A prospective comparative study of blended and pure coagulation current in endoscopic mucosal resection of large sessile colorectal polyps

A retrospective comparative study of argon plasma versus polypectome snare tip coagulation: effect on recurrence rate after resection of large laterally spreading type lesions

Background

Endoscopic mucosal resection (EMR) is an established technique for treating large laterally spreading type (LST) lesions ≥20 mm. The aim of our study was to compare the use of argon plasma (APC) versus snare-tip coagulation on the recurrence rate of large LST lesions.

Methods

All patients with large LST lesions resected by EMR between January 2006 and December 2014 were enrolled. After piecemeal resection, patients underwent either APC or snare-tip coagulation of the rim of the resection area and any residual adenomatous tissue. Follow up included colonoscopy and biopsies. Medical records, including characteristics of patients and polyps, complications and recurrence were retrieved and collected.

Results

One hundred one patients were included in the final analysis. They were divided into the APC group (n=50) and the snare-tip coagulation group (n=51). The 2 groups were similar concerning patients’ characteristics, size of polyps and histology. Post-polypectomy coagulation syndrome was observed in 8 patients (7.9%) (APC group: n=5 and snare tip group: n=3). EMR-related bleeding occurred in 9 patients (8.9%) (APC group: n=4 and snare tip group: n=5). Total recurrence rate was 14.85% (16% and 13.7% in APC and snare-tip groups, respectively, P=0.34).

Conclusion

The effectiveness of snare-tip coagulation is comparable with that of APC with respect to recurrence rate after resection of large LST lesions. It thus represents a cost-effective alternative to APC.

Three-Port Laparoscopic Right Colectomy Versus Conventional Five-Port Laparoscopy for Right-Sided Colon Cancer

BACKGROUND

The purpose of the study was to evaluate the safety and effectiveness of three-port laparoscopic right colectomy (3-LRC) for right-sided colon cancer compared with conventional five-port laparoscopic right colectomy (5-LRC).

MATERIALS AND METHODS

One hundred sixty-three patients diagnosed with right-sided colon adenocarcinoma underwent laparoscopic right colectomy (LRC) between April 2011 and December 2017. Seventy-four of these patients underwent 3-LRC procedure and 89 patients underwent 5-LRC. Clinical characteristics, perioperative short-term outcomes, and pathologic data were analyzed.

RESULTS

There were no differences in TNM stage, tumor location, estimated blood loss, complications, and open conversion rates. The operation time was shorter in the 3-LRC group than in 5-LRC group (140.9 ± 27.5 minutes versus 178.2 ± 38.2 minutes; P = .001). The number of harvested lymph nodes (28.5 ± 13.9 versus 22.6 ± 11.7; P = .004) was also higher in the 3-LRC group. The first passage of flatus and first oral diet were significantly faster in the 3-LRC group than in the 5-LRC group (2.8 ± 1.0 days versus 4.0 ± 1.2 days; P = .001, 3.6 ± 2.9 days versus 5.0 ± 1.5 days; P = .001). The number of patients who required analgesics is less in the 3-LRC group (32.4% versus 43.8%; P = .583).

CONCLUSION

3-LRC for right-sided colon cancer is technically feasible and is associated with a short operation time. We believe that 3-LRC effectively reduces the costs associated with equipment and manpower and represents a standard procedure.