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Son GM, Lee IY, Lee YS, Kye BH, Cho HM, Jang JH, Kim CN, Lee KY, Lee SH, Kim JG. Is Laparoscopic Complete Mesocolic Excision and Central Vascular Ligation Really Necessary for All Patients With Right-Sided Colon Cancer? Ann Coloproctol 2021; 37:434-444. [PMID: 34875818 PMCID: PMC8717068 DOI: 10.3393/ac.2021.00955.0136] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2021] [Accepted: 11/15/2021] [Indexed: 02/08/2023] Open
Abstract
Colon cancer treatment is on the way to evolution over several decades. The minimally invasive surgery has improved postoperative short-term outcomes. Adjuvant chemotherapy has prolonged the survival of advanced colon cancer patients. Hohenberger proposed the noble concept of complete mesocolic excision (CME) which consists of 3 components: plane surgery, sufficient longitudinal bowel resection, and central vascular ligation (CVL). Mesocolic plane surgery shares the same surgical principle of total mesorectal excision, which is maintaining the intact mesothelial envelope. However, there remain debates about the extent of bowel resection and the level of CVL for maximizing lymph node dissection. There is no solid clinical evidence for the oncological necessity and benefit of extended radical dissection in right hemicolectomy. CME with CVL based on open surgery has been adopted in laparoscopic surgery. So, it is also necessary to look at how the CME could be transformed and successfully implanted in the laparoscopic era. Recent rapid advances in surgical technology and cancer biology are preparing for fundamental changes in cancer surgery. In this study, we reviewed the history, oncological necessity, and compatibility of CME for the right hemicolectomy in the laparoscopic era and outline the new perspectives on the evolution of cancer surgery.
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Affiliation(s)
- Gyung Mo Son
- Department of Surgery, Pusan National University Yangsan Hospital, Pusan National University School of Medicine,Yangsan, Korea
| | - In Young Lee
- Department of Surgery, Pusan National University Yangsan Hospital, Pusan National University School of Medicine,Yangsan, Korea
| | - Yoon Suk Lee
- Department of Surgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Bong-Hyeon Kye
- Division of Colorectal Surgery, Department of Surgery, St. Vincent's Hospital, College of Medicine, The Catholic University of Korea, Suwon, Korea
| | - Hyeon-Min Cho
- Division of Colorectal Surgery, Department of Surgery, St. Vincent's Hospital, College of Medicine, The Catholic University of Korea, Suwon, Korea
| | - Je-Ho Jang
- Department of Surgery, Daejeon Eulji Medical Center, Eulji University School of Medicine, Daejeon, Korea
| | - Chang-Nam Kim
- Department of Surgery, Daejeon Eulji Medical Center, Eulji University School of Medicine, Daejeon, Korea
| | - Kil Yeon Lee
- Department of Surgery, Kyung Hee University College of Medicine, Seoul, Korea
| | - Suk-Hwan Lee
- Department of Surgery, Kyung Hee University Hospital at Gangdong, Kyung Hee University School of Medicine, Seoul, Korea
| | - Jun-Gi Kim
- Department of Surgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea.,Department of Surgery, Pyeongtaek St. Mary's Hospital, Pyeongtaek, Korea
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Chaouch MA, Dougaz MW, Mesbehi M, Jerraya H, Nouira R, Khan JS, Dziri C. A meta-analysis comparing hand-assisted laparoscopic right hemicolectomy and open right hemicolectomy for right-sided colon cancer. World J Surg Oncol 2020; 18:91. [PMID: 32381008 PMCID: PMC7206699 DOI: 10.1186/s12957-020-01869-w] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2020] [Accepted: 04/30/2020] [Indexed: 12/15/2022] Open
Abstract
Background Mini-invasive colorectal cancer surgery was adopted widely in recent years. This meta-analysis aimed to compare hand-assisted laparoscopic surgery (HALS) with open right hemicolectomy (OS) for malignant disease. Methods PRISMA guidelines with random effects model were adopted using Review Manager Version 5.3 for pooled estimates. Results Seven studies that involved 506 patients were included. Compared to OS, HALS improved results in terms of blood loss (MD = 53.67, 95% CI 10.67 to 96.67, p = 0.01), time to first flatus (MD = 21.11, 95% CI 14.99 to 27.23, p < 0.00001), postoperative pain score, and overall hospital stay (MD = 3.47, 95% CI 2.12 to 4.82, p < 0.00001). There was no difference as concerns post-operative mortality, morbidity (OR = 1.55, 95% CI 0.89 to 2.7, p = 0.12), wound infection (OR = 1.69, 95% CI 0.60 to 4.76, p = 0.32), operative time (MD = − 16.10, 95% CI [− 36.57 to 4.36], p = 0.12), harvested lymph nodes (MD = 0.59, 95% CI − 0.18 to 1.36, p = 0.13), and recurrence (OR = 0.97, 95% CI 0.30 to 3.15, p = 0.96). Conclusions HALS is an efficient alternative to OS in right colectomy which combines the advantages of OS with the mini-invasive surgery.
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Affiliation(s)
- Mohamed Ali Chaouch
- Department B of Surgery, Charles Nicolle Hospital, University Tunis El Manar, Tunis, Tunisia.
| | - Mohamed Wejih Dougaz
- Department B of Surgery, Charles Nicolle Hospital, University Tunis El Manar, Tunis, Tunisia
| | - Meriem Mesbehi
- Department B of Surgery, Charles Nicolle Hospital, University Tunis El Manar, Tunis, Tunisia
| | - Hichem Jerraya
- Department B of Surgery, Charles Nicolle Hospital, University Tunis El Manar, Tunis, Tunisia
| | - Ramzi Nouira
- Department B of Surgery, Charles Nicolle Hospital, University Tunis El Manar, Tunis, Tunisia
| | - Jim S Khan
- Department of Colorectal Surgery, Queen Alexandra Hospital, Southwick Hill road, Cosham, Portsmouth, UK
| | - Chadli Dziri
- Department B of Surgery, Charles Nicolle Hospital, University Tunis El Manar, Tunis, Tunisia
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Pelz JOW, Wagner J, Lichthardt S, Baur J, Kastner C, Matthes N, Germer CT, Wiegering A. Laparoscopic right-sided colon resection for colon cancer-has the control group so far been chosen correctly? World J Surg Oncol 2018; 16:117. [PMID: 29954404 PMCID: PMC6022499 DOI: 10.1186/s12957-018-1417-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2018] [Accepted: 06/13/2018] [Indexed: 12/16/2022] Open
Abstract
Background The treatment strategies for colorectal cancer located in the right side of the colon have changed dramatically during the last decade. Due to the introduction of complete mesocolic excision (CME) with central ligation of the vessels and systematic lymph node dissection, the long-term survival of affected patients has increased significantly. It has also been proposed that right-sided colon resection can be performed laparoscopically with the same extent of resection and equal long-term results. Methods A retrospective evaluation of a prospectively expanded database on right-sided colorectal cancer or adenoma treated at the University Hospital of Wuerzburg between 2009 and 2016 was performed. All patients underwent CME. This data was analyzed alone and in comparison to the published data describing laparoscopic right-sided colon resection for colon cancer. Results The database contains 279 patients, who underwent right-sided colon resection due to colorectal cancer or colorectal adenoma (255 open; 24 laparoscopic). Operation data (time, length of stay, time on ICU) was equal or superior to laparoscopy, which is comparable to the published results. Surprisingly, the surrogate parameter for correct CME (the number of removed lymph nodes) was significantly higher in the open group. In a subgroup analysis only including patients who were feasible for laparoscopic resection and had been operated with an open procedure by an experienced surgeon, operation time was significantly shorter and the number of removed lymph nodes is significantly higher in the open group. Conclusion So far, several studies demonstrate that laparoscopic right-sided colon resection is comparable to open resection. Our data suggests that a consequent CME during an open operation leads to significantly more removed lymph nodes than in laparoscopically resected patients and in several so far published data of open control groups from Europe. Further prospective randomized trials comparing the long-term outcome are urgently needed before laparoscopy for right-sided colon resection can be recommended ubiquitously.
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Affiliation(s)
- Jörg O W Pelz
- Department of General, Visceral, Vascular and Pediatric Surgery, University Hospital, University of Wuerzburg, Oberduerrbacherstr.6, 97080, Wuerzburg, Germany.,Comprehensive Cancer Centre Mainfranken, University Hospital, University of Wuerzburg, Josef-Schneiderstr. 6, 97080, Wuerzburg, Germany
| | - Johanna Wagner
- Department of General, Visceral, Vascular and Pediatric Surgery, University Hospital, University of Wuerzburg, Oberduerrbacherstr.6, 97080, Wuerzburg, Germany
| | - Sven Lichthardt
- Department of General, Visceral, Vascular and Pediatric Surgery, University Hospital, University of Wuerzburg, Oberduerrbacherstr.6, 97080, Wuerzburg, Germany
| | - Johannes Baur
- Department of General, Visceral, Vascular and Pediatric Surgery, University Hospital, University of Wuerzburg, Oberduerrbacherstr.6, 97080, Wuerzburg, Germany
| | - Caroline Kastner
- Department of General, Visceral, Vascular and Pediatric Surgery, University Hospital, University of Wuerzburg, Oberduerrbacherstr.6, 97080, Wuerzburg, Germany
| | - Niels Matthes
- Department of General, Visceral, Vascular and Pediatric Surgery, University Hospital, University of Wuerzburg, Oberduerrbacherstr.6, 97080, Wuerzburg, Germany
| | - Christoph-Thomas Germer
- Department of General, Visceral, Vascular and Pediatric Surgery, University Hospital, University of Wuerzburg, Oberduerrbacherstr.6, 97080, Wuerzburg, Germany.,Comprehensive Cancer Centre Mainfranken, University Hospital, University of Wuerzburg, Josef-Schneiderstr. 6, 97080, Wuerzburg, Germany
| | - Armin Wiegering
- Department of General, Visceral, Vascular and Pediatric Surgery, University Hospital, University of Wuerzburg, Oberduerrbacherstr.6, 97080, Wuerzburg, Germany. .,Comprehensive Cancer Centre Mainfranken, University Hospital, University of Wuerzburg, Josef-Schneiderstr. 6, 97080, Wuerzburg, Germany. .,Department of Biochemistry and Molecular Biology, University of Wuerzburg, Am Hubland, 97074, Wuerzburg, Germany.
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Hand-assisted Laparoscopy: Expensive but Considerable Step Between Laparoscopic and Open Colectomy. Surg Laparosc Endosc Percutan Tech 2018; 28:214-218. [PMID: 29912135 DOI: 10.1097/sle.0000000000000545] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE Hand-assisted laparoscopic colectomy (HALC) and laparoscopic-assisted colectomy (LAC) have been shown to have comparable short-term outcomes while there are limited data regarding costs. The aim of our study was to compare the short-term outcomes and costs of HALC and LAC. MATERIALS AND METHODS In total, 46 patients who underwent HALC or LAC for benign or malignant disease between January 2011 and December 2014 at our institution were included in the study. Patients were randomized into HALC or LAC group. Patients' demographics and characteristics, operative details, short-term outcomes, and costs were evaluated. RESULTS There were 25 patients in LAC group and 21 patients in HALC group. Patient's demographics and characteristics and short-term outcomes were comparable between the LAC and HALC groups. Conversion rate was significantly lower in the HALC group (4.7% vs. 28%, P=0.03) while surgical costs ($1706.83±203.70 vs. $1304.93±305.67, P=0.038) and total costs ($2427.18±254.27 vs. $2044.03±215.22, P=0.021) were significantly higher in HALC group. CONCLUSIONS HALC is associated with increased surgical and total hospital costs, and decreased rate of conversion. Although it is more expensive, HALC may be helpful by providing a step between LAC and open surgery before considering conversion.
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Zhang X, Wu Q, Gu C, Hu T, Bi L, Wang Z. Hand-assisted laparoscopic surgery versus conventional open surgery in intraoperative and postoperative outcomes for colorectal cancer: An updated systematic review and meta-analysis. Medicine (Baltimore) 2017; 96:e7794. [PMID: 28816967 PMCID: PMC5571704 DOI: 10.1097/md.0000000000007794] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
AIM This meta-analysis aims to compare hand-assisted laparoscopic surgery (HALS) and conventional open surgery (OS) for colorectal cancer (CRC) in terms of intraoperative and postoperative outcomes, and to explore the safety, feasibility of HALS for CRC surgery. METHODS A systematic literature search with no limits was performed in PubMed, Embase, and Medline. The last search was performed on April 23, 2017. The outcomes of interests included intraoperative outcomes (operative time, blood loss, length of incision, transfusion, and lymph nodes harvested), postoperative outcomes (length of hospital stay, length of postoperative hospital stay, time to first flatus, time to first liquid diet, time to first soft diet, time to first bowel movement, postoperative complications, reoperation, ileus, anastomotic leakage, wound infection, urinary complication, pulmonary infection, and mortality). RESULTS Fifteen articles published between 2007 and 2017 with a total of 1962 patients with CRC were included in our meta-analysis. HALS was associated with longer operative time, less blood loss, smaller length of incision, shorter hospital days and postoperative hospital days, less time to first flatus, less wound infection, and less postoperative complications. There was no difference in blood transfusion, lymph node harvested, time to first liquid or soft diet, time to first bowel movement, reoperation, ileus, anastomotic leakage, pulmonary infection, urinary complications, or mortality. CONCLUSIONS Our meta-analysis suggests that HALS in CRC surgery improves cosmesis and results in better postoperative recovery outcomes by reducing postoperative complications and hospital days. Furthermore, a large randomized control study is warranted to compare the short-term and long-term outcomes of those 2 techniques for CRC treatment.
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Affiliation(s)
- Xubing Zhang
- Department of Gastrointestinal Surgery, West China Hospital, Sichuan University
- West China School of Medicine, Sichuan University, Chengdu, China
| | - Qingbin Wu
- Department of Gastrointestinal Surgery, West China Hospital, Sichuan University
- West China School of Medicine, Sichuan University, Chengdu, China
| | - Chaoyang Gu
- Department of Gastrointestinal Surgery, West China Hospital, Sichuan University
| | - Tao Hu
- Department of Gastrointestinal Surgery, West China Hospital, Sichuan University
- West China School of Medicine, Sichuan University, Chengdu, China
| | - Liang Bi
- Department of Gastrointestinal Surgery, West China Hospital, Sichuan University
- West China School of Medicine, Sichuan University, Chengdu, China
| | - Ziqiang Wang
- Department of Gastrointestinal Surgery, West China Hospital, Sichuan University
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Tajima T, Mukai M, Yokoyama D, Higami S, Uda S, Hasegawa S, Nomura E, Sadahiro S, Yasuda S, Makuuchi H. Comparison of hand-assisted laparoscopic surgery (HALS) and conventional laparotomy in patients with colorectal cancer: Final results from a single center. Oncol Lett 2017; 13:4953-4958. [PMID: 28588735 DOI: 10.3892/ol.2017.6035] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2016] [Accepted: 03/31/2017] [Indexed: 01/31/2023] Open
Abstract
In recent years, the use of laparoscopic surgery has been expanded to include radical curative resection. In a previous study, 212 patients with primary colorectal cancer (stages I-III) underwent radical curative resection by hand-assisted laparoscopic surgery (HALS) (n=98) or conventional laparotomy (CL) (n=114) and were compared with respect to 3-year relapse-free survival (3Y-RFS) and 3-year overall survival (3Y-OS). The study included 210/212 patients who were followed up to 5 years, including 96 patients who underwent HALS and 114 treated with CL. The two groups were matched for stage, clinical background, and postoperative management. Patient characteristics were compared and the 5Y-RFS and 5Y-OS were determined. The 5-year follow-up rate was 97.6%. In stage I-III patients, 5Y-RFS and 5Y-OS showed no significant differences between HALS and CL. The patients with stage I disease accounted for 41.7% (40/96) of the patients undergoing HALS, while stage I patients only accounted for 23.7% (27/114) of the patients undergoing CL, and the difference was significant (P=0.005). Stage II patients undergoing CL were older than those treated with HALS (P=0.017). However, there were no differences in the characteristics of stage III patients undergoing HALS or CL. In conclusion, HALS achieved a similar survival to CL in patients with stage I to III colorectal cancer. Compared with CL, HALS was performed more safely and achieved superior cosmetic results.
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Affiliation(s)
- Takayuki Tajima
- Department of Surgery, Tokai University School of Medicine, Isehara, Kanagawa 259-1193, Japan
| | - Masaya Mukai
- Department of Surgery, Tokai University Hachioji Hospital, Hachioji, Tokyo 192-0032, Japan
| | - Daiki Yokoyama
- Department of Surgery, Tokai University Hachioji Hospital, Hachioji, Tokyo 192-0032, Japan
| | - Shigeo Higami
- Department of Surgery, Tokai University Hachioji Hospital, Hachioji, Tokyo 192-0032, Japan
| | - Shuji Uda
- Department of Surgery, Tokai University Hachioji Hospital, Hachioji, Tokyo 192-0032, Japan
| | - Sayuri Hasegawa
- Department of Surgery, Tokai University School of Medicine, Isehara, Kanagawa 259-1193, Japan
| | - Eiji Nomura
- Department of Surgery, Tokai University Hachioji Hospital, Hachioji, Tokyo 192-0032, Japan
| | - Sotaro Sadahiro
- Department of Surgery, Tokai University School of Medicine, Isehara, Kanagawa 259-1193, Japan
| | - Seiei Yasuda
- Department of Surgery, Tokai University School of Medicine, Isehara, Kanagawa 259-1193, Japan
| | - Hiroyasu Makuuchi
- Department of Surgery, Tokai University School of Medicine, Isehara, Kanagawa 259-1193, Japan.,Department of Surgery, Tokai University Hachioji Hospital, Hachioji, Tokyo 192-0032, Japan
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Vaccarezza H, Sahovaler A, Im V, Rossi G, Vaccaro C. Hand-assisted laparoscopic colorectal surgery with double-glove technique. SURGICAL PRACTICE 2016. [DOI: 10.1111/1744-1633.12190] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Hernán Vaccarezza
- General Surgery Department, Italian Hospital of Buenos Aires; Buenos Aires City Argentina
| | - Axel Sahovaler
- General Surgery Department, Italian Hospital of Buenos Aires; Buenos Aires City Argentina
| | - Víctor Im
- General Surgery Department, Italian Hospital of Buenos Aires; Buenos Aires City Argentina
| | - Gustavo Rossi
- General Surgery Department, Italian Hospital of Buenos Aires; Buenos Aires City Argentina
| | - Carlos Vaccaro
- General Surgery Department, Italian Hospital of Buenos Aires; Buenos Aires City Argentina
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Abstract
PURPOSE Laparoscopy for colorectal cancer resection bares early post-operative advantages and results in equal oncologic long-term outcome. However, data on laparoscopic right hemi-colectomy is scarce. Aim of the present study was to analyze a well selected collective of patients with right-sided colon cancer treated open and laparoscopically with regard to peri-operative and long-term outcome. METHODS We analyzed all patients who underwent right-sided hemi-colectomy for colon cancer between January 1996 and March 2013. Data was extracted from our prospective database. Inclusion criteria were tumor localization in the ascending colon, oncologic resection, histology of an adenocarcinoma, tumors UICC I-III, and R0 resection. Exclusion criteria were multiple malignancies including colon, emergency operation, adenoma or pT0 status, and UICC IV. For the matched pairs approach between patients undergoing laparoscopic (LAP) or open (OPEN) surgery, the parameters age, UICC stage, tumor grading, and sex were applied. RESULTS A total of 188 patients was included in the analysis with n = 94 in both the LAP and the OPEN group. Some peri-operative results demonstrated advantages for laparoscopy including median return to liquid (p < 0.0001) and solid diet (p = 0.008), median length of ICU stay (p < 0.0001), and median length of hospital stay (p = 0.022). No significant differences were revealed for complication rates, rates of anastomotic leakage, or 30-day mortality. Lymph node yield was identical. Also, no differences in oncologic long-term outcome were detected. Rates for local recurrence were 4.3 and 2.0 %. CONCLUSION This matched pairs analysis verifies peri-operative advantages of laparoscopy explicitly for the sub-group of CRC patients undergoing right-sided hemi-colectomy in comparison to open surgery while demonstrating equivalent oncologic long-term results.
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Li Z, Li D, Jie Z, Zhang G, Liu Y. Comparative Study on Therapeutic Efficacy Between Hand-Assisted Laparoscopic Surgery and Conventional Laparotomy for Acute Obstructive Right-Sided Colon Cancer. J Laparoendosc Adv Surg Tech A 2015; 25:548-54. [PMID: 26134068 DOI: 10.1089/lap.2014.0645] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
INTRODUCTION This retrospective study aims to compare open colectomy and hand-assisted laparoscopic surgery (HALS) in the management of acute obstructive right-sided colon cancer and to analyze and evaluate the feasibility and safety of HALS. PATIENTS AND METHODS Ten consecutive patients who underwent hand-assisted laparoscopic right hemicolectomy due to acute obstructive right-sided colon cancer were retrospectively well matched with 25 patients scheduled for a conventional laparotomy during the same time. Demographic, intraoperative, and postoperative data were assessed. RESULTS The HALS group had the advantage in the length of incision (5.8±0.7 cm) over the conventional group (16±2.3 cm) (P<.05), and the mean blood loss during the operations was significantly less in the HALS group (30±15.2 mL) than in the laparotomy group (90±29.4 mL) (P<.05). Moreover, the time of postoperative ambulation was earlier (2.5±0.8 days versus 3.2±0.9 days) (P<.05). Seven cases underwent intestinal decompression for severe intestinal dilatation and had a satisfactory result. The hand-assisted device can fairly meet the demands of a minimally invasive operation and can protect the abdominal incision and avoid infection. There was no intergroup difference in complication rate, although the conventional group had a higher rate. CONCLUSIONS In this study, compared with conventional laparotomy for acute obstructive right-sided colon neoplasm, HALS is associated with less blood loss, shorter incision, and earlier ambulation. Emergency laparoscopic-assisted right hemicolectomy can be safely performed in patients with obstructing right-sided colonic carcinoma. If practiced more, it might be advocated as a bridge between the conventional open approach and traditional laparoscopic surgery.
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Affiliation(s)
- Zhengrong Li
- Department of Gastrointestinal Surgery, First Affiliated Hospital, Nanchang University , Nanchang, Jiangxi Province, China
| | - Daojiang Li
- Department of Gastrointestinal Surgery, First Affiliated Hospital, Nanchang University , Nanchang, Jiangxi Province, China
| | - Zhigang Jie
- Department of Gastrointestinal Surgery, First Affiliated Hospital, Nanchang University , Nanchang, Jiangxi Province, China
| | - Guoyang Zhang
- Department of Gastrointestinal Surgery, First Affiliated Hospital, Nanchang University , Nanchang, Jiangxi Province, China
| | - Yi Liu
- Department of Gastrointestinal Surgery, First Affiliated Hospital, Nanchang University , Nanchang, Jiangxi Province, China
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Tajima T, Mukai M, Noguchi W, Higami S, Uda S, Yamamoto S, Hasegawa S, Nomura E, Sadahiro S, Yasuda S, Makuuchi H. Comparison of hand-assisted laparoscopic surgery and conventional laparotomy for rectal cancer: Interim results from a single center. Mol Clin Oncol 2015; 3:533-538. [PMID: 26137262 DOI: 10.3892/mco.2015.508] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2014] [Accepted: 01/27/2015] [Indexed: 12/24/2022] Open
Abstract
Minimally invasive laparoscopic surgery has become widespread and the indications for such surgery have recently been extended to various conditions, including rectal cancer. The objective of this study was to compare the clinical outcome of hand-assisted laparoscopic surgery (HALS) and conventional laparotomy (CL) in patients with rectal cancer. Patients who underwent radical resection of stage I-III primary rectal cancer (n=111) were classified into those receiving HALS (n=57) and those receiving CL (n=54); the two groups were matched for stage and postoperative treatment. The 3-year relapse-free survival (3Y-RFS) and 3-year overall survival (3Y-OS) were calculated and compared between the two groups. Intraoperative blood loss, operating time, postoperative hospital stay and complications were also compared between the two groups. There were no significant differenceS in 3Y-RFS or 3Y-OS between the HALS and CL groups for patients with all-stage (I, II and III) rectal cancer. The mean (median) intraoperative blood loss was 344.0 (247.0) ML in the HALS group vs. 807.5 (555.5) ML in the CL group (P<0.001). The mean (median) postoperative hospital stay was 19.8 (17) and 25.5 (18.3) days, respectively (P=0.039). There were no significant differences in the operating time or the incidence of complications between the two groups. Based on these results, HALS was found to be comparable to CL regarding survival, while achieving less blood loss and a superior cosmetic outcome. However, longer follow-up is required to confirm these findings.
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Affiliation(s)
- Takayuki Tajima
- Department of Surgery, Tokai University School of Medicine, Isehara, Kanagawa 259-1193, Japan
| | - Masaya Mukai
- Department of Surgery, Tokai University Hachioji Hospital, Hachioji, Tokyo 192-0032, Japan
| | - Wataru Noguchi
- Department of Surgery, Tokai University Hachioji Hospital, Hachioji, Tokyo 192-0032, Japan
| | - Shigeo Higami
- Department of Surgery, Tokai University Hachioji Hospital, Hachioji, Tokyo 192-0032, Japan
| | - Shuuji Uda
- Department of Surgery, Tokai University Hachioji Hospital, Hachioji, Tokyo 192-0032, Japan
| | - Souichirou Yamamoto
- Department of Surgery, Tokai University Hachioji Hospital, Hachioji, Tokyo 192-0032, Japan
| | - Sayuri Hasegawa
- Department of Surgery, Tokai University Hachioji Hospital, Hachioji, Tokyo 192-0032, Japan
| | - Eiji Nomura
- Department of Surgery, Tokai University Hachioji Hospital, Hachioji, Tokyo 192-0032, Japan
| | - Sotaro Sadahiro
- Department of Surgery, Tokai University School of Medicine, Isehara, Kanagawa 259-1193, Japan
| | - Seiei Yasuda
- Department of Surgery, Tokai University School of Medicine, Isehara, Kanagawa 259-1193, Japan
| | - Hiroyasu Makuuchi
- Department of Surgery, Tokai University School of Medicine, Isehara, Kanagawa 259-1193, Japan ; Department of Surgery, Tokai University Hachioji Hospital, Hachioji, Tokyo 192-0032, Japan
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Gong JQ, Cao YK, Wang YH, Zhang GH, Wang PH, Luo GD. Three-step hand-assisted laparoscopic surgery for radical distal gastrectomy: an effective surgical approach. Int J Clin Exp Med 2014; 7:2156-2164. [PMID: 25232401 PMCID: PMC4161561] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2014] [Accepted: 07/27/2014] [Indexed: 06/03/2023]
Abstract
OBJECTIVE Three-step hand-assisted laparoscopic D2 radical gastrectomy (HALG) is a modified surgical technique based on hand-assisted laparoscopic surgery (HALS) for the treatment of gastric cancer. This surgical approach is particularly easy and convenient for radical distal gastrectomy. In order to thoroughly understand the advantages of applying "three-step HALG" in distal gastrectomy, our center conducted a retrospective study to analyze data from patients who underwent HALG and laparoscopic-assisted D2 radical gastrectomy (LAG) during the corresponding time period. METHODS The HALG procedure is performed in three steps, namely the operation performed through an auxiliary incision under direct vision, hand-assisted laparoscopic operation, and gastrointestinal tract reconstruction through the auxiliary incision under direct vision. This study performed comprehensive, in-depth comparative analyses on the clinical data of two groups of patients who underwent HALG and LAG. RESULTS The auxiliary incision under the xiphoid was maximally utilized in the HALG procedure. The rate of conversion to open surgery in HALG group patients was significantly lower than in the LAG group (P = 0.03), and the operating time was significantly shorter in the HALG group than in the LAG group (P = 0.00). There was no significant difference in the pain rate score on postoperative day 2 and on the day of discharge between the HALG and LAG groups (P > 0.05). No statistically significant difference was found in the time to recovery of bowel function, postoperative hospital stay, or postoperative complications (P > 0.05), although the values were all lower in the HALG group than in the LAG group. CONCLUSION "Three-step HALG" is a highly feasible surgical approach for radical distal gastrectomy.
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Gong J, Cao Y, Li Y, Zhang G, Wang P, Luo G. Hand-assisted laparoscopic versus laparoscopy-assisted D2 radical gastrectomy: a prospective study. Surg Endosc 2014; 28:2998-3006. [PMID: 24879135 DOI: 10.1007/s00464-014-3566-y] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2013] [Accepted: 04/20/2014] [Indexed: 12/22/2022]
Abstract
BACKGROUD The feasibility and safety of Hand-assisted laparoscopic D2 radical gastrectomy (HALG) have been seldom reported, also, benefits and outcomes are not defined. METHODS We performed a comprehensive and in-depth comparative analysis of the general information, the intraoperative data and postoperative data in the Group HALG and the Group laparoscopy-assisted D2 radical gastrectomy (LAG). RESULTS The general data of HALG and LAG were no differences (P > 0.05); the blood loss and unexpected injury were similar(P > 0.05); the operative time, the incision length, the number of lymph nodes recovered, the rate of procedure conversion, the amount of postoperative complications, and the length of postoperative hospital stay of Group HALG were prior to that of Group LAG(P < 0.05); there were no differences for the pain score after day 2, the recovery time of intestinal function, the rate of reoperation, the 30-day hospital and readmission rate(P > 0.05); and there were significant linear correlations between the length of postoperative hospital stay and the operative time for both groups(P = 0.00). CONCLUSION Compared with LAG, HALG had similar features of being minimally invasive and radical in treating gastric cancers, and HALG was safer than LAG.
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Affiliation(s)
- JiaQing Gong
- Department of General Surgery, The People's Liberation Army General Hospital of ChengDu Command, ChengDu, 610083, Sichuan Province, China,
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Tajima T, Mukai M, Yamazaki M, Higami S, Yamamoto S, Hasegawa S, Nomura E, Sadahiro S, Yasuda S, Makuuchi H. Comparison of hand-assisted laparoscopic surgery and conventional laparotomy for colorectal cancer: Interim results from a single institution. Oncol Lett 2014; 8:627-632. [PMID: 25013477 PMCID: PMC4081301 DOI: 10.3892/ol.2014.2182] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2013] [Accepted: 03/20/2014] [Indexed: 11/06/2022] Open
Abstract
The present study aimed to compare the results of hand-assisted laparoscopic surgery (HALS) and conventional laparotomy (CL) at a single institution in Japan. Of the 212 patients with stage I/II/III colorectal cancer who received a curative resection, 98 patients underwent HALS and 114 patients underwent CL. The clinical background and post-operative management did not differ between the two groups. There were no significant differences in the 3-year relapse-free and 3-year overall survival rates between the HALS and CL groups for the patients in any stage. Blood loss during surgery was 250.1 and 135.5 ml (mean and median; the same hereafter) in stage I patients receiving HALS versus 608.2 and 315.5 ml in stage I CL patients (P=0.006), while it was 277.6 and 146 ml in stage II patients receiving HALS versus 548.6 and 347 ml in stage II CL patients (P=0.004). Post-operative hospital stay was recorded at 16.8 and 15 days in stage III patients receiving HALS versus 23.1 and 21 days in stage III CL patients (P=0.001). There were no significant differences in the operating time or complications between the two groups. These results indicate that the survival rate was comparable for HALS and CL, while HALS caused less surgical stress and achieved a better cosmetic outcome. The results of the final analysis of this cohort are awaited.
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Affiliation(s)
- Takayuki Tajima
- Department of Surgery, Tokai University School of Medicine, Bohseidai, Isehara, Kanagawa 259-1193, Japan
| | - Masaya Mukai
- Department of Surgery, Tokai University Hachioji Hospital, Hachioji, Tokyo 192-0032, Japan
| | - Masashi Yamazaki
- Department of Surgery, Tokai University Hachioji Hospital, Hachioji, Tokyo 192-0032, Japan
| | - Shigeo Higami
- Department of Surgery, Tokai University Hachioji Hospital, Hachioji, Tokyo 192-0032, Japan
| | - Souichirou Yamamoto
- Department of Surgery, Tokai University Hachioji Hospital, Hachioji, Tokyo 192-0032, Japan
| | - Sayuri Hasegawa
- Department of Surgery, Tokai University School of Medicine, Bohseidai, Isehara, Kanagawa 259-1193, Japan
| | - Eiji Nomura
- Department of Surgery, Tokai University Hachioji Hospital, Hachioji, Tokyo 192-0032, Japan
| | - Sotaro Sadahiro
- Department of Surgery, Tokai University School of Medicine, Bohseidai, Isehara, Kanagawa 259-1193, Japan
| | - Seiei Yasuda
- Department of Surgery, Tokai University School of Medicine, Bohseidai, Isehara, Kanagawa 259-1193, Japan
| | - Hiroyasu Makuuchi
- Department of Surgery, Tokai University School of Medicine, Bohseidai, Isehara, Kanagawa 259-1193, Japan ; Department of Surgery, Tokai University Hachioji Hospital, Hachioji, Tokyo 192-0032, Japan
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Kim H. Should hand-assisted laparoscopic surgery be placed in the realm of minimally invasive surgery? Ann Coloproctol 2013; 29:42-3. [PMID: 23700569 PMCID: PMC3659241 DOI: 10.3393/ac.2013.29.2.42] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Affiliation(s)
- Hungdai Kim
- Department of Surgery, Kangbuk Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
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