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Hand Assisted Laparoscopic Surgery for Colorectal Cancer: Surgical and Oncological Outcomes from a Single Tertiary Referral Centre. J Clin Med 2022; 11:jcm11133781. [PMID: 35807066 PMCID: PMC9267732 DOI: 10.3390/jcm11133781] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2022] [Revised: 06/21/2022] [Accepted: 06/26/2022] [Indexed: 02/04/2023] Open
Abstract
The aim of this study was to report overall experience, perioperative and long-term survival results in a single tertiary referral center in Lithuania with hand assisted laparoscopic surgery (HALS) for colorectal cancer. A prospectively maintained database included 467 patients who underwent HALS for left-sided colon and rectal cancer, from April 2006 to October 2016. All those operations were performed by three consultant surgeons and nine surgical residents, in all cases assisted by one of the same consultant surgeons. There were 230 (49.25%) females, with an average age of 64 ± 9.7 years (range, 26–91 years). The procedures performed included 170 (36.4%) anterior rectal resections with partial mesorectal excision, 160 (34.26%) sigmoid colectomies, 81 (17.35%) left hemicolectomies, 45 (9.64%) low anterior rectal resections with total mesorectal excision, and 11 (2.25%) other procedures. Stage I colorectal cancer was found in 140 (29.98%) patients, 139 (29.76%) stage II, 152 (32.55%) stage III and 36 (7.71%) stage IV. There were five conversions to open surgery (1.1%). The mean postoperative hospital stay was 6.9 ± 3.4 days (range, 1–30 days). In total, 33 (7.06%) patients developed postoperative complications. The most common complications were small bowel obstruction (n = 6), anastomotic leakage (n = 5), intraabdominal abscess (n = 4) and dysuria (n = 4). There were two postoperative deaths (0.43%). Overall, 5-year survival for all TNM stages was 85.7%, 93.2% for stage I, 88.5% for stage II and 76.3% for stage III. Hand assisted colorectal surgery for left-sided colon and rectal cancer in a single tertiary referral center was feasible and safe, having all the advantages of minimally invasive surgery, with good perioperative parameters, adequate oncological quality and excellent survival.
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Samalavicius NE, Klimasauskiene V, Dulskas A. Laparoscopic hand-assisted total mesorectal excision for mid rectal cancer using the Gelport system-a video vignette. Colorectal Dis 2021; 23:1018. [PMID: 33480166 DOI: 10.1111/codi.15536] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2020] [Revised: 12/15/2020] [Accepted: 01/12/2021] [Indexed: 02/08/2023]
Affiliation(s)
- Narimantas E Samalavicius
- Department of Surgery, Klaipeda University Hospital, Klaipeda, Lithuania.,Faculty of Medicine, Institute of Clinical Medicine, Vilnius University, Vilnius, Lithuania.,Faculty of Health Sciences, Health Research and Innovation Centre, Klaipeda University, Klaipeda, Lithuania
| | | | - Audrius Dulskas
- Faculty of Medicine, Institute of Clinical Medicine, Vilnius University, Vilnius, Lithuania.,Departament of General and Abdominal Surgery and Oncology, National Cancer Institute, Vilnius, Lithuania.,Faculty of Health Care, University of Applied Sciences, Vilnius, Lithuania
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Laparoscopic and Robotic Surgery for Rectal Cancer—Comparative Study Between Two Centres. Indian J Surg 2021. [DOI: 10.1007/s12262-020-02287-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
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Samalavicius NE, Kavaliauskas P, Dulskas A. Hand-assisted laparoscopic surgery for rectal cancer - a video vignette. Colorectal Dis 2019; 21:1336-1337. [PMID: 31389150 DOI: 10.1111/codi.14803] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2019] [Accepted: 07/23/2019] [Indexed: 02/08/2023]
Affiliation(s)
- N E Samalavicius
- Department of Surgery, Klaipeda University Hospital, Klaipeda, Lithuania.,Institute of Clinical Medicine, Faculty of Medicine, Vilnius University, Vilnius, Lithuania
| | - P Kavaliauskas
- Department of General and Abdominal Surgery and Oncology, National Cancer Institute, Vilnius, Lithuania
| | - A Dulskas
- Institute of Clinical Medicine, Faculty of Medicine, Vilnius University, Vilnius, Lithuania.,Department of General and Abdominal Surgery and Oncology, National Cancer Institute, Vilnius, Lithuania.,Faculty of Health Care, University of Applied Sciences, Vilnius, Lithuania
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High vascular ligation in left-sided colon cancer surgery is safe and adequate. Eur Surg 2018. [DOI: 10.1007/s10353-018-0542-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
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Overbey DM, Cowan ML, Hosokawa PW, Chapman BC, Vogel JD. Laparoscopic colectomy in obese patients: a comparison of laparoscopic and hand-assisted laparoscopic techniques. Surg Endosc 2017; 31:3912-3921. [PMID: 28281115 DOI: 10.1007/s00464-017-5422-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2016] [Accepted: 01/20/2017] [Indexed: 12/17/2022]
Abstract
BACKGROUND Recent American College of Surgeons National Surgical Quality Improvement Project (ACS-NSQIP)-based evidence indicates that laparoscopic (LAP) colectomy results in improved outcomes compared to hand-assisted laparoscopic (HAL) colectomy in the general population. Previous comparative studies demonstrated that the HAL technique offers distinct advantages for obese patients. The aim of this study was to perform comparative analyses of HAL and LAP colectomy and low anterior resection (LAR) in obese patients. METHODS The ACS-NSQIP public use file and targeted colectomy dataset, 2012-2014, were utilized for patients undergoing colectomy and LAR. Only obese patients (BMI > 30) and laparoscopic or hand-assisted operations were included. Patient, operation, and outcome variables were compared in two separate cohorts: colectomy and LAR. Bivariate analysis compared the approaches, followed by multivariable regression. RESULTS Of 9610 obese patients included, HAL and LAP colectomy were performed in 3126 and 3793 patients and LAR in 1431 and 1260 patients, respectively. In comparison to LAP colectomy, HAL colectomy patients had increased comorbidities including class 2 and 3 obesity. HAL colectomy was associated with higher overall morbidity (20 vs. 16%, p < 0.001), infectious complications (10.2 vs. 7.7%, p < 0.001), anastomotic leaks (3.0 vs. 2.2%, p = 0.03), and ileus (11 vs. 8%, p < 0.001). Multivariate analysis indicated that overall morbidity (OR 1.27, 95% CI 1.11-1.44), infectious complications (OR 1.35, 95% CI 1.14-1.59), and ileus (OR 1.33, 95% CI 1.12-1.57) were each increased in the HAL colectomy cohort but not different for HAL and LAP LAR. CONCLUSIONS In comparison to LAP colectomy, the HAL technique is used more often in obese patients with an increased operative risk profile. While inherent bias and unmeasured variables limit the analysis, the available data indicate that the HAL technique is associated with increased perioperative morbidity. Alternatively, HAL and LAP LAR are performed in obese patients with a similar risk profile and result in similar postoperative outcomes.
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Affiliation(s)
- Douglas M Overbey
- Department of Surgery, University of Colorado, 12631 E 17th Ave, C302, Aurora, CO, 80045, USA.,Department of Surgery, VA Eastern Colorado HealthCare System, Denver, CO, USA
| | - Michelle L Cowan
- Department of Surgery, University of Colorado, 12631 E 17th Ave, C302, Aurora, CO, 80045, USA.,Department of Surgery, VA Eastern Colorado HealthCare System, Denver, CO, USA
| | - Patrick W Hosokawa
- Adult and Child Consortium for Health Outcomes Research and Delivery Science (ACCORDS), Aurora, CO, USA
| | - Brandon C Chapman
- Department of Surgery, University of Colorado, 12631 E 17th Ave, C302, Aurora, CO, 80045, USA
| | - Jon D Vogel
- Department of Surgery, University of Colorado, 12631 E 17th Ave, C302, Aurora, CO, 80045, USA.
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Zampieri N, Castellani R, Francia L. Is There Still a Role for Video-Assisted Laparoscopic Gastric Banding in Severe Obesity? Bariatr Surg Pract Patient Care 2016. [DOI: 10.1089/bari.2015.0034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Nicola Zampieri
- Department of Surgery, University of Verona, AOUI, Verona, Italy
| | - Roberto Castellani
- Department of Surgery, Casa di Cura San Francesco Hospital, Verona, Italy
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Laparoscopic sigmoid colectomy: Are all laparoscopic techniques created equal? Surg Endosc 2015; 30:3567-72. [DOI: 10.1007/s00464-015-4654-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2015] [Accepted: 10/28/2015] [Indexed: 11/26/2022]
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Moghadamyeghaneh Z, Carmichael JC, Mills S, Pigazzi A, Nguyen NT, Stamos MJ. Hand-Assisted Laparoscopic Approach in Colon Surgery. J Gastrointest Surg 2015. [PMID: 26302878 DOI: 10.1007/s11605015-2924-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
BACKGROUND This study sought to compare outcomes of patients who underwent hand-assisted laparoscopic (HAL) colectomy with open and laparoscopic colectomy (LP). STUDY DESIGN The NSQIP databases were used to examine the clinical data of patients who underwent elective colectomy during 2012-2013. Multivariate regression analysis was performed to compare the three surgical approaches. RESULTS We sampled a total of 21,090 patients who underwent colectomy. Of these, 7480 (35.5 %) had open colectomy (OC), 8751 (41.5 %) had a laparoscopic colectomy, 2860 (13.6 %) had a HAL colectomy, and 1999 (9.5 %) had an open procedure converted from LC or HAL. Multivariate regression analysis revealed HAL colectomy had a similar mortality (AOR 0.53, P = 0.07) and a lower morbidity (AOR 0.37, P < 0.01) compared to OC. LC had lower mortality (AOR 0.58, P = 0.02) and morbidity (AOR 0.43, P < 0.01) compared to OC. Mortality of patients who underwent HAL was not significantly different from LC (AOR 0.90, P = 0.79); however, morbidity of such patients was significantly higher than for patients who underwent LC (AOR 1.29, P < 0.01). CONCLUSIONS HAL colectomy is a safe approach with significant advantages compared to open colectomy. Although the morbidity of patients who underwent HAL is higher than patients who underwent LC, the morbidity rate is still lower than OC.
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Affiliation(s)
- Zhobin Moghadamyeghaneh
- Department of Surgery, University of California, Irvine, School of Medicine, 333 City Blvd. West Suite 1600, Orange, CA, 92868, USA
| | - Joseph C Carmichael
- Department of Surgery, University of California, Irvine, School of Medicine, 333 City Blvd. West Suite 1600, Orange, CA, 92868, USA
| | - Steven Mills
- Department of Surgery, University of California, Irvine, School of Medicine, 333 City Blvd. West Suite 1600, Orange, CA, 92868, USA
| | - Alessio Pigazzi
- Department of Surgery, University of California, Irvine, School of Medicine, 333 City Blvd. West Suite 1600, Orange, CA, 92868, USA
| | - Ninh T Nguyen
- Department of Surgery, University of California, Irvine, School of Medicine, 333 City Blvd. West Suite 1600, Orange, CA, 92868, USA
| | - Michael J Stamos
- Department of Surgery, University of California, Irvine, School of Medicine, 333 City Blvd. West Suite 1600, Orange, CA, 92868, USA.
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Moghadamyeghaneh Z, Carmichael JC, Mills S, Pigazzi A, Nguyen NT, Stamos MJ. Hand-Assisted Laparoscopic Approach in Colon Surgery. J Gastrointest Surg 2015; 19:2045-53. [PMID: 26302878 DOI: 10.1007/s11605-015-2924-y] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2015] [Accepted: 08/11/2015] [Indexed: 01/31/2023]
Abstract
BACKGROUND This study sought to compare outcomes of patients who underwent hand-assisted laparoscopic (HAL) colectomy with open and laparoscopic colectomy (LP). STUDY DESIGN The NSQIP databases were used to examine the clinical data of patients who underwent elective colectomy during 2012-2013. Multivariate regression analysis was performed to compare the three surgical approaches. RESULTS We sampled a total of 21,090 patients who underwent colectomy. Of these, 7480 (35.5 %) had open colectomy (OC), 8751 (41.5 %) had a laparoscopic colectomy, 2860 (13.6 %) had a HAL colectomy, and 1999 (9.5 %) had an open procedure converted from LC or HAL. Multivariate regression analysis revealed HAL colectomy had a similar mortality (AOR 0.53, P = 0.07) and a lower morbidity (AOR 0.37, P < 0.01) compared to OC. LC had lower mortality (AOR 0.58, P = 0.02) and morbidity (AOR 0.43, P < 0.01) compared to OC. Mortality of patients who underwent HAL was not significantly different from LC (AOR 0.90, P = 0.79); however, morbidity of such patients was significantly higher than for patients who underwent LC (AOR 1.29, P < 0.01). CONCLUSIONS HAL colectomy is a safe approach with significant advantages compared to open colectomy. Although the morbidity of patients who underwent HAL is higher than patients who underwent LC, the morbidity rate is still lower than OC.
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Affiliation(s)
- Zhobin Moghadamyeghaneh
- Department of Surgery, University of California, Irvine, School of Medicine, 333 City Blvd. West Suite 1600, Orange, CA, 92868, USA
| | - Joseph C Carmichael
- Department of Surgery, University of California, Irvine, School of Medicine, 333 City Blvd. West Suite 1600, Orange, CA, 92868, USA
| | - Steven Mills
- Department of Surgery, University of California, Irvine, School of Medicine, 333 City Blvd. West Suite 1600, Orange, CA, 92868, USA
| | - Alessio Pigazzi
- Department of Surgery, University of California, Irvine, School of Medicine, 333 City Blvd. West Suite 1600, Orange, CA, 92868, USA
| | - Ninh T Nguyen
- Department of Surgery, University of California, Irvine, School of Medicine, 333 City Blvd. West Suite 1600, Orange, CA, 92868, USA
| | - Michael J Stamos
- Department of Surgery, University of California, Irvine, School of Medicine, 333 City Blvd. West Suite 1600, Orange, CA, 92868, USA.
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Zhang GD, Zhi XT, Zhang JL, Bu GB, Ma G, Wang KL. Preoperative prediction of conversion from laparoscopic rectal resection to open surgery: a clinical study of conversion scoring of laparoscopic rectal resection to open surgery. Int J Colorectal Dis 2015; 30:1209-16. [PMID: 26077668 DOI: 10.1007/s00384-015-2275-x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/31/2015] [Indexed: 02/07/2023]
Abstract
OBJECTIVE The objectives of this paper were to establish a model for the conversion of laparoscopic rectal resection to open surgery and to predict possible conversion before surgery. METHODS The clinical data of 602 cases of laparoscopic rectal resection were retrospectively assessed. Risk factors associated with conversion of laparoscopic rectal resection to open rectal surgery were identified by logistic regression analysis. Also, a scoring system was created to calculate a score for the conversion of laparoscopic rectal resection to predict possible conversion for patients who underwent laparoscopic rectal resection before surgery. RESULTS A total of 90 patients required conversion (total conversion rate = 14.95%). The established model included six variables: male gender, surgical experience (≤25 cases), history of abdominal surgery, body mass index ≥ 28, tumor diameter ≥ 6 cm, and tumor invasion or metastasis, for which 6, 4, 5, 10, 15, and 21 points were assigned, respectively. A patient with a total score >14.5 points was considered to have a high probability of conversion, whereas a patient with a total score <14.5 points was considered at a low risk. CONCLUSION Preoperative determination of conversion score may predict possible conversion of laparoscopic rectal resection and thus reduce unnecessary open rectal surgery.
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Affiliation(s)
- Guang-Dong Zhang
- Department of General Surgery, Qi Lu Hospital of Shandong University, 107#, Wenhua Xi Road, Jinan City, 250012, China,
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Affiliation(s)
- Chang-Nam Kim
- Department of Surgery, Eulji University School of Medicine, Daejeon, Korea
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