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Yu S, Ji Y, Luo T, Xu P, Zhen Z, Deng J. A modified technique of transanal specimen extraction in the laparoscopic anterior rectal resection for upper rectal or lower sigmoid colon cancer: a retrospective study. BMC Surg 2021; 21:82. [PMID: 33579251 PMCID: PMC7881460 DOI: 10.1186/s12893-021-01085-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2019] [Accepted: 02/01/2021] [Indexed: 01/10/2023] Open
Abstract
Background In recent years, natural orifice specimen extraction surgery (NOSES) has become a field of special interest for colorectal surgeons. Some researchers have reported transanal specimen extraction in the laparoscopic anterior rectal resection, including intersphincteric resection (ISR) and rectal eversion-resection. However, these surgical procedures have certain limitations. Based on the proven expertise in laparoscopic surgery, our center has developed a modified technique of transanal specimen extraction. The aim of this study was to investigate the safety and feasibility of a modified technique of transanal specimen extraction in the laparoscopic anterior rectal resection. Methods From January 2011 to January 2014, the patients with upper rectal or lower sigmoid colon cancer who had undergone laparoscopic anterior rectal resection with specimen extraction by a modified transanal technique were enrolled in the observation group, and the patients who had undergone laparoscopic anterior rectal resection with specimen extraction via an abdominal incision by the same surgeons during the same period were enrolled in the control group. Results A total of 36 patients were included in the observation group and 128 patients were included in the control group. There were no significant differences (P > 0.05) between the two groups in terms of the mean operative time [144 ± 10 min vs. 141 ± 11 min], mean intraoperative blood loss [63 ± 6 ml vs. 61 ± 7 ml], and the mean time to anal exhaust [67 ± 7 h vs. 65 ± 8 h]. However, there were significant differences (P < 0.05) between the two groups in terms of the mean postoperative Visual Analogue Scale (VAS) pain scores [3.4 ± 1.1 vs. 4.5 ± 1.2], mean postoperative hospital stay [6.0 ± 1.1 days ± vs. 7.2 ± 1.2 days], and incidence of postoperative complications (4/36 vs. 15/128). Long-term follow-up results showed that there was no significant difference (P > 0.05) between the two groups in terms of the 3- or 5-year overall survival. Conclusions The modified technique of transanal specimen extraction in the laparoscopic anterior rectal resection fulfilled the principle of no-neoplasm touch technique, with advantages, such as minimal trauma, rapid recovery, and fewer complications. Long-term follow-up results also showed satisfactory oncological outcomes.
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Affiliation(s)
- Si Yu
- Department of General Surgery, The Second People's Hospital of Foshan, Foshan, China
| | - Yong Ji
- Department of General Surgery, The First People's Hospital of Foshan (Foshan Hospital of Sun Yat-Sen University), Foshan, China
| | - Tedong Luo
- Department of General Surgery, The First People's Hospital of Foshan (Foshan Hospital of Sun Yat-Sen University), Foshan, China
| | - Pengjie Xu
- Department of General Surgery, The First People's Hospital of Foshan (Foshan Hospital of Sun Yat-Sen University), Foshan, China
| | - Zuojun Zhen
- Department of General Surgery, The First People's Hospital of Foshan (Foshan Hospital of Sun Yat-Sen University), Foshan, China
| | - Jianzhong Deng
- Department of General Surgery, The First People's Hospital of Foshan (Foshan Hospital of Sun Yat-Sen University), Foshan, China.
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Jin H, Ibahim A, Bae J, Lee C, Han S, Lee I, Lee D, Lee Y. Initial experience of laparoscopic complete mesocolic excision with D3 lymph node dissection for right colon cancer using Artisential®, a new laparoscopic articulating instrument. J Minim Access Surg 2021; 18:235-240. [PMID: 35313433 PMCID: PMC8973474 DOI: 10.4103/jmas.jmas_88_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Background: Laparoscopic complete mesocolic excision (CME) with D3 lymph node dissection for the right colon is becoming popular, but still technically challenging. Several articulating laparoscopic instruments had been introduced to reduce technical difficulties; however, those were not practical. This study aimed to report the first clinical experience of using ArtiSential®, a new laparoscopic articulating instrument in laparoscopic complete mesocolic with D3 lymph node dissection for right colon cancer. Patients and Methods: This was a retrospective, single-institution, consecutive case study. From October 2018 to March 2020, a total of 33 patients underwent laparoscopic right hemicolectomy using ArtiSential® , a new articulating instrument. We compared the short-term outcomes of patients who underwent surgery using ArtiSential® (AG) to the conventional instrument (CG). Results: In total, there were 33 cases in AG and 43 cases in CG. There were no significant differences in operation time (141.0 ± 22.5 vs. 156.0 ± 50.6 min, P = 0.09), mean estimated blood loss (46.8 ± 36.2 vs. 100.8 ± 300.6 ml, P = 0.31) and intra-operative and post-operative complications. However, the number of harvested lymph nodes was higher and the length of hospital stay was shorter in AG than in CG (32.6 ± 12.2 vs. 24.6 ± 7.4, P < 0.01 and 3.0 ± 1.2 vs. 4.1 ± 2.2 days, P = 0.01, respectively). Conclusions: Laparoscopic CME with D3 lymph node dissection for right colon cancer using ArtiSential®, the new articulating laparoscopic instrument is safe and technically feasible.
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Martel G, Boushey RP, Marcello PW. Reprint of: Results of the laparoscopic colon cancer randomized trials: An evidence-based review. SEMINARS IN COLON AND RECTAL SURGERY 2018. [DOI: 10.1053/j.scrs.2018.11.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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4
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Jung KU, Yun SH, Cho YB, Kim HC, Lee WY, Chun HK. The Role of Hand-Assisted Laparoscopic Technique in the Age of Single-Incision Laparoscopy: An Effective Alternative to Avoid Open Conversion in Colorectal Surgery. J Laparoendosc Adv Surg Tech A 2018; 28:415-421. [DOI: 10.1089/lap.2017.0553] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Affiliation(s)
- Kyung uk Jung
- Department of Surgery, Kangbuk Samsung Hospital, Sungkyunkwan University of School of Medicine, Seoul, Republic of Korea
| | - Seong Hyeon Yun
- Department of Surgery, Samsung Medical Center, Sungkyunkwan University of School of Medicine, Seoul, Republic of Korea
| | - Yong Beom Cho
- Department of Surgery, Samsung Medical Center, Sungkyunkwan University of School of Medicine, Seoul, Republic of Korea
| | - Hee Cheol Kim
- Department of Surgery, Samsung Medical Center, Sungkyunkwan University of School of Medicine, Seoul, Republic of Korea
| | - Woo Yong Lee
- Department of Surgery, Samsung Medical Center, Sungkyunkwan University of School of Medicine, Seoul, Republic of Korea
| | - Ho-Kyung Chun
- Department of Surgery, Kangbuk Samsung Hospital, Sungkyunkwan University of School of Medicine, Seoul, Republic of Korea
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Liu Q, Luo D, Lian P, Yu W, Zhu J, Cai S, Li Q, Li X. Reevaluation of laparoscopic surgery's value in pathological T4 colon cancer with comparison to open surgery: A retrospective and propensity score-matched study. Int J Surg 2018; 53:12-17. [PMID: 29555522 DOI: 10.1016/j.ijsu.2018.03.029] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2018] [Accepted: 03/08/2018] [Indexed: 12/18/2022]
Abstract
PURPOSE In spite of the unique advantages of minimally invasive treatment, laparoscopic surgery is not recommended in T4 colon cancer patients with the concern of technical feasibility and suboptimal oncologic outcomes. We used the database of our center to reevaluate laparoscopic surgery's value in T4 colon cancer and compared with open surgery in both short- and long-term outcomes. METHODS We conducted a retrospective and propensity score-matched study of pathological T4 colon cancer patients who received laparoscopic surgery or open surgery from March 2011 to August 2015. RESULTS A total of 411 pathological T4 colon cancer patients were identified. Propensity score matching (PSM) resulted in 86 patients in laparoscopic group and 86 patients in open group. Our study showed longer operation time, less blood loss and less length of postsurgical stay compared with open surgeries (167 ± 56 min vs. 111 ± 50.1 min, P < 0.001; 72 ± 61.5 mL vs. 113 ± 113.9 mL, P = 0.004; 7.3 ± 2.1 days vs. 7.9 ± 2.1 days, P = 0.046, respectively). 7 (8.2%) patients underwent conversions to open surgery. 5-years of DFS and OS showed no statistic difference between the two groups. The 1-, 3-, and 5-years OS rates were 89.4%, 77.5% and 73.2% for laparoscopic surgery and 95.2%, 82.7% and 73.9% for open surgery (P = 0.618). The 1-, 3-, and 5-years OS rates were 89.5%, 77.2% and 61.7% for laparoscopic surgery and 91.7%, 75.3% and 66.8% for open surgery (P = 0.903). CONCLUSION Our analysis demonstrates that there is no statistic difference in short- and long-oncologic outcomes in our center and it is a reliable evidence to support the clinical application of laparoscopic surgery in T4 colon cancer patients. Still, considering the lack of randomized controlled trails, conducting large prospective multi-center population-based studies is not only required, but also pressing.
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Affiliation(s)
- Qi Liu
- Department of Colorectal Surgery, Fudan University Shanghai Cancer Center, Shanghai, China; Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
| | - Dakui Luo
- Department of Colorectal Surgery, Fudan University Shanghai Cancer Center, Shanghai, China; Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
| | - Peng Lian
- Department of Colorectal Surgery, Fudan University Shanghai Cancer Center, Shanghai, China; Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
| | - Wencheng Yu
- Department of Colorectal Surgery, Fudan University Shanghai Cancer Center, Shanghai, China; Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
| | - Ji Zhu
- Department of Radiology, Fudan University Shanghai Cancer Center, Shanghai, China; Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
| | - Sanjun Cai
- Department of Colorectal Surgery, Fudan University Shanghai Cancer Center, Shanghai, China; Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
| | - Qingguo Li
- Department of Colorectal Surgery, Fudan University Shanghai Cancer Center, Shanghai, China; Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China.
| | - Xinxiang Li
- Department of Colorectal Surgery, Fudan University Shanghai Cancer Center, Shanghai, China; Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China.
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Laparoscopic Versus Open Approach for Intersphincteric Resection-Results from a Tertiary Cancer Center in India. Indian J Surg Oncol 2017; 8:474-478. [PMID: 29203976 DOI: 10.1007/s13193-017-0672-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2016] [Accepted: 06/08/2017] [Indexed: 12/19/2022] Open
Abstract
The study aims to compare open intersphincteric resection (OISR) with laparoscopic intersphincteric resection (LISR) in terms of short-term oncological and clinical outcomes. This is a retrospective review of a prospectively maintained database including all the patients of rectal cancer who underwent intersphincteric resection (ISR) at Tata Memorial Centre between 1st July 2013 and 30th November 2015. Short-term oncological parameters evaluated included circumferential resection margin involvement (CRM), distal resection margin involvement, and number of nodes harvested. Perioperative outcomes included blood loss, length of hospital stay and 30-day postoperative morbidity and mortality. Chi-square test was used to compare the results between the two groups. Thirty nine cases of OISR and 34 cases of LISR were included in the study. Median BMI was higher in LISR group; otherwise, the two groups were comparable in all aspects. There were no conversions in LISR group. CRM involvement was seen in four patients (10%) in the conventional group compared to none in the LISR group. Median hospital stay was comparable between the two groups. Laparoscopic ISR is safe and can be performed with low conversion rate in selected group of patients.
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Comparison of Reduced Port Totally Laparoscopic-assisted Total Gastrectomy (Duet TLTG) and Conventional Laparoscopic-assisted Total Gastrectomy. Surg Laparosc Endosc Percutan Tech 2017; 26:e132-e136. [PMID: 27846181 DOI: 10.1097/sle.0000000000000329] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
BACKGROUND The aim of this study was to compare surgical outcomes of patients with gastric cancer undergoing reduced port totally laparoscopic-assisted total gastrectomy (duet TLTG) with those of patients undergoing conventional laparoscopic-assisted total gastrectomy (LATG). MATERIALS AND METHODS Between January 2013 and 2015, 54 patients with gastric cancer underwent LATG at the Samsung Medical Center. Duet TLTG using 3 ports was performed in 30 patients, and conventional LATG using 5 ports was performed in 24 patients. Either extracorporeal or intracorporeal anastomosis was used for esophagojejunostomy. Surgical outcomes were compared between the operation methods. RESULTS The operating time was similar for duet TLTG and conventional LATG [222 min (range, 163 to 287 min) vs. 233 min (range, 170 to 310 min), respectively; P=0.807]. Blood loss during surgery was also similar between duet TLTG and conventional LATG groups [100 mL (range, 50 to 400 mL) vs. 175 mL (range, 50 to 400 mL), respectively; P=0.249]. The median number of nodes dissected [duet TLTG vs. conventional LATG, 47 (20 to 67) vs. 41 (22 to 70), P=0.338] was not different between groups. Pain scores were 3.9, 3.3, and 2.9, and 3.9, 3.4, and 2.8, at postoperative days 1, 3, and 5, respectively, in the duet TLTG and the conventional LATG groups (P=0.857, 0.659, and 0.427, respectively). Overall complication rates in the duet TLTG and conventional LATG groups were not significantly different (36.7% vs. 16.7%, P=0.103). CONCLUSIONS Duet TLTG is an acceptable procedure with quality of lymph node dissection, including the number of dissected lymph nodes and morbidity.
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Julien M, Dove J, Quindlen K, Halm K, Shabahang M, Wild J, Blansfield J. Evolution of Laparoscopic Surgery for Colorectal Cancer: The Impact of the Clinical Outcomes of Surgical Therapy Group Trial. Am Surg 2016. [DOI: 10.1177/000313481608200825] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
The Clinical Outcomes of Surgical Therapy Group (COST) Trial established laparoscopic procedures offer short-term benefits while preserving the same oncologic outcomes in colorectal cancer (CRC) patients compared with open procedures. The aim of this study was to evaluate the trend of laparoscopic resection for CRC before and after the publication of the COST Trial. Retrospective study of surgically treated CRC patients was conducted from January 2000 to December 2009. Surveillance, Epidemiology, and End Results Program and Medicare. Between 2000 and 2009, 147,388 patients underwent resection for CRC, 9,901 resections were performed laparoscopically. In 2000, 1.0 per cent of colorectal resections were performed laparoscopically. There was a dramatic increase in laparoscopic resections in 2009 to 30.4 per cent. During this time period, rates of laparoscopic resections increased for all tumor stages. Right colectomies and early stage tumors had the most significant rise from 3.1 per cent (2004) to 38.7 per cent (2009) and 4.41 per cent (2004) to 39.17 per cent (2009), respectively; whereas, rectal and later stage tumors resection rates were more modest from 2.1 per cent (2004) to 13.2 per cent (2009) and 1.41 per cent (2004) to 17.10 per cent (2009), respectively. This study demonstrates the COST Trial had a significant impact on utilization of laparoscopic colorectal resection for CRC. Although laparoscopic colorectal resections have been accepted for all types of CRCs, more difficult procedures are being adopted at slower rates.
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Affiliation(s)
| | - James Dove
- Geisinger Medical Center, Danville, Pennsylvania
| | | | - Kristen Halm
- Geisinger Medical Center, Danville, Pennsylvania
| | | | - Jeffrey Wild
- Geisinger Medical Center, Danville, Pennsylvania
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Pure Laparoscopic Versus Open Left Lateral Sectionectomy for Hepatocellular Carcinoma: A Single-Center Experience. World J Surg 2016; 40:198-205. [PMID: 26316115 DOI: 10.1007/s00268-015-3237-8] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
INTRODUCTION Laparoscopic left lateral sectionectomy has been proven to be a safe and effective treatment for liver lesions. However, most of the literatures only reported this treatment method on benign lesion or colorectal metastases. The data on long-term outcome of laparoscopic left lateral section resection in patients with HCC and cirrhosis are still limited. The aim of this study is to analyze the survival outcome of laparoscopic left lateral sectionectomy when compared to open approach in patients with HCCs. METHOD Between January 2004 and September 2014, 967 patients had primary HCC with hepatectomy performed. Twenty-four patients had undergone pure laparoscopic left lateral sectionectomy for hepatocellular carcinoma (HCC). Twenty-nine patients with case-matched tumor characteristics and liver functions but received open left lateral sectionectomy for HCC were included for comparison. RESULTS Comparing laparoscopic group to open resection group, the median operation time was 190.5 versus 195 min (P = 0.734); the median blood loss was 100 versus 300 ml (P < 0.001). Hospital stay was 5 days in laparoscopic group versus 6 days in the open group (P = 0.057). There was no difference between the two groups in terms of complications (P = 0.495). The median survival in laparoscopic group was >115 months versus >125 months in the open group (P = 0.853). CONCLUSION Laparoscopic left lateral sectionectomy for HCC is a safe and simple procedure associated with less blood loss. The survival outcome is comparable with conventional open approach. It is becoming a more favorable treatment option even for patients with HCC and cirrhosis.
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Kim SM, Ha MH, Seo JE, Kim JE, Choi MG, Sohn TS, Bae JM, Kim S, Lee JH. Comparison of single-port and reduced-port totally laparoscopic distal gastrectomy for patients with early gastric cancer. Surg Endosc 2015; 30:3950-7. [PMID: 26694180 DOI: 10.1007/s00464-015-4706-8] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2015] [Accepted: 11/24/2015] [Indexed: 12/31/2022]
Abstract
BACKGROUND Laparoscopy-assisted distal gastrectomy (LADG) is a treatment method for patients with early gastric cancer; however, single- or reduced-port LADG for these patients has been rarely reported. OBJECTIVE To compare surgical outcomes of patients with gastric cancer undergoing single-port totally laparoscopic distal gastrectomy (TLDG) to those of patients undergoing reduced-port (three ports) TLDG. METHODS This retrospective study included 94 patients with early gastric cancer who underwent single-port or reduced-port TLDG at Samsung Medical Center between May 2014 and December 2014. Surgical outcomes were compared between operation methods. RESULTS There are more female patients (54.2 vs. 19.6 %, p = 0.001) and less obese patients (21.1 ± 2.1 vs. 24.6 ± 3.2 kg/m(2), p = 0.001) in the single-port TLDG group. There were no significant differences in blood loss during surgery, the number of dissected lymph nodes, and the pain score at postoperative first day between two groups. The variance in operation time for the reduced-port TLDG was significantly greater than that for single-port TLDG (p = 0.01). Complication rates in the single-port and reduced-TLDG groups were similar (20.8 vs. 21.7 %, p = 1.000). No postoperative deaths occurred in either group. CONCLUSIONS Single-port TLDG might be considered as a treatment option for a limited subset, such as females or less obese patients with early gastric cancer.
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Affiliation(s)
- Su Mi Kim
- Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Man Ho Ha
- Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Jeong Eun Seo
- Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Ji Eun Kim
- Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Min Gew Choi
- Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Tae Sung Sohn
- Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Jae Moon Bae
- Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Sung Kim
- Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Jun Ho Lee
- Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.
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Yang CK, Liang WS, Liu CK, Hsu HH. Intussusception Caused by Colonic Tumors in Elderly Patients: A Case Series of Seven Patients. INT J GERONTOL 2015. [DOI: 10.1016/j.ijge.2014.06.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
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12
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Jung KU, Park Y, Lee KY, Sohn SK. Robotic transverse colectomy for mid-transverse colon cancer: surgical techniques and oncologic outcomes. J Robot Surg 2015; 9:131-6. [PMID: 26531113 DOI: 10.1007/s11701-015-0502-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2014] [Accepted: 02/08/2015] [Indexed: 12/13/2022]
Abstract
Robot-assisted surgery for colon cancer has been reported in many studies, most of which worked on right and/or sigmoid colectomy. The aim of this study was to report our experience of robotic transverse colectomy with an intracorporeal anastomosis, provide details of the surgical technique, and present the theoretical benefits of the procedure. This is a retrospective review of prospectively collected data of robotic surgery for colorectal cancer performed by a single surgeon between May 2007 and February 2011. Out of 162 consecutive cases, we identified three robotic transverse colectomies, using a hand-sewn intracorporeal anastomosis. Two males and one female underwent transverse colectomies for malignant or premalignant disease. The mean docking time, time spent using the robot, and total operative time were 5, 268, and 307 min, respectively. There were no conversions to open or conventional laparoscopic technique. The mean length of specimen and number of lymph nodes retrieved were 14.1 cm and 6.7, respectively. One patient suffered from a wound seroma and recovered with conservative management. The mean hospital stay was 8.7 days. After a median follow-up of 72 months, there were no local or systemic recurrences. Robotic transverse colectomy seems to be a safe and feasible technique. It may minimize the necessity of mobilizing both colonic flexures, with facilitated intracorporeal hand-sewn anastomosis. However, further prospective studies with a larger number of patients are required to draw firm conclusions.
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Affiliation(s)
- Kyung Uk Jung
- Department of Surgery, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Yoonah Park
- Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul, 135-710, Republic of Korea.
| | - Kang Young Lee
- Department of Surgery, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Seung-Kook Sohn
- Department of Surgery, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
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Kim SM, Ha MH, Seo JE, Kim JE, Choi MG, Sohn TS, Bae JM, Kim S, Lee JH. Comparison of Reduced Port Totally Laparoscopic Distal Gastrectomy (Duet TLDG) and Conventional Laparoscopic-Assisted Distal Gastrectomy. Ann Surg Oncol 2015; 22:2567-72. [PMID: 25564174 DOI: 10.1245/s10434-014-4333-y] [Citation(s) in RCA: 50] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2014] [Indexed: 12/21/2022]
Abstract
BACKGROUND Laparoscopic-assisted distal gastrectomy (LADG) is a treatment method for patients with early gastric cancer; however, single or reduced port LADG has been rarely reported. This study aimed to compare surgical outcomes of patients with gastric cancer undergoing reduced port totally laparoscopic distal gastrectomy (duet TLDG) to those of patients undergoing conventional LADG. METHODS This retrospective study included 202 patients with early gastric cancer who underwent duet TLDG (102 patients) or conventional LADG (100 patients) at Samsung Medical Center between October 2013 and April 2014. RESULTS Operating time was shorter for duet TLDG than for conventional LADG (mean ± SD 121.1 ± 19.3 min vs. 153.0 ± 38.1 min, P < 0.001). Blood loss during surgery was similar between duet TLDG and conventional LADG groups (91.4 ± 68.4 mL vs. 85.4 ± 59.8 mL, P = 0.506). Complication rates in the duet TLDG and conventional LADG groups were similar (15.7 % vs. 10.0 %, P = 0.294). The quality of lymph node dissection, including the median number of nodes dissected (median [range] duet TLDG vs. conventional LADG, 36 [17-76] vs. 34 [15-64], P = 0.570) and number of dissected nodes in each lymph node station, did not differ between groups. The median postoperative hospital stay was similar (7 [7-23] days vs. 7 [6-9], P = 0.423). Pain scores were 3.6, 3.2, and 2.8, and 3.7, 3.1, and 2.6, at postoperative days 1, 3, and 5, respectively, in the duet TLDG and conventional LADG groups (P = 0.408, 0.250, and 0.130). CONCLUSIONS Reduced port duet TLDG for early gastric cancer is feasible in terms of patient safety and quality of lymph node dissection.
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Affiliation(s)
- Su Mi Kim
- Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
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Intraoperative adverse events during laparoscopic colorectal resection—better laparoscopic treatment but unchanged incidence. Lessons learnt from a Swiss multi-institutional analysis of 3,928 patients. Langenbecks Arch Surg 2014; 399:297-305. [DOI: 10.1007/s00423-013-1156-4] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2013] [Accepted: 12/22/2013] [Indexed: 10/25/2022]
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Toda S, Kuroyanagi H. Laparoscopic surgery for rectal cancer: current status and future perspective. Asian J Endosc Surg 2014; 7:2-10. [PMID: 24355022 DOI: 10.1111/ases.12074] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2013] [Revised: 10/01/2013] [Accepted: 10/04/2013] [Indexed: 01/14/2023]
Abstract
Although laparoscopic surgery for colon cancer is accepted in the treatment guidelines, the laparoscopic approach for rectal cancer is recommended only in clinical trials. Thus far, several trials have shown favorable short-term results such as early recovery and short hospital stay, but long-term results remain a critical concern for laparoscopic rectal cancer surgery. To date, no randomized control trials have shown an increased local recurrence after laparoscopic surgery for rectal cancer. Additionally, according to previous studies, open conversion, which is more frequent in laparoscopic rectal surgery than in laparoscopic colon surgery, may affect short-term and long-term survival. The evidence on male sexual function has been contradictory. Long-term results from ongoing multicenter trials will be available within several years. Based on accumulated evidence from well-organized clinical trials, laparoscopic surgery will likely be accepted as a treatment choice for rectal cancer. In the future, extended laparoscopic rectal surgery might be feasible for additional procedures such as laparoscopic lateral pelvic lymph node dissection and laparoscopic total pelvic exenteration for rectal cancer invading the adjacent pelvic organ.
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Affiliation(s)
- Shigeo Toda
- Department of Gastroenterological Surgery, Toranomon Hospital, Tokyo, Japan
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Cheung TT, Poon RTP, Yuen WK, Chok KSH, Tsang SHY, Yau T, Chan SC, Lo CM. Outcome of laparoscopic versus open hepatectomy for colorectal liver metastases. ANZ J Surg 2013; 83:847-852. [PMID: 23035809 DOI: 10.1111/j.1445-2197.2012.06270.x] [Citation(s) in RCA: 47] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/15/2012] [Indexed: 09/07/2023]
Abstract
BACKGROUND Liver resection provides one of the best oncological outcomes for liver metastases in patients with colorectal cancer. However, long-term results concerning laparoscopic resection versus open hepatectomy for stage IV colon cancer are still limited. The aim of this study is to compare the survival outcome of laparoscopic liver resection with open liver resection for colorectal metastases. METHOD Between October 2002 and September 2011, a total of 1697 patients underwent liver resection for liver tumour and 60 patients underwent pure laparoscopic liver resection. Twenty patients had laparoscopic resection for colorectal liver metastases. Case-matched control patients who received open liver resection were included for comparison. The immediate operative outcomes and survival outcomes including operation morbidity were compared. RESULTS Twenty patients underwent laparoscopic resection of liver metastases. Forty patients who had open hepatectomy for colorectal metastases were selected as case control. Comparing the laparoscopic group with the open resection group, the median operating time was 180 min versus 210 min P = 0.059, the median blood loss was 200 versus 310 mL (P = 0.043). Hospital stay was 4.5 versus 7 days (P = 0.021), disease-free survival was 9.8 versus 10.9 months (P = 0.299), and the median survival was 69.4 versus 42.1 months (P = 0.235). CONCLUSIONS Laparoscopic liver resection is a safe and effective treatment for liver metastases in patients with colorectal cancer. It is associated with less blood loss and shorter hospital stay when compared with open surgery. Long-term survival is comparable to the conventional open approach.
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Affiliation(s)
- Tan To Cheung
- Department of Surgery, The University of Hong Kong, Hong Kong, China
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17
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Schlachta CM, Ashamalla S, Smith A. MIS in the management of colon and rectal cancer: consensus meeting of the Colorectal Cancer Association of Canada. Surg Endosc 2013; 27:3981-9. [DOI: 10.1007/s00464-013-3152-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2013] [Accepted: 07/22/2013] [Indexed: 01/24/2023]
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18
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Ding J, Liao GQ, Xia Y, Zhang ZM, Liu S, Yan ZS. Laparoscopic versus open right hemicolectomy for colon cancer: a meta-analysis. J Laparoendosc Adv Surg Tech A 2013; 23:8-16. [PMID: 23317438 DOI: 10.1089/lap.2012.0274] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
OBJECTIVE This meta-analysis was designed to assess the feasibility and safety of laparoscopic right hemicolectomy for colon cancer. RESEARCH DESIGN A systematic search of the MEDLINE, EMBASE, and Cochrane databases identified 12 studies that met the inclusion criteria for data extraction. Publications that compared laparoscopic right hemicolectomy and open right hemicolectomy for treatment of colon cancer in the past 20 years were collected for review. The primary outcomes used for meta-analysis were operating time, blood loss, number of harvested lymph nodes, time to first flatus, postoperative hospital stay, postoperative complications, mortality, and rate of recurrence. RESULTS Twelve studies that included 1057 patients were examined. Of these patients, 475 and 582 had undergone laparoscopic right hemicolectomy and open right hemicolectomy, respectively. There were significant reductions in blood loss, time to first flatus, postoperative hospital stay, and rate of wound but a operating time for laparoscopic right hemicolectomy compared with open right hemicolectomy. Other outcome variables such as number of harvested lymph nodes, postoperative complications except wound infection, mortality, and rate of recurrence were not found to be statistically significant for either group. CONCLUSIONS Compared with open right hemicolectomy, laparoscopic right hemicolectomy has the advantages of minimal invasion, faster recovery, and a lower rate of wound infection, and it can achieve the same degree of radicality and short-term prognosis as open right hemicolectomy. The drawback is that the operative time is longer.
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Affiliation(s)
- Jie Ding
- Department of Gastrointestinal Surgery, Guizhou Provincial People's Hospital, Guiyang, China
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19
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Long-term survival analysis of pure laparoscopic versus open hepatectomy for hepatocellular carcinoma in patients with cirrhosis: a single-center experience. Ann Surg 2013; 257:506-11. [PMID: 23299521 DOI: 10.1097/sla.0b013e31827b947a] [Citation(s) in RCA: 192] [Impact Index Per Article: 17.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/07/2022]
Abstract
INTRODUCTION Laparoscopic liver resection has been reported as a safe and effective approach to the management of liver cancer. However, studies of long-term outcomes regarding tumor recurrence and patient survival in comparison with the conventional open approach are limited. The aim of this study was to analyze the survival outcome of laparoscopic liver resection versus open liver resection. PATIENTS AND METHODS Between October 2002 and September 2009, 32 patients underwent pure laparoscopic liver resection for hepatocellular carcinoma (HCC). Case-matched control patients (n = 64) who received open liver resection for HCC were included for comparison. Patients were matched in terms of cancer stage, tumor size, location of tumor, and magnitude of resection. Immediate operation outcomes, operation morbidity, disease-free survival, and overall survival were compared between groups. RESULTS With the laparoscopic group compared with the open resection group, operation time was 232.5 minutes versus 204.5 minutes (P = 0.938), blood loss was 150 mL versus 300 mL (P = 0.001), hospital stay was 4 days versus 7 days (P < 0.0001), postoperative complication was 2 (6.3%) versus 12 (18.8%) (P = 0.184), disease-free survival was 78.5 months versus 29 months (P = 0.086), and overall survival was 92 months versus 71 months (P = 0.142). The disease-free survival for stage II HCC was 22.1 months versus 12.4 months (P = 0.075). CONCLUSIONS Laparoscopic liver resection for HCC is associated with less blood loss, shorter hospital stay, and fewer postoperative complications in selected patients with no compromise in survival.
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Krane MK, Allaix ME, Zoccali M, Umanskiy K, Rubin MA, Villa A, Hurst RD, Fichera A. Does morbid obesity change outcomes after laparoscopic surgery for inflammatory bowel disease? Review of 626 consecutive cases. J Am Coll Surg 2013; 216:986-96. [PMID: 23523148 DOI: 10.1016/j.jamcollsurg.2013.01.053] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2012] [Revised: 12/01/2012] [Accepted: 01/29/2013] [Indexed: 12/16/2022]
Abstract
BACKGROUND Little is known about the impact of obesity on morbidity in patients with inflammatory bowel disease (IBD) who are undergoing laparoscopic resections. The aim of this study was to evaluate outcomes in a consecutive series of normal weight (NW), overweight (OW), and obese (OB) patients undergoing elective laparoscopic colorectal surgery for IBD. STUDY DESIGN This study is a retrospective analysis of a prospectively collected, Institutional Review Board-approved IBD database. RESULTS Laparoscopic colorectal resection was performed in 626 patients (335 NW, 206 OW, and 85 OB) between August 2002 and December 2011. Operative time and blood loss were significantly higher in the OW and OB groups compared with the NW group (p = 0.001 and p < 0.001). No differences were observed in terms of intraoperative blood transfusions (p = 0.738) or complications (p = 0.196). The OW and OB groups had a significantly higher conversion rate (p = 0.049 and p = 0.037) and a longer incision compared with the NW group (p = 0.002 and p < 0.001). Obesity was an independent predictor of conversion to open surgery. No significant differences between groups were observed in terms of overall 30-day postoperative morbidity (p = 0.294) and mortality (p = 0.796). Long-term complications occurred in 6.3% NW, 7.3% OW, and 4.7% OB patients (p = 0.676). Incisional hernias were more common in the OB group compared with the NW group (p = 0.020). On multivariate analysis, obesity was not an independent risk factor for either early or late postoperative complications. CONCLUSIONS Obesity increases the complexity of laparoscopic resections in IBD with higher blood loss, operative time, and conversion rates, without worsening outcomes.
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Affiliation(s)
- Mukta K Krane
- Department of Surgery, University of Chicago Pritzker School of Medicine, Chicago, IL 60637, USA.
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21
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Allaix ME, Fichera A. Robotic Use in Colorectal Disease: A Critical Analysis. SEMINARS IN COLON AND RECTAL SURGERY 2013. [DOI: 10.1053/j.scrs.2012.10.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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22
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Bonnet S, Abid B, Wind P, Delmas V, Douard R. Anatomical basis of laparoscopic medial-to-lateral mobilization of the descending colon. Clin Anat 2013; 26:377-85. [PMID: 23339112 DOI: 10.1002/ca.22191] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2012] [Revised: 09/19/2012] [Accepted: 09/23/2012] [Indexed: 02/01/2023]
Abstract
In laparoscopic colorectal resection, the medial-to-lateral approach has been largely adopted. This approach can be initiated by the division of either the inferior mesenteric artery (IMA) or the inferior mesenteric vein (IMV). This cadaveric study aimed to establish the feasibility of IMV dissection as the initial landmark of medial-to-lateral left colonic mobilization for evaluating the size of the peritoneal window between the IMV at the lower part of the pancreas and the origin of the IMA (IMA-IMV distance) and the point of origin of the IMA compared to the lower edge of the third part of the duodenum (IMA-D3 distance). These distances were recorded on 30 fresh cadavers. The IMA-D3 distance was 0.4 ± 2.2 cm (mean ± SD). The IMA originated from the aorta at the level of or below the D3 in 21 cases (70%). The IMA-IMV distance was 5.5 ± 1.8 cm and was greater or equal to 5 cm (large window) in 21 cases (70%). IMA-IMV distance was correlated with IMA-D3 showing that a large window was inversely correlated with a low IMA origin (P < 0.001). IMA-D3 distance was not correlated with weight, height and sex. IMA-IMV distance was largerin male (6.7 ± 0.9 vs. 4.9 ± 1.8, P = 0.001) and correlated with weight, (r = 0.60, 95%CI = 0.03-0.10, P < 0.001) and height (r = 0.54, 95%CI = 0.05-0.21, P = 0.002). IMV can be used as the initial landmark for laparoscopic medial-to-lateral dissection in two-thirds of cases. A too-small window can require first IMA division. The choice between the two different medial-to-lateral approaches could be made by evaluating the anatomical relationship between IMA, IMV, and D3.
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Affiliation(s)
- S Bonnet
- URDIA Anatomie EA4465, Paris Descartes Faculty of Medicine, Paris, France
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23
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Boulind CE, Ewings P, Bulley SH, Reid JM, Jenkins JT, Blazeby JM, Francis NK. Feasibility study of analgesia via epidural versus continuous wound infusion after laparoscopic colorectal resection. Br J Surg 2012; 100:395-402. [PMID: 23254324 DOI: 10.1002/bjs.8999] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/03/2012] [Indexed: 11/06/2022]
Abstract
Abstract
Background
With the adoption of enhanced recovery and emerging new modalities of analgesia after laparoscopic colorectal resection (LCR), the role of epidural analgesia has been questioned. This pilot trial assessed the feasibility of a randomized controlled trial (RCT) comparing epidural analgesia and use of a local anaesthetic wound infusion catheter (WIC) following LCR.
Methods
Between April 2010 and May 2011, patients undergoing elective LCR in two centres were randomized to analgesia via epidural or WIC. Sham procedures were used to blind surgeons, patients and outcome assessors. The primary outcome was the feasibility of a large RCT, and all outcomes for a definitive trial were tested. The success of blinding was assessed using a mixed-methods approach.
Results
Forty-five patients were eligible, of whom 34 were randomized (mean(s.d.) age 70(11·8) years). Patients were followed up per-protocol; there were no deaths, and five patients had a total of six complications. Challenges with capturing pain data were identified and resolved. Mean(s.d.) pain scores on the day of discharge were 1·9(3·1) in the epidural group and 0·7(0·7) in the WIC group. Median length of stay was 4 (range 2–35, interquartile range 3–5) days. Mean use of additional analgesia (intravenous morphine equivalents) was 12 mg in the WIC arm and 9 mg in the epidural arm. Patient blinding was successful in both arms. Qualitative interviews suggested that patients found participation in the trial acceptable and that they would consider participating in a future trial.
Conclusion
A blinded RCT investigating the role of epidural and WIC administration for postoperative analgesia following LCR is feasible. Rigorous standard operating procedures for data collection are required.
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Affiliation(s)
- C E Boulind
- Department of Surgery, Yeovil District Hospital NHS Foundation Trust, Yeovil, UK
- Academic Unit of Surgical Research, School of Social and Community Medicine, University of Bristol, UK
| | - P Ewings
- South West Research Design Service, Musgrove Park Hospital, Taunton, UK
| | - S H Bulley
- Department of Surgery, Yeovil District Hospital NHS Foundation Trust, Yeovil, UK
| | - J M Reid
- Department of Surgery, Yeovil District Hospital NHS Foundation Trust, Yeovil, UK
| | - J T Jenkins
- Department of Surgery, St Mark's Hospital, Northwick Park, Harrow, UK
| | - J M Blazeby
- Academic Unit of Surgical Research, School of Social and Community Medicine, University of Bristol, UK
- University Hospitals Bristol NHS Foundation Trust, Bristol, UK
| | - N K Francis
- Department of Surgery, Yeovil District Hospital NHS Foundation Trust, Yeovil, UK
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Chan AC, Law WL. Outcome of laparoscopic surgery in colorectal cancer: a critical appraisal. Expert Rev Pharmacoecon Outcomes Res 2012; 7:479-89. [PMID: 20528393 DOI: 10.1586/14737167.7.5.479] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Despite the wide application of laparoscopic surgery for various common surgical conditions, the development of laparoscopic colorectal surgery has been slow. The obstacle for its advancement is formed by a steep learning curve and concerns about the oncologic safety in cases of malignant diseases. With refinement in instrumentation and improvement in surgical techniques in recent years, laparoscopic colectomy has become a safe and feasible procedure. The short-term advantages in terms of quicker recovery of bowel function, less postoperative pain and shorter hospital stay of laparoscopic colectomy over conventional treatment seem to be indisputable. Results from large prospective randomized trials revealed the oncologic outcome to be comparable between the two treatments. Furthermore, the incidence of port-site metastasis was shown to be similar between the two approaches. For rectal cancer, laparoscopic-assisted total mesorectal excision has been shown to be a safe and feasible procedure. The incidence of postoperative morbidity including anastomotic leakage appears to be comparable between the two treatments. However, the long-term outcome especially for local recurrence and overall survival remains uncertain. Prospective randomized study with long follow-up is required to elucidate this issue.
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Affiliation(s)
- Albert Cy Chan
- University of Hong Kong Medical Centre, Department of Surgery, Queen Mary Hospital, Pokfulam Road, Hong Kong.
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25
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Ng LWC, Tung LM, Cheung HYS, Wong JCH, Chung CC, Li MKW. Hand-assisted laparoscopic versus total laparoscopic right colectomy: a randomized controlled trial. Colorectal Dis 2012; 14:e612-7. [PMID: 22413783 DOI: 10.1111/j.1463-1318.2012.03028.x] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
AIM Laparoscopic colectomy for colorectal cancer is associated with definite short-term benefits, and is increasingly practised worldwide. The limitations of a pure laparoscopic approach include a relative lack of tactile feedback and long procedural time. Hand-assisted laparoscopic surgery was introduced in an attempt to facilitate operation by improving the tactile sensation. To date, there is no consensus as to which approach is better. Herein we conducted a randomized controlled trial comparing hand-assisted laparoscopic colectomy (HALC) with total laparoscopic colectomy (TLC) in the management of right-sided colonic cancer. METHODS Adult patients with carcinoma of the caecum and ascending colon were recruited and randomized to undergo either HALC or TLC. Measured outcomes included operative time, blood loss, conversion rate, postoperative morbidities, postoperative pain, length of hospital stay, disease recurrence and patient survival. RESULTS Sixty patients (HALC=30, TLC=30) were recruited. The two groups were comparable with regard to age, gender distribution, body mass index and final histopathological staging. No difference was observed between the groups in terms of operating time, conversion rate, operative blood loss, pain score and length of hospital stay. With a median follow-up of 27 to 33 months, no difference was observed in terms of disease recurrence, and the 5-year survival rates remained similar (83%vs 80%, P=0.923). CONCLUSION HALC is safe and feasible, but it does not show any significant benefits over TLC in terms of operating time and conversion rate. Routine use of the hand-assisted laparoscopic technique in right hemicolectomy is therefore not recommended.
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Affiliation(s)
- L W C Ng
- Department of Surgery, Pamela Youde Nethersole Eastern Hospital, Chai Wan Hong Kong SAR, China.
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26
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Aly OE, Quayyum Z. Has laparoscopic colorectal surgery become more cost-effective over time? Int J Colorectal Dis 2012; 27:855-60. [PMID: 22290571 DOI: 10.1007/s00384-012-1410-1] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/19/2012] [Indexed: 02/04/2023]
Abstract
BACKGROUND Several studies have confirmed that laparoscopic colorectal surgery (LCS) has superior short-term outcomes when compared to open colorectal surgery. However, the evidence for cost-effectiveness of LCS is less clear. AIM The aim of this study is to explore the cost-effectiveness of LCS over time since it was first developed in 1991. METHODS Systematic review of the literature was conducted. Electronic databases (PubMed, ScienceDirect and Google Scholar) were searched for studies from 1991 to 2010 using the keywords "laparoscopic, colorectal surgery cost, economic evaluation". RESULTS Fifteen economic evaluations met the inclusion criteria. The percentage cost difference between open and laparoscopic surgery varied widely between different studies. The general trend when observing all the included economic evaluations is that there is a moderate negative correlation between progression of time and the size of the cost gap between laparoscopic and open surgery (R-value=-0.44). This correlation is even stronger (R-value=-0.64, P=0.046) if the studies are subdivided by the country where the surgery was carried out in. Western healthcare systems, even though they had a heterogeneous set of results (SD=27%), showed a decline in costs of laparoscopic surgery with time. CONCLUSION From the current trends, it is projected that the results of future economic evaluations will unequivocally show that laparoscopic surgery is cheaper than open surgery. The initial higher costs of laparoscopic surgery training may be worth the savings made in the long term if it is practised in settings where postoperative care is expensive.
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Affiliation(s)
- O E Aly
- Medical Student - School of Medicine and Dentistry, University of Aberdeen, Aberdeen AB25 2ZD, Scotland, UK.
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27
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Martel G, Duhaime S, Barkun JS, Boushey RP, Ramsay CR, Fergusson DA. The quality of research synthesis in surgery: the case of laparoscopic surgery for colorectal cancer. Syst Rev 2012; 1:14. [PMID: 22588035 PMCID: PMC3351744 DOI: 10.1186/2046-4053-1-14] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2011] [Accepted: 02/17/2012] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND Several systematic reviews and meta-analyses populate the literature on the effectiveness of laparoscopic surgery for colorectal cancer. The utility of this body of work is unclear. The objective of this study was to synthesize all such systematic reviews in terms of clinical effectiveness, to appraise their quality, and to determine whether areas of duplication exist across reviews. METHODS Systematic reviews comparing laparoscopic and open surgery for colorectal cancer were identified using a comprehensive search protocol (1991 to 2008). The primary outcome was overall survival. The methodological quality of reviews was appraised using the Assessment of Multiple Systematic Reviews (AMSTAR) instrument. Abstraction and quality appraisal was carried out by two independent reviewers. Reviews were synthesized, and outcomes were compared qualitatively. A citation analysis was carried out using simple matrices to assess the comprehensiveness of each review. RESULTS In total, 27 reviews were included; 13 reviews included only randomized controlled trials. Rectal cancer was addressed exclusively by four reviews. There was significant overlap between review purposes, populations and, outcomes. The mean AMSTAR score (out of 11) was 5.8 (95% CI: 4.6 to 7.0). Overall survival was evaluated by ten reviews, none of which found a significant difference. Three reviews provided a selective meta-analysis of time-to-event data. Previously published systematic reviews were poorly and highly selectively referenced (mean citation ratio 0.16, 95% CI: 0.093 to 0.22). Previously published trials were not comprehensively identified and cited (mean citation ratio 0.56, 95% CI: 0.46 to 0.65). CONCLUSIONS Numerous overlapping systematic reviews of laparoscopic and open surgery for colorectal cancer exist in the literature. Despite variable methods and quality, survival outcomes are congruent across reviews. A duplication of research efforts appears to exist in the literature. Further systematic reviews or meta-analyses are unlikely to be justified without specifying a significantly different research objective. This works lends support to the registration and updating of systematic reviews.
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Affiliation(s)
- Guillaume Martel
- Department of Surgery, Department of Epidemiology & Community Medicine, and Ottawa Hospital Research Institute, The Ottawa Hospital, University of Ottawa, Ottawa, Ontario, Canada.
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Hsu TC. Abdominoperineal Resection without an Abdominal Incision for Rectal Cancer Has the Advantage of No Abdominal Wound Complication and Easier Stoma Care. Am Surg 2012. [DOI: 10.1177/000313481207800233] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abdominoperineal resection has been used for years for the management of low rectal cancer. However, the abdominal incision is associated with many complications and causes interference of the stoma care. If the abdominal incision can be avoided, it would be beneficial to the patient. The aim of the study is to evaluate the possibility and safety of performing abdominoperineal resection and the oncology result without an abdominal incision. From September 2001 to May 2010, 40 patients with rectal malignancies received excision of the rectum, anus, and perineum through a perineal incision and a skin hole created for stomy. No harmonic scalpel or laser was used during surgery. No laparoscope or hand port was used in the procedure. There were 19 males and 21 females. Age ranged from 31 to 87 years old (average, 62.9 years). There were 39 adenocarcinomas and one malignant gastrointestinal stromal cell tumor. There was no operative mortality. Six patients had postoperative complications; three patients had intestinal obstructions; and one patient each had bleeding, urinary tract infection, and colostomy separation from the skin. The lymph nodes in the specimens ranged from 9 to 33 cm (average, 16.8 cm). The survival is similar to the traditional abdominoperineal resection. This limited experience suggests that an abdominal incision is not necessary for radical resection of the rectum, anus, and perineum in patients with low-lying rectal cancer. It also offers the patient easier care of stoma without interference of the abdominal incision.
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Affiliation(s)
- Tzu-Chi Hsu
- Division of Colon and Rectal Surgery, Department of Surgery, Taipei Mackay Memorial Hospital, and the Department of Surgery, Taipei Medical University, Taipei, Taiwan
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Abstract
BACKGROUND Laparoscopic surgery for colorectal cancer has undergone tremendous advancement in the last two decades, with maturation of techniques and integration into current practice. SOURCES OF DATA Worldwide English-language literature on laparoscopic surgery for the management of colon and rectal cancer was reviewed. AREAS OF AGREEMENT A large body of evidence has attested to the improved short-term outcomes and long-term oncological safety of laparoscopic surgery for colon cancer. Laparoscopic colectomy can be recommended to suitable patients where expertise is available. Laparoscopic resection for rectal cancer is feasible, with good evidence of faster post-operative recovery and adequate surgical quality, but requires more data on long-term oncological outcomes. This review examines the evidence and current practice of laparoscopic surgery for colorectal cancer. AREAS OF CONTROVERSY Does laparoscopic surgery confer a survival advantage for colorectal cancer patients? GROWING POINTS The role of single-incision laparoscopic surgery and robotic surgery in colorectal cancer. AREAS TIMELY FOR DEVELOPING RESEARCH Barriers to the adoption of the laparoscopic technique.
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Affiliation(s)
- J H Lai
- Department of Surgery, The University of Hong Kong, Queen Mary Hospital, Hong Kong
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30
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Rawlinson A, Kang P, Evans J, Khanna A. A systematic review of enhanced recovery protocols in colorectal surgery. Ann R Coll Surg Engl 2011; 93:583-8. [PMID: 22041232 PMCID: PMC3566681 DOI: 10.1308/147870811x605219] [Citation(s) in RCA: 109] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/11/2011] [Indexed: 12/20/2022] Open
Abstract
INTRODUCTION Colorectal surgery has been associated with a complication rate of 15-20% and mean post-operative inpatient stays of 6-11 days. The principles of enhanced recovery after surgery (ERAS) are well established and have been developed to optimise peri-operative care and facilitate discharge. The purpose of this systematic review is to present an updated review of peri-operative care in colorectal surgery from the available evidence and ERAS group recommendations. METHODS Systematic searches of the PubMed and Embase™ databases and the Cochrane library were conducted. A hand search of bibliographies of identified studies was conducted to identify any additional articles missed by the initial search strategy. RESULTS A total of 59 relevant studies were identified. These included six randomised controlled trials and seven clinical controlled trials that fulfilled the inclusion criteria. These studies showed reductions in duration of inpatient stays in the ERAS groups compared with more traditional care as well as reductions in morbidity and mortality rates. CONCLUSIONS Reviewing the data reveals that ERAS protocols have a role in reducing post-operative morbidity and result in an accelerated recovery following colorectal surgery. Similarly, both primary and overall hospital stays are reduced significantly. However, the available evidence suggests that ERAS protocols do not reduce hospital readmissions or mortality. These findings help to confirm that ERAS protocols should now be implemented as the standard approach for peri-operative care in colorectal surgery.
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Affiliation(s)
- A Rawlinson
- Department of Surgery, Northampton General Hospital, Northampton, UK
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31
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Bretagnol F, Dedieu A, Zappa M, Guedj N, Ferron M, Panis Y. T4 colorectal cancer: is laparoscopic resection contraindicated? Colorectal Dis 2011; 13:138-43. [PMID: 20653697 DOI: 10.1111/j.1463-1318.2010.02380.x] [Citation(s) in RCA: 69] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
AIM T4 colorectal cancer remains a contraindication for laparoscopy. It is argued that the risk of incomplete resection could be higher than in open surgery. Furthermore, difficulty in dissection could lead to a very high rate of conversion. There is little information on this. The study aimed at assessing feasibility and operative and oncologic results of laparoscopic resection for T4 colorectal cancer. METHOD Between 2006 and 2009, 39 patients with colorectal cancer with suspected involvement of another organ (T4) on computed tomography scanning and/or magnetic resonance imaging were included. The cancers were in the right colon (n = 18), left colon (n =9) and rectum (n = 12). The distribution of possible organ involvement was abdominal or pelvic side-wall (n = 21), urinary bladder (n = 4), small bowel or colon (n = 6), vagina and ovary (n = 3), prostate or seminal vesicles (n = 3) and duodenum (n = 2). RESULTS The overall conversion rate was 18%. Postoperative mortality and morbidity were 2.5 and 33%, respectively. Clinical anastomotic leakage rate was 15% (n = 6). Abdominal reoperation was required in three (7%) patients. Pathological invasion to other organs (pT4) was confirmed in 30 (77%) patients. The R1 resection rate was 13% (4 of 30). After a median follow up of 19 months (range 1.5-45 months), the overall survival and disease-free survival rates were 97 and 89%, respectively. CONCLUSION This study suggests that laparoscopic surgery is feasible for colorectal T4 cancer resection. Laparoscopy cannot therefore be considered an absolute contraindication for T4 colorectal cancer.
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Affiliation(s)
- F Bretagnol
- Department of Colorectal Surgery Department of Radiology Department of Pathology, Beaujon Hospital (APHP), Clichy, France
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32
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Lai JH, Ng KH, Ooi BS, Ho KS, Lim JF, Tang CL, Eu KW. Laparoscopic resection for colorectal polyps: a single institution experience. ANZ J Surg 2010; 81:275-80. [PMID: 21418473 DOI: 10.1111/j.1445-2197.2010.05580.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
BACKGROUND Endoscopic polypectomy, although routinely used for the treatment of colorectal polyps, may be limited by polyp size, location and histology. Laparoscopic resection for malignant polyps and polyps not amenable to endoscopic removal has the advantage of adequate disease clearance as well as the short-term benefits of laparoscopic surgery. This study evaluates the outcomes of such an approach. METHODS Patients who had laparoscopic resection for colorectal polyps between January 2005 and July 2008 were identified from a prospective database. Polyps that were malignant, large, difficult to snare or incompletely excised, were included. Demographics, perioperative details and histopathology were analysed. RESULTS Seventy-eight patients (44 male) with a median age of 62.5 years (range 24-86) were studied. The majority (79%) were laparoscopic anterior resections for sigmoid or rectal polyps. Median operating time was 125 min (range, 65-225). Eight cases (10.3%) were converted to open mainly due to adhesions. There was no post-operative mortality. Perioperative complications occurred in seven patients (8.9%). Median hospital stay was 6 days (range 4-78). Median polyp size was 20 mm (range, 5-75). There were 44 benign polyps (55.7%); majority were tubulovillous adenomas (n= 22), and tubular adenomas (n= 10). Thirty-five patients (44.3%) had invasive cancer, with T1 (n= 27) and T2 (n= 2) tumours. Three of these patients (8.6%) had lymph node metastases. Median number of lymph nodes sampled was six (range 0-23). CONCLUSION Laparoscopic resection is safe and effective for colorectal polyps not amenable to colonoscopic removal, and is especially important for adequate clearance in the case of malignant polyps.
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Affiliation(s)
- Jiunn-Herng Lai
- Department of Colorectal Surgery, Singapore General Hospital, Singapore
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33
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Abstract
Surgery is undergoing revolutionary change as a result of newer approaches to pain control, the introduction of techniques that reduce the post-operative stress response, and the use of minimally invasive operations, such as laparoscopic surgery. As demand for hospital beds continues to escalate, it is paramount that patients recover from surgery quickly and safely; the use of evidence-based interventions to hasten recovery within an enhanced recovery programme (ERP) can play a vital role in achieving this, as well as reducing costs by shortening hospital stay. This article outlines the principles and key elements of an ERP, and discusses how it can help to achieve an improved and safe recovery and shorter hospital stay for patients, thereby reducing the cost to the NHS of inpatient treatment and recovery. The literature surrounding the development of 'enhanced recovery' (also called 'fast-track') surgery is reviewed to determine whether it is appropriate for patients undergoing elective colorectal surgery.
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Affiliation(s)
- Rebecca Slater
- Department of Stoma Care, St Marks Hospital, Harrow, Middlesex
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Ellis-Clark JM, Lumley JW, Stevenson ARL, Stitz RW. Laparoscopic restorative proctectomy - hybrid approach or totally laparoscopic? ANZ J Surg 2010; 80:807-12. [DOI: 10.1111/j.1445-2197.2010.05335.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
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35
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Lázár G, Paszt A, Simonka Z, Rokszin R, Abrahám S. [Laparoscopic surgery in colorectal tumors]. Magy Onkol 2010; 54:117-22. [PMID: 20576587 DOI: 10.1556/monkol.54.2010.2.5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
The minimally invasive technique, by means of the undoubted advantages of the method, has become fully accepted in the surgical treatments of the most benign and functional diseases. Today it has been proven that the laparoscopic technique is safely usable also in the surgical treatment of colorectal tumors. The authors, analyzing their own and the international experiences, present the laparoscopic surgical treatment of colorectal tumors. Seventy-four patients were treated with laparoscopic-assisted colorectal intestinal resection in the Department of Surgery of the University of Szeged between January 1, 2005 and December 31, 2008. The surgical indication was neoplastic colorectal lesion in 40 cases. The average age of them was 64 years (from 36 to 89 years). Four patients belonged to the risk group of ASA I, 11 patients to ASA II, 24 to ASA III, and one to ASA IV. Twenty-six patients underwent rectosigmoideal resection, 2 had rectal exstirpation, 9 had right hemicolectomy and one had left hemicolectomy. There were no surgical or postoperative complications. Four conversions and in one case a reoperation occurred due to adhesion ileus. The startup of the passage (2.4 days, on average) and the possibility of nourishing per os were significantly shortened. The histological processes of specimens justified tumor-free oral, aboral and circumferential resection in all cases. Summarizing our own and international experiences it can be stated that the laparoscopic surgeries performed due to colorectal tumors are safe, and are also appropriate with respect to oncosurgery. There are a number of benefits for the patients mainly in the early postoperative period (faster recovery, shorter hospitalization) and their long-term survival results are good as well.
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Affiliation(s)
- György Lázár
- Szegedi Tudományegyetem, Altalános Orvosi Kar Szent-Györgyi Albert Klinikai Központ, Sebészeti Klinika 6720 Szeged Pécsi u. 6.
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36
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El-Gazzaz G, Geisler D, Hull T. Risk of clinical leak after laparoscopic versus open bowel anastomosis. Surg Endosc 2010; 24:1898-903. [PMID: 20112117 DOI: 10.1007/s00464-009-0867-7] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2009] [Accepted: 11/23/2009] [Indexed: 11/30/2022]
Affiliation(s)
- Galal El-Gazzaz
- A30 Department of Colorectal Surgery, Cleveland Clinic Foundation, Cleveland, OH 44195, USA.
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Enhanced recovery after surgery (ERAS) programs for patients having colorectal surgery: a meta-analysis of randomized trials. J Gastrointest Surg 2009; 13:2321-9. [PMID: 19459015 DOI: 10.1007/s11605-009-0927-2] [Citation(s) in RCA: 180] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2009] [Accepted: 04/28/2009] [Indexed: 01/31/2023]
Abstract
BACKGROUND Enhanced recovery after surgery programs have been introduced with aims of improving patient care, reducing complication rates, and shortening hospital stay following colorectal surgery. The aim of this meta-analysis was to determine whether enhanced recovery after surgery programs, when compared to traditional perioperative care, are associated with reduced primary hospital length of stay in adult patients undergoing elective colorectal surgery. METHODS MEDLINE, EMBASE, the Cochrane Central Registry of Controlled Trials, and the reference lists were searched for relevant articles. Only randomized controlled trials comparing an enhanced recovery program with traditional postoperative care were included. RESULTS Three of four included studies showed significantly shorter primary lengths of stay for patients enrolled in enhanced recovery programs. There was no significant difference in postoperative mortality when the two groups were compared [relative risk (RR) = 0.53; 95% CI = 0.12-2.38; test for heterogeneity, p = 0.40 and I (2) = 0], and patients in enhanced recovery programs were less likely to develop postoperative complications (RR = 0.61, 95% CI = 0.42-0.88; test for heterogeneity, p = 0.95 and I (2) = 0). AUTHORS' CONCLUSIONS There is some evidence to suggest that enhanced recovery after surgery programs are better than traditional perioperative care, but evidence from a larger, better quality randomized controlled trial is necessary.
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Vlug MS, Wind J, van der Zaag E, Ubbink DT, Cense HA, Bemelman WA. Systematic review of laparoscopic vs open colonic surgery within an enhanced recovery programme. Colorectal Dis 2009; 11:335-43. [PMID: 18727715 DOI: 10.1111/j.1463-1318.2008.01679.x] [Citation(s) in RCA: 65] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
BACKGROUND Fast track surgery accelerates recovery, reduces morbidity and shortens hospital stay. It is unclear what the effects are of laparoscopic or open surgery within a fast track programme. The aim of this systematic review was to review the existing evidence. METHOD A systematic review was performed of all randomized (RCTs) and controlled clinical trials (CCTs) on laparoscopic and open surgery within a fast track setting. Primary endpoints were primary and overall hospital stay, readmission rate, morbidity and mortality. Study selection, quality assessment and data extraction were performed independently by two observers. RESULTS Only two RCTs and three CCTs were eligible for final analysis, which reported on 400 patients. Data could not be pooled because of clinical heterogeneity. One RCT and one CCT stated a shorter primary hospital stay in the laparoscopic group of 3 and 2 days, respectively. In one RCT, the readmission rate was lower in the laparoscopic group; absolute risk reduction (ARR) 21.4% [95% confidence interval (CI): 6-42.3%] resulting in a number needed to treat (NNT) of 4.7 patients (95% CI: 2.4-176). Another study showed a 23% difference in favour of the laparoscopic group with regard to morbidity (95% CI: 6.3-39.1%), i.e. an NNT of 4.4 patients (95% CI: 2.6-15.9). There were no significant differences in mortality rates. CONCLUSION Due to the present lack of data, no robust conclusions can be made. A large randomized controlled trial is required to compare laparoscopic with open surgery within a fast track setting.
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Affiliation(s)
- M S Vlug
- Department of Surgery, Academic Medical Center at the University of Amsterdam, Amsterdam, The Netherlands
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Rimonda R, Arezzo A, Garrone C, Allaix ME, Giraudo G, Morino M. Electrothermal bipolar vessel sealing system vs. harmonic scalpel in colorectal laparoscopic surgery: a prospective, randomized study. Dis Colon Rectum 2009; 52:657-61. [PMID: 19404071 DOI: 10.1007/dcr.0b013e3181a0a70a] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
PURPOSE This study was designed to compare the efficacy and safety of laparoscopic colorectal surgery performed with the aid of LigaSure vessel-sealing system or Ultracision. METHODS Patients eligible for elective laparoscopic right or left hemicolectomy or anterior resection of rectum were randomly assigned to either the use of Ligasure or Ultracision. The primary end point was intraoperative reduction of blood loss. Secondary end points were intraoperative and postoperative morbidity and operative time. RESULTS Between April 2005 and December 2006, 140 consecutive patients were included in the study (70 Ligasure and 70 Ultracision. We performed 31 right hemicolectomies, 69 left hemicolectomies, and 40 anterior resections of rectum. Blood loss was 109.6 ml (Ultracision 107.9 ml vs. Ligasure 111.2 ml, P value = 0.72). Intraoperative complication rate was 2.8 percent (Ultracision 1.4 percent vs. Ligasure 4.2 percent, P value < 0.01). Postoperative mortality was 0.7 percent. The overall conversion rate was 7.8 percent, 6 in the Ligasure group and 5 in the Ultracision group (P value = 0.09). Operative time, considered from pneumoperitoneum to minilaparotomy, was 115.7 minutes (Ultracision 114.8 minutes vs. Ligasure 116.3 minutes, P value = 0.89). CONCLUSIONS Results showed that Ligasure and Ultracision are both useful instruments for laparoscopic colorectal surgery with no significant difference in terms of intraoperative/postoperative morbidity and operative time. Choice of which technique to perform should be according to the surgeon's preference.
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40
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Abstract
The Australian Safety and Efficacy Register of New Interventional Procedures--Surgical (ASERNIP-S) came into being 10 years ago to provide health technology assessments specifically tailored towards new surgical techniques and technologies. It was and remains the only organisation in the world to focus on this area of research. Most funding has been provided by the Australian Government Department of Health, and assessments have helped inform the introduction of new surgical techniques into Australia. ASERNIP-S is a project of the Royal Australasian College of Surgeons. The ASERNIP-S program employs a diverse range of methods including systematic reviews, technology overviews, assessments of new and emerging surgical technologies identified by horizon scanning, and audit. Support and guidance for the program is provided by Fellows of the Royal Australasian College of Surgeons. ASERNIP-S works closely with consumers to produce health technology assessments and audits, as well as consumer information to keep patients fully informed of research. Since its inception, the ASERNIP-S program has developed a strong international profile through the production of over 60 reports on evidence-based surgery, surgical technologies and audit. The work undertaken by ASERNIP-S has evolved from assessments of the safety and efficacy of procedures to include guidance on policies and surgical training programs. ASERNIP-S needs to secure funding so that it can continue to play an integral role in the improvement of quality of care both in Australia and internationally.
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Affiliation(s)
- Guy Maddern
- Australian Safety and Efficacy Register of New Interventional Procedures-Surgical, Royal Australasian College of Surgeons, Adelaide
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41
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Allardyce RA, Bagshaw PF, Frampton CM, Frizelle FA, Hewett PJ, Rieger NA, Smith S, Solomon MJ, Stevenson ARL. AUSTRALIAN AND NEW ZEALAND STUDY COMPARING LAPAROSCOPIC AND OPEN SURGERIES FOR COLON CANCER IN ADULTS: ORGANIZATION AND CONDUCT†. ANZ J Surg 2008; 78:840-7. [DOI: 10.1111/j.1445-2197.2008.04678.x] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
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Dowson HM, Cowie AS, Ballard K, Gage H, Rockall TA. Systematic Review of Quality of Life following Laparoscopic and open colorectal surgery. Colorectal Dis 2008; 10:757-68. [PMID: 18573115 DOI: 10.1111/j.1463-1318.2008.01603.x] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
OBJECTIVE To compare the health-related quality of life (HRQoL) of patients following laparoscopic and open colorectal surgery. METHODS A systematic review was performed according to Quorum guidelines. Prospective studies comparing the HRQoL of patients after laparoscopic and open colorectal surgery were identified. The primary outcome measure was postoperative quality of life; performance status and cosmesis were secondary outcome measures. RESULTS 23 studies were identified that satisfied the inclusion criteria; 18 assessed HRQoL, 4 performance status, and 3 cosmesis. It was not possible to perform a meta-analysis due to study heterogeneity. The studies reported outcomes for 2946 patients. The most frequent HRQoL instruments employed were SF-36, EORTC, and GIQLI. 6 studies, using a total of 12 separate measures, evaluated QoL during the first 3 post-operative months: 10 of these measures showed no significant difference, and 2 showed an improved HRQoL with laparoscopy. Twelve further studies evaluated HRQoL up to 5 years post-operatively: 9 showed no difference between the 2 groups, and 3 demonstrated a benefit for laparoscopy. Three of 4 studies assessing performance status on discharge, and all 3 studies assessing cosmesis, reported benefits with the laparoscopic approach. CONCLUSIONS The current evidence suggests there is no significant difference in HRQoL following laparoscopic and open colorectal surgery, although there is a lack of good quality data. There is a trend towards improved quality of life outcomes and performance status with laparoscopy in the early post-operative period. There is a need for further research, particularly assessing quality of life in the early post-operative period.
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Affiliation(s)
- H M Dowson
- Minimal Access Therapy Training Unit, Postgraduate Medical School, Manor Park, Guildford, Surrey, UK.
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43
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Abstract
Laparoscopic resection has become one of the choices for colectomy for various colon and rectal diseases in recent years. Despite some uncertainties of laparoscopic procedures, especially during cancer surgery, its popularity has forced surgeons to pursue the approach. One of the concerns is inadequate examination of the intra-abdominal organs with a laparoscope. This study is a retrospective analysis of a single surgeon's experience of the frequencies of unexpected findings during laparotomies. From July 1990 to November 2005, 2775 patients with various colorectal diseases receiving laparotomies by a single surgeon were analyzed. Among them, 2282 patients were operated for primary colorectal cancer. Excluded were patients who did not receive a formal laparotomy, who had a recent laparotomy, who had peritoneal and omental metastasis, and whose pathology did not attract attention for management. Exploration of the entire peritoneal cavity was performed for all cases in the series. There were 1423 males and 1352 females. Ages ranged from 12 to 94 years, averaging 62.6-years-old. Forty-six patients (1.7%) were found to have unexpected intra-abdominal lesions during laparotomies. Eleven patients were found to have synchronous colorectal cancers; five patients were found to have unexpected liver metastases; three patients each were found to have gastric cancers, stromal tumors of the small bowel, and ectopic pancreas; two patients each were found to have gastric leiomyosarcomas, pancreatic cancers, mucoceles of the appendix, ulcers of the small intestine, bleeding Meckel's diverticula, pancreatitis, and perforations of the ileum; one patient each was found to have gall bladder cancer, malignant carcinoid tumor, pheochromocytoma, diverticulitis of the jejunum, diverticulitis of the colon, duplication of the colon, and aortic aneurysm larger than 6 cm. Forty-one of the lesions were likely to be missed by laparoscope. This experience suggests that incomplete laparotomies might miss various pathologies. Laparoscopy is not a complete form of laparotomy because of loss of tactile sensation. Laparoscopy might result in an inadequate or inappropriate management due to misdiagnosis.
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Affiliation(s)
- Tzu-Chi Hsu
- From the Division of Colon and Rectal Surgery, Department of Surgery, Taipei Mackay Memorial Hospital, and the Department of Surgery, Taipei Medical University, Taipei, Taiwan
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Laurent C, Leblanc F, Bretagnol F, Capdepont M, Rullier E. Long-term wound advantages of the laparoscopic approach in rectal cancer. Br J Surg 2008; 95:903-8. [PMID: 18551506 DOI: 10.1002/bjs.6134] [Citation(s) in RCA: 109] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
BACKGROUND No long-term advantage of the laparoscopic approach has been demonstrated in colorectal surgery. This study compared the risk of incisional hernia between laparoscopic and open surgery for rectal cancer. METHODS Between 1994 and 2004, patients who had restorative mesorectal excision for rectal cancer by laparoscopy were compared with those treated by open surgery. Follow-up was prospective, and incisional hernia was considered to be any abdominal wound dehiscence occurring at the midline, extraction, trocar or ileostomy site. Cumulative risks of hernia were evaluated by the Kaplan-Meier method and compared with the log rank test. RESULTS Some 155 patients had a laparoscopic and 165 an open procedure. The two groups were similar in terms of age, sex, body mass index, tumour stage, loop ileostomy and morbidity. The conversion rate was 20.6 per cent. The rate of incisional hernia in all patients was 11.4 per cent at 1 year, 21.1 per cent at 2 years and 23.7 per cent at 5 years. The rate of hernia at 5 years was significantly lower in the laparoscopic than in the open group (13.0 versus 33.0 per cent; P < 0.001). The rate of hernia due specifically to the laparoscopic procedure (extraction and trocar sites) was ten times less than that after a primary or secondary open procedure (2.1 versus 16.1-33.1 per cent; P < 0.001). CONCLUSION The laparoscopic approach decreases the risk of long-term incisional hernia following restorative mesorectal excision for rectal cancer. The benefit is most apparent in patients without conversion or postoperative complication.
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Affiliation(s)
- C Laurent
- Department of Surgery, Saint-Andre Hospital, Victor-Segalen University, Bordeaux, France.
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45
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Abstract
This article reviews recent advances in surgical techniques and adjuvant therapies for colorectal cancer, including total mesorectal excision, the resection of liver and lung metastasis and advances in chemoradiation and foreshadows some interventions that may lie just beyond the frontier. In particular, little is known about the intracellular and extracellular cascades that may influence colorectal cancer cell adhesion and metastasis. Although the phosphorylation of focal adhesion kinases and focal adhesion associated proteins in response to integrin-mediated cell matrix binding (”outside in integrin signaling”) is well described, the stimulation of cell adhesion by intracellular signals activated by pressure prior to adhesion represents a different signal paradigm. However, several studies have suggested that increased pressure and shear stress activate cancer cell adhesion. Further studies of the pathways that regulate integrin-driven cancer cell adhesion may identify ways to disrupt these signals or block integrin-mediated adhesion so that adhesion and eventual metastasis can be prevented in the future.
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Abstract
During the past 15 years, there has been increasing enthusiasm for the use of laparoscopic techniques in the operative treatment of patients suffering from colorectal disease. Laparoscopic colectomy has been demonstrated to be safe for patients suffering from adenocarcinoma of the intraperitoneal colon. Attention is now being focused on the treatment of patients with rectal adenocarcinoma using laparoscopic methods. Prospective data analysis will be crucial in determining whether laparoscopic proctectomy provides equivalent results to open procedures.
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Affiliation(s)
- Thomas E Read
- Division of Colon and Rectal Surgery, Western Pennsylvania Hospital, Clinical Campus of Temple University School of Medicine, Pittsburgh, Pennsylvania 15224, USA.
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Anderson C, Uman G, Pigazzi A. Oncologic outcomes of laparoscopic surgery for rectal cancer: a systematic review and meta-analysis of the literature. Eur J Surg Oncol 2008; 34:1135-42. [PMID: 18191529 DOI: 10.1016/j.ejso.2007.11.015] [Citation(s) in RCA: 94] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2007] [Accepted: 11/28/2007] [Indexed: 12/11/2022] Open
Abstract
AIM To review and compare the oncologic outcomes in patients with rectal cancer undergoing laparoscopic vs. open rectal surgery. METHODS An electronic literature search was performed for trials reporting oncologic outcomes for laparoscopic rectal resections. Variables of interest were survival, recurrence rates, margin status and nodal retrieval. Trials were excluded if variables were not specifically analysed for rectal resections. A meta-analysis was performed to assess the difference in oncologic outcomes between the two treatment approaches. RESULTS Data on a total of 1403 laparoscopic (LG) and 1755 open (OG) rectal resections were gathered from 24 publications. Overall survival at 3 years (LG=76%, OG=69%) was not statistically different between the two treatment groups. The mean local recurrence rates were 7% for laparoscopic and 8% for open procedures (NS). There was no difference in radial margin positivity, 5% of patients undergoing laparoscopic surgery compared to 8% for open surgery. Laparoscopic procedures harvested a mean of 10 nodes as compared to 12 for open procedures, p=0.001. CONCLUSIONS Data gathered in this meta-analysis indicate that there are no oncologic differences between laparoscopic and open resections for treatment of primary rectal cancer.
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Affiliation(s)
- C Anderson
- Department of General Oncologic Surgery, City of Hope Medical Center, 1500 Duarte Road, Duarte, CA 91010, USA
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Laparoscopic versus open colorectal resection for cancer: a meta-analysis of results of randomized controlled trials on recurrence. Eur J Surg Oncol 2007; 34:1217-24. [PMID: 18155389 DOI: 10.1016/j.ejso.2007.11.004] [Citation(s) in RCA: 48] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2007] [Accepted: 11/01/2007] [Indexed: 01/02/2023] Open
Abstract
AIMS Laparoscopic resection for colorectal cancer remains controversial. This is because it is uncertain whether recurrence rates after laparoscopic-assisted surgery is comparable to those reported after open surgery. We performed a meta-analysis of the published literature in an attempt to answer this question. METHODS Eligible articles were identified by searches of MEDLINE, EMBase and the Cochrane database. Prospective randomized clinical trials were eligible if they included patients with colorectal cancer treated by laparoscopic surgery versus open surgery and followed for recurrence. RESULTS Ten trials with information on disease recurrence on 2474 patients were included. In the combined results, no statistically significant difference in the OR for overall recurrence between the laparoscopic surgery and open surgery group was found (OR 0.93, 95% CI 0.71-1.21, P=0.58). Stratified by recurrence type, the combined results of the individual reports show no statistically significant difference for local recurrence (OR 0.80, 95% CI 0.50-1.29, P=0.36), distant metastases (OR 0.90, 95% CI 0.62-1.29, P=0.56) and port or wound-site recurrence (OR 1.04, 95% CI 0.18-6.03, P=0.97) between the two surgical techniques. CONCLUSION This meta-analysis supports that the recurrence rates for patients with colorectal cancer treated by laparoscopic surgery do not differ from those for open surgery. Longer follow-up studies will further define outcomes, comparing the two techniques in the treatment of colorectal cancer.
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Martel G, Boushey RP, Marcello PW. Results of the Laparoscopic Colon Cancer Randomized Trials: An Evidence-Based Review. SEMINARS IN COLON AND RECTAL SURGERY 2007. [DOI: 10.1053/j.scrs.2007.10.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
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50
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Abstract
Since the first report in 1991 the laparoscopic resection of colon cancer is progressing slowly and just in the last 2-3 years is becoming more popular. The resistance to its use by some general and colo-rectal surgeons is receding. The explanations are that technology is evolving quickly and there is a worldwide diffusion of more sophisticated surgical instruments. Moreover several randomized trials have been published showing that the outcomes of laparoscopic colon surgery are similar or better than those of conventional surgery and the early reports suggesting the tumour dissemination were not confirmed. The revolution in oncological surgery that we are observing in these last decades with the introduction and diffusion of mini-invasive approach is comparable to that regarding conventional surgery during the period of Halsted. Therefore the principles of surgery accepted during the years must not be forgotten.
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