1
|
Falola AF, Fadairo RT, Dada OS, Adenikinju JS, Ogbodu E, Effiong-John B, Akande DG, Okere MO, Adelotan A, Ndong A. Current state of minimally invasive general surgical practice in Africa: A systematic review and meta-analysis of the laparoscopic procedures performed and outcomes. World J Surg 2024; 48:1634-1650. [PMID: 38809177 DOI: 10.1002/wjs.12195] [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: 10/29/2023] [Accepted: 04/15/2024] [Indexed: 05/30/2024]
Abstract
BACKGROUND Minimally invasive surgery, including laparoscopy and robotics, has significantly improved general surgical (GS) practice globally. While robot-assisted GS practice is yet to be adopted in the majority of Africa, laparoscopy has been utilized to improve surgical outcomes. This study aims to review the laparoscopic GS procedures (LGSPs) performed and evaluate outcomes such as conversion to open surgery, morbidity, and mortality in Africa. METHODS Four databases (PubMed, Google Scholar, WoS, and AJOL) were searched, identifying 8022 publications. Following screening, 40 studies across Africa that reported LGSPs (n ≥ 2) performed and outcomes met the inclusion criteria. A meta-analysis conducted using R statistical software estimated the pooled prevalences with the 95% CI of conversion, morbidity, and mortality. RESULTS A total of 6381 procedures performed in 15 African countries were analyzed in this study. Majority, 72.89%, of the procedures were performed in Senegal, South Africa, and Nigeria. The major procedures performed were cholecystectomy (37.09%), appendicectomy (33.36%), and diagnostic laparoscopy (9.98%). The meta-analysis revealed a conversion rate of 5% [95% CI: 4, 7]. Adhesion (28.13%), hemorrhage (16.67%), technical difficultly (12.50%), and equipment failure (11.46%) were the predominant indications for conversion. Surgical site infection (42.75%) was the major cause of morbidity. The prevalences of morbidity and mortality were 7% [95% CI: 5, 10] and 0.12% [95% CI: 0, 0.29], respectively. CONCLUSION A wide range of basic and advanced LGSPs were performed. The outcomes obtained indicate successful implementation of the laparoscopic approach. Importantly, this study serves as a foundational work for further research on minimally invasive surgery in Africa.
Collapse
Affiliation(s)
- Adebayo Feranmi Falola
- General Surgery Community, Surgery Interest Group of Africa, Lagos, Nigeria
- College of Medicine, University of Ibadan, Ibadan, Nigeria
| | - Rhoda Tolulope Fadairo
- General Surgery Community, Surgery Interest Group of Africa, Lagos, Nigeria
- College of Medicine, University of Ibadan, Ibadan, Nigeria
| | - Oluwasina Samuel Dada
- General Surgery Community, Surgery Interest Group of Africa, Lagos, Nigeria
- University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Joseph Sanmi Adenikinju
- General Surgery Community, Surgery Interest Group of Africa, Lagos, Nigeria
- London Northwest University Healthcare NHS Trust, Harrow, London, UK
| | - Emmanuella Ogbodu
- General Surgery Community, Surgery Interest Group of Africa, Lagos, Nigeria
- Asaba Specialist Hospital, Asaba, Nigeria
| | - Blessing Effiong-John
- General Surgery Community, Surgery Interest Group of Africa, Lagos, Nigeria
- College of Medicine, University of Ibadan, Ibadan, Nigeria
| | - Damilola Grace Akande
- General Surgery Community, Surgery Interest Group of Africa, Lagos, Nigeria
- College of Medicine, University of Ibadan, Ibadan, Nigeria
| | - Madeleine Oluomachi Okere
- General Surgery Community, Surgery Interest Group of Africa, Lagos, Nigeria
- University of Port Harcourt Teaching Hospital, Port Harcourt, Nigeria
| | - Anuoluwapo Adelotan
- General Surgery Community, Surgery Interest Group of Africa, Lagos, Nigeria
- University of Port Harcourt Teaching Hospital, Port Harcourt, Nigeria
| | - Abdourahmane Ndong
- General Surgery Community, Surgery Interest Group of Africa, Lagos, Nigeria
- Department of Surgery, Gaston Berger University, Saint-Louis, Senegal
| |
Collapse
|
2
|
Ebrahimian S, Verma A, Sakowitz S, Olmedo MO, Chervu N, Khan A, Hawkins A, Benharash P, Lee H. Association of hospital volume with conversion to open from minimally invasive colectomy in patients with diverticulitis: A national analysis. PLoS One 2023; 18:e0284729. [PMID: 37115767 PMCID: PMC10146460 DOI: 10.1371/journal.pone.0284729] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2023] [Accepted: 04/05/2023] [Indexed: 04/29/2023] Open
Abstract
BACKGROUND Despite the known advantages of minimally invasive surgery (MIS) for diverticular disease, the impact of conversions to open (CtO) colectomy remains understudied. The present study used a nationally representative database to characterize risk factors and outcomes associated with CtO in patients with diverticular disease. METHODS All elective adult hospitalizations entailing colectomy for diverticulitis were identified in the 2017-2019 Nationwide Readmissions Database. Annual institutional caseloads of MIS and open colectomy were independently tabulated. Restricted cubic splines were utilized to non-linearly estimate the risk-adjusted association between hospital volumes and CtO. Additional regression models were developed to evaluate the association of CtO with outcomes of interest. RESULTS Of an estimated 110,281 patients with diverticulitis who met study criteria, 39.3% underwent planned open colectomy, 53.3% completed MIS, and 7.4% had a CtO. Following adjustment, an inverse relationship between hospital MIS volume and risk of CtO was observed. In contrast, increasing hospital open volume was positively associated with greater risk of CtO. On multivariable analysis, CtO was associated with lower odds of mortality (AOR 0.3, p = 0.001) when compared to open approach, and similar risk of mortality when compared to completed MIS (AOR 0.7, p = 0.436). CONCLUSION In the present study, institutional MIS volume exhibited inverse correlation with adjusted rates of CtO, independent of open colectomy volume. CtO was associated with decreased rates of mortality compared to planned open approach but equivalence risk relative to completed MIS. Our findings highlight the importance of MIS experience and suggest that MIS may be safely pursued as the initial surgical approach among diverticulitis patients.
Collapse
Affiliation(s)
- Shayan Ebrahimian
- Division of Cardiac Surgery, Cardiovascular Outcomes Research Laboratories, David Geffen School of Medicine at UCLA, Los Angeles, CA, United States of America
| | - Arjun Verma
- Division of Cardiac Surgery, Cardiovascular Outcomes Research Laboratories, David Geffen School of Medicine at UCLA, Los Angeles, CA, United States of America
| | - Sara Sakowitz
- Division of Cardiac Surgery, Cardiovascular Outcomes Research Laboratories, David Geffen School of Medicine at UCLA, Los Angeles, CA, United States of America
| | - Manuel Orellana Olmedo
- Division of Cardiac Surgery, Cardiovascular Outcomes Research Laboratories, David Geffen School of Medicine at UCLA, Los Angeles, CA, United States of America
- Department of Surgery, Harbor-UCLA Medical Center, Torrance, CA, United States of America
| | - Nikhil Chervu
- Division of Cardiac Surgery, Cardiovascular Outcomes Research Laboratories, David Geffen School of Medicine at UCLA, Los Angeles, CA, United States of America
| | - Aimal Khan
- Department of Surgery, Vanderbilt University Medical Center, Nashville, TN, United States of America
| | - Alexander Hawkins
- Department of Surgery, Vanderbilt University Medical Center, Nashville, TN, United States of America
| | - Peyman Benharash
- Division of Cardiac Surgery, Cardiovascular Outcomes Research Laboratories, David Geffen School of Medicine at UCLA, Los Angeles, CA, United States of America
| | - Hanjoo Lee
- Department of Surgery, Harbor-UCLA Medical Center, Torrance, CA, United States of America
| |
Collapse
|
3
|
de'Angelis N, Schena CA, Piccoli M, Casoni Pattacini G, Pecchini F, Winter DC, O'Connell L, Carcoforo P, Urbani A, Aisoni F, Martínez-Pérez A, Celentano V, Chiarugi M, Tartaglia D, Coccolini F, Arces F, Di Saverio S, Frontali A, Fuks D, Denet C, Genova P, Guerrieri M, Ortenzi M, Kraft M, Pellino G, Vidal L, Lakkis Z, Antonot C, Perrotto O, Vertier J, Le Roy B, Micelli Lupinacci R, Milone M, De Palma GD, Petri R, Santangelo A, Scabini S, De Rosa R, Tonini V, Valverde A, Bianchi G, Carra MC, Zorcolo L, Deidda S, Restivo A, Andolfi E, Paquet JC, Bartoletti S, Orci L, Ris F, Espin E. Impact of operation duration on postoperative outcomes of minimally-invasive right colectomy. Colorectal Dis 2022; 24:1505-1515. [PMID: 35819005 DOI: 10.1111/codi.16243] [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: 04/23/2022] [Revised: 06/04/2022] [Accepted: 06/23/2022] [Indexed: 01/07/2023]
Abstract
AIM Operation time (OT) is a key operational factor influencing surgical outcomes. The present study aimed to analyse whether OT impacts on short-term outcomes of minimally-invasive right colectomies by assessing the role of surgical approach (robotic [RRC] or laparoscopic right colectomy [LRC]), and type of ileocolic anastomosis (i.e., intracorporal [IA] or extra-corporal anastomosis [EA]). METHODS This was a retrospective analysis of the Minimally-invasivE surgery for oncological Right ColectomY (MERCY) Study Group database, which included adult patients with nonmetastatic right colon adenocarcinoma operated on by oncological RRC or LRC between January 2014 and December 2020. Univariate and multivariate analyses were used. RESULTS The study sample was composed of 1549 patients who were divided into three groups according to the OT quartiles: (1) First quartile, <135 min (n = 386); (2) Second and third quartiles, 135-199 min (n = 731); and (3) Fourth quartile ≥200 min (n = 432). The majority (62.7%) were LRC-EA, followed by LRC-IA (24.3%), RRC-IA (11.1%), and RRC-EA (1.9%). Independent predictors of an OT ≥ 200 min included male gender, age, obesity, diabetes, use of indocyanine green fluorescence, and IA confection. An OT ≥ 200 min was significantly associated with an increased risk of postoperative noninfective complications (AOR: 1.56; 95% CI: 1.15-2.13; p = 0.004), whereas the surgical approach and the type of anastomosis had no impact on postoperative morbidity. CONCLUSION Prolonged OT is independently associated with increased odds of postoperative noninfective complications in oncological minimally-invasive right colectomy.
Collapse
Affiliation(s)
- Nicola de'Angelis
- Unit of General Surgery, CARE Department, Henri Mondor University Hospital (AP-HP), Créteil, France.,University of Paris Est, UPEC, Créteil, France
| | - Carlo Alberto Schena
- Unit of General Surgery, CARE Department, Henri Mondor University Hospital (AP-HP), Créteil, France
| | - Micaela Piccoli
- Department of General Surgery, Emergencies and New Technologies, Baggiovara Civil Hospital, Modena, Italy
| | - Gianmaria Casoni Pattacini
- Department of General Surgery, Emergencies and New Technologies, Baggiovara Civil Hospital, Modena, Italy
| | - Francesca Pecchini
- Department of General Surgery, Emergencies and New Technologies, Baggiovara Civil Hospital, Modena, Italy
| | - Des C Winter
- Department of Surgery, St. Vincent's University Hospital, Elm Park, Dublin 4, Ireland
| | - Lauren O'Connell
- Department of Surgery, St. Vincent's University Hospital, Elm Park, Dublin 4, Ireland
| | - Paolo Carcoforo
- Unit of General Surgery, Department of Surgery, University Hospital of Ferrara, University of Ferrara, Ferrara, Italy
| | - Alessia Urbani
- Unit of General Surgery, Department of Surgery, University Hospital of Ferrara, University of Ferrara, Ferrara, Italy
| | - Filippo Aisoni
- Unit of General Surgery, Department of Surgery, University Hospital of Ferrara, University of Ferrara, Ferrara, Italy
| | - Aleix Martínez-Pérez
- Unit of General Surgery, CARE Department, Henri Mondor University Hospital (AP-HP), Créteil, France
| | - Valerio Celentano
- University of Portsmouth, Portsmouth, UK.,Department of Surgery and Cancer, Imperial College, London, UK
| | - Massimo Chiarugi
- General, Emergency and Trauma Surgery Department, Pisa University Hospital, Pisa, Italy
| | - Dario Tartaglia
- General, Emergency and Trauma Surgery Department, Pisa University Hospital, Pisa, Italy
| | - Federico Coccolini
- General, Emergency and Trauma Surgery Department, Pisa University Hospital, Pisa, Italy
| | - Francesco Arces
- General, Emergency and Trauma Surgery Department, Pisa University Hospital, Pisa, Italy
| | - Salomone Di Saverio
- Cambridge University Hospitals NHS Foundation Trust, Addenbrooke's Hospital, Cambridge Biomedical Campus, Cambridge, UK
| | - Alice Frontali
- Department of General Surgery, University of Milan, ASST Fatebenefratelli Sacco, Milan, Italy.,Department of Biomedical and Clinical Sciences 'L. Sacco', University of Milan, ASST Fatebenefratelli Sacco, Milan, Italy
| | - David Fuks
- Department of Digestive Oncologic and Metabolic Surgery, Institut Mutualiste Montsouris, Paris Descartes University, Paris, France
| | - Christine Denet
- Department of Digestive Oncologic and Metabolic Surgery, Institut Mutualiste Montsouris, Paris Descartes University, Paris, France
| | - Pietro Genova
- Department of Surgical, Oncological and Oral Sciences (Di.Chir.On.S.), Paolo Giaccone University Hospital, University ofPalermo, Palermo, Italy
| | - Mario Guerrieri
- Department of General Surgery, Università Politecnica Delle Marche, Ancona, Italy
| | - Monica Ortenzi
- Department of General Surgery, Università Politecnica Delle Marche, Ancona, Italy
| | - Miquel Kraft
- Unit of Colorectal Surgery, Department of General and Digestive Surgery, University Hospital Vall d'Hebron-Universitat Autonoma de Barcelona, Barcelona, Spain
| | - Gianluca Pellino
- Unit of Colorectal Surgery, Department of General and Digestive Surgery, University Hospital Vall d'Hebron-Universitat Autonoma de Barcelona, Barcelona, Spain
| | - Laura Vidal
- Unit of Colorectal Surgery, Department of General and Digestive Surgery, University Hospital Vall d'Hebron-Universitat Autonoma de Barcelona, Barcelona, Spain
| | - Zaher Lakkis
- Liver Transplantation Unit, Department of Digestive Surgical Oncology, University Hospital of Besançon, Besançon, France
| | - Céphise Antonot
- Liver Transplantation Unit, Department of Digestive Surgical Oncology, University Hospital of Besançon, Besançon, France
| | - Ornella Perrotto
- Department of Digestive and Oncologic Surgery, Hospital Nord, CHU Saint-Etienne, Saint-Etienne, France
| | - Jeanne Vertier
- Department of Digestive and Oncologic Surgery, Hospital Nord, CHU Saint-Etienne, Saint-Etienne, France
| | - Bertrand Le Roy
- Department of Digestive and Oncologic Surgery, Hospital Nord, CHU Saint-Etienne, Saint-Etienne, France
| | - Renato Micelli Lupinacci
- Department of Digestive, Oncologic and Metabolic Surgery, Ambroise Paré Hospital, AP-HP, Paris Saclay University, Boulogne-Billancourt, France
| | - Marco Milone
- Department of Clinical Medicine and Surgery, "Federico II" University of Naples, Naples, Italy
| | | | - Roberto Petri
- General Surgery Department, Azienda Sanitaria Universitaria Friuli Centrale (ASU FC), Udine, Italy
| | - Antonio Santangelo
- General Surgery Department, Azienda Sanitaria Universitaria Friuli Centrale (ASU FC), Udine, Italy
| | - Stefano Scabini
- General and oncologic surgical unit, Policlinico San Martino, Genoa, Italy
| | - Raffaele De Rosa
- General and oncologic surgical unit, Policlinico San Martino, Genoa, Italy
| | - Valeria Tonini
- Emergency Surgery Department, IRCCS Azienda Ospedaliero-Universitaria Di Bologna, Bologna, Italy
| | - Alain Valverde
- Groupe Hospitalier Diaconesses Croix Saint-Simon, Paris, France
| | - Giorgio Bianchi
- Unit of General Surgery, CARE Department, Henri Mondor University Hospital (AP-HP), Créteil, France
| | | | - Luigi Zorcolo
- Colon and Rectal Surgery Unit, University of Cagliari, Cagliari, Italy
| | - Simona Deidda
- Colon and Rectal Surgery Unit, University of Cagliari, Cagliari, Italy
| | - Angelo Restivo
- Colon and Rectal Surgery Unit, University of Cagliari, Cagliari, Italy
| | - Enrico Andolfi
- San Donato Hospital, General and Emergency Surgery Unit, Arezzo, Italy
| | - Jean-Christophe Paquet
- Unit of Digestive and Urologic Surgery, Groupe Hospitalier Nord-Essonne, Site de Longjumeau, France
| | - Sebastiano Bartoletti
- Division of Abdominal and Transplantation Surgery, Department of Surgery, Faculty of Medicine, Geneva University Hospitals, Geneva, Switzerland
| | - Lorenzo Orci
- Division of Abdominal and Transplantation Surgery, Department of Surgery, Faculty of Medicine, Geneva University Hospitals, Geneva, Switzerland
| | - Frederic Ris
- Division of Abdominal and Transplantation Surgery, Department of Surgery, Faculty of Medicine, Geneva University Hospitals, Geneva, Switzerland
| | - Eloy Espin
- Unit of Colorectal Surgery, Department of General and Digestive Surgery, University Hospital Vall d'Hebron-Universitat Autonoma de Barcelona, Barcelona, Spain
| | | |
Collapse
|
4
|
Bogani G, Di Donato V, Muzii L, Casarin J, Ghezzi F, Malzoni M, Greggi S, Landoni F, Bazzurini L, Zanagnolo V, Multinu F, Angioli R, Plotti F, Caruso G, Fischetti M, Ferrandina G, Palaia I, Benedetti Panici P, Scambia G, Raspagliesi F. Assessing the role of minimally invasive radical hysterectomy for early-stage cervical cancer. Eur J Obstet Gynecol Reprod Biol 2022; 275:64-69. [PMID: 35753229 DOI: 10.1016/j.ejogrb.2022.06.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2022] [Revised: 05/19/2022] [Accepted: 06/04/2022] [Indexed: 11/04/2022]
Abstract
Surgery is the mainstay of treatment in the management of early-stage cervical cancer. Until the publication of the Laparoscopic Approach to Cervical Cancer (LACC) trial, minimally invasive radical hysterectomy was the recommended approach to treat patients with early-stage disease. The results of the LACC trial questioned the adoption of minimally invasive surgery in cervical cancer. In comparison with the open approach, minimally invasive surgery correlated with worse disease-free and cancer-specific survival. Similarly, other retrospective studies highlighted this correlation, thus corroborating the results of the LACC trials. In the present review, we evaluated current evidence and further prospective of the adoption of minimally invasive radical hysterectomy in cervical cancer. Moreover, we sought to assess some unsolved issues regarding the role of minimally invasive surgery in early-stage cervical cancer patients.
Collapse
Affiliation(s)
- Giorgio Bogani
- Department of Gynecological, Obstetrical and Urological Sciences, "Sapienza" University of Rome, Italy
| | - Violante Di Donato
- Department of Gynecological, Obstetrical and Urological Sciences, "Sapienza" University of Rome, Italy.
| | - Ludovico Muzii
- Department of Gynecological, Obstetrical and Urological Sciences, "Sapienza" University of Rome, Italy
| | - Jvan Casarin
- Department of Obstetrics and Gynecology, 'Filippo Del Ponte' Hospital, University of Insubria, Varese, Italy
| | - Fabio Ghezzi
- Department of Obstetrics and Gynecology, 'Filippo Del Ponte' Hospital, University of Insubria, Varese, Italy
| | - Mario Malzoni
- Endoscopica Malzoni, Center for Advanced Endoscopic Gynecological Surgery, Avellino, Italy
| | - Stefano Greggi
- Gynecology Oncology Unit, Istituto Nazionale Tumori IRCCS "Fondazione G. Pascale", Naples, Italy
| | - Fabio Landoni
- Gynecology Oncology Surgical Unit, Department of Obstetrics and Gynecology, San Gerardo Hospital, University of Milano-Bicocca, Monza, Italy
| | - Luca Bazzurini
- Gynecology Oncology Surgical Unit, Department of Obstetrics and Gynecology, San Gerardo Hospital, University of Milano-Bicocca, Monza, Italy
| | - Vanna Zanagnolo
- Gynecology Oncology Unit, Istituto Europeo di Oncologia, Milano, Italy
| | - Francesco Multinu
- Gynecology Oncology Unit, Istituto Europeo di Oncologia, Milano, Italy
| | | | | | - Giuseppe Caruso
- Department of Gynecological, Obstetrical and Urological Sciences, "Sapienza" University of Rome, Italy
| | - Margherita Fischetti
- Department of Gynecological, Obstetrical and Urological Sciences, "Sapienza" University of Rome, Italy
| | - Gabriella Ferrandina
- UOC Ginecologia Oncologica, Dipartimento per la salute della Donna e del Bambino e della Salute Pubblica, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Roma, Italy
| | - Innocenza Palaia
- Department of Gynecological, Obstetrical and Urological Sciences, "Sapienza" University of Rome, Italy
| | | | - Giovanni Scambia
- UOC Ginecologia Oncologica, Dipartimento per la salute della Donna e del Bambino e della Salute Pubblica, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Roma, Italy
| | - Francesco Raspagliesi
- Gynecological Oncology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori di Milano, Italy
| |
Collapse
|
5
|
Guidolin K, Spence RT, Azin A, Hirpara DH, Lam-Tin-Cheung K, Quereshy F, Chadi S. The effect of operative duration on the outcome of colon cancer procedures. Surg Endosc 2021; 36:5076-5083. [PMID: 34782967 DOI: 10.1007/s00464-021-08871-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2021] [Accepted: 11/07/2021] [Indexed: 11/25/2022]
Abstract
BACKGROUND Prolonged operative duration has been associated with increased post-operative morbidity in numerous surgical subspecialties; however, data are limited in operations for colon cancer specifically and existing literature makes unwarranted methodological assumptions of linearity. We sought to assess the effects of extended operative duration on perioperative outcomes in those undergoing segmental colectomy for cancer using a methodologically sound approach. METHODS We conducted a retrospective cohort study of patients undergoing segmental colectomy for cancer between 2014 and 2018, logged in the National Surgical Quality Improvement Program datasets. Our primary outcome was a composite of any complication within 30 days; secondary outcomes included length of stay and discharge disposition. Our main factor of interest was operative duration. RESULTS We analyzed 26,380 segmental colectomy cases, the majority of which were approached laparoscopically (64.95%) and were right sided (62.93%). Median operative duration was 152 (95% CI 112-206) minutes. On multivariable regression, increased operative duration was linearly associated with any complication (OR = 1.003, 95% CI 1.003-1.003, p < 0.0001) in the overall cohort, as was length of stay (p < 0.0001). All subgroups except for the laparoscopic left colectomy group were linearly associated with operative duration. In the laparoscopic left colectomy group, an inflection point in the odds of any complication was found at 176 min (OR = 1.39, 95% CI 1.20-1.61, p < 0.0001). CONCLUSIONS This study suggests that the risk of perioperative complications increases linearly with increasing operative duration, where each additional 30 min increases the odds of complication by 10%. In those undergoing laparoscopic left colectomy, the risk of complications sharply increases after ~ 3 h, suggesting that surgeons should aim to complete these procedures within 3 h where possible.
Collapse
Affiliation(s)
- Keegan Guidolin
- Department of Surgery, University of Toronto, Toronto, ON, Canada
| | - Richard T Spence
- Department of Surgery, University of Toronto, Toronto, ON, Canada
| | - Arash Azin
- Department of Surgery, University of Toronto, Toronto, ON, Canada
| | | | | | - Fayez Quereshy
- Department of Surgery, University of Toronto, Toronto, ON, Canada
- Department of Surgery, University Health Network, Toronto, ON, Canada
| | - Sami Chadi
- Department of Surgery, University of Toronto, Toronto, ON, Canada.
- Department of Surgery, University Health Network, Toronto, ON, Canada.
| |
Collapse
|
6
|
Wang Y, Hu H, Feng C, Liu D, Ding N. Effect of Ultrasound-Guided Quadratus Lumborum Block Preemptive Analgesia on Postoperative Recovery of Patients with Open Radical Colon Cancer Surgery: A Retrospective Study. Cancer Manag Res 2021; 13:6859-6867. [PMID: 34512025 PMCID: PMC8420684 DOI: 10.2147/cmar.s322678] [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: 06/04/2021] [Accepted: 08/21/2021] [Indexed: 11/23/2022] Open
Abstract
Purpose To evaluate the effect of ultrasound-guided quadratus lumborum block (QLB) preemptive analgesia on recovery in colon cancer patients undergoing open radical surgery and provide reference for its clinical application. Methods From July 2019 to June 2020, according to the anesthesia method, 56 patients who received open radical colon surgery were divided into two groups: Group Q (n=27), which received QLB combined general anesthesia, and Group C (n=29), which received general anesthesia only. Both groups were given self-controlled intravenous analgesia pump after surgery. The primary outcome is a series of parameters representing postoperative recovery. The secondary outcome was VAS scores and opioid consumption. Results The first time of getting up, flatus, taking semi-liquid diet and the postoperative hospital stay in Group Q were significantly reduced (P<0.01). The rest and active VAS scores were significantly lower in Group Q (P<0.01). The opioids consumption was significantly decreased in Group Q (P<0.05). Conclusion The application of ultrasound-guided QLB preemptive analgesia in open radical colon cancer surgery can significantly enhance the postoperative analgesia effect, reduce opioid consumption, and accelerate the postoperative recovery of the patients. Clinical Trial Registration Number The Chinese Clinical Trial Registry (ChiCTR-2000034824).
Collapse
Affiliation(s)
- Ying Wang
- Department of Operation, The Second Hospital, Cheeloo College of Medicine, Shandong University, Jinan, People's Republic of China
| | - Hongping Hu
- Department of Anesthesiology, The Third People's Hospital of Liaocheng, Liaocheng, People's Republic of China
| | - Chang Feng
- Department of Anesthesiology, The Second Hospital, Cheeloo College of Medicine, Shandong University, Jinan, People's Republic of China
| | - Dongyi Liu
- Department of Anesthesiology, The Second Hospital, Cheeloo College of Medicine, Shandong University, Jinan, People's Republic of China
| | - Ning Ding
- Department of Outpatient, The Second Hospital, Cheeloo College of Medicine, Shandong University, Jinan, People's Republic of China
| |
Collapse
|
7
|
European multicenter propensity score match study of laparoscopic vs. open colectomy for splenic flexure carcinomas: Results from the Splenic Flexure Cancer (SFC) Study Group. J Visc Surg 2021; 159:373-382. [PMID: 34238728 DOI: 10.1016/j.jviscsurg.2021.06.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
AIM OF THE STUDY This European multicenter study aims to compare the results of laparoscopic versus laparotomy approach for the resection of splenic flexure colon carcinoma (SFC). PATIENTS AND METHODS Patients with SFC who required curative resection by laparoscopy (LAP) or laparotomy (OPEN) between 2000 and 2018 were included. Three types of interventions were considered: extended right hemi-colectomy, left hemi-colectomy and splenic flexure resection. The LAP and OPEN groups were matched according to propensity score and compared with Chi-square, Mann-Whitney tests, and multivariate regression models. Overall survival and recurrence-free survival were assessed using the Kaplan-Meier method. RESULTS The study population consisted of 399 patients, including 297 operated by LAP and 102 by OPEN. Extended right hemi-colectomy was performed in 35.8% of cases, left hemi-colectomy in 32.8% and splenic flexure resection in 31.4%. After propensity score matching, the LAP (n=64) and OPEN (n=64) groups were comparable for all pre-operative variables and tumor characteristics. The LAP group showed less blood loss and a shorter interval to return of transit and feeding compared to the OPEN group, regardless of the resection technique. There were no differences between the groups in terms of overall survival and 5-year recurrence-free survival. CONCLUSION These results support the application of laparoscopy for the resection of SFC.
Collapse
|
8
|
de'Angelis N, Espin E, Ris F, Landi F, Le Roy B, Coccolini F, Celentano V, Gurrado A, Pezet D, Bianchi G, Memeo R, Vitali GC, Solis A, Denet C, Di Saverio S, de'Angelis GL, Kraft M, Gonzálvez-Guardiola P, Stakelum A, Catena F, Fuks D, Winter DC, Testini M, Martínez-Pérez A. Emergency surgery for splenic flexure cancer: results of the SFC Study Group database. World J Emerg Surg 2021; 16:20. [PMID: 33926504 PMCID: PMC8086132 DOI: 10.1186/s13017-021-00365-0] [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: 02/18/2021] [Accepted: 04/19/2021] [Indexed: 12/01/2022] Open
Abstract
Background The effectiveness of surgical treatment for splenic flexure carcinomas (SFCs) in emergency settings remains unexplored. This study aims to compare the perioperative and long-term outcomes of different alternatives for emergency SFC resection. Method This multicenter retrospective study was based on the SFC Study Group database. For the present analysis, SFC patients were selected if they had received emergency surgical resection with curative intent between 2000 and 2018. Extended right colectomy (ERC), left colectomy (LC), and segmental left colectomy (SLC) were evaluated and compared. Results The study sample was composed of 90 SFC patients who underwent emergency ERC (n = 55, 61.1%), LC (n = 18, 20%), or SLC (n = 17, 18.9%). Bowel obstruction was the most frequent indication for surgery (n = 75, 83.3%), and an open approach was chosen in 81.1% of the patients. A higher incidence of postoperative complications was observed in the ERC group (70.9%) than in the LC (44.4%) and SLC groups (47.1%), with a significant procedure-related difference for severe postoperative complications (Dindo-Clavien ≥ III; adjusted odds ratio for ERC vs. LC:7.23; 95% CI 1.51-34.66; p = 0.013). Anastomotic leakage occurred in 8 (11.2%) patients, with no differences between the groups (p = 0.902). R0 resection was achieved in 98.9% of the procedures, and ≥ 12 lymph nodes were retrieved in 92.2% of patients. Overall and disease-free survival rates at 5 years were similar between the groups and were significantly associated with stage pT4 and the presence of synchronous metastases. Conclusion In the emergency setting, ERC and open surgery are the most frequently performed procedures. ERC is associated with increased odds of severe postoperative complications when compared to more conservative SFC resections. Nonetheless, all the alternatives seem to provide similar pathologic and long-term outcomes, supporting the oncological safety of more conservative resections for emergency SFCs.
Collapse
Affiliation(s)
- Nicola de'Angelis
- Unit of Minimally Invasive and Robotic Digestive Surgery, General Regional Hospital F. Miulli, Acquaviva delle Fonti, Bari, Italy.,University of Paris Est, UPEC, Créteil, France
| | - Eloy Espin
- Unit of Colorectal Surgery, Department of General and Digestive Surgery, University Hospital Vall d'Hebron-Universitat Autonoma de Barcelona, Barcelona, Spain
| | - Frederic Ris
- Service of Abdominal Surgery, Geneva University Hospitals and Medical School, Geneva, Switzerland
| | - Filippo Landi
- Department of General Surgery, Viladecans Hospital, Barcelona, Spain
| | - Bertrand Le Roy
- Department of Digestive and Hepato-biliary Surgery, Hospital Estaing, CHU Clermont-Ferrand, Clermont-Ferrand, France
| | - Federico Coccolini
- General, Emergency and Trauma Surgery Department, Bufalini Hospital, Cesena, Italy
| | - Valerio Celentano
- Minimally Invasive Colorectal Unit, Portsmouth Hospitals NHS Trust, Portsmouth, UK.,University of Portsmouth, Portsmouth, UK
| | - Angela Gurrado
- Academic Unit of General Surgery, Department of Biomedical Sciences and Human Oncology, University of Bari "Aldo Moro" Medical School, Bari, Italy
| | - Denis Pezet
- Department of Digestive and Hepato-biliary Surgery, Hospital Estaing, CHU Clermont-Ferrand, Clermont-Ferrand, France
| | - Giorgio Bianchi
- Unit of Minimally Invasive and Robotic Digestive Surgery, General Regional Hospital F. Miulli, Acquaviva delle Fonti, Bari, Italy
| | - Riccardo Memeo
- Unit of HPB and Emergency Surgery, General Regional Hospital F. Miulli, Acquaviva delle Fonti, Bari, Italy
| | - Giulio C Vitali
- Service of Abdominal Surgery, Geneva University Hospitals and Medical School, Geneva, Switzerland
| | - Alejandro Solis
- Unit of Colorectal Surgery, Department of General and Digestive Surgery, University Hospital Vall d'Hebron-Universitat Autonoma de Barcelona, Barcelona, Spain
| | - Christine Denet
- Department of Digestive Oncologic and Metabolic Surgery, Institut Mutualiste Montsouris, Paris Descartes University, Paris, France
| | - Salomone Di Saverio
- Cambridge University Hospitals NHS Foundation Trust, Addenbrooke's Hospital, Cambridge Biomedical Campus, Cambridge, UK
| | - Gian Luigi de'Angelis
- Gastroenterology and Endoscopy Unit, University Hospital of Parma, University of Parma, Parma, Italy.
| | - Miquel Kraft
- Unit of Colorectal Surgery, Department of General and Digestive Surgery, University Hospital Vall d'Hebron-Universitat Autonoma de Barcelona, Barcelona, Spain
| | | | - Aine Stakelum
- Department of Surgery, St. Vincent's University Hospital, Elm Park, Dublin 4, Ireland
| | - Fausto Catena
- Department of Emergency and Trauma Surgery, Parma University Hospital, Parma, Italy
| | - David Fuks
- Department of Digestive Oncologic and Metabolic Surgery, Institut Mutualiste Montsouris, Paris Descartes University, Paris, France
| | - Des C Winter
- Department of Surgery, St. Vincent's University Hospital, Elm Park, Dublin 4, Ireland
| | - Mario Testini
- Academic Unit of General Surgery, Department of Biomedical Sciences and Human Oncology, University of Bari "Aldo Moro" Medical School, Bari, Italy
| | - Aleix Martínez-Pérez
- Unit of Minimally Invasive and Robotic Digestive Surgery, General Regional Hospital F. Miulli, Acquaviva delle Fonti, Bari, Italy
| | | |
Collapse
|
9
|
Long-term oncologic outcome and risk factors after conversion in laparoscopic surgery for colon cancer. Int J Colorectal Dis 2020; 35:395-402. [PMID: 31872265 DOI: 10.1007/s00384-019-03489-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/05/2019] [Indexed: 02/04/2023]
Abstract
PURPOSE The goal of this study was to evaluate the long-term oncologic outcomes after laparoscopic converted surgery for patients with colon cancer. METHODS Retrospective database of consecutive curative-intent laparoscopic-assisted surgery for primary stage I-III colon cancer was reviewed from 2000 to 2013. The patients were divided into non-conversion and conversion groups. The patient characters, operative features, perioperative parameters, pathologic features, and oncologic outcomes were compared. RESULTS A total of 4010 patients were included in the study: 3929 in the non-conversion group and 81 (2%) in the conversion group. The median follow-up period was 63.9 months. There were significant differences in age, preoperative clinical T-stage, and tumor size between the groups. In operative details between the two groups, there were also significant differences in access to surgery, tumor location, cancer obstruction, cancer perforation, and estimated blood loss (P < 0.001). The two most common reasons for conversion were adhesion (n = 37, 46%) and bleeding (n = 21, 26%). Multivariate analysis showed that conversion was an independent predictor of both overall survival (OS) (P < 0.001) and disease-free survival (P = 0.003). The 5-year OS rate of the conversion group was 79.6%, and that of the non-conversion group was 96.2% (P < 0.001). The multivariate predictors of conversion were age, type of surgery, cancer obstruction, cancer perforation, and clinical T-stage. CONCLUSION Conversion to open surgery may affect patient survival and recurrence after laparoscopic-assisted surgery for colon cancer. Our data suggest that conversion is associated with poor outcomes, but we should not hesitate to convert it to patients who have difficulty in laparoscopic surgery.
Collapse
|
10
|
Extended right colectomy, left colectomy, or segmental left colectomy for splenic flexure carcinomas: a European multicenter propensity score matching analysis. Surg Endosc 2020; 35:661-672. [PMID: 32072288 DOI: 10.1007/s00464-020-07431-9] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2019] [Accepted: 02/10/2020] [Indexed: 12/13/2022]
Abstract
BACKGROUND The surgical resection of the splenic flexure carcinoma (SFC) is challenging and the optimal surgical procedure for SFCs remains a matter of debate. The present study aimed to compare in a multicenter European sample of patients the short- and long-term outcomes of extended right (ERC) vs. left (LC) vs. segmental left colectomy (SLC) for SFCs. METHODS This retrospective multicenter study analyzed the surgical and oncological outcomes of SFC patients undergoing elective curative intent surgery between 2000 and 2018. Descriptive and exploratory analyses were first conducted on the whole sample. Outcomes of the different procedures (ERC vs. LC vs. SLC) were then compared using propensity score matching for multilevel treatment. Overall (OS) and disease-free survival (DFS) were evaluated by Kaplan-Meier method. RESULTS From a total of 399 SFC patients, 143 (35.8%) underwent ERC, 131 (32.8%) underwent LC, and 125 (31.4%) underwent SLC. Overall, 297 (74.4%) were laparoscopic procedures. An increase in operative time, time to flatus, time to regular diet, and hospital stay was observed with the progressive extension of SFC resection. ERC was associated with significantly increased risk of postoperative ileus compared to both LC and SLC. A significantly greater number of lymph nodes were retrieved by ERC, but the objective of at least 12 retrieved lymph nodes was achieved in 85% of patients, without procedure-related differences. No differences were observed in OS or DFS between ERC, LC, and SLC. CONCLUSION The present study supports the resection of SFCs by colon-sparing surgical techniques, such as SLC.
Collapse
|
11
|
Siddiqui J, Young CJ. Thirteen-year experience with hand-assisted laparoscopic surgery in colorectal patients. ANZ J Surg 2019; 90:113-118. [PMID: 31828890 DOI: 10.1111/ans.15578] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2019] [Accepted: 10/26/2019] [Indexed: 12/11/2022]
Abstract
BACKGROUND We report outcomes on 324 consecutive cases of hand-assisted laparoscopic surgery (HALS) in colorectal patients over 13 years performed by a single surgeon. METHODS A prospectively maintained database was used to identify all patients undergoing HALS colorectal procedures for benign or malignant indications from September 2004 to February 2018, at two major tertiary centres in Sydney, Australia. RESULTS Median age was 64 years, 51% were female and median body mass index was 26. Colorectal cancer (55%), diverticular disease (13%) and polyp related conditions (13%) were common indications. Anterior resection (65%) and right hemicolectomy (18%) were most commonly performed. Median operative time was 244 min (190-300) and 75% of Gelport incisions were Pfannenstiel. Sixty-three percent of colorectal cancer patients had a T3 or T4 cancer. Median tumour size was 35 mm (25-45). Seven percent required conversion to open and 4% a re-operation in the early post-operative period. Thirty-six percent had a post-operative complication, and 11% were major complications. Follow-up extended to 12.8 years and there were 33 late deaths. Being in a high dependency unit or intensive care unit was significant for late mortality (odds ratio 2.8, 95% confidence interval 1.06-7.78, P = 0.037). Three percent developed an incisional hernia and 6% had small bowel obstruction at long-term follow-up. CONCLUSION HALS is an effective technique for both benign and malignant colorectal indications with the added advantage of tactile feedback and a lower rate of conversion to open.
Collapse
Affiliation(s)
- Javariah Siddiqui
- Department of Colorectal Surgery, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia.,Central Clinical School, The University of Sydney, Sydney, New South Wales, Australia
| | - Christopher J Young
- Department of Colorectal Surgery, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia.,Central Clinical School, The University of Sydney, Sydney, New South Wales, Australia
| |
Collapse
|