1
|
Ahuja V, Murthy SS, Leeds IL, Paredes LG, Su DG, Tsutsumi A, Perkal MF, King JT. Surgical Outcomes and Utilization of Laparoscopic Versus Robotic Techniques for Elective Colectomy in Asian American and Native Hawaiian-Pacific Islanders (AAPI) Diagnosed With Colon Cancer. J Surg Res 2024; 302:40-46. [PMID: 39083904 DOI: 10.1016/j.jss.2024.07.007] [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: 11/14/2023] [Revised: 05/16/2024] [Accepted: 07/03/2024] [Indexed: 08/02/2024]
Abstract
INTRODUCTION Asian American and Native Hawaiian-Pacific Islanders (AAPI) are the fastest growing racial-ethnic group, with 18.9 million people in 2019, and is predicted to rise to 46 million by 2060. Colorectal cancer (CRC) is the most common cancer in AAPI men and the third most common in women. Treatment techniques like laparoscopic colectomy (LC) emerged as the standard of care for CRC resections; however, new robotic technologies can be advantageous. Few studies have compared clinical outcomes across minimally invasive approaches for AAPI patients with CRC. This study compares utilization and clinical outcomes of LC versus robotic colectomies (RCs) in AAPI patients. METHODS We queried the American College of Surgeons National Surgical Quality Improvement Program database for elective RC and LC in AAPI patients from 2012 to 2020. Outcomes included unplanned conversion to open, operative time, complications, 30-d mortality, and length of stay. Multivariable logistic regression analyses assessed the association between outcomes and the operative approach. RESULTS Between 2012 and 2020, 83,841 patients underwent elective LC or RC. Four thousand six hundred fifty-eight AAPI patients underwent 3817 (82%) LCs and 841 (18%) RCs. In 2012, all procedures were performed laparoscopically; by 2020, 27% were robotic. Mean operative time was shorter in LC (192 versus 249 min, P < 0.001). On multivariable logistic regression, there was no difference in infection (odds ratio [OR] 0.8, 95% confidence interval [CI] 0.59-1.12), anastomotic leak (OR 0.97, 95% CI 0.59-1.61), or death (OR 0.9, 95% CI 0.31-2.61). Length of stay was shorter for RC (-0.44 d, 95% CI -0.71 to -0.18 d). CONCLUSIONS Overall, AAPI postoperative outcomes are similar between LC and RC. Future studies that evaluate costs and resource utilization can assist hospitals in determining whether implementing robotic-assisted technologies in their hospitals and communities will be appropriate.
Collapse
Affiliation(s)
- Vanita Ahuja
- VA Connecticut Healthcare System, US Department of Veterans Affairs, West Haven, Connecticut; Department of Surgery, Yale School of Medicine, New Haven, Connecticut
| | - Shilpa S Murthy
- VA Connecticut Healthcare System, US Department of Veterans Affairs, West Haven, Connecticut; Department of Surgery, Yale School of Medicine, New Haven, Connecticut
| | - Ira L Leeds
- VA Connecticut Healthcare System, US Department of Veterans Affairs, West Haven, Connecticut; Department of Surgery, Yale School of Medicine, New Haven, Connecticut
| | - Lucero G Paredes
- VA Connecticut Healthcare System, US Department of Veterans Affairs, West Haven, Connecticut; Department of Surgery, Yale School of Medicine, New Haven, Connecticut; National Clinical Scholars Program, Yale University School of Medicine, New Haven, Connecticut; Department of Surgery, Maine Medical Center, Portland, Maine
| | - David G Su
- Department of Surgery, Yale School of Medicine, New Haven, Connecticut
| | - Ayaka Tsutsumi
- Department of Surgery, Yale School of Medicine, New Haven, Connecticut
| | - Melissa F Perkal
- VA Connecticut Healthcare System, US Department of Veterans Affairs, West Haven, Connecticut; Department of Surgery, Yale School of Medicine, New Haven, Connecticut
| | - Joseph T King
- VA Connecticut Healthcare System, US Department of Veterans Affairs, West Haven, Connecticut; Department of Neurosurgery, Yale University School of Medicine, New Haven, Connecticut
| |
Collapse
|
2
|
Hashimoto S, Tominaga T, Nonaka T, Shiraishi T, To K, Takeshita H, Fukuoka H, Araki M, Tanaka K, Sawai T, Nagayasu T. Mid-term outcomes of laparoscopic vs open colectomy for pathological T4 and/or N2 colon cancer patients: Multicenter study using propensity score matched analysis. Asian J Endosc Surg 2023; 16:400-408. [PMID: 36799190 DOI: 10.1111/ases.13171] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2022] [Revised: 01/31/2023] [Accepted: 02/04/2023] [Indexed: 02/18/2023]
Abstract
OBJECTIVES We aimed to assess mid-term outcomes after laparoscopic surgery (LAP) vs open surgery (OP) for pathological T4 (pT4) and/or N2 (pN2) colon cancer. METHODS We retrospectively reviewed 255 primary tumor resections for pT4 and/or pN2 colon cancer performed from 2015 to 2020 at six hospitals, divided into LAP (n = 204) and OP groups (n = 51). After propensity score matching to minimize selection bias, 47 matched patients per group were assessed. RESULTS Before matching, the rate of males (53.9% vs. 37.3%, P = .042), left sided colon cancer (53.9% vs 37.3%, P = .042), D3 lymph node dissection (90.7% vs 68.6%, P < .001) and body mass index (kg/m2 ) (22.3 vs 21.8, P = .039) were significantly greater in the LAP group. The rate of pT4b (7.8% vs 40.4%, P < .001) was lower and pN2 was higher (57.4% vs 37.3%, P = .012) in the LAP group. After matching, preoperative characteristics and pathologic status were equivalent between the groups. The LAP and OP groups showed comparable overall survival (OS) (2-year OS, 84.5% vs 76.8%, P = .055) and recurrence-free survival (RFS) (2-year RFS, 73.9% vs 52.8%, P = .359). In the patients with pT4, OS (2-year OS, 79.4% vs 75.7%, P = .359) and RFS (2-year RFS, 71.3% vs 58.7%) were comparable. In the patients with pN2, OS (2-year OS, 83.4% vs 76.3%) and RFS (2-year RFS, 69.6% vs 36.2%) were also comparable. CONCLUSIONS LAP for pT4 and/or pN2 colon cancer showed comparable mid-term outcomes compared with OP. LAP was an acceptable surgical approach in this cohort.
Collapse
Affiliation(s)
- Shintaro Hashimoto
- Department of Surgical Oncology, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - Tetsuro Tominaga
- Department of Surgical Oncology, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - Takashi Nonaka
- Department of Surgical Oncology, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - Toshio Shiraishi
- Department of Surgical Oncology, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - Kazuo To
- Department of Surgery, National Hospital Organization Ureshino Medical Center, Ureshino, Japan
| | - Hiroaki Takeshita
- Department of Surgery, National Hospital Organization Nagasaki Medical Center, Ohmura, Japan
| | | | - Masato Araki
- Department of Surgery, Sasebo City General Hospital, Sasebo, Japan
| | - Kenji Tanaka
- Department of Surgery, Saiseikai Nagasaki Hospital, Nagasaki, Japan
| | - Terumitsu Sawai
- Department of Surgical Oncology, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - Takeshi Nagayasu
- Department of Surgical Oncology, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| |
Collapse
|
3
|
Lin HY, Huang TM, Lin CY, Shen MC. Low prevalence of deep vein thrombosis among colorectal cancer patients undergoing surgery in Taiwan: A prospective cross-sectional study. Asian J Surg 2023; 46:1426-1427. [PMID: 36155164 DOI: 10.1016/j.asjsur.2022.09.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2022] [Accepted: 09/06/2022] [Indexed: 11/29/2022] Open
Affiliation(s)
- Hsuan-Yu Lin
- Division of Hematology/Oncology, Department of Internal Medicine, Changhua Christian Hospital, Changhua, Taiwan
| | - Ting-Ming Huang
- Division of Colorectal Surgery, Department of Surgery, Changhua Christian Hospital, Changhua, Taiwan
| | - Ching-Yeh Lin
- Division of Hematology/Oncology, Department of Internal Medicine, Changhua Christian Hospital, Changhua, Taiwan
| | - Ming-Ching Shen
- Division of Hematology/Oncology, Department of Internal Medicine, Changhua Christian Hospital, Changhua, Taiwan; Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan; Department of Laboratory Medicine, National Taiwan University Hospital, Taipei, Taiwan.
| |
Collapse
|
4
|
Udayasiri DK, Hiscock R, Jones IT, Skandarajah A, Hayes IP. Overall survival comparing laparoscopic to open surgery for right-sided colon cancer: propensity score inverse probability weighting population study. ANZ J Surg 2023. [PMID: 36797227 DOI: 10.1111/ans.18338] [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: 11/13/2022] [Revised: 02/04/2023] [Accepted: 02/07/2023] [Indexed: 02/18/2023]
Abstract
BACKGROUND This retrospective cohort study reports on overall survival and short-term complications, comparing laparoscopic to open resection for right-sided colon cancers. It is one of the largest studies in the field with generalizable population-level results. METHOD This study on right sided colon cancers used prospectively collected administrative data linked to a death registry over 5 years from 2014 to 2018. Exclusion criteria were private patients, patients aged less than 10 years, synchronous and metachronous cancers. Propensity score weighting was used to balance cohorts and Cox proportional hazards regression was used to assess the hazard of death. In addition, logistic regression analysis was used to assess secondary outcomes. For completeness, unweighted data was similarly analysed. RESULTS There were 3603 patients identified for the analysis: 1729 open patients and 1874 laparoscopic patients. Cox proportional hazards regression analysis of the weighted data showed no evidence of a statistically significant effect of laparoscopic surgery compared to open surgery on overall survival for right-sided colon cancers (HR 0.86, 95% CI 0.71-1.04, P = 0.112). The weighted data showed lower odds of prolonged length of stay, return to theatre and discharge destination other than home in the laparoscopic cohort compared to the open cohort. There was no difference in inpatient mortality. Unweighted results were similar. CONCLUSION This study validates the use of laparoscopic surgery for right-sided colon cancer, showing similar long-term overall survival and inpatient mortality compared to open surgery. It is superior to open surgery for the short-term outcomes of LOS, return to theatre and discharge destination other than home.
Collapse
Affiliation(s)
- Dilshan K Udayasiri
- Colorectal Surgical Unit, The Royal Melbourne Hospital, Melbourne, Victoria, Australia.,Department of General Surgical Specialties, The Royal Melbourne Hospital, Melbourne, Victoria, Australia.,Department of Surgery, The University of Melbourne, Melbourne, Victoria, Australia
| | - Richard Hiscock
- Department of Anaesthetics, Mercy Hospital for Women, Melbourne, Victoria, Australia.,Department of Obstetrics and Gynaecology, The University of Melbourne, Melbourne, Victoria, Australia
| | - Ian T Jones
- Colorectal Surgical Unit, The Royal Melbourne Hospital, Melbourne, Victoria, Australia.,Department of General Surgical Specialties, The Royal Melbourne Hospital, Melbourne, Victoria, Australia.,Department of Surgery, The University of Melbourne, Melbourne, Victoria, Australia
| | - Anita Skandarajah
- Department of General Surgical Specialties, The Royal Melbourne Hospital, Melbourne, Victoria, Australia.,Department of Surgery, The University of Melbourne, Melbourne, Victoria, Australia
| | - Ian P Hayes
- Colorectal Surgical Unit, The Royal Melbourne Hospital, Melbourne, Victoria, Australia.,Department of General Surgical Specialties, The Royal Melbourne Hospital, Melbourne, Victoria, Australia.,Department of Surgery, The University of Melbourne, Melbourne, Victoria, Australia
| |
Collapse
|
5
|
Jadid KD, Cao Y, Petersson J, Sjövall A, Angenete E, Matthiessen P. Long-term oncological outcomes for minimally invasive surgery versus open surgery for colon cancer-a population-based nationwide study with a non-inferiority design. Colorectal Dis 2023; 25:954-963. [PMID: 36762443 DOI: 10.1111/codi.16512] [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: 10/23/2022] [Revised: 01/20/2023] [Accepted: 01/29/2023] [Indexed: 02/11/2023]
Abstract
AIM The study aimed to compare 5-year overall survival in a national cohort of patients undergoing curative abdominal resection for colon cancer by minimally invasive surgery (MIS) or by the open (OPEN) technique. METHODS All patients diagnosed between 2010 and 2016 in Sweden with pathological Union International Contre le Cancer Stages I-III colon cancer localized in the caecum, ascending colon, hepatic flexure or sigmoid colon and those who underwent curative right sided hemicolectomy, sigmoid resection or high anterior resection by MIS or OPEN were included. Patients were identified in the Swedish Colorectal Cancer Registry from which all data were retrieved. The analyses were performed as intention-to-treat and the relationship between surgical technique (MIS or OPEN) and overall mortality within 5 years was analysed. For the primary research question a non-inferiority hypothesis was assumed with a statistical power of 90%, a one-side type I error of 2.5% and a non-inferiority margin of 2%. For the secondary analyses, multilevel survival regression models with the patients matched by propensity scores were employed, adjusted for patient- and tumour-related variables. RESULTS A total of 11 605 pathological Union International Contre le Cancer Stages I-III patients were included with 3297 MIS (28.4%) and 8308 OPEN (71.6%) and were followed until 31 December 2020. The primary analysis demonstrated superiority for MIS compared to OPEN. The multilevel survival regression analyses confirmed that 5-year overall survival was higher in MIS with a hazard ratio of 0.874 (95% confidence interval 0.791-0.965), and if excluding pT4 the outcome was similar, with a hazard ratio of 0.847 (95% confidence interval 0.756-0.948). CONCLUSION This observational study demonstrated that MIS was favourable to OPEN with regard to 5-year overall survival. These results support the use of laparoscopic colon cancer surgery in routine practice.
Collapse
Affiliation(s)
- Kaveh Dehlaghi Jadid
- Department of Surgery, Örebro University Hospital, Örebro, Sweden.,Department of Surgery, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
| | - Yang Cao
- Clinical Epidemiology and Biostatistics, School of Medical Sciences, Örebro University, Örebro, Sweden
| | - Josefin Petersson
- SSORG-Scandinavian Surgical Outcomes Research Group, Department of Surgery, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.,Region Västra Götaland, Department of Surgery, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Annika Sjövall
- Gastrointestinal Oncology and Colorectal Surgery Unit, Department of Pelvic Cancer, Karolinska University Hospital, Stockholm, Sweden
| | - Eva Angenete
- SSORG-Scandinavian Surgical Outcomes Research Group, Department of Surgery, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.,Region Västra Götaland, Department of Surgery, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Peter Matthiessen
- Department of Surgery, Örebro University Hospital, Örebro, Sweden.,Department of Surgery, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
| |
Collapse
|
6
|
Zhang M, Liu Z, Wang X. Is natural orifice specimen extraction surgery the future direction of minimally invasive colorectal surgery? Surg Open Sci 2022; 10:106-110. [PMID: 36111268 PMCID: PMC9467874 DOI: 10.1016/j.sopen.2022.08.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2022] [Revised: 07/02/2022] [Accepted: 08/15/2022] [Indexed: 11/26/2022] Open
|
7
|
McKechnie T, Khamar J, Daniel R, Lee Y, Park L, Doumouras AG, Hong D, Bhandari M, Eskicioglu C. The Senhance Surgical System in Colorectal Surgery: A Systematic Review. J Robot Surg 2022; 17:325-334. [PMID: 36127508 DOI: 10.1007/s11701-022-01455-0] [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: 08/25/2022] [Accepted: 09/08/2022] [Indexed: 10/14/2022]
Abstract
The Senhance Surgical System allows for infrared eye tracking, haptic feedback, and an adjustable upright seat allowing for improved ergonomics. This systematic review was designed with the aim of reviewing the current literature pertaining to the use of the Senhance Surgical System in colorectal surgery. Medline, EMBASE, and CENTRAL were searched. Articles were eligible for inclusion if they evaluated adults undergoing colorectal surgery with the Senhance Surgical System. The primary outcome was intraoperative efficacy; as defined by operative time, estimated blood loss (EBL), and conversion. A DerSimonian and Laird inverse variance random-effects meta-analysis was used to generate overall effect size estimates and narrative review was provided for each outcome. Six observational studies with 223 patients (mean age: 63.7, 41.2% female, mean BMI: 24.4 kg/m2) were included. The most common indication for surgery was colorectal cancer (n = 180, 80.7%) and the most common operation was anterior resection (n = 72, 32.3%). Meta-analyses demonstrated a pooled total operative time of 229.8 min (95% CI 189.3-270.4, I2 = 0%), console time of 141.3 min (95% CI 106.5-176.1, I2 = 0%), and docking time of 10.8 min (95% CI 6.4-15.2, I2 = 0%). The pooled EBL was 37.0 mL (95% CI 24.7-49.2, I2 = 20%). Overall, there were nine (4.0%) conversions to laparoscopy/laparotomy. The Senhance Surgical System has an acceptable safety profile, reasonable docking and console times, low conversion rates, and an affordable case cost across a variety of colorectal surgeries. Further prospective, comparative trials with other robotic surgical platforms are warranted.
Collapse
Affiliation(s)
- Tyler McKechnie
- Division of General Surgery, Department of Surgery, McMaster University, Hamilton, ON, Canada
| | - Jigish Khamar
- Michael G. DeGroote School of Medicine, McMaster University, Hamilton, ON, Canada
| | - Ryan Daniel
- Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Yung Lee
- Division of General Surgery, Department of Surgery, McMaster University, Hamilton, ON, Canada
| | - Lily Park
- Division of General Surgery, Department of Surgery, McMaster University, Hamilton, ON, Canada
| | - Aristithes G Doumouras
- Division of General Surgery, Department of Surgery, McMaster University, Hamilton, ON, Canada.,Michael G. DeGroote School of Medicine, McMaster University, Hamilton, ON, Canada.,Division of General Surgery, Department of Surgery, McMaster University. St. Joseph's Healthcare Hamilton, 50 Charlton Avenue East, Hamilton, ON, L8N 4A6, Canada
| | - Dennis Hong
- Division of General Surgery, Department of Surgery, McMaster University, Hamilton, ON, Canada.,Michael G. DeGroote School of Medicine, McMaster University, Hamilton, ON, Canada.,Division of General Surgery, Department of Surgery, McMaster University. St. Joseph's Healthcare Hamilton, 50 Charlton Avenue East, Hamilton, ON, L8N 4A6, Canada
| | - Mohit Bhandari
- Division of General Surgery, Department of Surgery, McMaster University, Hamilton, ON, Canada.,Michael G. DeGroote School of Medicine, McMaster University, Hamilton, ON, Canada
| | - Cagla Eskicioglu
- Division of General Surgery, Department of Surgery, McMaster University, Hamilton, ON, Canada. .,Michael G. DeGroote School of Medicine, McMaster University, Hamilton, ON, Canada. .,Division of General Surgery, Department of Surgery, McMaster University. St. Joseph's Healthcare Hamilton, 50 Charlton Avenue East, Hamilton, ON, L8N 4A6, Canada.
| |
Collapse
|
8
|
Du Q, Yang Y, Zhang J, Liu X, Wang Y, Yang L. Laparoscopic versus open left hemicolectomy for left-sided colon cancer: protocol for a systematic review and meta-analysis. BMJ Open 2022; 12:e062216. [PMID: 35732400 PMCID: PMC9226930 DOI: 10.1136/bmjopen-2022-062216] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
INTRODUCTION Laparoscopic colectomy has been widely used clinically due to its minimally invasive advantages, and many studies have also demonstrated its safety and efficacy. However, the efficacy of laparoscopic left hemicolectomy remains unclear due to the differences in pathogenesis and surgical details between left and right colon cancers. Therefore, we plan to conduct a systematic review and meta-analysis to investigate whether laparoscopic techniques can be safely used in left hemicolectomy. METHOD AND ANALYSIS This meta-analysis protocol will be completed and reported according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses Protocols guidelines. A systematic search was performed for all articles related to laparoscopic left hemicolectomy in PubMed, Web of Science, Medline, EMBASE and the Cochrane Library from inception to 5 November 2021. Article screening and data extraction were performed independently by two authors and cross-checked after completion. The literature to be included will use corresponding tools for bias risk assessment. Subgroup analyses and sensitivity analyses will be used to explore potential heterogeneity. ETHICS AND DISSEMINATION Because this systematic review is based on studies with published results and does not involve intervention in patients, no ethical review is required. The results of this study will be published in a peer-reviewed journal. PROSPERO REGISTRATION NUMBER CRD42022291526.
Collapse
Affiliation(s)
- Qiang Du
- Department of Gastrointestinal Surgery, Sichuan University West China Hospital, Chengdu, Sichuan, China
| | - Yang Yang
- Department of Gastrointestinal Surgery, Sichuan University West China Hospital, Chengdu, Sichuan, China
| | - Jianhao Zhang
- Department of Gastrointestinal Surgery, Sichuan University West China Hospital, Chengdu, Sichuan, China
| | - Xueting Liu
- Department of Evidence-Based Medicine and Clinical Epidemiology, Sichuan University West China Hospital, Chengdu, Sichuan, China
| | - Yong Wang
- Department of Gastrointestinal Surgery, Sichuan University West China Hospital, Chengdu, Sichuan, China
| | - Lie Yang
- Department of Gastrointestinal Surgery, Sichuan University West China Hospital, Chengdu, Sichuan, China
- Institute of Digestive Surgery, State Key Laboratory of Biotherapy and Cancer Center, Sichuan University West China Hospital, Chengdu, Sichuan, China
| |
Collapse
|
9
|
Durak D, Alkurt EG, Turhan VB, Tutan B, Sahiner IT, Kendirci M. Comparison of Short-Term Results of Laparoscopic and Open Surgeries for Colorectal Cancer: A Single-Center Experience. Cureus 2022; 14:e24635. [PMID: 35663698 PMCID: PMC9152636 DOI: 10.7759/cureus.24635] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/30/2022] [Indexed: 12/11/2022] Open
Abstract
OBJECTIVE Although laparoscopic colon cancer surgeries have increased in recent years, their oncological competence is questioned. In our study, we aimed to evaluate oncological competence by comparing laparoscopic and open surgery. METHOD The study was planned retrospectively. A total of 94 patients were included in the study, 42 of whom underwent laparoscopy, and 52 patients underwent open surgery. Both groups were compared in terms of demographic characteristics, staging, number of benign/malignant lymph nodes, histological findings, and complications. RESULT The final pathology report of all patients was adenocarcinoma. The median number of dissected lymph nodes was 20.9 in the open group (8-34) and 19.46 in the laparoscopy group (7-31) (p = 0.639). The median number of dissected malignant lymph nodes was 1 (0-13) in the open surgery group and 3.1 (0-8) in the laparoscopy group (p = 0.216). The laparoscopy group exhibited a longer operation time (281.2 ± 54.2 and 221.0 ± 51.5 min, respectively; p = 0.036) than the open surgery group, but a shorter intensive care unit (ICU) discharge, quicker initiation oral feeding, and shorter length of hospital stay (4.0 ± 0.9 vs 5.7 ± 2.0 days, respectively; p < 0.001). DISCUSSION Laparoscopic surgery elicits many benefits such as less wound infection, lower requirement for blood transfusion, shorter hospitalization, quicker initiation of oral feeding, and mobilization. Our study has shown that laparoscopic surgery provides quite adequate lymph node dissection when compared to oncological surgery, which is viewed with suspicion in the light of these benefits of laparoscopy.
Collapse
Affiliation(s)
- Dogukan Durak
- Gastrointestinal Surgery, Hitit University Çorum Erol Olçok Training and Research Hospital, Çorum, TUR
| | - Ertugrul G Alkurt
- General Surgery/Surgical Oncology, Hitit Üniversitesi Erol Olçok Eğitim ve Araştırma Hastanesi, Çorum, TUR
| | - Veysel Barış Turhan
- General Surgery, Turkish Ministry of Health Hitit University Çorum Erol Olçok Training and Research Hospital, Çorum, TUR
| | - Berksun Tutan
- General Surgery, Hitit University Çorum Erol Olçok Training and Research Hospital, Çorum, TUR
| | | | - Murat Kendirci
- General Surgery, Hitit University, Faculty of Medicine, Çorum, TUR
| |
Collapse
|
10
|
Vogelsang RP, Fransgaard T, Falk Klein M, Gögenur I. Long-term oncological outcomes in patients undergoing laparoscopic versus open surgery for colon cancer: A nationwide cohort study. Colorectal Dis 2022; 24:439-448. [PMID: 34905273 DOI: 10.1111/codi.16022] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2021] [Revised: 11/01/2021] [Accepted: 12/07/2021] [Indexed: 02/08/2023]
Abstract
AIM To estimate the effect of laparoscopy versus laparotomy on recurrence status in patients undergoing intended curative resection for stage I-III colon cancer using nationwide data. METHOD A retrospective cohort study using prospectively collected nationwide quality assurance data on all patients undergoing elective, intended curative surgery for UICC stage I-III colon cancer in Denmark from 1 January 2010, through 31 December 2013. The association between laparoscopic versus open surgery and recurrence status was investigated using cause-specific hazard and subdistribution hazard models with death from any cause as a competing event. RESULTS In total, 4369 patients undergoing elective intended curative surgery for colon cancer were included in the analysis. Overall, 3243 (74.2%) patients underwent laparoscopic surgery. During a median follow-up time of 84 months, 1191 (27.2%) patients experienced recurrence, and 1304 (29.8%) patients died. The cause-specific hazard of recurrence following laparoscopic versus open surgery was HRCS = 1.08, 95% CI: 0.90-1.28, p = 0.422. The subdistribution hazard of recurrence following laparoscopic versus open surgery was HRSD =0.99, 95% CI: 0.84-1.16, p = 0.880. CONCLUSION Elective laparoscopic resection for UICC stage I-III colon cancer is oncologically safe and comparable with open resection. These results confirm the external validity of previous RCTs in everyday clinical settings.
Collapse
Affiliation(s)
| | - Tina Fransgaard
- Department of Surgery, Center for Surgical Science, Zealand University Hospital, Koege, Denmark
| | - Mads Falk Klein
- Department of Surgery, Herlev University Hospital, Herlev, Denmark
| | - Ismail Gögenur
- Department of Surgery, Center for Surgical Science, Zealand University Hospital, Koege, Denmark.,Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| |
Collapse
|
11
|
Struys M, Ceelen W. Incidence of lymph node recurrence after primary surgery for non-metastatic colon cancer: A systematic review. Eur J Surg Oncol 2022; 48:1679-1684. [DOI: 10.1016/j.ejso.2022.04.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2022] [Accepted: 04/22/2022] [Indexed: 12/24/2022] Open
|
12
|
Chen TC, Liang JT. Robotic versus laparoscopic surgery for rectal cancer after neoadjuvant chemoradiotherapy: A propensity-score matching analysis. J Formos Med Assoc 2021; 121:1532-1540. [PMID: 34789424 DOI: 10.1016/j.jfma.2021.10.025] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2021] [Revised: 10/23/2021] [Accepted: 10/29/2021] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND We aimed to investigate the advantages of robotic versus laparoscopic surgery for rectal cancer after neoadjuvant chemoradiotherapy as these remains unclear. METHODS We retrospectively recruited eligible patients with rectal cancer undergoing robotic or laparoscopic surgery following neoadjuvant chemoradiotherapy. We compared the surgical outcomes between patients undergoing either robotic surgery or laparoscopic surgery was based on the propensity-score matching analysis. RESULTS A total of 171 patients were recruited, including 76 who underwent robotic surgery and 95 who underwent laparoscopic surgery. There were no significant differences in clinical and pathological characteristics between the groups after propensity-score matching (56 matched pairs). Longer operation times (324.964 ± 83.435 vs. 246.232 ± 111.324 min, p < 0.001) and more blood loss (187.679 ± 176.615 vs. 98.214 ± 107.011, p < 0.001) were observed in the robotic group. The major complication rates were similar between the treatment groups after propensity matching (p = 0.086). There were no significant differences in disease-free survival rates (p = 0.205) and overall survival rates (p = 0.837) between the groups. CONCLUSIONS Robotic surgery is associated with similar technical safety and oncologic efficacy compared to laparoscopic surgery for the treatment of rectal cancer after neoadjuvant chemoradiotherapy; it is an acceptable option for patients requiring minimally invasive surgery. Nevertheless, the longer operation times and greater blood loss seen in the present study are a stark reminder that the convenience and surgical precision, on which the marketing of robotic surgery is rooted, are yet to be proven and require further investigation.
Collapse
Affiliation(s)
- Tzu-Chun Chen
- Graduate Institute of Clinical Medicine, College of Medicine, National Taiwan University, Taipei, Taiwan; Department of Surgical Oncology, National Taiwan University Cancer Center, Taiwan
| | - Jin-Tung Liang
- Division of Colorectal Surgery, Department of Surgery, National Taiwan University Hospital, Taipei, Taiwan.
| |
Collapse
|
13
|
Laparoscopic versus Open Transverse-Incision Approach for Right Hemicolectomy: A Systematic Review and Meta-Analysis. ACTA ACUST UNITED AC 2021; 57:medicina57010080. [PMID: 33477793 PMCID: PMC7832342 DOI: 10.3390/medicina57010080] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2021] [Accepted: 01/17/2021] [Indexed: 02/05/2023]
Abstract
Background and Objectives: There is general agreement on the benefits of laparoscopy for treatment of rectal and left colon cancers, whereas findings regarding the comparison of laparoscopic and open right colonic resections are discordant. The aim of this systematic review and meta-analysis was to assess the outcomes and advantages of laparoscopic versus transverse-incision open surgery for management of right colon cancer. Materials and Methods: A systematic review was performed according to the Preferred Reporting Items for Systematic Review and Meta-Analyses (PRISMA) guidelines. Comparative studies evaluating the results of laparoscopic and transverse-incision open right hemicolectomies were analyzed. The measured outcomes were mean operative time, time to feeding, duration of hospital stay, and number of lymph nodes harvested. Results: A total of 5 studies including 318 patients met the inclusion criteria. Meta-analysis revealed no differences in time to resume oral feeding, hospital stay, and number of lymph nodes harvested in between groups, but mean length of surgery was significantly longer in the laparoscopic group. Conclusion: These data confirm that the preferred approach to right hemicolectomy is yet unclear. Laparoscopy has a longer operative time than transverse-incision open surgery, and no significant short-term benefits were observed for the studied parameters. Well-designed randomized control trials (RCTs) might help to identify the differences between these two techniques for the surgical treatment of right colon cancer.
Collapse
|
14
|
Efficient and Safe Method for Splenic Flexure Mobilization in Laparoscopic Left Hemicolectomy: A Propensity Score-weighted Cohort Study. Surg Laparosc Endosc Percutan Tech 2020; 31:196-202. [PMID: 33284257 PMCID: PMC8132887 DOI: 10.1097/sle.0000000000000884] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2020] [Accepted: 10/16/2020] [Indexed: 01/20/2023]
Abstract
Supplemental Digital Content is available in the text. Because methods of performing laparoscopic left hemicolectomy differ between surgeons, standardizing the procedure is crucial to reduce complications and secure good oncologic outcomes.
Collapse
|
15
|
Alawfi H, Kim HS, Yang SY, Kim NK. Robotics Total Mesorectal Excision Up To the Minute. Indian J Surg Oncol 2020; 11:552-564. [PMID: 33281399 PMCID: PMC7714834 DOI: 10.1007/s13193-020-01109-3] [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: 02/24/2020] [Accepted: 05/22/2020] [Indexed: 10/24/2022] Open
Abstract
Surgical techniques have evolved over the past few decades, and minimally invasive surgery has been rapidly adapted to become a preferred operative approach for treating colorectal diseases. However, many of the procedures remain a technical challenge for surgeons to perform laparoscopically, which has prompted the development of robotic platforms. Robotic surgery has been introduced as the latest advance in minimally invasive surgery. The present article provides an overview of robotic rectal surgery and describes many advances that have been made in the field over the past two decades. More specifically, the introduction of the robotic platform and its benefits, and the limitations of current robotic technology, are discussed. Although the main advantages of robotic surgery over conventional laparoscopy appear to be lower conversion rates and better surgical specimen quality, oncological and functional outcomes appear to be similar to those of other alternatives. Other potential benefits include earlier recovery of voiding and sexual function after robotic total mesorectal excision. Nevertheless, the costs and lack of haptic feedback remain the primary limitations to the widespread use of robotic technology in the field.
Collapse
Affiliation(s)
| | - Ho Seung Kim
- Department of Surgery, Division of Colorectal Surgery, Severance Hospital, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-Gu, Seoul, 03722 Korea
| | - Seung Yoon Yang
- Department of Surgery, Division of Colorectal Surgery, Severance Hospital, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-Gu, Seoul, 03722 Korea
| | - Nam Kyu Kim
- Department of Surgery, Division of Colorectal Surgery, Severance Hospital, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-Gu, Seoul, 03722 Korea
| |
Collapse
|
16
|
Liao YT, Liang JT. Applicability of minimally invasive surgery for clinically T4 colorectal cancer. Sci Rep 2020; 10:20347. [PMID: 33230168 PMCID: PMC7683557 DOI: 10.1038/s41598-020-77317-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2020] [Accepted: 11/10/2020] [Indexed: 01/02/2023] Open
Abstract
The role of minimally invasive surgery (MIS) to treat clinically T4 (cT4) colorectal cancer (CRC) remains uncertain and deserves further investigation. A retrospective cohort study was conducted between September 2006 and March 2019 recruiting patients diagnosed as cT4 CRC and undergoing MIS at a university hospital and its branch. Patients’ demography, clinicopathology, surgical and oncological outcomes, and radicality were analyzed. A total of 128 patients were recruited with an average follow-up period of 33.8 months. The median time to soft diet was 6 days, and the median postoperative hospitalization periods was 11 days. The conversion and complication (Clavien–Dindo classification ≥ II) rates were 7.8% and 27.3%, respectively. The 30-day mortality was 0.78%. R0 resection rate was 92.2% for cT4M0 and 88.6% for pT4M0 patients. For cT4 CRC patients, the disease-free survival and 3-year overall survival were 86.1% and 86.8% for stage II, 54.1% and 57.9% for stage III, and 10.8% and 17.8% for stage IV. With acceptable conversion, complication and mortality rate, MIS may achieve satisfactory R0 resection rate and thus lead to good oncological outcomes for selected patients with cT4 CRC.
Collapse
Affiliation(s)
- Yu-Tso Liao
- Graduate Institute of Clinical Medicine, College of Medicine, National Taiwan University, Taipei, Taiwan, ROC.,Division of Colorectal Surgery, Department of Surgery, Biomedical Park Hospital, National Taiwan University Hospital, Hsinchu, Taiwan, ROC
| | - Jin-Tung Liang
- Division of Colorectal Surgery, Department of Surgery, National Taiwan University Hospital and College of Medicine, Taipei, Taiwan, ROC.
| |
Collapse
|
17
|
Recurrence Risk after Radical Colorectal Cancer Surgery-Less Than before, But How High Is It? Cancers (Basel) 2020; 12:cancers12113308. [PMID: 33182510 PMCID: PMC7696064 DOI: 10.3390/cancers12113308] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2020] [Revised: 10/27/2020] [Accepted: 11/06/2020] [Indexed: 02/06/2023] Open
Abstract
Simple Summary Evidence indicates that recurrence risk after colon cancer today is less than it was when trials performed decades ago showed that adjuvant chemotherapy reduces the risk and prolong disease-free and overall survival. After rectal cancer surgery, local recurrence rates have decreased but it is unclear if systemic recurrences have. After a systematic review of available literature reporting recurrence risks after curative colorectal cancer surgery we report that the risks are lower today than they were in the past and that this risk reduction is not solely ascribed to the use of adjuvant therapy. Adjuvant therapy always means overtreatment of many patients, already cured by the surgery. Fewer recurrences mean that progress in the care of these patients has happened but also that the present guidelines giving recommendations based upon old data must be adjusted. The relative gains from adding chemotherapy are not altered, but the absolute number of patients gaining is less. Abstract Adjuvant chemotherapy aims at eradicating tumour cells sometimes present after radical surgery for a colorectal cancer (CRC) and thereby diminish the recurrence rate and prolong time to recurrence (TTR). Remaining tumour cells will lead to recurrent disease that is usually fatal. Adjuvant therapy is administered based upon the estimated recurrence risk, which in turn defines the need for this treatment. This systematic overview aims at describing whether the need has decreased since trials showing that adjuvant chemotherapy provides benefits in colon cancer were performed decades ago. Thanks to other improvements than the administration of adjuvant chemotherapy, such as better staging, improved surgery, the use of radiotherapy and more careful pathology, recurrence risks have decreased. Methodological difficulties including intertrial comparisons decades apart and the present selective use of adjuvant therapy prevent an accurate estimate of the magnitude of the decreased need. Furthermore, most trials do not report recurrence rates or TTR, only disease-free and overall survival (DFS/OS). Fewer colon cancer patients, particularly in stage II but also in stage III, today display a sufficient need for adjuvant treatment considering the burden of treatment, especially when oxaliplatin is added. In rectal cancer, neo-adjuvant treatment will be increasingly used, diminishing the need for adjuvant treatment.
Collapse
|
18
|
Abstract
Abstract
Background
To evaluate a new procedure in daily clinical practice, it might not be sufficient to rely exclusively on the findings of randomized clinical trials (RCTs). This is the first systematic review providing a synthesis of the most important RCTs and relevant retrospective cohort studies on short- and long-term outcomes of laparoscopic surgery in colon cancer patients.
Materials and methods
In a literature search, more than 1800 relevant publications on the topic were identified. Relevant RCTs and representative high-quality retrospective studies were selected based on the widely accepted Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) criteria. Finally, 9 RCTs and 14 retrospective cohort studies were included.
Results
Laparoscopic surgery for colon cancer is associated with a slightly longer duration of surgery, but a variety of studies show an association with a lower rate of postoperative complications and a shorter duration of hospital stay. Particularly in older patients with more frequent comorbidities, laparoscopy seems to contribute to decreasing postoperative mortality. Concerning long-term oncologic outcomes, the laparoscopic and open techniques were shown to be at least equivalent.
Conclusion
The findings of the existing relevant RCTs on laparoscopic surgery for colon cancer are mostly confirmed by representative retrospective cohort studies based on real-world data; therefore, its further implementation into clinical practice can be recommended.
Collapse
|
19
|
Skelton WP, Franke AJ, Iqbal A, George TJ. Comprehensive literature review of randomized clinical trials examining novel treatment advances in patients with colon cancer. J Gastrointest Oncol 2020; 11:790-802. [PMID: 32953161 PMCID: PMC7475336 DOI: 10.21037/jgo-20-184] [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] [Received: 04/11/2020] [Accepted: 07/20/2020] [Indexed: 12/18/2022] Open
Abstract
The treatment of colon cancer has had numerous recent advances, in terms of surgical approach, adjuvant therapies, and more. In this review, the authors examine randomized clinical trials comparing open surgery to laparoscopic surgery (including total mesocolic excision), and also examine the role of robotic surgery. Novel surgical techniques including the no-touch technique, side-to-side anastomosis, suture technique, complete mesocolic excision (CME) with central vascular ligation (CVL), and natural orifice transluminal endoscopic surgery (NOTES) are outlined. The role of placing endoscopic self-expandable metal stents (SEMS) for colonic obstruction is compared and contrasted with the surgical approach, and the effect that the anti-VEGF inhibitor bevacizumab may have on this side effect profile is further explored. The role of the resection of the primary tumor in the setting of metastatic disease is examined with respect to survival benefit. Pathways of perioperative care which can accelerate post-surgical recovery, including enhanced recovery after surgery (ERAS) are examined. The role of adjuvant chemotherapy in patients with high-risk stage II and patients with stage III disease is examined, along with the role on circulating tumor DNA (ctDNA) as well as with the biologic targeted agents cetuximab and bevacizumab. Lastly, the authors detail the postoperative surveillance schedules after surgical resection with respect to survival outcomes.
Collapse
Affiliation(s)
- William Paul Skelton
- Division of Medical Oncology, H. Lee Moffitt Cancer Center and Research Institute, University of South Florida, Florida, USA
| | - Aaron J. Franke
- Division of Medical Oncology, H. Lee Moffitt Cancer Center and Research Institute, University of South Florida, Florida, USA
| | - Atif Iqbal
- Section of Colorectal Surgery, Baylor College of Medicine, Houston, USA
| | - Thomas J. George
- Division of Hematology & Oncology, Department of Medicine, University of Florida College of Medicine, Florida, USA
| |
Collapse
|
20
|
Mundo AI, Greening GJ, Fahr MJ, Hale LN, Bullard EA, Rajaram N, Muldoon TJ. Diffuse reflectance spectroscopy to monitor murine colorectal tumor progression and therapeutic response. JOURNAL OF BIOMEDICAL OPTICS 2020; 25:1-16. [PMID: 32141266 PMCID: PMC7058691 DOI: 10.1117/1.jbo.25.3.035002] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/10/2020] [Accepted: 02/17/2020] [Indexed: 05/08/2023]
Abstract
SIGNIFICANCE Many studies in colorectal cancer (CRC) use murine ectopic tumor models to determine response to treatment. However, these models do not replicate the tumor microenvironment of CRC. Physiological information of treatment response derived via diffuse reflectance spectroscopy (DRS) from murine primary CRC tumors provide a better understanding for the development of new drugs and dosing strategies in CRC. AIM Tumor response to chemotherapy in a primary CRC model was quantified via DRS to extract total hemoglobin content (tHb), oxygen saturation (StO2), oxyhemoglobin, and deoxyhemoglobin in tissue. APPROACH A multimodal DRS and imaging probe (0.78 mm outside diameter) was designed and validated to acquire diffuse spectra longitudinally-via endoscopic guidance-in developing colon tumors under 5-fluoruracil (5-FU) maximum-tolerated (MTD) and metronomic regimens. A filtering algorithm was developed to compensate for positional uncertainty in DRS measurements Results: A maximum increase in StO2 was observed in both MTD and metronomic chemotherapy-treated murine primary CRC tumors at week 4 of neoadjuvant chemotherapy, with 21 ± 6 % and 17 ± 6 % fold changes, respectively. No significant changes were observed in tHb. CONCLUSION Our study demonstrates the feasibility of DRS to quantify response to treatment in primary CRC models.
Collapse
Affiliation(s)
- Ariel I. Mundo
- University of Arkansas, Department of Biomedical Engineering, Fayetteville, Arkansas, United States
| | - Gage. J. Greening
- University of Arkansas, Department of Biomedical Engineering, Fayetteville, Arkansas, United States
| | - Michael J. Fahr
- University of Arkansas, Department of Computer Science, Fayetteville, Arkansas, United States
| | - Lawrence N. Hale
- University of Arkansas, Department of Chemistry and Biochemistry, Fayetteville, Arkansas, United States
| | - Elizabeth A. Bullard
- University of Arkansas, Department of Biomedical Engineering, Fayetteville, Arkansas, United States
| | - Narasimhan Rajaram
- University of Arkansas, Department of Biomedical Engineering, Fayetteville, Arkansas, United States
| | - Timothy J. Muldoon
- University of Arkansas, Department of Biomedical Engineering, Fayetteville, Arkansas, United States
- Address all correspondence to Timothy J. Muldoon, E-mail:
| |
Collapse
|
21
|
Abstract
The role of robotics in colon and rectal surgery has been established as an important and effective tool for the surgeon. Its inherent technologies have provided for increased visualization and ease of dissection in the minimally invasive approach to surgery. The value of the robot is apparent in the more challenging aspects of colon and rectal procedures, including the intracorporeal anastomosis for right colectomies and the low pelvic dissection for benign and malignant diseases.
Collapse
|
22
|
Becattini C, Pace U, Rondelli F, Delrio P, Ceccarelli G, Boncompagni M, Graziosi L, Visonà A, Chiari D, Avruscio G, Frasson S, Gussoni G, Biancafarina A, Camporese G, Donini A, Bucci AF, Agnelli G. Rivaroxaban for extended antithrombotic prophylaxis after laparoscopic surgery for colorectal cancer. Design of the PRO-LAPS II STUDY. Eur J Intern Med 2020; 72:53-59. [PMID: 31818628 DOI: 10.1016/j.ejim.2019.11.015] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2019] [Revised: 11/15/2019] [Accepted: 11/19/2019] [Indexed: 01/16/2023]
Abstract
BACKGROUND The clinical benefit of extending prophylaxis for venous thromboembolism (VTE) beyond hospital discharge after laparoscopic surgery for cancer is undefined. Extended prophylaxis with rivaroxaban is effective in reducing post-operative VTE after major orthopedic surgery without safety concern. METHODS PROLAPS II is an investigator-initiated, randomized, double-blind study aimed at assessing the efficacy and safety of extended antithrombotic prophylaxis with rivaroxaban compared with placebo after laparoscopic surgery for colorectal cancer in patients who had received antithrombotic prophylaxis with low molecular-weight heparin for 7 ± 2 days (NCT03055026). Patients are randomized to receive rivaroxaban (10 mg once daily) or placebo for 3 weeks (up to day 28 ± 2 from surgery). The primary study outcome is a composite of symptomatic objectively confirmed VTE, asymptomatic ultrasonography-detected DVT or VTE-related death at 28 ± 2 days from laparoscopic surgery. The primary safety outcome is major bleeding defined according to the International Society of Thrombosis and Haemostasis. Symptomatic objectively confirmed VTE, asymptomatic ultrasonography-detected DVT, major bleeding or death by day 28 ± 2 and by day 90 from surgery are secondary outcomes. Assuming an 8% event rate with placebo and 60% reduction in the primary study outcome with rivaroxaban, 323 patients per group are necessary to show a statistically significant difference between the study groups. DISCUSSION The PROLAPS II is the first study with an oral anti-Xa agent in cancer surgery. The study has the potential to improve clinical practice by answering the question on the clinical benefit of extending prophylaxis after laparoscopic surgery for colorectal cancer.
Collapse
Affiliation(s)
- Cecilia Becattini
- Department of Internal and Cardiovascular Medicine and Stroke Unit, University of Perugia, Italy.
| | - Ugo Pace
- National Cancer Institute, "G. Pascale" Foundation, Napoli, Italy.
| | - Fabio Rondelli
- Department of General Surgery, S. Giovanni Battista Hospital, Foligno, Italy.
| | - Paolo Delrio
- National Cancer Institute, "G. Pascale" Foundation, Napoli, Italy.
| | | | - Michela Boncompagni
- Department of General Surgery, S. Maria della Misericordia Hospital, Perugia, Italy.
| | - Luigina Graziosi
- Department of Oncology Surgery, University of Perugia, Perugia, Italy.
| | - Adriana Visonà
- Department of Vascular Medicine, S.Giacomo Apostolo Hospital, Catelfranco Veneto, Treviso, Italy.
| | - Damiano Chiari
- Department of General Surgery, Istituto Clinico Humanitas Mater Domini, Castellanza, Varese, Italy.
| | - Giampiero Avruscio
- Department of Cardiac, Thoracic and Vascular Sciences, Unit of Angiology, University Hospital of Padua, Padua, Italy.
| | | | | | | | - Giuseppe Camporese
- Department of Cardiac, Thoracic and Vascular Sciences, Unit of Angiology, University Hospital of Padua, Padua, Italy.
| | - Annibale Donini
- Department of Oncology Surgery, University of Perugia, Perugia, Italy.
| | | | - Giancarlo Agnelli
- Department of Internal and Cardiovascular Medicine and Stroke Unit, University of Perugia, Italy.
| |
Collapse
|
23
|
Akagi T, Inomata M. Essential advances in surgical and adjuvant therapies for colorectal cancer 2018-2019. Ann Gastroenterol Surg 2020; 4:39-46. [PMID: 32021957 PMCID: PMC6992683 DOI: 10.1002/ags3.12307] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2019] [Revised: 11/18/2019] [Accepted: 12/13/2019] [Indexed: 02/07/2023] Open
Abstract
Surgical resection and adjuvant chemotherapy are the only treatment modalities for localized colorectal cancer that can obtain a "cure." The goal in surgically treating primary colorectal cancer is complete tumor removal along with dissection of systematic D3 lymph nodes. Adjuvant treatment controls recurrence and improves the prognosis of patients after they undergo R0 resection. Various clinical studies have promoted the gradual spread and clinical use of new surgical approaches such as laparoscopic surgery, robotic surgery, and transanal total mesorectal excision (TaTME). Additionally, the significance of adjuvant chemotherapy has been established and it is now recommended in the JSCCR (the Japanese Society for Cancer of the Colon and Rectum) guideline as a standard treatment. Herein, we review and summarize current surgical treatment and adjuvant chemotherapy for localized colorectal cancer and discuss recent advances in personalized medicine related to adjuvant chemotherapy.
Collapse
Affiliation(s)
- Tomonori Akagi
- Department of Gastroenterological and Pediatric SurgeryFaculty of MedicineOita UniversityYufu‐CityJapan
| | - Masafumi Inomata
- Department of Gastroenterological and Pediatric SurgeryFaculty of MedicineOita UniversityYufu‐CityJapan
| |
Collapse
|
24
|
Manceau G, Brouquet A, Chaibi P, Passot G, Bouché O, Mathonnet M, Regimbeau JM, Lo Dico R, Lefèvre JH, Peschaud F, Facy O, Volpin E, Chouillard E, Beyert-Berjot L, Verny M, Karoui M, Benoist S. Multicenter phase III randomized trial comparing laparoscopy and laparotomy for colon cancer surgery in patients older than 75 years: the CELL study, a Fédération de Recherche en Chirurgie (FRENCH) trial. BMC Cancer 2019; 19:1185. [PMID: 31801485 PMCID: PMC6894257 DOI: 10.1186/s12885-019-6376-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2019] [Accepted: 11/18/2019] [Indexed: 12/15/2022] Open
Abstract
Background Several multicenter randomized controlled trials comparing laparoscopy and conventional open surgery for colon cancer have demonstrated that laparoscopic approach achieved the same oncological results while improving significantly early postoperative outcomes. These trials included few elderly patients, with a median age not exceeding 71 years. However, colon cancer is a disease of the elderly. More than 65% of patients operated on for colon cancer belong to this age group, and this proportion may become more pronounced in the coming years. In current practice, laparoscopy is underused in this population. Methods The CELL (Colectomy for cancer in the Elderly by Laparoscopy or Laparotomy) trial is a multicenter, open-label randomized, 2-arm phase III superiority trial. Patients aged 75 years or older with uncomplicated colonic adenocarcinoma or endoscopically unresectable colonic polyp will be randomized to either colectomy by laparoscopy or laparotomy. The primary endpoint of the study is overall postoperative morbidity, defined as any complication classification occurring up to 30 days after surgery. The secondary endpoints are: 30-day and 90-day postoperative mortality, 30-day readmission rate, quality of surgical resection, health-related quality of life and evolution of geriatric assessment. A 35 to 20% overall postoperative morbidity rate reduction is expected for patients operated on by laparoscopy compared with those who underwent surgery by laparotomy. With a two-sided α risk of 5% and a power of 80% (β = 0.20), 276 patients will be required in total. Discussion To date, no dedicated randomized controlled trial has been conducted to evaluate morbidity after colon cancer surgery by laparoscopy or laparotomy in the elderly and the benefits of laparoscopy is still debated in this context. Thus, a prospective multicenter randomized trial evaluating postoperative outcomes specifically in elderly patients operated on for colon cancer by laparoscopy or laparotomy with curative intent is warranted. If significant, such a study might change the current surgical practices and allow a significant improvement in the surgical management of this population, which will be the vast majority of patients treated for colon cancer in the coming years. Trial registration ClinicalTrials.gov NCT03033719 (January 27, 2017).
Collapse
Affiliation(s)
- Gilles Manceau
- Department of Digestive and Hepato-Pancreato-Biliary Surgery, Sorbonne University, Assistance Publique Hôpitaux de Paris, Pitié-Salpêtrière Hospital, Paris, France.
| | - Antoine Brouquet
- Department of Surgery, Paris-Sud University, Assistance Publique Hôpitaux de Paris, Bicetre Hospital, Le Kremlin-Bicetre, France
| | - Pascal Chaibi
- Unité d'onco-hémato-gériatrie, Sorbonne University, Assistance Publique Hôpitaux de Paris, Charles Foix Hospital, Ivry-sur-Seine, France
| | - Guillaume Passot
- Department of Surgical Oncology, CHU Lyon Sud, Hospices Civils de Lyon, Lyon, France
| | - Olivier Bouché
- Department of Digestive Oncology, Reims University Hospital, Reims, France
| | - Murielle Mathonnet
- Department of Digestive and Endocrine Surgery, Dupuytren University Hospital, Limoges University, Limoges, France
| | - Jean-Marc Regimbeau
- Department of Digestive and Oncological Surgery, Amiens University Hospital, Amiens, France
| | - Rea Lo Dico
- Department of Visceral and Oncologic Surgery, Paris Diderot University, Assistance Publique - Hôpitaux de Paris, Saint-Louis Hospital, Paris, France
| | - Jérémie H Lefèvre
- Department of Surgery, Sorbonne University, Assistance Publique - Hôpitaux de Paris, Saint-Antoine Hospital, Paris, France
| | - Frédérique Peschaud
- Department of Digestive, Oncologic and Metabolic Surgery, Versailles St-Quentin-en-Yvelines/Paris Saclay University, Assistance Publique - Hôpitaux de Paris Ambroise Paré Hospital, Boulogne-Billancourt, France
| | - Olivier Facy
- Department of Digestive Surgical Oncology, Dijon University Hospital, Dijon, France
| | - Enrico Volpin
- Department of visceral and urological surgery, Simone Veil Hospital, Eaubonne, France
| | - Elie Chouillard
- Department of Minimally Invasive Surgery, Poissy Saint Germain Medical Center, Poissy, France
| | - Laura Beyert-Berjot
- Department of Digestive Surgery, Aix-Marseille Université, Marseille, France
| | - Marc Verny
- Department of Geriatrics, Sorbonne University, Assistance Publique - Hôpitaux de Paris, Pitié-Salpêtrière Hospital, Paris, France
| | - Mehdi Karoui
- Department of Digestive and Hepato-Pancreato-Biliary Surgery, Sorbonne University, Assistance Publique Hôpitaux de Paris, Pitié-Salpêtrière Hospital, Paris, France
| | - Stéphane Benoist
- Department of Surgery, Paris-Sud University, Assistance Publique Hôpitaux de Paris, Bicetre Hospital, Le Kremlin-Bicetre, France
| |
Collapse
|
25
|
Chiu CC, Lin WL, Shi HY, Huang CC, Chen JJ, Su SB, Lai CC, Chao CM, Tsao CJ, Chen SH, Wang JJ. Comparison of Oncologic Outcomes in Laparoscopic versus Open Surgery for Non-Metastatic Colorectal Cancer: Personal Experience in a Single Institution. J Clin Med 2019; 8:jcm8060875. [PMID: 31248135 PMCID: PMC6616913 DOI: 10.3390/jcm8060875] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2019] [Revised: 06/12/2019] [Accepted: 06/17/2019] [Indexed: 02/07/2023] Open
Abstract
The oncologic merits of the laparoscopic technique for colorectal cancer surgery remain debatable. Eligible patients with non-metastatic colorectal cancer who were scheduled for an elective resection by one surgeon in a medical institution were randomized to either laparoscopic or open surgery. During this period, a total of 188 patients received laparoscopic surgery and the other 163 patients received the open approach. The primary endpoint was cancer-free five-year survival after operative treatment, and the secondary endpoint was the tumor recurrence incidence. Besides, surgical complications were also compared. There was no statistically significant difference between open and laparoscopic groups regarding the average number of lymph nodes dissected, ileus, anastomosis leakage, overall mortality rate, cancer recurrence rate, or cancer-free five-year survival. Even though performing a laparoscopic approach used a significantly longer operation time, this technique was more effective for colorectal cancer treatment in terms of shorter hospital stay and less blood loss. Meanwhile, fewer patients receiving the laparoscopic approach developed postoperative urinary tract infection, wound infection, or pneumonia, which reached statistical significance. For non-metastatic colorectal cancer patients, laparoscopic surgery resulted in better short-term outcomes, whether in several surgical complications and intra-operative blood loss. Though there was no significant statistical difference in terms of cancer-free five-year survival and tumor recurrence, it is strongly recommended that patients undergo laparoscopic surgery if not contraindicated.
Collapse
Affiliation(s)
- Chong-Chi Chiu
- Department of General Surgery, Chi Mei Medical Center, Liouying 73657, Taiwan.
- Department of General Surgery, Chi Mei Medical Center, Tainan 71004, Taiwan.
- Department of Electrical Engineering, Southern Taiwan University of Science and Technology, Tainan 71005, Taiwan.
| | - Wen-Li Lin
- Department of Cancer Center, Chi Mei Medical Center, Liouying 73657, Taiwan.
| | - Hon-Yi Shi
- Department of Healthcare Administration and Medical Informatics, Kaohsiung Medical University, Kaohsiung 80708, Taiwan.
- Department of Business Management, National Sun Yat Sen University, Kaohsiung 80424, Taiwan.
- Department of Medical Research, Kaohsiung Medical University Hospital, Kaohsiung 80708, Taiwan.
| | - Chien-Cheng Huang
- Department of Emergency Medicine, Chi-Mei Medical Center, Tainan 71004, Taiwan.
- Department of Senior Services, Southern Taiwan University of Science and Technology, Tainan 71005, Taiwan.
| | - Jyh-Jou Chen
- Department of Gastroenterology and Hepatology, Chi Mei Medical Center, Liouying 73657, Taiwan.
| | - Shih-Bin Su
- Department of Occupational Medicine, Chi Mei Medical Center, Liouying 73657, Taiwan.
- Department of Occupational Medicine, Chi Mei Medical Center, Tainan 71004, Taiwan.
- Department of Leisure, Recreation and Tourism Management, Southern Taiwan University of Science and Technology, Tainan 71005, Taiwan.
| | - Chih-Cheng Lai
- Department of Intensive Care Medicine, Chi Mei Medical Center, Liouying 73657, Taiwan.
| | - Chien-Ming Chao
- Department of Intensive Care Medicine, Chi Mei Medical Center, Liouying 73657, Taiwan.
| | - Chao-Jung Tsao
- Department of Oncology, Chi Mei Medical Center, Liouying 73657, Taiwan.
| | - Shang-Hung Chen
- National Institute of Cancer Research, National Health Research Institutes, Tainan 70403, Taiwan.
| | - Jhi-Joung Wang
- Department of Medical Research, Chi Mei Medical Center, Tainan 71004, Taiwan.
- AI Biomed Center, Southern Taiwan University of Science and Technology, Tainan 71005, Taiwan.
| |
Collapse
|
26
|
Song XJ, Liu ZL, Zeng R, Ye W, Liu CW. A meta-analysis of laparoscopic surgery versus conventional open surgery in the treatment of colorectal cancer. Medicine (Baltimore) 2019; 98:e15347. [PMID: 31027112 PMCID: PMC6831213 DOI: 10.1097/md.0000000000015347] [Citation(s) in RCA: 34] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND This meta-analysis aimed to explore the overall effect and safety of anterior laparoscopic surgery versus conventional open surgery for patients with colorectal cancer based on eligible randomized controlled trials (RCTs), especially the difference in the postoperative incidence of deep venous thrombosis (DVT). METHODS PubMed, Cochrane, and Embase were searched based on keywords to identify eligible studies before February 2018. Only RCTs were eligible. We analyzed the main outcomes using the relative risk (RR) or mean difference (MD) along with 95% confidence interval (95% CI). RESULTS In this meta-analysis, we analyzed a total of 24 studies with 4592 patients in the laparoscopic surgery group and 3865 patients in the open surgery group. The results indicated that compared with the open surgery, laparoscopic surgery significantly decreased estimated blood loss (SMD: -1.14, 95%CI: -1.70 to -0.57), hospital stay (SMD: -1.12, 95%CI: -1.76 to -0.47), postoperative mortality (RR: 0.60, 95%CI: 0.41-0.86) and postoperative complication (RR: 0.83, 95%CI: 0.72-0.95). However, the operative time (WMD: 40.46, 95%CI: 35.94-44.9) was statistically higher in the laparoscopic surgery group than the open surgery group, and there was no significant difference in the incidence of DVT between the 2 groups (RR: 0.96, 95%CI: 0.46-2.02). CONCLUSION Laparoscopic surgery is superior to open surgery for patients with colorectal cancer. But the 2 surgeries showed no significant difference in the incidence of DVT.
Collapse
|
27
|
Freischlag K, Adam M, Turner M, Watson J, Ezekian B, Schroder PM, Mantyh C, Migaly J. With widespread adoption of MIS colectomy for colon cancer, does hospital type matter? Surg Endosc 2019; 33:159-168. [PMID: 29946919 DOI: 10.1007/s00464-018-6289-7] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2018] [Accepted: 06/18/2018] [Indexed: 01/21/2023]
Abstract
BACKGROUND Recent studies have shown that hospital type impacts patient outcomes, but no studies have examined hospital differences in outcomes for patients undergoing minimally invasive surgery (MIS) for segmental colectomies. METHODS The 2010-2014 National Cancer Data Base was queried for patients undergoing segmental colectomy for non-metastatic colon adenocarcinoma. Descriptive statistics characterized MIS utilization by hospital type. Multivariable models were used to examine the effect of hospital type on outcomes after MIS. Survival probability was plotted using the Kaplan-Meier method. RESULTS 80,922 patients underwent MIS segmental colectomy for colon cancer from 2010 to 2014. From 2010 to 2014, the number of MIS segmental colectomies increased by 157% at academic hospitals, 151% at comprehensive hospitals, and 153% at community hospitals. Compared to academic hospitals, community and comprehensive hospitals had greater adjusted odds of positive margins (Community OR 1.525, 95% Confidence Interval 1.233-1.885; Comprehensive OR 1.216, 95% CI 1.041-1.42), incomplete number of lymph nodes analyzed (< 12 LNs) from surgery (Community OR 2.15, 95% CI 1.98-2.32; Comprehensive OR 1.42, 95% CI 1.34-1.51), and greater 30-day mortality (Community OR 1.43, 95% CI 1.14-1.78; Comprehensive OR 1.36, 95% CI 1.17-1.59). Patient survival probability was higher at academic hospitals at 5 years (Academic 69% vs. Comprehensive 66% vs. Community 63%, p < 0.001). Community hospitals and comprehensive hospitals had significantly higher risk of adjusted long-term mortality (Community HR 1.28; 95% CI 1.19-1.37; p < 0.001; Comprehensive HR 1.14; 95% CI 1.09-1.20; p < 0.001). CONCLUSIONS Despite widespread use of laparoscopic oncologic surgery, short- and long-term outcomes from MIS for segmental colectomy are superior at academic hospitals. This difference may be due to superior perioperative oncologic technique and surgical outcomes at academic hospitals. Our data provide important information for patients, referring physicians, and surgeons about the significance of hospital type in management of colon cancer.
Collapse
Affiliation(s)
- K Freischlag
- Duke University School of Medicine, Durham, NC, USA.
| | - M Adam
- Duke University Medical Center, Surgery, Durham, NC, USA
| | - M Turner
- Duke University Medical Center, Surgery, Durham, NC, USA
| | - J Watson
- Duke University Medical Center, Surgery, Durham, NC, USA
| | - B Ezekian
- Duke University Medical Center, Surgery, Durham, NC, USA
| | - P M Schroder
- Duke University Medical Center, Surgery, Durham, NC, USA
| | - C Mantyh
- Duke University Medical Center, Surgery, Durham, NC, USA
| | - J Migaly
- Duke University Medical Center, Surgery, Durham, NC, USA
| |
Collapse
|
28
|
Martel G, Boushey RP, Marcello PW. Reprint of: Results of the laparoscopic colon cancer randomized trials: An evidence-based review. SEMINARS IN COLON AND RECTAL SURGERY 2018. [DOI: 10.1053/j.scrs.2018.11.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
|
29
|
Chen TC, Liang JT, Chang TC. Should Surgical Treatment Be Provided to Patients with Colorectal Cancer Who Are Aged 90 Years or Older? J Gastrointest Surg 2018; 22:1958-1967. [PMID: 29943137 DOI: 10.1007/s11605-018-3843-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2018] [Accepted: 06/12/2018] [Indexed: 01/31/2023]
Abstract
PURPOSE The number of patients aged ≥ 90 years is increasing worldwide; however, the treatment guidelines for colorectal cancer in elderly patients remain unclear. This study aimed to investigate the clinical outcomes of patients with primary colorectal cancer aged ≥ 90 years. METHODS We retrospectively reviewed the medical records of 100 patients (aged ≥ 90 years) with primary colorectal adenocarcinoma. Their demographic and clinical characteristics and surgical outcomes were assessed. RESULTS The patients who underwent tumor resections (n = 71) showed longer overall and cancer-specific survival than those who underwent non-operative treatments (n = 29) (median overall survival time: 23.92 months vs. 2.99 months, P < 0.0001). Age, body mass index, performance status, advanced cancer stage (stages 3 and 4), and treatment strategy were identified as risk factors, prognostic factors, and predictors of overall survival. No significant differences in the postoperative morbidity rate, in-hospital mortality rate, and survival time were found between the elective laparoscopic (n = 27) and elective open (n = 37) surgery subgroups. However, the in-hospital mortality rate was 6.25% (4/64) in the patients who underwent elective open surgeries and 42.9% (3/7) in those who underwent emergent open surgeries (p = 0.0179). CONCLUSIONS In clinical practice, surgical treatment should not be denied to patients with primary colorectal cancer aged ≥ 90 years. However, the high complication and mortality rates for emergency surgeries act as a deterrent. Further studies to eliminate the bias between operative and non-operative groups may be needed to validate our results.
Collapse
Affiliation(s)
- Tzu-Chun Chen
- Graduate Institute of Clinical Medicine, College of Medicine, National Taiwan University, Taipei City, Taiwan
- Division of Colorectal Surgery, Department of Surgery, National Taiwan University Hospital Hsinchu Branch, Hsinchu City, Taiwan
| | - Jin-Tung Liang
- Division of Colorectal Surgery, Department of Surgery, National Taiwan University Hospital, 7 Chung-Shan South Road, Zhongzheng District, Taipei, 100, Taiwan, Republic of China.
| | - Tung-Cheng Chang
- Division of Colorectal Surgery, Department of Surgery, Taipei University Shuang-Ho Hospital, Taipei City, Taiwan
| |
Collapse
|
30
|
Robotic surgery trends in general surgical oncology from the National Inpatient Sample. Surg Endosc 2018; 33:2591-2601. [PMID: 30357525 DOI: 10.1007/s00464-018-6554-9] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2018] [Accepted: 10/17/2018] [Indexed: 12/15/2022]
Abstract
BACKGROUND Robotic surgery is offered at most major medical institutions. The extent of its use within general surgical oncology, however, is poorly understood. We hypothesized that robotic surgery adoption in surgical oncology is increasing annually, that is occurring in all surgical sites, and all regions of the US. STUDY DESIGN We identified patients with site-specific malignancies treated with surgical resection from the National Inpatient Sample 2010-2014 databases. Operations were considered robotic if any ICD-9-CM robotic procedure code was used. RESULTS We identified 147,259 patients representing the following sites: esophageal (3%), stomach (5%), small bowel (5%), pancreas (7%), liver (5%), and colorectal (75%). Most operations were open (71%), followed by laparoscopic (26%), and robotic (3%). In 2010, only 1.1% of operations were robotic; over the 5-year study period, there was a 5.0-fold increase in robotic surgery, compared to 1.1-fold increase in laparoscopy and 1.2-fold decrease in open surgery (< 0.001). These trends were observed for all surgical sites and in all regions of the US, they were strongest for esophageal and colorectal operations, and in the Northeast. Adjusting for age and comorbidities, odds of having a robotic operation increased annually (5.6 times more likely by 2014), with similar length of stay (6.9 ± 6.5 vs 7.0 ± 6.5, p = 0.52) and rate of complications (OR 0.91, 95% CI 0.83-1.01, p = 0.08) compared to laparoscopy. CONCLUSIONS Robotic surgery as a platform for minimally invasive surgery is increasing over time for oncologic operations. The growing use of robotic surgery will affect surgical oncology practice in the future, warranting further study of its impact on cost, outcomes, and surgical training.
Collapse
|
31
|
Tan ECH, Yang MC, Chen CC. Effects of laparoscopic surgery on survival, quality of care and utilization in patients with colon cancer: a population-based study. Curr Med Res Opin 2018; 34:1663-1671. [PMID: 29863425 DOI: 10.1080/03007995.2018.1484713] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
OBJECTIVE Laparoscopy is a safe and effective treatment for colon cancer. However, its effects on short- and long-term health outcomes and medical utilization are not fully elucidated. This study aimed to compare short- and long-term utilization and health outcomes of colon cancer patients who underwent either laparoscopic or open surgery in a population-based cohort. METHODS This study was conducted by linking data from Taiwan Cancer Registry, National Health Insurance claims and Death Registry. Patients aged 18 and older with colon cancer between 2009 and 2012 were included in the study. Propensity score matching was used to minimize selection bias between laparoscopic and open surgery groups. Cox proportional hazard regression and generalized linear mixed logistic regression were used to test hypotheses. RESULTS Among the 11,269 colon cancer patients who underwent colectomy, 3236 (28.72%) received laparoscopy and 8033 (71.28%) underwent open surgery. Patients who received laparoscopic surgery had better overall survival (HR = 0.82; 95% CI: 0.70-0.97). These patients also had lower 30 day mortality (0.44% vs. 0.91%), lower 1 year mortality (2.83% vs. 4.68%), lower overall occurrence of complications (6.16% vs. 8.77%), shorter mean length of stay (12.53 vs. 14.93 days) and lower cost for index hospitalization (US$4325.34 vs. US$4453.90). No significant differences were observed in medical utilization over a period of 365 days after the surgery. CONCLUSIONS Our results demonstrate that, in both the short- and long-term post-operation periods, laparoscopic surgery reduced the likelihood of postoperative complications, 30 day, and 1 year mortality while being no more expensive than open surgery for colon cancer.
Collapse
Affiliation(s)
- Elise Chia-Hui Tan
- a Division of Clinical Chinese Medicine , National Research Institute of Chinese Medicine , Ministry of Health and Welfare , Taipei , Taiwan
- b Institute of Health Policy and Management , College of Public Health , National Taiwan University , Taipei , Taiwan
| | - Ming-Chin Yang
- b Institute of Health Policy and Management , College of Public Health , National Taiwan University , Taipei , Taiwan
| | - Chien-Chih Chen
- c Department of Surgery , Koo Foundation, Sun Yat-Sen Cancer Center , Taipei , Taiwan
- d College of Medicine , National Yang-Ming University , Taipei , Taiwan
| |
Collapse
|
32
|
Douaiher J, Hussain T, Langenfeld SJ. Predictors of adequate lymph node harvest during colectomy for colon cancer. Am J Surg 2018; 218:113-118. [PMID: 30201139 DOI: 10.1016/j.amjsurg.2018.08.020] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2018] [Revised: 06/17/2018] [Accepted: 08/26/2018] [Indexed: 02/06/2023]
Abstract
BACKGROUND Consensus guidelines recommend a yield of 12 lymph nodes in resections for colon cancer. Factors affecting this yield are not well defined. METHODS Retrospective study using the colectomy-targeted American College of Surgeons National Surgical Quality Improvement Program for years 2014-2016. Primary outcome was resection of at least 12 nodes. Univariate and multivariate analyses determined factors associated with ≥12 LN yield. RESULTS 17,612 colectomies for colon cancer were extracted from the NSQIP database. 7.26% of cases did not reach a 12 LN harvest. Harvesting ≥12 LN was 74% more likely (p = 0.001) if the resection was laparoscopic and 72% more likely (p < 0.0001) if hand-assisted. Advanced T and N stage had a higher likelihood of reaching 12 LN harvest. Older age, female gender and smoking history decreased the likelihood of ≥12 LN harvest. CONCLUSIONS Laparoscopic and robotic colectomies were 1.5-2.5 times more likely to achieve adequate LN harvest compared to open surgery. Several non-modifiable patient and disease related factors may render adequate LN yield challenging.
Collapse
Affiliation(s)
- Jeffrey Douaiher
- Walnut Creek Medical Center, Kaiser Permanente Department of General Surgery, Walnut Creek, CA 94596, United States.
| | - Tanvir Hussain
- Department of Quality, Alameda Health System, Oakland, CA, 94621, United States
| | - Sean J Langenfeld
- Department of Surgery, University of Nebraska Medical Center, Omaha, 68198, NE, United States
| |
Collapse
|
33
|
Sheng S, Zhao T, Wang X. Comparison of robot-assisted surgery, laparoscopic-assisted surgery, and open surgery for the treatment of colorectal cancer: A network meta-analysis. Medicine (Baltimore) 2018; 97:e11817. [PMID: 30142771 PMCID: PMC6112974 DOI: 10.1097/md.0000000000011817] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND The aim of this study was to find the better treatment for colorectal cancer (CRC) by comparing robot-assisted colorectal surgery (RACS), laparoscopic-assisted colorectal surgery (LACS), and open surgery using network meta-analysis. METHODS A literature search updated to August 15, 2017 was performed. All the included literatures were evaluated according to the quality evaluation criteria of bias risk recommended by the Cochrane Collaboration. All data were comprehensively analyzed by ADDIS. Odds ratio (OR), mean difference (MD), and 95% confidence interval (CI) were used to show the effect index of all data. The degree of convergence of the model was evaluated by the Brooks-Gelman-Rubin method with the potential scale reduction factor (PSRF) as the evaluation indicator. RESULTS The PSRF values of operation time, estimated blood loss, length of hospital stay, complication, mortality, and anastomotic leakage ranged from 1.00 to 1.01, and those of wound infection, bleeding, and ileus ranged from 1.00 to 1.02. Open surgery had the shortest operation time compared with LACS and RACS. Furthermore, compared with LACS, the amount of blood loss, complication, mortality, bleeding rate, and ileus rate for RACS were the least, and the length of hospital stay for RACS was the shortest. The anastomotic leakage rate for LACS was the least, but there was no significant difference compared with those of RACS and open surgery. The wound infection rate for LACS was the least, but there was no significant difference compared with that of RACS. CONCLUSION RACS might be a better treatment for patients with CRC.
Collapse
Affiliation(s)
| | - Tiancheng Zhao
- Department of Endoscopy Center, China-Japan Union Hospital of Jilin University
| | - Xu Wang
- Department of Colorectal and Anal Surgery, The First Hospital of Jilin University, Changchun, Jilin Province, China
| |
Collapse
|
34
|
Pelz JOW, Wagner J, Lichthardt S, Baur J, Kastner C, Matthes N, Germer CT, Wiegering A. Laparoscopic right-sided colon resection for colon cancer-has the control group so far been chosen correctly? World J Surg Oncol 2018; 16:117. [PMID: 29954404 PMCID: PMC6022499 DOI: 10.1186/s12957-018-1417-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2018] [Accepted: 06/13/2018] [Indexed: 12/16/2022] Open
Abstract
Background The treatment strategies for colorectal cancer located in the right side of the colon have changed dramatically during the last decade. Due to the introduction of complete mesocolic excision (CME) with central ligation of the vessels and systematic lymph node dissection, the long-term survival of affected patients has increased significantly. It has also been proposed that right-sided colon resection can be performed laparoscopically with the same extent of resection and equal long-term results. Methods A retrospective evaluation of a prospectively expanded database on right-sided colorectal cancer or adenoma treated at the University Hospital of Wuerzburg between 2009 and 2016 was performed. All patients underwent CME. This data was analyzed alone and in comparison to the published data describing laparoscopic right-sided colon resection for colon cancer. Results The database contains 279 patients, who underwent right-sided colon resection due to colorectal cancer or colorectal adenoma (255 open; 24 laparoscopic). Operation data (time, length of stay, time on ICU) was equal or superior to laparoscopy, which is comparable to the published results. Surprisingly, the surrogate parameter for correct CME (the number of removed lymph nodes) was significantly higher in the open group. In a subgroup analysis only including patients who were feasible for laparoscopic resection and had been operated with an open procedure by an experienced surgeon, operation time was significantly shorter and the number of removed lymph nodes is significantly higher in the open group. Conclusion So far, several studies demonstrate that laparoscopic right-sided colon resection is comparable to open resection. Our data suggests that a consequent CME during an open operation leads to significantly more removed lymph nodes than in laparoscopically resected patients and in several so far published data of open control groups from Europe. Further prospective randomized trials comparing the long-term outcome are urgently needed before laparoscopy for right-sided colon resection can be recommended ubiquitously.
Collapse
Affiliation(s)
- Jörg O W Pelz
- Department of General, Visceral, Vascular and Pediatric Surgery, University Hospital, University of Wuerzburg, Oberduerrbacherstr.6, 97080, Wuerzburg, Germany.,Comprehensive Cancer Centre Mainfranken, University Hospital, University of Wuerzburg, Josef-Schneiderstr. 6, 97080, Wuerzburg, Germany
| | - Johanna Wagner
- Department of General, Visceral, Vascular and Pediatric Surgery, University Hospital, University of Wuerzburg, Oberduerrbacherstr.6, 97080, Wuerzburg, Germany
| | - Sven Lichthardt
- Department of General, Visceral, Vascular and Pediatric Surgery, University Hospital, University of Wuerzburg, Oberduerrbacherstr.6, 97080, Wuerzburg, Germany
| | - Johannes Baur
- Department of General, Visceral, Vascular and Pediatric Surgery, University Hospital, University of Wuerzburg, Oberduerrbacherstr.6, 97080, Wuerzburg, Germany
| | - Caroline Kastner
- Department of General, Visceral, Vascular and Pediatric Surgery, University Hospital, University of Wuerzburg, Oberduerrbacherstr.6, 97080, Wuerzburg, Germany
| | - Niels Matthes
- Department of General, Visceral, Vascular and Pediatric Surgery, University Hospital, University of Wuerzburg, Oberduerrbacherstr.6, 97080, Wuerzburg, Germany
| | - Christoph-Thomas Germer
- Department of General, Visceral, Vascular and Pediatric Surgery, University Hospital, University of Wuerzburg, Oberduerrbacherstr.6, 97080, Wuerzburg, Germany.,Comprehensive Cancer Centre Mainfranken, University Hospital, University of Wuerzburg, Josef-Schneiderstr. 6, 97080, Wuerzburg, Germany
| | - Armin Wiegering
- Department of General, Visceral, Vascular and Pediatric Surgery, University Hospital, University of Wuerzburg, Oberduerrbacherstr.6, 97080, Wuerzburg, Germany. .,Comprehensive Cancer Centre Mainfranken, University Hospital, University of Wuerzburg, Josef-Schneiderstr. 6, 97080, Wuerzburg, Germany. .,Department of Biochemistry and Molecular Biology, University of Wuerzburg, Am Hubland, 97074, Wuerzburg, Germany.
| |
Collapse
|
35
|
Chen TC, Liang JT. Robotic low anterior resection of rectal cancer with partial resection of urinary bladder and reconstruction - a video vignette. Colorectal Dis 2018; 20:354. [PMID: 29341403 DOI: 10.1111/codi.14017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2017] [Accepted: 11/12/2017] [Indexed: 02/08/2023]
Affiliation(s)
- T-C Chen
- Division of Colorectal Surgery, Department of Surgery, National Taiwan University Hospital, Hsinchu Branch, Taipei, Taiwan
| | - J-T Liang
- Division of Colorectal Surgery, Department of Surgery, National Taiwan University Hospital and College of Medicine, Taipei, Taiwan
| |
Collapse
|
36
|
Carvello M, de Groof EJ, de Buck van Overstraeten A, Sacchi M, Wolthuis AM, Buskens CJ, D'Hoore A, Bemelman WA, Spinelli A. Single port laparoscopic ileocaecal resection for Crohn's disease: a multicentre comparison with multi-port laparoscopy. Colorectal Dis 2018. [PMID: 28622435 DOI: 10.1111/codi.13777] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
AIM Single port (SP) ileocaecal resection (ICR) is an established technique but there are no large studies comparing SP and multi-port (MP) laparoscopic surgery in Crohn's disease (CD). The aim of this study was to compare postoperative pain scores and analgesia requirements after SP and MP laparoscopic ICR for CD. METHOD This was a retrospective study of patients undergoing SP or MP ICR for CD in three tertiary referral centres from February 1999 to October 2014. Baseline characteristics (age, sex, body mass index and indication for surgery) were compared. Primary end-points were postoperative pain scores, analgesia requirements and short-term postoperative outcomes. RESULTS SP ICR (n = 101) and MP ICR (n = 156) patients were included in the study. Visual analogue scale scores were significantly lower after SP ICR on postoperative day 1 (P = 0.016) and day 2 (P = 0.04). Analgesia requirements were significantly reduced on postoperative day 2 in the SP group compared with the MP group (P = 0.007). Duration of surgery, conversion to open surgery and stoma rates were comparable between the two groups. Surgery was more complex in terms of additional procedures when MP was adopted (P = 0.001). There were no differences in postoperative complication rates, postoperative food intake, length of stay and readmissions. CONCLUSION These data suggest that in comparison to standard laparoscopic surgery SP ICR might be less painful and patients might require less opioid analgesia.
Collapse
Affiliation(s)
- M Carvello
- Colon and Rectal Surgery Unit, Humanitas Clinical and Research Center, Rozzano, Milan, Italy
| | - E J de Groof
- Department of Surgery, Academic Medical Center, Amsterdam, The Netherlands
| | | | - M Sacchi
- Colon and Rectal Surgery Unit, Humanitas Clinical and Research Center, Rozzano, Milan, Italy
| | - A M Wolthuis
- Department of Abdominal Surgery, University Hospital Leuven, Leuven, Belgium
| | - C J Buskens
- Department of Surgery, Academic Medical Center, Amsterdam, The Netherlands
| | - A D'Hoore
- Colon and Rectal Surgery Unit, Humanitas Clinical and Research Center, Rozzano, Milan, Italy
| | - W A Bemelman
- Department of Surgery, Academic Medical Center, Amsterdam, The Netherlands
| | - A Spinelli
- Colon and Rectal Surgery Unit, Humanitas Clinical and Research Center, Rozzano, Milan, Italy.,Department of Biomedical Science, Humanitas University, Rozzano, Milan, Italy
| |
Collapse
|
37
|
Negoi I, Hostiuc S, Negoi RI, Beuran M. Laparoscopic vs open complete mesocolic excision with central vascular ligation for colon cancer: A systematic review and meta-analysis. World J Gastrointest Oncol 2017; 9:475-491. [PMID: 29290918 PMCID: PMC5740088 DOI: 10.4251/wjgo.v9.i12.475] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2017] [Revised: 07/08/2017] [Accepted: 09/07/2017] [Indexed: 02/05/2023] Open
Abstract
AIM To compare the effectiveness of laparoscopic complete mesocolic excision (CME) with central vascular ligation (L-CME) with its open (O-CME) counterpart.
METHODS We conducted an electronic search of the PubMed/MEDLINE, Excerpta Medica Database, Web of Science Core Collection, Cochrane Center Register of Controlled Trails, Cochrane Database of Systematic Reviews, SciELO, and Korean Journal databases from their inception until May 2017. We considered randomized controlled trials (RCTs) and controlled clinical trials (CCTs) that included patients with colonic cancer comparing L-CME and O-CME. Primary outcomes included the quality of the resected specimen (lymph nodes retrieved, complete mesocolic plane excision, tumor to arterial high tie, resected mesocolon surface). Secondary outcomes included the three-year and five-year overall and disease-free survival rates, recurrence of the disease, surgical data, and postoperative morbidity and mortality. Two authors of the review screened the methodological quality of the eligible trials and independently extracted data from individual studies.
RESULTS A total of one RCT and eleven CCTs (four from Europe and seven from Asia) met the inclusion criteria for the current meta-analysis. These studies involved 1619 patients in L-CME and 1477 patients in O-CME. The L-CME was associated with the same quality of the resected specimen, with no differences regarding the retrieved lymphnodes (MD = -1.06, 95%CI: -3.65 to 1.53, P = 0.42), and tumor to high tie distance (MD = 14.26 cm, 95%CI: -4.30 to 32.82, P = 0.13); the surface of the resected mesocolon was higher in the L-CME group (MD = 11.75 cm2, 95%CI: 9.50 to 13.99, P < 0.001). The L-CME was associated with a lower rate of blood transfusions (OR = 0.45, 95%CI: 0.27 to 0.75, P = 0.002), faster recovery of gastrointestinal function, and less postoperative overall complication rate. The L-CME approach was associated with a statistical significant better three-year overall (OR = 2.02, 95%CI: 1.31 to 3.12, P = 0.001, I2 = 28%) and disease-free (OR = 1.45, 95% CI: 1.00 to 2.10, P = 0.05, I2 = 0%) survival.
CONCLUSION The laparoscopic approach offers the same quality of the resected specimen as the open approach in complete mesocolic excision with central vascular ligation for colon cancer. The laparoscopic complete mesocolic excision with central vascular ligation is superior in all perioperative results and at least non-inferior in long-term oncological outcomes.
Collapse
Affiliation(s)
- Ionut Negoi
- Department of General Surgery, Emergency Hospital of Bucharest, Carol Davila University of Medicine and Pharmacy Bucharest, Bucharest 014461, Romania
| | - Sorin Hostiuc
- National Institute of Legal Medicine Mina Minovici, Carol Davila University of Medicine and Pharmacy Bucharest, Bucharest 014461, Romania
| | - Ruxandra Irina Negoi
- Department of Anatomy, Carol Davila University of Medicine and Pharmacy Bucharest, Bucharest 014461, Romania
| | - Mircea Beuran
- Emergency Hospital of Bucharest, Carol Davila University of Medicine and Pharmacy Bucharest, Bucharest 014461, Romania
| |
Collapse
|
38
|
Garas G, Markar SR, Malietzis G, Ashrafian H, Hanna GB, Zacharakis E, Jiao LR, Argiris A, Darzi A, Athanasiou T. Induced Bias Due to Crossover Within Randomized Controlled Trials in Surgical Oncology: A Meta-regression Analysis of Minimally Invasive versus Open Surgery for the Treatment of Gastrointestinal Cancer. Ann Surg Oncol 2017; 25:221-230. [PMID: 29110271 PMCID: PMC5740197 DOI: 10.1245/s10434-017-6210-y] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2017] [Indexed: 12/14/2022]
Abstract
BACKGROUND Randomized controlled trials (RCTs) inform clinical practice and have provided the evidence base for introducing minimally invasive surgery (MIS) in surgical oncology. Crossover (unplanned intraoperative conversion of MIS to open surgery) may affect clinical outcomes and the effect size generated from RCTs with homogenization of randomized groups. OBJECTIVES Our aims were to identify modifiable factors associated with crossover and assess the impact of crossover on clinical endpoints. METHODS A systematic review was performed to identify all RCTs comparing MIS with open surgery for gastrointestinal cancer (1990-2017). Meta-regression analysis was performed to analyze factors associated with crossover and the influence of crossover on endpoints, including 30-day mortality, anastomotic leak rate, and early complications. RESULTS Forty RCTs were included, reporting on 11,625 patients from 320 centers. Crossover was shown to affect one in eight patients (mean 12.6%, range 0-45%) and increased with American Society of Anesthesiologists score (β = + 0.895; p = 0.050). Pretrial surgeon volume (β = - 2.344; p = 0.037), composite RCT quality score (β = - 7.594; p = 0.014), and site of tumor (β = - 12.031; p = 0.021, favoring lower over upper gastrointestinal tumors) showed an inverse relationship with crossover. Importantly, multivariate weighted linear regression revealed a statistically significant positive correlation between crossover and 30-day mortality (β = + 0.125; p = 0.033), anastomotic leak rate (β = + 0.550; p = 0.004), and early complications (β = + 1.255; p = 0.001), based on intention-to-treat analysis. CONCLUSIONS Crossover in trials was associated with an increase in 30-day mortality, anastomotic leak rate, and early complications within the MIS group based on intention-to-treat analysis, although our analysis did not assess causation. Credentialing surgeons by procedural volume and excluding high comorbidity patients from initial trials are important in minimizing crossover and optimizing RCT validity.
Collapse
Affiliation(s)
- George Garas
- Surgical Epidemiology Unit, Department of Surgery and Cancer, Imperial College London, St. Mary's Hospital, London, UK. .,Department of Surgical Research and Innovation, The Royal College of Surgeons of England, London, UK.
| | - Sheraz R Markar
- Surgical Epidemiology Unit, Department of Surgery and Cancer, Imperial College London, St. Mary's Hospital, London, UK
| | - George Malietzis
- Surgical Epidemiology Unit, Department of Surgery and Cancer, Imperial College London, St. Mary's Hospital, London, UK
| | - Hutan Ashrafian
- Surgical Epidemiology Unit, Department of Surgery and Cancer, Imperial College London, St. Mary's Hospital, London, UK
| | - George B Hanna
- Surgical Epidemiology Unit, Department of Surgery and Cancer, Imperial College London, St. Mary's Hospital, London, UK
| | - Emmanouil Zacharakis
- Department of Surgery and Cancer, Imperial College London, Hammersmith Hospital, London, UK
| | - Long R Jiao
- Department of Surgery and Cancer, Imperial College London, Hammersmith Hospital, London, UK
| | - Athanassios Argiris
- Department of Medical Oncology, Thomas Jefferson University, Philadelphia, PA, USA
| | - Ara Darzi
- Surgical Epidemiology Unit, Department of Surgery and Cancer, Imperial College London, St. Mary's Hospital, London, UK.,Department of Surgical Research and Innovation, The Royal College of Surgeons of England, London, UK
| | - Thanos Athanasiou
- Surgical Epidemiology Unit, Department of Surgery and Cancer, Imperial College London, St. Mary's Hospital, London, UK.,Department of Surgical Research and Innovation, The Royal College of Surgeons of England, London, UK.,Health Technology Assessment Committee, National Institute of Health and Care Excellence, London, UK
| |
Collapse
|
39
|
Denet C, Fuks D, Cocco F, Chopinet S, Abbas M, Costea C, Levard H, Perniceni T, Gayet B. Effects of age after laparoscopic right colectomy for cancer: Are there any specific outcomes? Dig Liver Dis 2017; 49:562-567. [PMID: 28065524 DOI: 10.1016/j.dld.2016.12.014] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2016] [Revised: 12/07/2016] [Accepted: 12/09/2016] [Indexed: 12/11/2022]
Abstract
BACKGROUND Laparoscopic approach in colorectal surgery has demonstrated to give advantages in terms of postoperative outcomes, particularly in high-risk patients. The aim was to assess the impact of patients' age on the short-term outcomes after laparoscopic right colectomy for cancer. METHODS From January 2004 to September 2014, all patients who underwent laparoscopic right colectomy for cancer in a single institution were divided into four groups (A: <64 years; B: 65-74 years; C: 75-84 years; D ≥85 years). Risk factors for postoperative complications were determined on multivariable analysis. RESULTS Laparoscopic right colectomy was performed in 507 patients, including 171 (33.7%) in A, 168 (33.1%) in B, 131 (25.8) in C and 37 (7.4%) in D. Patients in Group C and Group D had higher ASA score (p<0.0001) and presented more frequently with anaemia (20.6% and 29.7%, p=0.001). Stages III and IV were more frequently encountered in groups C and D. Overall morbidity was 27.5% without any difference in the four groups (24.5%, 29.1%, 7.5% and 18.4% respectively, p=0.58). The rate of minor complications (such as wound infection or postoperative ileus) was higher in Group D compared to other groups (p=0.05). The only independent variable correlated with postoperative morbidity was intraoperative blood transfusion (OR 2.82; CI 95% 1.05-4.59, p<0.0001). CONCLUSIONS The present series suggests that patient's age did not significantly jeopardize the postoperative outcomes after laparoscopic right colectomy for cancer.
Collapse
Affiliation(s)
- Christine Denet
- Department of Digestive Disease, Institute Mutualiste Montsouris, Paris Descartes University, Paris, France
| | - David Fuks
- Department of Digestive Disease, Institute Mutualiste Montsouris, Paris Descartes University, Paris, France.
| | - Francesca Cocco
- Department of Digestive Disease, Institute Mutualiste Montsouris, Paris Descartes University, Paris, France
| | - Sophie Chopinet
- Department of Digestive Disease, Institute Mutualiste Montsouris, Paris Descartes University, Paris, France
| | - Marcel Abbas
- Department of Digestive Disease, Institute Mutualiste Montsouris, Paris Descartes University, Paris, France
| | - Cyprian Costea
- Department of Digestive Disease, Institute Mutualiste Montsouris, Paris Descartes University, Paris, France
| | - Hugues Levard
- Department of Digestive Disease, Institute Mutualiste Montsouris, Paris Descartes University, Paris, France
| | - Thierry Perniceni
- Department of Digestive Disease, Institute Mutualiste Montsouris, Paris Descartes University, Paris, France
| | - Brice Gayet
- Department of Digestive Disease, Institute Mutualiste Montsouris, Paris Descartes University, Paris, France
| |
Collapse
|
40
|
Bayar R, Mzoughi Z, Djebbi A, Halek G, Khalfallah MT. [Laparoscopic colectomy versus colectomy performed via laparotomy in the treatment of non-metastatic colic adenocarcinomas]. Pan Afr Med J 2016; 25:165. [PMID: 28292127 PMCID: PMC5326039 DOI: 10.11604/pamj.2016.25.165.10071] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2016] [Accepted: 09/26/2016] [Indexed: 02/07/2023] Open
Abstract
INTRODUCTION Laparoscopic colectomy is considered with increasing frequency the gold standard treatment for colorectal cancer. Our study aims to show that short-term results and the oncological safety of laparoscopy are at least equivalent to those of laparotomy in the treatment of non-metastatic colic adenocarcinomas. We also highlight the impact of the learning curve on outcomes after laparoscopy in patients with these cancers. METHODS We conducted a retrospective study of all patients undergoing surgery for resectable colic adenocarcinomas over a period of 6 years. The study population was divided into 2 groups based on the surgical procedure used initially. The group "OC" included 35 patients who underwent midline laparotomy and the group "LAC" included 30 patients who underwent laparoscopy. All data were analyzed using SPSS software version 19.0. RESULTS Our study showed that there was no significant difference in short-term outcomes between the 2 groups, namely intraoperative morbidity, hospital stay, intensive care unit stay as well as postoperative morbidity and mortality. Regarding the long-term outcomes, there was also no significant difference in the incidence of late complications, type of recurrence, overall survival and disease-free survival. Oncological safety based on the limits of resection and the number of lymph nodes removed was not significantly different between the two groups. Operative time was significantly longer in the laparoscopic group (p <0.001). Convertion rate was 33%. It went from 67% in the first 2 years of the study to 13% in the last 2 years. The conversion from laparoscopy to laparotomy had no significant impact neither on early postoperative outcomes nor on overall survival and disease-free survival. CONCLUSION Laparoscopy is a surgical procedure resulting in at least equivalent short and long term outcomes as laparotomy. The learning curve representing a "prerequisite" has no negative impact on the outcomes of laparoscopic treatment of non-metastatic colic cancers.
Collapse
Affiliation(s)
- Rached Bayar
- Université de Tunis El Manar, Faculté de Medecine de Tunis, 1007, Tunis, Tunisie; Service de Chirurgie Viscérale CHU Mongi Slim, Sidi Daoued La Marsa, Tunisie
| | - Zeineb Mzoughi
- Université de Tunis El Manar, Faculté de Medecine de Tunis, 1007, Tunis, Tunisie; Service de Chirurgie Viscérale CHU Mongi Slim, Sidi Daoued La Marsa, Tunisie
| | - Achref Djebbi
- Université de Tunis El Manar, Faculté de Medecine de Tunis, 1007, Tunis, Tunisie; Service de Chirurgie Viscérale CHU Mongi Slim, Sidi Daoued La Marsa, Tunisie
| | - Ghassen Halek
- Université de Tunis El Manar, Faculté de Medecine de Tunis, 1007, Tunis, Tunisie; Service de Chirurgie Viscérale CHU Mongi Slim, Sidi Daoued La Marsa, Tunisie
| | - Mohamed Taher Khalfallah
- Université de Tunis El Manar, Faculté de Medecine de Tunis, 1007, Tunis, Tunisie; Service de Chirurgie Viscérale CHU Mongi Slim, Sidi Daoued La Marsa, Tunisie
| |
Collapse
|
41
|
Currie AC, Malietzis G, Jenkins JT, Yamada T, Ashrafian H, Athanasiou T, Okabayashi K, Kennedy RH. Network meta-analysis of protocol-driven care and laparoscopic surgery for colorectal cancer. Br J Surg 2016; 103:1783-1794. [PMID: 27762436 DOI: 10.1002/bjs.10306] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2015] [Revised: 06/28/2016] [Accepted: 07/25/2016] [Indexed: 12/22/2022]
Abstract
BACKGROUND Laparoscopic approaches and standardized recovery protocols have reduced morbidity following colorectal cancer surgery. As the optimal regimen remains inconclusive, a network meta-analysis was undertaken of treatments for the development of postoperative complications and mortality. METHODS MEDLINE, Embase, trial registries and related reviews were searched for randomized trials comparing laparoscopic and open surgery within protocol-driven or conventional perioperative care for colorectal cancer resection, with complications as a defined endpoint. Relative odds ratios (ORs) for postoperative complications and mortality were estimated for aggregated data. RESULTS Forty trials reporting on 11 516 randomized patients were included with the network. Open surgery within conventional perioperative care was the index for comparison. The OR relating to complications was 0·77 (95 per cent c.i. 0·65 to 0·91) for laparoscopic surgery within conventional care, 0·69 (0·48 to 0·99) for open surgery within protocol-driven care, and 0·43 (0·28 to 0·67) for laparoscopic surgery within protocol-driven care. Sensitivity analyses excluding trials of low rectal cancer and those with a high risk of bias did not affect the treatment estimates. Meta-analyses demonstrated that mortality risk was unaffected by perioperative strategy. CONCLUSION Laparoscopic surgery combined with protocol-driven care reduces colorectal cancer surgery complications, but not mortality. The reduction in complications with protocol-driven care is greater for open surgery than for laparoscopic approaches. Registration number: CRD42015017850 (https://www.crd.york.ac.uk/PROSPERO).
Collapse
Affiliation(s)
- A C Currie
- Department of Surgery, St Mark's Hospital and Academic Institute, Harrow, UK
| | - G Malietzis
- Department of Surgery, St Mark's Hospital and Academic Institute, Harrow, UK
| | - J T Jenkins
- Department of Surgery, St Mark's Hospital and Academic Institute, Harrow, UK
| | - T Yamada
- Department of Surgery, School of Medicine, Keio University, Shinjuku, Tokyo, Japan
| | - H Ashrafian
- Department of Surgery and Cancer, Imperial College London, London, UK
| | - T Athanasiou
- Department of Surgery and Cancer, Imperial College London, London, UK
| | - K Okabayashi
- Department of Surgery, School of Medicine, Keio University, Shinjuku, Tokyo, Japan
| | - R H Kennedy
- Department of Surgery, St Mark's Hospital and Academic Institute, Harrow, UK
| |
Collapse
|
42
|
Abstract
Minimally invasive surgery is slowly taking over as the preferred operative approach for colorectal diseases. However, many of the procedures remain technically difficult. This article will give an overview of the state of minimally invasive surgery and the many advances that have been made over the last two decades. Specifically, we discuss the introduction of the robotic platform and some of its benefits and limitations. We also describe some newer techniques related to robotics.
Collapse
Affiliation(s)
- Matthew Whealon
- Department of Surgery, University of California, Irvine, Orange, California
| | - Alessio Vinci
- Department of Surgery, University of California, Irvine, Orange, California
| | - Alessio Pigazzi
- Department of Surgery, University of California, Irvine, Orange, California
| |
Collapse
|
43
|
Comparative benefits of laparoscopic surgery for colorectal cancer in octogenarians: a case-matched comparison of short- and long-term outcomes with middle-aged patients. Surg Today 2016; 47:587-594. [DOI: 10.1007/s00595-016-1410-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2016] [Accepted: 08/02/2016] [Indexed: 12/13/2022]
|
44
|
Church J, Erkan A. Scope or scalpel? A matched study of the treatment of large colorectal polyps. ANZ J Surg 2016; 88:177-181. [PMID: 27491016 DOI: 10.1111/ans.13675] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2016] [Revised: 06/02/2016] [Accepted: 06/08/2016] [Indexed: 01/26/2023]
Abstract
BACKGROUND Large colorectal polyps can be treated either endoscopically or by formal resection. The aim of this study was to clarify the relative advantages and disadvantages of surgical resection and colonoscopic snaring as means of treating large colorectal polyps. METHODS This is a matched cohort study, comparing cases of surgical resection of benign colorectal polyps with endoscopic resection. Cases drawn from pathology and endoscopy databases were matched for the size and site of polyps, and the groups were compared for the end points of complications, length of hospital stay and completeness of the removal of the polyp. RESULTS There were 78 patients in each group, with mean ages of 65.6 years (colonoscopy) and 66.8 years (surgery). A total of 39 of the surgery group and 47 of the colonoscopy group were men. Mean polyp size was 34.1 mm (colonoscopy) and 32.1 mm (surgery). There was an exact match for polyp location. Complications occurred in eight colonoscopy patients (10.3%) and 42 surgery patients (56.0%) (P < 0.001, chi-square). Length of hospital stay was 0 days for colonoscopy patients and 7.3 ± 4.7 days for surgery (P < 0.001). The surgery group was separated into laparoscopic (n = 35) and open (n = 43) surgery. There was no difference in complication rates (42.4 versus 53.5%, respectively) but laparoscopic had shorter length of stay (5.8 days ± 4.9 SD versus 8.4 days ± 4.3 SD). Recurrence of surgically resected polyps was zero; at last follow-up 13% of snared polyps persisted. CONCLUSION Although resection is a more certain and absolute way of treating benign polyps, endoscopic polypectomy is preferable.
Collapse
Affiliation(s)
- James Church
- Department of Colorectal Surgery, Digestive Diseases Institute, Cleveland Clinic Foundation, Cleveland, Ohio, USA
| | - Arman Erkan
- Department of Colorectal Surgery, Digestive Diseases Institute, Cleveland Clinic Foundation, Cleveland, Ohio, USA
| |
Collapse
|
45
|
Laparoscopic caudal-to-cranial approach for radical lymph node dissection in right hemicolectomy. Langenbecks Arch Surg 2016; 401:741-6. [PMID: 27318491 DOI: 10.1007/s00423-016-1465-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2015] [Accepted: 06/14/2016] [Indexed: 01/04/2023]
Abstract
PURPOSE The present study evaluated the safety and feasibility of this caudal-to-cranial laparoscopic dissection approach for the curative resection of right-sided colon cancer. To the best of our knowledge, no study has reported the caudal-to-cranial approach in the laparoscopic right colectomy with curative intent for colon cancer. METHOD The key procedure of the caudal-to-cranial approach is the commencement of the dissection at the mesentery root, thus entering into the Toldt's space before the mesenteric vessels are accessed. We retrospectively analyzed the data obtained from a prospectively established database on 80 consecutive patients who had undergone laparoscopic right hemicolectomy with caudally approached radical lymph node dissection for curable right-sided colon cancer between June 2014 and June 2015. RESULTS There were 38 male and 42 female patients, with a mean age of 72.5 years (range, 53-83) and a mean BMI of 22.1 kg/m(2) (16.5-35.2). All procedures were successful without any serious intraoperative complications or any conversion to open surgery. The mean operation time was 178.3 min (range, 150-215), and the mean blood loss was 81.6 ml (range, 50-200). The mean number of harvested lymph nodes was 19 (range, 12-25). CONCLUSIONS The findings indicate that laparoscopic caudal-to-cranial approach for radical lymph node dissection is a feasible and safe procedure for the treatment of curable right-sided colon cancer.
Collapse
|
46
|
Nationwide implementation of laparoscopic surgery for colon cancer: short-term outcomes and long-term survival in a population-based cohort. Surg Endosc 2016; 30:4853-4864. [DOI: 10.1007/s00464-016-4819-8] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2015] [Accepted: 02/04/2016] [Indexed: 02/07/2023]
|
47
|
Yamada T, Okabayashi K, Hasegawa H, Tsuruta M, Yoo JH, Seishima R, Kitagawa Y. Meta-analysis of the risk of small bowel obstruction following open or laparoscopic colorectal surgery. Br J Surg 2016; 103:493-503. [DOI: 10.1002/bjs.10105] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2015] [Revised: 12/13/2015] [Accepted: 12/14/2015] [Indexed: 12/17/2022]
Abstract
Abstract
Background
One of the potential advantages of laparoscopic compared with open colorectal surgery is a reduction in postoperative bowel obstruction events. Early reports support this proposal, but accumulated evidence is lacking.
Methods
A systematic review and meta-analysis was performed of randomized clinical trials and observational studies by searching the PubMed and Cochrane Library databases from 1990 to August 2015. The primary outcomes were early and late postoperative bowel obstruction following laparoscopic and open colorectal surgery. Both ileus and bowel obstruction were defined as a postoperative bowel obstruction. Subgroup and sensitivity analyses were performed, and a random-effects model was used to account for the heterogeneity among the studies.
Results
Twenty-four randomized clinical trials and 88 observational studies were included in the meta-analysis; 106 studies reported early outcome and 12 late outcome. Collectively, these studies reported on the outcomes of 148 392 patients, of whom 58 133 had laparoscopic surgery and 90 259 open surgery. Compared with open surgery, laparoscopic surgery was associated with reduced rates of early (odds ratio 0·62, 95 per cent c.i. 0·54 to 0·72; P < 0·001) and late (odds ratio 0·61, 0·41 to 0·92; P = 0·019) postoperative bowel obstruction. Weighted mean values for early postoperative bowel obstruction were 8 (95 per cent c.i. 6 to 10) and 5 (3 to 7) per cent for open and laparoscopic surgery respectively, and for late bowel obstruction were 4 (2 to 6) and 3 (1 to 5) per cent respectively.
Conclusion
The reduction in postoperative bowel obstruction demonstrates an advantage of laparoscopic surgery in patients with colorectal disease.
Collapse
Affiliation(s)
- T Yamada
- Department of Surgery, Keio University School of Medicine, Tokyo, Japan
| | - K Okabayashi
- Department of Surgery, Keio University School of Medicine, Tokyo, Japan
| | - H Hasegawa
- Department of Surgery, Keio University School of Medicine, Tokyo, Japan
| | - M Tsuruta
- Department of Surgery, Keio University School of Medicine, Tokyo, Japan
| | - J-H Yoo
- Department of Surgery, National Hospital Organization Saitama National Hospital, 2–1 Suwa Wako, Saitama, Japan
| | - R Seishima
- Department of Surgery, Keio University School of Medicine, Tokyo, Japan
| | - Y Kitagawa
- Department of Surgery, Keio University School of Medicine, Tokyo, Japan
| |
Collapse
|
48
|
Laparoscopic right hemicolectomy: short- and long-term outcomes of intracorporeal versus extracorporeal anastomosis. Surg Endosc 2015; 30:3933-42. [PMID: 26715015 DOI: 10.1007/s00464-015-4704-x] [Citation(s) in RCA: 60] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2015] [Accepted: 11/20/2015] [Indexed: 12/13/2022]
Abstract
BACKGROUND The use of laparoscopy for right hemicolectomy has gained popularity allowing the option of a totally laparoscopic intracorporeal anastomosis (IA) for intestinal reconstruction. This technique may alleviate some of the technical limitations that a surgeon faces with a laparoscopic-assisted extracorporeal anastomosis (EA). METHODS A retrospective chart review of 195 consecutive patients who underwent laparoscopic right hemicolectomy by four colorectal surgeons at three institutions from March 2005 to June 2014 was performed. Multivariate regression analysis was used to compare postoperative and oncologic outcomes. RESULTS A total of 195 patients underwent laparoscopic right hemicolectomy over the study period, with 86 (44 %) patients receiving IA and 109 (56 %) patients receiving an EA. The most common indication for surgery in both groups was cancer: 56 (65 %) of IA cases and 57 (52 %) of EA cases. IA had a significantly higher rate of minor complications but no difference in serious complications compared to EA. Conversion to open resection was higher in EA. Using multivariate analysis to compare IA versus EA, there was no significant difference in length of stay, return of bowel function, risk of anastomotic leak, risk of intraabdominal abscess or risk of wound complications. Amongst cancer resections, there was no significant difference in the median number of lymph nodes harvested (18 LNs in IA group vs. 19 LNs in EA group, P > 0.05). There was also no significant difference in overall survival and disease-free survival at 5.7 years between the two groups. CONCLUSIONS IA in laparoscopic right hemicolectomy is associated with similar postoperative and oncologic outcomes compared to EA. IA may possess advantages in terms of conversion and flexibility of specimen extraction, but this is counterbalanced by a higher incidence of minor complications. These findings suggest that IA represents a valid technique in the arsenal of the experienced colorectal surgeon without compromising outcomes.
Collapse
|
49
|
Abstract
The adoption of laparoscopic colorectal surgery has been a slow but steady progress. The first adopters rapidly expanded the application of the technology to all colorectal pathology. Issues related to extraction and port site recurrence of cancer delayed widespread adoption until incontrovertible data from well-powered prospective randomized studies confirmed equipoise with open surgery. Since that time, the data has consistently demonstrated patient-care benefits related to reductions in both short- and long-term complications historically associated with open colectomy. The potential for further improvement related to single-port access, robotic assistance, and natural orifice access for both the surgery and/or extraction will await the test of time. However, it is clear now that laparoscopic colorectal surgery is the new standard of care and a key enabler of enhanced recovery programs.
Collapse
Affiliation(s)
- Anthony J Senagore
- Department of Surgery, Case Western Reserve University, School of Medicine, Cleveland, Ohio
| |
Collapse
|
50
|
Li S, Jiang F, Tu J, Zheng X. Long-Term Oncologic Outcomes of Laparoscopic versus Open Surgery for Middle and Lower Rectal Cancer. PLoS One 2015; 10:e0135884. [PMID: 26335944 PMCID: PMC4559379 DOI: 10.1371/journal.pone.0135884] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2015] [Accepted: 07/27/2015] [Indexed: 02/07/2023] Open
Abstract
Background Laparoscopic surgery for middle and lower rectal cancer remain controversial because anatomical and complex surgical procedures specifically influence oncologic outcomes. This study analyzes the long-term outcomes of laparoscopic versus open surgery for middle and lower rectal cancer. Methods Patients (laparoscopic: n = 129, open: n = 152) who underwent curative resection for middle and lower rectal cancer from 2003 to 2008 participated in the study. The same surgical team performed all operations. The mean follow up time of all patients was 74.3 months. Results No statistical difference in local recurrence rate (7.8% vs. 7.2%; log-rank = 0.024; P = 0.876) and distant recurrence rate (20.9% vs.16.4%; log-rank = 0.699; P = 0.403) between laparoscopic and open groups were observed within 5 years. The 5-year overall survival rates of the laparoscopic and open groups were 72.9% and 75.7%, respectively; no significant statistical difference was observed between them (log-rank = 0.163; P = 0.686). The 5-year survival rates between groups were not different between stages: Stage I (92.6% vs. 86.7%; log-rank = 0.533; P = 0.465); stage II (75.8% vs. 80.5%; log-rank = 0.212; P = 0.645); and Stage III (63.8% vs. 69.1%, log-rank = 0272;P = 0.602). However, significant statistical difference amongst different stages were observed (log-rank = 1.802; P = 0.003). Conclusion Laparoscopic and open surgery for middle and lower rectal cancer offer equivalent long-term oncologic outcomes. Laparoscopic surgery is feasible in these patients.
Collapse
Affiliation(s)
- Shaotang Li
- Department of General Surgery, the First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejian, People’s Republic of China
| | - Feizhao Jiang
- Department of General Surgery, the First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejian, People’s Republic of China
| | - Jingfu Tu
- Department of General Surgery, the First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejian, People’s Republic of China
| | - Xiaofeng Zheng
- Department of General Surgery, the First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejian, People’s Republic of China
- * E-mail:
| |
Collapse
|