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Jia L, Zhao H, Liu J. Meta-analysis of postoperative incision infection risk factors in colorectal cancer surgery. Front Surg 2024; 11:1415357. [PMID: 39193402 PMCID: PMC11347452 DOI: 10.3389/fsurg.2024.1415357] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2024] [Accepted: 07/09/2024] [Indexed: 08/29/2024] Open
Abstract
Objective To evaluate the risk factors for postoperative incision infection in colorectal cancer, this meta-analysis aimed to identify key variables impacting infection incidence following colorectal cancer surgery. Methods Utilizing a meta-analytical approach, studies published from January 2015 to December 2022 were systematically collected and analyzed through the assessment of factors like body mass index, diabetes, albumin levels, malnutrition, and surgical duration. Results The meta-analysis of eleven high-quality studies revealed that elevated BMI, diabetes, low albumin levels, malnutrition, and extended surgical duration were associated with increased infection risk, while laparoscopic procedures showed potential for risk reduction. Conclusions This study underscores the significance of preoperative risk assessment and management in mitigating postoperative incision infections in colorectal cancer patients. The findings present actionable insights for clinicians to enhance patient prognoses and overall quality of life.
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Affiliation(s)
- Li Jia
- Department of Infection Control, People's Hospital of Dayi County, Chengdu, Sichuan Province, China
| | - Huacai Zhao
- Department of Urology, People's Hospital of Dayi County, Chengdu, Sichuan Province, China
| | - Jia Liu
- Department of Infection Control, Chengdu Fifth People’s Hospital, Chengdu, Sichuan Province, China
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2
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Li J, Yao H, Lu Y, Zhang S, Zhang Z. Chinese national clinical practice guidelines on prevention, diagnosis and treatment of early colorectal cancer. Chin Med J (Engl) 2024:00029330-990000000-01169. [PMID: 39104005 DOI: 10.1097/cm9.0000000000003253] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2023] [Indexed: 08/07/2024] Open
Abstract
BACKGROUND The incidence and mortality of colorectal cancer (CRC) in China are increasing in recent years. The clarified pathogenesis and detectable precancerous lesions of CRC make it possible to prevent, screen, and diagnose CRC at an early stage. With the development of endoscopic and surgical techniques, the choice of treatment for early CRC is also worth further discussion, and accordingly, a standard follow-up program after treatment needs to be established. METHODS This clinical practice guideline (CPG) was developed following the recommended process of the World Health Organization, adopting Grading of Recommendations Assessment, Development and Evaluation (GRADE) in assessing evidence quality, and using the Evidence to Decision framework to formulate clinical recommendations, thereby minimizing bias and increasing transparency of the CPG development process. We used the Reporting Items for practice Guidelines in HealThcare (RIGHT) statement and Appraisal of Guidelines for Research and Evaluation II (AGREE II) as reporting and conduct guides to ensure the guideline's completeness and transparency. RESULTS This CPG comprises 46 recommendations concerning prevention, screening, diagnosis, treatment, and surveillance of CRC. In these recommendations, we have indicated protective and risk factors for CRC and made recommendations for chemoprevention. We proposed a suitable screening program for CRC based on the Chinese context. We also provided normative statements for the diagnosis, treatment, and surveillance of CRC based on existing clinical evidence and guidelines. CONCLUSIONS The 46 recommendations in this CPG are formed with consideration for stakeholders' values and preferences, feasibility, and acceptability. Recommendations are generalizable to resource-limited settings with similar CRC epidemiology pattern as China.
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Affiliation(s)
- Jingnan Li
- Department of Gastroenterology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing 100730, China
| | - Hongwei Yao
- Department of General Surgery, Beijing Friendship Hospital, Capital Medical University, National Clinical Research Center for Digestive Diseases, Beijing 100050, China
| | - Yun Lu
- Department of General Surgery, The Affiliated Hospital of Qingdao University, Qingdao, Shandong 266555, China
| | - Shutian Zhang
- Department of Gastroenterology, Beijing Friendship Hospital, Capital Medical University, National Clinical Research Center for Digestive Disease, Beijing 100050, China
| | - Zhongtao Zhang
- Department of General Surgery, Beijing Friendship Hospital, Capital Medical University, National Clinical Research Center for Digestive Diseases, Beijing 100050, China
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Machairas N, Di Martino M, Primavesi F, Underwood P, de Santibanes M, Ntanasis-Stathopoulos I, Urban I, Tsilimigras DI, Siriwardena AK, Frampton AE, Pawlik TM. Simultaneous resection for colorectal cancer with synchronous liver metastases: current state-of-the-art. J Gastrointest Surg 2024; 28:577-586. [PMID: 38583912 DOI: 10.1016/j.gassur.2024.01.034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2023] [Revised: 01/25/2024] [Accepted: 01/27/2024] [Indexed: 04/09/2024]
Abstract
BACKGROUND A large proportion of patients with colorectal cancer (CRC) presents with synchronous colorectal liver metastases (sCRLM) at diagnosis. Surgical approaches for patients with sCRLM have evolved over the past decades. Simultaneous resection (SR) of CRC and sCRLM for selected patients has emerged as a safe and efficient alternative approach to traditional staged resections. METHODS A comprehensive review of the literature was performed using MEDLINE/PubMed and Web of Science databases with the end of search date October 30, 2023. The MeSH terms "simultaneous resections" and "combined resections" in combination with "colorectal liver metastases," "colorectal cancer," "liver resection," and "hepatectomy" were searched in the title and/or abstract. RESULTS SRs aim to achieve maximal tumor clearance, minimizing the risk of disease progression and optimizing the potential for long-term survival. Improvements in perioperative care, advances in surgical techniques, and a better understanding of patient selection criteria have collectively contributed to reducing morbidity and mortality associated with these complex procedures. Several studies have demonstrated that SR are associated with reduced overall length of stay and lower costs with comparable morbidity and long-term outcomes. In light of these outcomes, the proportion of patients undergoing SR for CRC and sCRLM has increased substantially over the past 2 decades. CONCLUSION For patients with sCRLM, SR represents an attractive alternative to the traditional staged approach and should be selectively used; however, the decision on whether to proceed with a simultaneous versus staged approach should be individualized based on several patient- and disease-related factors.
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Affiliation(s)
- Nikolaos Machairas
- Second Department of Propaedeutic Surgery, National and Kapodistrian University of Athens, Medical School, Athens, Greece
| | - Marcello Di Martino
- Department of Health Sciences, University of Piemonte Orientale, Novara, Italy; Department of Surgery, University Maggiore Hospital della Carita, Novara, Italy
| | - Florian Primavesi
- Department of General, Visceral and Vascular Surgery, HPB Centre, Salzkammergutklinikum Hospital, Vöcklabruck, Austria
| | - Patrick Underwood
- Department of Surgery, The Ohio State University Wexner Medical Center and James Cancer Hospital and Solove Research Institute, Columbus, Ohio, United States
| | - Martin de Santibanes
- Department of Surgery, Division of HPB Surgery, Liver and Transplant Unit, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | - Ioannis Ntanasis-Stathopoulos
- Department of Clinical Therapeutics, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Iveta Urban
- Department of General, Visceral and Vascular Surgery, HPB Centre, Salzkammergutklinikum Hospital, Vöcklabruck, Austria
| | - Diamantis I Tsilimigras
- Department of Surgery, The Ohio State University Wexner Medical Center and James Cancer Hospital and Solove Research Institute, Columbus, Ohio, United States
| | - Ajith K Siriwardena
- Hepato-Pancreato-Biliary Unit, Manchester Royal Infirmary, Manchester M13 9WL, United Kingdom
| | - Adam E Frampton
- HPB Surgical Unit, Royal Surrey NHS Foundation Trust, Guildford, Surrey, United Kingdom; Section of Oncology, Surrey Cancer Research Institute, Department of Clinical and Experimental Medicine, Faculty of Health and Medical Sciences, The Leggett Building, University of Surrey, Guildford, United Kingdom
| | - Timothy M Pawlik
- Department of Surgery, The Ohio State University Wexner Medical Center and James Cancer Hospital and Solove Research Institute, Columbus, Ohio, United States; Department of Surgery, The Urban Meyer III and Shelley Meyer Chair for Cancer Research, The Ohio State University, Wexner Medical Center, Columbus, Ohio, United States.
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4
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Abernethy EK, Aly EH. Postoperative Ileus after Minimally Invasive Colorectal Surgery: A Summary of Current Strategies for Prevention and Management. Dig Surg 2024; 41:79-91. [PMID: 38359801 PMCID: PMC11025667 DOI: 10.1159/000537805] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2023] [Accepted: 02/12/2024] [Indexed: 02/17/2024]
Abstract
BACKGROUND Postoperative ileus (POI) is one of the most common postoperative complications after colorectal surgery and prolongs hospital stays. Minimally invasive surgery (MIS) has reduced POI, but it remains common. This review explores the current methods for preventing and managing POI after MIS. SUMMARY Preoperative interventions, including optimising nutrition, preoperative medicationn, and mechanical bowel preparation with oral antibiotics, may have a role in preventing POI. Transversus abdominis plane blocks and lidocaine could replace epidural analgesia in MIS. Fluid overload should be avoided; in some cases, goal-directed fluid therapy may aid in achieving this. Pharmacological agents, such as prucalopride and dexmedetomidine, could target mechanisms underlying POI. New strategies to stimulate vagal nerve activity may promote postoperative gastrointestinal motility. Preoperative bowel stimulation could potentially reduce POI following loop ileostomy closure. However, the evidence base for several interventions remains weak and requires further corroboration with robust studies. KEY MESSAGES Despite the increasing use of MIS, POI remains a major issue following colorectal surgery. Further strategies to prevent POI are rapidly emerging. Studies using standardised definitions and perioperative care will help validate these interventions and remove barriers to accurate meta-analysis. Future studies should focus on establishing the impact of these interventions on POI after MIS specifically.
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Affiliation(s)
| | - Emad H Aly
- University of Aberdeen, Aberdeen, UK
- Aberdeen Royal Infirmary, Aberdeen, UK
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Bohne A, Grundler E, Knüttel H, Völkel V, Fürst A. Impact of laparoscopic versus open surgery on humoral immunity in patients with colorectal cancer: a systematic review and meta-analysis. Surg Endosc 2024; 38:540-553. [PMID: 38102395 PMCID: PMC10830603 DOI: 10.1007/s00464-023-10582-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2023] [Accepted: 11/04/2023] [Indexed: 12/17/2023]
Abstract
BACKGROUND Laparoscopic surgery (LS) is hypothesized to result in milder proinflammatory reactions due to less severe operative trauma, which may contribute to the observed clinical benefits after LS. However, previous systematic reviews and meta-analyses on the impact of LS on immunocompetence are outdated, limited and heterogeneous. Therefore, the humoral response after laparoscopic and open colorectal cancer (CRC) resections was evaluated in a comprehensive systematic review and meta-analysis. METHODS Included were randomized controlled trials (RCTs) measuring parameters of humoral immunity after LS compared to open surgery (OS) in adult patients with CRC of any stage. MEDLINE, Embase, Web of Science (SCI-EXPANDED), Cochrane Library, Google Scholar, ClinicalTrials.gov and ICTRP (World Health Organization) were systematically searched. Risk of bias (RoB) was assessed using the Cochrane RoB2 tool. Weighted inverse variance meta-analysis of mean differences was performed for C-reactive protein (CRP), interleukin (IL)-6, IL-8, tumour necrosis factor (TNF)α and vascular endothelial growth factor (VEGF) using the random-effects method. Methods were prospectively registered in PROSPERO (CRD42021264324). RESULTS Twenty RCTs with 1131 participants were included. Narrative synthesis and meta-analysis up to 8 days after surgery was performed. Quantitative synthesis found concentrations to be significantly lower after LS at 0-2 h after surgery (IL-8), at 3-9 h (CRP, IL-6, IL-8, TNFα) and at postoperative day 1 (CRP, IL-6, IL-8, VEGF). At 3-9 h, IL-6 was notably lower in the LS group by 86.71 pg/ml (mean difference [MD] - 86.71 pg/ml [- 125.05, - 48.37], p < 0.00001). Combined narratively, 13 studies reported significantly lower concentrations of considered parameters in LS patients, whereas only one study reported lower inflammatory markers (for CRP and IL-6) after OS. CONCLUSION The increase in postoperative concentrations of several proinflammatory parameters was significantly less pronounced after LS than after OS in this meta-analysis. Overall, the summarized evidence reinforces the view of a lower induction of inflammation due to LS.
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Affiliation(s)
- A Bohne
- Universität Regensburg, Universitätsstraße 31, 93053, Regensburg, Germany.
| | - E Grundler
- Universität Regensburg, Universitätsstraße 31, 93053, Regensburg, Germany
| | - H Knüttel
- Universität Regensburg, Universitätsbibliothek Regensburg, Universitätsstraße 31, 93053, Regensburg, Germany
| | - V Völkel
- Tumorzentrum Regensburg - Zentrum für Qualitätssicherung und Versorgungsforschung, Universität Regensburg, Am Biopark 9, 93053, Regensburg, Germany
| | - A Fürst
- Caritas Krankenhaus St. Josef Regensburg, Klinik Für Allgemein-, Viszeral-, Thoraxchirurgie und Adipositasmedizin, Landshuter Str. 65, 93053, Regensburg, Germany
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Bohne A, Grundler E, Knüttel H, Fürst A, Völkel V. Influence of Laparoscopic Surgery on Cellular Immunity in Colorectal Cancer: A Systematic Review and Meta-Analysis. Cancers (Basel) 2023; 15:3381. [PMID: 37444491 DOI: 10.3390/cancers15133381] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2023] [Revised: 06/22/2023] [Accepted: 06/25/2023] [Indexed: 07/15/2023] Open
Abstract
Colorectal cancer (CRC) is the third most common cancer worldwide. The main treatment options are laparoscopic (LS) and open surgery (OS), which might differ in their impact on the cellular immunity so indispensable for anti-infectious and antitumor defense. MEDLINE, Embase, Web of Science (SCI-EXPANDED), the Cochrane Library, Google Scholar, ClinicalTrials.gov, and ICTRP (WHO) were systematically searched for randomized controlled trials (RCTs) comparing cellular immunity in CRC patients of any stage between minimally invasive and open surgical resections. A random effects-weighted inverse variance meta-analysis was performed for cell counts of natural killer (NK) cells, white blood cells (WBCs), lymphocytes, CD4+ T cells, and the CD4+/CD8+ ratio. The RoB2 tool was used to assess the risk of bias. The meta-analysis was prospectively registered in PROSPERO (CRD42021264324). A total of 14 trials including 974 participants were assessed. The LS groups showed more favorable outcomes in eight trials, with lower inflammation and less immunosuppression as indicated by higher innate and adaptive cell counts, higher NK cell activity, and higher HLA-DR expression rates compared to OS, with only one study reporting lower WBCs after OS. The meta-analysis yielded significantly higher NK cell counts at postoperative day (POD)4 (weighted mean difference (WMD) 30.80 cells/µL [19.68; 41.92], p < 0.00001) and POD6-8 (WMD 45.08 cells/µL [35.95; 54.21], p < 0.00001). Although further research is required, LS is possibly associated with less suppression of cellular immunity and lower inflammation, indicating better preservation of cellular immunity.
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Affiliation(s)
- Annika Bohne
- Fakultät für Medizin, Universität Regensburg, Universitätsstraße 31, 93053 Regensburg, Germany
| | - Elena Grundler
- Fakultät für Medizin, Universität Regensburg, Universitätsstraße 31, 93053 Regensburg, Germany
| | - Helge Knüttel
- Universitätsbibliothek Regensburg, Universität Regensburg, Universitätsstraße 31, 93053 Regensburg, Germany
| | - Alois Fürst
- Caritas Krankenhaus St. Josef Regensburg, Klinik für Allgemein-, Viszeral-, Thoraxchirurgie und Adipositasmedizin, Landshuter Str. 65, 93053 Regensburg, Germany
| | - Vinzenz Völkel
- Tumorzentrum Regensburg-Zentrum für Qualitätssicherung und Versorgungsforschung der Universität Regensburg, Am BioPark 9, 93053 Regensburg, Germany
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7
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Fujimoto T, Manabe T, Yukimoto K, Tsuru Y, Kitagawa H, Okuyama K, Takesue S, Kai K, Noshiro H. Risk Factors for Postoperative Paralytic Ileus in Advanced-age Patients after Laparoscopic Colorectal Surgery: A Retrospective Study of 124 Consecutive Patients. J Anus Rectum Colon 2023; 7:30-37. [PMID: 36743464 PMCID: PMC9876602 DOI: 10.23922/jarc.2022-044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/20/2022] [Accepted: 11/09/2022] [Indexed: 01/25/2023] Open
Abstract
Objectives Postoperative paralytic ileus (POI) is one of the most common and troublesome complications following colorectal surgery. However, to date, the risk factors for POI remain unclear. This study aimed to identify the risk factors for POI following laparoscopic colorectal surgery in advanced-age patients. Methods The clinical data of 124 patients aged ≥75 years who underwent curative colorectal surgery from January 2018 to December 2020 were retrospectively reviewed. The relationship between POI and clinicopathological data including sarcopenia and visceral fat obesity was then assessed. Sarcopenia was defined as a low skeletal muscle mass index; visceral obesity, visceral fat with an area ≥100 cm2 on computed tomography at the level of the third lumbar vertebra; and sarcobesity, sarcopenia with visceral obesity. Results The rate of POI was 9% (12/124 patients), and all the affected patients improved with conservative treatment. In the univariate and multivariate analyses, sarcopenia and sarcobesity were significant predictive factors for POI. Conclusions Sarcopenia and sarcobesity may be risk factors for POI in patients aged ≥75 years after laparoscopic colorectal surgery.
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Affiliation(s)
- Takaaki Fujimoto
- Department of Surgery, Saga University Faculty of Medicine, Nabeshima, Japan
| | - Tatsuya Manabe
- Department of Surgery, Saga University Faculty of Medicine, Nabeshima, Japan
| | - Kumpei Yukimoto
- Department of Surgery, Saga University Faculty of Medicine, Nabeshima, Japan
| | - Yasuhiro Tsuru
- Department of Surgery, Saga University Faculty of Medicine, Nabeshima, Japan
| | - Hiroshi Kitagawa
- Department of Surgery, Saga University Faculty of Medicine, Nabeshima, Japan
| | - Keiichiro Okuyama
- Department of Surgery, Saga University Faculty of Medicine, Nabeshima, Japan
| | - Shin Takesue
- Department of Surgery, Saga University Faculty of Medicine, Nabeshima, Japan
| | - Keita Kai
- Department of Pathology, Saga University Hospital, Nabeshima, Japan
| | - Hirokazu Noshiro
- Department of Surgery, Saga University Faculty of Medicine, Nabeshima, Japan
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Durak D, Alkurt EG, Turhan VB, Tutan B, Sahiner IT, Kendirci M. Comparison of Short-Term Results of Laparoscopic and Open Surgeries for Colorectal Cancer: A Single-Center Experience. Cureus 2022; 14:e24635. [PMID: 35663698 PMCID: PMC9152636 DOI: 10.7759/cureus.24635] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/30/2022] [Indexed: 12/11/2022] Open
Abstract
OBJECTIVE Although laparoscopic colon cancer surgeries have increased in recent years, their oncological competence is questioned. In our study, we aimed to evaluate oncological competence by comparing laparoscopic and open surgery. METHOD The study was planned retrospectively. A total of 94 patients were included in the study, 42 of whom underwent laparoscopy, and 52 patients underwent open surgery. Both groups were compared in terms of demographic characteristics, staging, number of benign/malignant lymph nodes, histological findings, and complications. RESULT The final pathology report of all patients was adenocarcinoma. The median number of dissected lymph nodes was 20.9 in the open group (8-34) and 19.46 in the laparoscopy group (7-31) (p = 0.639). The median number of dissected malignant lymph nodes was 1 (0-13) in the open surgery group and 3.1 (0-8) in the laparoscopy group (p = 0.216). The laparoscopy group exhibited a longer operation time (281.2 ± 54.2 and 221.0 ± 51.5 min, respectively; p = 0.036) than the open surgery group, but a shorter intensive care unit (ICU) discharge, quicker initiation oral feeding, and shorter length of hospital stay (4.0 ± 0.9 vs 5.7 ± 2.0 days, respectively; p < 0.001). DISCUSSION Laparoscopic surgery elicits many benefits such as less wound infection, lower requirement for blood transfusion, shorter hospitalization, quicker initiation of oral feeding, and mobilization. Our study has shown that laparoscopic surgery provides quite adequate lymph node dissection when compared to oncological surgery, which is viewed with suspicion in the light of these benefits of laparoscopy.
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Affiliation(s)
- Dogukan Durak
- Gastrointestinal Surgery, Hitit University Çorum Erol Olçok Training and Research Hospital, Çorum, TUR
| | - Ertugrul G Alkurt
- General Surgery/Surgical Oncology, Hitit Üniversitesi Erol Olçok Eğitim ve Araştırma Hastanesi, Çorum, TUR
| | - Veysel Barış Turhan
- General Surgery, Turkish Ministry of Health Hitit University Çorum Erol Olçok Training and Research Hospital, Çorum, TUR
| | - Berksun Tutan
- General Surgery, Hitit University Çorum Erol Olçok Training and Research Hospital, Çorum, TUR
| | | | - Murat Kendirci
- General Surgery, Hitit University, Faculty of Medicine, Çorum, TUR
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Higashijima J, Kono T, Shimada M, Sugitani A, Kashihara H, Takasu C, Nishi M, Tokunaga T, Yoshikawa K. High Ligation of the Inferior Mesenteric Artery Induces Hypoperfusion of the Sigmoid Colon Stump During Anterior Resection. Front Surg 2021; 8:756873. [PMID: 34966775 PMCID: PMC8710543 DOI: 10.3389/fsurg.2021.756873] [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: 08/11/2021] [Accepted: 11/03/2021] [Indexed: 11/13/2022] Open
Abstract
Background: Anastomotic leakage (AL) after colorectal surgery is associated with insufficient vascular perfusion of the anastomotic ends. This study aimed to evaluate the effect of high vs. low ligation of the ileocolic artery and inferior mesenteric artery, respectively, on the vascular perfusion of the bowel stumps during ileocecal resection (ICR) and anterior rectal resection (AR). Methods: We retrospectively evaluated patients who underwent ICR or AR between 2016 and 2020. Real-time indocyanine green fluorescence angiography was performed to measure the fluorescence time (FT) as a marker of the blood flow in the proximal and distal stumps before anastomosis. Results: Thirty-four patients with lower right-sided colon cancer underwent laparoscopic ICR. Forty-one patients with rectosigmoid colon or rectal cancer underwent robotic high AR (HAR) (n = 8), robotic low AR (LAR) (n = 6), laparoscopic HAR (n = 8), or laparoscopic LAR (n = 19). The FT was similar in the ileal and ascending colon stumps (p = 1.000) and did not differ significantly between high vs. low ligation of the ileocolic artery (p = 0.934). The FT was similar in the sigmoid colon and rectal stumps (p = 0.642), but high inferior mesenteric artery ligation significantly prolonged FT in the sigmoid colon during AR compared with low ligation (p = 0.004), indicating that the high ligation approach caused significant hypoperfusion compared with low ligation. The AL rate was similar after low vs. high ligation. Conclusions: Low vascular perfusion of the bowel stumps may not be an absolute risk factor for AL. High inferior mesenteric artery ligation could induce sigmoid colon stump hypoperfusion during anterior rectal resection.
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Affiliation(s)
- Jun Higashijima
- Department of Digestive Surgery and Transplantation, Institute of Health Biosciences, The University of Tokushima, Tokushima, Japan
| | - Toru Kono
- Department of Digestive Surgery and Transplantation, Institute of Health Biosciences, The University of Tokushima, Tokushima, Japan.,Center for Clinical and Biomedical Research, Sapporo Higashi Tokushukai Hospital, Sapporo, Japan.,Advanced Surgery Center, Sapporo Higashi Tokushukai Hospital, Sapporo, Japan
| | - Mitsuo Shimada
- Department of Digestive Surgery and Transplantation, Institute of Health Biosciences, The University of Tokushima, Tokushima, Japan
| | - Ayumu Sugitani
- Center for Clinical and Biomedical Research, Sapporo Higashi Tokushukai Hospital, Sapporo, Japan
| | - Hideya Kashihara
- Department of Digestive Surgery and Transplantation, Institute of Health Biosciences, The University of Tokushima, Tokushima, Japan
| | - Chie Takasu
- Department of Digestive Surgery and Transplantation, Institute of Health Biosciences, The University of Tokushima, Tokushima, Japan
| | - Masaaki Nishi
- Department of Digestive Surgery and Transplantation, Institute of Health Biosciences, The University of Tokushima, Tokushima, Japan
| | - Takuya Tokunaga
- Department of Digestive Surgery and Transplantation, Institute of Health Biosciences, The University of Tokushima, Tokushima, Japan
| | - Kozo Yoshikawa
- Department of Digestive Surgery and Transplantation, Institute of Health Biosciences, The University of Tokushima, Tokushima, Japan
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10
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Ichikawa N, Homma S, Funakoshi T, Obuchi K, Ohshima T, Uemura K, Kon H, Ohno Y, Yokota R, Taketomi A, Kazui K, Ishikawa T, Mizukami T, Mino K, Maeda Y, Yoshida T, Shimokuni T, Aiyama T, Ono H, Morita T. The incidence of cardiovascular thrombotic complications after laparoscopic resection in colorectal cancer in Japanese hospitals: A large‐scale clinical study. Ann Gastroenterol Surg 2021; 6:396-404. [PMID: 35634183 PMCID: PMC9130878 DOI: 10.1002/ags3.12531] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2021] [Revised: 11/07/2021] [Accepted: 11/25/2021] [Indexed: 11/26/2022] Open
Abstract
Aim The aim of this retrospective study was to investigate the incidence of cardiovascular thrombotic complications after laparoscopic resection in colorectal cancer. Methods This study involved 2017 patients with stages 0‐III colorectal cancer who underwent laparoscopic surgery at 17 Japanese hospitals between January 2010 and December 2013. We assessed the incidence of postoperative cardiovascular thrombotic and haemorrhagic complications. Results Laparoscopic surgeries were performed in 1152 men and 865 women with 1405 colon and 612 rectal cancers, respectively. Overall, 3%, 38%, 17%, 8%, and 9% of patients had comorbidities of heart failure, high blood pressure, diabetes, history of stroke, and vascular disease, respectively. Antithrombotic agents were being consumed by 17% of patients. The types (and perioperative rest periods) of the antithrombotic agents were aspirin in 58% (18.6 days), clopidogrel in 19% (21.1 days), cilostazol in 13% (13.3 days), and warfarin potassium in 21% (14.6 days) of cases with antithrombotic agents. Surgical time and blood loss in the total cohort were 234 minutes and 56 mL. Four cases (0.2%) had cardiovascular thrombotic complications, including one severe cardiac infarction and one stroke with major sequelae (CHADS2 scores were 2 points in both cases). Hemorrhagic complications occurred in 19 cases (0.9%). In particular, the incidence of the major gastroduodenal haemorrhagic ulcer was higher in cases with antithrombotic agents than without them (0.05% vs 0%, P = .02). Conclusion The incidence of cardiovascular thrombotic complications was rare, although severe cardiac infarction and stroke could occur even after minimally invasive surgery in colorectal cancer.
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Affiliation(s)
- Nobuki Ichikawa
- Department of Gastroenterological Surgery I Graduate School of Medicine Hokkaido University Sapporo Japan
| | - Shigenori Homma
- Department of Gastroenterological Surgery I Graduate School of Medicine Hokkaido University Sapporo Japan
| | - Tohru Funakoshi
- Department of Surgery Sapporo‐Kosei General Hospital Sapporo Japan
| | - Keisuke Obuchi
- Department of Surgery Hakodate Municipal Hospital Hakodate Japan
| | - Takahiro Ohshima
- Department of Surgery Sapporo City General Hospital Sapporo Japan
| | - Kazuhito Uemura
- Department of Surgery Tomakomai City Hospital Tomakomai Japan
| | - Hirofumi Kon
- Department of Surgery KKR Sapporo Medical Center Sapporo Japan
| | - Yosuke Ohno
- Department of Surgery Asahikawa‐Kosei General Hospital Asahikawa Japan
| | - Ryoichi Yokota
- Department of Surgery Sunagawa City Medical Center Sunagawa Japan
| | - Akinobu Taketomi
- Department of Gastroenterological Surgery I Graduate School of Medicine Hokkaido University Sapporo Japan
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Costa G, Fransvea P, Lepre L, Rondelli F, Costa A, Campanelli M, Lisi G, Mastrangeli MR, Laracca GG, Garbarino GM, Ceccarelli G. 2D vs 3D laparoscopic right colectomy: A propensity score-matching comparison of personal experience with systematic review and meta-analysis. World J Gastrointest Surg 2021; 13:597-619. [PMID: 34194617 PMCID: PMC8223707 DOI: 10.4240/wjgs.v13.i6.597] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2021] [Revised: 05/04/2021] [Accepted: 05/18/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND The benefits of laparoscopic approach for right colectomy have been well established. However, the technical difficulty to construct the intra-corporeal anastomosis is still cumbersome.
AIM To analyze the results of 3D and 2D laparoscopic right colectomy and to compare it to the published series through a systematic review and meta-analysis.
METHODS A retrospective study with propensity score matching analysis of patients undergoing laparoscopic right colectomy at Umbria2 Hospitals from January 2014 to March 2020 was performed. A systematic review was accomplished comparing 2D and 3D right colectomy.
RESULTS In the personal series 47 patients of the 2D group were matched to 47 patients of the 3D group. The 3D group showed a favorable trend in terms of mean operative time (170.7 ± 32.9 min vs 183.8 ± 35.4 min; P = 0.053) and a significant lower anastomotic time (16.9 ± 2.3 min vs 19.6 ± 2.9 min, P < 0.001). The complete mesocolic excision (CME) subgroups analysis showed a shorter anastomotic time (16.5 ± 1.8 min vs 19.9 ± 3.0 min; P < 0.001) and operative time (175.0 ± 38.5 min vs 193.7 ± 37.1 min; P = 0.063) in the 3D group. Six studies and our series were included in the meta-analysis with 551 patients (2D group: 291; 3D group: 260).The pooled analysis demonstrated a significant difference in favour of the 3D group regarding the operative time (P < 0.001) and the anastomotic time (P < 0.001) while no differences were identified between groups in terms of blood loss (P = 0.827), LNH yield (P = 0.243), time to first flatus (P = 0.333), postoperative complications (P = 0.718) and length of stay (P = 0.835).
CONCLUSION The meta-analysis results showed that 3D laparoscopic right colectomy shortens operative and anastomotic time without affecting the standard lymphadenectomy. In our series, the advantage of the 3D system becomes evident when CME and/or more complex associated procedure are requested significantly reducing both the total operative and the anastomotic time.
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Affiliation(s)
| | - Pietro Fransvea
- Department of Emergency and Trauma Surgery, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome 00168, Italy
| | - Luca Lepre
- General Surgery Unit, Santo Spirito in Sassia Hospital, Rome 00193, Italy
| | - Fabio Rondelli
- Department of Surgical Science, University of Perugia, Santa Maria Teaching Hospital, Terni 05100, Italy
| | - Alessandro Costa
- Catholic University “Our Lady of Good Council” School of Medicine, Tirane 1023, Albania
| | - Michela Campanelli
- Department of Emergency Surgery, Tor Vergata University Hospital, Rome 00133, Italy
| | - Giorgio Lisi
- Department of General Surgery, Sant'Eugenio Hospital, Rome 00144, Italy
| | | | - Giovanni Guglielmo Laracca
- Department of Medical Surgical Science and Translational Medicine, Sapienza University of Rome, Sant'Andrea Hospital, Rome 00189, Italy
| | - Giovanni Maria Garbarino
- Department of Medical Surgical Science and Translational Medicine, Sapienza University of Rome, Sant'Andrea Hospital, Rome 00189, Italy
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Pollack E, Johnston S, Petraiuolo WJ, Roy S, Galvain T. Economic Analysis of Leak Complications in Anastomoses Performed with Powered versus Manual Circular Staplers in Left-Sided Colorectal Resections: A US-Based Cost Analysis. CLINICOECONOMICS AND OUTCOMES RESEARCH 2021; 13:531-540. [PMID: 34168470 PMCID: PMC8217739 DOI: 10.2147/ceor.s305296] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2021] [Accepted: 06/10/2021] [Indexed: 12/17/2022] Open
Abstract
Purpose To estimate the cost impact of using the ECHELON CIRCULAR™ Powered Stapler (ECP) compared with manual circular staplers (standard of care, SOC) among patients undergoing colectomy procedures that involve left-sided anastomosis. Methods A US hospital-based budget impact model was developed to estimate the impact of ECP in reducing the surgical complication of anastomotic leak. The incremental acquisition cost of ECP vs SOC was compared to the net potential savings from reduced complication costs. The model was based on complication rates from a recently published matching-adjusted indirect comparison (MAIC) that compared clinical and healthcare utilization outcomes of patients using ECP with those of a propensity score-matched retrospective SOC control cohort from a real-world clinical practice population. The model assessed total cost, average length of stay (LOS), proportion of patients with a non-home discharge, and all-cause readmission. Deterministic (DSA) and probabilistic sensitivity analyses (PSA) were conducted to evaluate the robustness of the model assumptions and inputs. Results Despite a higher device cost of $412 for ECP compared with $298 for a manual stapler, annual savings due to avoided complications with ECP was $53,987 for anastomotic leak, assuming 100 procedures per year with each type of circular stapler. ECP also helped to avoid 27 LOS days, 0.38 readmissions and 0.22 non-home discharges. Sensitivity analyses around potential drivers of costs established the robustness of economic savings with the use of ECP - with annual savings being most impacted by the probability of anastomotic leak complication in the DSA. Conclusion This model demonstrates that among patients undergoing left-sided colectomy procedures, the incremental cost of using the ECHELON CIRCULAR™ Powered Stapler instead of a manual circular stapler was offset by the savings from lowered incidence and cost of management of anastomotic leaks in the hospital setting.
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Affiliation(s)
- Esther Pollack
- Franchise Health Economics and Market Access, Ethicon, Blue Ash, OH, USA
| | - Stephen Johnston
- Medical Device Epidemiology and Real-World Data Sciences, Johnson & Johnson, New Brunswick, NJ, USA
| | | | - Sanjoy Roy
- Franchise Health Economics and Market Access, Ethicon, Blue Ash, OH, USA
| | - Thibaut Galvain
- Global Health Economics, Johnson and Johnson Medical Devices, New Brunswick, NJ, USA
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Laparoscopic versus Open Transverse-Incision Approach for Right Hemicolectomy: A Systematic Review and Meta-Analysis. ACTA ACUST UNITED AC 2021; 57:medicina57010080. [PMID: 33477793 PMCID: PMC7832342 DOI: 10.3390/medicina57010080] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2021] [Accepted: 01/17/2021] [Indexed: 02/05/2023]
Abstract
Background and Objectives: There is general agreement on the benefits of laparoscopy for treatment of rectal and left colon cancers, whereas findings regarding the comparison of laparoscopic and open right colonic resections are discordant. The aim of this systematic review and meta-analysis was to assess the outcomes and advantages of laparoscopic versus transverse-incision open surgery for management of right colon cancer. Materials and Methods: A systematic review was performed according to the Preferred Reporting Items for Systematic Review and Meta-Analyses (PRISMA) guidelines. Comparative studies evaluating the results of laparoscopic and transverse-incision open right hemicolectomies were analyzed. The measured outcomes were mean operative time, time to feeding, duration of hospital stay, and number of lymph nodes harvested. Results: A total of 5 studies including 318 patients met the inclusion criteria. Meta-analysis revealed no differences in time to resume oral feeding, hospital stay, and number of lymph nodes harvested in between groups, but mean length of surgery was significantly longer in the laparoscopic group. Conclusion: These data confirm that the preferred approach to right hemicolectomy is yet unclear. Laparoscopy has a longer operative time than transverse-incision open surgery, and no significant short-term benefits were observed for the studied parameters. Well-designed randomized control trials (RCTs) might help to identify the differences between these two techniques for the surgical treatment of right colon cancer.
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Pozios I, Seeliger H, Lauscher JC, Stroux A, Weixler B, Kamphues C, Beyer K, Kreis ME, Lehmann KS, Seifarth C. Risk factors for upper and lower type prolonged postoperative ileus following surgery for Crohn's disease. Int J Colorectal Dis 2021; 36:2165-2175. [PMID: 34142229 PMCID: PMC8426236 DOI: 10.1007/s00384-021-03969-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/30/2021] [Indexed: 02/04/2023]
Abstract
PURPOSE Prolonged postoperative ileus (PPOI) is common after bowel resections, especially in Crohn's disease (CD). The pathophysiology of PPOI is not fully understood. PPOI could affect only the upper or lower gastrointestinal (GI) tract. The aim of this study was to assess risk factors for diverse types of PPOI, particularly to differentiate PPOI of upper and lower GI tract. METHODS A retrospective analysis of 163 patients with CD undergoing ileocecal resection from 2015 to 2020 in a single center was performed. PPOI of the upper GI tract was predefined as the presence of vomiting or use of nasogastric tube longer than the third postoperative day. Lower PPOI was predefined as the absence of defecation for more than three days. Independent risk factors were identified by multivariable logistic regression analysis. RESULTS Overall incidence of PPOI was 42.7%. PPOI of the upper GI tract was observed in 30.7% and lower PPOI in 20.9% of patients. Independent risk factors for upper PPOI included older age, surgery by a resident surgeon, hand-sewn anastomosis, prolonged opioid analgesia, and reoperation, while for lower PPOI included BMI ≤ 25 kg/m2, preoperative anemia, and absence of ileostomy. CONCLUSION This study identified different risk factors for upper and lower PPOI after ileocecal resection in patients with CD. A differentiated upper/lower type approach should be considered in future research and clinical practice. High-risk patients for each type of PPOI should be closely monitored, and modifiable risk factors, such as preoperative anemia and opioids, should be avoided if possible.
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Affiliation(s)
- Ioannis Pozios
- Department of General and Visceral Surgery, Charité – Universitätsmedizin Berlin, Freie Universität Berlin and Humboldt-Universität Zu Berlin, Hindenburgdamm 30, 12203 Berlin, Germany
| | - Hendrik Seeliger
- Department of General and Visceral Surgery, Charité – Universitätsmedizin Berlin, Freie Universität Berlin and Humboldt-Universität Zu Berlin, Hindenburgdamm 30, 12203 Berlin, Germany
| | - Johannes C. Lauscher
- Department of General and Visceral Surgery, Charité – Universitätsmedizin Berlin, Freie Universität Berlin and Humboldt-Universität Zu Berlin, Hindenburgdamm 30, 12203 Berlin, Germany
| | - Andrea Stroux
- Institute of Biometry and Clinical Epidemiology, Charité – Universitätsmedizin Berlin, Freie Universität Berlin and Humboldt-Universität Zu Berlin, Charitéplatz 1, 10117 Berlin, Germany ,Berlin Institute of Health, Charité – Universitätsmedizin Berlin, Charitéplatz 1, 10117 Berlin, Germany
| | - Benjamin Weixler
- Department of General and Visceral Surgery, Charité – Universitätsmedizin Berlin, Freie Universität Berlin and Humboldt-Universität Zu Berlin, Hindenburgdamm 30, 12203 Berlin, Germany
| | - Carsten Kamphues
- Department of General and Visceral Surgery, Charité – Universitätsmedizin Berlin, Freie Universität Berlin and Humboldt-Universität Zu Berlin, Hindenburgdamm 30, 12203 Berlin, Germany
| | - Katharina Beyer
- Department of General and Visceral Surgery, Charité – Universitätsmedizin Berlin, Freie Universität Berlin and Humboldt-Universität Zu Berlin, Hindenburgdamm 30, 12203 Berlin, Germany
| | - Martin E. Kreis
- Department of General and Visceral Surgery, Charité – Universitätsmedizin Berlin, Freie Universität Berlin and Humboldt-Universität Zu Berlin, Hindenburgdamm 30, 12203 Berlin, Germany
| | - Kai S. Lehmann
- Department of General and Visceral Surgery, Charité – Universitätsmedizin Berlin, Freie Universität Berlin and Humboldt-Universität Zu Berlin, Hindenburgdamm 30, 12203 Berlin, Germany
| | - Claudia Seifarth
- Department of General and Visceral Surgery, Charité – Universitätsmedizin Berlin, Freie Universität Berlin and Humboldt-Universität Zu Berlin, Hindenburgdamm 30, 12203 Berlin, Germany
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Kakavas S, Karayiannis D, Bouloubasi Z, Poulia KA, Kompogiorgas S, Konstantinou D, Vougas V. Global Leadership Initiative on Malnutrition Criteria Predict Pulmonary Complications and 90-Day Mortality after Major Abdominal Surgery in Cancer Patients. Nutrients 2020; 12:nu12123726. [PMID: 33287107 PMCID: PMC7761640 DOI: 10.3390/nu12123726] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2020] [Revised: 11/26/2020] [Accepted: 12/01/2020] [Indexed: 12/11/2022] Open
Abstract
Although several studies have reported an association between malnutrition and the risk of severe complications after abdominal surgery, there have been no studies evaluating the use of Global Leadership Initiative on Malnutrition (GLIM) criteria for predicting postoperative pulmonary complications (PPCs) following major abdominal surgery in cancer patients. This study aimed to investigate the association among the diagnosis of malnutrition by GLIM criteria, PPCs risk and 90-day all-cause mortality rate following major abdominal surgery in cancer patients. We prospectively analyzed 218 patients (45% male, mean age 70.6 ± 11.2 years) with gastrointestinal cancer who underwent major abdominal surgery at our hospital between October 2018 and December 2019. Patients were assessed preoperatively using GLIM criteria of malnutrition, and 90-day all-cause mortality and PPCs were recorded. In total, 70 patients (32.1%) were identified as malnourished according to GLIM criteria, of whom 41.1% fulfilled the criteria for moderate and 12.6% for severe malnutrition. PPCs were detected in 48 of 218 patients (22%) who underwent major abdominal surgery. Univariate logistic regression analysis revealed that the diagnosis of malnutrition was significantly associated with the risk of PPCs. Furthermore, in multivariate model analysis adjusted for other clinical confounding factors, malnutrition remained an independent factor associated with the risk of PPCs (RR = 1.82; CI = 1.21–2.73) and 90-day all-cause mortality (RR = 1.97; CI = 1.28–2.63, for severely malnourished patients). In conclusion, preoperative presence of malnutrition, diagnosed by the use of GLIM criteria, is associated with the risk of PPCs and 90-day mortality rate in cancer patients undergoing major abdominal surgery.
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Affiliation(s)
- Sotirios Kakavas
- 1st Pulmonary Department, Evangelismos General Hospital of Athens, Ypsilantou 45-47, 10676 Athens, Greece; (S.K.); (S.K.)
| | - Dimitrios Karayiannis
- Department of Clinical Nutrition, Evangelismos General Hospital of Athens, Ypsilantou 45-47, 10676 Athens, Greece;
- Correspondence: ; Tel.: +3-021-320-450-35; Fax: +3-021-320-413-85
| | - Zoi Bouloubasi
- Department of Clinical Nutrition, Evangelismos General Hospital of Athens, Ypsilantou 45-47, 10676 Athens, Greece;
| | - Kalliopi Anna Poulia
- Department of Nutrition and Dietetics, Laiko General Hospital, 11527 Athens, Greece;
| | - Steven Kompogiorgas
- 1st Pulmonary Department, Evangelismos General Hospital of Athens, Ypsilantou 45-47, 10676 Athens, Greece; (S.K.); (S.K.)
| | - Dimitrios Konstantinou
- Transplant Unit, 1st Department of Surgery, Evangelismos General Hospital of Athens, 10676 Athens, Greece; (D.K.); (V.V.)
| | - Vasileios Vougas
- Transplant Unit, 1st Department of Surgery, Evangelismos General Hospital of Athens, 10676 Athens, Greece; (D.K.); (V.V.)
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