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Cao G, Zhao Y, Zhang X, Man D, Wang F, Cai X. Comparing the long-term follow-up anal function between robot-assisted and laparoscopic surgery for low rectal cancer: A meta-analysis and systematic review. Int J Med Robot 2024; 20:e2659. [PMID: 38961654 DOI: 10.1002/rcs.2659] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2024] [Revised: 05/07/2024] [Accepted: 06/29/2024] [Indexed: 07/05/2024]
Abstract
BACKGROUND Robotic-assisted surgery (RAS) is increasingly used for treating low rectal cancer. Its comparative effectiveness against laparoscopic surgery (LAS) in enhancing long-term anal function remains uncertain. METHODS A meta-analysis was conducted to compare long-term anal function outcomes between patients undergoing RAS and LAS. Meta-regression and sensitivity analyses were performed to assess available evidence. Studies published up to September 2023 in English or Chinese were included. RESULTS Seven studies were identified. RAS patients exhibited lower low anterior resection syndrome (LARS) scores (standardised mean difference [SMD] = -1.39; 95% confidence interval [CI]: -2.64 to -0.15) and Wexner scores (SMD = -0.74; 95% CI: -1.20 to -0.27) compared with LAS patients. However, RAS did not significantly reduce major LARS risk (odds ratio = 0.85; 95% CI: 0.68-1.04). CONCLUSIONS RAS slightly improved postoperative anal function compared with LAS. Further studies with large samples are warranted to confirm or update our findings.
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Affiliation(s)
- Gaoyang Cao
- Department of Colorectal Surgery, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang, China
| | - Yaoyao Zhao
- Department of Gynecology and Pelvic Rehabilitation, Zhuji People's Hospital of Zhejiang Province, Zhuji, Zhejiang, China
| | - Xinjie Zhang
- Department of Colorectal Surgery, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang, China
| | - Da Man
- Department of Colorectal Surgery, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang, China
| | - Fei Wang
- Department of Colorectal Surgery, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang, China
| | - Xianlei Cai
- Department of Gastrointestinal Surgery, The Lihuili Affiliated Hospital, Ningbo University (Ningbo Medical Center Lihuili Hospital), Ningbo, Zhejiang, China
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2
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Flemming S. [Robotic rectal surgery]. CHIRURGIE (HEIDELBERG, GERMANY) 2024; 95:589-599. [PMID: 38695886 DOI: 10.1007/s00104-024-02088-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 04/02/2024] [Indexed: 06/21/2024]
Abstract
Colorectal cancer is one of the most frequent cancerous diseases in industrial nations, whereby tumors of the rectum constitute approximately 30-40% of all colorectal cancers. In addition to the implementation and establishment of novel neoadjuvant concepts for the treatment of rectal cancer, there has been a continuous evolution of surgical techniques in recent years towards minimally invasive surgery. In this respect robot-assisted surgery has become more and more popular despite seemingly weak evidence regarding clinical benefits and the not to be ignored economic aspects; however, recently published high-quality studies provide new evidence showing advantages for a robotic resection in patients suffering from rectal cancer. Thus, the progressive implementation of robotic surgical systems is increasingly attaining a scientific foundation.
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Affiliation(s)
- Sven Flemming
- Klinik und Poliklinik für Allgemein‑, Viszeral‑, Transplantations‑, Gefäß- und Kinderchirurgie, Zentrum für Operative Medizin, Universitätsklinikum Würzburg, Oberdürrbacher Str. 6, 97080, Würzburg, Deutschland.
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3
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Mohamedahmed AYY, Zaman S, Wuheb AA, Ismail A, Nnaji M, Alyamani AA, Eltyeb HA, Yassin NA. Peri-operative, oncological and functional outcomes of robotic versus transanal total mesorectal excision in patients with rectal cancer: A systematic review and meta-analysis. Tech Coloproctol 2024; 28:75. [PMID: 38951249 DOI: 10.1007/s10151-024-02947-x] [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: 08/30/2023] [Accepted: 05/25/2024] [Indexed: 07/03/2024]
Abstract
BACKGROUND Comparative outcomes of robotic low anterior resection (rTME) and trans-anal total mesorectal excision (TaTME) in patients with low rectal cancer were evaluated. METHODS A systematic online search was conducted using the following databases: PubMed, Scopus, Cochrane database, The Virtual Health Library, Clinical trials.gov and Science Direct. Comparative studies of rTME versus TaTME for low rectal cancer were included. Primary outcomes were postoperative complications, including anastomotic leak, surgical site infection, and Clavien-Dindo complication rate. Total operative time, conversion to open surgery, intra-operative blood loss, intensive therapy unit (ITU) and total hospital length of stay (LOS), oncological outcomes and functional outcomes were the other evaluated outcome parameters. RESULTS A total of 12 studies with a total number of 3025 patients divided between rTME (n = 1881) and TaTME (n = 1144) groups were included. There was no significant difference between the two groups for total operative time (P = 0.39), conversion to open surgery (P = 0.29) and intra-operative blood loss (P = 0.62). Clavien-Dindo ≥ 3 complication rate (P = 0.47), anastomotic leak (P = 0.89), rates of re-operation (P = 0.62) and re-admission (P = 0.92), R0 resections (P = 0.52), ITU LOS (P = 0.63) and total hospital LOS (P = 0.30) also showed similar results between the two groups. However, the rTME group had higher rates of total harvested lymph nodes (P = 0.04) and complete total mesorectal excision (TME) resections (P = 0.05). Albeit with a limited dataset, the Wexner and low anterior resection syndrome (LARS) scores showed better functional results in the rTME group compared with the TaTME group (P = 0.0009 and P = 0.00001, respectively). CONCLUSION Compared with TaTME, rTME seems to provide better functional outcomes, higher lymph node yield and more complete TME resections with a similar post-operative complications profile.
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Affiliation(s)
- A Y Y Mohamedahmed
- Department of Colorectal and General Surgery, Royal Wolverhampton NHS Trust, Wolverhampton, West Midlands, UK.
- General Surgery Department, University Hospitals of Derby and Burton NHS Trust, Burton on Trent, UK.
| | - S Zaman
- Department of General Surgery, Sandwell and West, Birmingham Hospitals NHS Trust, Birmingham, West Midlands, UK.
- Institute of Cancer and Genomic Science, College of Medical and Dental Science, University of Birmingham, Edgbaston, Birmingham, UK.
| | - A A Wuheb
- Department of Colorectal and General Surgery, Royal Wolverhampton NHS Trust, Wolverhampton, West Midlands, UK
| | - A Ismail
- Department of Colorectal and General Surgery, Royal Wolverhampton NHS Trust, Wolverhampton, West Midlands, UK
| | - M Nnaji
- Department of Colorectal and General Surgery, Royal Wolverhampton NHS Trust, Wolverhampton, West Midlands, UK
| | - A A Alyamani
- Department of Colorectal and General Surgery, Royal Wolverhampton NHS Trust, Wolverhampton, West Midlands, UK
| | - H A Eltyeb
- Department of General Surgery, Royal Victoria Infirmary, Newcastle Upon Tyne, UK
| | - N A Yassin
- Colorectal Surgery Department, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
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4
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Song L, Xu WQ, Wei ZQ, Tang G. Robotic vs laparoscopic abdominoperineal resection for rectal cancer: A propensity score matching cohort study and meta-analysis. World J Gastrointest Surg 2024; 16:1280-1290. [PMID: 38817290 PMCID: PMC11135314 DOI: 10.4240/wjgs.v16.i5.1280] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2023] [Revised: 02/29/2024] [Accepted: 04/10/2024] [Indexed: 05/23/2024] Open
Abstract
BACKGROUND Robotic surgery (RS) is gaining popularity; however, evidence for abdominoperineal resection (APR) of rectal cancer (RC) is scarce. AIM To compare the efficacy of RS and laparoscopic surgery (LS) in APR for RC. METHODS We retrospectively identified patients with RC who underwent APR by RS or LS from April 2016 to June 2022. Data regarding short-term surgical outcomes were compared between the two groups. To reduce the effect of potential confounding factors, propensity score matching was used, with a 1:1 ratio between the RS and LS groups. A meta-analysis of seven trials was performed to compare the efficacy of robotic and laparoscopic APR for RC surgery. RESULTS Of 133 patients, after propensity score matching, there were 42 patients in each group. The postoperative complication rate was significantly lower in the RS group (17/42, 40.5%) than in the LS group (27/42, 64.3%) (P = 0.029). There was no significant difference in operative time (P = 0.564), intraoperative transfusion (P = 0.314), reoperation rate (P = 0.314), lymph nodes harvested (P = 0.309), or circumferential resection margin (CRM) positive rate (P = 0.314) between the two groups. The meta-analysis showed patients in the RS group had fewer positive CRMs (P = 0.04), lesser estimated blood loss (P < 0.00001), shorter postoperative hospital stays (P = 0.02), and fewer postoperative complications (P = 0.002) than patients in the LS group. CONCLUSION Our study shows that RS is a safe and effective approach for APR in RC and offers better short-term outcomes than LS.
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Affiliation(s)
- Li Song
- Department of Gastrointestinal Surgery, Chengdu Fifth People's Hospital, Chengdu 610000, Sichuan Province, China
| | - Wen-Qiong Xu
- Department of Nephrology, Chengdu Fifth People's Hospital, Chengdu 610000, Sichuan Province, China
| | - Zheng-Qiang Wei
- Department of Gastrointestinal Surgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing 400000, China
| | - Gang Tang
- Division of Biliary Tract Surgery, Department of General Surgery, West China Hospital, Sichuan University, Chengdu 610041, Sichuan Province, China
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5
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Patel SV, Wiseman V, Zhang L, Merchant SJ, Caycedo-Marulanda A, MacDonald PH. The impact of robotic rectal cancer surgery at a Canadian regional cancer centre: a retrospective cohort study. Can J Surg 2024; 67:E206-E213. [PMID: 38692680 PMCID: PMC11068423 DOI: 10.1503/cjs.002523] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/04/2023] [Indexed: 05/03/2024] Open
Abstract
BACKGROUND Although robotic surgery has several advantages over other minimally invasive surgery (MIS) techniques for rectal cancer surgery, the uptake in Canada has been limited owing to a perceived increase in cost and lack of training. The objective of this study was to determine the impact of access to robotic surgery in a Canadian setting. METHODS We conducted a retrospective cohort study involving consecutive adults undergoing surgical resection for rectal cancer between 2017 and 2020. The primary exposure was access to robotic surgery. Outcomes included MIS utilization, short-term outcomes, total cost of care, and quality of surgical resection. We completed univariate and multivariate analyses. RESULTS We included 171 individuals in this cohort study (85 in the prerobotic period and 86 in the robotic period). The 2 groups had similar baseline characteristics. A higher proportion of individuals underwent successful MIS in the robotic phase (86% v. 46%, p < 0.001). Other benefits included a shorter mean length of hospital stay (5.1 d v. 9.2 d, p < 0.001). The quality of surgical resection was similar between groups. The total cost of care was $16 746 in the robotic period and $18 808 in the prerobotic period (mean difference -$1262, 95% confidence interval -$4308 to $1783; p = 0.4). CONCLUSION Access to robotic rectal cancer surgery increased successful completion of MIS and shortened hospital stay, with a similar total cost of care. Robotic rectal cancer surgery can enhance patient outcomes in the Canadian setting.
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Affiliation(s)
- Sunil V Patel
- From the Department of Surgery, Queen's University, Kingston, Ont. (Patel, Wiseman, Merchant, MacDonald); the Department of Surgery, University of Ottawa, Ottawa, Ont. (Zhang); Orlando Health, Orlando, United States (Caycedo-Marulanda).
| | - Vanessa Wiseman
- From the Department of Surgery, Queen's University, Kingston, Ont. (Patel, Wiseman, Merchant, MacDonald); the Department of Surgery, University of Ottawa, Ottawa, Ont. (Zhang); Orlando Health, Orlando, United States (Caycedo-Marulanda)
| | - Lisa Zhang
- From the Department of Surgery, Queen's University, Kingston, Ont. (Patel, Wiseman, Merchant, MacDonald); the Department of Surgery, University of Ottawa, Ottawa, Ont. (Zhang); Orlando Health, Orlando, United States (Caycedo-Marulanda)
| | - Shaila J Merchant
- From the Department of Surgery, Queen's University, Kingston, Ont. (Patel, Wiseman, Merchant, MacDonald); the Department of Surgery, University of Ottawa, Ottawa, Ont. (Zhang); Orlando Health, Orlando, United States (Caycedo-Marulanda)
| | - Antonio Caycedo-Marulanda
- From the Department of Surgery, Queen's University, Kingston, Ont. (Patel, Wiseman, Merchant, MacDonald); the Department of Surgery, University of Ottawa, Ottawa, Ont. (Zhang); Orlando Health, Orlando, United States (Caycedo-Marulanda)
| | - P Hugh MacDonald
- From the Department of Surgery, Queen's University, Kingston, Ont. (Patel, Wiseman, Merchant, MacDonald); the Department of Surgery, University of Ottawa, Ottawa, Ont. (Zhang); Orlando Health, Orlando, United States (Caycedo-Marulanda)
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Yavuz R, Aras O, Çiyiltepe H, Çakır T, Ensari CÖ, Gömceli İ. Effect of Robotic Inferior Mesenteric Artery Ligation Level on Low Anterior Resection Syndrome in Rectum Cancer. J Laparoendosc Adv Surg Tech A 2024; 34:387-392. [PMID: 38574307 DOI: 10.1089/lap.2023.0472] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/06/2024] Open
Abstract
Background: Life expectancy of patients with rectal cancer is increasing day by day with innovative treatments. Low anterior resection syndrome (LARS), which disrupts the comfort of life in these patients, has become a serious problem. We aimed to evaluate the effect of high ligation (HL) and low ligation (LL) techniques on LARS in rectal cancer surgery performed with the robotic method. Materials and Methods: The data of patients diagnosed with mid-distal rectal cancer between 2016 and 2021 who underwent robotic low anterior resection by the same team in the same center with neoadjuvant chemoradiotherapy were retrospectively evaluated. Patients were divided into two groups as those who underwent HL and LL procedures. Preoperative, 8 weeks after neoadjuvant treatment, 3 and 12 months after ileostomy closure were evaluated. Results: A total of 84 patients (41 HL, 43 LL) were included in the study. There was no statistically significant difference between the demographic characteristics and pathology data of the patients. Although there was a decrease in LARS scores after neoadjuvant treatment, there was a statistically significant difference between the two groups at 3 and 12 months after ileostomy closure (P: .001, P: .015). Conclusions: In patients who underwent robotic low anterior resection, there is a statistically significant difference in the LARS score in the first 1 year with the LL technique compared with that of the HL technique, and the LL technique has superiority in reducing the development of LARS between the two oncologically indistinguishable methods.
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Affiliation(s)
- Rıdvan Yavuz
- Antalya Training and Research Hospital, Gastroenterology Surgery Department, Antalya, Turkey
| | - Orhan Aras
- Antalya Training and Research Hospital, Gastroenterology Surgery Department, Antalya, Turkey
| | - Hüseyin Çiyiltepe
- Antalya Training and Research Hospital, Gastroenterology Surgery Department, Antalya, Turkey
| | - Tebessüm Çakır
- Antalya Training and Research Hospital, Gastroenterology Surgery Department, Antalya, Turkey
| | - Cemal Özben Ensari
- Antalya Training and Research Hospital, Gastroenterology Surgery Department, Antalya, Turkey
| | - İsmail Gömceli
- Antalya Bilim University, Vocational School of Health Services, Antalya, Turkey
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7
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Lefetz O, Baste JM, Hamel JF, Mordojovich G, Lefevre-Scelles A, Coq JM. Robotic surgery and work-related stress: A systematic review. APPLIED ERGONOMICS 2024; 117:104188. [PMID: 38301320 DOI: 10.1016/j.apergo.2023.104188] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/20/2023] [Revised: 11/24/2023] [Accepted: 11/28/2023] [Indexed: 02/03/2024]
Abstract
Despite robot-assisted surgery (RAS) becoming increasingly common, little is known about the impact of the underlying work organization on the stress levels of members of the operating room (OR) team. To this end, assessing whether RAS may impact work-related stress, identifying associated stress factors and surveying relevant measurement methods seems critical. Using three databases (Scopus, Medline, Google Scholar), a systematic review was conducted leading to the analysis of 20 articles. Results regarding OR team stress levels and measurement methods were heterogeneous, which could be explained by differing research conditions (i.e., lab. vs. real-life). Relevant stressors such as (in)experience with RAS and quality of team communication were identified. Development of a common, more reliable methodology of stress assessment is required. Research should focus on real-life conditions in order to develop valid and actionable knowledge. Surgical teams would greatly benefit from discussing RAS-related stressors and developing team-specific strategies to handle them.
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Affiliation(s)
- Ophélie Lefetz
- Univ Rouen Normandie, CRFDP, UR 7475, F-76000, Rouen, France.
| | - Jean-Marc Baste
- Faculté de Médecine et de Pharmacie, Université de Rouen, 22 Boulevard Gambetta, CS, 76183, Rouen Cedex 1, France; Rouen University Hospital, Department of general and thoracic surgery, F-76000, Rouen, France; Normandie Univ, UNIROUEN, INSERM, U1096, Rouen University Hospital, Rouen, France
| | | | - Gerardo Mordojovich
- Clínica Alemana de Santiago, Av. Vitacura 5951, Vitacura, Región Metropolitana, Santiago, Chile; Hospital de la Fuerza Aérea de Chile, Santiago, Chile; Universidad Mayor de Santiago, Santiago, Chile
| | - Antoine Lefevre-Scelles
- Rouen University Hospital, Department of intensive care, anesthesia and perioperative medicine, F-76000, Rouen, France; Rouen University Hospital, Emergency Care Training Center (CESU-76A) of Emergency medical service (SAMU-76A), F-76000, Rouen, France
| | - Jean-Michel Coq
- Univ Rouen Normandie, CRFDP, UR 7475, F-76000, Rouen, France
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Dixon F, Vitish-Sharma P, Khanna A, Keeler BD. Robotic assisted surgery reduces ergonomic risk during minimally invasive colorectal resection: the VOLCANO randomised controlled trial. Langenbecks Arch Surg 2024; 409:142. [PMID: 38676748 PMCID: PMC11055713 DOI: 10.1007/s00423-024-03322-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2024] [Accepted: 04/14/2024] [Indexed: 04/29/2024]
Abstract
PURPOSE Minimally invasive surgery benefits patients but poor operating ergonomics causes musculoskeletal injuries in surgeons. This randomised controlled trial aims to assess whether robotic-assisted surgery with the open-console Versius® system can reduce surgeons' ergonomic risks during major colorectal resections. METHODS Prospectively registered at ClinicalTrials.gov (NCT05262296) in March 2022. Adult patients requiring a minimally invasive colorectal resection were potentially eligible. Photographs taken at 2-min intervals were analysed using the objective Rapid Entire Body Assessment (REBA) posture analysis scale to calculate intraoperative surgeon ergonomic risk. Secondary outcomes included team communication (Oxford NOTECHS II), surgeon cognitive strain (modified NASA-TLX scale), and clinical outcomes. RESULTS Sixty patients were randomised in a 2:1 ratio (40 robot, 20 laparoscopic). Mean age was 65yrs and 34 (57%) were male. Body Mass Index did not differ between the 2 groups (overall mean 29.0 ± 5) and there were equal proportions of left and right-colonic resections. REBA was significantly lower in the robotic arm (median robot REBA score 3 vs lap REBA 5 [p < 0.001]), equating to an injury risk category drop from "medium" to "low risk". There were no significant differences in team communication, operative duration, or patient outcomes. Surgeon cognitive strain was lower in robotic cases (mean robot 32.4 ± 10.3 vs lap 45.6 ± 14.3 [p < 0.001]). CONCLUSIONS This trial demonstrates that robotic surgery with an open-console system reduces ergonomic risk scores and cognitive strain during colorectal resections, with no apparent detriment to team communication. This may therefore be a safe & feasible solution to the increasing problem of work-related musculoskeletal injuries in surgeons.
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Affiliation(s)
- Frances Dixon
- Department of Surgery, Milton Keynes University Hospital NHS Foundation Trust, Milton Keynes, Eaglestone, MK6 5LD, UK.
- University of Buckingham, Buckingham, MK18 1EG, UK.
| | - Parveen Vitish-Sharma
- Department of Surgery, Milton Keynes University Hospital NHS Foundation Trust, Milton Keynes, Eaglestone, MK6 5LD, UK
- University of Buckingham, Buckingham, MK18 1EG, UK
| | - Achal Khanna
- Department of Surgery, Milton Keynes University Hospital NHS Foundation Trust, Milton Keynes, Eaglestone, MK6 5LD, UK
| | - Barrie D Keeler
- Department of Surgery, Milton Keynes University Hospital NHS Foundation Trust, Milton Keynes, Eaglestone, MK6 5LD, UK
- University of Buckingham, Buckingham, MK18 1EG, UK
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9
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Kamada T, Ohdaira H, Takahashi J, Aida T, Nakashima K, Ito E, Hata T, Yoshida M, Eto K, Suzuki Y. Novel tumor marker index using carcinoembryonic antigen and carbohydrate antigen 19-9 is a significant prognostic factor for resectable colorectal cancer. Sci Rep 2024; 14:4192. [PMID: 38378762 PMCID: PMC10879146 DOI: 10.1038/s41598-024-54917-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2023] [Accepted: 02/18/2024] [Indexed: 02/22/2024] Open
Abstract
We evaluated the usefulness of a newly devised tumor marker index (TMI), namely, the geometric mean of normalized carcinoembryonic antigen (CEA) and carbohydrate antigen 19-9 (CA19-9), in determining colorectal cancer (CRC) prognosis. This retrospective cohort study included 306 patients with stages I-III CRC who underwent elective laparoscopic resection between April 2010 and March 2020. Survival rates and risk factors of relapse-free survival (RFS) and cancer-specific survival (CSS) were analyzed using Kaplan-Meier curves and Cox proportional hazards model. High-TMI group (122 patients) had significantly lower rates (95% confidence interval [95% CI]) for 5-year RFS (89.7%, 83.9-93.5 vs. 65.8%, 56.3-73.8, p < 0.001) and CSS (94.9%, 89.4-97.6 vs. 77.3%, 67.7-84.4, p < 0.001) than low-TMI group. Multivariate analysis (hazard ratio [95% CI]) indicated ≥ T3 disease (RFS: 2.69, 1.12-6.45, p = 0.026; CSS: 7.64, 1.02-57.3, p = 0.048), stage III CRC (RFS: 3.30, 1.74-6.28, p < 0.001; CSS: 6.23, 2.04-19.0, p = 0.001), and high TMI (RFS: 2.50, 1.43-4.38, p = 0.001; CSS: 3.80, 1.63-8.87, p = 0.002) as significant RFS and CSS predictors. Area under the curve (AUC) of 5-year cancer deaths (0.739, p < 0.001) was significantly higher for TMI than for CEA or CA19-9 alone. Preoperative TMI is a useful prognostic indicator for patients with resectable CRC.
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Affiliation(s)
- Teppei Kamada
- Department of Surgery, International University of Health and Welfare Hospital, 537-3, Iguchi, Nasushiobara, Tochigi, 329-2763, Japan.
- Department of Surgery, The Jikei University School of Medicine, 3-25-8, Nishi-shimbashi, Minato-ku, Tokyo, 105-8461, Japan.
| | - Hironori Ohdaira
- Department of Surgery, International University of Health and Welfare Hospital, 537-3, Iguchi, Nasushiobara, Tochigi, 329-2763, Japan
| | - Junji Takahashi
- Department of Surgery, International University of Health and Welfare Hospital, 537-3, Iguchi, Nasushiobara, Tochigi, 329-2763, Japan
- Department of Surgery, The Jikei University School of Medicine, 3-25-8, Nishi-shimbashi, Minato-ku, Tokyo, 105-8461, Japan
| | - Takashi Aida
- Department of Surgery, International University of Health and Welfare Hospital, 537-3, Iguchi, Nasushiobara, Tochigi, 329-2763, Japan
- Department of Surgery, The Jikei University School of Medicine, 3-25-8, Nishi-shimbashi, Minato-ku, Tokyo, 105-8461, Japan
| | - Keigo Nakashima
- Department of Surgery, International University of Health and Welfare Hospital, 537-3, Iguchi, Nasushiobara, Tochigi, 329-2763, Japan
- Department of Surgery, The Jikei University School of Medicine, 3-25-8, Nishi-shimbashi, Minato-ku, Tokyo, 105-8461, Japan
| | - Eisaku Ito
- Department of Surgery, International University of Health and Welfare Hospital, 537-3, Iguchi, Nasushiobara, Tochigi, 329-2763, Japan
- Department of Surgery, The Jikei University School of Medicine, 3-25-8, Nishi-shimbashi, Minato-ku, Tokyo, 105-8461, Japan
| | - Taigo Hata
- Department of Surgery, International University of Health and Welfare Hospital, 537-3, Iguchi, Nasushiobara, Tochigi, 329-2763, Japan
- Department of Surgery, The Jikei University School of Medicine, 3-25-8, Nishi-shimbashi, Minato-ku, Tokyo, 105-8461, Japan
| | - Masashi Yoshida
- Department of Surgery, International University of Health and Welfare Hospital, 537-3, Iguchi, Nasushiobara, Tochigi, 329-2763, Japan
| | - Ken Eto
- Department of Surgery, The Jikei University School of Medicine, 3-25-8, Nishi-shimbashi, Minato-ku, Tokyo, 105-8461, Japan
| | - Yutaka Suzuki
- Department of Surgery, International University of Health and Welfare Hospital, 537-3, Iguchi, Nasushiobara, Tochigi, 329-2763, Japan
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10
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Zhao S, Li R, Zhou J, Sun L, Sun Q, Wang W, Wang D. Comparative analysis of robotic and laparoscopic surgery for mid and low rectal cancer in patients with varied body mass indexes: evaluating of short-term outcomes. J Robot Surg 2024; 18:67. [PMID: 38329619 DOI: 10.1007/s11701-023-01803-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2023] [Accepted: 12/17/2023] [Indexed: 02/09/2024]
Abstract
The main aim of this study was to evaluate and contrast the efficacy of robotic and laparoscopic surgical procedures in the treatment of low and mid rectal cancer in different BMI (body mass index) groups. The clinical records of patients who had laparoscopic or robotic proctectomy at a single center between December 2019 and August 2023 were analyzed. Then we utilized a classification framework to categorize individuals based on their BMI into three unique groups: non-obese, overweight, and obese. The short-term efficacy was evaluated. A consecutive sample of 1413 patients was included in this retrospective investigation. 1158 people out of the total sample chose laparoscopic surgery, whereas 255 people chose robotic surgery. In the group of obese people, robotic surgery showed a statistically significant decrease in blood loss compared to laparoscopic surgery (P = 0.026). People who were overweight or obese were in the hospital for a shorter amount of time after robotic surgery than after laparoscopic surgery (P = 0.033 and P = 0.031, respectively). People with different BMIs in the robotic surgery group took less time to have a flatus passage and oral intake those in the laparoscopic surgery group. Oncological outcomes and the frequency of complications were comparable between the two treatments with different BMIs. Surgical resection of patients undergoing low-anterior surgery may benefit from a robotic approach, particularly in overweight and obese patients.
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Affiliation(s)
- Shuai Zhao
- Department of General Surgery, Northern Jiangsu People's Hospital, Clinical Teaching Hospital of Medical School, Nanjing University, Yangzhou, China
| | - Ruiqi Li
- Department of General Surgery, Northern Jiangsu People's Hospital, Clinical Teaching Hospital of Medical School, Nanjing University, Yangzhou, China
| | - Jiajie Zhou
- Department of General Surgery, Northern Jiangsu People's Hospital, Clinical Teaching Hospital of Medical School, Nanjing University, Yangzhou, China
| | - Longhe Sun
- Department of General Surgery, Taizhou Fourth People's Hospital, Taizhou, China
| | - Qiannan Sun
- Department of General Surgery, Northern Jiangsu People's Hospital, Yangzhou, China
- Yangzhou Key Laboratory of Basic and Clinical Transformation of Digestive and Metabolic Diseases, Yangzhou, China
| | - Wei Wang
- Department of General Surgery, Northern Jiangsu People's Hospital, Yangzhou, China
- Graduate School, Dalian Medical University, Dalian, China
| | - Daorong Wang
- Department of General Surgery, Northern Jiangsu People's Hospital, Clinical Teaching Hospital of Medical School, Nanjing University, Yangzhou, China.
- Department of General Surgery, Northern Jiangsu People's Hospital, Yangzhou, China.
- Yangzhou Key Laboratory of Basic and Clinical Transformation of Digestive and Metabolic Diseases, Yangzhou, China.
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11
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Csirzó Á, Kovács DP, Szabó A, Fehérvári P, Jankó Á, Hegyi P, Nyirády P, Sipos Z, Sára L, Ács N, Szabó I, Valent S. Robot-assisted laparoscopy does not have demonstrable advantages over conventional laparoscopy in endometriosis surgery: a systematic review and meta-analysis. Surg Endosc 2024; 38:529-539. [PMID: 38062181 PMCID: PMC10830624 DOI: 10.1007/s00464-023-10587-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2023] [Accepted: 11/04/2023] [Indexed: 02/02/2024]
Abstract
BACKGROUND Endometriosis is a chronic condition affecting 6-10% of women of reproductive age, with endometriosis-related pain and infertility being the leading symptoms. Currently, the gold standard treatment approach to surgery is conventional laparoscopy (CL); however, the increasing availability of robot-assisted surgery is projected as a competitor of CL. This study aimed to compare the perioperative outcomes of robot-assisted laparoscopy (RAL) and CL in endometriosis surgery. OBJECTIVES We aimed to compare the effectiveness and safety of these two procedures. METHODS A systematic search was conducted in three medical databases. Studies investigating different perioperative outcomes of endometriosis-related surgeries were included. Results are presented as odds ratios (OR) or mean differences (MD) with 95% confidence intervals (CI). RESULTS Our search yielded 2,014 records, of which 13 were eligible for data extraction. No significant differences were detected between the CL and RAL groups in terms of intraoperative complications (OR = 1.07, CI 0.43-2.63), postoperative complications (OR = 1.3, CI 0.73-2.32), number of conversions to open surgery (OR = 1.34, CI 0.76-2.37), length of hospital stays (MD = 0.12, CI 0.33-0.57), blood loss (MD = 16.73, CI 4.18-37.63) or number of rehospitalizations (OR = 0.95, CI 0.13-6.75). In terms of operative times (MD = 28.09 min, CI 11.59-44.59) and operating room times (MD = 51.39 min, CI 15.07-87.72;), the RAL technique remained inferior. CONCLUSION RAL does not have statistically demonstrable advantages over CL in terms of perioperative outcomes for endometriosis-related surgery.
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Affiliation(s)
- Ádám Csirzó
- Centre for Translational Medicine, Semmelweis University, Üllői út 26, 1082, Budapest, Hungary
- Department of Obstetrics and Gynecology, Semmelweis University, Budapest, Hungary
| | - Dénes Péter Kovács
- Centre for Translational Medicine, Semmelweis University, Üllői út 26, 1082, Budapest, Hungary
- Department of Obstetrics and Gynecology, Semmelweis University, Budapest, Hungary
| | - Anett Szabó
- Centre for Translational Medicine, Semmelweis University, Üllői út 26, 1082, Budapest, Hungary
- Department of Urology, Semmelweis University, Budapest, Hungary
| | - Péter Fehérvári
- Centre for Translational Medicine, Semmelweis University, Üllői út 26, 1082, Budapest, Hungary
- Department of Biostatistics, University of Veterinary Medicine Budapest, Budapest, Hungary
| | - Árpád Jankó
- Centre for Translational Medicine, Semmelweis University, Üllői út 26, 1082, Budapest, Hungary
| | - Péter Hegyi
- Centre for Translational Medicine, Semmelweis University, Üllői út 26, 1082, Budapest, Hungary
- Institute of Pancreatic Diseases, Semmelweis University, Budapest, Hungary
| | - Péter Nyirády
- Centre for Translational Medicine, Semmelweis University, Üllői út 26, 1082, Budapest, Hungary
- Department of Urology, Semmelweis University, Budapest, Hungary
| | - Zoltán Sipos
- Medical School, Institute for Translational Medicine, University of Pécs, Pecs, Hungary
- Medical School, Institute of Bioanalysis, University of Pécs, Pecs, Hungary
| | - Levente Sára
- Centre for Translational Medicine, Semmelweis University, Üllői út 26, 1082, Budapest, Hungary
- Department of Obstetrics and Gynecology, Semmelweis University, Budapest, Hungary
| | - Nándor Ács
- Centre for Translational Medicine, Semmelweis University, Üllői út 26, 1082, Budapest, Hungary
- Department of Obstetrics and Gynecology, Semmelweis University, Budapest, Hungary
| | - István Szabó
- Department of Obstetrics and Gynecology, Semmelweis University, Budapest, Hungary
| | - Sándor Valent
- Centre for Translational Medicine, Semmelweis University, Üllői út 26, 1082, Budapest, Hungary.
- Department of Obstetrics and Gynecology, Semmelweis University, Budapest, Hungary.
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12
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Huang CK, Shih CH, Kao YS. Elderly Rectal Cancer: An Updated Review. Curr Oncol Rep 2024; 26:181-190. [PMID: 38270849 DOI: 10.1007/s11912-024-01495-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/03/2024] [Indexed: 01/26/2024]
Abstract
PURPOSE OF REVIEW Treatment of rectal cancer patients of advanced age should be modulated by life expectancy and tolerance. Due to the rapid advance of this field, we aim to conduct an updated review of this topic. RECENT FINDINGS The field of elderly rectal cancer has advanced a lot. This review covers all the treatment aspects of elderly rectal cancer, including the prognostic factor, surgery, radiotherapy, chemotherapy, and palliative treatment. We also provide the future aspect of the management of elderly rectal cancer. The advancement of prognostic factor research, surgery, radiotherapy, chemotherapy, and palliative treatment has made the care of elderly rectal cancer patients better. The future of these fields should focus on the definition of the elderly and the application of particle therapy.
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Affiliation(s)
- Chih-Kai Huang
- Division of General Surgery, Department of Surgery, Cheng Hsin General Hospital, Taipei, Taiwan
| | - Chi-Hsiu Shih
- Division of Hematology and Oncology, Taoyuan General Hospital, Ministry of Health and Welfare, Taoyuan, Taiwan
| | - Yung-Shuo Kao
- Department of Radiation Oncology, Taoyuan General Hospital, Ministry of Health and Welfare, No.1492, Zhongshan Rd., Taoyuan Dist., Taoyuan City, 330, Taiwan.
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13
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Boal M, Di Girasole CG, Tesfai F, Morrison TEM, Higgs S, Ahmad J, Arezzo A, Francis N. Evaluation status of current and emerging minimally invasive robotic surgical platforms. Surg Endosc 2024; 38:554-585. [PMID: 38123746 PMCID: PMC10830826 DOI: 10.1007/s00464-023-10554-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2023] [Accepted: 10/20/2023] [Indexed: 12/23/2023]
Abstract
BACKGROUND The rapid adoption of robotics within minimally invasive surgical specialties has also seen an explosion of new technology including multi- and single port, natural orifice transluminal endoscopic surgery (NOTES), endoluminal and "on-demand" platforms. This review aims to evaluate the validation status of current and emerging MIS robotic platforms, using the IDEAL Framework. METHODS A scoping review exploring robotic minimally invasive surgical devices, technology and systems in use or being developed was performed, including general surgery, gynaecology, urology and cardiothoracics. Systems operating purely outside the abdomen or thorax and endoluminal or natural orifice platforms were excluded. PubMed, Google Scholar, journal reports and information from the public domain were collected. Each company was approached via email for a virtual interview to discover more about the systems and to quality check data. The IDEAL Framework is an internationally accepted tool to evaluate novel surgical technology, consisting of four stages: idea, development/exploration, assessment, and surveillance. An IDEAL stage, synonymous with validation status in this review, was assigned by reviewing the published literature. RESULTS 21 companies with 23 different robotic platforms were identified for data collection, 13 with national and/or international regulatory approval. Of the 17 multiport systems, 1 is fully evaluated at stage 4, 2 are stage 3, 6 stage 2b, 2 at stage 2a, 2 stage 1, and 4 at the pre-IDEAL stage 0. Of the 6 single-port systems none have been fully evaluated with 1 at stage 3, 3 at stage 1 and 2 at stage 0. CONCLUSIONS The majority of existing robotic platforms are currently at the preclinical to developmental and exploratory stage of evaluation. Using the IDEAL framework will ensure that emerging robotic platforms are fully evaluated with long-term data, to inform the surgical workforce and ensure patient safety.
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Affiliation(s)
- M Boal
- The Griffin Institute, Northwick Park and St Marks Hospital, London, UK
- Wellcome/EPSRC Centre for Intervention and Surgical Sciences, University College London, London, UK
- Association of Laparoscopic Surgeons of Great Britain and Ireland (ALSGBI) Academy, London, UK
| | | | - F Tesfai
- The Griffin Institute, Northwick Park and St Marks Hospital, London, UK
- Wellcome/EPSRC Centre for Intervention and Surgical Sciences, University College London, London, UK
- Association of Laparoscopic Surgeons of Great Britain and Ireland (ALSGBI) Academy, London, UK
| | - T E M Morrison
- Association of Laparoscopic Surgeons of Great Britain and Ireland (ALSGBI) Academy, London, UK
| | - S Higgs
- Gloucestershire Hospitals NHS Foundation Trust, Gloucester, UK
| | - J Ahmad
- University Hospitals Coventry and Warwickshire, Coventry, UK
| | - A Arezzo
- Department of Surgical Sciences, University of Turin, Turin, Italy
| | - N Francis
- The Griffin Institute, Northwick Park and St Marks Hospital, London, UK.
- Yeovil District Hospital, Somerset NHS Foundation Trust, Yeovil, UK.
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14
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Kamei J, Fujimura T. Current status of robot-assisted total pelvic exenteration focusing on the field of urology: a clinical practice review. Transl Cancer Res 2024; 13:453-461. [PMID: 38410226 PMCID: PMC10894324 DOI: 10.21037/tcr-23-1039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2023] [Accepted: 12/08/2023] [Indexed: 02/28/2024]
Abstract
Total pelvic exenteration (TPE) is a highly invasive surgery associated with high rates of perioperative morbidity and mortality and is commonly performed for several types of locally advanced or recurrent pelvic cancers. It involves multivisceral resection, including the rectum, sigmoid colon, bladder, prostate, uterus, vagina, or ovaries, and urologists normally perform radical cystectomy or radical prostatectomy and urinary diversion in collaboration with colorectal surgeons and gynecologists. In the urological field, robot-assisted surgeries have been widely performed as one of the main minimally invasive procedures because of their superior perioperative or oncological outcomes compared to open or laparoscopic surgeries. In pelvic exenteration (PE) surgery, laparoscopic surgeries have shown superior rates of mortality, morbidity, and R0 resection compared to open surgeries. Robot-assisted TPE for the treatment of locally advanced rectal cancer was first reported in 2014, and reports of its safety and usefulness have gradually increased. Robot-assisted PE, in which multivisceral resection in a narrow pelvic space is easier, will eventually be a standard minimally invasive procedure, although evidence has been limited to date. This clinical practice review summarizes the indications for surgery, perioperative complications, and oncological outcomes of robot-assisted TPE and highlights the current status of robot-assisted TPE for patients with urological malignancies and its surgical technique, focusing on the manipulation of urological organs.
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Affiliation(s)
- Jun Kamei
- Department of Urology, Jichi Medical University, Tochigi, Japan
- Department of Urology, The University of Tokyo Hospital, Tokyo, Japan
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15
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Zhao S, Ma Y, Li R, Zhou J, Sun L, Sun Q, Wang W, Wang D. Impact of visceral fat area on short-term outcomes in robotic surgery for mid and low rectal cancer. J Robot Surg 2024; 18:59. [PMID: 38289448 DOI: 10.1007/s11701-023-01814-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2023] [Accepted: 12/25/2023] [Indexed: 02/01/2024]
Abstract
Rectal cancer is one of the most prevalent cancers that arise in the digestive tract. The purpose of this retrospective study was to investigate the impact of visceral fat area (VFA) on postoperative outcomes in mid and low rectal cancer patients undergoing robotic surgery (RS). Data were collected on patients who underwent robotic anterior rectal resection in a single center from December 2019 to October 2023. Clinical pathology information was analyzed. Statistical analysis was done on the computed tomography (CT) imaging data. A total of 277 patients were included in the study, including 121 cases with visceral obesity (VO) and 156 cases without VO. There was no statistically significant disparity in the lymph node dissection count, blood loss, duration of hospitalization, time to first liquid diet, early postoperative complications, histopathologic specimen indices (quality of TME and CRM involvement rate), and or the rate of conversion to open surgery between VO and non-VO group (P > 0.05). Nevertheless, the group of individuals with VO experienced a lengthier duration of surgery (P < 0.001) and a delayed time until the first passage of flatus (P < 0.001) in comparison to the group without VO. The study suggests that VO does not significantly impact early complications or the quality of surgical outcomes in mid and low rectal cancer patients undergoing robotic surgery. The findings support the continued use of RS as an optimal strategy for technically demanding patients.
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Affiliation(s)
- Shuai Zhao
- Department of General Surgery, Northern Jiangsu People's Hospital, Clinical Teaching Hospital of Medical School, Nanjing University, Yangzhou, China
| | - Yue Ma
- Department of General Surgery, Northern Jiangsu People's Hospital, Clinical Teaching Hospital of Medical School, Nanjing University, Yangzhou, China
| | - Ruiqi Li
- Department of General Surgery, Northern Jiangsu People's Hospital, Clinical Teaching Hospital of Medical School, Nanjing University, Yangzhou, China
| | - Jiajie Zhou
- Department of General Surgery, Northern Jiangsu People's Hospital, Clinical Teaching Hospital of Medical School, Nanjing University, Yangzhou, China
| | - Longhe Sun
- Department of General Surgery, Taizhou Fourth People's Hospital, Taizhou, China
| | - Qiannan Sun
- Department of General Surgery, Northern Jiangsu People's Hospital, Yangzhou, China
- Yangzhou Key Laboratory of Basic and Clinical Transformation of Digestive and Metabolic Diseases, Yangzhou, China
| | - Wei Wang
- Department of General Surgery, Northern Jiangsu People's Hospital, Yangzhou, China
| | - Daorong Wang
- Department of General Surgery, Northern Jiangsu People's Hospital, Clinical Teaching Hospital of Medical School, Nanjing University, Yangzhou, China.
- Department of General Surgery, Northern Jiangsu People's Hospital, Yangzhou, China.
- Yangzhou Key Laboratory of Basic and Clinical Transformation of Digestive and Metabolic Diseases, Yangzhou, China.
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16
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Guo F, Xia C, Wang Z, Wang R, Gao J, Meng Y, Pan J, Zhang Q, Ren S. Nomogram for predicting the surgical difficulty of laparoscopic total mesorectal excision and exploring the technical advantages of robotic surgery. Front Oncol 2024; 14:1303686. [PMID: 38347843 PMCID: PMC10860337 DOI: 10.3389/fonc.2024.1303686] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2023] [Accepted: 01/09/2024] [Indexed: 02/15/2024] Open
Abstract
Background Total mesorectal excision (TME), represents a key technique in radical surgery for rectal cancer. This study aimed to construct a preoperative nomogram for predicting the surgical difficulty of laparoscopic total mesorectal excision (L-TME) and to investigate whether there were potential benefits of robotic TME (R-TME) for patients with technically challenging rectal cancer. Methods Consecutive mid-low rectal cancer patients receiving total mesorectal excision were included. A preoperative nomogram to predict the surgical difficulty of L-TME was established and validated. Patients with technically challenging rectal cancer were screened by calculating the prediction score of the nomogram. Then patients with technically challenging rectal cancer who underwent different types of surgery, R-TME or L-TME, were analyzed for comparison. Results A total of 533 consecutive patients with mid-low rectal cancer who underwent TME at a single tertiary medical center between January 2018 and January 2021 were retrospectively enrolled. Multivariable analysis demonstrated that mesorectal fat area, intertuberous distance, tumor size, and tumor height were independent risk factors for surgical difficulty. Subsequently, these variables were used to construct the nomogram model to predict the surgical difficulty of L-TME. The area under the receiver operating characteristic curve of the nomogram was 0.827 (95% CI 0.745 - 0.909) and 0.809 (95% CI 0.674- 0.944) in the training and validation cohort, respectively. For patients with technically challenging rectal cancer, R-TME was associated with a lower diverting ileostomy rate (p = 0.003), less estimated blood loss (p < 0.043), shorter procedure time (p = 0.009) and shorter postoperative hospital stay (p = 0.037). Conclusion In this study, we established a preoperative nomogram to predict the surgical difficulty of L-TME. Furthermore, this study also indicated that R-TME has potential technical advantages for patients with technically challenging rectal cancer.
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Affiliation(s)
- Fangliang Guo
- Department of Gastrointestinal Surgery, The Second Affiliated Hospital of Dalian Medical University, Dalian, Liaoning, China
| | - Cong Xia
- Department of Gastrointestinal Surgery, The Second Affiliated Hospital of Dalian Medical University, Dalian, Liaoning, China
| | - Zongheng Wang
- Department of Gastrointestinal Surgery, The Second Affiliated Hospital of Dalian Medical University, Dalian, Liaoning, China
| | - Ruiqi Wang
- Department of Public Health, China Medical University, Shenyang, Liaoning, China
| | - Jianfeng Gao
- Department of Gastrointestinal Surgery, The Second Affiliated Hospital of Dalian Medical University, Dalian, Liaoning, China
| | - Yue Meng
- Department of Gastrointestinal Surgery, The Second Affiliated Hospital of Dalian Medical University, Dalian, Liaoning, China
| | - Jiahao Pan
- Department of General Surgery, Shanghai Changzheng Hospital, Shanghai, China
| | - Qianshi Zhang
- Department of Gastrointestinal Surgery, The Second Affiliated Hospital of Dalian Medical University, Dalian, Liaoning, China
| | - Shuangyi Ren
- Department of Gastrointestinal Surgery, The Second Affiliated Hospital of Dalian Medical University, Dalian, Liaoning, China
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17
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Kim IK, Lee CS, Bae JH, Han SR, Alshalawi W, Kim BC, Lee IK, Lee DS, Lee YS. Perioperative outcomes of laparoscopic low anterior resection using ArtiSential ® versus robotic approach in patients with rectal cancer: a propensity score matching analysis. Tech Coloproctol 2024; 28:25. [PMID: 38231341 DOI: 10.1007/s10151-023-02895-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2023] [Accepted: 11/26/2023] [Indexed: 01/18/2024]
Abstract
BACKGROUND Total mesorectal excision using conventional straight fixed devices may be technically difficult because of the narrow and concave pelvis. Several laparoscopic articulating tools have been introduced as an alternative to robotic systems. The aim of this study was to compare perioperative outcomes between laparoscopic low anterior resection using ArtiSential® and robot-assisted surgery for rectal cancer. METHODS This retrospective study included 682 patients who underwent laparoscopic or robotic low anterior resection for rectal cancer from September 2018 to December 2021. Among them, 82 underwent laparoscopic surgery using ArtiSential® (group A) and 201 underwent robotic surgery (group B). A total of 73 [group A; 66.37 ± 11.62; group B 65.79 ± 11.34] patients were selected for each group using a propensity score matching analysis. RESULTS There was no significant difference in the baseline characteristics between group A and B. Mean operative time was longer in group B than A (163.5 ± 61.9 vs 250.1 ± 77.6 min, p < 0.001). Mean length of hospital stay was not significantly different between the two groups (6.2 ± 4.7 vs 6.7 ± 6.1 days, p = 0.617). Postoperative complications, reoperation, and readmission within 30 days after surgery were similar between the two groups. Pathological findings revealed that the circumferential resection margins were above 10 mm in both groups (11.00 ± 7.47 vs 10.17 ± 6.25 mm, p = 0.960). At least 12 lymph nodes were sufficiently harvested, with no significant difference in the number harvested between the groups (20.5 ± 9.9 vs 19.7 ± 7.3, p = 0.753). CONCLUSIONS Laparoscopic low anterior resection using ArtiSential® can achieve acceptable clinical and oncologic outcomes. ArtiSential®, a multi-joint and articulating device, may serve a feasible alternative approach to robotic surgery in rectal cancer.
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Affiliation(s)
- I K Kim
- Division of Colorectal Surgery, Department of Surgery, Seoul St. Mary's Hospital College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - C S Lee
- Department of Colorectal Surgery, Hansol Hospital, Seoul, Republic of Korea
| | - J H Bae
- Division of Colorectal Surgery, Department of Surgery, Seoul St. Mary's Hospital College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - S R Han
- Division of Colorectal Surgery, Department of Surgery, Seoul St. Mary's Hospital College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - W Alshalawi
- Division of Colorectal Surgery, Department of Surgery, Seoul St. Mary's Hospital College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
- Department of Surgery, King Saud Medical City, Riyadh, Saudi Arabia
| | - B C Kim
- Division of Colorectal Surgery, Department of Surgery, Seoul St. Mary's Hospital College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - I K Lee
- Division of Colorectal Surgery, Department of Surgery, Seoul St. Mary's Hospital College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - D S Lee
- Division of Colorectal Surgery, Department of Surgery, Seoul St. Mary's Hospital College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Y S Lee
- Division of Colorectal Surgery, Department of Surgery, Seoul St. Mary's Hospital College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea.
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18
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Makarov V, Yessentayeva S, Kadyrbayeva R, Irsaliev R, Novikov I. Modifications to the video-assisted thoracoscopic surgery technique reduce 1-year mortality and postoperative complications in intrathoracic tumors. Eur J Cancer Prev 2024; 33:53-61. [PMID: 37401484 DOI: 10.1097/cej.0000000000000825] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/05/2023]
Abstract
OBJECTIVE The purpose of the study is to analyze the immediate outcomes and results of video-assisted thoracoscopic lobectomy and lung resection performed in the surgical department of the AOC between 2014 and 2018. METHODS For the period from 2014 to 2018, 118 patients with peripheral lung cancer were operated on in the surgical department of the AOC. The following operations were performed: lobectomy in 92 cases (78%), of which: upper lobectomy, 44 (47.8%); average lobectomy, 13 (14.1%); lower lobectomy, 32 (35%); bilobectomy, 3 (3.3%). All patients underwent extensive lymphadenectomy on the side of the operation. In 22 patients, for various reasons, preservation of thoracotomy was performed. RESULTS The absence of N0 lymph node damage was observed in 82 patients (70%), the first-order lymph node damage N1 in 13 (11%), N2 in 13 (11%), N3 in 5 (4%), and NX in 5 (4%). Histological examination revealed: squamous cell carcinoma - 35.1%, adenocarcinoma - 28.5%, undifferentiated carcinoma - 8.3%, NSCLC - 5.6%, NEO - 4.6%, sarcoma - 1.8%. At the same time, in 12.7% of patients, mts was detected - lung damage, and in 3.4%, malignant cells were not detected. Most patients were activated on the first day after surgery. CONCLUSION An analysis of the direct results of the study allows us to conclude that video-assisted thoracoscopic surgery is a highly effective, minimally invasive, safe method for treating peripheral lung cancer, which allows us to recommend it for wider use in oncological practice.
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Affiliation(s)
- Valeriy Makarov
- Faculty of Medicine and Health Care, Al-Farabi Kazakh National University
- Department of Oncosurgery, Almaty Regional Multidisciplinary Clinic
| | | | - Rabiga Kadyrbayeva
- Department of Oncosurgery, Kazakh Research Institute of Oncology and Radiology
| | - Rustem Irsaliev
- Department of Oncosurgery, Almaty Oncology Center, Almaty, Republic of Kazakhstan
| | - Igor Novikov
- Department of Oncosurgery, Almaty Regional Multidisciplinary Clinic
- Department of Oncology and Mammology, Kazakh-Russian Medical University
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19
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Knitter S, Maurer MM, Winter A, Dobrindt EM, Seika P, Ritschl PV, Raakow J, Pratschke J, Denecke C. Robotic-Assisted Ivor Lewis Esophagectomy Is Safe and Cost Equivalent Compared to Minimally Invasive Esophagectomy in a Tertiary Referral Center. Cancers (Basel) 2023; 16:112. [PMID: 38201540 PMCID: PMC10778089 DOI: 10.3390/cancers16010112] [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: 09/27/2023] [Revised: 12/19/2023] [Accepted: 12/22/2023] [Indexed: 01/12/2024] Open
Abstract
In recent decades, robotic-assisted minimally invasive esophagectomy (RAMIE) has been increasingly adopted for patients with esophageal cancer (EC) or cancer of the gastroesophageal junction (GEJ). However, concerns regarding its costs compared to conventional minimally invasive esophagectomy (MIE) have emerged. This study examined outcomes and costs of RAMIE versus total MIE in 128 patients who underwent Ivor Lewis esophagectomy for EC/GEJ at our department between 2017 and 2021. Surgical costs were higher for RAMIE (EUR 12,370 vs. EUR 10,059, p < 0.001). Yet, median daily (EUR 2023 vs. EUR 1818, p = 0.246) and total costs (EUR 30,510 vs. EUR 29,180, p = 0.460) were comparable. RAMIE showed a lower incidence of postoperative pneumonia (8% vs. 25%, p = 0.029) and a trend towards shorter hospital stays (15 vs. 17 days, p = 0.205), which may have equalized total costs. Factors independently associated with higher costs included readmission to the intensive care unit (hazard ratio [HR] = 7.0), length of stay (HR = 13.5), anastomotic leak (HR = 17.0), and postoperative pneumonia (HR = 5.4). In conclusion, RAMIE does not impose an additional financial burden. This suggests that RAMIE may be considered as a valid alternative approach for esophagectomy. Attention to typical cost factors can enhance postoperative care across surgical methods.
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Affiliation(s)
- Sebastian Knitter
- Department of Surgery, Campus Charité Mitte and Campus Virchow-Klinikum, Charité—Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Augustenburger Platz 1, 13353 Berlin, Germany
| | - Max M. Maurer
- Department of Surgery, Campus Charité Mitte and Campus Virchow-Klinikum, Charité—Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Augustenburger Platz 1, 13353 Berlin, Germany
- BIH Biomedical Innovation Academy, BIH Charité Clinician Scientist Program, Berlin Institute of Health at Charité—Universitätsmedizin Berlin, Charitéplatz 1, 10117 Berlin, Germany
| | - Axel Winter
- Department of Surgery, Campus Charité Mitte and Campus Virchow-Klinikum, Charité—Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Augustenburger Platz 1, 13353 Berlin, Germany
| | - Eva M. Dobrindt
- Department of Surgery, Campus Charité Mitte and Campus Virchow-Klinikum, Charité—Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Augustenburger Platz 1, 13353 Berlin, Germany
| | - Philippa Seika
- Department of Surgery, Campus Charité Mitte and Campus Virchow-Klinikum, Charité—Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Augustenburger Platz 1, 13353 Berlin, Germany
| | - Paul V. Ritschl
- Department of Surgery, Campus Charité Mitte and Campus Virchow-Klinikum, Charité—Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Augustenburger Platz 1, 13353 Berlin, Germany
| | - Jonas Raakow
- Department of Surgery, Campus Charité Mitte and Campus Virchow-Klinikum, Charité—Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Augustenburger Platz 1, 13353 Berlin, Germany
| | - Johann Pratschke
- Department of Surgery, Campus Charité Mitte and Campus Virchow-Klinikum, Charité—Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Augustenburger Platz 1, 13353 Berlin, Germany
| | - Christian Denecke
- Department of Surgery, Campus Charité Mitte and Campus Virchow-Klinikum, Charité—Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Augustenburger Platz 1, 13353 Berlin, Germany
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20
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Liu XR, Liu F, Li ZW, Liu XY, Zhang W, Peng D. The risk of postoperative complications is higher in stage I-III colorectal cancer patients with previous abdominal surgery: a propensity score matching analysis. Clin Transl Oncol 2023; 25:3471-3478. [PMID: 37173570 DOI: 10.1007/s12094-023-03210-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2023] [Accepted: 04/29/2023] [Indexed: 05/15/2023]
Abstract
PURPOSE The aim of this study is to investigate whether previous abdominal surgery (PAS) affected stage I-III colorectal cancer (CRC) patients who underwent radical resection. METHODS Stage I-III CRC patients who received surgery at a single clinical center from Jan 2014 to Dec 2022 were retrospectively included in this study. Baseline characteristics and short-term outcomes were compared between the PAS group and the non-PAS group. Univariate and multivariate logistic regression analyses were used to find risk factors for overall complications and major complications. A 1:1 ratio propensity score matching (PSM) was used to minimize the selection bias between the two groups. Statistical analysis was performed using SPSS (version 22.0) software. RESULTS A total of 5895 stage I-III CRC patients were included according to the inclusion and exclusion criteria. The PAS group had 1336 (22.7%) patients, and the non-PAS group had 4559 (77.3%) patients. After the PSM, there were 1335 patients in each group, and no significant difference was found in all baseline characteristics between the two groups (P > 0.05). After comparing the short-term outcomes, the PAS group had a longer operation time (before PSM, P < 0.01; after PSM, P < 0.01) and more overall complications (before PSM, P = 0.027; after PSM, P = 0.022) whether before or after PSM. In univariate and multivariate logistic regression analyses, PAS was an independent risk factor for overall complications (univariate analysis, P = 0.022; multivariate analysis, P = 0.029) but not for major complications (univariate analysis, P = 0.688). CONCLUSION Stage I-III CRC patients with PAS might experience longer operation time and have a higher risk of postoperative overall complications. However, it did not appear to significantly affect the major complications. Surgeons should take steps to improve surgical outcomes for patients with PAS.
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Affiliation(s)
- Xu-Rui Liu
- Department of Gastrointestinal Surgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing, 400016, China
| | - Fei Liu
- Department of Gastrointestinal Surgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing, 400016, China
| | - Zi-Wei Li
- Department of Gastrointestinal Surgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing, 400016, China
| | - Xiao-Yu Liu
- Department of Gastrointestinal Surgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing, 400016, China
| | - Wei Zhang
- Department of Gastrointestinal Surgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing, 400016, China
| | - Dong Peng
- Department of Gastrointestinal Surgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing, 400016, China.
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21
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Pietersen PI, Hertz P, Olsen RG, Møller LB, Konge L, Bjerrum F. Transfer of skills between laparoscopic and robot-assisted surgery: a systematic review. Surg Endosc 2023; 37:9030-9042. [PMID: 37875694 DOI: 10.1007/s00464-023-10472-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2023] [Accepted: 09/17/2023] [Indexed: 10/26/2023]
Abstract
BACKGROUND Robot-assisted surgery is today well-implemented in many surgical specialties, but requires another skill set than laparoscopy. Most often, robot-assisted surgery is considered add-on to laparoscopic skills but very little is known about the transfer of skills. The aim of the study was to examine to what extent surgical skills are transferable between laparoscopic and robot-assisted surgery. METHODS A systematic search was conducted in three databases (Ovid Medline, Embase, and Web of Science). Studies investigating transfer of skills between laparoscopy and robot-assisted surgery in either a phantom-based, simulation-based, animal model, or clinical setting were eligible for inclusion. Quality assessment was done using the Medical education research study quality instrument and educational New Ottawa Scale. RESULTS Of 15,610 studies identified, 89 studies continued to full-text reading, and 37 studies were included. Four studies were found non-comparable and were left out of the results for the primary outcome. All 33 studies explored transfer from laparoscopy to robot-assisted surgery and 17 found a positive transfer whereas 15 did not. Only 11 studies explored transfer from robot-assisted surgery to laparoscopy, of which only three found a positive transfer. CONCLUSION An almost equal number of publications found a positive transfer and no transfer from laparoscopic to robot-assisted surgery. Fewer studies explored the transfer from robot-assisted surgery to laparoscopy. Very little evidence supports that surgeons trained solely in robot-assisted surgery can perform laparoscopy. This must be considered in future training programs as robot-assisted surgery is expected to become the first-in-line modality for many future surgeons.
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Affiliation(s)
- Pia Iben Pietersen
- Department of Radiology, Odense University Hospital, Kløvervænget 10, Entrance 112, 2nd floor, 5000, Odense C, Denmark.
- Simulation Center (SimC), Odense University Hospital, Odense, Denmark.
| | - Peter Hertz
- Department of Surgery, Hospital Lillebaelt, University of Southern Denmark, Kolding, Denmark
| | - Rikke Groth Olsen
- Copenhagen Prostate Cancer Center, Rigshospitalet, Copenhagen, Denmark
- Center for HR & Education, The Capital Region of Denmark, Copenhagen Academy for Medical Education and Simulation (CAMES), Copenhagen, Denmark
| | - Louise Birch Møller
- Center for HR & Education, The Capital Region of Denmark, Copenhagen Academy for Medical Education and Simulation (CAMES), Copenhagen, Denmark
| | - Lars Konge
- Center for HR & Education, The Capital Region of Denmark, Copenhagen Academy for Medical Education and Simulation (CAMES), Copenhagen, Denmark
- University of Copenhagen, Copenhagen, Denmark
| | - Flemming Bjerrum
- Center for HR & Education, The Capital Region of Denmark, Copenhagen Academy for Medical Education and Simulation (CAMES), Copenhagen, Denmark
- Department of Gastrointestinal and Hepatic Diseases, Copenhagen University Hospital - Herlev and Gentofte, Herlev, Denmark
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22
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Barzola E, Cornejo L, Gómez N, Pigem A, Julià D, Ortega N, Delisau O, Bobb KA, Farrés R, Planellas P. Comparative analysis of short-term outcomes and oncological results between robotic-assisted and laparoscopic surgery for rectal cancer by multiple surgeon implementation: a propensity score-matched analysis. J Robot Surg 2023; 17:3013-3023. [PMID: 37924415 DOI: 10.1007/s11701-023-01736-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2023] [Accepted: 09/26/2023] [Indexed: 11/06/2023]
Abstract
Robotic-assisted surgery (RAS) is becoming increasingly common for the surgical treatment of rectal cancer. However, the use and implementation of robotic surgery remains controversial. This study aimed to compare the short-term outcomes of robotic surgery, focusing on pathological results and disease-free survival (DFS), in our cohort with initial robotic experience by multiple surgeon implementation. This retrospective study enrolled 571 patients diagnosed with rectal cancer, who were treated with chemoradiotherapy and surgery between January 2015 and December 2021. Surgical outcomes after RAS and laparoscopic surgery (LS) were compared using a propensity score-matching (PSM) analysis. After matching, 200 patients (100 in each group) were included. The median operative time was significantly longer in the RAS group than in the LS group (p < 0.001). The conversion and morbidity rates were similar between the groups. A significantly higher rate of complete mesorectal excision (92% vs. 72%; p = 0.001) and number of lymph nodes harvested (p = 0.009) was observed in the RAS group. There were no statistically significant differences between the groups regarding circumferential and distal resection margin involvement. The 3-year overall and disease-free survival rate was similar between the two groups (p = 0.849 and p = 0.582, respectively). Two patients in the LS group developed local recurrence and 27 patients (15.4%) developed metastatic disease. Multivariate analysis showed that tumor stage III was the only factor associated with disease-free survival (HR, 9.34; (95% CI 1.13-77.1), p = 0.038). RAS and LS showed similar outcomes in terms of perioperative, anatomopathological, and disease-free survival, after multiple surgeon implementations.
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Affiliation(s)
- E Barzola
- Colorectal Surgery Unit, Department of General and Digestive Surgery, University Hospital of Girona, Department of Medical Sciences, Faculty of Medicine, University of Girona, Girona Biomedical Research Institute (IDIBGI), Girona, Spain
| | - L Cornejo
- Girona Biomedical Research Institute (IDIBGI), Girona, Spain
| | - N Gómez
- Colorectal Surgery Unit, Department of General and Digestive Surgery, University Hospital of Girona, Department of Medical Sciences, Faculty of Medicine, University of Girona, Girona Biomedical Research Institute (IDIBGI), Girona, Spain
| | - A Pigem
- Colorectal Surgery Unit, Department of General and Digestive Surgery, University Hospital of Girona, Department of Medical Sciences, Faculty of Medicine, University of Girona, Girona Biomedical Research Institute (IDIBGI), Girona, Spain
| | - D Julià
- Colorectal Surgery Unit, Department of General and Digestive Surgery, University Hospital of Girona, Department of Medical Sciences, Faculty of Medicine, University of Girona, Girona Biomedical Research Institute (IDIBGI), Girona, Spain
| | - N Ortega
- Colorectal Surgery Unit, Department of General and Digestive Surgery, University Hospital of Girona, Department of Medical Sciences, Faculty of Medicine, University of Girona, Girona Biomedical Research Institute (IDIBGI), Girona, Spain
| | - O Delisau
- Colorectal Surgery Unit, Department of General and Digestive Surgery, University Hospital of Girona, Department of Medical Sciences, Faculty of Medicine, University of Girona, Girona Biomedical Research Institute (IDIBGI), Girona, Spain
| | - K A Bobb
- Department of Clinical Surgical Sciences, Faculty of Medical Sciences, University of the West Indies-St. Augustine, Eric Williams Medical Sciences Complex, Mount Hope, Trinidad, West Indies, Trinidad and Tobago
| | - R Farrés
- Colorectal Surgery Unit, Department of General and Digestive Surgery, University Hospital of Girona, Department of Medical Sciences, Faculty of Medicine, University of Girona, Girona Biomedical Research Institute (IDIBGI), Girona, Spain
| | - P Planellas
- Colorectal Surgery Unit, Department of General and Digestive Surgery, University Hospital of Girona, Department of Medical Sciences, Faculty of Medicine, University of Girona, Girona Biomedical Research Institute (IDIBGI), Girona, Spain.
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23
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Sterk MFM, Crolla RMPH, Verseveld M, Dekker JWT, van der Schelling GP, Verhoef C, Olthof PB. Uptake of robot-assisted colon cancer surgery in the Netherlands. Surg Endosc 2023; 37:8196-8203. [PMID: 37644155 PMCID: PMC10615967 DOI: 10.1007/s00464-023-10383-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2023] [Accepted: 08/06/2023] [Indexed: 08/31/2023]
Abstract
BACKGROUND The robot-assisted approach is now often used for rectal cancer surgery, but its use in colon cancer surgery is less well defined. This study aims to compare the outcomes of robotic-assisted colon cancer surgery to conventional laparoscopy in the Netherlands. METHODS Data on all patients who underwent surgery for colon cancer from 2018 to 2020 were collected from the Dutch Colorectal Audit. All complications, readmissions, and deaths within 90 days after surgery were recorded along with conversion rate, margin and harvested nodes. Groups were stratified according to the robot-assisted and laparoscopic approach. RESULTS In total, 18,886 patients were included in the analyses. The operative approach was open in 15.2%, laparoscopic in 78.9% and robot-assisted in 5.9%. The proportion of robot-assisted surgery increased from 4.7% in 2018 to 6.9% in 2020. There were no notable differences in outcomes between the robot-assisted and laparoscopic approach for Elective cT1-3M0 right, left, and sigmoid colectomy. Only conversion rate was consistently lower in the robotic group. (4.6% versus 8.8%, 4.6% versus 11.6%, and 1.6 versus 5.9%, respectively). CONCLUSIONS This nationwide study on surgery for colon cancer shows there is a gradual but slow adoption of robotic surgery for colon cancer up to 6.9% in 2020. When comparing the outcomes of right, left, and sigmoid colectomy, clinical outcomes were similar between the robotic and laparoscopic approach. However, conversion rate is consistently lower in the robotic procedures.
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Affiliation(s)
| | | | - Mareille Verseveld
- Department of Surgery, Franciscus Gasthuis & Vlietland, Rotterdam, The Netherlands
| | | | | | - Cornelis Verhoef
- Department of Surgery, Erasmus MC Cancer Institute, Dr. Molewaterplein 40, 3015GD, Rotterdam, The Netherlands
| | - Pim B Olthof
- Department of Surgery, Amphia Hospital, Breda, The Netherlands.
- Department of Surgery, Erasmus MC Cancer Institute, Dr. Molewaterplein 40, 3015GD, Rotterdam, The Netherlands.
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24
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Yamada K, Enokida Y, Kato R, Imaizumi J, Takada T, Ojima H. The Feasibility and Reliability of Upper Arm-Worn Apple Watch Heart Rate Monitoring for Surgeons During Surgery: Observational Study. JMIR Hum Factors 2023; 10:e50891. [PMID: 37910162 PMCID: PMC10652190 DOI: 10.2196/50891] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2023] [Revised: 09/05/2023] [Accepted: 09/23/2023] [Indexed: 11/03/2023] Open
Abstract
BACKGROUND Health care professionals, particularly those in surgical settings, face high stress levels, impacting their well-being. Traditional monitoring methods, like using Holter electrocardiogram monitors, are impractical in the operating room, limiting the assessment of physicians' health. Wrist-worn heart rate monitors, like the Apple Watch, offer promise but are restricted in surgeries due to sterility issues. OBJECTIVE This study aims to assess the feasibility and accuracy of using an upper arm-worn Apple Watch for heart rate monitoring during robotic-assisted surgeries, comparing its performance with that of a wrist-worn device to establish a reliable alternative monitoring site. METHODS This study used 2 identical Apple Watch Series 8 devices to monitor the heart rate of surgeons during robotic-assisted surgery. Heart rate data were collected from the wrist-worn and the upper arm-worn devices. Statistical analyses included calculating the mean difference and SD of difference between the 2 devices, constructing Bland-Altman plots, assessing accuracy based on mean absolute error and mean absolute percentage error, and calculating the intraclass correlation coefficient. RESULTS The mean absolute errors for the whole group and for participants A, B, C, and D were 3.63, 3.58, 2.70, 3.93, and 4.28, respectively, and the mean absolute percentage errors were 3.58%, 3.34%, 2.42%, 4.58%, and 4.00%, respectively. Bland-Altman plots and scatter plots showed no systematic error when comparing the heart rate measurements obtained from the upper arm-worn and the wrist-worn Apple Watches. The intraclass correlation coefficients for participants A, B, C, and D were 0.559, 0.651, 0.508, and 0.563, respectively, with a significance level of P<.001, indicating moderate reliability. CONCLUSIONS The findings of this study suggest that the upper arm is a viable alternative site for monitoring heart rate during surgery using an Apple Watch. The agreement and reliability between the measurements obtained from the upper arm-worn and the wrist-worn devices were good, with no systematic error and a high level of accuracy. These findings have important implications for improving data collection and management of the physical and mental demands of operating room staff during surgery, where wearing a watch on the wrist may not be feasible.
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Affiliation(s)
- Kazunosuke Yamada
- Department of Gastroenterological Surgery, Gunma Prefectural Cancer Center, Oota City, Gunma, Japan
| | - Yasuaki Enokida
- Department of Gastroenterological Surgery, Gunma Prefectural Cancer Center, Oota City, Gunma, Japan
| | - Ryuji Kato
- Department of Gastroenterological Surgery, Gunma Prefectural Cancer Center, Oota City, Gunma, Japan
| | - Jun Imaizumi
- Department of Gastroenterological Surgery, Gunma Prefectural Cancer Center, Oota City, Gunma, Japan
| | - Takahiro Takada
- Department of Gastroenterological Surgery, Gunma Prefectural Cancer Center, Oota City, Gunma, Japan
| | - Hitoshi Ojima
- Department of Gastroenterological Surgery, Gunma Prefectural Cancer Center, Oota City, Gunma, Japan
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25
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Riner AN, Sharp SP. ASO Author Reflections: Identifying Racial Disparities for Minimally Invasive Approaches to the Surgical Treatment of Colorectal Cancer. Ann Surg Oncol 2023; 30:6760. [PMID: 37454020 DOI: 10.1245/s10434-023-13742-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2023] [Accepted: 06/01/2023] [Indexed: 07/18/2023]
Affiliation(s)
- Andrea N Riner
- Department of Surgery, University of Florida College of Medicine, Gainesville, FL, USA
| | - Stephen P Sharp
- Department of Surgery, Virginia Commonwealth University, Richmond, VA, USA.
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26
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Reddavid R, Sofia S, Puca L, Moro J, Ceraolo S, Jimenez-Rodriguez R, Degiuli M. Robotic Rectal Resection for Rectal Cancer in Elderly Patients: A Systematic Review and Meta-Analysis. J Clin Med 2023; 12:5331. [PMID: 37629373 PMCID: PMC10456068 DOI: 10.3390/jcm12165331] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2023] [Revised: 08/01/2023] [Accepted: 08/08/2023] [Indexed: 08/27/2023] Open
Abstract
Rectal cancer is estimated to increase due to an expanding aging population, thus affecting elderly patients more frequently. The optimal surgical treatment for this type of patient remains controversial because they are often excluded from or underrepresented in trials. This meta-analysis aimed to evaluate the feasibility and the safety of robotic surgery in elderly patients (>70 years old) undergoing curative treatment for rectal cancer. Studies comparing elderly (E) and young (Y) patients submitted to robotic rectal resection were searched on PubMed, Embase, and the Cochrane Library. Data regarding surgical oncologic quality, post-operative, and survival outcomes were extracted. Overall, 322 patients underwent robotic resection (81 in the E group and 241 in the Y group) for rectal cancer. No differences between the two groups were found regarding distal margins and the number of nodes yielded (12.70 in the E group vs. 14.02 in the Y group, p = 0.16). No differences were found in conversion rate, postoperative morbidity, mortality, and length of stay. Survival outcomes were only reported in one study. The results of this study suggest that elderly patients can be submitted to robotic resection for rectal cancer with the same oncologic surgical quality offered to young patients, without increasing postoperative mortality and morbidity.
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Affiliation(s)
- Rossella Reddavid
- University of Turin, Department of Oncology, Division of Surgical Oncology and Digestive Surgery, San Luigi University Hospital, 10043 Turin, Italy; (S.S.); (L.P.); (J.M.)
| | - Silvia Sofia
- University of Turin, Department of Oncology, Division of Surgical Oncology and Digestive Surgery, San Luigi University Hospital, 10043 Turin, Italy; (S.S.); (L.P.); (J.M.)
| | - Lucia Puca
- University of Turin, Department of Oncology, Division of Surgical Oncology and Digestive Surgery, San Luigi University Hospital, 10043 Turin, Italy; (S.S.); (L.P.); (J.M.)
| | - Jacopo Moro
- University of Turin, Department of Oncology, Division of Surgical Oncology and Digestive Surgery, San Luigi University Hospital, 10043 Turin, Italy; (S.S.); (L.P.); (J.M.)
| | - Simona Ceraolo
- Nursing Degree Program, Department of Clinical and Biological Sciences, University of Turin, 10124 Torino, Italy;
| | | | - Maurizio Degiuli
- University of Turin, Department of Oncology, Division of Surgical Oncology and Digestive Surgery, San Luigi University Hospital, 10043 Turin, Italy; (S.S.); (L.P.); (J.M.)
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27
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Geitenbeek RTJ, Burghgraef TA, Broekman M, Schop BPA, Lieverse TGF, Hompes R, Havenga K, Postma MJ, Consten ECJ. Economic analysis of open versus laparoscopic versus robot-assisted versus transanal total mesorectal excision in rectal cancer patients: A systematic review. PLoS One 2023; 18:e0289090. [PMID: 37506122 PMCID: PMC10381040 DOI: 10.1371/journal.pone.0289090] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2023] [Accepted: 07/11/2023] [Indexed: 07/30/2023] Open
Abstract
OBJECTIVES Minimally invasive total mesorectal excision is increasingly being used as an alternative to open surgery in the treatment of patients with rectal cancer. This systematic review aimed to compare the total, operative and hospitalization costs of open, laparoscopic, robot-assisted and transanal total mesorectal excision. METHODS This systematic review was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement (PRISMA) (S1 File) A literature review was conducted (end-of-search date: January 1, 2023) and quality assessment performed using the Consensus Health Economic Criteria. RESULTS 12 studies were included, reporting on 2542 patients (226 open, 1192 laparoscopic, 998 robot-assisted and 126 transanal total mesorectal excision). Total costs of minimally invasive total mesorectal excision were higher compared to the open technique in the majority of included studies. For robot-assisted total mesorectal excision, higher operative costs and lower hospitalization costs were reported compared to the open and laparoscopic technique. A meta-analysis could not be performed due to low study quality and a high level of heterogeneity. Heterogeneity was caused by differences in the learning curve and statistical methods used. CONCLUSION Literature regarding costs of total mesorectal excision techniques is limited in quality and number. Available evidence suggests minimally invasive techniques may be more expensive compared to open total mesorectal excision. High-quality economical evaluations, accounting for the learning curve, are needed to properly assess costs of the different techniques.
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Affiliation(s)
- Ritchie T J Geitenbeek
- Department of Surgery, Meander Medical Center, Amersfoort, The Netherlands
- Department of Surgery, Groningen University Medical Center, University of Groningen, Groningen, The Netherlands
| | - Thijs A Burghgraef
- Department of Surgery, Meander Medical Center, Amersfoort, The Netherlands
- Department of Surgery, Groningen University Medical Center, University of Groningen, Groningen, The Netherlands
| | - Mark Broekman
- Department of Surgery, Groningen University Medical Center, University of Groningen, Groningen, The Netherlands
| | - Bram P A Schop
- Department of Surgery, Groningen University Medical Center, University of Groningen, Groningen, The Netherlands
| | - Tom G F Lieverse
- Department of Surgery, Groningen University Medical Center, University of Groningen, Groningen, The Netherlands
| | - Roel Hompes
- Department of Surgery, Amsterdam University Medical Centre, Location Amsterdam Medical Centre, Amsterdam, The Netherlands
| | - Klaas Havenga
- Department of Surgery, Groningen University Medical Center, University of Groningen, Groningen, The Netherlands
| | - Maarten J Postma
- Department of Health Sciences, University Medical Centre Groningen, University of Groningen, Groningen, The Netherlands
- Department of Economics, Econometrics & Finance, Faculty of Economics & Business, University of Groningen, Groningen, The Netherlands
| | - Esther C J Consten
- Department of Surgery, Meander Medical Center, Amersfoort, The Netherlands
- Department of Surgery, Groningen University Medical Center, University of Groningen, Groningen, The Netherlands
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28
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Formisano G, Ferraro L, Salaj A, Giuratrabocchetta S, Piccolo G, Di Raimondo G, Bianchi PP. Robotic Total Mesorectal Excision for Low Rectal Cancer: A Narrative Review and Description of the Technique. J Clin Med 2023; 12:4859. [PMID: 37510973 PMCID: PMC10381747 DOI: 10.3390/jcm12144859] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2023] [Revised: 07/21/2023] [Accepted: 07/22/2023] [Indexed: 07/30/2023] Open
Abstract
Robotic surgery may offer significant advantages for treating extraperitoneal rectal cancer. Although laparoscopy has been shown to be safe and effective, laparoscopic total mesorectal excision (TME) remains technically challenging and is still performed in selected centers. Robotic anterior resection (RAR) may overcome the drawback of conventional laparoscopy, providing high-quality surgery with favorable oncological outcomes. Moreover, recent data show how RAR offers clinical and oncological benefits when affording difficult TMEs, such as low and advanced rectal tumors, in terms of complication rate, specimen quality, recurrence rate, and survival. This series aims to review the most recent and relevant literature, reporting mid- and long-term oncological outcomes and focusing on minimally invasive RAR for low rectal cancer.
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Affiliation(s)
- Giampaolo Formisano
- Department of Surgery, Asst Santi Paolo e Carlo, Dipartimento di Scienze della Salute, University of Milan, 20122 Milan, Italy
| | - Luca Ferraro
- Department of General Surgery, Asst Santi Paolo e Carlo, 20142 Milan, Italy
| | - Adelona Salaj
- Department of Surgery, Asst Santi Paolo e Carlo, Dipartimento di Scienze della Salute, University of Milan, 20122 Milan, Italy
| | - Simona Giuratrabocchetta
- Department of Surgery, Asst Santi Paolo e Carlo, Dipartimento di Scienze della Salute, University of Milan, 20122 Milan, Italy
| | - Gaetano Piccolo
- Department of Surgery, Asst Santi Paolo e Carlo, Dipartimento di Scienze della Salute, University of Milan, 20122 Milan, Italy
| | - Giulia Di Raimondo
- Department of Surgery, Asst Santi Paolo e Carlo, Dipartimento di Scienze della Salute, University of Milan, 20122 Milan, Italy
| | - Paolo Pietro Bianchi
- Department of Surgery, Asst Santi Paolo e Carlo, Dipartimento di Scienze della Salute, University of Milan, 20122 Milan, Italy
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29
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Ciocan RA, Graur F, Ciocan A, Cismaru CA, Pintilie SR, Berindan-Neagoe I, Hajjar NA, Gherman CD. Robot-Guided Ultrasonography in Surgical Interventions. Diagnostics (Basel) 2023; 13:2456. [PMID: 37510199 PMCID: PMC10378616 DOI: 10.3390/diagnostics13142456] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2023] [Accepted: 07/19/2023] [Indexed: 07/30/2023] Open
Abstract
INTRODUCTION The introduction of robotic-guided procedures in surgical techniques has brought an increase in the accuracy and control of resections. Surgery has evolved as a technique since the development of laparoscopy, which has added to the visualisation of the peritoneal cavity from a different perspective. Multi-armed robot associated with real-time intraoperative imaging devices brings important manoeuvrability and dexterity improvements in certain surgical fields. MATERIALS AND METHODS The present study is designed to synthesise the development of imaging techniques with a focus on ultrasonography in robotic surgery in the last ten years regarding abdominal surgical interventions. RESULTS All studies involved abdominal surgery. Out of the seven studies, two were performed in clinical trials. The other five studies were performed on organs or simulators and attempted to develop a hybrid surgical technique using ultrasonography and robotic surgery. Most studies aim to surgically identify both blood vessels and nerve structures through this combined technique (surgery and imaging). CONCLUSIONS Ultrasonography is often used in minimally invasive surgical techniques. This adds to the visualisation of blood vessels, the correct identification of tumour margins, and the location of surgical instruments in the tissue. The development of ultrasound technology from 2D to 3D and 4D has brought improvements in minimally invasive and robotic surgical techniques, and it should be further studied to bring surgery to a higher level.
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Affiliation(s)
- Răzvan Alexandru Ciocan
- Department of Surgery-Practical Abilities, "Iuliu Hațieganu" University of Medicine and Pharmacy Cluj-Napoca, Marinescu Street, No. 23, 400337 Cluj-Napoca, Romania
| | - Florin Graur
- Department of Surgery, "Iuliu Hațieganu" University of Medicine and Pharmacy Cluj-Napoca, Croitorilor Street, No. 19-21, 400162 Cluj-Napoca, Romania
| | - Andra Ciocan
- Department of Surgery, "Iuliu Hațieganu" University of Medicine and Pharmacy Cluj-Napoca, Croitorilor Street, No. 19-21, 400162 Cluj-Napoca, Romania
| | - Cosmin Andrei Cismaru
- Research Center for Functional Genomics, Biomedicine and Translational Medicine, "Iuliu Hațieganu" University of Medicine and Pharmacy Cluj-Napoca, Victor Babeș Street, No. 8, 400347 Cluj-Napoca, Romania
| | - Sebastian Romeo Pintilie
- "Iuliu Hațieganu" University of Medicine and Pharmacy Cluj-Napoca, Victor Babeș Street, No. 8, 400347 Cluj-Napoca, Romania
| | - Ioana Berindan-Neagoe
- Research Center for Functional Genomics, Biomedicine and Translational Medicine, "Iuliu Hațieganu" University of Medicine and Pharmacy Cluj-Napoca, Victor Babeș Street, No. 8, 400347 Cluj-Napoca, Romania
| | - Nadim Al Hajjar
- Department of Surgery, "Iuliu Hațieganu" University of Medicine and Pharmacy Cluj-Napoca, Croitorilor Street, No. 19-21, 400162 Cluj-Napoca, Romania
| | - Claudia Diana Gherman
- Department of Surgery-Practical Abilities, "Iuliu Hațieganu" University of Medicine and Pharmacy Cluj-Napoca, Marinescu Street, No. 23, 400337 Cluj-Napoca, Romania
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Ye SP, Yu HX, Liu DN, Lu WJ, Wu C, Xu HC, Li TY. Comparison of robotic-assisted and laparoscopic-assisted natural orifice specimen extraction surgery in short-terms outcomes of middle rectal cancer. World J Surg Oncol 2023; 21:196. [PMID: 37403084 DOI: 10.1186/s12957-023-03083-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2023] [Accepted: 06/17/2023] [Indexed: 07/06/2023] Open
Abstract
BACKGROUND Surgery is becoming less invasive as technology advances. Natural orifice specimen extraction surgery (NOSES) ushered in a new era of minimally invasive techniques. At the same time, NOSES is gaining popularity in the world. With their distinct advantages, surgical robots have advanced the development of NOSES. The aim of current study was to compare the short-term outcomes between robotic-assisted NOSES and laparoscopic-assisted NOSES for the treatment of middle rectal cancer. METHODS Patients with middle rectal cancer who underwent robotic-assisted or laparoscopic-assisted NOSES at the First Affiliated Hospital of Nanchang University between January 2020 and June 2022 had their clinicopathological data collected retrospectively. 46 patients were enrolled in the study: 23 in the robotic group and 23 in the laparoscopic group. Short-term outcomes and postoperative anal function in the two groups were compared. RESULTS There was no significant difference in the clinicopathological data between the two groups. The robotic group had less intraoperative blood loss (p = 0.04), less postoperative abdominal drainage (p = 0.02), lower postoperative white blood cell counts (p = 0.024) and C-reactive protein levels (p = 0.017), and shorter catheter removal time when compared to the laparoscopic group (p = 0.003). Furthermore, there were no significant difference in mean operative time (159 ± 31 min vs 172 ± 41 min) between the robotic and laparoscopic groups (p = 0.235), but time to naked the rectum (86.4 ± 20.9 min vs. 103.8 ± 31.5 min p = 0.033) and time of digestive tract reconstruction (15.6 ± 3.88 min vs. 22.1 ± 2.81 min p < 0.01) in the robotic group were significantly shorter than laparoscopic group. The robotic group had lower postoperative Wexner scores than the laparoscopic group. CONCLUSIONS This research reveals that combining a robotic surgical system and NOSES results in superior outcomes, with short-term outcomes preferable to laparoscopic-assisted NOSES.
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Affiliation(s)
- Shan-Ping Ye
- Department of General Surgery, The First Affiliated Hospital of Nanchang University, No. 17 Yongwaizheng Street, Nanchang, 330006, Jiangxi Province, China
| | - Hong-Xin Yu
- Department of General Surgery, The First Affiliated Hospital of Nanchang University, No. 17 Yongwaizheng Street, Nanchang, 330006, Jiangxi Province, China
| | - Dong-Ning Liu
- Department of General Surgery, The First Affiliated Hospital of Nanchang University, No. 17 Yongwaizheng Street, Nanchang, 330006, Jiangxi Province, China
| | - Wei-Jie Lu
- Department of General Surgery, The First Affiliated Hospital of Nanchang University, No. 17 Yongwaizheng Street, Nanchang, 330006, Jiangxi Province, China
| | - Can Wu
- Department of General Surgery, The First Affiliated Hospital of Nanchang University, No. 17 Yongwaizheng Street, Nanchang, 330006, Jiangxi Province, China
| | - Hao-Cheng Xu
- Department of General Surgery, The First Affiliated Hospital of Nanchang University, No. 17 Yongwaizheng Street, Nanchang, 330006, Jiangxi Province, China
| | - Tai-Yuan Li
- Department of General Surgery, The First Affiliated Hospital of Nanchang University, No. 17 Yongwaizheng Street, Nanchang, 330006, Jiangxi Province, China.
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Fujino S, Yasui M, Ohue M, Miyoshi N. Efficacy of transanal drainage tube in preventing anastomotic leakage after surgery for rectal cancer: A meta-analysis. World J Gastrointest Surg 2023; 15:1202-1210. [PMID: 37405086 PMCID: PMC10315128 DOI: 10.4240/wjgs.v15.i6.1202] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/26/2022] [Revised: 03/21/2023] [Accepted: 04/25/2023] [Indexed: 06/15/2023] Open
Abstract
BACKGROUND Anastomotic leakage (AL) following rectal cancer surgery is an important cause of mortality and recurrence. Although transanal drainage tubes (TDTs) are expected to reduce the rate of AL, their preventive effects are controversial.
AIM To reveal the effect of TDT in patients with symptomatic AL after rectal cancer surgery.
METHODS A systematic literature search was performed using the PubMed, Embase, and Cochrane Library databases. We included randomized controlled trials (RCTs) and prospective cohort studies (PCSs) in which patients were assigned to two groups depending on the use or non-use of TDT and in which AL was evaluated. The results of the studies were synthesized using the Mantel-Haenszel random-effects model, and a two-tailed P value > 0.05 was considered statistically significant.
RESULTS Three RCTs and two PCSs were included in this study. Symptomatic AL was examined in all 1417 patients (712 with TDT), and TDTs did not reduce the symptomatic AL rate. In a subgroup analysis of 955 patients without a diverting stoma, TDT reduced the symptomatic AL rate (odds ratio = 0.50, 95% confidence interval: 0.29–0.86, P = 0.012).
CONCLUSION TDT may not reduce AL overall among patients undergoing rectal cancer surgery. However, patients without a diverting stoma may benefit from TDT placement.
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Affiliation(s)
- Shiki Fujino
- Innovative Oncology Research and Regenerative Medicine, Osaka International Cancer Institute, Osaka 541-8567, Japan
| | - Masayoshi Yasui
- Department of Surgery, Osaka International Cancer Institute, Osaka 541-8567, Japan
| | - Masayuki Ohue
- Department of Surgery, Osaka International Cancer Institute, Osaka 541-8567, Japan
| | - Norikatsu Miyoshi
- Innovative Oncology Research and Regenerative Medicine, Osaka International Cancer Institute, Osaka 541-8567, Japan
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Narwanti I, Yu ZY, Sethy B, Lai MJ, Lee HY, Olena P, Lee SB, Liou JP. 6-Regioisomeric 5,8-quinolinediones as potent CDC25 inhibitors against colorectal cancers. Eur J Med Chem 2023; 258:115505. [PMID: 37302341 DOI: 10.1016/j.ejmech.2023.115505] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2023] [Revised: 05/13/2023] [Accepted: 05/17/2023] [Indexed: 06/13/2023]
Abstract
Precise and accurate control of cell cycle progression is required to maintain cell identity and proliferation. Failing to keep it will lead to genome instability and tumorigenesis. Cell Division Cycle 25 (CDC25) phosphatases are the key to regulating the activity of the master cell cycle controller, cyclin-dependent kinases (CDKs). Dysregulation of CDC25 has been shown to associate with several human malignancies. Here, we reported a series of derivatives of the CDC25 inhibitor, NSC663284, bearing quinones as core scaffolds and morpholin alkylamino side chains. Among these derivatives, the cytotoxic activity of the 6-isomer of 5,8-quinolinedione derivatives (6b, 16b, 17b, and 18b) displayed higher potency against colorectal cancer (CRC) cells. Compound 6b possessed the most antiproliferative activity, with IC50 values of 0.59 μM (DLD1) and 0.44 μM (HCT116). The treatment of compound 6b resulted in a remarkable effect on cell cycle progression, blocking S-phase progression in DLD1 cells straight away while slowing S-phase progression and accumulated cells in the G2/M phase in HCT116 cells. Furthermore, we showed that compound 6b inhibited CDK1 dephosphorylation and H4K20 methylation in cells. The treatment with compound 6b induced DNA damage and triggered apoptosis. Our study identifies compound 6b as a potent CDC25 inhibitor that induces genome instability and kills cancer cells through an apoptotic pathway, deserving further investigation to fulfill its candidacy as an anti-CRC agent.
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Affiliation(s)
- Iin Narwanti
- School of Pharmacy, College of Pharmacy, Taipei Medical University, Taipei, Taiwan; Faculty of Pharmacy, Universitas Ahmad Dahlan, Yogyakarta, Indonesia
| | - Zih-Yao Yu
- Ph.D. Program in Drug Discovery and Development Industry, College of Pharmacy, Taipei Medical University, Taipei, Taiwan
| | - Bidyadhar Sethy
- School of Pharmacy, College of Pharmacy, Taipei Medical University, Taipei, Taiwan
| | - Mei-Jung Lai
- TMU Research Center for Drug Discovery, Taipei Medical University, Taipei, Taiwan
| | - Hsueh-Yun Lee
- School of Pharmacy, College of Pharmacy, Taipei Medical University, Taipei, Taiwan; Ph.D. Program in Drug Discovery and Development Industry, College of Pharmacy, Taipei Medical University, Taipei, Taiwan; TMU Research Center for Drug Discovery, Taipei Medical University, Taipei, Taiwan
| | | | - Sung-Bau Lee
- Ph.D. Program in Drug Discovery and Development Industry, College of Pharmacy, Taipei Medical University, Taipei, Taiwan; Master Program in Clinical Genomics and Proteomics, College of Pharmacy, Taipei Medical University, Taipei, Taiwan.
| | - Jing-Ping Liou
- School of Pharmacy, College of Pharmacy, Taipei Medical University, Taipei, Taiwan; Ph.D. Program in Drug Discovery and Development Industry, College of Pharmacy, Taipei Medical University, Taipei, Taiwan; TMU Research Center for Drug Discovery, Taipei Medical University, Taipei, Taiwan.
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Cheng K, Li L, Du Y, Wang J, Chen Z, Liu J, Zhang X, Dong L, Shen Y, Yang Z. A systematic review of image-guided, surgical robot-assisted percutaneous puncture: Challenges and benefits. MATHEMATICAL BIOSCIENCES AND ENGINEERING : MBE 2023; 20:8375-8399. [PMID: 37161203 DOI: 10.3934/mbe.2023367] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/11/2023]
Abstract
Percutaneous puncture is a common medical procedure that involves accessing an internal organ or tissue through the skin. Image guidance and surgical robots have been increasingly used to assist with percutaneous procedures, but the challenges and benefits of these technologies have not been thoroughly explored. The aims of this systematic review are to furnish an overview of the challenges and benefits of image-guided, surgical robot-assisted percutaneous puncture and to provide evidence on this approach. We searched several electronic databases for studies on image-guided, surgical robot-assisted percutaneous punctures published between January 2018 and December 2022. The final analysis refers to 53 studies in total. The results of this review suggest that image guidance and surgical robots can improve the accuracy and precision of percutaneous procedures, decrease radiation exposure to patients and medical personnel and lower the risk of complications. However, there are many challenges related to the use of these technologies, such as the integration of the robot and operating room, immature robotic perception, and deviation of needle insertion. In conclusion, image-guided, surgical robot-assisted percutaneous puncture offers many potential benefits, but further research is needed to fully understand the challenges and optimize the utilization of these technologies in clinical practice.
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Affiliation(s)
- Kai Cheng
- Yantai Affiliated Hospital of Binzhou Medical University, Yantai, Shandong 264100, China
| | - Lixia Li
- Yantai Affiliated Hospital of Binzhou Medical University, Yantai, Shandong 264100, China
| | - Yanmin Du
- Yantai Affiliated Hospital of Binzhou Medical University, Yantai, Shandong 264100, China
| | - Jiangtao Wang
- Yantai Affiliated Hospital of Binzhou Medical University, Yantai, Shandong 264100, China
| | - Zhenghua Chen
- Yantai Affiliated Hospital of Binzhou Medical University, Yantai, Shandong 264100, China
| | - Jian Liu
- Yantai Affiliated Hospital of Binzhou Medical University, Yantai, Shandong 264100, China
| | - Xiangsheng Zhang
- Yantai Affiliated Hospital of Binzhou Medical University, Yantai, Shandong 264100, China
| | - Lin Dong
- Center on Frontiers of Computing Studies, Peking University, Beijing 100089, China
| | - Yuanyuan Shen
- Yantai Affiliated Hospital of Binzhou Medical University, Yantai, Shandong 264100, China
| | - Zhenlin Yang
- Yantai Affiliated Hospital of Binzhou Medical University, Yantai, Shandong 264100, China
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Houqiong J, Ziwen W, Chonghan Z, Penghui H, Hongxin Y, Weijie L, Dongning L, Taiyuan L. Comparison of transabdominal wall specimen retrieval and natural orifice specimen extraction robotic surgery in the outcome of colorectal cancer treatment. Front Surg 2023; 10:1092128. [PMID: 36874472 PMCID: PMC9978825 DOI: 10.3389/fsurg.2023.1092128] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2022] [Accepted: 01/16/2023] [Indexed: 02/18/2023] Open
Abstract
Background Natural orifice specimen extraction surgery (NOSES), as a new star of minimally invasive techniques, has been increasingly favored and promoted in the field of surgery around the world. Most previous studies were comparative studies of laparoscopic NOSES and conventional laparoscopic surgery. However, there is little research on comparing robotic colorectal cancer NOSES with conventional robotic-assisted colorectal cancer resection surgery. Participant and methods This study is a retrospective study of propensity score matching (PSM). This study included Ninety-one propensity score-matched pairs of the participant who had undergone robotic colorectal cancer resection surgery at our center between January 2017 and December 2020. The covariates used in the propensity score included gender, age, BMI, ASA score, maximum tumor diameter, the tumor's height from the anal verge, histological differentiation, AJCC stage, T stage, N stage, and history of previous abdominal surgery. The outcome measurement criteria included postoperative complications, inflammatory response, pelvic floor function, anal function, cosmetic outcome, quality of life, disease-free survival (DFS), and overall survival (OS). Results The robotic NOSES group had faster recovery time from gastrointestinal function (P = 0.014), shorter abdominal incision length (P < 0.001), less pain (P < 0.001), less additional analgesia required (P < 0.001), and lower postoperative indicators of white blood cell count (P < 0.001) and C-reactive protein content compared to the robotic-assisted resection surgery (RARS) group (P = 0.035). Additionally, the robotic NOSES group had significantly better body imagery (P < 0.001), cosmetic scores (P < 0.001), somatic function (P = 0.003), role function (P = 0.039), emotional function (P = 0.001), social function (P = 0.004), and overall function (P < 0.001) than the RARS group. The two groups demonstrated no significant difference between DFS and OS. Conclusion Robotic colorectal cancer NOSES is a safe and feasible minimally invasive procedure and offers shorter abdominal incisions, less pain, less surgical stress response, and better postoperative quality of life. Therefore, this technique can be further promoted for colorectal cancer patients eligible for NOSES.
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Affiliation(s)
- Ju Houqiong
- Department of General Surgery, The First Affiliated Hospital of Nanchang University, Nanchang, China.,Laboratory of Digestive Surgery, Nanchang University, Nanchang, China
| | - Wan Ziwen
- Laboratory of Digestive Surgery, Nanchang University, Nanchang, China.,The First Clinical Medical College of Nanchang University, Nanchang, China
| | - Zhong Chonghan
- Department of General Surgery, The First Affiliated Hospital of Nanchang University, Nanchang, China.,Laboratory of Digestive Surgery, Nanchang University, Nanchang, China
| | - He Penghui
- Department of General Surgery, The First Affiliated Hospital of Nanchang University, Nanchang, China.,Laboratory of Digestive Surgery, Nanchang University, Nanchang, China
| | - Yu Hongxin
- Department of General Surgery, The First Affiliated Hospital of Nanchang University, Nanchang, China.,Laboratory of Digestive Surgery, Nanchang University, Nanchang, China
| | - Lu Weijie
- Department of General Surgery, The First Affiliated Hospital of Nanchang University, Nanchang, China.,Laboratory of Digestive Surgery, Nanchang University, Nanchang, China
| | - Liu Dongning
- Department of General Surgery, The First Affiliated Hospital of Nanchang University, Nanchang, China.,Laboratory of Digestive Surgery, Nanchang University, Nanchang, China
| | - Li Taiyuan
- Department of General Surgery, The First Affiliated Hospital of Nanchang University, Nanchang, China.,Laboratory of Digestive Surgery, Nanchang University, Nanchang, China
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Somashekhar SP, Saklani A, Dixit J, Kothari J, Nayak S, Sudheer OV, Dabas S, Goud J, Munikrishnan V, Sugoor P, Penumadu P, Ramachandra C, Mehendale S, Dahiya A. Clinical Robotic Surgery Association (India Chapter) and Indian rectal cancer expert group’s practical consensus statements for surgical management of localized and locally advanced rectal cancer. Front Oncol 2022; 12:1002530. [PMID: 36267970 PMCID: PMC9577482 DOI: 10.3389/fonc.2022.1002530] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2022] [Accepted: 09/16/2022] [Indexed: 11/13/2022] Open
Abstract
Introduction There are standard treatment guidelines for the surgical management of rectal cancer, that are advocated by recognized physician societies. But, owing to disparities in access and affordability of various treatment options, there remains an unmet need for personalizing these international guidelines to Indian settings. Methods Clinical Robotic Surgery Association (CRSA) set up the Indian rectal cancer expert group, with a pre-defined selection criterion and comprised of the leading surgical oncologists and gastrointestinal surgeons managing rectal cancer in India. Following the constitution of the expert Group, members identified three areas of focus and 12 clinical questions. A thorough review of the literature was performed, and the evidence was graded as per the levels of evidence by Oxford Centre for Evidence-Based Medicine. The consensus was built using the modified Delphi methodology of consensus development. A consensus statement was accepted only if ≥75% of the experts were in agreement. Results Using the results of the review of the literature and experts’ opinions; the expert group members drafted and agreed on the final consensus statements, and these were classified as “strong or weak”, based on the GRADE framework. Conclusion The expert group adapted international guidelines for the surgical management of localized and locally advanced rectal cancer to Indian settings. It will be vital to disseminate these to the wider surgical oncologists and gastrointestinal surgeons’ community in India.
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Affiliation(s)
- S. P. Somashekhar
- Department of Surgical Oncology, Manipal Hospital, Bengaluru, Karnataka, India
- *Correspondence: S. P. Somashekhar,
| | - Avanish Saklani
- Department of Surgical Oncology, Tata Memorial Hospital, Mumbai, Maharashtra, India
| | - Jagannath Dixit
- Department of GI Surgery, HCG Hospital, Bengaluru, Karnataka, India
| | - Jagdish Kothari
- Department of Surgical Oncology HCG Hospital, Ahmedabad, Gujarat, India
| | - Sandeep Nayak
- Department of Surgical Oncology, Fortis Hospital, Bengaluru, Karnataka, India
| | - O. V. Sudheer
- Department of GI Surgery and Surgical Oncology, Amrita Institute of Medical Science, Kochi, Kerala, India
| | - Surender Dabas
- Department of Surgical Oncology, BL Kapur-Max Superspeciality Hospital, Delhi, India
| | - Jagadishwar Goud
- Department of Surgical Oncology, AOI Hospital, Hyderabad, Telangana, India
| | | | - Pavan Sugoor
- Department of Surgical Oncology, Kidwai Memorial Institute of Oncology, Bengaluru, Karnataka, India
| | | | - C. Ramachandra
- Director and Head, Department of Surgical Oncology, Kidwai Memorial Institute of Oncology, Bengaluru, Karnataka, India
| | - Shilpa Mehendale
- Director and Head, Department of Surgical Oncology, Kidwai Memorial Institute of Oncology, Bengaluru, Karnataka, India
| | - Akhil Dahiya
- Department of Clinical and Medical Affairs, Intuitive Surgical, California, CA, United States
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Effects of metastatic CRC predictors on treatment outcomes. Surg Oncol 2022; 44:101835. [PMID: 36027665 DOI: 10.1016/j.suronc.2022.101835] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2022] [Revised: 07/27/2022] [Accepted: 08/08/2022] [Indexed: 11/21/2022]
Abstract
BACKGROUND Colorectal cancer (CRC) is the third most commonly diagnosed malignant tumor. The problem of mCRC is urgent due to both an increase in the number of metastatic tumors and the implementation of high-tech treatment methods that have significantly improved the results of a 5-year survival. METHODS The research used the method of experiment and observation. Current study included data of 332 patients with CRC who received comprehensive treatment from 2014 to 2018 in oncology centers of the Republic of Kazakhstan. The patients were treated according to the clinical protocols for the treatment of oncological diseases approved in the Republic of Kazakhstan, including surgical treatment, as well as chemotherapy and radiation therapy, depending on the stage and localization of the process. A comprehensive treatment also included surgical treatment, chemotherapy, targeted chemotherapy and, in some cases, radiation therapy for rectal cancer. The diagnosis was confirmed morphologically in all patients; process dissemination was recorded using standard examination methods. Among the patients, women prevailed - 182 (54.8%) women and 150 men (45.2%) were included; the Caucasian race prevailed - 170 (51.2%) patients and 162 (48.8%) patients were of the Asian race. The mean age of the patients at the time of treatment was 56.4 ± 0.6 years (from 25 to 79 years). Histologically, adenocarcinoma prevailed represented by glandular - in 95.6%, mucous - in 2.9% and trabecular - in 1.5% of cases. A comprehensive treatment was used in 209 (63.0%) patients and other types of treatment were used in 123 (37.0%) patients (PCT, stoma + PCT). Radiation therapy was administered to 13 (3.9%) patients diagnosed with rectal cancer. RESULTS A comparative analysis of the results of pharmacotherapy in the patients with mCRC showed that of 332 patients, 263 (79.2%) received targeted chemotherapy and 69 (20.8%) received standard polychemotherapy. At the time of the study, 85 (32.3%) patients in the targeted chemotherapy group were still alive, with a median survival of 42.0 ± 1.7 months, 95% CI (38.6-45.4). In the polychemotherapy group, 7 (10.1%) patients were alive, while the median survival rate was 20.0 ± 1.7 months, 95% CI (16.6-23.4). CONCLUSION Based on the results, it was concluded that targeted chemotherapy schemes increased progression-free survival, compared to standard polychemotherapy schemes.
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Ravindra C, Igweonu-Nwakile EO, Ali S, Paul S, Yakkali S, Teresa Selvin S, Thomas S, Bikeyeva V, Abdullah A, Radivojevic A, Abu Jad AA, Ravanavena A, Balani P. Comparison of Non-Oncological Postoperative Outcomes Following Robotic and Laparoscopic Colorectal Resection for Colorectal Malignancy: A Systematic Review and Meta-Analysis. Cureus 2022; 14:e27015. [PMID: 35989760 PMCID: PMC9386330 DOI: 10.7759/cureus.27015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2022] [Accepted: 07/19/2022] [Indexed: 11/09/2022] Open
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Tschann P, Weigl MP, Lechner D, Mittelberger C, Jäger T, Gruber R, Girotti PNC, Mittermair C, Clemens P, Attenberger C, Szeverinski P, Brock T, Frick J, Emmanuel K, Königsrainer I, Presl J. Is Robotic Assisted Colorectal Cancer Surgery Equivalent Compared to Laparoscopic Procedures during the Introduction of a Robotic Program? A Propensity-Score Matched Analysis. Cancers (Basel) 2022; 14:cancers14133208. [PMID: 35804985 PMCID: PMC9264883 DOI: 10.3390/cancers14133208] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2022] [Revised: 06/26/2022] [Accepted: 06/28/2022] [Indexed: 12/10/2022] Open
Abstract
Simple Summary The introduction of a robotic program is challenging and requires extensive experience in minimally invasive surgery. Short-term outcomes and oncological quality should not differ between robotic and laparoscopic surgery. To our knowledge, no data on the quality of surgery at the time of introduction of the robotic platform are available. The aim of this study was to compare short-term outcomes and oncological findings of robotic-assisted colorectal resections with those of conventional laparoscopic surgery within the first three years after the introduction of the robotic platform. Abstract Background: Robotic surgery represents a novel approach for the treatment of colorectal cancers and has been established as an important and effective method over the last years. The aim of this work was to evaluate the effect of a robotic program on oncological findings compared to conventional laparoscopic surgery within the first three years after the introduction. Methods: All colorectal cancer patients from two centers that either received robotic-assisted or conventional laparoscopic surgery were included in a comparative study. A propensity-score-matched analysis was used to reduce confounding differences. Results: A laparoscopic resection (LR Group) was performed in 82 cases, and 93 patients were treated robotic-assisted surgery (RR Group). Patients’ characteristics did not differ between groups. In right-sided resections, an intracorporeal anastomosis was significantly more often performed in the RR Group (LR Group: 5 (26.31%) vs. RR Group: 10 (76.92%), p = 0.008). Operative time was shown to be significantly shorter in the LR Group (LR Group: 200 min (150–243) vs. 204 min (174–278), p = 0.045). Conversions to open surgery did occur more often in the LR Group (LR Group: 16 (19.51%) vs. RR Group: 5 (5.38%), p = 0.004). Postoperative morbidity, the number of harvested lymph nodes, quality of resection and postoperative tumor stage did not differ between groups. Conclusion: In this study, we could clearly demonstrate robotic-assisted colorectal cancer surgery as effective, feasible and safe regarding postoperative morbidity and oncological findings compared to conventional laparoscopy during the introduction of a robotic system.
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Affiliation(s)
- Peter Tschann
- Department of General and Thoracic Surgery, Academic Teaching Hospital Feldkirch, Carinagasse 47, 6800 Feldkirch, Austria; (M.P.W.); (D.L.); (C.M.); (P.N.C.G.); (T.B.); (J.F.); (I.K.)
- Correspondence: ; Tel.: +43-(0)-5522-303-0; Fax: +43-(0)-5522-303-7505
| | - Markus P. Weigl
- Department of General and Thoracic Surgery, Academic Teaching Hospital Feldkirch, Carinagasse 47, 6800 Feldkirch, Austria; (M.P.W.); (D.L.); (C.M.); (P.N.C.G.); (T.B.); (J.F.); (I.K.)
| | - Daniel Lechner
- Department of General and Thoracic Surgery, Academic Teaching Hospital Feldkirch, Carinagasse 47, 6800 Feldkirch, Austria; (M.P.W.); (D.L.); (C.M.); (P.N.C.G.); (T.B.); (J.F.); (I.K.)
| | - Christa Mittelberger
- Department of General and Thoracic Surgery, Academic Teaching Hospital Feldkirch, Carinagasse 47, 6800 Feldkirch, Austria; (M.P.W.); (D.L.); (C.M.); (P.N.C.G.); (T.B.); (J.F.); (I.K.)
| | - Tarkan Jäger
- Department of Surgery, Paracelsus Medical University/Salzburger Landeskliniken (SALK), 5020 Salzburg, Austria; (T.J.); (R.G.); (K.E.); (J.P.)
| | - Ricarda Gruber
- Department of Surgery, Paracelsus Medical University/Salzburger Landeskliniken (SALK), 5020 Salzburg, Austria; (T.J.); (R.G.); (K.E.); (J.P.)
| | - Paolo N. C. Girotti
- Department of General and Thoracic Surgery, Academic Teaching Hospital Feldkirch, Carinagasse 47, 6800 Feldkirch, Austria; (M.P.W.); (D.L.); (C.M.); (P.N.C.G.); (T.B.); (J.F.); (I.K.)
| | - Christof Mittermair
- Department of Surgery, St. John of God Hospital, Teaching Hospital of Paracelsus Medical University, 5020 Salzburg, Austria;
| | - Patrick Clemens
- Department of Radio-Oncology, Academic Teaching Hospital, 6800 Feldkirch, Austria;
| | - Christian Attenberger
- Private University in the Principality of Liechtenstein, 9495 Triesen, Liechtenstein;
- Institute of Medical Physics, Academic Teaching Hospital Feldkirch, 6800 Feldkirch, Austria;
| | - Philipp Szeverinski
- Institute of Medical Physics, Academic Teaching Hospital Feldkirch, 6800 Feldkirch, Austria;
| | - Thomas Brock
- Department of General and Thoracic Surgery, Academic Teaching Hospital Feldkirch, Carinagasse 47, 6800 Feldkirch, Austria; (M.P.W.); (D.L.); (C.M.); (P.N.C.G.); (T.B.); (J.F.); (I.K.)
| | - Jürgen Frick
- Department of General and Thoracic Surgery, Academic Teaching Hospital Feldkirch, Carinagasse 47, 6800 Feldkirch, Austria; (M.P.W.); (D.L.); (C.M.); (P.N.C.G.); (T.B.); (J.F.); (I.K.)
| | - Klaus Emmanuel
- Department of Surgery, Paracelsus Medical University/Salzburger Landeskliniken (SALK), 5020 Salzburg, Austria; (T.J.); (R.G.); (K.E.); (J.P.)
| | - Ingmar Königsrainer
- Department of General and Thoracic Surgery, Academic Teaching Hospital Feldkirch, Carinagasse 47, 6800 Feldkirch, Austria; (M.P.W.); (D.L.); (C.M.); (P.N.C.G.); (T.B.); (J.F.); (I.K.)
| | - Jaroslav Presl
- Department of Surgery, Paracelsus Medical University/Salzburger Landeskliniken (SALK), 5020 Salzburg, Austria; (T.J.); (R.G.); (K.E.); (J.P.)
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Medical disease and ambulatory surgery, new insights in patient selection based on medical disease. Curr Opin Anaesthesiol 2022; 35:385-391. [PMID: 35671030 DOI: 10.1097/aco.0000000000001132] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE OF REVIEW Improvements in perioperative care contributed to enlarge the eligibility criteria for day case surgery and more and more patients with comorbidities may be concerned. However, underlying medical diseases may influence postoperative outcomes, and therefore, must be considered when selecting patients to undergo ambulatory surgery. RECENT FINDINGS To limit postoperative complications, rigid patient selection criteria are often applied in ambulatory surgery. In practice, however, most of these criteria predict the occurrence of treatable perioperative adverse events but not the need for unanticipated admission or readmission. SUMMARY The underlying medical diseases should not be considered as sole criteria but they should rather be regarded as a dynamic process, which includes the surgical procedure as well as the experience and expertise of the perioperative setting.
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Hossain MS, Karuniawati H, Jairoun AA, Urbi Z, Ooi DJ, John A, Lim YC, Kibria KMK, Mohiuddin AM, Ming LC, Goh KW, Hadi MA. Colorectal Cancer: A Review of Carcinogenesis, Global Epidemiology, Current Challenges, Risk Factors, Preventive and Treatment Strategies. Cancers (Basel) 2022; 14:cancers14071732. [PMID: 35406504 PMCID: PMC8996939 DOI: 10.3390/cancers14071732] [Citation(s) in RCA: 199] [Impact Index Per Article: 99.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2022] [Revised: 03/22/2022] [Accepted: 03/27/2022] [Indexed: 02/07/2023] Open
Abstract
Colorectal cancer (CRC) is the second most deadly cancer. Global incidence and mortality are likely to be increased in the coming decades. Although the deaths associated with CRC are very high in high-income countries, the incidence and fatalities related to CRC are growing in developing countries too. CRC detected early is entirely curable by surgery and subsequent medications. However, the recurrence rate is high, and cancer drug resistance increases the treatment failure rate. Access to early diagnosis and treatment of CRC for survival is somewhat possible in developed countries. However, these facilities are rarely available in developing countries. Highlighting the current status of CRC, its development, risk factors, and management is crucial in creating public awareness. Therefore, in this review, we have comprehensively discussed the current global epidemiology, drug resistance, challenges, risk factors, and preventive and treatment strategies of CRC. Additionally, there is a brief discussion on the CRC development pathways and recommendations for preventing and treating CRC.
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Affiliation(s)
- Md. Sanower Hossain
- Department of Biomedical Science, Kulliyyah of Allied Health Sciences, International Islamic University Malaysia, Kuantan 25200, Pahang, Malaysia
- Faculty of Science, Sristy College of Tangail, Tangail 1900, Bangladesh
- Correspondence: (M.S.H.); (L.C.M.); Tel.: +60-1169609649 (M.S.H.); +673-246-0922 (ext. 2202) (L.C.M.)
| | - Hidayah Karuniawati
- Discipline of Social and Administrative Pharmacy, School of Pharmaceutical Sciences, Universiti Sains Malaysia, Gelugor 11800, Pulau Pinang, Malaysia; (H.K.); (A.A.J.)
- Department of Pharmacology and Clinical Pharmacy, Faculty of Pharmacy, Universitas Muhammadiyah Surakarta, Surakarta 57102, Indonesia
| | - Ammar Abdulrahman Jairoun
- Discipline of Social and Administrative Pharmacy, School of Pharmaceutical Sciences, Universiti Sains Malaysia, Gelugor 11800, Pulau Pinang, Malaysia; (H.K.); (A.A.J.)
- Health and Safety Department, Dubai Municipality, Dubai 67, United Arab Emirates
| | - Zannat Urbi
- Department of Industrial Biotechnology, Faculty of Industrial Sciences & Technology, Universiti Malaysia Pahang, Kuantan 26300, Pahang, Malaysia;
| | - Der Jiun Ooi
- Department of Oral Biology & Biomedical Sciences, Faculty of Dentistry, MAHSA University, Jenjarom 42610, Selangor, Malaysia;
| | - Akbar John
- Institute of Oceanography and Maritime Studies (INOCEM), Kulliyyah of Science, International Islamic University Malaysia, Kuantan 25200, Pahang, Malaysia;
| | - Ya Chee Lim
- PAP Rashidah Sa’adatul Bolkiah Institute of Health Sciences, Universiti Brunei Darussalam, Gadong BE1410, Brunei;
| | - K. M. Kaderi Kibria
- Department of Biotechnology & Genetic Engineering, Mawlana Bhashani Science and Technology University, Tangail 1902, Bangladesh; (K.M.K.K.); (A.K.M.M.)
| | - A.K. M. Mohiuddin
- Department of Biotechnology & Genetic Engineering, Mawlana Bhashani Science and Technology University, Tangail 1902, Bangladesh; (K.M.K.K.); (A.K.M.M.)
| | - Long Chiau Ming
- PAP Rashidah Sa’adatul Bolkiah Institute of Health Sciences, Universiti Brunei Darussalam, Gadong BE1410, Brunei;
- Correspondence: (M.S.H.); (L.C.M.); Tel.: +60-1169609649 (M.S.H.); +673-246-0922 (ext. 2202) (L.C.M.)
| | - Khang Wen Goh
- Faculty of Data Science and Information Technology, INTI International University, Nilai 71800, Negeri Sembilan, Malaysia;
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