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Liu X, Wu X, Zhu R, Yu W, Zhou B. Comparison of survival outcomes between laparoscopic and open colectomy for transverse colon cancer: a systematic review and meta-analysis. Int J Colorectal Dis 2023; 38:111. [PMID: 37126075 DOI: 10.1007/s00384-023-04414-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/25/2023] [Indexed: 05/02/2023]
Abstract
PURPOSE This study aimed to compare laparoscopic with open resection for transverse colon cancer (TCC) regarding long-term survival outcomes. METHODS Systematic literature search was performed on PubMed, Ovid, and Cochrane Library for studies comparing laparoscopic with open resection for TCC. The last search was performed on October 7, 2022. Oncological and survival outcomes were collected and analyzed. This meta-analysis was performed using Review Manager Software (v 5.3). RESULTS This study included fifteen studies published between 2014 and 2022 with 2556 patients in total. When compared with the laparoscopic group, the open group had significantly more tumors locating on middle transverse colon (P = 0.006, OR = 0.67, 95%CI [0.50, 0.89], I2 = 12%) and more patients received transverse colectomy (P = 0.03, OR = 0.66, 95%CI [0.46, 0.96], I2 = 53%) as results. Comparable tumor stage (P = 0.13, OR = 0.81, 95%CI [0.62, 1.06], I2 = 55%) and number of lymph node harvested (P = 0.22, WMD = -0.81, 95%CI [-2.09, 0.47], I2 = 73%) were observed between the two groups. As for survival outcomes, no significant difference was observed between the two groups for 5-year disease-free survival (DFS; P = 0.61, OR = 0.93, 95%CI [0.72, 1.21], I2 = 0%), 5-year overall survival (OS; P = 0.83, OR = 0.97, 95%CI [0.71, 1.32], I2 = 0%), 3-year DFS (P = 0.97, OR = 0.96, 95%CI [0.69, 1.32], I2 = 0%), and 3-year OS (P = 0.67, OR = 0.92, 95%CI [0.63, 1.35], I2 = 0%). In the subgroup analysis according to tumor stage, the results did not change. CONCLUSION Current evidence based on studies demonstrated that laparoscopic procedure could be safely performed for TCC, and it would not affect the long-term survival. Randomized clinical trials with a larger sample size are warranted in the future for further investigation.
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Affiliation(s)
- Xianwei Liu
- Department of General Surgery, Jiu Jiang No.1 People's Hospital, Jiujiang, Jiangxi Province, China
| | - Xiaoyu Wu
- Department of General Surgery, Jiu Jiang No.1 People's Hospital, Jiujiang, Jiangxi Province, China
| | - Renfang Zhu
- Department of General Surgery, Jiu Jiang No.1 People's Hospital, Jiujiang, Jiangxi Province, China
| | - Wenbing Yu
- Department of General Surgery, Jiu Jiang No.1 People's Hospital, Jiujiang, Jiangxi Province, China
| | - Bing Zhou
- Department of Pathology, The Second Affiliated Hospital of Jiujiang University, No. 1699, Shili Avenue, Jiujiang, 332005, China.
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Liu XJ, Lang ZQ, Zhang W, Zhang XQ, Lu PF, Xie F, Liang B, Huang ZP, Zou ZH. Clinical and survival outcomes of colectomy for transverse colon cancer in elderly patients. Medicine (Baltimore) 2023; 102:e33046. [PMID: 36862857 PMCID: PMC9981399 DOI: 10.1097/md.0000000000033046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/04/2023] Open
Abstract
It remains controversial whether elderly patients with transverse colon cancer present worse prognoses. Our study utilized evidence from multi-center databases to evaluate the perioperative and oncology outcomes of radical resection of colon cancer in elderly and nonelderly patients. In this study, we analyzed 416 patients with transverse colon cancer who underwent radical surgery from January 2004 to May 2017, including 151 elderly (aged ≥ 65 years) and 265 nonelderly (aged < 65 years) patients. We retrospectively compared the perioperative and oncological outcomes between these 2 groups. The median follow-up in the elderly and nonelderly groups was 52 and 64 months, respectively. There were no significant differences in the overall survival (OS) (P = .300) and disease-free survival (DFS) (P = .380) between the elderly and nonelderly groups. However, the elderly group had longer hospital stays (P < .001), a higher complication rate (P = .027), and fewer lymph nodes harvested (P = .002). The N classification and differentiation were significantly associated with OS based on univariate analysis, and the N classification was an independent prognostic factor for OS based on multivariate analysis (P < .05). Similarly, the N classification and differentiation were significantly correlated with the DFS based on univariate analysis. However, multivariate analysis indicated that the N classification was an independent prognostic factor for DFS (P < .05). In conclusion, the survival and surgical outcomes in elderly patients were similar to nonelderly patients. The N classification was an independent factor for OS and DFS. Even though elderly patients with transverse colon cancer present a higher surgical risk than nonelderly patients, performing radical resection in elderly patients can be an appropriate choice for treatment.
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Affiliation(s)
- Xiang-Jun Liu
- Department of General Surgery, The Second Affiliated Hospital of Nanchang University, Jiangxi, People’s Republic of China
| | - Zhi-Quan Lang
- Department of General Surgery, The Second Affiliated Hospital of Nanchang University, Jiangxi, People’s Republic of China
- Zhongnan Hospital of Wuhan University, Institute of Hepatobiliary Diseases of Wuhan University, Transplant Center of Wuhan University, Hubei Key Laboratory of Medical Technology on Transplantation, Wuhan, Hubei, People’s Republic of China
| | - Wei Zhang
- Department of General Surgery, The Second Affiliated Hospital of Nanchang University, Jiangxi, People’s Republic of China
| | - Xiao-Qing Zhang
- Department of General Surgery, The Second Affiliated Hospital of Nanchang University, Jiangxi, People’s Republic of China
| | - Ping-Fan Lu
- Department of General Surgery, The Second Affiliated Hospital of Nanchang University, Jiangxi, People’s Republic of China
| | - Feng Xie
- Department of General Surgery, The Second Affiliated Hospital of Nanchang University, Jiangxi, People’s Republic of China
| | - Bo Liang
- Department of General Surgery, The Second Affiliated Hospital of Nanchang University, Jiangxi, People’s Republic of China
| | - Zhi-Ping Huang
- Departments of Hepatobiliary Surgery, General Hospital of Southern Theatre Command, Guangzhou, People’s Republic of China
- * Correspondence: Zhi-Ping Huang, Department of Hepatobiliary Surgery, General Hospital of Southern Theatre Command, Guangzhou 510010, China (e-mail: )
| | - Zhen-Hong Zou
- Department of General Surgery, The Second Affiliated Hospital of Nanchang University, Jiangxi, People’s Republic of China
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Oncological outcomes of open, laparoscopic and robotic colectomy in patients with transverse colon cancer. Tech Coloproctol 2022; 26:821-830. [PMID: 35804251 DOI: 10.1007/s10151-022-02650-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2021] [Accepted: 05/25/2022] [Indexed: 10/17/2022]
Abstract
BACKGROUND Literature concerning surgical management of transverse colon cancer is scarce, since many key trials excluded transverse colon cancer. The aim of this study was to evaluate clinical and oncological outcomes comparing open, laparoscopic and robotic transverse colon cancer resection. METHODS Consecutive patients who underwent elective surgery for transverse colon cancer between December 2005 and July 2021 were included. Data were kept in a prospective database approved by the institutional ethics committee. Primary outcome was overall and disease-free survival. Secondary outcomes included complications, operative time, length of stay and lymph node harvest. Statistical analysis was corrected for age and tumour localisation. RESULTS Two hundred and forty-six (38 robotic, 71 open and 137 laparoscopic resections) were recruited in this study. There were five conversions during laparoscopic procedures. Operative time was significantly shorter in robotic vs laparoscopic procedures (195 vs 238 min, p = 0.005) and length of stay was shorter in robotic vs laparoscopic and open group (7 vs 9 vs 15 days, p < 0.001). There was no difference in overall complications. R0 resections were similar. Lymph node harvest was highest in the robotic group vs. laparoscopic or open (32 vs. 29 vs. 21, p < 0.001). Overall survival was 97%, 85% and 60% (p < 0.001) and disease-free survival was 91%, 78% and 56% (p < 0.001) for the robotic, laparoscopic and open groups, respectively. CONCLUSIONS Minimally invasive surgery for transverse colon cancer is safe and offers good clinical and oncological outcomes. Robotic resection is associated with significantly shorter operating times, higher lymph node harvest, lower conversion rate and does not increase morbidity. Differences in disease-free and overall survival should be further explored in randomised controlled trials.
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Matsumoto A, Shinohara H, Suzuki H. Laparoscopic and open surgery in patients with transverse colon cancer: short-term and oncological outcomes. BJS Open 2021; 5:6369777. [PMID: 34518870 PMCID: PMC8438262 DOI: 10.1093/bjsopen/zrab078] [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: 03/08/2021] [Accepted: 07/26/2021] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Studies evaluating the outcomes after laparoscopic resections of transverse colon cancers are scant. This manuscript aimed to compare surgical and oncological outcomes after laparoscopic (Lap) and open procedures for transverse colon carcinomas. METHODS All consecutive patients who underwent resection for a cancer located in the transverse colon between 2003 and 2019 were reviewed. Patients were categorized according to the surgical approach (Lap versus open) and groups were compared. Outcome measures were the short-term results, complications and functional recovery; moreover, recurrence-free survival (RFS) and overall survival (OS) rates were compared overall and after propensity score matching (PSM) based on age, sex, ASA classification, BMI, carcinoembryonic antigen (CEA) level, use of postoperative chemotherapy, location of tumour, stage and grading, operation time, blood loss and complications. RESULTS Of 248 transverse resections reviewed, 146 (81 Lap and 65 open) were selected for data analysis. Blood loss, fluid intake and the incidence of wound infection were significantly lower and the hospital stay was significantly shorter in the Lap group (P < 0.001). The operation time and incidence of complications (Clavien-Dindo classification grade 3 or above) did not differ significantly between the two groups. Mean follow-up was of 75.4 months in the Lap group and 78.6 months in the open group. Regression analyses showed that OS was associated with the postoperative carcinoembryonic antigen (CEA) level (hazard ratio 1.18 (95 per cent c.i. 1.10 to 1.27); P < 0.001), BMI (hazard ratio 0.81 (95 per cent c.i. 0.68 to 0.96); P = 0.017), operation time (hazard ratio 0.99 (95 per cent c.i. 0.97 to 1.00; P = 0.010), and postoperative chemotherapy (hazard ratio 0.27 (95 per cent c.i. 0.08 to 0.96); P = 0.042), while RFS was associated with the postoperative CEA level (hazard ratio 1.13 (95 per cent c.i. 1.07 to 1.20); P < 0.001). PSM selected 42 patients for data comparison of long-term results, and showed no significant differences between groups (RFS: P = 0.530; OS: P = 0.561). CONCLUSION Lap and open resections for transverse colon cancer provided similar outcomes in terms of severe post-operative complication and long-term results.
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Affiliation(s)
- A Matsumoto
- Department of Surgery, Hanyu General Hospital, Hanyu, Japan
| | - H Shinohara
- Department of Surgery, Tsuchiura Kyodo General Hospital, Tsuchiura, Japan
| | - H Suzuki
- Department of Health Information System Management Technology Room, Tsuchiura Kyodo General Hospital, Tsuchiura, Japan
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Li Z, Zou Z, Lang Z, Sun Y, Zhang X, Dai M, Mao S, Han Z. Laparoscopic versus open radical resection for transverse colon cancer: evidence from multi-center databases. Surg Endosc 2021; 35:1435-1441. [PMID: 33507386 DOI: 10.1007/s00464-021-08285-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2019] [Accepted: 01/05/2021] [Indexed: 12/19/2022]
Abstract
BACKGROUND The role of laparoscopic approach is still a controversy for transverse colon cancer. Our investigation aimed to evaluate the perioperative and oncologic outcomes of laparoscopic versus open radical resection for transverse colon cancer based on evidence from multi-center databases. METHODS 416 patients with transverse colon cancer undergoing radical surgery were analyzed including 181 laparoscopic resections and 235 open resections from January 2004 to May 2017 based on multi-center databases. Perioperative and oncologic outcomes were compared. RESULTS No statistical differences regarding the baseline characteristics were observed between the two groups except the procedure type. Compared with open approach, laparoscopic approach was associated with statistically longer operation time (209.96 vs. 173.31 min, P = 0.002), significantly shorter time to soft food intake (4.73 vs. 6.01 days, P = 0.034), and shorter postoperative hospitalization (12.05 vs. 14.44 days, P = 0.001). In terms of oncologic outcomes, laparoscopic resection was correlated with statistically more lymph node retrieval (13.52 vs. 15.91, P = 0.002) and similar 5-year overall survival (91.2% vs. 89.1%, P = 0.356) and disease-free survival (89.6% vs. 86.0%, P = 0.873), compared with open resection. CONCLUSIONS For patients with transverse colon cancer, laparoscopic approach can achieve several short-term advantages without decreasing long-term oncologic survival.
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Affiliation(s)
- Zhenjia Li
- Department of General Surgery, The Second Affiliated Hospital of Nanchang University, 1 Minde Road, Nanchang, Jiangxi, People's Republic of China
| | - Zhenhong Zou
- Department of General Surgery, The Second Affiliated Hospital of Nanchang University, 1 Minde Road, Nanchang, Jiangxi, People's Republic of China
| | - Zhiquan Lang
- Nanchang University, Nanchang, Jiangxi, People's Republic of China
| | - Yuting Sun
- Nanchang University, Nanchang, Jiangxi, People's Republic of China
| | - Xuerui Zhang
- Nanchang University, Nanchang, Jiangxi, People's Republic of China
| | - Min Dai
- Department of General Surgery, The First Affiliated Hospital, Nanchang University, Yongwai Zhengjie, Nanchang, 330006, Jiangxi, People's Republic of China
| | - Shengxun Mao
- Department of General Surgery, The Second Affiliated Hospital of Nanchang University, 1 Minde Road, Nanchang, Jiangxi, People's Republic of China.
| | - Zelong Han
- Department of Gastroenterology, Nanfang Hospital, Southern Medical University, Guangzhou, 510515, Guangdong, People's Republic of China.
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Comparing the safety, efficacy, and oncological outcomes of laparoscopic and open colectomy in transverse colon cancer: a meta-analysis. Int J Colorectal Dis 2020; 35:373-386. [PMID: 31980872 DOI: 10.1007/s00384-020-03516-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/20/2020] [Indexed: 02/06/2023]
Abstract
INTRODUCTION In order to compare the safety, efficacy, and oncological outcomes of laparoscopic (LC) and open colectomy (OC) for transverse colon cancer (TCC) patients, the present systematic review of the literature and meta-analysis was designed. METHODS This study was conducted following the Cochrane Handbook for Systematic Reviews of Interventions and the PRISMA guidelines. A systematic screening of the electronic databases was performed (Medline, Web of Science and Scopus). The validity of the pooled results was verified through the performance of trial sequential analysis (TSA). The level of evidence was estimated using the GRADE approach. RESULTS Overall, 21 studies and 2498 patients were included in our study. Pooled comparisons and TSA analyses reported a superiority of LC over OC in terms of postoperative complications (OR 0.64, p = 0.0003), blood loss (WMD - 86.84, p < 0.00001), time to first flatus (WMD - 0.94, p < 0.00001) and oral diet (WMD - 1.25, p < 0.00001), and LOS (WMD - 2.39, p < 0.00001). Moreover, OC displayed a lower operation duration (p < 0.00001). A higher rate of complete mesocolic excision (p = 0.001) was related to OC. Although inconclusive in TSA, the recurrence rate in LC group was lower. LC and OC were equivalent in terms of postoperative survival outcomes. CONCLUSIONS Considering several limitations of the eligible studies and the subsequent low level of evidence, further RCTs of a higher quality and methodological level are required to verify the findings of our meta-analysis.
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Koinuma K, Horie H, Ito H, Naoi D, Sadatomo A, Tahara M, Inoue Y, Kono Y, Sasaki T, Sugimoto H, Lefor AK, Sata N. Four-directional approach to the meso-transverse attachment combined with preoperative radiological vascular simulation facilitates short-term surgical outcomes in laparoscopic transverse colon cancer surgery. Asian J Endosc Surg 2019; 12:150-156. [PMID: 29963764 DOI: 10.1111/ases.12628] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2018] [Revised: 05/24/2018] [Accepted: 06/07/2018] [Indexed: 12/16/2022]
Abstract
INTRODUCTION Transverse colon resection is one of the most difficult laparoscopic procedures because of anatomic hazards such as variations in the mesenteric vascular anatomy and the complex structure of organs and surrounding membranes. METHODS We evaluated the short-term surgical outcomes of laparoscopic transverse colon resection using a creative approach. This approach included preoperative surgical simulation using virtual surgical anatomy by CT, a four-directional approach to the mesentery, and 3-D imaging during laparoscopic surgery. RESULTS A total of 45 consecutive patients who underwent laparoscopic resection for transverse colon cancer from June 2013 to December 2017 were enrolled in this study. All procedures were completed safely, with minor postoperative complications, including two patients with anastomotic stenosis, two with intra-abdominal phlegmon, one with delayed gastric emptying, and one with pneumonia, all treated non-operatively. There were no conversions to open resection. Operation time was 203 min (range, 125-322 min), and the estimated blood loss during surgery was 5 mL (range, 0-370 mL). The mean postoperative hospital stay was 10 days (range, 7-21 days), and no patients required readmission. CONCLUSION Short-term surgical outcomes after laparoscopic transverse colon resection demonstrated that this creative approach was safe and feasible. The four-directional approach to the meso-transverse attachment combined with preoperative radiological simulation can facilitate laparoscopic transverse colon surgery.
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Affiliation(s)
- Koji Koinuma
- Department of Surgery, Jichi Medical University, Shimotsuke, Japan
| | - Hisanaga Horie
- Department of Surgery, Jichi Medical University, Shimotsuke, Japan
| | - Homare Ito
- Department of Surgery, Jichi Medical University, Shimotsuke, Japan
| | - Daishi Naoi
- Department of Surgery, Jichi Medical University, Shimotsuke, Japan
| | - Ai Sadatomo
- Department of Surgery, Jichi Medical University, Shimotsuke, Japan
| | - Makiko Tahara
- Department of Surgery, Jichi Medical University, Shimotsuke, Japan
| | - Yoshiyuki Inoue
- Department of Surgery, Jichi Medical University, Shimotsuke, Japan
| | - Yoshihiko Kono
- Department of Surgery, Jichi Medical University, Shimotsuke, Japan
| | - Takahiro Sasaki
- Department of Radiology, Jichi Medical University, Shimotsuke, Japan
| | - Hideharu Sugimoto
- Department of Radiology, Jichi Medical University, Shimotsuke, Japan
| | | | - Naohiro Sata
- Department of Surgery, Jichi Medical University, Shimotsuke, Japan
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Awad M, Awad F, Carter F, Jervis B, Buzink S, Foster J, Jakimowicz J, Francis NK. Consensus views on the optimum training curriculum for advanced minimally invasive surgery: A delphi study. Int J Surg 2018; 53:137-142. [DOI: 10.1016/j.ijsu.2018.03.039] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2017] [Revised: 02/09/2018] [Accepted: 03/19/2018] [Indexed: 12/18/2022]
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Kwak HD, Ju JK, Lee SY, Kim CH, Kim YJ, Kim HR. A comparison of laparoscopic and open D3 lymphadenectomy for transverse colon cancer. Int J Colorectal Dis 2017; 32:1733-1739. [PMID: 28879395 DOI: 10.1007/s00384-017-2890-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/13/2017] [Indexed: 02/04/2023]
Abstract
PURPOSE The type of surgery or surgical approach for transverse colon cancer treatment largely depends on the tumor location or surgeon's preference. However, extensive lymphadenectomy appears to improve the long-term outcomes of locally advanced colon cancers. This study was designed to compare the short- and long-term outcomes after surgery via the laparoscopic or open approach with radical D3 lymph node dissection in patients with stage II and III transverse colon cancer. METHODS Patients were treated for stage II and III transverse colon cancer between May 2006 and December 2014. This retrospective study evaluated data collected prospectively at a tertiary teaching hospital. Radical D3 lymphadenectomy included the principal middle colic artery nodes. RESULTS The study included 144 patients among whom 118 (81.9%) underwent laparoscopic surgery. Significantly more patients in the laparoscopic group underwent extended right hemicolectomy compared with the open group (90.7 vs. 65.4%, p = 0.005). The operative time was longer in the laparoscopic group (151.3 vs. 131.2 min, p = 0.021), and the open group had a greater estimated blood loss volume (160.8 vs. 289.3 ml, p = 0.011). Although the groups differed in terms of tumor size (5.8 vs 7.9 cm, p = 0.007), other pathologic outcomes did not differ. The groups did not differ regarding postoperative parameters or disease-free, overall, and cancer-specific survivals. CONCLUSION Despite differences in surgical methods and related factors, no long-term differences in outcomes were observed between laparoscopic and open approaches to radical D3 lymphadenectomy in patients with stage II and III transverse colon cancer.
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Affiliation(s)
- Han Deok Kwak
- Department of Surgery, Chonnam National University Hospital, 42 Jaebong-ro, Dong-gu, Gwangju, 61469, Republic of Korea
| | - Jae Kyun Ju
- Department of Surgery, Chonnam National University Hospital, 42 Jaebong-ro, Dong-gu, Gwangju, 61469, Republic of Korea.
| | - Soo Young Lee
- Department of Surgery, Chonnam National University Hwasun Hospital, 322 Seoyang-ro, Hwasun-eup, Hwasun-gun, Jeonnam, 58128, Republic of Korea
| | - Chang Hyun Kim
- Department of Surgery, Chonnam National University Hwasun Hospital, 322 Seoyang-ro, Hwasun-eup, Hwasun-gun, Jeonnam, 58128, Republic of Korea
| | - Young Jin Kim
- Department of Surgery, Chonnam National University Hwasun Hospital, 322 Seoyang-ro, Hwasun-eup, Hwasun-gun, Jeonnam, 58128, Republic of Korea
| | - Hyeong Rok Kim
- Department of Surgery, Chonnam National University Hwasun Hospital, 322 Seoyang-ro, Hwasun-eup, Hwasun-gun, Jeonnam, 58128, Republic of Korea.
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Wu Q, Wei M, Ye Z, Bi L, Zheng E, Hu T, Gu C, Wang Z. Laparoscopic Colectomy Versus Open Colectomy for Treatment of Transverse Colon Cancer: A Systematic Review and Meta-Analysis. J Laparoendosc Adv Surg Tech A 2017; 27:1038-1050. [PMID: 28355104 DOI: 10.1089/lap.2017.0031] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND The surgical management of transverse colon cancer (TCC) is still not standardized. The aim of this meta-analysis was to evaluate the effect of laparoscopic colectomy (LC) for treatment of TCC in terms of short-term and long-term outcomes compared with open colectomy. METHOD A systematic literature search with no limits was performed in PubMed and Embase. The last search was performed on September 15, 2016. The short-term outcomes included intraoperative outcomes, postoperative outcomes, and oncological surgical quality. The long-term outcomes included overall survival (OS) and disease-free survival (DFS). RESULTS Thirteen articles and one conference abstract published between 2010 and 2016 with a total of 1728 patients were enrolled in this meta-analysis. LC was associated with significant less estimated blood loss, fewer total postoperative complications, and shorter time to first flatus, time to liquid diet, length of hospital stay, and length of postoperative hospital stay. However, longer operative time was needed in LC. There was no statistically significant difference between the groups concerning the intraoperative complications, mortality, ileus, anastomotic leakage, bleeding, wound infection, abdominal infection, lymph nodes harvested, proximal resection margin, distal resection margin, OS, or DFS. CONCLUSION Our meta-analysis suggests that LC is a safe and feasible technique for TCC associated with less estimated blood loss, fewer total postoperative complications, quicker recovery of intestinal function, shorter length of hospital stay, and equivalent long-term outcomes. Furthermore, a large-scaled, prospective randomized controlled study is warranted to verify those results.
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Affiliation(s)
- Qingbin Wu
- 1 Department of Gastrointestinal Surgery, West China Hospital, Sichuan University , Chengdu, China .,2 West China School of Medicine, Sichuan University , Chengdu, China
| | - Mingtian Wei
- 1 Department of Gastrointestinal Surgery, West China Hospital, Sichuan University , Chengdu, China .,3 State Key Laboratory of Biotherapy and Cancer Center/Collaborative Innovation Center for Biotherapy, West China Hospital, Sichuan University , Chengdu, China
| | - Zengpanpan Ye
- 2 West China School of Medicine, Sichuan University , Chengdu, China
| | - Liang Bi
- 1 Department of Gastrointestinal Surgery, West China Hospital, Sichuan University , Chengdu, China .,2 West China School of Medicine, Sichuan University , Chengdu, China
| | - Erliang Zheng
- 1 Department of Gastrointestinal Surgery, West China Hospital, Sichuan University , Chengdu, China .,2 West China School of Medicine, Sichuan University , Chengdu, China
| | - Tao Hu
- 1 Department of Gastrointestinal Surgery, West China Hospital, Sichuan University , Chengdu, China .,2 West China School of Medicine, Sichuan University , Chengdu, China
| | - Chaoyang Gu
- 1 Department of Gastrointestinal Surgery, West China Hospital, Sichuan University , Chengdu, China .,2 West China School of Medicine, Sichuan University , Chengdu, China
| | - Ziqiang Wang
- 1 Department of Gastrointestinal Surgery, West China Hospital, Sichuan University , Chengdu, China
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Laparoscopic vs open approach for transverse colon cancer. A systematic review and meta-analysis of short and long term outcomes. Int J Surg 2017; 41:78-85. [PMID: 28344158 DOI: 10.1016/j.ijsu.2017.03.050] [Citation(s) in RCA: 44] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2017] [Accepted: 03/17/2017] [Indexed: 12/15/2022]
Abstract
BACKGROUND Transverse colon malignancies have been excluded from all randomized controlled trials comparing laparoscopic against open colectomies, potentially due to the advanced laparoscopic skills required for dissecting around the middle colic vessels and the associated morbidity. Concerns have been expressed that the laparoscopic approach may compromise the oncological clearance in transverse colon cancer. This study aimed to comprehensively compare the laparoscopic (LPA) to the open (OPA) approach by performing a meta-analysis of long and short term outcomes. METHODS Medline, Embase, Cochrane library, Scopus and Web of Knowledge databases were interrogated. Selected studies were critically appraised and the short-term morbidity and long term oncological outcomes were meta-analyzed. Sensitivity analysis according to the quality of the study, type of procedure (laparoscopic vs laparoscopically assisted) and level of lymphadenectomy was performed. Statistical heterogeneity and publication bias were also investigated. RESULTS Eleven case control trials (1415 patients) were included in the study. There was no difference between the LPA and the OPA in overall survival [Hazard Ratio (HR) = 0.83 (0.56, 1.22); P = 0.34], disease free survival (p = 0.20), local recurrence (p = 0.81) or distant metastases (p = 0.24). LPA was found to have longer operative time [Weighted mean difference (WMD) = 45.00 (29.48, 60.52); P < 0.00001] with earlier establishment of oral intake [WMD = -1.68 (-1.84, -1.53); P < 0.00001] and shorter hospital stay [WMD = -2.94 (-4.27, -1.62); P = 0.0001]. No difference was found in relation to anastomotic leakage (p = 0.39), intra-abdominal abscess (p = 0.25), lymph nodes harvested (p = 0.17). CONCLUSIONS LPA seems to be safe with equivalent oncological outcomes to OPA and better short term outcomes in selected patient populations. High quality Randomized control trials are required to further investigate the role of laparoscopy in transverse colon cancer.
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Kim JW, Kim JY, Kang BM, Lee BH, Kim BC, Park JH. Short- and long-term outcomes of laparoscopic surgery vs open surgery for transverse colon cancer: a retrospective multicenter study. Onco Targets Ther 2016; 9:2203-9. [PMID: 27143915 PMCID: PMC4846052 DOI: 10.2147/ott.s103763] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
Purpose The purpose of the present study was to compare the perioperative and oncologic outcomes between laparoscopic surgery and open surgery for transverse colon cancer. Patients and methods We conducted a retrospective review of patients who underwent surgery for transverse colon cancer at six Hallym University-affiliated hospitals between January 2005 and June 2015. The perioperative outcomes and oncologic outcomes were compared between laparoscopic and open surgery. Results Of 226 patients with transverse colon cancer, 103 underwent laparoscopic surgery and 123 underwent open surgery. There were no differences in the patient characteristics between the two groups. Regarding perioperative outcomes, the operation time was significantly longer in the laparoscopic group than in the open group (267.3 vs 172.7 minutes, P<0.001), but the time to soft food intake (6.0 vs 6.6 days, P=0.036) and the postoperative hospital stay (13.7 vs 15.7 days, P=0.018) were shorter in the laparoscopic group. The number of harvested lymph nodes was lower in the laparoscopic group than in the open group (20.3 vs 24.3, P<0.001). The 5-year overall survival (90.8% vs 88.6%, P=0.540) and disease-free survival (86.1% vs 78.9%, P=0.201) rates were similar in both groups. Conclusion The present study showed that laparoscopic surgery is associated with several perioperative benefits and similar oncologic outcomes to open surgery for the resection of transverse colon cancer. Therefore, laparoscopic surgery offers a safe alternative to open surgery in patients with transverse colon cancer.
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Affiliation(s)
- Jong Wan Kim
- Department of Surgery, Dongtan Sacred Heart Hospital, College of Medicine, Hallym University, Hwaseong Si, Republic of Korea
| | - Jeong Yeon Kim
- Department of Surgery, Dongtan Sacred Heart Hospital, College of Medicine, Hallym University, Hwaseong Si, Republic of Korea
| | - Byung Mo Kang
- Department of Surgery, Chuncheon Sacred Heart Hospital, College of Medicine, Hallym University, Chuncheon Si, Republic of Korea
| | - Bong Hwa Lee
- Department of Surgery, Hallym Sacred Heart Hospital, College of Medicine, Hallym University, Anyang Si, Republic of Korea
| | - Byung Chun Kim
- Department of Surgery, Kangnam Sacred Heart Hospital, College of Medicine, Hallym University, Seoul, Republic of Korea
| | - Jun Ho Park
- Department of Surgery, Kangdong Sacred Heart Hospital, College of Medicine, Hallym University, Seoul, Republic of Korea
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Yamada T, Okabayashi K, Hasegawa H, Tsuruta M, Yoo JH, Seishima R, Kitagawa Y. Meta-analysis of the risk of small bowel obstruction following open or laparoscopic colorectal surgery. Br J Surg 2016; 103:493-503. [DOI: 10.1002/bjs.10105] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2015] [Revised: 12/13/2015] [Accepted: 12/14/2015] [Indexed: 12/17/2022]
Abstract
Abstract
Background
One of the potential advantages of laparoscopic compared with open colorectal surgery is a reduction in postoperative bowel obstruction events. Early reports support this proposal, but accumulated evidence is lacking.
Methods
A systematic review and meta-analysis was performed of randomized clinical trials and observational studies by searching the PubMed and Cochrane Library databases from 1990 to August 2015. The primary outcomes were early and late postoperative bowel obstruction following laparoscopic and open colorectal surgery. Both ileus and bowel obstruction were defined as a postoperative bowel obstruction. Subgroup and sensitivity analyses were performed, and a random-effects model was used to account for the heterogeneity among the studies.
Results
Twenty-four randomized clinical trials and 88 observational studies were included in the meta-analysis; 106 studies reported early outcome and 12 late outcome. Collectively, these studies reported on the outcomes of 148 392 patients, of whom 58 133 had laparoscopic surgery and 90 259 open surgery. Compared with open surgery, laparoscopic surgery was associated with reduced rates of early (odds ratio 0·62, 95 per cent c.i. 0·54 to 0·72; P < 0·001) and late (odds ratio 0·61, 0·41 to 0·92; P = 0·019) postoperative bowel obstruction. Weighted mean values for early postoperative bowel obstruction were 8 (95 per cent c.i. 6 to 10) and 5 (3 to 7) per cent for open and laparoscopic surgery respectively, and for late bowel obstruction were 4 (2 to 6) and 3 (1 to 5) per cent respectively.
Conclusion
The reduction in postoperative bowel obstruction demonstrates an advantage of laparoscopic surgery in patients with colorectal disease.
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Affiliation(s)
- T Yamada
- Department of Surgery, Keio University School of Medicine, Tokyo, Japan
| | - K Okabayashi
- Department of Surgery, Keio University School of Medicine, Tokyo, Japan
| | - H Hasegawa
- Department of Surgery, Keio University School of Medicine, Tokyo, Japan
| | - M Tsuruta
- Department of Surgery, Keio University School of Medicine, Tokyo, Japan
| | - J-H Yoo
- Department of Surgery, National Hospital Organization Saitama National Hospital, 2–1 Suwa Wako, Saitama, Japan
| | - R Seishima
- Department of Surgery, Keio University School of Medicine, Tokyo, Japan
| | - Y Kitagawa
- Department of Surgery, Keio University School of Medicine, Tokyo, Japan
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14
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Pascual M, Salvans S, Pera M. Laparoscopic colorectal surgery: Current status and implementation of the latest technological innovations. World J Gastroenterol 2016; 22:704-717. [PMID: 26811618 PMCID: PMC4716070 DOI: 10.3748/wjg.v22.i2.704] [Citation(s) in RCA: 69] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2015] [Accepted: 12/14/2015] [Indexed: 02/06/2023] Open
Abstract
The introduction of laparoscopy is an example of surgical innovation with a rapid implementation in many areas of surgery. A large number of controlled studies and meta-analyses have shown that laparoscopic colorectal surgery is associated with the same benefits than other minimally invasive procedures, including lesser pain, earlier recovery of bowel transit and shorter hospital stay. On the other hand, despite initial concerns about oncological safety, well-designed prospective randomized multicentre trials have demonstrated that oncological outcomes of laparoscopy and open surgery are similar. Although the use of laparoscopy in colorectal surgery has increased in recent years, the percentages of patients treated with surgery using minimally invasive techniques are still reduced and there are also substantial differences among centres. It has been argued that the limiting factor for the use of laparoscopic procedures is the number of surgeons with adequate skills to perform a laparoscopic colectomy rather than the tumour of patients’ characteristics. In this regard, future efforts to increase the use of laparoscopic techniques in colorectal surgery will necessarily require more efforts in teaching surgeons. We here present a review of recent controversies of the use of laparoscopy in colorectal surgery, such as in rectal cancer operations, the possibility of reproducing complete mesocolon excision, and the benefits of intra-corporeal anastomosis after right hemicolectomy. We also describe the results of latest innovations such as single incision laparoscopic surgery, robotic surgery and natural orifice transluminal endoscopic surgery for colon and rectal diseases.
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15
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Le ZB, Jie ZG, Liu Y, Li ZR, Cao Y, Li DJ, Tan SX. Clinical application of hand-assisted laparoscopy in transverse colectomy for middle transverse colon cancer. Shijie Huaren Xiaohua Zazhi 2015; 23:5722-5727. [DOI: 10.11569/wcjd.v23.i35.5722] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
AIM: To assess the safety, feasibility and clinical application value of hand-assisted laparoscopy in transverse colectomy for middle transverse colon cancer.
METHODS: From April 2012 to April 2015, a total of 20 patients with middle transverse colon cancer underwent radical transverse colon resection at Department of Gastrointestinal Surgery of the First Affiliated Hospital of Nanchang University, of whom 11 underwent hand assisted laparoscopic surgery (HALS), and 9 underwent laparoscopic-assisted surgery (LAS). The clinical data of all the patients were retrospectively analyzed and compared between the two groups.
RESULTS: All the 20 patients had successful surgery. There was no conversion to open surgery or no operative death. Operative time was significantly shorter in the HALS group than in the LAS group (153.6 min ± 28.1 min vs 190.6 min ± 35.0 min, P = 0.017). There were no significant differences between the two groups in blood loss (121.8 mL ± 79.4 mL vs 116.1 mL ± 78.1 mL), number of lymph nodes harvested (15.4 ± 5.4 vs 17.6 ± 11.7), rate of postoperative complications (9.1% vs 11.1%), postoperative exhaust time (3.1 d ± 0.7 d vs 2.9 d ± 0.6 d), or postoperative hospital stay (7.4 d ± 0.7 d vs 7.8 d ± 1.1 d) (P > 0.05). The patients were followed for 2-38 months. In the HALS group, one patient developed intestinal obstruction at 1 mo and one patient developed liver metastases at 8 mo. In the LAS group, one patient died of extensive abdominal metastasis.
CONCLUSION: The hand-assisted laparoscopic technique is feasible and safe in the radical resection of middle transverse colon cancer. Due to a small number of patients included and short follow-up time in this study, further studies are required.
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Kim MK, Won DY, Lee JK, Kang WK, Kye BH, Cho HM, Kim HJ, Kim JG. Laparoscopic Surgery for Transverse Colon Cancer: Short- and Long-Term Outcomes in Comparison with Conventional Open Surgery. J Laparoendosc Adv Surg Tech A 2015; 25:982-9. [PMID: 26583447 DOI: 10.1089/lap.2015.0122] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Abstract
BACKGROUND Published studies on laparoscopic surgery for transverse colon cancer are scarce. More studies are necessary to evaluate the feasibility, safety, and long-term oncologic outcomes of laparoscopic surgery for transverse colon cancer. SUBJECTS AND METHODS From April 1996 to December 2010, 102 consecutive patients with stage II or III disease who had undergone curative resection for transverse colon cancer were enrolled. Seventy-nine patients underwent laparoscopy-assisted colectomy (LAC), whereas 23 patients underwent conventional open colectomy (OC). Short- and long-term outcomes of the two groups were compared. RESULTS The OC group had a larger tumor size (7.6 ± 3.4 cm versus 5.2 ± 2.3 cm, P = .004) and more retrieved lymph nodes (26.4 ± 11.6 versus 17.5 ± 9.4, P = .002), without differences in resection margins. In the LAC group, return to diet was faster (4.5 ± 1.2 days versus 5.4 ± 1.8 days, P = .013), and postoperative hospital stay was shorter (12.1 ± 4.2 days versus 15.9 ± 4.8 days, P = .000). There were no differences in occurrence of intra- or postoperative complications. There were no statistically significant differences in overall survival rate (OS) or disease-free survival rate (DFS) between the two groups (5-year OS, 90.4% versus 90.5%, P = .670; 5-year DFS, 84.2% versus 90.7%, P = .463). CONCLUSIONS Laparoscopic surgery for transverse colon cancer has better short-term outcomes compared with open surgery, with acceptable long-term outcomes. As in colorectal cancer of other sites, laparoscopic surgery can be a feasible alternative to conventional surgery for transverse colon cancer.
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Affiliation(s)
- Min Ki Kim
- 1 Department of Surgery, College of Medicine, Seoul St. Mary's Hospital, The Catholic University of Korea , Seoul, Korea
| | - Dae-Youn Won
- 1 Department of Surgery, College of Medicine, Seoul St. Mary's Hospital, The Catholic University of Korea , Seoul, Korea
| | - Jin-Kwon Lee
- 1 Department of Surgery, College of Medicine, Seoul St. Mary's Hospital, The Catholic University of Korea , Seoul, Korea
| | - Won-Kyung Kang
- 1 Department of Surgery, College of Medicine, Seoul St. Mary's Hospital, The Catholic University of Korea , Seoul, Korea
| | - Bong-Hyeon Kye
- 2 Department of Surgery, College of Medicine, St. Vincent Hospital, The Catholic University of Korea , Suwon, Korea
| | - Hyeon-Min Cho
- 2 Department of Surgery, College of Medicine, St. Vincent Hospital, The Catholic University of Korea , Suwon, Korea
| | - Hyung-Jin Kim
- 2 Department of Surgery, College of Medicine, St. Vincent Hospital, The Catholic University of Korea , Suwon, Korea
| | - Jun-Gi Kim
- 1 Department of Surgery, College of Medicine, Seoul St. Mary's Hospital, The Catholic University of Korea , Seoul, Korea
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17
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Moghadamyeghaneh Z, Hanna MH, Carmichael JC, Pigazzi A, Stamos MJ, Mills S. Comparison of open, laparoscopic, and robotic approaches for total abdominal colectomy. Surg Endosc 2015; 30:2792-8. [DOI: 10.1007/s00464-015-4552-8] [Citation(s) in RCA: 49] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2015] [Accepted: 09/01/2015] [Indexed: 01/24/2023]
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18
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Sheng W, Zhang B, Chen W, Gu D, Gao W. Laparoscopic colectomy for transverse colon cancer: comparative analysis of short- and long-term outcomes. Int J Clin Exp Med 2015; 8:16029-16035. [PMID: 26629108 PMCID: PMC4658997] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2015] [Accepted: 06/21/2015] [Indexed: 06/05/2023]
Abstract
This study evaluated the short- and long-term outcomes of laparoscopic colectomy compared with open colectomy for patients with transverse colon cancer by matched-pair analysis. This study enrolled 59 patients who underwent laparoscopic colectomy and compared them with 59 matched patients who underwent open colectomy for transverse colon cancer. The following parameters were matched: clinical stage and type of resection. Both short- and long-term outcomes of laparoscopic colectomy were compared with those of open colectomy. No difference was observed between the two groups in terms of age, gender, ASA score, comorbidity, clinical stage and operative procedures. Regarding short-term outcomes, blood loss, time to first flatus, time to liquid diet and postoperative stay were significantly shorter in the laparoscopy group than in the open group, while operation time was significantly longer in the laparoscopy group than in the open group. Postoperative complication was similar between the two groups. With respect to long-term outcomes, the two groups did not differ significantly in terms of 5-year overall and disease-free survival. In summary, laparoscopic colectomy is a safe and feasible option for selected patients with transverse colon cancer. The short- and long-term outcomes of laparoscopic colectomy are considered to be acceptable.
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Affiliation(s)
- Weizheng Sheng
- Department of General Surgery, Zhongshan Hospital, Fudan University 180 Feng Lin Road, Shanghai 200032, People's Republic of China
| | - Bo Zhang
- Department of General Surgery, Zhongshan Hospital, Fudan University 180 Feng Lin Road, Shanghai 200032, People's Republic of China
| | - Weifeng Chen
- Department of General Surgery, Zhongshan Hospital, Fudan University 180 Feng Lin Road, Shanghai 200032, People's Republic of China
| | - Dayong Gu
- Department of General Surgery, Zhongshan Hospital, Fudan University 180 Feng Lin Road, Shanghai 200032, People's Republic of China
| | - Weidong Gao
- Department of General Surgery, Zhongshan Hospital, Fudan University 180 Feng Lin Road, Shanghai 200032, People's Republic of China
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Choi YY, Park JS, Park SY, Kim HJ, Yeo J, Kim JC, Park S, Choi GS. Can intravenous patient-controlled analgesia be omitted in patients undergoing laparoscopic surgery for colorectal cancer? Ann Surg Treat Res 2015; 88:86-91. [PMID: 25692119 PMCID: PMC4325645 DOI: 10.4174/astr.2015.88.2.86] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2014] [Revised: 09/11/2014] [Accepted: 09/18/2014] [Indexed: 11/30/2022] Open
Abstract
Purpose Opioid-based intravenous patient-controlled analgesia (IV-PCA) is a popular method of postoperative analgesia, but many patients suffer from PCA-related complications. We hypothesized that PCA was not essential in patients undergoing major abdominal surgery by minimal invasive approach. Methods Between February 2013 and August 2013, 297 patients undergoing laparoscopic surgery for colorectal cancer were included in this retrospective comparative study. The PCA group received conventional opioid-based PCA postoperatively, and the non-PCA group received intravenous anti-inflammatory drugs (Tramadol) as necessary. Patients reported their postoperative pain using a subjective visual analogue scale (VAS). The PCA-related adverse effects and frequency of rescue analgesia were evaluated, and the recovery rates were measured. Results Patients in the PCA group experienced less postoperative pain on days 4 and 5 after surgery than those in the non-PCA group (mean [SD] VAS: day 4, 6.2 [0.3] vs. 7.0 [0.3], P = 0.010; and day 5, 5.1 [0.2] vs. 5.5 [0.2], P = 0.030, respectively). Fewer patients in the non-PCA group required additional parenteral analgesia (41 of 93 patients vs. 53 of 75 patients, respectively), and none in the non-PCA group required rescue PCA postoperatively. The incidence of postoperative nausea and vomiting was significantly higher in the non-PCA group than in the PCA group (P < 0.001). The mean (range) length of hospital stay was shorter in the non-PCA group (7.9 [6-10] days vs. 8.7 [7-16] days, respectively, P = 0.03). Conclusion Our Results suggest that IV-PCA may not be necessary in selected patients those who underwent minimal invasive surgery for colorectal cancer.
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Affiliation(s)
- Young Yeon Choi
- Colorectal Cancer Center, Kyungpook National University Hospital, Kyungpook National University School of Medicine, Daegu, Korea
| | - Jun Seok Park
- Colorectal Cancer Center, Kyungpook National University Hospital, Kyungpook National University School of Medicine, Daegu, Korea
| | - Soo Yeun Park
- Colorectal Cancer Center, Kyungpook National University Hospital, Kyungpook National University School of Medicine, Daegu, Korea
| | - Hye Jin Kim
- Colorectal Cancer Center, Kyungpook National University Hospital, Kyungpook National University School of Medicine, Daegu, Korea
| | - Jinseok Yeo
- Department of Anesthesia and Pain Medicine, Kyungpook National University Hospital, Kyungpook National University School of Medicine, Daegu, Korea
| | - Jong-Chan Kim
- Department of Anesthesia and Pain Medicine, Kyungpook National University Hospital, Kyungpook National University School of Medicine, Daegu, Korea
| | - Sungsik Park
- Department of Anesthesia and Pain Medicine, Kyungpook National University Hospital, Kyungpook National University School of Medicine, Daegu, Korea
| | - Gyu-Seog Choi
- Colorectal Cancer Center, Kyungpook National University Hospital, Kyungpook National University School of Medicine, Daegu, Korea
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