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Ma L, Yu H, Zhu Y, Li W, Xu K, Zhao A, Ding L, Gao H. Laparoscopy is non-inferior to open surgery for rectal cancer: A systematic review and meta-analysis. Cancer Med 2024; 13:e7363. [PMID: 38970275 PMCID: PMC11226727 DOI: 10.1002/cam4.7363] [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: 12/04/2023] [Revised: 05/19/2024] [Accepted: 05/27/2024] [Indexed: 07/08/2024] Open
Abstract
BACKGROUND Laparoscopic surgery has been endorsed by clinical guidelines for colon cancer, but not for rectal cancer on account of unapproved oncologic equivalence with open surgery. AIMS We started this largest-to-date meta-analysis to comprehensively evaluate the safety and efficacy of laparoscopy in the treatment of rectal cancer compared with open surgery. MATERIALS & METHODS Both randomized and nonrandomized controlled trials comparing laparoscopic proctectomy and open surgery between January 1990 and March 2020 were searched in PubMed, Cochrane Library and Embase Databases (PROSPERO registration number CRD42020211718). The data of intraoperative, pathological, postoperative and survival outcomes were compared between two groups. RESULTS Twenty RCTs and 93 NRCTs including 216,615 patients fulfilled the inclusion criteria, with 48,888 patients received laparoscopic surgery and 167,727 patients underwent open surgery. Compared with open surgery, laparoscopic surgery group showed faster recovery, less complications and decreased mortality within 30 days. The positive rate of circumferential margin (RR = 0.79, 95% CI: 0.72 to 0.85, p < 0.0001) and distal margin (RR = 0.75, 95% CI: 0.66 to 0.85 p < 0.0001) was significantly reduced in the laparoscopic surgery group, but the completeness of total mesorectal excision showed no significant difference. The 3-year and 5-year local recurrence, disease-free survival and overall survival were all improved in the laparoscopic surgery group, while the distal recurrence did not differ significantly between the two approaches. CONCLUSION Laparoscopy is non-inferior to open surgery for rectal cancer with respect to oncological outcomes and long-term survival. Moreover, laparoscopic surgery provides short-term advantages, including faster recovery and less complications.
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Affiliation(s)
- Ling Ma
- Department of Gastrointestinal Tumor SurgeryBeijing Shijitan Hospital Affiliated to Capital Medical UniversityBeijingPeople's Republic of China
| | - Hai‐jiao Yu
- Department of Gastrointestinal Tumor SurgeryBeijing Shijitan Hospital Affiliated to Capital Medical UniversityBeijingPeople's Republic of China
| | - Yu‐bing Zhu
- Department of Gastrointestinal Tumor SurgeryBeijing Shijitan Hospital Affiliated to Capital Medical UniversityBeijingPeople's Republic of China
| | - Wen‐xia Li
- Department of Gastrointestinal Tumor SurgeryBeijing Shijitan Hospital Affiliated to Capital Medical UniversityBeijingPeople's Republic of China
| | - Kai‐yu Xu
- Department of Gastrointestinal Tumor SurgeryBeijing Shijitan Hospital Affiliated to Capital Medical UniversityBeijingPeople's Republic of China
| | - Ai‐min Zhao
- Department of Gastrointestinal Tumor SurgeryBeijing Shijitan Hospital Affiliated to Capital Medical UniversityBeijingPeople's Republic of China
| | - Lei Ding
- Department of Gastrointestinal Tumor SurgeryBeijing Shijitan Hospital Affiliated to Capital Medical UniversityBeijingPeople's Republic of China
| | - Hong Gao
- Department of Gastrointestinal Tumor SurgeryBeijing Shijitan Hospital Affiliated to Capital Medical UniversityBeijingPeople's Republic of China
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Petersson J, Matthiessen P, Jadid KD, Bock D, Angenete E. Short-term results in a population based study indicate advantage for minimally invasive rectal cancer surgery versus open. BMC Surg 2024; 24:52. [PMID: 38341534 PMCID: PMC10858513 DOI: 10.1186/s12893-024-02336-z] [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: 08/30/2023] [Accepted: 01/29/2024] [Indexed: 02/12/2024] Open
Abstract
BACKGROUND The aim of this study was to determine if minimally invasive surgery (MIS) for rectal cancer is non-inferior to open surgery (OPEN) regarding adequacy of cancer resection in a population based setting. METHODS All 9,464 patients diagnosed with rectal cancer 2012-2018 who underwent curative surgery were included from the Swedish Colorectal Cancer Registry. PRIMARY OUTCOMES Positive circumferential resection margin (CRM < 1 mm) and positive resection margin (R1). Non-inferiority margins used were 2.4% and 4%. SECONDARY OUTCOMES 30- and 90-day mortality, clinical anastomotic leak, re-operation < 30 days, 30- and 90-day re-admission, length of stay (LOS), distal resection margin < 1 mm and < 12 resected lymph nodes. Analyses were performed by intention-to-treat using unweighted and weighted multiple regression analyses. RESULTS The CRM was positive in 3.8% of the MIS group and 5.4% of the OPEN group, risk difference -1.6% (95% CI -1.623, -1.622). R1 was recorded in 2.8% of patients in the MIS group and in 4.4% of patients in the OPEN group, risk difference -1.6% (95% CI -1.649, -1.633). There were no differences between the groups in adjusted unweighted and weighted analyses. All analyses demonstrated decreased mortality and re-admissions at 30 and 90 days as well as shorter LOS following MIS. CONCLUSIONS In this population based setting MIS for rectal cancer was non-inferior to OPEN regarding adequacy of cancer resection with favorable short-term outcomes.
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Affiliation(s)
- Josefin Petersson
- Department of Surgery, SSORG Sahlgrenska University Hospital/Östra, 416 85, Göteborg, Sweden.
- Sunshine Coast University Hospital, Britinya, QLD, Australia.
| | - Peter Matthiessen
- Department of Surgery, Faculty of Medicine and Health Sciences, Örebro University, Örebro, Sweden
| | - Kaveh Dehlaghi Jadid
- Department of Surgery, Faculty of Medicine and Health Sciences, Örebro University, Örebro, Sweden
| | - David Bock
- Department of Surgery, SSORG Sahlgrenska University Hospital/Östra, 416 85, Göteborg, Sweden
| | - Eva Angenete
- Department of Surgery, SSORG Sahlgrenska University Hospital/Östra, 416 85, Göteborg, Sweden
- Department of Surgery, Region Västra Götaland, Sahlgrenska University Hospital, Göteborg, Sweden
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3
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Formisano G, Ferraro L, Salaj A, Giuratrabocchetta S, Piccolo G, Di Raimondo G, Bianchi PP. Robotic Total Mesorectal Excision for Low Rectal Cancer: A Narrative Review and Description of the Technique. J Clin Med 2023; 12:4859. [PMID: 37510973 PMCID: PMC10381747 DOI: 10.3390/jcm12144859] [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: 06/21/2023] [Revised: 07/21/2023] [Accepted: 07/22/2023] [Indexed: 07/30/2023] Open
Abstract
Robotic surgery may offer significant advantages for treating extraperitoneal rectal cancer. Although laparoscopy has been shown to be safe and effective, laparoscopic total mesorectal excision (TME) remains technically challenging and is still performed in selected centers. Robotic anterior resection (RAR) may overcome the drawback of conventional laparoscopy, providing high-quality surgery with favorable oncological outcomes. Moreover, recent data show how RAR offers clinical and oncological benefits when affording difficult TMEs, such as low and advanced rectal tumors, in terms of complication rate, specimen quality, recurrence rate, and survival. This series aims to review the most recent and relevant literature, reporting mid- and long-term oncological outcomes and focusing on minimally invasive RAR for low rectal cancer.
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Affiliation(s)
- Giampaolo Formisano
- Department of Surgery, Asst Santi Paolo e Carlo, Dipartimento di Scienze della Salute, University of Milan, 20122 Milan, Italy
| | - Luca Ferraro
- Department of General Surgery, Asst Santi Paolo e Carlo, 20142 Milan, Italy
| | - Adelona Salaj
- Department of Surgery, Asst Santi Paolo e Carlo, Dipartimento di Scienze della Salute, University of Milan, 20122 Milan, Italy
| | - Simona Giuratrabocchetta
- Department of Surgery, Asst Santi Paolo e Carlo, Dipartimento di Scienze della Salute, University of Milan, 20122 Milan, Italy
| | - Gaetano Piccolo
- Department of Surgery, Asst Santi Paolo e Carlo, Dipartimento di Scienze della Salute, University of Milan, 20122 Milan, Italy
| | - Giulia Di Raimondo
- Department of Surgery, Asst Santi Paolo e Carlo, Dipartimento di Scienze della Salute, University of Milan, 20122 Milan, Italy
| | - Paolo Pietro Bianchi
- Department of Surgery, Asst Santi Paolo e Carlo, Dipartimento di Scienze della Salute, University of Milan, 20122 Milan, Italy
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4
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Gomez Ruiz M, Ballestero Diego R, Tejedor P, Cagigas Fernandez C, Cristobal Poch L, Suarez Pazos N, Castillo Diego J. Robotic surgery for locally advanced T4 rectal cancer: feasibility and oncological quality. Updates Surg 2023; 75:589-597. [PMID: 36763301 DOI: 10.1007/s13304-023-01450-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2022] [Accepted: 02/03/2023] [Indexed: 02/11/2023]
Abstract
For T4 rectal tumours and local recurrences (LR) of rectal cancer, a radical resection beyond TME, sometimes by multi-visceral resection, is important to obtain safe margins and improve survival. The use of the laparoscopic approach (LA) for these cases is still controversial and associated with a high rate of conversion. However, robotic surgery might offer some advantages that can overcome some of the limitations of LA. Therefore, we aimed to analyse the postoperative outcomes and medium-term oncological results of robotic surgery for locally advanced rectal cancer (pathological T4) and LR. A retrospective analysis was performed including patients who had undergone robotic rectal resection in a single institution over an 11-year period, and had a T4 tumour confirmed in the pathological report. Primary endpoint was to analyse postoperative complications (30-day) and the rate of conversion. Secondary endpoints include pathological assessment of the quality of the specimen, local recurrence and survival [2-year disease-free survival (DFS) and overall survival (OS)]. A total of 41 patients were analysed, including a total of 24 patients (60%) that required a multivisceral resection. The median distance from the tumour to the anorectal junction was 7 (4-12) cm. Conversion to open surgery was necessary in 2 cases (5%). The overall morbidity rate was 78% (n = 32), with 37% of major complications, most of them urinary (n = 7). Median length of hospital stay (LOS) was 13 (7-27) days. The 30-day mortality rate was 7% (n = 3). An R0 resection was achieved in 85.4% of the cases (n = 35) due to 6 cases of the positive circumferential resection margin. 2-year disease-free survival (DFS) and overall survival (OS) for the T4 tumours were 72% and 85%, respectively. There were 8 cases of local recurrence (22.2%); 6 of them met the selection criteria for salvage surgery. Robotic surgery for locally advanced T4 rectal cancer and multi-visceral resections is safe and feasible, with a low rate of conversion and an acceptable rate of postoperative morbidity in this subgroup of patients. Oncological results have shown to be comparable with the laparoscopic series published, preserving a good quality of the resected specimen. However, comparative studies and a longer follow-up period is needed to confirm the oncologic findings and to support the general adoption of the robotic system for these complex interventions.
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Affiliation(s)
- Marcos Gomez Ruiz
- Colorectal Surgery Unit, General Surgery Department, Marqués de Valdecilla University Hospital, 39008, Santander, Spain
- Valdecilla Biomedical Research Institute (IDIVAL), 39010, Santander, Spain
| | - Roberto Ballestero Diego
- Urology, Marqués de Valdecilla University Hospital, 39008, Santander, Spain
- Valdecilla Biomedical Research Institute (IDIVAL), 39010, Santander, Spain
| | - Patricia Tejedor
- Colorectal Surgery Unit, General Surgery Department, Gregorio Marañón University Hospital, Madrid, Spain.
| | - Carmen Cagigas Fernandez
- Colorectal Surgery Unit, General Surgery Department, Marqués de Valdecilla University Hospital, 39008, Santander, Spain
- Valdecilla Biomedical Research Institute (IDIVAL), 39010, Santander, Spain
| | - Lidia Cristobal Poch
- Colorectal Surgery Unit, General Surgery Department, Marqués de Valdecilla University Hospital, 39008, Santander, Spain
- Valdecilla Biomedical Research Institute (IDIVAL), 39010, Santander, Spain
| | - Natalia Suarez Pazos
- Colorectal Surgery Unit, General Surgery Department, Marqués de Valdecilla University Hospital, 39008, Santander, Spain
- Valdecilla Biomedical Research Institute (IDIVAL), 39010, Santander, Spain
| | - Julio Castillo Diego
- Colorectal Surgery Unit, General Surgery Department, Marqués de Valdecilla University Hospital, 39008, Santander, Spain
- Valdecilla Biomedical Research Institute (IDIVAL), 39010, Santander, Spain
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5
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Akagi T, Nakajima K, Hirano Y, Abe T, Inada R, Kono Y, Shiroshita H, Ohyama T, Inomata M, Yamamoto S, Naitoh T, Sakai Y, Watanabe M. Laparoscopic versus open resection for stage II/III rectal cancer in obese patients: A multicenter propensity score-based analysis of short- and long-term outcomes. Ann Gastroenterol Surg 2023; 7:71-80. [PMID: 36643354 PMCID: PMC9831897 DOI: 10.1002/ags3.12599] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2022] [Accepted: 06/24/2022] [Indexed: 01/18/2023] Open
Abstract
Aim Whether a laparoscopic procedure can contribute to the improvement of clinical outcomes in obese patients with stage II/III rectal cancer compared to an open procedure remains unclear. Objective This study evaluated the technical and oncological safety of laparoscopic surgery versus open surgery in obese patients (body mass index [BMI] ≥25 kg/m2) with rectal cancer. Patients and Methods Data were collected from patients with pathological stage II/III rectal cancer and analyzed. Operations were performed via laparoscopic or open surgery from 2009 to 2013. A comparative analysis was performed after applying propensity score matching to the two cohorts (laparoscopic group and open group). The primary endpoint was 3-y relapse-free survival (RFS). Results Overall, 524 eligible cases were collected from 51 institutions. Equal numbers of propensity score-matched patients were included in the laparoscopic (n = 193) group and open (n = 193) group. Although the rate of D3 lymph node dissection did not differ between the laparoscopic group (87.0%) and the open group (88.6%), the median number of harvested lymph nodes was significantly lower in the laparoscopic group versus open group (17.5 vs 21, P = 0.0047). The median postoperative hospital stay was also significantly shorter in the laparoscopic group (14 d) vs the open group (17 d) (P = 0.0014). Three-y RFS was not significantly different between the two groups (hazard ratio 1.2454, 95% confidence interval 0.9201-1.6884, P = 0.4689). Conclusion The short- and long-term results of this large cohort study (UMIN ID: UMIN000033529) indicated that laparoscopic surgery in obese rectal cancer patients has advantageous short-term outcomes and no disadvantageous long-term outcomes.
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Affiliation(s)
- Tomonori Akagi
- Gastroenterological and Pediatric Surgery Oita University of Faculty of Medicine Oita Japan
| | | | - Yasumitsu Hirano
- Department of Gastroenterological Surgery Saitama Medical University International Medical Center Saitama Japan
| | - Tomoya Abe
- Department of Gastroenterological Surgery Sendai City Medical Center Sendai Open Hospital Sendai Japan
| | - Ryo Inada
- Department of Gastroenterological Surgery Kochi Health Sciences Center Kochi Japan
| | - Yohei Kono
- Gastroenterological and Pediatric Surgery Oita University of Faculty of Medicine Oita Japan
| | - Hidefumi Shiroshita
- Gastroenterological and Pediatric Surgery Oita University of Faculty of Medicine Oita Japan
| | | | - Masafumi Inomata
- Gastroenterological and Pediatric Surgery Oita University of Faculty of Medicine Oita Japan
| | | | - Takeshi Naitoh
- Department of Lower Gastrointestinal Surgery Kitasato University School of Medicine Sagamihara Japan
| | | | - Masahiko Watanabe
- Department of Surgery Kitasato University Kitasato Institute Hospital Tokyo Japan
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6
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Dehlaghi Jadid K, Cao Y, Petersson J, Angenete E, Matthiessen P. Long term oncological outcomes for laparoscopic versus open surgery for rectal cancer - A population-based nationwide noninferiority study. Colorectal Dis 2022; 24:1308-1317. [PMID: 35656573 PMCID: PMC9796648 DOI: 10.1111/codi.16204] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2022] [Revised: 04/12/2022] [Accepted: 05/22/2022] [Indexed: 01/01/2023]
Abstract
AIM The aim of this work was to compare the 5-year overall survival in a national cohort of patients undergoing curative abdominal resection for rectal cancer by laparoscopic (LAP) or open (OPEN) surgery. METHOD All patients diagnosed with clinical Stage I-III rectal cancer and who underwent LAP or OPEN abdominal curative surgery in Sweden between 2010 and 2016 were retrieved from the Swedish Colorectal Cancer Registry. A noninferiority study design was employed with a statistical power of 90%, a one-side type I error of 2.5% and a noninferiority margin of 2%. The analyses were performed as intention-to-treat and the relationship between surgical technique and overall mortality within 5 years was analysed. Multilevel regression models with the patients matched by propensity scores adjusted for patient- and tumour-related variables were used. RESULTS A total of 8410 Stage I-III cancer patients were included. This group underwent 2094 LAP (24.9%) and 6316 OPEN (75.1%) procedures and were followed until 31 December 2020. Multivariable Cox regression demonstrated that 5-year overall survival was higher in the LAP group [hazard ratio (HR) 0.877; 95% CI 0.775-0.993]. [Correction added on 21 November 2022, after first online publication: In the preceding sentence, the CI value for LAP group has been corrected from "0.877" to "0.775" in this version.] The outcome was similar when multiple imputation and propensity score matching were employed. When cT4 patients were excluded there was no difference (HR 0.885; 95% CI 0.790-1.033). At 5-years' follow-up local recurrence was not different, at 2.9% for the LAP group and 3.6% for the OPEN group (p = 0.075), while metastatic disease was more frequent in the OPEN group (19.6% compared with 15.6% for LAP; p < 0.001). CONCLUSION This study demonstrated that the LAP technique was not inferior to OPEN surgery with regard to overall 5-year survival. These results support the use of laparoscopic surgery.
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Affiliation(s)
- Kaveh Dehlaghi Jadid
- Department of SurgeryÖrebro University HospitalÖrebroSweden,Department of Surgery, Faculty of Medicine and HealthÖrebro UniversityÖrebroSweden
| | - Yang Cao
- Clinical Epidemiology and Biostatistics, School of Medical SciencesÖrebro UniversityÖrebroSweden
| | - Josefin Petersson
- SSORG – Scandinavian Surgical Outcomes Research Group, Department of Surgery, Institute of Clinical Sciences, Sahlgrenska AcademyUniversity of GothenburgGothenburgSweden,Region Västra Götaland, Department of SurgerySahlgrenska University HospitalGothenburgSweden
| | - Eva Angenete
- SSORG – Scandinavian Surgical Outcomes Research Group, Department of Surgery, Institute of Clinical Sciences, Sahlgrenska AcademyUniversity of GothenburgGothenburgSweden,Region Västra Götaland, Department of SurgerySahlgrenska University HospitalGothenburgSweden
| | - Peter Matthiessen
- Department of SurgeryÖrebro University HospitalÖrebroSweden,Department of Surgery, Faculty of Medicine and HealthÖrebro UniversityÖrebroSweden
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7
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Pla-Martí V, Martín-Arévalo J, Moro-Valdezate D, García-Botello S, Pérez-Santiago L, Lapeña-Rodríguez M, Bauzá-Collado M, Huerta M, Roselló-Keränen S, Espí-Macías A. Prognostic implications of surgical specimen quality on the oncological outcomes of open and laparoscopic surgery in mid and low rectal cancer. Langenbecks Arch Surg 2021; 406:2759-2767. [PMID: 34716825 PMCID: PMC8803799 DOI: 10.1007/s00423-021-02351-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2021] [Accepted: 10/06/2021] [Indexed: 11/03/2022]
Abstract
Purpose Determine differences in pathologic outcomes between laparoscopic (LAP) and open surgery (OPEN) for mid and low rectal cancer and its influence in long-term oncological outcomes. Methods Retrospective case matched study at a tertiary institution. Adults with rectal cancer below 12 cm from the anal verge operated between January 2005 and September 2018 were included. Primary outcomes were quality of specimen, overall survival (OS), disease-free survival (DFS), and local recurrence (LR). Results The study included 311 patients, LAP = 108 (34.7%), OPEN = 203 (65,3%). A successful resection was accomplished in 81% of the LAP group and in 84.5% of the OPEN (p = 0.505). No differences in free distal margin (LAP = 100%, OPEN = 97.5%; p = 0.156) or circumferential resection margin (LAP = 95.2%, OPEN = 93.2%; p = 0.603) were observed. However, mesorectum quality was incomplete in 16.2% for LAP and in 8.1% for OPEN (p = 0.048). OS was 91.1% for LAP and 81.1% for OPEN (p = 0.360). DFS was 81.4% for LAP and 77.5% for OPEN (p = 0.923). Overall, LR was 2.3% without differences between groups. Conclusions Laparoscopic approach could affect the quality of surgical specimen due to technical aspects. However, if principles of surgical oncology are respected, minor pathologic differences in the quality of the mesorectum may not influence on the long-term oncologic outcomes.
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Affiliation(s)
- Vicente Pla-Martí
- Colorectal Surgery Unit, Department of General and Digestive Surgery, Biomedical Research Institute INCLIVA, Hospital Clínico Universitario, Av. Blasco Ibáñez, 17. 46010, Valencia, Spain.,Department of Surgery, Universidad de Valencia, Valencia, Spain
| | - José Martín-Arévalo
- Colorectal Surgery Unit, Department of General and Digestive Surgery, Biomedical Research Institute INCLIVA, Hospital Clínico Universitario, Av. Blasco Ibáñez, 17. 46010, Valencia, Spain
| | - David Moro-Valdezate
- Colorectal Surgery Unit, Department of General and Digestive Surgery, Biomedical Research Institute INCLIVA, Hospital Clínico Universitario, Av. Blasco Ibáñez, 17. 46010, Valencia, Spain. .,Department of Surgery, Universidad de Valencia, Valencia, Spain.
| | - Stephanie García-Botello
- Colorectal Surgery Unit, Department of General and Digestive Surgery, Biomedical Research Institute INCLIVA, Hospital Clínico Universitario, Av. Blasco Ibáñez, 17. 46010, Valencia, Spain.,Department of Surgery, Universidad de Valencia, Valencia, Spain
| | - Leticia Pérez-Santiago
- Colorectal Surgery Unit, Department of General and Digestive Surgery, Biomedical Research Institute INCLIVA, Hospital Clínico Universitario, Av. Blasco Ibáñez, 17. 46010, Valencia, Spain
| | - María Lapeña-Rodríguez
- Colorectal Surgery Unit, Department of General and Digestive Surgery, Biomedical Research Institute INCLIVA, Hospital Clínico Universitario, Av. Blasco Ibáñez, 17. 46010, Valencia, Spain
| | - Mireia Bauzá-Collado
- Colorectal Surgery Unit, Department of General and Digestive Surgery, Biomedical Research Institute INCLIVA, Hospital Clínico Universitario, Av. Blasco Ibáñez, 17. 46010, Valencia, Spain
| | - Marisol Huerta
- Department of Medical Oncology, INCLIVA Biomedical Research Institute, University of Valencia, Valencia, Spain
| | - Susana Roselló-Keränen
- Department of Medical Oncology, INCLIVA Biomedical Research Institute, University of Valencia, Valencia, Spain.,Instituto de Salud Carlos III, CIBERONC, Valencia, Spain
| | - Alejandro Espí-Macías
- Colorectal Surgery Unit, Department of General and Digestive Surgery, Biomedical Research Institute INCLIVA, Hospital Clínico Universitario, Av. Blasco Ibáñez, 17. 46010, Valencia, Spain.,Department of Surgery, Universidad de Valencia, Valencia, Spain
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8
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Hirpara DH, O'Rourke C, Azin A, Quereshy FA, Wexner SD, Chadi SA. Impact of BMI on Adverse Events After Laparoscopic and Open Surgery for Rectal Cancer. J Gastrointest Cancer 2021; 53:370-379. [PMID: 33660225 DOI: 10.1007/s12029-021-00612-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/15/2021] [Indexed: 11/28/2022]
Abstract
PURPOSE The impact of body mass index (BMI) on outcomes after open or laparoscopic surgery for rectal cancer remains unclear. The objective of this retrospective cohort study was to examine the interaction of body mass index and surgical modality (i.e., laparoscopy versus open) with respect to short-term clinical outcomes in patients with rectal cancer. METHODS The ACS-NSQIP database (2012-2016) was reviewed for patients undergoing open or laparoscopic surgery for rectal cancer. The primary outcome was 30-day all-cause morbidity. Logistic regression and Cox proportional hazard models were used for analysis. RESULTS A total of 16,145 patients were grouped into open (N = 6759, 42%) and laparoscopic (N = 9386, 58%) cohorts. Patients with higher BMI (p < 0.001) and those undergoing open surgery (p < 0.001) were at increased risk of all-cause morbidity. There was no significant change in the odds ratio of experiencing all-cause morbidity between open and laparoscopic surgery with increasing BMI (p = 0.572). Median length of stay was significantly shorter in the laparoscopy group (4 days vs. 6 days; p < 0.001), at the cost of increased operative time (239 min vs. 210 min, p < 0.001). The difference in operative time between laparoscopy and open surgery did not increase with rising BMI (i.e., ∆37 min vs. ∆39 min at BMI 25 kg/m2 vs 50 kg/m2, respectively, p = 0.491). CONCLUSION BMI may not be a strong modifier for surgical approach with respect to short-term clinical outcomes in patients with obesity and rectal cancer. Laparoscopic surgery was associated with improved short-term clinical outcomes, without much change in the absolute difference in operative time compared with open surgery, even at higher BMIs.
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Affiliation(s)
- Dhruvin H Hirpara
- Department of Surgery, University of Toronto, 149 College St., ON, M5T1P5, Toronto, USA
| | - Colin O'Rourke
- Benaroya Research Institute, Virginia Mason, 1201 Ninth Ave., WA, 98101-2795, Seattle, USA
| | - Arash Azin
- Department of Surgery, University of Toronto, 149 College St., ON, M5T1P5, Toronto, USA
| | - Fayez A Quereshy
- Division of Surgical Oncology and General Surgery, University Health Network and Princess Margaret Hospital, 399 Bathurst St., ON, M5T2S8, Toronto, USA
| | - Steven D Wexner
- Department of Colorectal Surgery, Digestive Disease Centre, Cleveland Clinic Florida, Cleveland Clinic Blvd., FL, Weston, USA
| | - Sami A Chadi
- Division of Surgical Oncology and General Surgery, University Health Network and Princess Margaret Hospital, 399 Bathurst St., ON, M5T2S8, Toronto, USA.
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9
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Hoshino N, Fukui Y, Hida K, Obama K. Similarities and differences between study designs in short- and long-term outcomes of laparoscopic versus open low anterior resection for rectal cancer: A systematic review and meta-analysis of randomized, case-matched, and cohort studies. Ann Gastroenterol Surg 2021; 5:183-193. [PMID: 33860138 PMCID: PMC8034685 DOI: 10.1002/ags3.12409] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2020] [Revised: 10/17/2020] [Accepted: 10/26/2020] [Indexed: 12/16/2022] Open
Abstract
AIM Randomized controlled trials (RCT) are the gold standard in surgical research, and case-matched studies, such as studies with propensity score matching, are expected to serve as an alternative to RCT. Both study designs have been used to investigate the potential superiority of laparoscopic surgery to open surgery for rectal cancer, but it remains unclear whether there are any differences in the findings obtained using these study designs. We aimed to examine similarities and differences between findings from different study designs regarding laparoscopic surgery for rectal cancer. METHODS Systematic review and meta-analyses. A comprehensive literature search was conducted using PubMed, Scopus, and Cochrane. RCT, case-matched studies, and cohort studies comparing laparoscopic low anterior resection and open low anterior resection for rectal cancer were included. In total, 8 short-term outcomes and 3 long-term outcomes were assessed. Meta-analysis was conducted stratified by study design using a random-effects model. RESULTS Thirty-five studies were included in this review. Findings did not differ between RCT and case-matched studies for most outcomes. However, the estimated treatment effect was largest in cohort studies, intermediate in case-matched studies, and smallest in RCT for overall postoperative complications and 3-year local recurrence. CONCLUSION Findings from case-matched studies were similar to those from RCT in laparoscopic low anterior resection for rectal cancer. However, findings from case-matched studies were sometimes intermediate between those of RCT and unadjusted cohort studies, and case-matched studies and cohort studies have a potential to overestimate the treatment effect compared with RCT.
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Affiliation(s)
- Nobuaki Hoshino
- Department of SurgeryKyoto University Graduate School of MedicineKyotoJapan
| | - Yudai Fukui
- Department of SurgeryKyoto University Graduate School of MedicineKyotoJapan
| | - Koya Hida
- Department of SurgeryKyoto University Graduate School of MedicineKyotoJapan
| | - Kazutaka Obama
- Department of SurgeryKyoto University Graduate School of MedicineKyotoJapan
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Tejedor P, Sagias F, Flashman K, Lee YH, Naqvi S, Kandala N, Khan J. The impact of robotic total mesorectal excision on survival of patients with rectal cancer-a propensity matched analysis. Int J Colorectal Dis 2019; 34:2081-2089. [PMID: 31712874 DOI: 10.1007/s00384-019-03417-9] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/25/2019] [Indexed: 02/07/2023]
Abstract
INTRODUCTION Robotic surgery can overcome some limitations of laparoscopic total mesorectal excision (L-TME), improving the quality of the surgery. We aim to compare the medium-term oncological outcomes of L-TME vs. robotic total mesorectal excision (R-TME) for rectal cancer. METHODS A retrospective analysis was performed including patients who underwent L-TME or R-TME between 2011 and 2017. Patients presenting with metastatic disease or R1 resection were excluded. From a total of 680 patients, 136 cases of R-TME were matched based on age, gender, stage and time of follow-up with an equal number of patients who underwent L-TME. We compared 3-year disease-free survival (DFS) and overall survival (OS). RESULTS Major complications were lower in the robotic group (13.2% vs. 22.8%, p = 0.04), highlighting the anastomotic leakage rate (7.4% vs. 16.9%, p = 0.01). The 3-year DFS rate for all stages was 69% for L-TME and 84% for R-TME (p = 0.02). For disease stage III, the 3-year DFS was significantly higher in the R-TME group. OS was also significantly superior in the robotic group for every stage, reaching 86% in stage III. In the multivariate analysis, R-TME was a significant positive prognostic factor for distant metastasis (OR 0.2 95% CI 0.1, 0.6, p = 0.001) and OS (OR 0.2 95% CI 0.07, 0.4, p = 0.000). Moreover, major complications were also found to have a negative impact on OS (OR 8.3 95% CI 3.2, 21.6, p = 0.000). CONCLUSION R-TME for rectal cancer can achieve better oncological outcomes compared with L-TME, especially in stage III rectal cancers. However, a longer follow-up period is needed to confirm these findings.
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Affiliation(s)
- P Tejedor
- Department of Colorectal Surgery, Queen Alexandra Hospital, Southwick Hill Road, Cosham, Portsmouth, PO6 3LY, UK
| | - F Sagias
- Department of Colorectal Surgery, Queen Alexandra Hospital, Southwick Hill Road, Cosham, Portsmouth, PO6 3LY, UK
| | - K Flashman
- Department of Colorectal Surgery, Queen Alexandra Hospital, Southwick Hill Road, Cosham, Portsmouth, PO6 3LY, UK
| | - Yeh Han Lee
- Department of Colorectal Surgery, Queen Alexandra Hospital, Southwick Hill Road, Cosham, Portsmouth, PO6 3LY, UK
| | - S Naqvi
- Department of Colorectal Surgery, Queen Alexandra Hospital, Southwick Hill Road, Cosham, Portsmouth, PO6 3LY, UK
| | - N Kandala
- Faculty of Sciences, School of Health Sciences & Social Work, University of Portsmouth, Portsmouth, UK
| | - Jim Khan
- Department of Colorectal Surgery, Queen Alexandra Hospital, Southwick Hill Road, Cosham, Portsmouth, PO6 3LY, UK.
- School of Health, Education, Medicine and Social Care, Anglia Ruskin University, Cambridge, UK.
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