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Kisielewski M, Wojewoda T, Richter K, Wysocki M, Jankowski M, Krawczyk W, Wantulok J, Jeleńska-Bieńkowska K, Stańczak M, Grudzińska E, Molasy B, Komorowski AL, Zdrojewski M, Sachańbiński T, Franczak P, Wierdak M, Dowgiałło-Gornowicz N, Wysocki WM. Preliminary results of Polish national multicenter study on colostomy reversal - LICO (Liquidation of Colostomy) study. Wideochir Inne Tech Maloinwazyjne 2024; 19:198-204. [PMID: 38973790 PMCID: PMC11223546 DOI: 10.5114/wiitm.2024.138785] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2023] [Accepted: 02/28/2024] [Indexed: 07/09/2024] Open
Abstract
Introduction Creation of colostomy is still a commonly performed procedure in emergency settings, when intestinal anastomosis cannot be performed safely. Reversing a stoma has been linked with high rates of morbidity and also mortality. Aim The primary goal of the study was to identify the risk of postoperative complications in patients undergoing colostomy liquidation. The secondary goal was to assess perioperative care parameters. Material and methods The LIquidation of COlostomy (LICO) study is an open multicenter prospective cohort study that began in October 2022 and will continue until December 2023. Data from 20 Polish surgical departments were collected. Overall 45 patients were reported over the initial 3 months; based on that group we performed a preliminary analysis. Results Mean operative time was 163 min. Patients were operated on by specialists in 93.3% of cases. Complications occurred in 15 (33.3%) patients. Wound infection was the most common complication (17.8%). In 3 (6.7%) cases anastomotic leakage was diagnosed, and in 2 of those cases reoperation was required. The overall mortality rate was 2.2%. The mean length of hospital stay was 10.1 days. Preoperative fasting was used in 53.3% of patients, and the mechanical bowel preparation rate was 75.6%. Only in 8.9% of cases was laparoscopic access used for stoma reversal, and only in 1 out of 45 cases was mesh used for incisional peristomal hernia prophylactics. The stoma site was closed by single sutures in 73.3%, and negative pressure assisted closure was performed in 6.7% of patients. Conclusions Colostomy liquidation is associated with significant morbidity and minor mortality in the Polish population. Standardized perioperative care should be established for stoma reversal surgery.
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Affiliation(s)
- Michał Kisielewski
- Chair of Surgery, Faculty of Medicine and Health Sciences, Andrzej Frycz Modrzewski Krakow University, Krakow, Poland
- Department of Oncological Surgery, 5th Military Clinical Hospital, Krakow, Poland
| | - Tomasz Wojewoda
- Chair of Surgery, Faculty of Medicine and Health Sciences, Andrzej Frycz Modrzewski Krakow University, Krakow, Poland
- Department of Oncological Surgery, 5th Military Clinical Hospital, Krakow, Poland
| | - Karolina Richter
- Faculty of Medicine and Health Sciences, Andrzej Frycz Modrzewski Krakow University, Krakow, Poland
| | - Michał Wysocki
- Department of General Surgery and Surgical Oncology, Ludwik Rydygier Memorial Hospital, Krakow, Poland
| | - Michał Jankowski
- Chair of Surgical Oncology, Ludwik Rydygier’s Collegium Medicum in Bydgoszcz, Nicolaus Copernicus University in Torun, Poland
- Department of Surgical Oncology, Oncology Center-Prof Franciszek Łukaszczyk Memorial Hospital, Bydgoszcz, Poland
| | - Wiktor Krawczyk
- Clinical Department of General, Colorectal and Trauma Surgery, Medical University of Silesia, Katowice, Poland
| | - Jakub Wantulok
- Clinical Department of General, Colorectal and Trauma Surgery, Medical University of Silesia, Katowice, Poland
| | - Karolina Jeleńska-Bieńkowska
- Department of General and Oncological Surgery, Military Institute of Medicine, National Research Institute, Warsaw, Poland
| | - Michał Stańczak
- Division of Oncological Propedeutics, Medical University of Gdansk and Surgical Oncology, Oncological Center, Gdynia, Poland
| | - Ewa Grudzińska
- Department of Gastrointestinal Surgery, Medical University of Silesia, Katowice, Poland
| | - Bartosz Molasy
- Collegium Medicum, Jan Kochanowki University, Kielce, Poland
| | - Andrzej L. Komorowski
- Department of Surgical Oncology, J. Śniadecki Specialist Hospital, Nowy Sącz, Poland
- College of Medicine, University of Rzeszów, Rzeszów, Poland
| | | | - Tomasz Sachańbiński
- Oncological Surgery Department with a Sub-department of Breast Diseases, Tadeusz Koszarowski Oncology Centre in Opole, Opole, Poland
- Institute of Medical Sciences, Faculty of Medicine, University of Opole, Opole, Poland
| | - Paula Franczak
- Department of General and Oncological Surgery, Ceynowa Hospital, Wejherowo, Poland
| | - Mateusz Wierdak
- 2 Department of General Surgery, Jagiellonian University Medical College, Krakow, Poland
| | - Natalia Dowgiałło-Gornowicz
- Department of General, Minimally Invasive, and Elderly Surgery, Collegium Medicum, University of Warmia and Mazury, Olsztyn, Poland
| | - Wojciech M. Wysocki
- Chair of Surgery, Faculty of Medicine and Health Sciences, Andrzej Frycz Modrzewski Krakow University, Krakow, Poland
- Department of Oncological Surgery, 5th Military Clinical Hospital, Krakow, Poland
- National Institute of Oncology Maria Skłodowska-Curie Memorial, Warsaw, Poland
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Zhou D, Su J, Yang X, Huang L, Zheng Z, Wei H, Fang J. Intracorporeal versus extracorporeal anastomosis in laparoscopic right hemicolectomy for overweight colon cancer patients: a case-control study. Langenbecks Arch Surg 2024; 409:112. [PMID: 38587671 DOI: 10.1007/s00423-024-03312-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2023] [Accepted: 04/03/2024] [Indexed: 04/09/2024]
Abstract
INTRODUCTION Either extracorporeal anastomosis (EA) or intracorporeal anastomosis (IA) could be selected for digestive reconstruction in laparoscopic right hemicolectomy (LRH). However, whether LRH with IA is feasible and beneficial for overweight right-side colon cancer (RCC) is unclear. This study aims to investigate the feasibility and advantage of IA in LRH for overweight RCC. METHODS Forty-eight consecutive overweight RCC patients undergoing LRH with IA were matched with 48 consecutive cases undergoing LRH with EA. Both clinical and surgical data were collected and analyzed. RESULTS The incidence of postoperative complications was 20.8% (10/48) in the EA group and 14.6% (7/48) in the IA group respectively, with no statistical difference. Compared to the EA group, patients in the IA group revealed faster gas (40.2 + 7.8 h vs. 45.6 + 7.9 h, P = 0.001) and stool discharge (4.0 + 1.2 d vs. 4.5 + 1.1 d, P = 0.040), shorter assisted incision (5.3 + 1.3 cm vs. 7.5 + 1.2 cm, P = 0.000), and less analgesic used (3.3 + 1.3 d vs. 4.0 + 1.3 d, P = 0.012). There were no significant differences in operation time, blood loss, or postoperative hospital stays. In the IA group, the first one third of cases presented longer operation time (228.4 + 29.3 min) compared to the middle (191.0 + 35.0 min, P = 0.003) and the last one third of patients (182.2 + 20.7 min, P = 0.000). CONCLUSION LRH with IA is feasible and safe for overweight RCC, with faster bowel function recovery and less pain. Accumulation of certain cases of LRH with IA will facilitate surgical procedures and reduce operation time.
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Affiliation(s)
- Dagui Zhou
- Department of Gastrointestinal Surgery, Third Affiliated Hospital of Sun Yat-Sen University, Tianhe Road 600, Guangzhou, 510630, China
| | - Jing Su
- Department of Nursing, Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China
| | - Xiaofeng Yang
- Department of Gastrointestinal Surgery, Third Affiliated Hospital of Sun Yat-Sen University, Tianhe Road 600, Guangzhou, 510630, China
| | - Lijun Huang
- Department of Gastrointestinal Surgery, Third Affiliated Hospital of Sun Yat-Sen University, Tianhe Road 600, Guangzhou, 510630, China
| | - Zongheng Zheng
- Department of Gastrointestinal Surgery, Third Affiliated Hospital of Sun Yat-Sen University, Tianhe Road 600, Guangzhou, 510630, China
| | - Hongbo Wei
- Department of Gastrointestinal Surgery, Third Affiliated Hospital of Sun Yat-Sen University, Tianhe Road 600, Guangzhou, 510630, China
| | - Jiafeng Fang
- Department of Gastrointestinal Surgery, Third Affiliated Hospital of Sun Yat-Sen University, Tianhe Road 600, Guangzhou, 510630, China.
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Liu XY, Zhang B, Kang B, Cheng YX, Yuan C, Tao W, Wei ZQ, Peng D. The Effect of Complications on Oncological Outcomes of Colorectal Cancer Patients After Primary Surgery: A Propensity Score Matching Analysis. Front Oncol 2022; 12:857062. [PMID: 35719908 PMCID: PMC9203956 DOI: 10.3389/fonc.2022.857062] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2022] [Accepted: 05/04/2022] [Indexed: 12/24/2022] Open
Abstract
Purpose The purpose of this study is to explore the oncologic outcomes of complications on colorectal cancer (CRC) patients who underwent primary surgery using a propensity score matching (PSM) analysis. Methods A retrospective study was conducted from Jan 2011 to Jan 2020 in a clinical center. The overall survival (OS) and disease-free survival (DFS) were compared among the no complications group, the major complications group and the minor complications group. Results A total of 4250 CRC patients who underwent radical primary surgery were included in the current study. Among them, 927 (21.8%) patients suffered complications. After 1:1 ratio PSM, there were 98 patients in the major complications group and in the minor complications group, and 911 patients in the overall complications group and in the no complications group. There was no significant difference in terms of baseline information after PSM (p>0.05). Complications were independent predictors of OS (p=0.000, HR=1.693, 95% CI=1.476-1.941) and DFS (p=0.000, HR=1.555, 95% CI=1.367-1.768). In terms of specific tumor stage, the no complications group had better OS on all stages (p=0.006) and stage III (p=0.003) CRC than the complications group after PSM. Furthermore, the no complications group had better DFS on all stages (p=0.005) and stage III (p=0.021) CRC than the complications group after PSM. However, there was no significant difference between the minor complications group and the major complications group in different tumor stages (p>0.05). Conclusion Complications were associated with poor prognosis of CRC and surgeons should be cautious of the adverse events.
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Affiliation(s)
- Xiao-Yu Liu
- Department of Gastrointestinal Surgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Bin Zhang
- Department of Gastrointestinal Surgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Bing Kang
- Department of Clinical Nutrition, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Yu-Xi Cheng
- Department of Gastrointestinal Surgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Chao Yuan
- Department of Gastrointestinal Surgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Wei Tao
- Department of Gastrointestinal Surgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Zheng-Qiang Wei
- Department of Gastrointestinal Surgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Dong Peng
- Department of Gastrointestinal Surgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
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Fang Y, Bai J, Zhang B, Wu D, Lin Y, Liu M. Laparoscopic Soave procedure for long-segment Hirschsprung's disease - single-center experience. Wideochir Inne Tech Maloinwazyjne 2020; 15:234-238. [PMID: 32117510 PMCID: PMC7020730 DOI: 10.5114/wiitm.2019.86807] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2019] [Accepted: 06/23/2019] [Indexed: 01/16/2023] Open
Abstract
INTRODUCTION Hirschsprung's disease (HD) is one of the most common and severe diseases treated in pediatric surgery. Since the introduction of the laparoscopic technique into pediatric surgery, laparoscopic-assisted radical surgery for HD has demonstrated unique advantages. Long-segment and total-colon HD are the best indications for laparoscopic-assisted surgery. AIM To summarize clinical experience of the laparoscopic Soave procedure for long-segment HD in a single center. MATERIAL AND METHODS The data of children with long-segment HD who underwent the laparoscopic Soave procedure in our department from January 2013 to May 2018 were reviewed. The clinical features, surgical procedures and follow-up results were summarized and analyzed. RESULTS Thirty-one children underwent the laparoscopic Soave procedure; none of them were converted to open surgery. The average hospitalization time was 8.7 days after the operation, and no immediate postoperative complications occurred. There was no recurrence of constipation. Six (19.3%) cases were complicated with HD associated enterocolitis in the first 3 months postoperatively; 5 (16.1%) cases had soiling in the first year. There were 0 cases of adhesive bowel obstruction, 0 cases of anastomotic stenosis, and 0 cases of constipation. CONCLUSIONS A small volume centre may achieve satisfactory results for long-segment HD. The laparoscopic Soave procedure is a minimally invasive, safe and effective treatment.
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Affiliation(s)
- Yifan Fang
- Pediatric Surgery Department, Fujian Provincial Maternity and Children Hospital, Fuzhou City, Fujian Province, China
| | - Jianxi Bai
- Pediatric Surgery Department, Fujian Provincial Maternity and Children Hospital, Fuzhou City, Fujian Province, China
| | - Bing Zhang
- Pediatric Surgery Department, Fujian Provincial Maternity and Children Hospital, Fuzhou City, Fujian Province, China
| | - Dianming Wu
- Pediatric Surgery Department, Fujian Provincial Maternity and Children Hospital, Fuzhou City, Fujian Province, China
| | - Yu Lin
- Pediatric Surgery Department, Fujian Provincial Maternity and Children Hospital, Fuzhou City, Fujian Province, China
| | - Mingkun Liu
- Pediatric Surgery Department, Fujian Provincial Maternity and Children Hospital, Fuzhou City, Fujian Province, China
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Intracorporeal versus extracorporeal anastomosis in laparoscopic right hemicolectomy - single center experience. Wideochir Inne Tech Maloinwazyjne 2019; 14:381-386. [PMID: 31534567 PMCID: PMC6748053 DOI: 10.5114/wiitm.2019.81725] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2018] [Accepted: 11/27/2018] [Indexed: 01/26/2023] Open
Abstract
Introduction Nowadays laparoscopic right hemicolectomy is widely accepted as the standard of care for benign and malignant colon disease. There are wide variations among laparoscopic techniques. One of the most discussed topics is the ileocolic anastomosis. There are two different techniques: intracorporeal anastomosis (IA) and extracorporeal anastomosis (EA). Aim To compare short-term outcomes of performing intracorporeal versus extracorporeal anastomosis in laparoscopic right hemicolectomy. Material and methods A retrospective chart review was performed of 92 consecutive patients who underwent laparoscopic right hemicolectomy, with either an IA or EA, from January 2013 to December 2016. Results Eighty-five patients were included in the analysis. There were 53 males and 32 females with a mean age of 67.1 ±13.2 years. Mean body mass index (BMI) was 27.7 ±4.8 kg/m2. An intracorporeal anastomosis was performed in 51 patients, while an extracorporeal anastomosis was performed in 34. The duration of operations was significantly longer when intracorporeal anastomosis was performed, taking 154 ±58 min compared to 95 ±34 min (p < 0.001), in the extracorporeal group. No mortality was observed in the IA group. The postoperative mortality in the EA group was 8.8% (p = 0.060). The rate of reoperation in the intracorporeal anastomosis group was 7.8%, whereas in the extracorporeal anastomosis group it was 14.7% (p = 0.474). Length of hospital stay in the IA group was shorter in comparison to the EA group (5.3 ±3.7 vs. 11.2 ±19.8 days, p = 0.022). Conclusions Our results are encouraging to consider the intracorporeal approach as the better way to fashion the anastomosis after laparoscopic right hemicolectomy.
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Upper extremity surface electromyography signal changes after laparoscopic training. Wideochir Inne Tech Maloinwazyjne 2018; 13:485-493. [PMID: 30524619 PMCID: PMC6280082 DOI: 10.5114/wiitm.2018.78744] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2018] [Accepted: 09/02/2018] [Indexed: 01/28/2023] Open
Abstract
Introduction Objective measures of laparoscopic skill in training are lacking. Aim To evaluate the changes in the surface electromyography (sEMG) signal during laparoscopic training, and to link them to intracorporeal knot tying. Material and methods Ten right-handed medical students (6 female), aged 25 ±0.98, without training in laparoscopy, were enrolled in the study. With no additional training, they tied intracorporeal single knots for 15 min. Then underwent laparoscopic training and redid the knot tying exercise. During both events, sEMG was recorded from 8 measurement points on the upper extremities and neck bilaterally. We analyzed changes in sEMG resulting from training and tried to find sEMG predictive parameters for higher technical competence defined by the number of knots tied after the training. Results The average number of knots increased after the training. Significant decreases in activity after the training were visible for the non-dominant hand deltoid and trapezius muscles. Dominant and non-dominant hands had different activation patterns. Differences largely disappeared after the training. All muscles, except for the dominant forearm and non-dominant thenar, produced a negative correlation between their activities and the number of tied knots. The strongest anticorrelation occurred for the non-dominant deltoid (r = –0.863, p < 0.05). Relatively strong relationships were identified in the case of the non-dominant trapezius and forearm muscles (r = –0.587, r = –0.504). Conclusions At least for some muscle groups there is a change in activation patterns after laparoscopic training. Proximal muscle groups tend to become more relaxed and the distal ones become more active. Changes in the non-dominant hand are more pronounced than in the dominant hand.
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Postoperative complications are associated with worse survival after laparoscopic surgery for non-metastatic colorectal cancer - interim analysis of 3-year overall survival. Wideochir Inne Tech Maloinwazyjne 2018; 13:326-332. [PMID: 30302145 PMCID: PMC6174179 DOI: 10.5114/wiitm.2018.76179] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2018] [Accepted: 05/22/2018] [Indexed: 12/15/2022] Open
Abstract
Introduction Postoperative morbidity after colorectal resections for cancer remains a significant problem. Data on the influence of complications on survival after laparoscopic colorectal resection are still limited. Aim To analyze the impact of postoperative complications on long-term survival after radical laparoscopic resection for colorectal cancer. Material and methods Two hundred and sixty-five consecutive non-metastatic colorectal cancer patients undergoing laparoscopic colorectal resection for cancer were included in the analysis. The entire study group was divided into two subgroups based on the occurrence of postoperative complications. Group 1 included patients without postoperative morbidity and group 2 included patients with complications. The primary outcome was overall survival. Results Median follow-up was 45 (IQR: 34–55) months. Group 1 consisted of 187 (70.5%) patients and group 2 comprised 78 (29.5%) patients. Studied groups were comparable in terms of sex, age, body mass index, ASA class, cancer staging, localization of the tumor and operative time. Patients in group 1 had significantly better overall 3-year survival compared to those with complications (84.9% vs. 69.8%, p = 0.022). Kaplan-Meier curves showed significantly improved survival rates in patients without complications compared with complicated cases. The Cox proportional multivariate model showed that postoperative complications (HR = 2.83; 95% CI: 1.35–5.92; p = 0.0058) and AJCC III (HR = 3.17; 95% CI: 1.52–6.6; p = 0.0021) were independent predictors of worse survival after laparoscopic colorectal cancer surgery. Conclusions Our analysis of interim results after 3 years confirms that complications after laparoscopic colorectal cancer surgery have an impact on survival. For this reason, these patients should be carefully monitored after surgery aiming at early detection of recurrence.
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