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de'Angelis N, Schena CA, Espin-Basany E, Piccoli M, Alfieri S, Aisoni F, Coccolini F, Frontali A, Kraft M, Lakkis Z, Le Roy B, Luzzi AP, Milone M, Pattacini GC, Pellino G, Petri R, Piozzi GN, Quero G, Ris F, Winter DC, Khan J. Robotic versus laparoscopic right colectomy for nonmetastatic pT4 colon cancer: A European multicentre propensity score-matched analysis. Colorectal Dis 2024. [PMID: 38978153 DOI: 10.1111/codi.17089] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2023] [Revised: 04/14/2024] [Accepted: 04/16/2024] [Indexed: 07/10/2024]
Abstract
AIM Minimally invasive surgery has been increasingly adopted for locally advanced colon cancer. However, evidence comparing robotic (RRC) versus laparoscopic right colectomy (LRC) for nonmetastatic pT4 cancers is lacking. METHODS This was a multicentre propensity score-matched (PSM) study of a cohort of consecutive patients with pT4 right colon cancer treated with RRC or LRC. The two surgical approaches were compared in terms of R0, number of lymph nodes harvested, intra- and postoperative complication rates, overall (OS), and disease-free survival (DFS). RESULTS Among a total of 200 patients, 39 RRC were compared with 78 PS-matched LRC patients. The R0 rate was similar between RRC and LRC (92.3% vs. 96.2%, respectively; p = 0.399), as was the odds of retrieving 12 or more lymph nodes (97.4% vs. 96.2%; p = 1). No significant difference was noted for the mean operating time (192.9 min vs. 198.3 min; p = 0.750). However, RRC was associated with fewer conversions to laparotomy (5.1% vs. 20.5%; p = 0.032), less blood loss (36.9 vs. 95.2 mL; p < 0.0001), fewer postoperative complications (17.9% vs. 41%; p = 0.013), a shorter time to flatus (2 vs. 2.8 days; p = 0.009), and a shorter hospital stay (6.4 vs. 9.5 days; p < 0.0001) compared with LRC. These results were confirmed even when converted procedures were excluded from the analysis. The 1-, 3- and 5-year OS (p = 0.757) and DFS (p = 0.321) did not significantly differ between RRC and LRC. CONCLUSION Adequate oncological outcomes are observed for RRC and LRC performed for pT4 right colon cancer. However, RRC is associated with lower conversion rates and improved short-term postoperative outcomes.
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Affiliation(s)
- Nicola de'Angelis
- Unit of Robotic and Minimally Invasive Surgery, Department of Surgery, Ferrara University Hospital, Ferrara, Italy
- Department of Translational Medicine, University of Ferrara, Ferrara, Italy
| | - Carlo Alberto Schena
- Unit of Robotic and Minimally Invasive Surgery, Department of Surgery, Ferrara University Hospital, Ferrara, Italy
- Digestive Surgery Unit, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Eloy Espin-Basany
- Unit of Colorectal Surgery, Department of General and Digestive Surgery, University Hospital Vall d'Hebron-Universitat Autonoma de Barcelona, Barcelona, Spain
| | - Micaela Piccoli
- Unit of General, Emergency Surgery and New Technologies, Ospedale Civile Baggiovara, Azienda Ospedaliero Universitaria Di Modena, Modena, Italy
| | - Sergio Alfieri
- Digestive Surgery Unit, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Filippo Aisoni
- Unit of General Surgery, Department of Surgery, Ferrara University Hospital, Ferrara, Italy
| | - Federico Coccolini
- General, Emergency and Trauma Surgery Department, Pisa University Hospital, Pisa, Italy
| | - Alice Frontali
- Department of General Surgery, Department of Biomedical and Clinical Sciences 'L. Sacco', University of Milan, ASST Fatebenefratelli Sacco, Milan, Italy
| | - Miquel Kraft
- Unit of Colorectal Surgery, Department of General and Digestive Surgery, University Hospital Vall d'Hebron-Universitat Autonoma de Barcelona, Barcelona, Spain
| | - Zaher Lakkis
- Department of Digestive Surgical Oncology, Liver Transplantation Unit, University Hospital of Besançon, Besançon, France
| | - Bertrand Le Roy
- Department of Digestive and Oncologic Surgery, Hospital Nord, CHU Saint-Etienne, Saint-Etienne, France
| | | | - Marco Milone
- Department of Clinical Medicine and Surgery, "Federico II" University of Naples, Naples, Italy
| | - Gianmaria Casoni Pattacini
- Unit of General, Emergency Surgery and New Technologies, Ospedale Civile Baggiovara, Azienda Ospedaliero Universitaria Di Modena, Modena, Italy
| | - Gianluca Pellino
- Unit of Colorectal Surgery, Department of General and Digestive Surgery, University Hospital Vall d'Hebron-Universitat Autonoma de Barcelona, Barcelona, Spain
| | - Roberto Petri
- General Surgery Department, Azienda Sanitaria Universitaria Friuli Centrale, Udine, Italy
| | | | - Giuseppe Quero
- Digestive Surgery Unit, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Frederic Ris
- Division of Abdominal and Transplantation Surgery, Department of Surgery, Faculty of Medicine, Geneva University Hospitals, Geneva, Switzerland
| | - Des C Winter
- Department of Surgery, St. Vincent's University Hospital, Dublin, Ireland
| | - Jim Khan
- Department of Colorectal Surgery, Portsmouth Hospitals University NHS Trust, Portsmouth, UK
- University of Portsmouth, Portsmouth, UK
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Ishiyama Y, Hirano Y, Tanaka H, Fujii T, Okazaki N, Hiranuma C, Deguchi K. Short-term and Long-term Outcomes After Laparoscopic Surgery for Pathological Stage T4a and T4b Colon Cancer. J Gastrointest Cancer 2024; 55:975-978. [PMID: 38289406 DOI: 10.1007/s12029-024-01017-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/10/2024] [Indexed: 06/20/2024]
Affiliation(s)
- Yasuhiro Ishiyama
- Department of Gastroenterological Surgery, Saitama Medical University International Medical Center, Hidaka, Japan.
| | - Yasumitsu Hirano
- Department of Gastroenterological Surgery, Saitama Medical University International Medical Center, Hidaka, Japan
| | - Hiroto Tanaka
- Department of Gastroenterological Surgery, Saitama Medical University International Medical Center, Hidaka, Japan
| | - Takatsugu Fujii
- Department of Gastroenterological Surgery, Saitama Medical University International Medical Center, Hidaka, Japan
| | - Naoto Okazaki
- Department of Gastroenterological Surgery, Saitama Medical University International Medical Center, Hidaka, Japan
| | - Chikashi Hiranuma
- Department of Gastroenterological Surgery, Saitama Medical University International Medical Center, Hidaka, Japan
| | - Katsuya Deguchi
- Department of Gastroenterological Surgery, Saitama Medical University International Medical Center, Hidaka, Japan
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Zhang J, Sun J, Liu J, Mei S, Quan J, Hu G, Li B, Zhuang M, Wang X, Tang J. Comparison of short- and long-term outcomes between laparoscopic and open multivisceral resection for clinical T4b colorectal cancer: A multicentre retrospective cohort study in China. EUROPEAN JOURNAL OF SURGICAL ONCOLOGY 2024; 50:107316. [PMID: 38086316 DOI: 10.1016/j.ejso.2023.107316] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2023] [Revised: 10/31/2023] [Accepted: 12/04/2023] [Indexed: 01/16/2024]
Abstract
BACKGROUND Laparoscopic surgery is controversial for patients with clinical T4b colorectal cancer (CRC) who require multivisceral resection (MVR). This study aims to explore and compare the safety and long-term oncological outcomes of laparoscopic surgery and open surgery for patients with clinical T4b CRC. MATERIALS AND METHODS This study was a retrospective cohort study based on a multicentre database. According to the operation method, the patients were divided into a laparoscopic MVR group and an open MVR group. The short-term and long-term outcomes were compared. RESULTS From January 2010 to December 2021, a total of 289 patients in the laparoscopic MVR group and 349 patients in the open MVR group were included. After propensity score matching, patients were stratified into a laparoscopic MVR group (n = 163) and an open MVR group (n = 163). Compared with the open MVR group, the laparoscopic MVR group had less blood loss (100 vs. 200, p < 0.001), a shorter time to first flatus (3 vs. 4, P < 0.001), a shorter postoperative hospital stay (10 vs. 12, P < 0.001), and a lower incidence of surgical site infection (2.5 % vs. 8.0 %, P = 0.043). The Kaplan-Meier curves showed that the two groups had similar overall survival (P = 0.283) and disease-free survival (P = 0.152). CONCLUSION Compared with open MVR, laparoscopic MVR had less blood loss, fewer surgical site infection complications, faster recovery and a shorter hospital stay. The long-term survival outcome of laparoscopic MVR was not inferior to that of open MVR.
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Affiliation(s)
- Jinzhu Zhang
- Department of Colorectal Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100021, China
| | - Jinfeng Sun
- Department of Anorectal Surgery, Chifeng Municipal Hospital, Chifeng, China
| | - Junguang Liu
- Department of General Surgery, Peking University First Hospital, Beijing, China
| | - Shiwen Mei
- Department of Colorectal Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100021, China
| | - Jichuan Quan
- Department of Colorectal Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100021, China
| | - Gang Hu
- Department of Colorectal Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100021, China
| | - Bo Li
- Department of Colorectal Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100021, China
| | - Meng Zhuang
- Department of Colorectal Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100021, China
| | - Xishan Wang
- Department of Colorectal Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100021, China.
| | - Jianqiang Tang
- Department of Colorectal Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100021, China.
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The use of laparoscopy for T4a and T4b colon cancer: are we playing with fire? Surg Endosc 2023:10.1007/s00464-023-09944-5. [PMID: 36894808 DOI: 10.1007/s00464-023-09944-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2022] [Accepted: 02/12/2023] [Indexed: 03/11/2023]
Abstract
BACKGROUND The laparoscopic approach for colon cancer has become widely accepted. However, its safety for T4 tumors, and particularly for T4b tumors when local invasion to adjacent structures occurs, remains controversial. This study aimed to compare short and long-term outcomes in patients undergoing laparoscopic vs. open resection for T4a and T4b colon cancers. METHODS A prospectively maintained, single-institution database was queried to identify patients with pathological stage T4a and T4b colon adenocarcinomas electively operated on between 2000 and 2012. Patients were divided into two groups based on the use of laparoscopy. Patient characteristics, perioperative, and oncologic outcomes were compared. RESULTS One hundred and nineteen patients [41 laparoscopic (L), 78 open surgeries (O)] met the inclusion criteria. No difference was observed in age, gender, BMI, ASA, and procedure between groups. Tumors treated by L were smaller than O (p = 0.003). No difference was observed in morbidity, mortality, reoperation, or readmission between the groups. Length of hospital stay was shorter in L than O (6 vs. 9 days, p = 0.005). Conversion to open was necessary in 22% of all T4 tumors laparoscopic cases. However, when tumors were subdivided by pT4 classification, conversion was necessary for 4 of 34 (12%) pT4a patients vs. 5 of 7 (71%) pT4b patients (p = 0.003). In the pT4b cohort (n = 37), more tumors were treated by the open approach (30 vs. 7). For pT4b tumors, the R0 resection rate was 94% (86% in L vs. 97% in O, p = 0.249). The use of laparoscopy did not impact overall survival, disease-free survival, cancer-specific survival, or tumor recurrence overall in all T4 or T4a and T4b tumors. CONCLUSIONS Laparoscopic surgery can be safely performed in pT4 tumors with similar oncologic outcomes as compared to open surgery. However, for pT4b tumors, the conversion rate is very high. The open approach may be preferable.
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Zaman S, Bhattacharya P, Mohamedahmed AYY, Cheung FY, Rakhimova K, Di Saverio S, Peravali R, Akingboye A. Outcomes following open versus laparoscopic multi-visceral resection for locally advanced colorectal cancer: A systematic review and meta-analysis. Langenbecks Arch Surg 2023; 408:98. [PMID: 36811741 DOI: 10.1007/s00423-023-02835-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2022] [Accepted: 02/13/2023] [Indexed: 02/24/2023]
Abstract
BACKGROUND This meta-analysis aims to compare morbidity, mortality, oncological safety, and survival outcomes after laparoscopic multi-visceral resection (MVR) of the locally advanced primary colorectal cancer (CRC) compared with open surgery. MATERIALS AND METHODS A systematic search of multiple electronic data sources was conducted, and all studies comparing laparoscopic and open surgery in patients with locally advanced CRC undergoing MVR were selected. The primary endpoints were peri-operative morbidity and mortality. Secondary endpoints were R0 and R1 resection, local and distant disease recurrence, disease-free survival (DFS), and overall survival (OS) rates. RevMan 5.3 was used for data analysis. RESULTS Ten comparative observational studies reporting a total of 936 patients undergoing laparoscopic MVR (n = 452) and open surgery (n = 484) were identified. Primary outcome analysis demonstrated a significantly longer operative time in laparoscopic surgery compared with open operations (P = 0.008). However, intra-operative blood loss (P<0.00001) and wound infection (P = 0.05) favoured laparoscopy. Anastomotic leak rate (P = 0.91), intra-abdominal abscess formation (P = 0.40), and mortality rates (P = 0.87) were comparable between the two groups. Moreover the total number of harvested lymph nodes, R0/R1 resections, local/distant disease recurrence, DFS, and OS rates were also comparable between the groups. CONCLUSION Although inherent limitations exist with observational studies, the available evidence demonstrates that laparoscopic MVR in locally advanced CRC seems to be a feasible and oncologically safe surgical option in carefully selected cohorts.
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Affiliation(s)
- Shafquat Zaman
- Department of General Surgery, Sandwell and West, Birmingham Hospitals NHS Trust, Birmingham, West Midlands, UK
| | - Pratik Bhattacharya
- Department of General Surgery, Sandwell and West, Birmingham Hospitals NHS Trust, Birmingham, West Midlands, UK
| | | | - Fang Yi Cheung
- Department of General Surgery, Sandwell and West, Birmingham Hospitals NHS Trust, Birmingham, West Midlands, UK
| | - Kamila Rakhimova
- Institute of Cancer and Genomic Science, College of Medical and Dental Science, University of Birmingham, Edgbaston, Birmingham, UK
| | - Salomone Di Saverio
- Department of General Surgery, ASUR Marche, Hospital of San Benedetto del Tronto (AP), AV5, San Benedetto del Tronto, Italy
| | - Rajeev Peravali
- Department of General Surgery, Sandwell and West, Birmingham Hospitals NHS Trust, Birmingham, West Midlands, UK
| | - Akinfemi Akingboye
- Department of General Surgery, The Dudley Group NHS Foundation Trust, Russells Hall Hospital, Dudley, West Midlands, UK
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6
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Osseis M, Dahboul H, Mouawad C, Aoun R, Kassar S, Chakhtoura G, Noun R. Laparoscopic and robotic multivisceral resection in colorectal cancer: A case series and systematic review. Asian J Endosc Surg 2023. [PMID: 36599163 DOI: 10.1111/ases.13162] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Revised: 12/21/2022] [Accepted: 12/25/2022] [Indexed: 01/05/2023]
Abstract
PURPOSE Multivisceral resection (MVR) with open approach is the standard surgical treatment for locally advanced colorectal cancer. However, the medical literature concerning the practice of minimally invasive MVR in order to reduce postoperative complications and hospital stay has been growing exponentially over the last years. The present study aimed to examine our experience and to provide a systematic review about the results and complications of minimally invasive MVR. METHODS Data of patients that underwent minimally invasive MVR for locally advanced colorectal cancer from 2015 to 2021 were retrospectively reviewed. The literature was searched for studies concerning minimally invasive MVR for colorectal cancer. RESULTS A total of 39 laparoscopic MVR were performed in our department. Complications occurred in 14 patients (35.9%) with major complications in five patients (18.82%) according to Clavien-Dindo classification. Conversion was required in one case (2.56%) with subsequent mortality (2.56%). Pathologic adjacent organs or structures invasion was observed in 30 patients (76.9%) and positive resection margin occurred in two cases (5.2%). Twenty-two studies including 1055 patients were identified after literature search. In these studies, laparoscopic surgery and robotic surgery were performed in 90.15% and 9.85% of the patients, respectively. R0 resection was established in 95% of cases, conversion rate varied between 0% and 41.7%, and postoperative mortality ranged between 0% and 7.7% in the included articles. CONCLUSION Minimally invasive approach may be a safe option for patients requiring MVR for locally advanced colorectal cancer, with equivalent oncological results and could result in better early postoperative outcomes to open approach. However, further studies on this topic are needed to confirm the results of the current study.
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Affiliation(s)
- Michael Osseis
- Department of Digestive Surgery, Hôtel-Dieu de France Hospital, Saint Joseph University of Beirut, Beirut, Lebanon
| | - Houssam Dahboul
- Department of Digestive Surgery, Hôtel-Dieu de France Hospital, Saint Joseph University of Beirut, Beirut, Lebanon
| | - Christian Mouawad
- Department of Digestive Surgery, Hôtel-Dieu de France Hospital, Saint Joseph University of Beirut, Beirut, Lebanon
| | - Rany Aoun
- Department of Digestive Surgery, Hôtel-Dieu de France Hospital, Saint Joseph University of Beirut, Beirut, Lebanon
| | - Serge Kassar
- Department of Digestive Surgery, Hôtel-Dieu de France Hospital, Saint Joseph University of Beirut, Beirut, Lebanon
| | - Ghassan Chakhtoura
- Department of Digestive Surgery, Hôtel-Dieu de France Hospital, Saint Joseph University of Beirut, Beirut, Lebanon
| | - Roger Noun
- Department of Digestive Surgery, Hôtel-Dieu de France Hospital, Saint Joseph University of Beirut, Beirut, Lebanon
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Ishiyama Y, Tachimori Y, Harada T, Mochizuki I, Tomizawa Y, Ito S, Oneyama M, Amiki M, Hara Y, Narita K, Goto M, Sekikawa K, Hirano Y. Oncologic outcomes after laparoscopic versus open multivisceral resection for local advanced colorectal cancer: A meta-analysis. Asian J Surg 2023; 46:6-12. [PMID: 35568616 DOI: 10.1016/j.asjsur.2022.02.047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2021] [Revised: 02/21/2022] [Accepted: 02/25/2022] [Indexed: 12/16/2022] Open
Abstract
Laparoscopic (lap) colectomies for advanced colorectal cancer (CRC) often require resection of other organs. We systematically reviewed currently available literature on lap multi-visceral resection for CRC, with regard to short- and long-term oncological outcomes, and compared them with open procedures. We performed a systematic literature search in MEDLINE, EMBASE, Google Scholar and PubMed from inception to November 30, 2020. The aim of this study was to synthesize short-term and oncological outcomes associated with laparoscopic versus open surgery. Pooled proportions and risk ratios (RRs) were calculated using an inverse variance method. We included six observational cohort studies published between 2012 and 2020 (lap procedures: n = 262; open procedures: n = 273). Collectively, they indicated that postoperative complications were significantly more common after open surgeries than lap surgeries (RR: 0.53; 95% confidence interval [CI]: 0.39-0.72; P < 0.00001), but the two approaches did not significantly differ in positive resection margins (RR: 0.75; 95% CI: 0.38-1.50; P = 0.42), local recurrence (RR: 0.66; 95% CI: 0.28-1.62; P = 0.37), or (based on two evaluable studies) 5-year OS (RR: 0.70; 95% CI: 0.46-1.04; P = 0.08) or 5-year DFS (RR: 0.86; 95% CI: 0.67-1.11) for T4b disease. In conclusion, laparoscopic and open multi-visceral resections for advanced CRC have comparable oncologic outcomes. Although a randomized study would be ideal for further research, no such studies are currently available.
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Affiliation(s)
- Yasuhiro Ishiyama
- Department of Surgery, Kawasaki Saiwai Hospital, Kawasaki, Japan; Department of Gastroenterological Surgery, Saitama Medical University International Medical Center, Hidaka, Japan.
| | - Yuji Tachimori
- Department of Surgery, Kawasaki Saiwai Hospital, Kawasaki, Japan
| | | | | | - Yuki Tomizawa
- Department of Surgery, Kawasaki Saiwai Hospital, Kawasaki, Japan
| | - Shingo Ito
- Department of Surgery, Kawasaki Saiwai Hospital, Kawasaki, Japan
| | - Masaki Oneyama
- Department of Surgery, Kawasaki Saiwai Hospital, Kawasaki, Japan
| | - Manabu Amiki
- Department of Surgery, Kawasaki Saiwai Hospital, Kawasaki, Japan
| | - Yoshiaki Hara
- Department of Surgery, Kawasaki Saiwai Hospital, Kawasaki, Japan
| | - Kazuhiro Narita
- Department of Surgery, Kawasaki Saiwai Hospital, Kawasaki, Japan
| | - Manabu Goto
- Department of Surgery, Kawasaki Saiwai Hospital, Kawasaki, Japan
| | - Koji Sekikawa
- Department of Surgery, Kawasaki Saiwai Hospital, Kawasaki, Japan
| | - Yasumitu Hirano
- Department of Gastroenterological Surgery, Saitama Medical University International Medical Center, Hidaka, Japan
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Chen P, Zhou H, Chen C, Qian X, Yang L, Zhou Z. Laparoscopic vs. open colectomy for T4 colon cancer: A meta-analysis and trial sequential analysis of prospective observational studies. Front Surg 2022; 9:1006717. [DOI: 10.3389/fsurg.2022.1006717] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2022] [Accepted: 10/10/2022] [Indexed: 11/06/2022] Open
Abstract
BackgroundTo evaluate short- and long-term outcomes of laparoscopic colectomy (LC) vs. open colectomy (OC) in patients with T4 colon cancer.MethodsThree authors independently searched PubMed, Web of Science, Embase, Cochrane Library, and Clinicaltrials.gov for articles before June 3, 2022 to compare the clinical outcomes of T4 colon cancer patients undergoing LC or OC.ResultsThis meta-analysis included 7 articles with 1,635 cases. Compared with OC, LC had lesser blood loss, lesser perioperative transfusion, lesser complications, lesser wound infection, and shorter length of hospital stay. Moreover, there was no significant difference between the two groups in terms of 5-year overall survival (5y OS), and 5-year disease-free survival (5y DFS), R0 resection rate, positive resection margin, lymph nodes harvested ≥12, and recurrence. Trial Sequential Analysis (TSA) results suggested that the potential advantages of LC on perioperative transfusion and the comparable oncological outcomes in terms of 5y OS, 5y DFS, lymph nodes harvested ≥12, and R0 resection rate was reliable and no need of further study.ConclusionsLaparoscopic surgery is safe and feasible in T4 colon cancer in terms of short- and long-term outcomes. TSA results suggested that future studies were not required to evaluate the 5y OS, 5y DFS, R0 resection rate, positive resection margin status, lymph nodes harvested ≥12 and perioperative transfusion differences between LC and OC.Systematic Review Registration:https://www.crd.york.ac.uk/PROSPERO/, identifier: CRD42022297792.
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Kamel MK, Al-Qudah G, Shchatsko A, Keane CA, Serpa E, Nituica C, Blebea J, Marar O. Robotic Approach is Associated With a Lower Conversion Rate Compared to Laparoscopic Approach for Patients Undergoing Colectomy for T4b Colon Cancer. An Analysis of the National Cancer Database. Surg Innov 2022:15533506221125323. [PMID: 36069752 DOI: 10.1177/15533506221125323] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
INTRODUCTION We examined the perioperative outcomes of patients undergoing open, laparoscopic, or robotic colectomy for T4b colon cancer, as well as the clinical factors associated with conversion to an open approach and its consequences on perioperative and oncologic outcomes. METHODS The National Cancer Database was queried for patients undergoing colectomy for cT4b colon cancer (2010-2016). Patients undergoing laparoscopic or robotic colectomy were matched using Propensity-Score analysis. Factors associated with conversion to an open approach were assessed using Logistic-regression multivariable-analysis (MVA). RESULTS Colectomy for cT4b colon cancer was performed in 9030 patients (open: n = 6,543, robotic: n = 157, laparoscopic: n = 2330). In the propensity-matched groups, robotic approach had lower rate of conversion (12% vs 37%, P < .001), shorter hospital stays (5 vs 7-days, P = .02), and similar overall-survival (5-yr: 49% vs 39%, P = .16), compared to laparoscopic approach. Conversion to an open approach was noted in 801(32%) of the patients undergoing minimally invasive surgical colectomy (robotic n = 23(15%), laparoscopic n = 778(33%). Factors associated with lower rate of conversion on multivariable-analysis included recent year of surgery (95% CI: 0.88-.97), robotic approach (95% CI: 0.22-.56), and surgeries performed in Academic hospitals (95% CI: 0.65-.96). Conversion to an open approach was associated with higher rate of positive parenchymal margin (31% vs 25%, P = .001), higher rate of 30-day readmission (12% vs 9.5%, P = .04), and similar overall survival (5-yr: 32% vs 35%, P = .19), compared to those who had no conversion. CONCLUSION At the National level, patients undergoing colectomy for T4b colon cancer via a robotic approach had more favorable perioperative outcomes compared to laparoscopic approach. Conversion to an open approach did not compromise long term survival, despite being associated with higher rate of positive margins and readmissions rate.
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Affiliation(s)
- Mohamed K Kamel
- Department of Surgery, College of Medicine, 26588Central Michigan University, Mt Pleasant, MI, USA
| | - Ghaith Al-Qudah
- Department of Surgery, College of Medicine, 26588Central Michigan University, Mt Pleasant, MI, USA
| | - Anastasiya Shchatsko
- Department of Surgery, College of Medicine, 26588Central Michigan University, Mt Pleasant, MI, USA
| | - Charles A Keane
- Department of Surgery, College of Medicine, 26588Central Michigan University, Mt Pleasant, MI, USA
| | - Eduardo Serpa
- Department of Surgery, College of Medicine, 26588Central Michigan University, Mt Pleasant, MI, USA
| | - Cristina Nituica
- Department of Surgery, College of Medicine, 26588Central Michigan University, Mt Pleasant, MI, USA
| | - John Blebea
- Department of Surgery, College of Medicine, 26588Central Michigan University, Mt Pleasant, MI, USA
| | - Omar Marar
- Department of Surgery, College of Medicine, 26588Central Michigan University, Mt Pleasant, MI, USA
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10
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Imaizumi K, Homma S, Miyaoka Y, Matsui H, Ichikawa N, Yoshida T, Takahashi N, Taketomi A. Exploration of the advantages of minimally invasive surgery for clinical T4 colorectal cancer compared with open surgery: A matched-pair analysis. Medicine (Baltimore) 2022; 101:e29869. [PMID: 35960060 PMCID: PMC9371553 DOI: 10.1097/md.0000000000029869] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
The indications of minimally invasive surgery (MIS) for T4 colorectal cancer are controversial because the advantages of MIS are unclear. Therefore, we compared overall survival (OS) and recurrence-free survival (RFS) as the primary endpoint, and short-term outcome, alteration in perioperative laboratory data, and the interval of postoperative chemotherapy from operation as secondary endpoints, between MIS and open surgery (OPEN) using a matched-pair analysis. We explored the advantages of MIS for T4 colorectal cancer. In this retrospective single-institution study, we included 125 patients with clinical T4 colorectal cancer who underwent curative-intent surgery of the primary tumor between October 2010 and September 2019. Conversion cases were excluded. MIS patients were matched to OPEN patients (ratio of 1:2) according to tumor location, clinical T stage, and preoperative treatment. We identified 25 and 50 patients who underwent OPEN and MIS, respectively, including 31 with distant metastasis. Both groups had similar background characteristics. The rate of major morbidities (Clavien-Dindo grade > III) was comparable between the 2 groups (P = .597), and there was no mortality in either group. MIS tended to result in shorter postoperative hospitalization than OPEN (P = .073). Perioperative alterations in laboratory data revealed that MIS suppressed surgical invasiveness better compared to OPEN. Postoperative chemotherapy, especially for patients with distant metastasis who underwent primary tumor resection, tended to be started earlier in the MIS group than in the OPEN group (P = .075). OS and RFS were comparable between the 2 groups (P = .996 and .870, respectively). In the multivariate analyses, MIS was not a significant prognostic factor for poor OS and RFS. MIS was surgically safe and showed similar oncological outcomes to OPEN-with the potential of reduced invasiveness and enhanced recovery from surgery. Therefore, patients undergoing MIS might receive subsequent postoperative treatments earlier.
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Affiliation(s)
- Ken Imaizumi
- Department of Gastroenterological Surgery I, Graduate School of Medicine, Hokkaido University, Sapporo, Hokkaido, Japan
| | - Shigenori Homma
- Department of Gastroenterological Surgery I, Graduate School of Medicine, Hokkaido University, Sapporo, Hokkaido, Japan
- * Correspondence: Shigenori Homma, MD, PhD, Department of Gastroenterological Surgery I, Graduate School of Medicine, Hokkaido University, N-15, W-7, Kita-Ku, Sapporo, Hokkaido 060-8638, Japan (e-mail: )
| | - Yoichi Miyaoka
- Department of Gastroenterological Surgery I, Graduate School of Medicine, Hokkaido University, Sapporo, Hokkaido, Japan
| | - Hiroki Matsui
- Department of Gastroenterological Surgery I, Graduate School of Medicine, Hokkaido University, Sapporo, Hokkaido, Japan
| | - Nobuki Ichikawa
- Department of Gastroenterological Surgery I, Graduate School of Medicine, Hokkaido University, Sapporo, Hokkaido, Japan
| | - Tadashi Yoshida
- Department of Gastroenterological Surgery I, Graduate School of Medicine, Hokkaido University, Sapporo, Hokkaido, Japan
| | - Norihiko Takahashi
- Department of Gastroenterological Surgery I, Graduate School of Medicine, Hokkaido University, Sapporo, Hokkaido, Japan
| | - Akinobu Taketomi
- Department of Gastroenterological Surgery I, Graduate School of Medicine, Hokkaido University, Sapporo, Hokkaido, Japan
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11
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Guidolin K, Ng D, Chadi S, Quereshy FA. Post-operative outcomes in patients with locally advanced colon cancer: a comparison of operative approach. Surg Endosc 2022; 36:4580-4587. [PMID: 34988743 DOI: 10.1007/s00464-021-08772-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2021] [Accepted: 10/12/2021] [Indexed: 01/29/2023]
Abstract
INTRODUCTION Surgeons may choose an open approach to locally advanced colon cancer (LACC) because of the elevated conversion rate (minimally invasive to open) in these patients (resulting in part from a judgment of the technical feasibility of a minimally invasive approach). Poorer outcomes have been suggested in those requiring conversion from a minimal access to an open approach; however, the influence of conversion has not been studied in LACC. We sought to compare perioperative outcomes in patients with T4aN2 colon cancer undergoing minimally invasive surgery (MIS), planned open (PO), and converted (CN) procedures to evaluate the influence of conversion in this subgroup. METHODS A retrospective cohort study was conducted using the NSQIP database. Patients with T4aN2 colon cancer undergoing elective resection were included; rectal/unknown tumor location, and T4b disease were excluded (to ensure homogeneity in surgical management). Patients were divided into cohorts based on approach: PO, MIS, and CN. Summary statistics were compared between groups. Multivariable analysis was conducted for mortality and morbidity outcomes. RESULTS 1286 cases were included (313 PO, 842 MIS, 131 CN); 10.2% underwent conversion. Those undergoing MIS had a shorter length of stay than those undergoing PO or CN (p < 0.0001). On univariable analysis, CN resulted in increased rates of any complication (p < 0.0001). CN also had a greater rate of anastomotic leak (p = 0.0046) and death (p = 0.05). On multivariable analysis, significant predictors of any complication included age, ASA class, M stage, and approach; however, CN did not increase the risk of complication compared with MIS, whereas PO nearly doubled the risk of complication (OR = 1.98, p = 0.0083). The only significant predictor of mortality on multivariable analysis was age (HR = 1.09, p = 0.0002)-approach was not associated with mortality. CONCLUSION PO confers the greatest risk of suffering any complication. Surgical approach was not associated with death. Results of our study challenge the notion that conversion is associated with the worst perioperative outcomes and an MIS approach should be considered in patients with LACC.
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Affiliation(s)
- Keegan Guidolin
- Department of Surgery, University of Toronto, Toronto, Canada.,Institute of Biomedical Engineering, University of Toronto, Toronto, Canada.,Princess Margaret Cancer Centre, Toronto, Canada
| | - Deanna Ng
- Institute of Medical Sciences, University of Toronto, Toronto, Canada
| | - Sami Chadi
- Department of Surgery, University of Toronto, Toronto, Canada.,Princess Margaret Cancer Centre, Toronto, Canada.,University Health Network, Toronto, Canada
| | - Fayez A Quereshy
- Department of Surgery, University of Toronto, Toronto, Canada. .,Princess Margaret Cancer Centre, Toronto, Canada. .,University Health Network, Toronto, Canada.
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12
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Podda M, Pisanu A, Morello A, Segalini E, Jayant K, Gallo G, Sartelli M, Coccolini F, Catena F, Di Saverio S. Laparoscopic versus open colectomy for locally advanced T4 colonic cancer: meta-analysis of clinical and oncological outcomes. Br J Surg 2022; 109:319-331. [PMID: 35259211 DOI: 10.1093/bjs/znab464] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2021] [Revised: 10/11/2021] [Accepted: 12/17/2021] [Indexed: 09/11/2023]
Abstract
BACKGROUND The aim of this study was to review the early postoperative and oncological outcomes after laparoscopic colectomy for T4 cancer compared with open surgery. METHOD MEDLINE, Embase, and the Cochrane Central Register of Controlled Trials were searched for any relevant clinical study comparing laparoscopic and open colectomy as treatment for T4 colonic cancer. The risk ratio (RR) with 95 per cent c.i. was calculated for dichotomous variables, and the mean difference (m.d.) with 95 per cent confidence interval for continuous variables. Grading of Recommendations Assessment, Development and Evaluation (GRADE) methodology was implemented for assessing quality of evidence (QoE). RESULTS Twenty-four observational studies (21 retrospective and 3 prospective cohort studies) were included, analysing a total of 18 123 patients: 9024 received laparoscopic colectomy and 9099 underwent open surgery. Laparoscopic colectomy was associated with lower rates of mortality (RR 0.48, 95 per cent c.i. 0.41 to 0.56; P < 0.001; I2 = 0 per cent, fixed-effect model; QoE moderate) and complications (RR 0.61, 0.49 to 0.76; P < 0.001; I2 = 20 per cent, random-effects model; QoE very low) compared with an open procedure. No differences in R0 resection rate (RR 1.01, 1.00 to 1.03; P = 0.12; I2 = 37 per cent, random-effects model; QoE very low) and recurrence rate (RR 0.98, 0.84 to 1.14; P = 0.81; I2 = 0 per cent, fixed-effect model; QoE very low) were found. CONCLUSION Laparoscopic colectomy for T4 colonic cancer is safe, and is associated with better clinical outcomes than open surgery and similar oncological outcomes.
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Affiliation(s)
- Mauro Podda
- Department of Emergency Surgery, Cagliari University Hospital 'D. Casula', Azienda Ospedaliero-Universitaria di Cagliari, Cagliari, Italy
| | - Adolfo Pisanu
- Department of Emergency Surgery, Cagliari University Hospital 'D. Casula', Azienda Ospedaliero-Universitaria di Cagliari, Cagliari, Italy
| | - Alessia Morello
- Department of Surgery, Maggiore Hospital, Crema, Italy
- Department of Surgery, San Matteo Hospital, University of Pavia, Pavia, Italy
| | | | - Kumar Jayant
- Department of Surgery, Chicago University Hospital, Chicago, Illinois, USA
| | - Gaetano Gallo
- Department of Medical and Surgical Sciences, University of Catanzaro, Catanzaro, Italy
| | - Massimo Sartelli
- Department of General and Emergency Surgery, Macerata General Hospital, Macerata, Italy
| | - Federico Coccolini
- Department of General, Emergency and Trauma Surgery, Pisa University Hospital, Pisa, Italy
| | - Fausto Catena
- Department of General, Emergency and Trauma Surgery, Bufalini Hospital, Cesena, Italy
| | - Salomone Di Saverio
- Department of Surgery, Madonna del Soccorso General Hospital, San Benedetto del Tronto, Italy
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13
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Sahakyan AM, Aleksanyan A, Batikyan H, Petrosyan H, Sahakyan MА. Lymph Node Status and Long-Term Oncologic Outcomes After Colon Resection in Locally Advanced Colon Cancer. Indian J Surg 2022. [DOI: 10.1007/s12262-021-02825-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
AbstractLocally advanced colon cancer is associated with poor prognosis. The aim of this report was to examine the association between the lymph node status and prognosis of locally advanced colon cancer. Perioperative and oncologic outcomes were studied in patients who had undergone colectomy for colon cancer between June 2004 and December 2018. Locally advanced colon cancer was defined as stage T4a/T4b cancer. The long-term oncologic results were investigated in patients with non-metastatic locally advanced colon cancer. Of 195 patients operated for locally advanced colon cancer, 83 (42.6%), 43 (22.1%), and 69 (35.3%) had pN0, pN1, and pN2 disease, respectively. Preoperative serum levels of CEA and CA 19-9, as well as incidence of distant metastases were significantly higher in patients with pN2 compared to those with pN0 and pN1. In non-metastatic setting, a trend towards higher incidence of recurrence was observed in node-positive patients. Nodal stage was a significant predictor for survival in the univariable analysis but non-significant after adjusting for confounders. Subgroup analyses among the patients with T4a and T4b cancer did not demonstrate any association between the nodal stage and survival. Preoperative CA 19-9 > 37 U/ml and adjuvant chemotherapy were the only prognostic factors in T4a and T4b colon cancer, respectively. Although a trend towards higher incidence of recurrence was observed in node-positive locally advanced colon cancer, nodal stage was not associated with survival. Adjuvant chemotherapy should be strongly considered in T4b stage colon cancer.
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Lee TH, Park H, Baek SJ, Kwak JM, Kim SH, Kim J. A Minimally Invasive Pelvic Multivisceral Resection Approach for Locally Advanced Primary Colorectal Cancers: A Single-Institution Experience. J Laparoendosc Adv Surg Tech A 2021; 32:727-732. [PMID: 34677096 DOI: 10.1089/lap.2021.0555] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
Background: The role of minimally invasive surgery (MIS) in locally advanced colorectal cancers (CRCs) suspected of direct invasion to adjacent organs or structures remains controversial. The aim of this study is to verify the safety and feasibility of minimally invasive multivisceral resection (MVR) surgery for locally advanced CRCs compared with conventional open surgery. Materials and Methods: Prospectively collected data from patients who underwent MVR for locally advanced CRCs from 2007 to 2017 were retrospectively reviewed. Patients with preoperative clinically suspected T4b stage cancers were enrolled in the study. Results: There were 30 and 19 patients in the MIS and open surgery groups, respectively. Seven patients in the MIS group required conversion, and the most common reason for conversion was ureter and bladder invasion. Tumor sizes were significantly larger in the open group (5.46 cm versus 7.48 cm, P = .010), whereas the MIS group included more patients with rectal cancers (56.7% versus 21%, P = .021). No differences were observed between the two groups in terms of operation time, estimated blood loss, and postoperative hospital stay. Curative (R0) resection was achieved in all patients, and the median follow-up period was 23 months. The 3-year overall survival in the MIS group was 73.6% and 77.9% in the open group (P = .445), and the 3-year total disease-free survival (DFS) was 59.2% and 51.4%, respectively (P = .695). Three-year local DFS was 83.3% for the MIS group, and 51.4% for the open group (P = .120). Conclusion: MIS for primary T4b CRCs without urinary tract invasion is safe and feasible.
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Affiliation(s)
- Tae Hoon Lee
- Department of Surgery, Korea University College of Medicine, Seoul, Korea
| | - Hyunmi Park
- Department of Surgery, Korea University College of Medicine, Seoul, Korea
| | - Se-Jin Baek
- Department of Surgery, Korea University College of Medicine, Seoul, Korea
| | - Jung-Myun Kwak
- Department of Surgery, Korea University College of Medicine, Seoul, Korea
| | - Seon-Hahn Kim
- Department of Surgery, Korea University College of Medicine, Seoul, Korea
| | - Jin Kim
- Department of Surgery, Korea University College of Medicine, Seoul, Korea
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15
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Verma A, Kumar S. Laparoscopy in Colonic Cancer. Indian J Surg 2021. [DOI: 10.1007/s12262-019-02054-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
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16
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Should be a locally advanced colon cancer still considered a contraindication to laparoscopic resection? Surg Endosc 2021; 36:3039-3048. [PMID: 34129086 DOI: 10.1007/s00464-021-08600-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2021] [Accepted: 06/06/2021] [Indexed: 12/24/2022]
Abstract
BACKGROUND The role of elective laparoscopic resection (LR) for the treatment of locally advanced colon cancer (LACC) is unclear. Most studies have retrospectively investigated the outcomes of LR for pT4 cancers, while clinical T4 (cT4) cancers are excluded in the large randomized controlled trials comparing LR and open resection (OR). The aim of this study was to investigate the outcomes in patients undergoing elective LR for LACC. METHODS A prospective single-institution database including consecutive patients undergoing elective LR for clinical LACC (high-risk T3 or T4 N0-2) between March 1996 and March 2017 was retrospectively reviewed. A multivariate analysis was performed to identify predictors of conversion to OR and risk factors for adverse oncologic outcomes. RESULTS A total of 300 patients undergoing LR for LACC were included. A multi-visceral resection was needed in 17 (5.7%) patients. A total of 63 (21%) LRs were converted to OR, mainly due to suspected adjacent organ invasion (82.5%) or obesity (9.5%). Overall postoperative Clavien-Dindo 3-4 complication rate was 4.7%, with no significant differences between completed and converted LRs. Final pathology showed 18 (6%) pT2, 215 (71.7%) pT3, 54 (18%) pT4a, and 13 (4.3%) pT4b cancers. A R0 resection was achieved in 98.3% of patients. On multivariate analysis, tumor size ≥ 7 cm and tumor site (splenic flexure) were the independent risk factors for conversion to OR. A pT4 colon cancer and LNR of 0.25 or greater, but not conversion to OR, were independently associated with both poorer OS and DFS. CONCLUSION(S) Clinical LACC should not be considered a contraindication to LR itself. Bulky tumors ≥ 7 cm and splenic flexure cancers are at higher risk of conversion to OR; however, there is no increased postoperative morbidity or adverse oncologic outcomes in converted patients.
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17
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The First Report of Laparoscopic Multivisceral Resection for a Gastrocolic Fistula Secondary to Colon Cancer. Surg Laparosc Endosc Percutan Tech 2021; 30:e8-e12. [PMID: 31985573 DOI: 10.1097/sle.0000000000000753] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Colon cancer rarely presents with a gastrocolic fistula and resection, if feasible, is usually carried out by open surgery. The authors present the first literature case report of laparoscopic multivisceral resection for gastrocolic fistula secondary to locally advanced colon cancer. MATERIALS AND METHODS A 54-year-old man presented with feculant vomiting, cachexia, and severe iron deficiency anemia. Investigations confirmed a large nonmetastatic splenic flexure colon cancer with fistulation into the stomach. After 10 weeks of nutritional support and laparoscopic defunctioning proximal transverse loop colostomy, we proceeded to laparoscopic extended left hemicolectomy with en bloc sleeve gastrectomy and partial splenectomy. RESULT The procedure was completed laparoscopically (operating time, 400 min; blood loss, 150 mL). He was discharged on the 6th postoperative day after an uneventful recovery. Histology showed an R0 resection of a pT4N1a (1/45 lymph nodes involved) colon cancer with gastrocolic fistula. CONCLUSION Laparoscopic multivisceral en bloc R0 resection of locally advanced colon cancer with gastrocolic fistula can be accomplished safely in experienced hands.
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18
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Nguyen TH, Tran HX, Thai TT, La DM, Tran HD, Le KT, Pham VTN, Le ANT, Nguyen BH. Feasibility and Safety of Laparoscopic Radical Colectomy for T4b Colon Cancer at a University Hospital in Vietnam. BIOMED RESEARCH INTERNATIONAL 2020; 2020:1762151. [PMID: 33224972 PMCID: PMC7673919 DOI: 10.1155/2020/1762151] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/10/2020] [Revised: 09/28/2020] [Accepted: 11/03/2020] [Indexed: 12/24/2022]
Abstract
BACKGROUND The choice of optimal treatment strategies for T4b colon cancers has still been discussed, particularly the initiation of neoadjuvant therapy or surgery. We conducted this study to evaluate the safety and feasibility of laparoscopic multivisceral resection for T4b colon cancers. METHODS We used the retrospective design to include all 43 patients with T4b colon cancer at a university hospital in Vietnam from March 2017 to March 2019. All patients were followed 30 days after the surgery, and information about the day of the first flatus, length of hospital stay, iatrogenic complications, postoperative morbidity, mortality, and adjuvant chemotherapy was collected. RESULTS The mean operating time was 187 minutes (ranging from 80 to 310), the mean blood loss was 64.3 ml (5-200), and the conversion rate was 2.3%. The mean number of lymph nodes harvested was 15.5 (SD = 8.06), and 33 patients (76.7%) had at least 12 lymph nodes harvested. A total of 21 patients (48.8%) had lymph node metastases with a mean number of lymph node metastases of 1.89 (SD = 3.4). The radial resection margin was R0 in all 43 patients (100%). The median time until the first flatus and hospital stay were 3 days (2-5) and 7.1 (6-11) days, respectively. There was no mortality at 30 days postoperatively, and one patient had iatrogenic complication (2.3%). CONCLUSION Laparoscopic radical colectomy was feasible and safe for patients with T4b colon cancer except those requiring major and complicated reconstruction.
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Affiliation(s)
- Thinh H. Nguyen
- Department of General Surgery, University of Medicine and Pharmacy at Ho Chi Minh City, 70000, Vietnam
- Department of Gastrointestinal Surgery, University Medical Center Ho Chi Minh City, 70000, Vietnam
| | - Hung X. Tran
- Department of General Surgery, University of Medicine and Pharmacy at Ho Chi Minh City, 70000, Vietnam
| | - Truc T. Thai
- Department of Medical Statistics and Informatics, University of Medicine and Pharmacy at Ho Chi Minh City, 70000, Vietnam
| | - Duc M. La
- Department of General Surgery, University of Medicine and Pharmacy at Ho Chi Minh City, 70000, Vietnam
| | - Huy D. Tran
- Department of General Surgery, University of Medicine and Pharmacy at Ho Chi Minh City, 70000, Vietnam
- Department of Gastrointestinal Surgery, University Medical Center Ho Chi Minh City, 70000, Vietnam
| | - Kien T. Le
- Department of Gastrointestinal Surgery, University Medical Center Ho Chi Minh City, 70000, Vietnam
| | - Vinh T. N. Pham
- Department of Gastrointestinal Surgery, University Medical Center Ho Chi Minh City, 70000, Vietnam
| | - An N. T. Le
- Department of Gastrointestinal Surgery, University Medical Center Ho Chi Minh City, 70000, Vietnam
| | - Bac H. Nguyen
- Department of General Surgery, University of Medicine and Pharmacy at Ho Chi Minh City, 70000, Vietnam
- Department of Gastrointestinal Surgery, University Medical Center Ho Chi Minh City, 70000, Vietnam
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Miyo M, Kato T, Takahashi Y, Miyake M, Toshiyama R, Hamakawa T, Sakai K, Nishikawa K, Miyamoto A, Hirao M. Short-term and long-term outcomes of laparoscopic colectomy with multivisceral resection for surgical T4b colon cancer: Comparison with open colectomy. Ann Gastroenterol Surg 2020; 4:676-683. [PMID: 33319158 PMCID: PMC7726680 DOI: 10.1002/ags3.12372] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2020] [Revised: 06/08/2020] [Accepted: 06/23/2020] [Indexed: 12/16/2022] Open
Abstract
AIM In response to the rising use of laparoscopic surgery, recent studies have shown that laparoscopic multivisceral resections for locally advanced colon cancer are safe, feasible, and provide acceptable oncological outcomes. However, the usefulness of laparoscopic multivisceral resection remains controversial. Here, we aimed to compare short-term and long-term outcomes between laparoscopic and open multivisceral resection approaches for treating locally advanced colon cancer. METHODS We retrospectively collected data on 1315 consecutive patients admitted to the National Hospital Organization, Osaka National Hospital, for surgical treatment of colorectal cancer between 2010 and 2017. We assessed invasiveness in terms of operating times, blood loss, and complications. Oncological outcomes included 5-year survival rates and recurrences. RESULTS We included 85 patients that underwent a colectomy with a multivisceral resection for locally advanced colon cancer; of these, 38 were treated with a laparoscopic approach and 47 were treated with an open approach. Compared to the open surgery group, the laparoscopic group had significantly less blood loss (median volume: 25 vs 140 mL, P <0.001), a lower complication rate (10.5% vs 29.8%, P = 0.036), and shorter hospital stays (12 vs 15 days, P = 0.028). After excluding patients with stage Ⅳ colon cancer, the groups showed similar pathologic outcomes and no significant differences in 5-year disease-free survival (73.9% vs 67.4%; P = 0.664) or 5-year overall survival (75.8% vs 67.7%; P = 0.695). CONCLUSION A laparoscopic approach for locally advanced colon cancer could be less invasive than an open approach without affecting oncological outcomes in selected patients.
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Affiliation(s)
- Masaaki Miyo
- National Hospital Organization Osaka National HospitalOsakaJapan
| | - Takeshi Kato
- National Hospital Organization Osaka National HospitalOsakaJapan
| | - Yusuke Takahashi
- National Hospital Organization Osaka National HospitalOsakaJapan
| | - Masakazu Miyake
- National Hospital Organization Osaka National HospitalOsakaJapan
| | - Reishi Toshiyama
- National Hospital Organization Osaka National HospitalOsakaJapan
| | - Takuya Hamakawa
- National Hospital Organization Osaka National HospitalOsakaJapan
| | - Kenji Sakai
- National Hospital Organization Osaka National HospitalOsakaJapan
| | | | - Atsushi Miyamoto
- National Hospital Organization Osaka National HospitalOsakaJapan
| | - Motohiro Hirao
- National Hospital Organization Osaka National HospitalOsakaJapan
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20
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Combined robotic and cystoscopic surgery for rectal cancer invading urinary bladder. Int Cancer Conf J 2020; 9:102-106. [PMID: 32582511 DOI: 10.1007/s13691-020-00413-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2020] [Accepted: 03/19/2020] [Indexed: 10/24/2022] Open
Abstract
Although the application of laparoscopic rectal surgery has been widely accepted by accumulated evidence, it remains technically difficult in some cases of obesity, narrow male pelvis, bulky tumors, or involvement of adjacent organs. After robotic rectal surgery has been covered by the health insurance system in Japan since April 2018, we have employed robotic rectal surgery for an increasing number of cases by taking advantages of its 3D vision and wrist function. When a colorectal cancer involves the urinary bladder, the surgical treatment of choice is an anterior resection with en bloc (partial or total) bladder resection, depending on the site and extent of bladder involvement. In the attached video, robotic surgery was conducted with the aid of intraoperative cystoscopy, which resulted in curative resection with negative margin. Given that the robotic system provides excellent stability and dexterity for bladder reconstruction, the robotic approach can be technically suitable for locally advanced T4 colorectal cancer with urinary involvement.
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21
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Mukai T, Nagasaki T, Akiyoshi T, Fukunaga Y, Yamaguchi T, Konishi T, Nagayama S, Ueno M. Laparoscopic multivisceral resection for locally advanced colon cancer: a single-center analysis of short- and long-term outcomes. Surg Today 2020; 50:1024-1031. [PMID: 32152770 DOI: 10.1007/s00595-020-01986-9] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2019] [Accepted: 01/28/2020] [Indexed: 11/24/2022]
Abstract
PURPOSE We evaluated the technical and oncological safety of laparoscopic multivisceral resection (MVR) in selected patients with locally advanced colon cancer (LACC). METHODS We compared the clinical backgrounds, and short- and long-term outcomes of patients who underwent laparoscopic vs. those who underwent open MVR for LACC en bloc at our hospital. RESULTS Between January, 2004 and December, 2015, 140 patients underwent MVR of the primary tumor en bloc via laparoscopic surgery (laparoscopic group; LG, n = 69) or open surgery (open group; OG, n = 71). Laparoscopic surgery was selected mainly for tumors that invaded the bladder and abdominal wall. The LG patients had smaller tumors (60 vs. 80 mm, p < 0.001), less blood loss (30 vs. 181 g, p < 0.001), and shorter hospital stays (12 vs. 19 days, p < 0.001) than the OG patients. Open conversion was required for two patients. Postoperative complications and R0 resection were comparable between the groups. Local recurrence occurred in two LG patients and two OG patients. The 5-year cancer-specific survival, disease-free survival, and local disease-free survival of patients with pT4b disease were not significantly different between the LG and OG groups (90.3% vs. 75.2%, 71.2% vs. 67.6%, and 97.1% vs. 94.2%). CONCLUSION Although the LG included patients with lower risk, the short- and long-term outcomes were equivalent to those of the OG, which included patients with higher risk.
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Affiliation(s)
- Toshiki Mukai
- Department of Gastroenterological Surgery, Cancer Institute Hospital of the Japanese Foundation for Cancer Research, 3-10-6 Ariake, Koto-ku, Tokyo, 135-8550, Japan.
| | - Toshiya Nagasaki
- Department of Gastroenterological Surgery, Cancer Institute Hospital of the Japanese Foundation for Cancer Research, 3-10-6 Ariake, Koto-ku, Tokyo, 135-8550, Japan
| | - Takashi Akiyoshi
- Department of Gastroenterological Surgery, Cancer Institute Hospital of the Japanese Foundation for Cancer Research, 3-10-6 Ariake, Koto-ku, Tokyo, 135-8550, Japan
| | - Yosuke Fukunaga
- Department of Gastroenterological Surgery, Cancer Institute Hospital of the Japanese Foundation for Cancer Research, 3-10-6 Ariake, Koto-ku, Tokyo, 135-8550, Japan
| | - Tomohiro Yamaguchi
- Department of Gastroenterological Surgery, Cancer Institute Hospital of the Japanese Foundation for Cancer Research, 3-10-6 Ariake, Koto-ku, Tokyo, 135-8550, Japan
| | - Tsuyoshi Konishi
- Department of Gastroenterological Surgery, Cancer Institute Hospital of the Japanese Foundation for Cancer Research, 3-10-6 Ariake, Koto-ku, Tokyo, 135-8550, Japan
| | - Satoshi Nagayama
- Department of Gastroenterological Surgery, Cancer Institute Hospital of the Japanese Foundation for Cancer Research, 3-10-6 Ariake, Koto-ku, Tokyo, 135-8550, Japan
| | - Masashi Ueno
- Department of Gastroenterological Surgery, Cancer Institute Hospital of the Japanese Foundation for Cancer Research, 3-10-6 Ariake, Koto-ku, Tokyo, 135-8550, Japan
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22
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Wasmann KA, Klaver CE, van der Bilt JD, van Dieren S, Nagtegaal ID, Punt CJ, van Ramshorst B, Wolthuis AM, de Wilt JH, D'Hoore A, van Santvoort HC, Tanis PJ. Laparoscopic surgery facilitates administration of adjuvant chemotherapy in locally advanced colon cancer: propensity score analyses. Cancer Manag Res 2019; 11:7141-7157. [PMID: 31534367 PMCID: PMC6681076 DOI: 10.2147/cmar.s205906] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2019] [Accepted: 05/14/2019] [Indexed: 12/13/2022] Open
Abstract
Purpose The aim of this study was to evaluate the impact of a laparoscopic approach on long-term oncological outcomes in curative intent surgery for pT4 colon cancer, in both overall and stratified subgroups with distinct clinical entities. Patients and methods Patients with a pT4N0-2M0 colon cancer from four centers between 2000 and 2014 were included. Laparoscopic and open approaches were compared according to the intention-to-treat principle. Propensity scores were used to adjust for baseline differences between the groups in three manners: i) as a linear predictor in a Cox regression model, ii) to create a 1:1 matched cohort, and iii) to stratify patients into four groups with an increasing chance of receiving laparoscopy. Results In total, 424 patients were included. After 1:1 matching, a laparoscopic approach correlated with higher rates of radical resection, lower morbidity, and a higher percentage of patients receiving adjuvant chemotherapy. This translated into better 5-year disease-free survival (52% vs 40%, HR 0.70; 95% CI 0.50–0.96) and 5-year overall survival (68% vs 57%, HR 0.66; 95% CI 0.43–0.99). These results were confirmed in the other two propensity score analyses. In the multivariable models, adjuvant chemotherapy remained independently associated with better survival, whereas surgical approach lost significance. Conclusions In locally advanced colon cancer, an intentional laparoscopic approach in experienced hands seems to decrease morbidity and to increase the proportion of patients receiving adjuvant chemotherapy. Receiving adjuvant chemotherapy was independently associated with improved survival.
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Affiliation(s)
- Karin Atgm Wasmann
- Department of Surgery, Amsterdam University Medical Centre, University of Amsterdam, AZ 1105, Amsterdam, The Netherlands
| | - Charlotte El Klaver
- Department of Surgery, Amsterdam University Medical Centre, University of Amsterdam, AZ 1105, Amsterdam, The Netherlands
| | - Jarmila Dw van der Bilt
- Department of Surgery, Amsterdam University Medical Centre, University of Amsterdam, AZ 1105, Amsterdam, The Netherlands.,Department of Abdominal Surgery, University Hospital Leuven, Leuven 3000, Belgium
| | - Susan van Dieren
- Clinical Research Unit, Amsterdam University Medical Centre, University of Amsterdam, AZ 1105, Amsterdam, The Netherlands
| | - Iris D Nagtegaal
- Department of Pathology, Radboud University Medical Centre, GA 6525, Nijmegen, The Netherlands
| | - Cornelis Ja Punt
- Department of Medical Oncology, Amsterdam University Medical Centre, University of Amsterdam, AZ 1105, Amsterdam, The Netherlands
| | - Bert van Ramshorst
- Department of Surgery, St. Antonius Hospital, CM 3435, Nieuwegein, The Netherlands
| | - Albert M Wolthuis
- Department of Abdominal Surgery, University Hospital Leuven, Leuven 3000, Belgium
| | - Johannes Hw de Wilt
- Department of Surgery, Radboud University Medical Centre, GA 6525, Nijmegen, The Netherlands
| | - André D'Hoore
- Department of Abdominal Surgery, University Hospital Leuven, Leuven 3000, Belgium
| | | | - Pieter J Tanis
- Department of Surgery, Amsterdam University Medical Centre, University of Amsterdam, AZ 1105, Amsterdam, The Netherlands
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23
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Nadiradze G, Yurttas C, Königsrainer A, Horvath P. Significance of multivisceral resections in oncologic surgery: A systematic review of the literature. World J Meta-Anal 2019; 7:269-289. [DOI: 10.13105/wjma.v7.i6.269] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2019] [Revised: 06/07/2019] [Accepted: 06/17/2019] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Multivisceral resections (MVR) are often necessary to reach clear resections margins but are associated with relevant morbidity and mortality. Factors associated with favorable oncologic outcomes and elevated morbidity rates are not clearly defined.
AIM To systematically review the literature on oncologic long-term outcomes and morbidity and mortality in cancer surgery a systematic review of the literature was performed.
METHODS PubMed was searched for relevant articles (published from 2000 to 2018). Retrieved abstracts were independently screened for relevance and data were extracted from selected studies by two researchers.
RESULTS Included were 37 studies with 3112 patients receiving MVR for colorectal cancer (1095 for colon cancer, 1357 for rectal cancer, and in 660 patients origin was not specified). The most common resected organs were the small intestine, bladder and reproductive organs. Median postoperative morbidity rate was 37.9% (range: 7% to 76.6%) and median postoperative mortality rate was 1.3% (range: 0% to 10%). The median conversion rate for laparoscopic MVR was 7.9% (range: 4.5% to 33%). The median blood loss was lower after laparoscopic MVR compared to the open approach (60 mL vs 638 mL). Lymph-node harvest after laparoscopic MVR was comparable. Report on survival rates was heterogeneous, but the 5-year overall-survival rate ranged from 36.7% to 90%, being worst in recurrent rectal cancer patients with a median 5-year overall survival of 23%. R0 -resection, primary disease setting and no lymph-node or lymphovascular involvement were the strongest predictors for long-term survival. The presence of true malignant adhesions was not exclusively associated with poorer prognosis.
Included were 16 studies with 1.600 patients receiving MVR for gastric cancer. The rate of morbidity ranged from 11.8% to 59.8%, and the main postoperative complications were pancreatic fistulas and pancreatitis, anastomotic leakage, cardiopulmonary events and post-operative bleedings. Total mortality was between 0% and 13.6% with an R0 -resection achieved in 38.4% to 100% of patients. Patients after R0 resection had 5-year overall survival rates of 24.1% to 37.8%.
CONCLUSION MVR provides, in a selected subset of patients, the possibility for good long-term results with acceptable morbidity rates. Unlikelihood of achieving R0 -status, lymphovascular- and lymph -node involvement, recurrent disease setting and the presence of metastatic disease should be regarded as relative contraindications for MVR.
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Affiliation(s)
- Giorgi Nadiradze
- Department of General, Visceral and Transplant Surgery, University of Tübingen, Comprehensive Cancer Center, Tübingen 72076, Germany
| | - Can Yurttas
- Department of General, Visceral and Transplant Surgery, University of Tübingen, Comprehensive Cancer Center, Tübingen 72076, Germany
| | - Alfred Königsrainer
- Department of General, Visceral and Transplant Surgery, University of Tübingen, Comprehensive Cancer Center, Tübingen 72076, Germany
| | - Philipp Horvath
- Department of General, Visceral and Transplant Surgery, University of Tübingen, Comprehensive Cancer Center, Tübingen 72076, Germany
- National Center for Pleura and Peritoneum, Tübingen 72076, Germany
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24
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Numata M, Sawazaki S, Aoyama T, Tamagawa H, Godai T, Sato T, Saeki H, Saigusa Y, Taguri M, Mushiake H, Oshima T, Yukawa N, Shiozawa M, Masuda M, Rino Y. Laparoscopic surgery in patients diagnosed with clinical N2 colon cancer. Surg Today 2019; 49:507-512. [PMID: 30666418 DOI: 10.1007/s00595-019-1762-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2018] [Accepted: 12/20/2018] [Indexed: 01/08/2023]
Abstract
PURPOSE The benefits of laparoscopic surgery for colorectal cancer have been well established. Several randomized controlled trials have demonstrated similar oncological outcomes between laparoscopic and open surgery for colon cancer. However, whether or not laparoscopic surgery is acceptable in patients with clinical N2 colon cancer is unclear. Therefore, the present study aimed to evaluate the safety and oncological outcomes of laparoscopic surgery for clinical N2 colon cancer. METHODS This retrospective study assessed a prospective database and identified 262 consecutive patients with clinical N2 colon cancer who underwent either laparoscopic or open primary resection between 2000 and 2016. After propensity-score matching, 162 patients were analyzed. The primary outcome of interest was the 3-year recurrence-free survival rate, and the secondary outcome of interest was the postoperative complication rate. RESULTS The 3-year recurrence-free survival rate did not differ markedly between the laparoscopic and open surgery groups (77.4% vs. 76.5%, p = 0.620). In addition, the incidence of postoperative complications did not differ markedly between the laparoscopic and open surgery groups (16.6% vs. 24.0%, p = 0.317). CONCLUSIONS Our findings suggest that laparoscopic surgery is safe and effective for clinical N2 colon cancer. Laparoscopic resection can be considered in patients diagnosed with clinical N2 colon cancer.
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Affiliation(s)
- Masakatsu Numata
- Department of Surgery, Yokohama City University, 3-9 Fukuura, Kanazawa-ku, Yokohama, Kanagawa, 236-0004, Japan.
| | - Sho Sawazaki
- Department of Surgery, Yokohama City University, 3-9 Fukuura, Kanazawa-ku, Yokohama, Kanagawa, 236-0004, Japan
| | - Toru Aoyama
- Department of Surgery, Yokohama City University, 3-9 Fukuura, Kanazawa-ku, Yokohama, Kanagawa, 236-0004, Japan
| | - Hiroshi Tamagawa
- Department of Surgery, Yokohama City University, 3-9 Fukuura, Kanazawa-ku, Yokohama, Kanagawa, 236-0004, Japan
| | - Teni Godai
- Department of Surgery, Fujisawa Shounandai Hospital, Fujisawa, Japan
| | - Tsutomu Sato
- Department of Surgery, Yokohama City University, 3-9 Fukuura, Kanazawa-ku, Yokohama, Kanagawa, 236-0004, Japan
| | - Hiroyuki Saeki
- Department of Surgery, Yokohama Minami Kyosai Hospital, Yokohama, Japan
| | - Yusuke Saigusa
- Department of Biostatistics, Yokohama City University, Yokohama, Japan
| | - Masataka Taguri
- Department of Biostatistics, Yokohama City University, Yokohama, Japan
| | - Hiroyuki Mushiake
- Department of Surgery, Yokohama City University, 3-9 Fukuura, Kanazawa-ku, Yokohama, Kanagawa, 236-0004, Japan
| | - Takashi Oshima
- Department of Gastroenterological Surgery, Kanagawa Cancer Hospital, Yokohama, Japan
| | - Norio Yukawa
- Department of Surgery, Yokohama City University, 3-9 Fukuura, Kanazawa-ku, Yokohama, Kanagawa, 236-0004, Japan
| | - Manabu Shiozawa
- Department of Gastroenterological Surgery, Kanagawa Cancer Hospital, Yokohama, Japan
| | - Munetaka Masuda
- Department of Surgery, Yokohama City University, 3-9 Fukuura, Kanazawa-ku, Yokohama, Kanagawa, 236-0004, Japan
| | - Yasushi Rino
- Department of Surgery, Yokohama City University, 3-9 Fukuura, Kanazawa-ku, Yokohama, Kanagawa, 236-0004, Japan
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25
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Zhang X, Wu Q, Hu T, Gu C, Bi L, Wang Z. Laparoscopic versus conventional open surgery in T4 rectal cancer: A case-control study. J Minim Access Surg 2019; 15:37-41. [PMID: 30416145 PMCID: PMC6293675 DOI: 10.4103/jmas.jmas_67_18] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
Background: Laparoscopic surgery (LAS) for T4 rectal cancer (RC) is still controversial. This study aims to compare LAS with conventional open surgery in patients with T4 RC. Patients and Methods: Patients undergoing laparoscopic or open curative resection for T4 RC from January 2010 to September 2014 in our hospital were enrolled. Patients’ clinicopathological characteristics and survival outcomes were collected and compared. All statistical analysis was performed using SPSS 22.0. Results: A total of 125 patients (39 open, 86 LAS) were included in this study finally. The baseline information between the two groups were comparable except that LAS group had a more anterior resection (P = 0.012) and less combined resection (P = 0.003). The results demonstrated that patients in LAS group had less blood loss (P < 0.001), smaller incision length (P < 0.001), faster time to first soft diet (P = 0.010) and less incidence of post-operative complications, although it was not significantly different (P = 0.063). In addition, the operative time was also comparable (P = 0.140) and the conversion rate was low (2/86). The 3-year overall survival (OS) was 71.8%, 79.1% in open, LAS group respectively and the 3-year disease-free survival (DFS) was 66.7%, 68.6% in open, laparoscopic group, respectively. The Kaplan curves demonstrated that there was no significant difference between the two groups in OS (P = 0.981) or DFS (P = 0.900). Conclusions: LAS is safe and feasible in selected patients with T4 RC. It can achieve a better perioperative outcomes, and the long-time survival is not inferior to open surgery. Prospective studies should be conducted in the future to reduce the selection bias.
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Affiliation(s)
- Xubing Zhang
- Department of Gastrointestinal Surgery, West China Hospital; West China School of Medicine, Sichuan University, Chengdu, China
| | - Qingbin Wu
- Department of Gastrointestinal Surgery, West China Hospital; West China School of Medicine, Sichuan University, Chengdu, China
| | - Tao Hu
- Department of Gastrointestinal Surgery, West China Hospital; West China School of Medicine, Sichuan University, Chengdu, China
| | - Chaoyang Gu
- Department of Gastrointestinal Surgery, West China Hospital, Sichuan University, Chengdu, China
| | - Liang Bi
- Department of Gastrointestinal Surgery, West China Hospital; West China School of Medicine, Sichuan University, Chengdu, China
| | - Ziqiang Wang
- Department of Gastrointestinal Surgery, West China Hospital, Sichuan University, Chengdu, China
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26
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Zhang X, Wu Q, Gu C, Hu T, Bi L, Wang Z. Comparison of short and long-time outcomes between laparoscopic and conventional open multivisceral resection for primary T4b colorectal cancer. Asian J Surg 2018; 42:401-408. [PMID: 30093256 DOI: 10.1016/j.asjsur.2018.06.010] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2018] [Revised: 05/23/2018] [Accepted: 06/22/2018] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND This study aimed to compare laparoscopic multivisceral resection (LMVR) with conventional open multivisceral resection (OMVR) for primary T4b colorectal cancer (CRC) in short and long-time outcomes. METHODS Patients receiving LMVR or OMVR for primary T4b CRC from January 2009 to June 2016 were enrolled. Patients' clinicopathological characteristics and survival data were collected and analyzed. Multivariable analysis was performed to find the factors related with survival. All statistical analysis was performed by SPSS 22.0. RESULTS A total of 91 patients (LMVR 38, OMVR 53) were included in this study. Patients undergoing LMVR were associated with smaller incision length (P < 0.001), less blood loss (P = 0.01) and comparable operative time (P = 0.071). Patients in LMVR group also had less time to first flatus (P = 0.025). The results also suggested LMVR could reduce the incidence of postoperative complication. The conversion rate was 28.9%. The 3-year OS was 64.2%, 68.4% in OMVR, LMVR group respectively and the 3-year DFS was 56.6%, 52.6% in OMVR, LMVR group respectively. The Kaplan curves demonstrated that LMVR group had similar OS (P = 0.896) and DFS (P = 0.806) when compared with OMVR group. In addition, the multivariate analysis demonstrated that laparoscopic surgery was not associated with poorer survival. CONCLUSION Not all MVR for T4b CRC should be performed by open procedure, LMVR can be safe and feasible for primary T4b CRC in selected patients. It can faster the postoperative recovery and reduce the incidence of postoperative complication. The OS and DFS are also not inferior to open group.
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Affiliation(s)
- Xubing Zhang
- Department of Gastrointestinal Surgery, West China Hospital, Sichuan University, Chengdu, China; West China School of Medicine, Sichuan University, Chengdu, China
| | - Qingbin Wu
- Department of Gastrointestinal Surgery, West China Hospital, Sichuan University, Chengdu, China; West China School of Medicine, Sichuan University, Chengdu, China
| | - Chaoyang Gu
- Department of Gastrointestinal Surgery, West China Hospital, Sichuan University, Chengdu, China
| | - Tao Hu
- Department of Gastrointestinal Surgery, West China Hospital, Sichuan University, Chengdu, China; West China School of Medicine, Sichuan University, Chengdu, China
| | - Liang Bi
- Department of Gastrointestinal Surgery, West China Hospital, Sichuan University, Chengdu, China; West China School of Medicine, Sichuan University, Chengdu, China
| | - Ziqiang Wang
- Department of Gastrointestinal Surgery, West China Hospital, Sichuan University, Chengdu, China.
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27
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Liu ZH, Wang N, Wang FQ, Dong Q, Ding J. Oncological outcomes of laparoscopic versus open surgery in pT4 colon cancers: A systematic review and meta-analysis. Int J Surg 2018; 56:221-233. [PMID: 29940259 DOI: 10.1016/j.ijsu.2018.06.032] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2018] [Revised: 06/01/2018] [Accepted: 06/20/2018] [Indexed: 02/07/2023]
Abstract
BACKGROUND Widespread adoption of minimally invasive surgery for colon cancer has achieved improved short-term benefits and better long-term oncological outcomes compared with open surgery. However, it is still controversial whether laparoscopic surgery is suitable for patients with stage T4 colon cancer. The aim of this meta-analysis was to compare short- and long-term oncological outcomes associated with laparoscopic and conventional open surgery for pT4 colon cancer. METHODS Published studies from 2003 to 2018 comparing oncological outcomes following laparoscopic and open surgery for pT4 colon cancer were systematically searched. Data on conversion rate, R0 resection rate, number of harvested lymph nodes, morbidity and mortality, and overall survival (OS) and disease-free survival (DFS) were subjected to meta-analysis using fixed-effect and random-effect models. RESULTS Twelve observational studies met the inclusion criteria with a total of 2396 cases (1250 laparoscopic and 1146 open). There was no significant difference in R0 resection rate [relative risk (RR) = 1.007; 95% confidence interval (CI) = 0.935-1.085; P = 0.850], number of harvested lymph nodes (MD = 0.004; 95% CI = -0.139 to 0.148; P = 0.951), mortality (RR = 0.509; 95% CI = 0.176-1.470; P = 0.212), and 3-year OS (RR = 1.056; 95% CI = 0.939-1.188; P = 0.360), 5-year OS (RR = 1.003; 95% CI = 0.883-1.139; P = 0.966), 3-year DFS (RR = 1.032; 95% CI = 0.903-1.179; P = 0.642), and 5-year DFS (RR = 0.995; 95% CI = 0.868-1.140; P = 0.973) between the groups. The rate of conversion from laparoscopic to open procedures was 10.7% (95% CI = 0.090-0.124). There was a significant difference in incidence of complications within 30 postoperative days between laparoscopic and open surgery (RR = 0.703; 95% CI = 0.564-0.876; P = 0.002). CONCLUSION Laparoscopic surgery is safe and feasible in pT4 colon cancer, oncological outcomes are similar, and more importantly, there are fewer postoperative complications compared with open surgery.
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Affiliation(s)
- Zhen-Hua Liu
- Medical College of Guizhou University, Guiyang 550025, China; Department of Gastrointestinal Surgery, Guizhou Provincial People's Hospital, Guiyang 550002, China
| | - Ning Wang
- Department of Pharmacy, Guizhou Orthopaedic Hospital, Guiyang 550002, China
| | - Fei-Qing Wang
- Department of Clinical Laboratory, First Affiliated Hospital of Guiyang College of Traditional Chinese Medicine, Guiyang 550001, China
| | - Qi Dong
- Department of Gastrointestinal Surgery, Guizhou Provincial People's Hospital, Guiyang 550002, China
| | - Jie Ding
- Department of Gastrointestinal Surgery, Guizhou Provincial People's Hospital, Guiyang 550002, China.
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28
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Klaver CEL, Kappen TM, Borstlap WAA, Bemelman WA, Tanis PJ. Laparoscopic surgery for T4 colon cancer: a systematic review and meta-analysis. Surg Endosc 2017; 31:4902-4912. [PMID: 28432461 PMCID: PMC5715041 DOI: 10.1007/s00464-017-5544-7] [Citation(s) in RCA: 61] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2017] [Accepted: 03/28/2017] [Indexed: 12/20/2022]
Abstract
BACKGROUND In colon cancer, T4 stage is still assumed to be a relative contraindication for laparoscopic surgery considering the oncological safety. The aim of this systematic review with meta-analysis was to evaluate short- and long-term oncological outcomes after laparoscopic surgery for T4 colon cancer, and to compare these with open surgery. METHODS Using systematic review of literature, studies reporting on radicality of resection, disease-free survival (DFS), and/or overall survival (OS) after laparoscopic surgery for T4 colon cancer were identified, with or without a control group of open surgery. Pooled proportions and risk ratios were calculated using an inverse variance method. RESULTS Thirteen observational cohort studies published between 2012 and 2017 were included, together consisting of 1217 patients that received laparoscopic surgery and 1357 with an open procedure. The proportion of multivisceral resections was larger in the open group in five studies. Based on 11 studies, the pooled proportion of R0 resection was 0.96 (95% CI: 0.91-0.99) and 0.96 (95% CI: 0.90-0.98) after laparoscopic and open surgery, respectively. Analysing (mainly) T4a subgroups in 6 evaluable studies revealed pooled R0 resection rates of 0.94 in both groups. No significant differences were found between laparoscopic and open surgery for any survival measure: RR 1.07 (95% CI: 0.96-1.20) for 3-year DFS, RR 1.04 (95% CI: 0.95-1.15) for 5-year DFS, RR 1.07 (95% CI: 0.99-1.14) for 3-year OS, and RR 1.05 (95% CI: 0.98-1.12) for 5-year OS. CONCLUSION Literature on laparoscopic surgery for T4 colon cancer is restricted to non-randomized comparisons with substantial allocation bias. Laparoscopic surgery for T4a tumours might be safe, whereas for T4b colon cancer requiring multivisceral resection it should be applied with caution.
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Affiliation(s)
- Charlotte E. L. Klaver
- Department of Surgery, Academic Medical Centre, University of Amsterdam, Room G4140, Meibergdreef 9, 1105AZ Amsterdam, The Netherlands
| | - Tijmen M. Kappen
- Department of Surgery, Academic Medical Centre, University of Amsterdam, Room G4140, Meibergdreef 9, 1105AZ Amsterdam, The Netherlands
| | - Wernard A. A. Borstlap
- Department of Surgery, Academic Medical Centre, University of Amsterdam, Room G4140, Meibergdreef 9, 1105AZ Amsterdam, The Netherlands
| | - Willem A. Bemelman
- Department of Surgery, Academic Medical Centre, University of Amsterdam, Room G4140, Meibergdreef 9, 1105AZ Amsterdam, The Netherlands
| | - Pieter J. Tanis
- Department of Surgery, Academic Medical Centre, University of Amsterdam, Room G4140, Meibergdreef 9, 1105AZ Amsterdam, The Netherlands
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