower than those in the control group (P < 0.05). At 12 h, 24 h, and 48 h following surgery, the visual analog scale scores of the observation group were considerably lower than those of the control group (P < 0.05). The observation group had shorter awakening and extubation times and lower Riker sedation-agitation scale scores than the control group (P < 0.05). The observation group exhibited considerably fewer effective pump presses, lower fentanyl dosages, and lower incidences of rescue analgesia within 24 h following surgery than the control group (P < 0.05). CONCLUSION The application effect of TAPB combined with remimazolam general anesthesia in anesthesia of patients undergoing gastrointestinal tumor surgery is good, which is helpful to promote faster recovery after operation.
Collapse
Affiliation(s)
- Jun Liu
- Department of Anesthesiology and Perioperative Medicine, The First Affiliated Hospital of Xinxiang Medical University, Weihui 453100, Henan Province, China
| | - Jian-Min Tian
- Department of Anesthesiology and Perioperative Medicine, The First Affiliated Hospital of Xinxiang Medical University, Weihui 453100, Henan Province, China
| | - Guo-Ze Liu
- Department of Anesthesiology and Perioperative Medicine, The First Affiliated Hospital of Xinxiang Medical University, Weihui 453100, Henan Province, China
| | - Jun-Na Sun
- Department of Anesthesiology and Perioperative Medicine, The First Affiliated Hospital of Xinxiang Medical University, Weihui 453100, Henan Province, China
| | - Peng-Fei Gao
- Department of Anesthesiology and Perioperative Medicine, The First Affiliated Hospital of Xinxiang Medical University, Weihui 453100, Henan Province, China
| | - Yong-Qiang Zhang
- Department of Anesthesiology and Perioperative Medicine, The First Affiliated Hospital of Xinxiang Medical University, Weihui 453100, Henan Province, China
| | - Xiu-Qin Yue
- Department of Anesthesiology and Perioperative Medicine, The First Affiliated Hospital of Xinxiang Medical University, Weihui 453100, Henan Province, China
| |
Collapse
|
9
|
Tong F, Ying Y, Pan H, Zhang L, Li H. Laparoscopy and laparotomy for patients with transverse colon cancer: comparative analysis of short-term surgical outcomes. Am J Transl Res 2023; 15:5835-5842. [PMID: 37854199 PMCID: PMC10579031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2023] [Accepted: 08/01/2023] [Indexed: 10/20/2023]
Abstract
OBJECTIVE To compare the efficacy of laparoscopy versus laparotomy in the treatment of transverse colon cancer. METHODS Data from 100 patients with transverse colon cancer treated in our hospital from January 2018 to December 2020 were retrospectively analyzed in this study. According to the treatment methods, these patients were assigned into two groups: a laparotomy group (n=50) and a laparoscopy group (n=50). The intraoperative parameters, postoperative recovery, incidences of complications, postoperative pain, quality of life (QoL) score, postoperative serum inflammatory cytokine (hs-CRP, TNF-α, and IL-6) levels, and prognostic nutritional index (PNI) were analyzed and compared between the two groups. RESULTS There was no significant difference in number of resected lymph nodes between the two groups. The operation time and intraoperative bleeding in the laparoscopy group were significantly less than those in the laparotomy group (P<0.05). The hospital stay, duration of gastrointestinal function recovery, and time of first postoperative flatus in the laparoscopy group were significantly shorter than those in the laparotomy group (all P<0.001). Moreover, the incidence of overall complications in the laparoscopy group was significantly lower than that in the laparotomy group (P<0.05). Compared with those in the laparotomy group, the VAS score was obviously lower and the QoL score was significantly higher in the laparoscopy group (all P<0.001). Patients in the laparoscopy group exhibited lower levels of postoperative hs-CRP, TNF-α and IL-6 in contrast to those in the laparotomy group (P<0.05). In additional, there was no significant difference in the PNI level before surgery between two groups. After surgery, the PNI level in the laparoscopy group was obviously higher than that in the laparotomy group (P<0.001). CONCLUSION Laparoscopy is superior to laparotomy in treatment of transverse colon cancer through achieving better intraoperative outcomes, promoting postoperative recovery, reducing the incidence of complications and inflammatory reactions, alleviating postoperative pain, and improving therapeutic effects.
Collapse
Affiliation(s)
- Feng Tong
- Department of Oncological Surgery, Lanxi People's Hospital Lanxi, Zhejiang, China
| | - Youhua Ying
- Department of Oncological Surgery, Lanxi People's Hospital Lanxi, Zhejiang, China
| | - Haihua Pan
- Department of Oncological Surgery, Lanxi People's Hospital Lanxi, Zhejiang, China
| | - Longfei Zhang
- Department of Oncological Surgery, Lanxi People's Hospital Lanxi, Zhejiang, China
| | - Hongchen Li
- Department of Oncological Surgery, Lanxi People's Hospital Lanxi, Zhejiang, China
| |
Collapse
|
10
|
Chen F, Lv Z, Feng W, Xu Z, Miao Y, Xu Z, Zhang Y, Gao H, Zheng M, Zong Y, Zhao J, Lu A. Intracorporeal versus extracorporeal anastomosis in laparoscopic right colectomy: a retrospective study. World J Surg Oncol 2023; 21:154. [PMID: 37208667 DOI: 10.1186/s12957-023-03023-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2022] [Accepted: 04/27/2023] [Indexed: 05/21/2023] Open
Abstract
BACKGROUND The surgical procedure for laparoscopic right colectomy (LRC) is not standardized. Some published studies show the superiority of ileocolic anastomosis (IIA), but the evidence so far is insufficient. This study aimed to investigate the potential advantages in postoperative recovery and safety of IIA in LRC. METHODS A total of 114 patients who underwent LRC with IIA (n = 58) or extracorporeal ileocolic anastomosis (EIA, n = 56) between January 2019 and September 2021 were enrolled. We collected certain factors as clinical features, intraoperative characteristics, oncological outcomes, postoperative recovery, and short-term outcomes. Our primary outcome was time to gastrointestinal (GI) function recovery. Secondary outcomes were postoperative complications within 30 days, postoperative pain, and length of hospital stay. RESULTS Faster GI recovery and less postoperative pain were observed in patients with IIA compared to EIA [time to first flatus: (2.4 ± 0.7) vs (2.8 ± 1.0) days, p < 0.01; time to liquid intake: (3.5 ± 0.7) vs (4.0 ± 1.1) days, p = 0.01; postoperative visual analogue scale score: (3.9 ± 1.0) vs (4.3 ± 0.6), p = 0.02]. No significant differences were detected in oncological outcomes or postoperative complications. IIA, rather than EIA, tended to be performed in patients with higher body mass index [(23.93 ± 3.52) vs (22.36 ± 2.87) kg/m2, p = 0.01]. CONCLUSIONS IIA is associated with faster GI function recovery and less postoperative pain and may be more favorable for obese patients.
Collapse
Affiliation(s)
- Fangqian Chen
- Department of General Surgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200025, China
- Shanghai Minimally Invasive Surgery Center, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200025, China
| | - Zeping Lv
- Department of General Surgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200025, China
- Shanghai Minimally Invasive Surgery Center, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200025, China
| | - Wenqing Feng
- Department of General Surgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200025, China
- Shanghai Minimally Invasive Surgery Center, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200025, China
| | - Zhuoqing Xu
- Department of General Surgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200025, China
- Shanghai Minimally Invasive Surgery Center, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200025, China
| | - Yiming Miao
- Department of General Surgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200025, China
- Shanghai Minimally Invasive Surgery Center, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200025, China
| | - Zifeng Xu
- Department of General Surgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200025, China
- Shanghai Minimally Invasive Surgery Center, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200025, China
| | - Yuchen Zhang
- Department of General Surgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200025, China
- Shanghai Minimally Invasive Surgery Center, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200025, China
| | - Han Gao
- Department of General Surgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200025, China
- Shanghai Minimally Invasive Surgery Center, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200025, China
| | - Minhua Zheng
- Department of General Surgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200025, China
- Shanghai Minimally Invasive Surgery Center, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200025, China
| | - Yaping Zong
- Department of General Surgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200025, China
- Shanghai Minimally Invasive Surgery Center, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200025, China
| | - Jingkun Zhao
- Department of General Surgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200025, China.
- Shanghai Minimally Invasive Surgery Center, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200025, China.
| | - Aiguo Lu
- Department of General Surgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200025, China.
- Shanghai Minimally Invasive Surgery Center, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200025, China.
| |
Collapse
|
11
|
Oliveira A, Faria S, Gonçalves N, Martins A, Leão P. Surgical approaches to colonic and rectal anastomosis: systematic review and meta-analysis. Int J Colorectal Dis 2023; 38:52. [PMID: 36814011 PMCID: PMC9947093 DOI: 10.1007/s00384-023-04328-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/28/2023] [Indexed: 02/24/2023]
Abstract
PURPOSE Postoperative complications after a colonic and rectal surgery are of significant concern to the surgical community. Although there are different techniques to perform anastomosis (i.e., handsewn, stapled, or compression), there is still no consensus on which technique provides the least number of postoperative problems. The objective of this study is to compare the different anastomotic techniques regarding the occurrence or duration of postoperative outcomes such as anastomotic dehiscence, mortality, reoperation, bleeding and stricture (as primary outcomes), and wound infection, intra-abdominal abscess, duration of surgery, and hospital stay (as secondary outcomes). METHODS Clinical trials published between January 1, 2010, and December 31, 2021, reporting anastomotic complications with any of the anastomotic technique were identified using the MEDLINE database. Only articles that clearly defined the anastomotic technique used, and report at least two of the outcomes defined were included. RESULTS This meta-analysis included 16 studies whose differences were related to the need of reoperation (p < 0.01) and the duration of surgery (p = 0.02), while for the anastomotic dehiscence, mortality, bleeding, stricture, wound infection, intra-abdominal abscess, and hospital stay, no significant differences were found. Compression anastomosis reported the lowest reoperation rate (3.64%) and the handsewn anastomosis the highest (9.49%). Despite this, more time to perform the surgery was required in compression anastomosis (183.47 min), with the handsewn being the fastest technique (139.92 min). CONCLUSIONS The evidence found was not sufficient to demonstrate which technique is most suitable to perform colonic and rectal anastomosis, since the postoperative complications were similar between the handsewn, stapled, or compression techniques.
Collapse
Affiliation(s)
- Ana Oliveira
- Life and Health Sciences Research Institute (ICVS), School of Medicine, University of Minho, Braga, 4710-057, Portugal
- ICVS/3B's-PT Government Associate Laboratory, Braga/Guimarães, Portugal
- 3B's Research Group, I3Bs - Research Institute on Biomaterials, Biodegradables & Biomimetics; Headquarters of the European Institute of Excellence on Tissue Engineering & Regenerative Medicine, University of Minho, AvePark-Parque de Ciência e Tecnologia, Zona Industrial da Gandra, Barco, Guimarães, 4805-017, Portugal
| | - Susana Faria
- Centre of Mathematics (CMAT), Department of Mathematics, University of Minho, Guimarães, 4800-058, Portugal
| | - Nuno Gonçalves
- Life and Health Sciences Research Institute (ICVS), School of Medicine, University of Minho, Braga, 4710-057, Portugal
- ICVS/3B's-PT Government Associate Laboratory, Braga/Guimarães, Portugal
| | - Albino Martins
- ICVS/3B's-PT Government Associate Laboratory, Braga/Guimarães, Portugal
- 3B's Research Group, I3Bs - Research Institute on Biomaterials, Biodegradables & Biomimetics; Headquarters of the European Institute of Excellence on Tissue Engineering & Regenerative Medicine, University of Minho, AvePark-Parque de Ciência e Tecnologia, Zona Industrial da Gandra, Barco, Guimarães, 4805-017, Portugal
| | - Pedro Leão
- Life and Health Sciences Research Institute (ICVS), School of Medicine, University of Minho, Braga, 4710-057, Portugal.
- ICVS/3B's-PT Government Associate Laboratory, Braga/Guimarães, Portugal.
| |
Collapse
|
12
|
Elmore U, Milone M, Parise P, Velotti N, Cossu A, Puccetti F, Barbieri L, Vertaldi S, Milone F, De Palma GD, Rosati R. Relaparoscopy in the management of post-operative complications after minimally invasive gastrectomy for gastric cancer. Updates Surg 2023; 75:429-434. [PMID: 35882769 PMCID: PMC9852154 DOI: 10.1007/s13304-022-01328-z] [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] [Received: 07/14/2021] [Accepted: 07/05/2022] [Indexed: 01/24/2023]
Abstract
Laparoscopy has already been validated for treatment of early gastric cancer. Despite that, no data have been published about the possibility of a minimally invasive approach to surgical complications after primary laparoscopic surgery. In this multicentre study, we describe our experience in the management of complications following laparoscopic gastrectomy for gastric cancer. A chart review has been performed over data from 781 patients who underwent elective gastrectomy for gastric cancer between January 1996 and July 2020 in two high referral department of gastric surgery. A fully descriptive analysis was performed, considering all the demographic characteristics of patients, the type of primary procedure and the type of complication which required reoperation. Moreover, a logistic regression was designed to investigate if either the patients or the primary surgery characteristics could affect conversion rate during relaparoscopy. Fifty-one patients underwent reintervention after elective laparoscopic gastric surgery. Among patients who received a laparoscopic reintervention, 11 patients (34.3%) required a conversion to open surgery. Recovery outcomes were significantly better in patients who completed the reoperation through laparoscopy. Relaparoscopy is safe and effective for management of complications following laparoscopic gastric surgery and represent a useful tool both for re-exploration and treatment, in expert and skilled hands.
Collapse
Affiliation(s)
- Ugo Elmore
- Department of Gastrointestinal Surgery, San Raffaele Hospital, Milan, Italy
| | - Marco Milone
- Department of Clinical Medicine and Surgery, University of Naples Federico II, Via Pansini n.5, 80131 Naples, Italy
| | - Paolo Parise
- Department of Gastrointestinal Surgery, San Raffaele Hospital, Milan, Italy
| | - Nunzio Velotti
- Department of Advanced Biomedical Sciences, University of Naples Federico II, Naples, Italy
| | - Andrea Cossu
- Department of Gastrointestinal Surgery, San Raffaele Hospital, Milan, Italy
| | - Francesco Puccetti
- Department of Gastrointestinal Surgery, San Raffaele Hospital, Milan, Italy
| | - Lavinia Barbieri
- Department of Gastrointestinal Surgery, San Raffaele Hospital, Milan, Italy
| | - Sara Vertaldi
- Department of Clinical Medicine and Surgery, University of Naples Federico II, Via Pansini n.5, 80131 Naples, Italy
| | - Francesco Milone
- Department of Advanced Biomedical Sciences, University of Naples Federico II, Naples, Italy
| | - Giovanni Domenico De Palma
- Department of Clinical Medicine and Surgery, University of Naples Federico II, Via Pansini n.5, 80131 Naples, Italy
| | - Riccardo Rosati
- Department of Gastrointestinal Surgery, San Raffaele Hospital, Milan, Italy
| |
Collapse
|
13
|
Effects of Sevoflurane Laryngeal Mask Inhalation Combined with Intravenous Anesthesia on Perioperative Stress and Myocardial Injury in Elderly Patients with Acute Cholecystitis and Coronary Heart Disease. Emerg Med Int 2022; 2022:6482491. [DOI: 10.1155/2022/6482491] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2022] [Accepted: 09/27/2022] [Indexed: 11/13/2022] Open
Abstract
Surgery is the first choice for the treatment of acute cholecystitis. To ensure the curative effect of surgery, laparoscopic anesthesia should be characterized by rapid induction, good analgesic effect, and rapid postoperative sobriety. With the aggravation of an aging population, acute cholecystitis combined with coronary heart disease is more common in the elderly. The selection of anesthesia protocols for these patients has become a hot topic in research. In this study, we selected 72 elderly patients with acute cholecystitis combined with coronary heart disease who were treated in our hospital from January 2019 to January 2022 to explore the effects of sevoflurane laryngeal mask inhalation combined with intravenous anesthesia on perioperative stress and myocardial injury in elderly patients with acute cholecystitis combined with coronary heart disease, in order to provide a scientific basis for the formulation of a surgical plan for elderly patients with acute cholecystitis combined with coronary heart disease.
Collapse
|
14
|
Jin Q, Long D, Liu C, Jiang Y, Zhou W, Yao H, Liu K. A propensity score matching study of totally robotic right hemicolectomy versus robot-assisted right hemicolectomy. J Robot Surg 2022; 17:905-914. [DOI: 10.1007/s11701-022-01472-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2022] [Accepted: 10/13/2022] [Indexed: 11/08/2022]
|
15
|
Safety and efficacy of totally minimally invasive right colectomy in the obese patients: a multicenter propensity score-matched analysis. Updates Surg 2022; 74:1281-1290. [PMID: 35639279 PMCID: PMC9338133 DOI: 10.1007/s13304-022-01298-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2022] [Accepted: 05/09/2022] [Indexed: 11/25/2022]
Abstract
Despite the well-known benefits of the minimally invasive approach for the right colon cancer treatment, less is known about its feasibility and advantages in morbid obese patients. The aim of this study is to compare the postoperative outcomes after totally minimally invasive right colectomy between the obese and non-obese population. Data derived from a prospectively maintained multicenter colorectal database were analysed, dividing the enrolled patients into two groups: obese (BMI > 29.99) patient group and non-obese patient group. Data about gender, age, American Society of Anesthesiologists (ASA) Score, tumor characteristics, operative time, anastomosis time, extraction site, incision length, intraoperative complications, postoperative complications, postoperative recovery, specimen length and retrieved nodes were taken to assess the achievement of the oncologic standards. After a propensity score matching, a total of 184 patients was included, 92 in each group. No differences were found in terms of demographic data and tumor characteristics. Intraoperative data showed a significant difference in terms of anastomosis time in favour of non-obese group (p < 0.0001). No intraoperative complications were recorded and no conversion was needed in both groups. No differences were found in terms of postoperative complications. There were no differences in terms of first mobilization (p = 0.745), time to first flatus (p = 0.241) time to tolerance to liquid and solid diet (p = 0.241 and p = 0.06) and length of hospital stay (p = 0.817). The analysis of oncologic outcomes demonstrated adequate results in both groups. The results obtained by our study confirmed the feasibility and safety of the totally minimally invasive approach even in obese population.
Collapse
|
16
|
Kong M, Gao Y, Guo X, Xie Y, Yu Y. Role of the CTRP family in tumor development and progression. Oncol Lett 2021; 22:723. [PMID: 34429763 PMCID: PMC8371956 DOI: 10.3892/ol.2021.12984] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2021] [Accepted: 05/19/2021] [Indexed: 12/17/2022] Open
Abstract
C1q tumor necrosis factor-related proteins (CTRPs), which are members of the adipokine superfamily, have gained significant interest in the recent years. CTRPs are homologs of adiponectin with numerous functions and are closely associated with metabolic diseases, such as abnormal glucose and lipid metabolism and diabetes. Previous studies have demonstrated that CTRPs are highly involved in the regulation of numerous physiological and pathological processes, including glycolipid metabolism, protein kinase pathways, cell proliferation, cell apoptosis and inflammation. CTRPs also play important roles in the development and progression of numerous types of tumor, including liver, colon and lung cancers. This observation can be attributed to the fact that diabetes, obesity and insulin resistance are independent risk factors for tumorigenesis. Numerous CTRPs, including CTRP3, CTRP4, CTRP6 and CTRP8, have been reported to be associated with tumor progression by activating multiple signal pathways. CTRPs could therefore be considered as diagnostic markers and therapeutic targets in some cancers. However, the underlying mechanisms of CTRPs in tumorigenesis remain unknown. The present review aimed to determine the roles and underlying mechanisms of CTRPs in tumorigenesis, which may help the development of novel cancer treatments in the future.
Collapse
Affiliation(s)
- Mowei Kong
- Department of Endocrinology, Affiliated Hospital of Chengde Medical University, Chengde, Hebei 067000, P.R. China
| | - Yu Gao
- Department of Endocrinology, Affiliated Hospital of Chengde Medical University, Chengde, Hebei 067000, P.R. China
| | - Xiang Guo
- Department of Respiratory, Affiliated Hospital of Chengde Medical University, Chengde, Hebei 067000, P.R. China
| | - Yuyu Xie
- Department of Dermatology, Affiliated Hospital of Chengde Medical University, Chengde, Hebei 067000, P.R. China
| | - Yamei Yu
- Department of Dermatology, Affiliated Hospital of Chengde Medical University, Chengde, Hebei 067000, P.R. China
| |
Collapse
|