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Cui M, Liu S. Meta-analysis of the effect of laparoscopic surgery and open surgery on long-term quality of life in patients with colorectal cancer. Medicine (Baltimore) 2023; 102:e34922. [PMID: 37682135 PMCID: PMC10489332 DOI: 10.1097/md.0000000000034922] [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: 04/19/2023] [Accepted: 08/03/2023] [Indexed: 09/09/2023] Open
Abstract
OBJECTIVE To compare the effect of laparoscopic surgery and open surgery on the quality of life of patients with colorectal cancer (CRC) in the growth period after the operation, and to provide a reference for surgical treatment decisions of patients with CRC. METHODS PubMed/MEDLINE, EMBASE, Web of Science, and Cochrane databases were searched through May 7, 2022 for clinical studies comparing the postoperative quality of life in CRC patients who underwent laparoscopic surgery with those who underwent open surgery. Data were extracted from eligible studies following rigorous quality review. All studies included patient numbers, surgery type, follow-up length, and quality of life scores. RESULTS A total of 6 studies were included, resulting in significantly better physical functioning scores with laparoscopic versus open surgery. (Standardized mean difference = 0.45; 95% CI (0.15, 0.75), P = .003). However, in general health, social functioning, bodily pain, vitality, quality of life index, Global Quality Scale, physical component summary and mental component summary, there was no telling difference between the 2 surgical therapies. CONCLUSION Compared with open surgery, laparoscopic surgery has weak advantages. There was no noteworthy difference in the long-term quality of life between the 2 surgical treatments for CRC patients. Whether laparoscopic surgery can bring more improvement to the quality of life of patients with CRC needs more high-quality clinical randomized studies to verify.
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Affiliation(s)
- Mengfan Cui
- Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Shimin Liu
- Shanghai University of Traditional Chinese Medicine, Shanghai, China
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Hoshino N, Hida K, Fujita Y, Ohira M, Ozawa H, Bando H, Akagi T, Kono Y, Nakajima K, Kojima Y, Nakamura T, Inomata M, Yamamoto S, Sakai Y, Naitoh T, Watanabe M, Obama K. Impact of laparoscopic surgery on short-term and long-term outcomes in elderly obese patients with colon cancer. Ann Gastroenterol Surg 2023; 7:757-764. [PMID: 37663960 PMCID: PMC10472405 DOI: 10.1002/ags3.12678] [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: 12/01/2022] [Revised: 02/15/2023] [Accepted: 04/03/2023] [Indexed: 09/05/2023] Open
Abstract
Background Laparoscopic surgery is reported to be useful in obese or elderly patients with colon cancer, who are at increased risk of postoperative complications because of comorbidities and physical decline. However, its usefulness is less clear in patients who are both elderly and obese and may be at high risk of complications. Methods Data for obese patients (body mass index ≥25) who underwent laparoscopic or open surgery for stage II or III colon cancer between January 2009 and December 2013 were collected by the Japan Society of Laparoscopic Colorectal Surgery. Surgical outcomes, postoperative complications, and relapse-free survival (RFS) were compared between patients who underwent open surgery and those who underwent laparoscopic surgery according to whether they were elderly (≥70 y) or nonelderly (<70 y). Results Data of 1549 patients (elderly, n = 598; nonelderly, n = 951) satisfied the selection criteria for analysis. Length of stay was shorter and surgical wound infection was less common in elderly obese patients who underwent laparoscopic surgery than in those underwent open surgery. There were no significant between-group differences in overall complications, anastomotic leakage, ileus/small bowel obstruction, or RFS. There were also no significant differences in RFS after laparoscopic surgery according to patient age. Conclusion Laparoscopic surgery is safe in elderly obese patients with colon cancer and does not worsen their prognosis. There was no significant difference in the effectiveness of laparoscopic surgery between obese patients who were elderly and those who were nonelderly.
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Affiliation(s)
- Nobuaki Hoshino
- Department of SurgeryKyoto University Graduate School of MedicineKyotoJapan
| | - Koya Hida
- Department of SurgeryKyoto University Graduate School of MedicineKyotoJapan
| | - Yusuke Fujita
- Department of SurgeryKyoto University Graduate School of MedicineKyotoJapan
| | | | - Heita Ozawa
- Department of Colorectal SurgeryTochigi Cancer CenterUtsunomiyaJapan
| | - Hiroyuki Bando
- Department of Gastroenterological SurgeryIshikawa Prefectural Central HospitalKanazawaJapan
| | - Tomonori Akagi
- Department of Gastroenterological and Pediatric SurgeryOita University Faculty of MedicineYufuJapan
| | - Yohei Kono
- Department of Gastroenterological and Pediatric SurgeryOita University Faculty of MedicineYufuJapan
| | | | - Yutaka Kojima
- Department of Coloproctological SurgeryJuntendo University Faculty of MedicineBunkyo‐kuJapan
| | - Takatoshi Nakamura
- Department of Surgical OncologyDokkyo Medical University Graduate School of MedicineShimotsuga‐gunJapan
| | - Masafumi Inomata
- Department of Gastroenterological and Pediatric SurgeryOita University Faculty of MedicineYufuJapan
| | - Seiichiro Yamamoto
- Department of Gastroenterological SurgeryTokai University School of MedicineShibuya CityJapan
| | | | - Takeshi Naitoh
- Department of Lower Gastrointestinal SurgeryKitasato University School of MedicineSagamiharaJapan
| | | | - Kazutaka Obama
- Department of SurgeryKyoto University Graduate School of MedicineKyotoJapan
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Yamashita M, Tominaga T, Nonaka T, Fukda A, Moriyama M, Oyama S, Tanaka K, Hamada K, Araki M, Sumida Y, Takeshita H, Hisanaga M, Fukuoka H, Wada H, Tou K, Sawai T, Nagayasu T. Impact of obesity on short-term outcomes of laparoscopic colorectal surgery for Japanese patients with colorectal cancer: A multicenter study. Asian J Endosc Surg 2021; 14:432-442. [PMID: 33111467 DOI: 10.1111/ases.12888] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2020] [Revised: 10/05/2020] [Accepted: 10/14/2020] [Indexed: 12/12/2022]
Abstract
INTRODUCTION The impact of obesity on short-term outcomes after laparoscopic colorectal surgery (LAC) in Asian patients is unclear. The purpose of the present multicenter study was to evaluate the safety and feasibility of LAC in obese Japanese patients. METHODS We retrospectively reviewed 1705 patients who underwent LAC between April 2016 and February 2019. Patients were classified according to body mass index (BMI): non-obese (BMI < 25 kg/m2 , n = 1335), obese I (BMI 25-29.9 kg/m2 , n = 313), and obese II (BMI ≥30 kg/m2 , n = 57). Clinical characteristics and surgical outcomes were compared among the three groups. RESULTS The proportion of patients with comorbidities (non-obese, 58.1%; obese I, 69.6%; obese II, 75.4%; P < .001) and median operation time (non-obese, 224 minutes; obese I, 235 minutes; obese II, 258 minutes; P = .004) increased significantly as BMI increased. The conversion rate was similar among the groups (P = .715). Infectious complications were significantly high in obese II patients (non-obese, 10.4%; obese I, 8.3%; obese II, 28.1%; P < .001). Multivariate analysis revealed that in obese II patients, BMI was an independent predictive factor of infectious postoperative complications (odds ratio 2.648; 95% confidence interval, 1.421-4.934; P = .002). CONCLUSION LAC has an increased risk of postoperative infectious complications in obese II patients, despite improvements in surgical technique. Management of obese II colorectal cancer patients requires meticulous perioperative management.
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Affiliation(s)
- Mariko Yamashita
- Department of Surgical Oncology, Nagasaki University Graduate School of Biomedical Science, Nagasaki, Japan.,Department of Surgery, Saiseikai Nagasaki Hospital, Nagasaki, Japan
| | - Tetsuro Tominaga
- Department of Surgical Oncology, Nagasaki University Graduate School of Biomedical Science, Nagasaki, Japan
| | - Takashi Nonaka
- Department of Surgical Oncology, Nagasaki University Graduate School of Biomedical Science, Nagasaki, Japan
| | - Akiko Fukda
- Department of Surgical Oncology, Nagasaki University Graduate School of Biomedical Science, Nagasaki, Japan
| | - Masaaki Moriyama
- Department of Surgical Oncology, Nagasaki University Graduate School of Biomedical Science, Nagasaki, Japan
| | - Syosaburo Oyama
- Department of Surgical Oncology, Nagasaki University Graduate School of Biomedical Science, Nagasaki, Japan
| | - Kenji Tanaka
- Department of Surgery, Saiseikai Nagasaki Hospital, Nagasaki, Japan
| | - Kiyoaki Hamada
- Department of Surgery, Sasebo City General Hospital, Nagasaki, Japan
| | - Masato Araki
- Department of Surgery, Sasebo City General Hospital, Nagasaki, Japan
| | - Yorihisa Sumida
- Department of Surgery, Sasebo City General Hospital, Nagasaki, Japan
| | - Hiroaki Takeshita
- Department of Surgery, National Hospital Organization Nagasaki Medical Center, Nagasaki, Japan
| | - Makoto Hisanaga
- Department of Surgery, Isahaya General Hospital, Nagasaki, Japan
| | | | - Hideo Wada
- Department of Surgery, Ureshino Medical Center, Saga, Japan
| | - Kazuo Tou
- Department of Surgery, Ureshino Medical Center, Saga, Japan
| | - Terumitsu Sawai
- Department of Surgical Oncology, Nagasaki University Graduate School of Biomedical Science, Nagasaki, Japan
| | - Takeshi Nagayasu
- Department of Surgical Oncology, Nagasaki University Graduate School of Biomedical Science, Nagasaki, Japan
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Bizzoca C, Zupo R, Aquilino F, Castellana F, Fiore F, Sardone R, Vincenti L. Video-Laparoscopic versus Open Surgery in Obese Patients with Colorectal Cancer: A Propensity Score Matching Study. Cancers (Basel) 2021; 13:cancers13081844. [PMID: 33924366 PMCID: PMC8069288 DOI: 10.3390/cancers13081844] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2021] [Revised: 04/08/2021] [Accepted: 04/11/2021] [Indexed: 12/24/2022] Open
Abstract
Simple Summary Extended evidence on minimally invasive surgery in colorectal cancer (CRC) settings is needed, especially as applied to obese patients. We aimed to explore and compare postoperative outcomes between open and video-laparoscopic (VL) surgery in two groups of obese patients undergoing surgical resection for CRC. VL surgery was found to reduce postoperative recovery time and the severity of complications. This Italian experience provides a further contribution to the short-term prognostic quality of minimally invasive VL surgery in obese patients. Abstract Background: Minimally invasive surgery in obese patients is still challenging, so exploring one more item in this research field ranks among the main goals of this research. We aimed to compare short-term postoperative outcomes of open and video-laparoscopic (VL) approaches in CRC obese patients undergoing colorectal resection. Methods: We performed a retrospective analysis of a surgical database including 138 patients diagnosed with CRC, undergoing VL (n = 87, 63%) and open (n = 51, 37%) colorectal surgery. As a first step, propensity score matching was performed to balance the comparison between the two intervention groups (VL and open) in order to avoid selection bias. The matched sample (N = 98) was used to run further regression models in order to analyze the observed VL surgery advantages in terms of postoperative outcome, focusing on hospitalization and severity of postoperative complications, according to the Clavien–Dindo classification. Results: The study sample was predominantly male (N = 86, 62.3%), and VL was more frequent than open surgery (63% versus 37%). The two subgroup results obtained before and after the propensity score matching showed comparable findings for age, gender, BMI, and tumor staging. The specimen length and postoperative time before discharge were longer in open surgery (OS) patients; the number of harvested lymph nodes was higher than in VL patients as well (p < 0.01). Linear regression models applied separately on the outcomes of interest showed that VL-treated patients had a shorter hospital stay by almost two days and about one point less Clavien–Dindo severity than OS patients on average, given the same exposure to confounding variables. Tumor staging was not found to have a significant role in influencing the short-term outcomes investigated. Conclusion: Comparing open and VL surgery, improved postoperative outcomes were observed for VL surgery in obese patients after surgical resection for CRC. Both postoperative recovery time and Clavien–Dindo severity were better with VL surgery.
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Affiliation(s)
- Cinzia Bizzoca
- General Surgery Unit “Ospedaliera”, University Hospital “Policlinico” of Bari, 70124 Bari, Italy; (F.F.); (L.V.)
- Correspondence: or
| | - Roberta Zupo
- Unit of Research Methodology and Data Sciences for Population Health, National Institute of Gastroenterology “Saverio de Bellis”, Research Hospital, Castellana Grotte, 70013 Bari, Italy; (R.Z.); (F.C.); (R.S.)
| | - Fabrizio Aquilino
- General Surgery Unit, National Institute of Gastroenterology “Saverio de Bellis”, Research Hospital, Castellana Grotte, 70013 Bari, Italy;
| | - Fabio Castellana
- Unit of Research Methodology and Data Sciences for Population Health, National Institute of Gastroenterology “Saverio de Bellis”, Research Hospital, Castellana Grotte, 70013 Bari, Italy; (R.Z.); (F.C.); (R.S.)
| | - Felicia Fiore
- General Surgery Unit “Ospedaliera”, University Hospital “Policlinico” of Bari, 70124 Bari, Italy; (F.F.); (L.V.)
| | - Rodolfo Sardone
- Unit of Research Methodology and Data Sciences for Population Health, National Institute of Gastroenterology “Saverio de Bellis”, Research Hospital, Castellana Grotte, 70013 Bari, Italy; (R.Z.); (F.C.); (R.S.)
| | - Leonardo Vincenti
- General Surgery Unit “Ospedaliera”, University Hospital “Policlinico” of Bari, 70124 Bari, Italy; (F.F.); (L.V.)
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