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Bedirli A, Yucel D, Ekim B. Laparoscopic anterior resection: new anastomosis technique in a pig model. JSLS 2016; 18:JSLS-D-13-00345. [PMID: 25392669 PMCID: PMC4208905 DOI: 10.4293/jsls.2014.00345] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Bowel anastomosis after anterior resection is one of the most difficult tasks to perform during laparoscopic colorectal surgery. This study aims to evaluate a new feasible and safe intracorporeal anastomosis technique after laparoscopic left-sided colon or rectum resection in a pig model. METHODS The technique was evaluated in 5 pigs. The OrVil device (Covidien, Mansfield, Massachusetts) was inserted into the anus and advanced proximally to the rectum. A 0.5-cm incision was made in the sigmoid colon, and the 2 sutures attached to its delivery tube were cut. After the delivery tube was evacuated through the anus, the tip of the anvil was removed through the perforation. The sigmoid colon was transected just distal to the perforation with an endoscopic linear stapler. The rectosigmoid segment to be resected was removed through the anus with a grasper, and distal transection was performed. A 25-mm circular stapler was inserted and combined with the anvil, and end-to-side intracorporeal anastomosis was then performed. RESULTS We performed the technique in 5 pigs. Anastomosis required an average of 12 minutes. We observed that the proximal and distal donuts were completely removed in all pigs. No anastomotic air leakage was observed in any of the animals. CONCLUSION This study shows the efficacy and safety of intracorporeal anastomosis with the OrVil device after laparoscopic anterior resection.
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Affiliation(s)
- Abdulkadir Bedirli
- Department of General Surgery, Gazi University Medical Faculty, Ankara, Turkey
| | - Deniz Yucel
- Department of General Surgery, Gazi University Medical Faculty, Ankara, Turkey
| | - Burcu Ekim
- Gazi University Laparoscopic Surgery Education and Research Center, Ankara, Turkey
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Silva-Velazco J, Stocchi L, Costedio M, Gorgun E, Kessler H, Remzi FH. Is there anything we can modify among factors associated with morbidity following elective laparoscopic sigmoidectomy for diverticulitis? Surg Endosc 2015; 30:3541-51. [PMID: 26541732 DOI: 10.1007/s00464-015-4651-6] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2015] [Accepted: 10/27/2015] [Indexed: 12/13/2022]
Abstract
BACKGROUND Laparoscopic sigmoidectomy for diverticulitis is widely accepted, using either endolinear staplers or traditional linear staplers under direct vision through the extraction site to transect the rectum. The aim of this study was to assess modifiable factors affecting perioperative morbidity after elective laparoscopic sigmoidectomy for diverticulitis. METHODS Potential associations between perioperative morbidity and demographic, disease-related, and treatment-related factors were assessed on all consecutive patients included in a prospectively collected database undergoing elective laparoscopic sigmoidectomy for diverticulitis between 1992 and 2013. Rectal transection with a linear stapler under direct vision through the extraction site was considered compatible with laparoscopic technique. RESULTS There were two deaths out of 1059 patients (0.19 %). Conversion rate was 13.1 %, overall morbidity 28 %, and anastomotic leak 3.7 %. Independent factors associated with morbidity in an intent-to-treat analysis were ASA 3 (OR 1.53, p = 0.006), conversion (OR 1.71, p = 0.015), and rectal transection without endolinear stapling (traditional linear stapler: OR 1.75, p = 0.003; surgical knife: OR 2.09, p = 0.002). The same factors along with complicated diverticulitis (OR 1.56, p = 0.013) were independently associated with overall morbidity among laparoscopically completed cases. BMI ≥ 35 (OR 2.3, p = 0.017), complicated diverticulitis (OR 2.37, p = 0.002), and rectal transection with a traditional linear stapler (OR 2.19, p = 0.018) were independently associated with abdomino-pelvic infections, both in an intent-to-treat analysis and among laparoscopically completed cases. The number of endolinear stapler firings was not associated with morbidity. CONCLUSIONS Most factors associated with morbidity of laparoscopic sigmoidectomy for diverticulitis cannot be easily modified. With the limitation of a retrospective analysis, modifiable factors to minimize morbidity are laparoscopic completion and endolinear stapling.
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Affiliation(s)
- Jorge Silva-Velazco
- Department of Colorectal Surgery, Digestive Disease Institute, Cleveland Clinic, 9500 Euclid Ave/A30, Cleveland, OH, 44195, USA
| | - Luca Stocchi
- Department of Colorectal Surgery, Digestive Disease Institute, Cleveland Clinic, 9500 Euclid Ave/A30, Cleveland, OH, 44195, USA.
| | - Meagan Costedio
- Department of Colorectal Surgery, Digestive Disease Institute, Cleveland Clinic, 9500 Euclid Ave/A30, Cleveland, OH, 44195, USA
| | - Emre Gorgun
- Department of Colorectal Surgery, Digestive Disease Institute, Cleveland Clinic, 9500 Euclid Ave/A30, Cleveland, OH, 44195, USA
| | - Hermann Kessler
- Department of Colorectal Surgery, Digestive Disease Institute, Cleveland Clinic, 9500 Euclid Ave/A30, Cleveland, OH, 44195, USA
| | - Feza H Remzi
- Department of Colorectal Surgery, Digestive Disease Institute, Cleveland Clinic, 9500 Euclid Ave/A30, Cleveland, OH, 44195, USA
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Shearer R, Gale M, Aly OE, Aly EH. Have early postoperative complications from laparoscopic rectal cancer surgery improved over the past 20 years? Colorectal Dis 2014; 15:1211-26. [PMID: 23711242 DOI: 10.1111/codi.12302] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2012] [Accepted: 01/21/2013] [Indexed: 02/01/2023]
Abstract
AIM Laparoscopic rectal cancer surgery has been increasingly used since 1991 following the publication of the first case series. Since then, several studies have confirmed that laparoscopic surgery for rectal cancer is challenging with associated morbidity and mortality. The aim of this study was to determine if the rates of early postoperative complications in laparoscopic rectal cancer surgery have improved over the past 20 years. METHOD A literature search of the EMBASE and MEDLINE databases between August 1991 and August 2011 was conducted using the keywords laparoscopy, rectal cancer and postoperative complications. Data were analysed using linear regression ANOVA performed in GNUMERICS software. RESULTS Ninety-seven studies were included for analysis. Over the last 20 years there has been no significant change in the rate of any early postoperative complications (anastomotic leak, conversion, sexual, urinary or faecal dysfunction, wound infection, overall morbidity or mortality). However, in the last 3 years, the rate of positive resection margins has decreased significantly (P = 0.01). CONCLUSION There was no evidence of a statistically significant change in early postoperative complications until 3 years ago. This may reflect the inherent morbidity associated with rectal surgery regardless of the approach used, the limitations of the current laparoscopic instrumentation or the relatively long learning curve. With increasing experience, a repeat analysis in the near future following the publication of ongoing randomized clinical trials might show improved outcomes.
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Affiliation(s)
- R Shearer
- Laparoscopic Colorectal Surgery and Training Unit, Aberdeen Royal Infirmary, Aberdeen, UK
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Lai R, Lu Y, Li Q, Guo J, Chen G, Zeng W. Risk factors for anastomotic leakage following anterior resection for colorectal cancer: the effect of epidural analgesia on occurrence. Int J Colorectal Dis 2013; 28:485-92. [PMID: 23014977 DOI: 10.1007/s00384-012-1585-5] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/16/2012] [Indexed: 02/04/2023]
Abstract
PURPOSE The effect of thoracic epidural analgesia (TEA) on anastomotic leakage (AL) after anterior resection for colorectal cancer is controversial. The aim of this study was to evaluate the risk factors including TEA for the occurrence of AL after anterior resection for colorectal cancer. METHODS This retrospective study included 1,312 patients with colorectal cancer who underwent anterior resection between 2000 and 2011 at the Cancer Center, Sun Yat-sen University. Univariate and multivariate logistics analyses were performed to determine the risk factors, including TEA, for AL. Additionally, we evaluated the effect of TEA on outcome parameters. RESULTS AL occurred in 118 (9 %) of the 1,312 patients. In univariate analysis, the American Society of Anesthesiologists (ASA) score, history of hypertension, episodes of hypotension, anastomosis technique, tumor localization, anesthesia duration, and perioperative blood transfusion were significant risk factors for AL. Multivariate analysis showed that ASA (P = 0.001), perioperative blood transfusion (P < 0.001), anastomosis technique (P = 0.019), anesthesia duration (P = 0.033), and tumor localization (P = 0.009) were independent factors affecting AL. TEA had no effect on the occurrence of AL (P = 0.451) in multivariate analysis. However, the length of hospital stay was shortened by the use of TEA (P < 0.001). CONCLUSIONS The results of this retrospective study suggest that TEA has no effect on the occurrence of AL. However, TEA may be recommended to shorten the length of hospital stay.
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Affiliation(s)
- Renchun Lai
- State Key Laboratory of Oncology in South China, Guangzhou, China
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Ahn BH, Lee KH, Park JB, Song MS, Kim JY, Kim JS. Short-term outcomes after laparoscopic surgery following preoperative chemoradiotherapy for rectal cancer. JOURNAL OF THE KOREAN SURGICAL SOCIETY 2012; 83:281-7. [PMID: 23166887 PMCID: PMC3491230 DOI: 10.4174/jkss.2012.83.5.281] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/13/2012] [Revised: 08/06/2012] [Accepted: 09/02/2012] [Indexed: 02/04/2023]
Abstract
Purpose The safety and the feasibility of performing laparoscopic surgery for rectal cancer after preoperative chemoradiotherapy (CRT) have not yet been established. Thus, the aim of this study was to evaluate the efficacy and the safety of laparoscopic rectal cancer surgery performed after preoperative CRT. Methods We enrolled 124 consecutive patients who underwent laparoscopic surgery for rectal cancer. Of these patients, 56 received preoperative CRT (CRT group), whereas 68 did not (non-CRT group). The patients who were found to have distant metastasis and open conversion during surgery were excluded. The clinicopathologic parameters were evaluated and the short-term outcomes were compared between the CRT and non-CRT groups. Results The mean operation time was longer in the CRT group (294 minutes; range, 140 to 485 minutes; P = 0.004). In the non-CRT group, the tumor sizes were larger (mean, 4.0 cm; range, 1.2 to 8.0 cm; P < 0.001) and more lymph nodes were harvested (mean, 12.9; range, 0 to 35; P < 0.001). However, there was no significant difference between the two groups in time to first bowel movement, tolerance of a soft diet, length of hospital stay, and postoperative complication rate. Conclusion Performing laparoscopic surgery for rectal cancer after preoperative CRT may be safe and feasible if performed by a highly skilled laparoscopic surgeon. Randomized controlled trials and long-term follow-up studies are necessary to support our results.
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Affiliation(s)
- Byong Hyon Ahn
- Department of Surgery, Chungnam National University Hospital, Daejeon, Korea
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Risk factors for anastomotic leakage after laparoscopic surgery for rectal cancer using a stapling technique. Surg Laparosc Endosc Percutan Tech 2012; 22:239-43. [PMID: 22678320 DOI: 10.1097/sle.0b013e31824fbb56] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
PURPOSE This study evaluated the risk factors for anastomotic leakage after laparoscopic surgery for rectal cancer using a stapling technique. METHODS The total prospective registry of 111 patients with rectal cancer who initially underwent laparoscopic low anterior resection using a stapling technique was reviewed. Univariate and multivariate analyses were carried out to identify relevant risk factors. RESULTS Overall anastomotic leakage rate was 5.4% (6/111). Univariate analysis demonstrated that body mass index (BMI) (P=0.0377) was significantly associated with anastomotic leakage. After univariate analysis, the variables of BMI and the size of the circular stapler (P=0.0923) were selected for multivariate analysis, as their P values were <0.2, and multivariate analysis demonstrated that BMI was independently predictive of developing anastomotic leakage (P=0.0458). CONCLUSIONS Laparoscopic surgery for rectal cancer using a stapling technique can be performed safely without increasing the risk of anastomotic leakage, and increased BMI might be a potential risk factor for anastomotic leakage.
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Kupcsulik P, Nagy A, Lázár G, Farkas J, Ottlakán A, Martyin G, Oláh T, Dinka T, Oláh A, Jakab F. [CS circular staplers for rectal surgery--a multicenter prospective study]. Magy Seb 2010; 63:62-6. [PMID: 20400396 DOI: 10.1556/maseb.63.2010.2.2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
While circular staplers are used worldwide - especially for rectal anastomoses - there are relatively few publications on the effectiveness of these instruments. Between May 2008 and March 2009 in a prospective multicenter surveillance study 136 patients were enrolled from nine surgical units in Hungary. Rectal anastomoses were performed mainly in the upper and middle third of the rectum. In 115 cases adenocarcinoma, in 16 patients other type of malignant tumors and in 5 cases with anastomosis in the distal third were estimated too. 20 laparoscopic and 116 "conventional" surgery was performed. 32 mm diameter type CS circular staplers were used in 50, 28 mm in 85, and 25 mm in one case. Intraoperative technical failure of the device occurred in four cases, immediate correction were performed successfully in all of these patients and they recovered without postoperative complications. Late anastomotic leaks were detected in five patients, of which three healed spontaneously and two required reoperation. In the whole series two patients died representing a 1.4 percent mortality rate. The CS circular staplers proved to be appropriate for infraperitoneal rectal anastomoses.
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Affiliation(s)
- Péter Kupcsulik
- Semmelweis Egyetem I. sz. Sebészeti Klinika 1082 Budapest Ulloi út 78.
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Kim JS, Cho SY, Min BS, Kim NK. Risk factors for anastomotic leakage after laparoscopic intracorporeal colorectal anastomosis with a double stapling technique. J Am Coll Surg 2010; 209:694-701. [PMID: 19959036 DOI: 10.1016/j.jamcollsurg.2009.09.021] [Citation(s) in RCA: 157] [Impact Index Per Article: 11.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2009] [Revised: 07/29/2009] [Accepted: 09/14/2009] [Indexed: 02/07/2023]
Abstract
BACKGROUND Laparoscopic rectal transection carries the risk of anastomotic leakage because of its technical difficulty and long staple line with an inadequate cutting angle. Our objective was to investigate the risk factors affecting anastomotic leakage after laparoscopic intracorporeal colorectal anastomosis with a double stapling technique. STUDY DESIGN Between November 2006 and September 2008, 270 consecutive patients underwent laparoscopic sigmoidectomy and anterior resection with double stapling technique for distal sigmoid and rectal cancer. Data were collected prospectively. Univariate and multivariate analyses were performed to determine risk factors for anastomotic leakage. Additionally, we evaluated the relationship between the number of stapler firings and clinical parameters. RESULTS Anastomotic leakage was noted in 17 (6.3%) of 270 patients. In univariate analyses, tumor location (p = 0.021), operation time (p = 0.025), number of stapler firings (p = 0.040), and diameter of the circular stapler (p = 0.022) were significant risk factors for anastomotic leakage. Multivariate analyses showed that middle or lower rectal cancer was an independent factor affecting anastomotic leakage (p = 0.013). The number of stapler firings increased significantly in men (p = 0.023), in patients with a tumor at a lower level (p = 0.034), and in those with longer operation times (p < 0.001). CONCLUSIONS A reduction in the number of linear stapler firings is necessary to avoid anastomotic leakage after laparoscopic colorectal anastomosis with a double stapling technique. We recommend that a diverting ileostomy is mandatory in patients with middle and lower rectal cancer where multiple linear staplers were used.
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Affiliation(s)
- Jin Soo Kim
- Department of Surgery, Yonsei University College of Medicine, Seoul 120-752, Korea
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Pereira RMA, Zanatta A, Preti CDL, de Paula FJF, da Motta ELA, Serafini PC. Should the Gynecologist Perform Laparoscopic Bowel Resection to Treat Endometriosis? Results Over 7 Years in 168 Patients. J Minim Invasive Gynecol 2009; 16:472-9. [DOI: 10.1016/j.jmig.2009.04.004] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2009] [Revised: 04/05/2009] [Accepted: 04/09/2009] [Indexed: 10/20/2022]
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10
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Barth U. [Incident reports with surgical staplers]. Chirurg 2009; 80:735-40. [PMID: 19517076 DOI: 10.1007/s00104-009-1721-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
BACKGROUND The study was initiated to evaluate the risks of surgical staplers. METHODS In the years 2002-2007, a total of 165 reports of incidents or corrective actions from 3 manufacturers were registered and retrospectively analyzed with respect to the prevalent product default appearance, the results of the manufacturer's investigations and the severity of the consequences for patient. RESULTS Severe patient consequences occurred in only 35.2%. In the majority of the cases no patient injury resulted from the reported malfunction and the investigations revealed no product error (52.7%). CONCLUSION The surgical staplers are predominantly safe for application in thoracic and abdominal surgery. The incident reports are important for risk assessment and improvement of the surgical staplers.
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Affiliation(s)
- U Barth
- Abteilung Medizinprodukte, Bundesinstitut für Arzneimittel und Medizinprodukte, Zitelmannstrasse 9-11, Bonn, Germany.
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11
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A Y-shaped vinyl hood that creates pneumoperitoneum in laparoscopic rectal cancer surgery (Y-hood method.): a new technique for laparoscopic low anterior resection. Surg Endosc 2009; 24:476-84. [DOI: 10.1007/s00464-009-0564-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2008] [Revised: 04/30/2009] [Accepted: 05/14/2009] [Indexed: 01/17/2023]
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Wound infection after a laparoscopic resection for colorectal cancer. Surg Today 2008; 38:618-22. [PMID: 18612786 DOI: 10.1007/s00595-007-3684-4] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2007] [Accepted: 10/08/2007] [Indexed: 02/04/2023]
Abstract
PURPOSE The aim of this study was to investigate whether the wound infection (WI) rate in laparoscopic surgery (LS) for colorectal cancer is lower than that in open surgery (OS), and to evaluate the influence of perioperative intravenous antibiotic prophylaxis on the development of WI in LS. METHODS We performed a meta-analysis study comparing the WI rate in patients who underwent either OS or LS in randomized controlled trials (RCTs), with a relatively large number of registered patients. Moreover, a subgroup analysis of recently reported RCTs from Japan was performed, and 290 consecutive patients who underwent LS for colorectal cancer at our institution were evaluated for the influence of perioperative intravenous antibiotic prophylaxis on the development of WI. RESULTS The WI rate of the LS group was significantly lower than that of the OS group in a meta-analysis; however, no positive effect of the intra-and postoperative antibiotic prophylaxis on the development of WI was demonstrated. CONCLUSIONS Laparoscopic surgery for colorectal cancer is considered a surgical technique that has a lower incidence of WI in comparison to OS. Well-designed prospective, randomized controlled trials should therefore be conducted to evaluate whether intraoperative repeated dosing or postoperative repeated dosing is effective in reducing WI in LS.
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Yamamoto S, Fujita S, Akasu T, Ishiguro S, Kobayashi Y, Moriya Y. Wound infection after elective laparoscopic surgery for colorectal carcinoma. Surg Endosc 2007; 21:2248-52. [PMID: 17514386 DOI: 10.1007/s00464-007-9358-x] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2006] [Revised: 12/26/2006] [Accepted: 01/22/2007] [Indexed: 12/29/2022]
Abstract
BACKGROUND The aim of this study was to evaluate various clinical parameters that would influence the occurrence of wound infection (WI) in elective laparoscopic surgery (LS) for colorectal carcinoma. METHODS The study included 290 patients who underwent LS between June 2001 and December 2005. WI was diagnosed within 30 days of the operation, and both superficial and deep incision surgical site infection were evaluated together. RESULTS Eighteen (6.2%) were diagnosed with WI. Of the infected patients, nine (50%) had WI at the extraction site, six (33%) at the port site of the drainage tube, and three (17%) at the supraumbilical incision. Following bivariate analysis, the variables of stoma creation, intraoperative hypotension, and length of operation were selected for multivariate analysis as their P values were <0.2, the predominant cutoff, and stoma creation and intraoperative hypotension were independently predictive of developing WI. Regarding the duration of postoperative hospital stay, there was no significant difference between patients with or without WI. CONCLUSIONS Stoma creation and intraoperative hypotension were independent risk factors for WI. The results obtained in this study should be considered in an effort to prevent WI in LS for colorectal carcinoma, although these risk factors need further evaluation.
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Affiliation(s)
- Seiichiro Yamamoto
- Division of Colorectal Surgery, National Cancer Center Hospital, 5-1-1, Tsukiji, Chuo-ku, Tokyo, 104-0045, Japan.
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Palanivelu C, Sendhilkumar K, Jani K, Rajan PS, Maheshkumar GS, Shetty R, Parthasarthi R. Laparoscopic anterior resection and total mesorectal excision for rectal cancer: a prospective nonrandomized study. Int J Colorectal Dis 2007; 22:367-72. [PMID: 16786316 DOI: 10.1007/s00384-006-0165-y] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/18/2006] [Indexed: 02/04/2023]
Abstract
BACKGROUND The purpose of this study was to present our experience of laparoscopic total mesorectal resection, including ultralow resection and coloanal anastomosis. MATERIALS AND METHODS Between 1993 and 2005, patients fit for general anesthesia, with resectable cancers, and with lower edge of tumor beyond 5 cm of the anal verge were subjected to laparoscopic anterior resection with sphincter preservation. Double stapling technique is used to establish bowel continuity. RESULTS A total of 170 patients, 88 males and 82 females, were subjected to successful laparoscopic anterior resection, which included high anterior resection (n=90), low anterior resection (n=52), ultralow anterior resection (n=20), and coloanal anastomosis (n=8). The average age of patients was 58.4 years (12-90 years). Mean operating time was 130 min and mean hospital stay was 7 days. The morbidity was 13.5% with nil mortality. With an average follow-up of 49 months (range 9 years to 3 months), 9 patients developed local recurrence and 45 patients developed distant metastasis. CONCLUSION In selected cases, laparoscopic anterior resection is possible for all levels of rectal tumors, allowing sphincter preservation and maintaining oncological safety.
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Affiliation(s)
- C Palanivelu
- Gem Hospital, 45 A, Pankaja Mill Road, Coimbatore, Tamilnadu 641045, India
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15
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Abstract
BACKGROUND Because definitive long-term results are not yet available, the oncological safety of laparoscopic surgery for treatment of rectal cancer remains controversial. However, laparoscopic total mesorectal excision (LTME) for rectal cancer has been proposed to have several short-term advantages in comparison with open total mesorectal excision (OTME). OBJECTIVES To evaluate whether there are any relevant differences in safety and efficacy after elective LTME, for the resection of rectal cancer, compared with OTME. SEARCH STRATEGY We searched MEDLINE, EMBASE, Cochrane Central register of Controlled Trials (CENTRAL), and Current Contents from 1990 to December 2005. Searches were conducted using MESH terms: "laparoscopy", "minimally invasive","colorectal neoplasms". Furthermore we used the following text words: laparoscopy, surgical procedures, minimally invasive, rectal cancer, rectal carcinoma, rectal adenocarcinoma, rectal neoplasms, anterior resection, abdominoperineal resection, total mesorectal excision. SELECTION CRITERIA We included randomised controlled trials (RCTs), controlled clinical trials and case series comparing LTME versus OTME. Furthermore case reports which describe LTME were also included. DATA COLLECTION AND ANALYSIS Two reviewers independently assessed study quality. All relevant studies have been categorized according to the evidence they provide according to the guidelines for "Levels of Evidence and Grades of Recommendation" supplied by the "Oxford Centre for Evidence-based Medicine". Disagreements were solved by discussion. MAIN RESULTS 80 studies were identified of which 48 studies, representing 4224 patients, met the inclusion criteria. Methodological quality of most of the included studies was poor; three studies were grade 1b (individual randomised trial), 12 grade 2b (individual cohort study), 5 grade 3b (individual case-control study) and 28 grade 4 (case-series). As only one RCT described primary outcome, 3-year and 5-year disease-free survival rates, no meta-analyses could be performed. No significant differences in terms of disease-free survival rate, local recurrence rate, mortality, morbidity, anastomotic leakage, resection margins, or recovered lymph nodes were found. There is evidence that LTME results in less blood loss, quicker return to normal diet, less pain, less narcotic use and less immune response. It seems likely that LTME is associated with longer operative time and higher costs. No results of quality of life were reported. AUTHORS' CONCLUSIONS Based on evidence mainly from non-randomized studies, LTME appears to have clinically measurable short-term advantages in patients with primary resectable rectal cancer. The long-term impact on oncological endpoints awaits the findings from large on-going randomized trials.
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Affiliation(s)
- S Breukink
- Groningen University Hospital, Dept. of Surg., Hanzeplein 1, 9700 RB, Groningen, Netherlands.
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Yamamoto S, Fujita S, Akasu T, Uehara K, Moriya Y. Reduction of prolonged postoperative hospital stay after laparoscopic surgery for colorectal carcinoma. Surg Endosc 2006; 20:1467-72. [PMID: 16823650 DOI: 10.1007/s00464-005-0651-2] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2005] [Accepted: 02/23/2006] [Indexed: 02/08/2023]
Abstract
BACKGROUND In evaluating the quality of laparoscopic surgery (LS) for colorectal carcinoma, many previous reports have used median or range values to assess the length of postoperative hospital stay and to show the complication and conversion rates separately. However, with this method, it is impossible to assess the proportion of patients who required prolonged postoperative hospital stay because of perioperative morbidities. This study investigated the proportion of patients who benefited from LS as minimally invasive surgery by assessing the percentage of patients who required prolonged postoperative hospital stay because of major perioperative morbidities. METHODS A review of 202 patients who underwent LS for colorectal carcinoma at the authors' hospital between January 2002 and December 2004 was performed. Short-term outcomes were compared among the patients who underwent LS in 2002, 2003, and 2004. RESULTS No significant differences were observed in baseline characteristics among the groups, and all the procedures in this study were completed laparoscopically. There were no significant differences in the operative times and intraoperative blood losses among the groups. Most of the patients resumed liquid intake on postoperative day 1 and solid food on day 3. However, there was a significant difference in the rate of postoperative prolonged hospital stays by year of surgery. In 2004, 97.3% of the patients (72/74) undergoing LS could be discharged to home within 8 days postoperatively. Major complications occurred at a low rate of 1.4% (1/74) in 2004. Regarding the reasons for prolonged postoperative hospital stay, inappropriate judgment of the physician in charge, based primarily on requests from patients without medical necessity, disappeared in 2004. CONCLUSIONS When LS is performed properly by specialists who have accumulated sufficient experience in both LS and conventional open surgery for colorectal carcinoma, up to 97% of patients undergoing LS can benefit from minimally invasive surgery.
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Affiliation(s)
- S Yamamoto
- Division of Colorectal Surgery, National Cancer Center Hospital, 5-1-1, Tsukiji, Chuo-ku, Tokyo, 104-0045, Japan
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