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Sakamoto Y, Itatani Y, Nishiyama K, Fujita Y, Hoshino N, Okamura R, Nishigori T, Hisamori S, Tsunoda S, Hida K, Obama K. Utility of articulating instruments as an alternative to robotic devices in laparoscopic right hemicolectomy. Int Cancer Conf J 2024; 13:78-82. [PMID: 38524662 PMCID: PMC10957826 DOI: 10.1007/s13691-024-00654-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2023] [Accepted: 01/01/2024] [Indexed: 03/26/2024] Open
Abstract
Laparoscopic complete mesocolic excision with central vessel ligation has been widely accepted for its oncological benefits in colon cancer surgery. However, laparoscopic right hemicolectomy involves a risk for vascular injury during dissection around the surgical trunk. This technical difficulty has been attributed to the limited movement of conventional laparoscopic forceps. Although robotic devices can overcome the restricted motion of laparoscopic devices, they are not yet widely used. The ArtiSential is an articulating laparoscopic instrument that has a two-joint end-effector that enables a wide range of motion precisely reflecting the surgeon's finger movements, and is designed to compensate for the drawbacks of conventional laparoscopic tools. The present study demonstrated the utility of articulating instruments in laparoscopic right hemicolectomy by comparing the authors' laparoscopic procedures, using articulating instruments, with robotic procedures. Articulating laparoscopic instruments can be successfully maneuvered in virtually the same manner as robotic devices and, as such, represent a viable alternative to robotic surgery. Supplementary Information The online version contains supplementary material available at 10.1007/s13691-024-00654-w.
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Affiliation(s)
- Yusuke Sakamoto
- Department of Surgery, Graduate School of Medicine, Kyoto University, Shogoin-Kawahara-cho, Sakyo-ku, Kyoto, 606-8507 Japan
| | - Yoshiro Itatani
- Department of Surgery, Graduate School of Medicine, Kyoto University, Shogoin-Kawahara-cho, Sakyo-ku, Kyoto, 606-8507 Japan
| | - Kazuhiro Nishiyama
- Department of Surgery, Graduate School of Medicine, Kyoto University, Shogoin-Kawahara-cho, Sakyo-ku, Kyoto, 606-8507 Japan
| | - Yusuke Fujita
- Department of Surgery, Graduate School of Medicine, Kyoto University, Shogoin-Kawahara-cho, Sakyo-ku, Kyoto, 606-8507 Japan
| | - Nobuaki Hoshino
- Department of Surgery, Graduate School of Medicine, Kyoto University, Shogoin-Kawahara-cho, Sakyo-ku, Kyoto, 606-8507 Japan
| | - Ryosuke Okamura
- Department of Surgery, Graduate School of Medicine, Kyoto University, Shogoin-Kawahara-cho, Sakyo-ku, Kyoto, 606-8507 Japan
| | - Tatsuto Nishigori
- Department of Surgery, Graduate School of Medicine, Kyoto University, Shogoin-Kawahara-cho, Sakyo-ku, Kyoto, 606-8507 Japan
| | - Shigeo Hisamori
- Department of Surgery, Graduate School of Medicine, Kyoto University, Shogoin-Kawahara-cho, Sakyo-ku, Kyoto, 606-8507 Japan
| | - Shigeru Tsunoda
- Department of Surgery, Graduate School of Medicine, Kyoto University, Shogoin-Kawahara-cho, Sakyo-ku, Kyoto, 606-8507 Japan
| | - Koya Hida
- Department of Surgery, Graduate School of Medicine, Kyoto University, Shogoin-Kawahara-cho, Sakyo-ku, Kyoto, 606-8507 Japan
| | - Kazutaka Obama
- Department of Surgery, Graduate School of Medicine, Kyoto University, Shogoin-Kawahara-cho, Sakyo-ku, Kyoto, 606-8507 Japan
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Anania G, Campagnaro A, Chiozza M, Randolph J, Resta G, Marino S, Pedon S, Agrusa A, Cuccurullo D, Cirocchi R. A SICE (Società Italiana di Chirurgia Endoscopica e Nuove Tecnologie) observational prospective multicenter study on anatomical variants of the superior mesenteric artery: intraoperative analysis during laparoscopic right hemicolectomy-CoDIG 2 database (ColonDx Italian Group). Updates Surg 2024:10.1007/s13304-024-01787-6. [PMID: 38526696 DOI: 10.1007/s13304-024-01787-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2023] [Accepted: 02/12/2024] [Indexed: 03/27/2024]
Abstract
Colorectal cancer, the third most common cancer worldwide, affects 40-45% of patients on the right side. Surgery, especially minimally invasive methods such as laparoscopic and robotic procedures, is the preferred treatment. However, these techniques present technical complications. The anatomical complexity and variations in vessel branching patterns pose challenges, particularly for less experienced surgeons. The CoDIG 2 is a nationwide observational study involving 76 specialized Italian general surgery departments focused on colorectal surgery. The centres were directed to maintain their standard surgical and clinical practices. The aim of this study was to analyse the intraoperative vascular anatomy of Italian patients who underwent laparoscopic right colectomy and explore the ligature techniques used by Italian surgeons. Surgeons reported information about vascularization of the right colon for 616 patients and about surgical anatomy of RCA for 368 patients. Fifty-three patients (10.8%) showed no RCA intraoperatively. The right colic artery (RCA) was categorized according to the Yada classification (types 1-4) during evaluation, and intraoperative assessments revealed that Yada type 1 was the most common type (55.2%), while radiologic evaluations revealed a higher prevalence of type 2. Furthermore, compared with the superior mesenteric vein (SMV), the RCA is more often located anteriorly according to intraoperative and contrast-enhanced CT examination; 59.9% were found in the anterior position during intraoperative examination, while 40.1% were found in the same position on preoperative contrast-enhanced CT. Vascularization of the right colon, including missing branches, additional branches, shared trunks, and retro-superior courses of the mesenteric vein, exhibited notable variations. To understand vascular variations, a preoperative radiological study is necessary; although there was no concordance between the intraoperative and radiological evaluations, this is a limitation of preinterventional radiological evaluation (PII) because it is always needed for oncological staging. This approach is especially critical for inexperienced surgeons to avoid potential complications, such as problematic bleeding.
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Affiliation(s)
- G Anania
- Unit of General Surgery, S. Anna University Hospital of Ferrara, Via Aldo Moro 8, Cona, FE, Italy
- Department of Medical Science, University of Ferrara, Via Fossato di Mortara 64/B, 44121, Ferrara, FE, Italy
| | - A Campagnaro
- Unit of General Surgery, S. Anna University Hospital of Ferrara, Via Aldo Moro 8, Cona, FE, Italy.
- Department of Medical Science, University of Ferrara, Via Fossato di Mortara 64/B, 44121, Ferrara, FE, Italy.
| | - M Chiozza
- Unit of General Surgery, S. Anna University Hospital of Ferrara, Via Aldo Moro 8, Cona, FE, Italy
- Department of Medical Science, University of Ferrara, Via Fossato di Mortara 64/B, 44121, Ferrara, FE, Italy
| | - J Randolph
- Georgia Baptist College of Nursing, Mercer University, Atlanta, GA, 30341, USA
| | - G Resta
- Unit of General Surgery, S. Anna University Hospital of Ferrara, Via Aldo Moro 8, Cona, FE, Italy
| | - S Marino
- Unit of General Surgery, S. Anna University Hospital of Ferrara, Via Aldo Moro 8, Cona, FE, Italy
| | - S Pedon
- Unit of General Surgery, S. Anna University Hospital of Ferrara, Via Aldo Moro 8, Cona, FE, Italy
- Department of Medical Science, University of Ferrara, Via Fossato di Mortara 64/B, 44121, Ferrara, FE, Italy
| | - A Agrusa
- Department of Surgical, Oncological and Oral Sciences, University of Palermo, Palermo, PA, Italy
| | - D Cuccurullo
- Division of Laparoscopic and Robotic Surgery Unit, A.O.R.N. Colli Monaldi Hospital, Napoli, NA, Italy
| | - R Cirocchi
- Department of Medicine and Surgery, University of Perugia, Piazza Università 1, 06123, Perugia, PG, Italy
- Division of Digestive and Emergency Surgery, Santa Maria Hospital, Via Tristano di Joannuccio 05100, Terni, TR, Italy
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Degiuli M, Aguilar AHR, Solej M, Azzolina D, Marchiori G, Corcione F, Bracale U, Peltrini R, Di Nuzzo MM, Baldazzi G, Cassini D, Sica GS, Pirozzi B, Muratore A, Calabrò M, Jovine E, Lombardi R, Anania G, Chiozza M, Petz W, Pizzini P, Persiani R, Biondi A, Reddavid R. A Randomized Phase III Trial of Complete Mesocolic Excision Compared with Conventional Surgery for Right Colon Cancer: Interim Analysis of a Nationwide Multicenter Study of the Italian Society of Surgical Oncology Colorectal Cancer Network (CoME-in trial). Ann Surg Oncol 2024; 31:1671-1680. [PMID: 38087139 PMCID: PMC10838239 DOI: 10.1245/s10434-023-14664-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2023] [Accepted: 11/12/2023] [Indexed: 02/06/2024]
Abstract
BACKGROUND Although complete mesocolic excision (CME) is supposed to be associated with a higher lymph node (LN) yield, decreased local recurrence, and survival improvement, its implementation currently is debated because the evidence level of these data is rather low and still not supported by randomized controlled trials. METHOD This is a multicenter, randomized, superiority trial (NCT04871399). The 3-year disease-free survival (DFS) was the primary end point of the study. The secondary end points were safety (duration of operation, perioperative complications, hospital length of stay), oncologic outcomes (number of LNs retrieved, 3- and 5-year overall survival, 5-year DFS), and surgery quality (specimen length, area and integrity rate of mesentery, length of ileocolic and middle-colic vessels). The trial design required the LN yield to be higher in the CME group at interim analysis. RESULTS Interim data analysis is presented in this report. The study enrolled 258 patients in nine referral centers. The number of LNs retrieved was significantly higher after CME (25 vs. 20; p = 0.012). No differences were observed with respect to intra- or post-operative complications, postoperative mortality, or duration of surgery. The hospital stay was even shorter after CME (p = 0.039). Quality of surgery indicators were higher in the CME arm of the study. Survival data still were not available. CONCLUSIONS Interim data show that CME for right colon cancer in referral centers is safe and feasible and does not increase perioperative complications. The study documented with evidence that quality of surgery and LN yield are higher after CME, and this is essential for continuation of patient recruitment and implementation of an optimal comparison. Trial registration The trial was registered at ClinicalTrials.gov with the code NCT04871399 and with the acronym CoME-In trial.
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Affiliation(s)
- Maurizio Degiuli
- Division of Surgical Oncology and Digestive Surgery, Department of Oncology, San Luigi University Hospital, University of Turin, Orbassano (Turin), Italy
| | - Aridai H Resendiz Aguilar
- Division of Surgical Oncology and Digestive Surgery, Department of Oncology, San Luigi University Hospital, University of Turin, Orbassano (Turin), Italy
| | - Mario Solej
- Division of Surgical Oncology and Digestive Surgery, Department of Oncology, San Luigi University Hospital, University of Turin, Orbassano (Turin), Italy
| | - Danila Azzolina
- Department of Environmental and Preventive Sciences, University of Ferrara, Via Fossato di Mortara, Ferrara, Italy
| | - Giulia Marchiori
- Department of Surgical Sciences, University of Turin, Turin, Italy
| | - Francesco Corcione
- Chirurgia Oncologica e Miniinvasiva Clinica Mediterranea Napoli, University of Naples Federico II, Naples, Italy
| | - Umberto Bracale
- Minimally Invasive, General and Oncologic Surgery Unit, University Federico II of Naples, Naples, Italy
| | - Roberto Peltrini
- Minimally Invasive, General and Oncologic Surgery Unit, University Federico II of Naples, Naples, Italy
| | - Maria M Di Nuzzo
- Minimally Invasive, General and Oncologic Surgery Unit, University Federico II of Naples, Naples, Italy
| | | | - Diletta Cassini
- ASST Ovest Milanese, P.O. Nuovo Ospedale di Legnano, Legnano, Italy
| | - Giuseppe S Sica
- Minimally Invasive and Gastrointestinal Surgery Unit, Università e Policlinico Tor Vergata, Rome, Italy
| | - Brunella Pirozzi
- Minimally Invasive and Gastrointestinal Surgery Unit, Università e Policlinico Tor Vergata, Rome, Italy
| | - Andrea Muratore
- Surgical Department, Edoardo Agnelli Hospital, Pinerolo, Italy
| | | | - Elio Jovine
- IRCCS AOU of Bologna, University of Bologna, Bologna, Italy
| | | | - Gabriele Anania
- Dipartimento Scienze Mediche, Università di Ferrara, Ferrara, Italy
| | - Matteo Chiozza
- Dipartimento Scienze Mediche, Università di Ferrara, Ferrara, Italy
| | - Wanda Petz
- Digestive Surgery, European Institute of Oncology-IRCCS, Milan, Italy
| | - Paolo Pizzini
- Digestive Surgery, European Institute of Oncology-IRCCS, Milan, Italy
| | - Roberto Persiani
- Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Alberto Biondi
- Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Rossella Reddavid
- Division of Surgical Oncology and Digestive Surgery, Department of Oncology, San Luigi University Hospital, University of Turin, Orbassano (Turin), Italy.
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Anania G, Chiozza M, Campagnaro A, Bagolini F, Resta G, Azzolina D, Silecchia G, Cirocchi R, Agrusa A, Cuccurullo D, Guerrieri M. Laparoscopic right hemicolectomy: a SICE (Società Italiana di Chirurgia Endoscopica e Nuove tecnologie) network prospective study on the approach to right colon lymphadenectomy in Italy: is there a standard?-CoDIG 2 (ColonDx Italian Group). Surg Endosc 2024; 38:1432-1441. [PMID: 38191814 PMCID: PMC10881627 DOI: 10.1007/s00464-023-10607-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2023] [Accepted: 11/17/2023] [Indexed: 01/10/2024]
Abstract
BACKGROUND Colon cancer is a disease with a worldwide spread. Surgery is the best option for the treatment of advanced colon cancer, but some aspects are still debated, such as the extent of lymphadenectomy. In Japanese guidelines, the gold standard was D3 dissection to remove the central lymph nodes (203, 213, and 223), but in 2009, Hoenberger et al. introduced the concept of complete mesocolic excision, in which surgical dissection follows the embryological planes to remove the mesentery entirely to prevent leakage of cancer cells and collect more lymph nodes. Our study describes how lymphadenectomy is currently performed in major Italian centers with an unclear indication on the type of lymphadenectomy that should be performed during right hemicolectomy (RH). METHODS CoDIG 2 is an observational multicenter national study that involves 76 Italian general surgery wards highly specialized in colorectal surgery. Each center was asked not to modify their usual surgical and clinical practices. The aim of the study was to assess the preference of Italian surgeons on the type of lymphadenectomy to perform during RH and the rise of any new trends or modifications in habits compared to the findings of the CoDIG 1 study conducted 4 years ago. RESULTS A total of 788 patients were enrolled. The most commonly used surgical technique was laparoscopic (82.1%) with intracorporeal (73.4%), side-to-side (98.7%), or isoperistaltic (96.0%) anastomosis. The lymph nodes at the origin of the vessels were harvested in an inferior number of cases (203, 213, and 223: 42.4%, 31.1%, and 20.3%, respectively). A comparison between CoDIG 1 and CoDIG 2 showed a stable trend in surgical techniques and complications, with an increase in the robotic approach (7.7% vs. 12.3%). CONCLUSIONS This analysis shows how lymphadenectomy is performed in Italy to achieve oncological outcomes in RH, although the technique to achieve a higher lymph node count has not yet been standardized. Trial registration (ClinicalTrials.gov) ID: NCT05943951.
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Affiliation(s)
- G Anania
- Unit of General Surgery, Department of Medical Science, University of Ferrara, via Fossato di Mortara 64/B, Ferrara, FE, Italy
| | - M Chiozza
- Unit of General Surgery, Department of Medical Science, University of Ferrara, via Fossato di Mortara 64/B, Ferrara, FE, Italy.
| | - A Campagnaro
- Unit of General Surgery, Department of Medical Science, University of Ferrara, via Fossato di Mortara 64/B, Ferrara, FE, Italy
| | - F Bagolini
- Unit of General Surgery, Department of Medical Science, University of Ferrara, via Fossato di Mortara 64/B, Ferrara, FE, Italy
| | - G Resta
- Unit of General Surgery, Department of Medical Science, University of Ferrara, via Fossato di Mortara 64/B, Ferrara, FE, Italy
| | - D Azzolina
- Division of Scienze dell'Ambiente e della Prevenzione, University of Ferrara, Ferrara, FE, Italy
| | - G Silecchia
- Department of Scienze Medico Chirurgiche e Medicina Traslazionale, University of Roma S. Andrea University Hospital, Rome, RM, Italy
| | - R Cirocchi
- Department of Medicine and Surgery, University of Perugia, Perugia, PG, Italy
| | - A Agrusa
- Department of Surgical, Oncological and Oral Sciences, University of Palermo, Palermo, PA, Italy
| | - D Cuccurullo
- Division of Laparoscopic and Robotic Surgery Unit, A.O.R.N. dei Colli Monaldi Hospital, Naples, NA, Italy
| | - M Guerrieri
- Division of Clinica Chirurgica Generale e D'Urgenza, Università Politecnica delle Marche, Ancona, AN, Italy
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Takagi K, Fuji T, Yamada M, Umeda Y. Robotic pancreatoduodenectomy after right hemicolectomy: A case report. Asian J Surg 2024:S1015-9584(24)00225-2. [PMID: 38331607 DOI: 10.1016/j.asjsur.2024.01.179] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2024] [Accepted: 01/26/2024] [Indexed: 02/10/2024] Open
Affiliation(s)
- Kosei Takagi
- Department of Gastroenterological Surgery, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, Okayama, Japan.
| | - Tomokazu Fuji
- Department of Gastroenterological Surgery, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, Okayama, Japan
| | - Motohiko Yamada
- Department of Gastroenterological Surgery, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, Okayama, Japan
| | - Yuzo Umeda
- Department of Gastroenterological Surgery, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, Okayama, Japan
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Zhao B, Ma Z, Wang J, Wang W, Yang T, Meng K. Which is the appropriate surgical procedure for appendiceal adenocarcinoma: appendectomy, partial colectomy or right hemicolectomy? Clin Transl Oncol 2024; 26:297-307. [PMID: 37368199 DOI: 10.1007/s12094-023-03259-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2023] [Accepted: 06/15/2023] [Indexed: 06/28/2023]
Abstract
OBJECTIVE The purpose of this study was to explore the appropriate surgical procedure and clinical decision for appendiceal adenocarcinoma. METHODS A total of 1,984 appendiceal adenocarcinoma patients from 2004 to 2015 were retrospectively identified from the Surveillance, Epidemiology, and End Results (SEER) database. All patients were divided into three groups based on the extent of surgical resection: appendectomy (N = 335), partial colectomy (N = 390) and right hemicolectomy (N = 1,259). The clinicopathological features and survival outcomes of three groups were compared, and independent prognostic factors were assessed. RESULTS The 5-year OS rates of patients who underwent appendectomy, partial colectomy and right hemicolectomy were 58.3%, 65.5% and 69.1%, respectively (right hemicolectomy vs appendectomy, P < 0.001; right hemicolectomy vs partial colectomy, P = 0.285; partial colectomy vs appendectomy, P = 0.045). The 5-year CSS rates of patients who underwent appendectomy, partial colectomy and right hemicolectomy were 73.2%, 77.0% and 78.7%, respectively (right hemicolectomy vs appendectomy, P = 0.046; right hemicolectomy vs partial colectomy, P = 0.545; partial colectomy vs appendectomy, P = 0.246). The subgroup analysis based on the pathological TNM stage indicated that there was no survival difference amongst three surgical procedures for stage I patients (5-year CSS rate: 90.8%, 93.9% and 98.1%, respectively). The prognosis of patients who underwent an appendectomy was poorer than that of those who underwent partial colectomy (5-year OS rate: 53.5% vs 67.1%, P = 0.005; 5-year CSS rate: 65.2% vs 78.7%, P = 0.003) or right hemicolectomy (5-year OS rate: 74.2% vs 53.23%, P < 0.001; 5-year CSS rate: 65.2% vs 82.5%, P < 0.001) for stage II disease. Right hemicolectomy did not show a survival advantage over partial colectomy for stage II (5-year CSS, P = 0.255) and stage III (5-year CSS, P = 0.846) appendiceal adenocarcinoma. CONCLUSIONS Right hemicolectomy may not always be necessary for appendiceal adenocarcinoma patients. An appendectomy could be sufficient for therapeutic effect of stage I patients, but limited for stage II patients. Right hemicolectomy was not superior to partial colectomy for advanced stage patients, suggesting omission of standard hemicolectomy might be feasible. However, adequate lymphadenectomy should be strongly recommended.
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Affiliation(s)
- Bochao Zhao
- Department of Gastrointestinal Surgery, Tianjin First Central Hospital, No.24 Fukang Road, Nankai District, Tianjin, 300190, People's Republic of China.
| | - Zhicheng Ma
- Department of Gastrointestinal Surgery, Tianjin First Central Hospital, No.24 Fukang Road, Nankai District, Tianjin, 300190, People's Republic of China
| | - Jingchao Wang
- Department of Gastrointestinal Surgery, Tianjin First Central Hospital, No.24 Fukang Road, Nankai District, Tianjin, 300190, People's Republic of China
| | - Weiqiang Wang
- Department of Gastrointestinal Surgery, Tianjin First Central Hospital, No.24 Fukang Road, Nankai District, Tianjin, 300190, People's Republic of China
| | - Tao Yang
- Department of Gastrointestinal Surgery, Tianjin First Central Hospital, No.24 Fukang Road, Nankai District, Tianjin, 300190, People's Republic of China
| | - Kewei Meng
- Department of Gastrointestinal Surgery, Tianjin First Central Hospital, No.24 Fukang Road, Nankai District, Tianjin, 300190, People's Republic of China.
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Grüter AAJ, Vlug MS, Spaanderman IT, Bins AD, Buffart TE, Tuynman JB. Challenging case of deficient mismatch repair right-sided locally advanced adenocarcinoma of the ascending colon with duodenal involvement: A case report including step-by-step video of operation. Int J Surg Case Rep 2024; 114:109137. [PMID: 38091709 PMCID: PMC10758974 DOI: 10.1016/j.ijscr.2023.109137] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2023] [Revised: 12/04/2023] [Accepted: 12/05/2023] [Indexed: 01/05/2024] Open
Abstract
INTRODUCTION AND IMPORTANCE Irresectable colon cancer presents a complex clinical challenge. Neoadjuvant immunotherapy has shown potential in improving resectability. Additionally, advancements in surgical techniques, including complete mesocolic excision (CME) with central vascular ligation (CVL), have contributed to better outcomes for right-sided colon cancer. This case report aims to demonstrate the successful laparoscopic resection of initial appearing irresectable colon cancer with suspected duodenal involvement. CASE PRESENTATION A 70-year-old female presented with an irresectable mismatch repair deficient (dMMR) adenocarcinoma of the ascending colon with suspected duodenal ingrowth. Neoadjuvant treatment with pembrolizumab and ataluren resulted in a significant response, allowing for surgical resection. A laparoscopic right hemicolectomy with CME, including CVL, intracorporeal anastomosis and extraction through a Pfannenstiel incision, was performed. Additionally, the serosal layer of the duodenum was shaved after observing the absence of intraluminal invasion. Postoperatively, transient gastroparesis occurred, but overall outcomes were favourable. CLINICAL DISCUSSION This case emphasizes the potential of immunotherapy in improving resectability for irresectable dMMR colon cancer with suspected involvement of surrounding organs. The combination of neoadjuvant therapy and advanced surgical techniques, such as CME with CVL, shows promise in achieving favourable clinical outcomes. However, further studies are needed to validate the effectiveness and safety of this combined approach in a larger cohort of patients. CONCLUSION The successful laparoscopic resection of initially irresectable dMMR colon cancer with duodenal involvement, following neoadjuvant immunotherapy, demonstrated promising outcomes. This case advocates for further exploration of neoadjuvant treatments' efficacy, coupled with advanced surgical techniques, in managing locally advanced right-sided colon cancer.
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Affiliation(s)
- Alexander A J Grüter
- Amsterdam UMC location Vrije Universiteit Amsterdam, Department of Surgery, De Boelelaan 1117, Amsterdam, the Netherlands; Cancer Center Amsterdam, Treatment and quality of life, Amsterdam, the Netherlands.
| | - Malaika S Vlug
- Amsterdam UMC location Vrije Universiteit Amsterdam, Department of Surgery, De Boelelaan 1117, Amsterdam, the Netherlands
| | - Ide T Spaanderman
- Amsterdam UMC, Department of Medical Oncology, De Boelelaan 1117, Amsterdam, the Netherlands
| | - Adriaan D Bins
- Amsterdam UMC, Department of Medical Oncology, De Boelelaan 1117, Amsterdam, the Netherlands
| | - Tineke E Buffart
- Amsterdam UMC, Department of Medical Oncology, De Boelelaan 1117, Amsterdam, the Netherlands
| | - Jurriaan B Tuynman
- Amsterdam UMC location Vrije Universiteit Amsterdam, Department of Surgery, De Boelelaan 1117, Amsterdam, the Netherlands
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Grüter AAJ, Coblijn UK, Toorenvliet BR, Tanis PJ, Tuynman JB. National implementation of an optimal standardised technique for right-sided colon cancer: protocol of an interventional sequential cohort study (Right study). Tech Coloproctol 2023; 27:1083-1090. [PMID: 37097330 PMCID: PMC10562307 DOI: 10.1007/s10151-023-02801-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2023] [Accepted: 04/03/2023] [Indexed: 04/26/2023]
Abstract
PURPOSE Minimally invasive right hemicolectomy (MIRH) is the cornerstone of treatment for patients with right-sided colon cancer. This operation has evolved during recent decades, with many innovations and improvements but this has also resulted in high variability of uptake with subsequent substantial variableness. The aim of this ongoing study is to identify current surgical variations, determine the most optimal and standardised MIRH and nationally train and implement that technique to improve short-term clinical and long-term oncological outcomes. METHODS The Right study is a national multicentre prospective interventional sequential cohort study. Firstly, current local practice was evaluated. Subsequently, a standardised surgical technique for right-sided colon cancer was determined using the Delphi consensus method, and this procedure was trained during hands-on courses. The standardised MIRH will be implemented with proctoring (implementation cohort), after which the performance will be monitored (consolidation cohort). Patients who will receive a minimally invasive (extended) right hemicolectomy for cT1-3N0-2M0 colon cancer will be included. The primary outcome is patient safety reflected in the 90-day overall complication rate according to the Clavien-Dindo classification. Secondary outcomes will include intraoperative complications, 90-day mortality rate, number of resected tumour-positive lymph nodes, completeness of mesocolic excision, surgical quality score, locoregional and distant recurrence and 5-year overall survival. A total number of 1095 patients (365 per cohort) will be included. DISCUSSION The Right study is designed to safely implement the best surgical practice concerning patients with right-sided colon cancer aiming to standardise and improve the surgical quality of MIRH at a national level. TRIAL REGISTRATION ClinicalTrials.gov: NCT04889456, May 2021.
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Affiliation(s)
- Alexander A J Grüter
- Department of Surgery, Amsterdam UMC Location Vrije Universiteit Amsterdam, De Boelelaan 1117, Amsterdam, The Netherlands.
- Cancer Center Amsterdam, Treatment and Quality of Life, Amsterdam, The Netherlands.
| | - Usha K Coblijn
- Department of Surgery, Antoni van Leeuwenhoek, Plesmanlaan 121, Amsterdam, The Netherlands
| | | | - Pieter J Tanis
- Department of Surgery, UMC Location University of Amsterdam, Meibergdreef 9, Amsterdam, The Netherlands
- Department of Surgery, Erasmus MC, Dr. Molewaterplein 40, Rotterdam, The Netherlands
| | - Jurriaan B Tuynman
- Department of Surgery, Amsterdam UMC Location Vrije Universiteit Amsterdam, De Boelelaan 1117, Amsterdam, The Netherlands
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Sakurai T, Yamaguchi T, Sakamoto T, Amano T, Mukai T, Hiyoshi Y, Nagasaki T, Akiyoshi T, Fukunaga Y. Novel mobilization of the medial approach without changing the position for robotic right hemicolectomy. Surg Today 2023; 53:1317-1319. [PMID: 36944715 DOI: 10.1007/s00595-023-02673-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2023] [Accepted: 02/16/2023] [Indexed: 03/23/2023]
Abstract
Conventional laparoscopic or robotic surgery for right-sided colon cancer often requires intraoperative repositioning and removal of the bowel. Changing positions during robotic surgery can be troublesome and robotic removal of the small intestine carries a risk of unexpected injury because robotic devices have a strong grasping force and no sense of touch. Herein, we introduce a novel mobilization of the medial approach without changing the position for robotic right hemicolectomy. Using this technique, mobilization is performed in counterclockwise succession, allowing all mobilizations and bowel removal to be completed sequentially, without positional change.
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Affiliation(s)
- Tsubasa Sakurai
- Department of Gastroenterological Surgery, Cancer Institute Hospital of the Japanese Foundation for Cancer Research, 3-8-31 Ariake, Koto-ku, Tokyo, 135-8550, Japan
| | - Tomohiro Yamaguchi
- Department of Gastroenterological Surgery, Cancer Institute Hospital of the Japanese Foundation for Cancer Research, 3-8-31 Ariake, Koto-ku, Tokyo, 135-8550, Japan.
| | - Takashi Sakamoto
- Department of Gastroenterological Surgery, Cancer Institute Hospital of the Japanese Foundation for Cancer Research, 3-8-31 Ariake, Koto-ku, Tokyo, 135-8550, Japan
- Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo, Tokyo, Japan
| | - Takahiro Amano
- Department of Gastroenterological Surgery, Cancer Institute Hospital of the Japanese Foundation for Cancer Research, 3-8-31 Ariake, Koto-ku, Tokyo, 135-8550, Japan
| | - Toshiki Mukai
- Department of Gastroenterological Surgery, Cancer Institute Hospital of the Japanese Foundation for Cancer Research, 3-8-31 Ariake, Koto-ku, Tokyo, 135-8550, Japan
| | - Yukiharu Hiyoshi
- Department of Gastroenterological Surgery, Cancer Institute Hospital of the Japanese Foundation for Cancer Research, 3-8-31 Ariake, Koto-ku, Tokyo, 135-8550, Japan
| | - Toshiya Nagasaki
- Department of Gastroenterological Surgery, Cancer Institute Hospital of the Japanese Foundation for Cancer Research, 3-8-31 Ariake, Koto-ku, Tokyo, 135-8550, Japan
| | - Takashi Akiyoshi
- Department of Gastroenterological Surgery, Cancer Institute Hospital of the Japanese Foundation for Cancer Research, 3-8-31 Ariake, Koto-ku, Tokyo, 135-8550, Japan
| | - Yosuke Fukunaga
- Department of Gastroenterological Surgery, Cancer Institute Hospital of the Japanese Foundation for Cancer Research, 3-8-31 Ariake, Koto-ku, Tokyo, 135-8550, Japan
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10
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Yu L, Liu Z, Chen Z, Wang X, Xu Z, Jiang W, Huang Y, Lin H, Chi P. Pathways of lymph node metastasis and prognosis after right hemicolectomy for cecal cancer: results from a retrospective single center. World J Surg Oncol 2023; 21:281. [PMID: 37674223 PMCID: PMC10481597 DOI: 10.1186/s12957-023-03148-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2023] [Accepted: 08/16/2023] [Indexed: 09/08/2023] Open
Abstract
BACKGROUND The recommended operation for cecum cancer (CC) is right hemicolectomy (RH) in some Western countries while the principle of D3 lymphadenectomy in Japan recommends resecting approximately 10 cm from the tumor edge. Therefore, the optimal surgical approach for cecum cancer (CC) remains controversial. We conducted this retrospective study to explore the pattern of lymph node metastasis and better surgical procedures for CC. METHODS A total of 224 cecum cancer patients from January 1, 2014, to December 31, 2021, were retrospectively included in the final study. The pattern of lymph node metastasis (LNM) was investigated. RESULTS A total of 113 (50.4%, 113/224) patients had pathologically confirmed LNM. The most frequent metastatic site was no. 201 lymph node (46%, 103/224), while 20 (8.9%, 20/224) patients had LNM in no. 202 lymph node, and 8 (3.6%, 8/224) patients had LNM in no. 203 lymph node. Only 1 (0.4%, 1/224) patient had LNM in no. 221 lymph node, four (1.8, 4/224%) patients had LNM in no. 223 lymph node, and no patients had LNM in no. 222 lymph node. LNM in no. 223 lymph node was significantly associated with a poor prognosis. Multivariate analysis indicated that LNM in no. 223 lymph node (HR = 4.59, 95% CI 1.18-17.86, P = 0.028) was the only independent risk factor associated with worse disease-free survival (DFS). CONCLUSIONS The LNM in no. 223 lymph node for cecum cancer was rare. Therefore, standard right hemicolectomy excision is too extensive for most CC cases.
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Affiliation(s)
- Liang Yu
- Department of Colorectal Surgery, Fujian Medical University Union Hospital, 29 Xinquan Road, Fuzhou, 350001, Fujian Province, China
| | - Zhun Liu
- Department of Colorectal Surgery, Fujian Medical University Union Hospital, 29 Xinquan Road, Fuzhou, 350001, Fujian Province, China
| | - Zhifen Chen
- Department of Colorectal Surgery, Fujian Medical University Union Hospital, 29 Xinquan Road, Fuzhou, 350001, Fujian Province, China.
| | - Xiaojie Wang
- Department of Colorectal Surgery, Fujian Medical University Union Hospital, 29 Xinquan Road, Fuzhou, 350001, Fujian Province, China
| | - Zongbin Xu
- Department of Colorectal Surgery, Fujian Medical University Union Hospital, 29 Xinquan Road, Fuzhou, 350001, Fujian Province, China
| | - Weizhong Jiang
- Department of Colorectal Surgery, Fujian Medical University Union Hospital, 29 Xinquan Road, Fuzhou, 350001, Fujian Province, China
| | - Ying Huang
- Department of Colorectal Surgery, Fujian Medical University Union Hospital, 29 Xinquan Road, Fuzhou, 350001, Fujian Province, China
| | - Huiming Lin
- Department of Colorectal Surgery, Fujian Medical University Union Hospital, 29 Xinquan Road, Fuzhou, 350001, Fujian Province, China
| | - Pan Chi
- Department of Colorectal Surgery, Fujian Medical University Union Hospital, 29 Xinquan Road, Fuzhou, 350001, Fujian Province, China
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11
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Domínguez Páez C, Salazar Andrade JA, Mendoza Tagle DI, Martín Pérez JA, Rodriguez Pulido JA, Cortazar Sánchez CA. Ileocecal intussusception as presentation for ascending colon carcinoma. Case report. Int J Surg Case Rep 2023; 108:108439. [PMID: 37413757 PMCID: PMC10382818 DOI: 10.1016/j.ijscr.2023.108439] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2023] [Revised: 06/13/2023] [Accepted: 06/23/2023] [Indexed: 07/08/2023] Open
Abstract
INTRODUCTION AND IMPORTANCE Intussusception is described as invagination of a segment of the bowel into the lumen of an adjacent segment. Although it is the most frequent cause of intestine obstruction during childhood, it is unusual in adulthood, where intussusception represents 1% of all intestine obstructions and 5 % of all intussusceptions. CASE PRESENTATION A 64-year-old female presented with a history of weight loss, intermittent diarrhea, and occasional transrectal bleeding. An abdominal computed tomography (CT scan) was performed showing a neoproliferative appearance and associated intussusception of the ascending colon. Colonoscopy revealed an ileocecal intussusception and a tumor on the ascending colon. Right hemicolectomy was performed. Histopathological findings were consistent with colon adenocarcinoma. CLINICAL DISCUSSION Adults have an organic lesion within the intussusception in up to 70 % of cases. The clinical presentation of intussusception can vary significantly between children and adults, who will often exhibit chronic nonspecific symptoms including nausea, changes in bowel habits, and gastrointestinal bleeding. The imaging diagnosis of intussusception is a difficult subject, the basis for the diagnosis is a high index of clinical suspicion and noninvasive techniques. CONCLUSION Intussusception is an extremely rare condition in adults, in this age group, the malignant entity is one of the main etiologies. Intussusception continues to be a rare entity and should be considered as a differential diagnosis of chronic abdominal pain and intestinal motility disorders; the treatment of choice continues to be surgical.
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Affiliation(s)
- Casandra Domínguez Páez
- Surgical Oncology Department, Centro Medico Nacional "20 de Noviembre", Social Services and Security Institute for the State Employees (I.S.S.S.T.E.), Mexico City, MX, Mexico.
| | - Jorge Alberto Salazar Andrade
- Surgical Oncology Department, Centro Medico Nacional "20 de Noviembre", Social Services and Security Institute for the State Employees (I.S.S.S.T.E.), Mexico City, MX, Mexico
| | - Dafne Ivonne Mendoza Tagle
- Surgical Oncology Department, Centro Medico Nacional "20 de Noviembre", Social Services and Security Institute for the State Employees (I.S.S.S.T.E.), Mexico City, MX, Mexico
| | - Jesús Antonio Martín Pérez
- Surgical Oncology Department, Centro Medico Nacional "20 de Noviembre", Social Services and Security Institute for the State Employees (I.S.S.S.T.E.), Mexico City, MX, Mexico
| | - Jorge Armando Rodriguez Pulido
- Surgical Oncology Department, Centro Medico Nacional "20 de Noviembre", Social Services and Security Institute for the State Employees (I.S.S.S.T.E.), Mexico City, MX, Mexico
| | - Carlos Arturo Cortazar Sánchez
- Surgical Oncology Department, Centro Medico Nacional "20 de Noviembre", Social Services and Security Institute for the State Employees (I.S.S.S.T.E.), Mexico City, MX, Mexico
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12
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Iguchi K, Numata M, Shiozawa M, Kazama K, Sawazaki S, Katayama Y, Numata K, Higuchi A, Godai T, Sugano N, Mushiake H, Rino Y. Analysis of surgical outcomes of laparoscopic versus open surgery for locally advanced mid-transverse colon cancer. Langenbecks Arch Surg 2023; 408:222. [PMID: 37266706 DOI: 10.1007/s00423-023-02963-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2023] [Accepted: 05/29/2023] [Indexed: 06/03/2023]
Abstract
PURPOSE This study compared the surgical outcomes between laparoscopic colectomy (LC) and open colectomy (OC) for mid-transverse colon cancer (MTC). METHODS This multicenter retrospective study compared the short- and long-term surgical outcomes for patients with advanced MTC (T3 and T4 with or without nodal involvement) who underwent LC or OC between January 2008 and December 2019 using a propensity score-matched analysis. RESULTS A total of 177 patients with advanced MTC were enrolled. After matching, 58 cases for the OC and LC groups were selected. No significant differences in age, sex, tumor progression, or procedure type (extended resection or segmental resection) existed between groups. The LC group had significantly less blood loss (20 mL vs. 50 mL, p=0.048) and a shorter postoperative hospital stay (8 days vs. 12 days, p<0.001) than the OC group. Postoperative complications (Clavien-Dindo grade ≥ 2) occurred in 27.6% and 25.9% of the OC and LC groups respectively (p=1). Three patients (5.2%) and one patient (1.7%) of the OC and LC groups respectively developed anastomotic leakage (p=0.62). Re-operation was required in five patients (8.6%) in the OC group and one patient (1.7%) in the LC group (p=0.21). No surgery-related deaths occurred in either group. The 3-year overall survival rates (stage II: LC 100% vs. OC 92.8%, p=0.15; stage III: 88.9% vs. 84.3%, p=0.88, respectively) were similar between the two groups. CONCLUSION LC is a minimally invasive technique with lesser blood loss, shorter postoperative hospital stays, and oncologic equivalence to OC. Hence, LC is useful for MTC treatment. TRIAL REGISTRATION UMIN000042676.
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Affiliation(s)
- Kenta Iguchi
- Department of Colorectal Surgery, Kanagawa Cancer Center, 2-3-2, Nakao, Asahi-ku, Yokohama, 241-8515, Japan.
| | - Masakatsu Numata
- Department of Surgery, Yokohama City University School of Medicine, Yokohama, Japan
| | - Manabu Shiozawa
- Department of Colorectal Surgery, Kanagawa Cancer Center, 2-3-2, Nakao, Asahi-ku, Yokohama, 241-8515, Japan
| | - Keisuke Kazama
- Department of Surgery, Yokohama City University School of Medicine, Yokohama, Japan
| | - Sho Sawazaki
- Department of Surgery, Yokohama City University School of Medicine, Yokohama, Japan
| | - Yusuke Katayama
- Department of Surgery, Yokohama City University School of Medicine, Yokohama, Japan
| | - Koji Numata
- Department of Surgery, Yokohama City University School of Medicine, Yokohama, Japan
| | - Akio Higuchi
- Department of Surgery, Yokohama City University School of Medicine, Yokohama, Japan
| | - Teni Godai
- Department of Surgery, Yokohama City University School of Medicine, Yokohama, Japan
| | - Nobuhiro Sugano
- Department of Surgery, Gastroenterological Center, Yokohama City University Medical Center, Yokohama, Japan
| | - Hiroyuki Mushiake
- Department of Surgery, Yokohama City University School of Medicine, Yokohama, Japan
| | - Yasushi Rino
- Department of Surgery, Yokohama City University School of Medicine, Yokohama, Japan
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Kiyosawa N, Koyama M, Miyagawa Y, Kitazawa M, Tokumaru S, Soejima Y. Goblet cell adenocarcinoma of the appendix: A case report of three cases. Int J Surg Case Rep 2023; 106:108229. [PMID: 37084554 PMCID: PMC10140787 DOI: 10.1016/j.ijscr.2023.108229] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2022] [Revised: 04/13/2023] [Accepted: 04/14/2023] [Indexed: 04/23/2023] Open
Abstract
INTRODUCTION AND IMPORTANCE Appendiceal goblet cell adenocarcinoma is in 0.3-0.9 % of appendectomy specimens. There is still controversy regarding whether surgery with dissection or additional resection is necessary for goblet cell adenocarcinoma and whether adjuvant chemotherapy is practical. We present three cases of goblet cell adenocarcinomas. CASE PRESENTATION Case 1: A 30-year-old woman was diagnosed with appendicitis and underwent appendicectomy. Histopathological evaluation revealed a malignant neoplasm with goblet-like cells and tumour infiltration into the subserosa. The patient underwent laparoscopic ileocecal resection, and the main lymph nodes at the root of the feeding vessels were removed. Case 2: A 50-year-old man was diagnosed with appendicitis and underwent appendicectomy. Histopathological evaluation revealed a malignant neoplasm with goblet-like cells; malignant cells were found at the surgical resection margins. The patient underwent laparoscopic ileocolic resection. Case 3: A 60-year-old man undergoing treatment for malignant melanoma. He was diagnosed with appendicitis associated with an appendiceal tumour, and emergency laparoscopic caecal resection was performed and diagnosed as goblet cell adenocarcinoma. We decided to prioritize treatment for malignant melanoma, and the patient is under follow-up for goblet cell adenocarcinoma and no metastasis was detected. CLINICAL DISCUSSION We performed additional resection in two case of goblet cell adenocarcinoma. Diagnosing appendiceal goblet cell adenocarcinoma is difficult, and the prognosis of patients with positive lymph nodes is poor. Surgical treatment should be considered for the advanced stages of this disease. CONCLUSION Goblet cell adenocarcinoma, diagnosed after appendectomy, additional resection including lymph node dissection may provide a long-term prognosis.
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Affiliation(s)
- Nami Kiyosawa
- Division of Gastroenterological, Hepato-Biliary-Pancreatic, Transplantation and Pediatric Surgery, Department of Surgery, Shinshu University School of Medicine, 3-1-1 Asahi, Matsumoto, Nagano 390-8621, Japan
| | - Makoto Koyama
- Division of Gastroenterological, Hepato-Biliary-Pancreatic, Transplantation and Pediatric Surgery, Department of Surgery, Shinshu University School of Medicine, 3-1-1 Asahi, Matsumoto, Nagano 390-8621, Japan.
| | - Yusuke Miyagawa
- Division of Gastroenterological, Hepato-Biliary-Pancreatic, Transplantation and Pediatric Surgery, Department of Surgery, Shinshu University School of Medicine, 3-1-1 Asahi, Matsumoto, Nagano 390-8621, Japan
| | - Masato Kitazawa
- Division of Gastroenterological, Hepato-Biliary-Pancreatic, Transplantation and Pediatric Surgery, Department of Surgery, Shinshu University School of Medicine, 3-1-1 Asahi, Matsumoto, Nagano 390-8621, Japan
| | - Shigeo Tokumaru
- Division of Gastroenterological, Hepato-Biliary-Pancreatic, Transplantation and Pediatric Surgery, Department of Surgery, Shinshu University School of Medicine, 3-1-1 Asahi, Matsumoto, Nagano 390-8621, Japan
| | - Yuji Soejima
- Division of Gastroenterological, Hepato-Biliary-Pancreatic, Transplantation and Pediatric Surgery, Department of Surgery, Shinshu University School of Medicine, 3-1-1 Asahi, Matsumoto, Nagano 390-8621, Japan
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14
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Symeonidis D, Karakantas KS, Kissa L, Samara AA, Bompou E, Tepetes K, Tzovaras G. Isoperistaltic vs antiperistaltic anastomosis after right hemicolectomy: A comprehensive review. World J Clin Cases 2023; 11:1694-1701. [PMID: 36970003 PMCID: PMC10037296 DOI: 10.12998/wjcc.v11.i8.1694] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2022] [Revised: 01/28/2023] [Accepted: 02/21/2023] [Indexed: 03/07/2023] Open
Abstract
To optimize the efficiency of ileocolic anastomosis following right hemicolectomy, several variations of the surgical technique have been tested. These include performing the anastomosis intra- or extracorporeally or performing a stapled or hand-sewn anastomosis. Among the least studied is the configuration of the two stumps (i.e., isoperistaltic or antiperistaltic) in the case of a side-to-side anastomosis. The purpose of the present study is to compare the isoperistaltic and antiperistaltic side-to-side anastomotic configuration after right hemicolectomy by reviewing the relevant literature. High-quality literature is scarce, with only three studies directly comparing the two alternatives, and no study has revealed any significant differences in the incidence of anastomosis-related complications such as leakage, stenosis, or bleeding. However, there may be a trend towards an earlier recovery of intestinal function following antiperistaltic anastomosis. Finally, existing data do not identify a certain anastomotic configuration (i.e., isoperistaltic or antiperistaltic) as superior over the other. Thus, the most appropriate approach is to master both anastomotic techniques and select between the two configurations based on each individual case scenario.
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Affiliation(s)
| | | | - Labrini Kissa
- Department of Surgery, University Hospital of Larissa, Larissa 41110, Greece
| | - Athina A Samara
- Department of Surgery, University Hospital of Larissa, Larissa 41110, Greece
| | - Effrosyni Bompou
- Department of Surgery, University Hospital of Larissa, Larissa 41110, Greece
| | | | - Georgios Tzovaras
- Department of Surgery, University Hospital of Larissa, Larissa 41110, Greece
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15
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Xie J, Bai J, Zheng T, Shu J, Liu ML. Causes of epigastric pain and vomiting after laparoscopic-assisted radical right hemicolectomy - superior mesenteric artery syndrome. World J Gastrointest Surg 2023; 15:193-200. [PMID: 36896299 PMCID: PMC9988633 DOI: 10.4240/wjgs.v15.i2.193] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2022] [Revised: 11/19/2022] [Accepted: 01/10/2023] [Indexed: 02/27/2023] Open
Abstract
BACKGROUND Superior mesenteric artery syndrome (SMAS) is a rare condition causing functional obstruction of the third portion of the duodenum. Postoperative SMAS following laparoscopic-assisted radical right hemicolectomy is even less prevalent and can often be unrecognized by radiologists and clinicians.
AIM To analyze the clinical features, risk factors, and prevention of SMAS after laparoscopic-assisted radical right hemicolectomy.
METHODS We retrospectively analyzed clinical data of 256 patients undergoing laparoscopic-assisted radical right hemicolectomy in the Affiliated Hospital of Southwest Medical University from January 2019 to May 2022. The occurrence of SMAS and its countermeasures were evaluated. Among the 256 patients, SMAS was confirmed in six patients (2.3%) by postoperative clinical presentation and imaging features. All six patients were examined by enhanced computed tomography (CT) before and after surgery. Patients who developed SMAS after surgery were used as the experimental group. A simple random sampling method was used to select 20 patients who underwent surgery at the same time but did not develop SMAS and received preoperative abdominal enhanced CT as the control group. The angle and distance between the superior mesenteric artery and abdominal aorta were measured before and after surgery in the experimental group and before surgery in the control group. The preoperative body mass index (BMI) of the experimental group and the control group was calculated. The type of lymphadenectomy and surgical approach in the experimental and control groups were recorded. The differences in angle and distance were compared preoperatively and postoperatively in the experimental group compared. The differences in angle, distance, BMI, type of lymphadenectomy and surgical approach between the experimental and control groups were compared, and the diagnostic efficacy of the significant parameters was assessed using receiver operating characteristic curves.
RESULTS In the experimental group, the aortomesenteric angle and distance after surgery were significantly decreased than those before surgery (P < 0.05). The aortomesenteric angle, distance and BMI were significantly higher in the control group than in the experimental (P < 0.05). There was no significant difference in the type of lymphadenectomy and surgical approach between the two groups (P > 0.05).
CONCLUSION The small preoperative aortomesenteric angle and distance and low BMI may be important factors for the complication. Over-cleaning of lymph fatty tissues may also be associated with this complication.
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Affiliation(s)
- Juan Xie
- Department of Radiology, The Affiliated Hospital of Southwest Medical University, Luzhou 646000, Sichuan Province, China
| | - Jiao Bai
- Department of Radiology, The Affiliated Hospital of Southwest Medical University, Luzhou 646000, Sichuan Province, China
| | - Ting Zheng
- Department of Radiology, The Affiliated Hospital of Southwest Medical University, Luzhou 646000, Sichuan Province, China
| | - Jian Shu
- Department of Radiology, The Affiliated Hospital of Southwest Medical University, Luzhou 646000, Sichuan Province, China
| | - Ma-Li Liu
- Department of Radiology, The Affiliated Hospital of Southwest Medical University, Luzhou 646000, Sichuan Province, China
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16
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Portale G, Bartolotta P, Azzolina D, Gregori D, Fiscon V. Laparoscopic right hemicolectomy with 2D or 3D video system technology: systematic review and meta-analysis. Int J Colorectal Dis 2023; 38:34. [PMID: 36773133 DOI: 10.1007/s00384-023-04342-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/07/2023] [Indexed: 02/12/2023]
Abstract
BACKGROUND Standard laparoscopic colorectal surgery relies on 2D image systems in most centers. However, 3D vision has gained popularity and is used nowadays in a constantly rising number of units. Right hemicolectomy with intracorporeal anastomosis and lymph node dissection represents a surgical procedure that may benefit the most from 3D vision. The aim of the study was to summarize the available literature on the use of 2D vs. 3D video imaging in patients undergoing laparoscopic right hemicolectomy. METHODS A comprehensive literature review was conducted including Medline/PubMed, Embase, and Scopus (PROSPERO registration number CRD 42022344764) through October 2022. The systematic review and meta-analysis were conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines. The risk of bias was evaluated using the ROBINS-I tool. Certainty of evidence was assessed using the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) guidelines and GRADEpro to develop a summary of evidence tables. Random-effects meta-analyses were conducted. RESULTS Five observational retrospective studies (496 patients, 275 2D and 216 3D) were included. One study was rated as having a critical risk of bias; the remaining had low to moderate risk. 2D laparoscopic right hemicolectomy patients showed longer anastomotic time in 3/3 studies (MD = 3.32; 95%CI, 1.58-5.05; p = 0.002) and an upward trend in operative time in 4/5 studies (MD = 9.98; 95%CI, -1.42, 21.37; p = 0.086) compared to 3D. The two image video systems had similar short-term outcomes, including the number of lymph nodes harvested (MD = -0.67; 95%CI, -2.47, 1.13; p = 0.47), morbidity (OR post-operative complications = 1.12; 95%CI, 0.71-1.77; p = 0.62), and length of stay (MD = 0.27; 95%CI, -0.59, 1.13; p = 0.9). CONCLUSIONS 2D and 2D laparoscopic right hemicolectomy had similar complications rate, with a shorter anastomotic time along with a downward trend in overall operative time for 3D. Larger prospective randomized trials are awaited before definitive conclusions can be drawn.
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Affiliation(s)
- Giuseppe Portale
- Department of General Surgery, Azienda Euganea ULSS 6, Cittadella, Padova, Italy.
| | - Patrizia Bartolotta
- Unit of Biostatistics, Epidemiology and Public Health, Department of Cardiac Thoracic Vascular Sciences and Public Health, University of Padova, 35121, Padova, Italy
| | - Danila Azzolina
- Unit of Biostatistics, Epidemiology and Public Health, Department of Cardiac Thoracic Vascular Sciences and Public Health, University of Padova, 35121, Padova, Italy
| | - Dario Gregori
- Unit of Biostatistics, Epidemiology and Public Health, Department of Cardiac Thoracic Vascular Sciences and Public Health, University of Padova, 35121, Padova, Italy
| | - Valentino Fiscon
- Department of General Surgery, Azienda Euganea ULSS 6, Cittadella, Padova, Italy
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Iwamoto M, Makutani Y, Yane Y, Ushijima H, Yoshioka Y, Wada T, Daito K, Tokoro T, Chiba Y, Ueda K, Kawamura J. The usefulness of the endoscopic surgical skill qualification system in laparoscopic right hemicolectomy: a single-center, retrospective analysis with propensity score matching. Langenbecks Arch Surg 2023; 408:33. [PMID: 36645519 DOI: 10.1007/s00423-023-02810-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2022] [Accepted: 01/11/2023] [Indexed: 01/17/2023]
Abstract
PURPOSE Recently, a new certification system called the Endoscopic Surgical Skill Qualification System (ESSQS) has been launched in Japan to improve surgical safety. This study aimed to determine whether ESSQS-qualified surgeons affect the short- and long-term outcomes of laparoscopic right hemicolectomy. METHODS A total of 187 colon cancer patients who underwent laparoscopic right hemicolectomy at Kindai University Hospital between January 2016 and December 2020 were enrolled. These patients were divided into two groups based on surgeries performed by ESSQS-qualified surgeons (QS group) and non-ESSQS-qualified surgeons (NQS group). The short- and long-term outcomes were compared between the two groups before and after propensity score matching (PSM). RESULTS After PSM, 43 patients from each group were included in the matched cohort. In the short-term outcomes, the total operative time was significantly longer in the NQS group than in the QS group (229 vs. 174 min, p < 0.0001). However, there were no significant differences in the two groups regarding blood loss (0 vs. 0 ml, p = 0.7126), conversion (0.0% vs. 7.0%, p = 0.0779), Clavien-Dindo ≥ 2 complications (9.3% vs. 7.0%, p = 0.6933), mortality (2.3% vs. 0.0%, p = 0.3145), and postoperative hospital stay (9 vs. 9 days, p = 0.5357). In the long-term outcomes, there were no significant differences between the two groups in the 3-year overall survival (86.6% vs. 83.0%, p = 0.8361) and recurrence-free survival (61.7% vs. 72.0%, p = 0.3394). CONCLUSION Laparoscopic right hemicolectomy performed by ESSQS-qualified surgeons contributed to shorter operative time. Under the supervision of ESSQS-qualified surgeons, almost equivalent safety and oncological outcomes are expected even in surgeries performed by non-ESSQS-qualified surgeons.
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Affiliation(s)
- Masayoshi Iwamoto
- Department of Surgery, Kindai University Faculty of Medicine, 377-2, Ohnohigashi, Osaka Sayama, Osaka, 589-8511, Japan.
| | - Yusuke Makutani
- Department of Surgery, Kindai University Faculty of Medicine, 377-2, Ohnohigashi, Osaka Sayama, Osaka, 589-8511, Japan
| | - Yoshinori Yane
- Department of Surgery, Kindai University Faculty of Medicine, 377-2, Ohnohigashi, Osaka Sayama, Osaka, 589-8511, Japan
| | - Hokuto Ushijima
- Department of Surgery, Kindai University Faculty of Medicine, 377-2, Ohnohigashi, Osaka Sayama, Osaka, 589-8511, Japan
| | - Yasumasa Yoshioka
- Department of Surgery, Kindai University Faculty of Medicine, 377-2, Ohnohigashi, Osaka Sayama, Osaka, 589-8511, Japan
| | - Toshiaki Wada
- Department of Surgery, Kindai University Faculty of Medicine, 377-2, Ohnohigashi, Osaka Sayama, Osaka, 589-8511, Japan
| | - Koji Daito
- Department of Surgery, Kindai University Faculty of Medicine, 377-2, Ohnohigashi, Osaka Sayama, Osaka, 589-8511, Japan
| | - Tadao Tokoro
- Department of Surgery, Kindai University Faculty of Medicine, 377-2, Ohnohigashi, Osaka Sayama, Osaka, 589-8511, Japan
| | - Yasutaka Chiba
- Division of Biostatistics, Clinical Research Center, Kindai University Faculty of Medicine, 377-2, Ohnohigashi, Osaka Sayama, Osaka, 589-8511, Japan
| | - Kazuki Ueda
- Department of Surgery, Kindai University Faculty of Medicine, 377-2, Ohnohigashi, Osaka Sayama, Osaka, 589-8511, Japan
| | - Junichiro Kawamura
- Department of Surgery, Kindai University Faculty of Medicine, 377-2, Ohnohigashi, Osaka Sayama, Osaka, 589-8511, Japan
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18
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Wu CY, Ye K. Bilateral ovarian metastasis after laparoscopic right hemicolectomy for signet-ring cell carcinoma. Asian J Surg 2022; 45:2903-2904. [PMID: 35780022 DOI: 10.1016/j.asjsur.2022.06.095] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2022] [Accepted: 06/16/2022] [Indexed: 12/15/2022] Open
Affiliation(s)
- Chu-Ying Wu
- Department of Gastrointestinal Surgery, the Second Affiliated Hospital of Fujian Medical University, No. 950 Donghai Street, Fengze Distrct, Quanzhou, 362000, Fujian Province, China
| | - Kai Ye
- Department of Gastrointestinal Surgery, the Second Affiliated Hospital of Fujian Medical University, No. 950 Donghai Street, Fengze Distrct, Quanzhou, 362000, Fujian Province, China.
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19
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Banchini F, Luzietti E, Romboli A, Palmieri G, Conti L, Capelli P. Could the top-down right hemicolectomy be an easier alternative to the classic medial-to-lateral approach in obese patients? A case report with video example. Int J Surg Case Rep 2022; 100:107752. [PMID: 36257139 DOI: 10.1016/j.ijscr.2022.107752] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2022] [Revised: 10/09/2022] [Accepted: 10/10/2022] [Indexed: 11/21/2022] Open
Abstract
Laparoscopic right hemicolectomy is performed only in 25% of cases in recent survey The medial-to-lateral and the bottom-to-up are the most frequent approaches used to perform surgery Top-to-down right hemicolectomy is an infrequent approach Obesity is an evident aspect complicating surgical dissection Top-to Down dissection could be an opportunity to use as alternative approach when classical dissection becomes intricate
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20
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Basukala S, Khand Y, Pahari S, Mainali P, Gurung N, Gurung S. Colorectal carcinoma presenting as spontaneous colocutaneous fistula - A rare case report and review of literature. Int J Surg Case Rep 2022; 96:107346. [PMID: 35763969 PMCID: PMC9237932 DOI: 10.1016/j.ijscr.2022.107346] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2022] [Revised: 06/19/2022] [Accepted: 06/20/2022] [Indexed: 02/07/2023] Open
Abstract
INTRODUCTION AND IMPORTANCE Colon cancer presenting as spontaneous enterocutaneous fistula are rare with only few cases reported in the literature. Such presentation signifies locally advanced disease with poorer outcomes. Enterocutaneous fistula increases morbidity and mortality in cancer and may potentially delay the definitive care. It poses a difficulty in management in terms of patient optimization, determining the type of resection (palliative or curative) and the operative timeline. CASE PRESENTATION A 47 years old female presented with complaints of foul smelling discharge from a fistulous opening in right iliac fossa with occasional per rectal bleeding for the past six months. Imaging showed ascending colon mass breaching the peritoneum with fistulous tract opening into subcutaneous plane. Exploratory laparotomy with right hemicolectomy and en bloc resection was performed. CLINICAL DISCUSSION Cutaneous fistula can be caused by traumatic, postoperative etiologies and about 20 % are of spontaneous etiologies. Colon cancer has the ability to mimic any abdominal disease with a wide spectrum of presentations. The locoregional extension from the bowel creates a passage of colonic contents to evacuate from the external opening. The fistulous tract of colon cancer is less likely to close spontaneously and may require surgical intervention following appropriate resuscitation. Due to features suggestive of bowel obstruction an early single stage surgery was performed in our case. CONCLUSION There are no existing guidelines for colon cancer with colocutaneous fistula because they are the same for benign fistulas (resuscitation, control of output, eradication of the infection, nutritional optimization, surgery) along with a multidisciplinary oncology team approach.
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Affiliation(s)
- Sunil Basukala
- Department of Surgery, Shree Birendra Hospital, Chhauni, Kathmandu 44600, Nepal
| | - Yugant Khand
- Nepalese Army Institute of Health Sciences – College of Medicine, Sanobharyang 44600, Kathmandu, Nepal,Corresponding author at: Nepalese Army Institute of Health Sciences-College of Medicine, Sanobharyang 44600, Kathmandu, Nepal.
| | - Soumya Pahari
- Nepalese Army Institute of Health Sciences – College of Medicine, Sanobharyang 44600, Kathmandu, Nepal
| | - Priya Mainali
- Nepalese Army Institute of Health Sciences – College of Medicine, Sanobharyang 44600, Kathmandu, Nepal
| | - Nirvik Gurung
- Nepalese Army Institute of Health Sciences – College of Medicine, Sanobharyang 44600, Kathmandu, Nepal
| | - Suman Gurung
- Department of Pathology, Shree Birendra Hospital, Chhauni, Kathmandu 44600, Nepal
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21
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Koyama M, Miyagawa Y, Kitazawa M, Tokumaru S, Nakamura S, Yamamoto Y, Ehara T, Hondo N, Soejima Y. Laparoscopic right hemicolectomy with a cranial-first approach for right-sided colon cancer. Tech Coloproctol 2022; 26:919-920. [PMID: 35676545 DOI: 10.1007/s10151-022-02641-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2022] [Accepted: 05/16/2022] [Indexed: 11/26/2022]
Affiliation(s)
- M Koyama
- Department of Surgery, Division of Gastroenterological, Hepato-Biliary-Pancreatic, Transplantation and Pediatric Surgery, Shinshu University School of Medicine, Asahi 3-1-1, Matsumoto, 390-8621, Japan.
| | - Y Miyagawa
- Department of Surgery, Division of Gastroenterological, Hepato-Biliary-Pancreatic, Transplantation and Pediatric Surgery, Shinshu University School of Medicine, Asahi 3-1-1, Matsumoto, 390-8621, Japan
| | - M Kitazawa
- Department of Surgery, Division of Gastroenterological, Hepato-Biliary-Pancreatic, Transplantation and Pediatric Surgery, Shinshu University School of Medicine, Asahi 3-1-1, Matsumoto, 390-8621, Japan
| | - S Tokumaru
- Department of Surgery, Division of Gastroenterological, Hepato-Biliary-Pancreatic, Transplantation and Pediatric Surgery, Shinshu University School of Medicine, Asahi 3-1-1, Matsumoto, 390-8621, Japan
| | - S Nakamura
- Department of Surgery, Division of Gastroenterological, Hepato-Biliary-Pancreatic, Transplantation and Pediatric Surgery, Shinshu University School of Medicine, Asahi 3-1-1, Matsumoto, 390-8621, Japan
| | - Y Yamamoto
- Department of Surgery, Division of Gastroenterological, Hepato-Biliary-Pancreatic, Transplantation and Pediatric Surgery, Shinshu University School of Medicine, Asahi 3-1-1, Matsumoto, 390-8621, Japan
| | - T Ehara
- Department of Surgery, Division of Gastroenterological, Hepato-Biliary-Pancreatic, Transplantation and Pediatric Surgery, Shinshu University School of Medicine, Asahi 3-1-1, Matsumoto, 390-8621, Japan
| | - N Hondo
- Department of Surgery, Division of Gastroenterological, Hepato-Biliary-Pancreatic, Transplantation and Pediatric Surgery, Shinshu University School of Medicine, Asahi 3-1-1, Matsumoto, 390-8621, Japan
| | - Y Soejima
- Department of Surgery, Division of Gastroenterological, Hepato-Biliary-Pancreatic, Transplantation and Pediatric Surgery, Shinshu University School of Medicine, Asahi 3-1-1, Matsumoto, 390-8621, Japan
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22
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Li MX, Lopez-Aguiar AG, Poultsides G, Rocha F, Weber S, Fields R, Idrees K, Cho C, Maithel SK, Zhang XF, Pawlik TM. Surgical Treatment of Neuroendocrine Tumors of the Terminal Ileum or Cecum: Ileocecectomy Versus Right Hemicolectomy. J Gastrointest Surg 2022; 26:1266-1274. [PMID: 35149952 DOI: 10.1007/s11605-022-05269-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/24/2021] [Accepted: 01/29/2022] [Indexed: 01/31/2023]
Abstract
BACKGROUND Simple ileocecectomy and right hemicolectomy are two potential operative approaches to treat patients with neuroendocrine neoplasm in the terminal ileum and/or cecum (IC-NENs). We sought to define the long-term outcome of patients undergoing ileocecectomy versus right hemicolectomy for IC-NENs, as well as characterize number of nodes evaluated and lymph node metastasis (LNM) associated with each procedure. METHODS Patients who underwent curative-intent resections for IC-NENs between 2000 and 2016 were identified from a multi-institutional database. The clinicopathologic characteristics, surgical procedures, and the overall (OS) and recurrence-free survival (RFS) were compared among patients who underwent formal right hemicolectomy versus ileocecectomy only. RESULTS Among 127 patients with IC-NENs, median size of the largest tumor size was 2.0 (IQR 1.2-2.9) cm; 35 (27.6%) patients had multiple lesions. At the time of surgery, 93 (73.2%) patients underwent a right hemicolectomy, whereas 34 (26.8%) had ileocecectomy only. Every patient had a lymph node dissection (LND) with a median number of 16 (IQR 12-22) nodes evaluated. A majority (n = 110, 86.6%) of patients had LNM with a median number of 3 (IQR 2-5) LNM. Patients who underwent hemicolectomy had more lymph nodes evaluated versus patients who had an ileocecectomy only (median, 18 vs. 14, p = 0.004). Patients who underwent formal right hemicolectomy versus ileocecectomy had a similar OS (median OS, 101.9 vs. 144.5 months, p = 0.44) and RFS (median RFS, 70.3 vs. not attained, p = 0.80), respectively. CONCLUSIONS Ileocecectomy had similar long-term outcomes versus right hemicolectomy in treatment of IC-NENs despite a difference in the lymph node harvest.
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Affiliation(s)
- Mu-Xing Li
- Department of Hepatobiliary Surgery and Institute of Advanced Surgical Technology and Engineering, The First Affiliated Hospital of Xi'an Jiaotong University, 277 West Yanta Road, Xi'an, China.,Department of General Surgery, Peking University Third Hospital, Beijing, China
| | - Alexandra G Lopez-Aguiar
- Division of Surgical Oncology, Department of Surgery, Winship Cancer Institute, Emory University, Atlanta, GA, USA
| | | | - Flavio Rocha
- Department of Surgery, Virginia Mason Medical Center, Seattle, WA, USA
| | - Sharon Weber
- Department of Surgery, School of Medicine and Public Health, University of Wisconsin, Madison, WI, USA
| | - Ryan Fields
- Department of Surgery, Washington University School of Medicine, St. Louis, WI, USA
| | - Kamran Idrees
- Division of Surgical Oncology, Department of Surgery, Vanderbilt University, Nashville, TN, USA
| | - Cliff Cho
- Division of Hepatopancreatobiliary and Advanced Gastrointestinal Surgery, Department of Surgery, University of Michigan, Ann Arbor, MI, USA
| | - Shishir K Maithel
- Division of Surgical Oncology, Department of Surgery, Winship Cancer Institute, Emory University, Atlanta, GA, USA
| | - Xu-Feng Zhang
- Department of Hepatobiliary Surgery and Institute of Advanced Surgical Technology and Engineering, The First Affiliated Hospital of Xi'an Jiaotong University, 277 West Yanta Road, Xi'an, China. .,Division of Surgical Oncology, The Ohio State University Wexner Medical Center and James Comprehensive Cancer Center, 395 W. 12th Ave., Suite 670, Columbus, OH, USA.
| | - Timothy M Pawlik
- Division of Surgical Oncology, The Ohio State University Wexner Medical Center and James Comprehensive Cancer Center, 395 W. 12th Ave., Suite 670, Columbus, OH, USA.
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23
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Bao MDL, Su H, Luo S, Xu Z, Wang XW, Liu Q, Zhou ZX, Wang XS, Zhou HT. [Safety and feasibility of overlapped delta-shaped anastomosis technique for digestive tract reconstruction during complete laparoscopic right hemicolectomy]. Zhonghua Zhong Liu Za Zhi 2022; 44:436-441. [PMID: 35615801 DOI: 10.3760/cma.j.cn112152-20200714-00655] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
Objective: To explore the clinical safety and feasibility of overlapped delta-shaped anastomosis (ODA) in totally laparoscopic right hemicolectomy (TLRHC). Methods: From May 2017 to October 2019, of the 219 patients who underwent TLRHC at the Cancer Hospital, Chinese Academy of Medical Science and Peking Union Medical College, 104 cases underwent ODA (ODA group) and 115 cases underwent conventional extracorporeal anastomosis (control group) were compared the surgical outcomes, postoperative recovery, pathological outcomes and perioperative complications. Results: The length of the skin incision in the ODA group was significantly shorter than that in the control group [(5.6±0.9) cm vs. (7.1±1.7) cm, P<0.05], and the time to first flatus and first defecation after surgery in the ODA group was significantly earlier than that in the control group [(1.7±0.7) days vs. (2.0±0.7) days; (3.2±0.6) days vs. (3.3±0.7) days, P<0.05]. While the anastomosis time, operation time, intraoperative blood loss, the time of first ground activities, the number of bowel movements within 12 days after surgery, postoperative hospital stay, tumor size, the distal and proximal margins, the number of lymph node harvested and postoperative TNM stage in the ODA group did not differ from that of the control group (P>0.05). The postoperative complication rates of patients in the ODA group and the control group were 3.8% (4/104) and 4.3% (5/115), respectively, and the difference was not significant (P>0.05). Conclusion: The application of ODA technology in TLRHC can significantly shorten thelength of skin incisionand the recovery time of bowel function, and can obtain satisfactory short-term efficacy.
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Affiliation(s)
- M D L Bao
- Department of Colorectal Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing 100021, China
| | - H Su
- Department of Colorectal Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing 100021, China
| | - S Luo
- Department of Colorectal Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing 100021, China
| | - Z Xu
- Department of Colorectal Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing 100021, China
| | - X W Wang
- Department of Colorectal Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing 100021, China
| | - Q Liu
- Department of Colorectal Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing 100021, China
| | - Z X Zhou
- Department of Colorectal Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing 100021, China
| | - X S Wang
- Department of Colorectal Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing 100021, China
| | - H T Zhou
- Department of Colorectal Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing 100021, China
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24
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Tei M, Suzuki Y, Ohtsuka M, Yoshikawa Y, Sueda T, Imasato M, Hasegawa J, Akamatsu H. Vascular variants in laparoscopic extended right hemicolectomy with central vascular ligation for right colon cancer. Surg Today 2022; 52:1414-1422. [PMID: 35536401 DOI: 10.1007/s00595-022-02511-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2021] [Accepted: 01/09/2022] [Indexed: 11/27/2022]
Abstract
PURPOSE To evaluate the right colic vascularity, focusing on the confluences of veins. METHODS The subjects of this retrospective study were 100 patients who underwent laparoscopic extended right hemicolectomy (Lap-ERHC) between April 2015 and September 2020, at our hospitals. Veins draining into the superior mesenteric vein (SMV) included the ileocecal vein (ICV), the right colic vein (RCV), the middle colic vein (MCV), and the gastrocolic trunk of Henle (GCT). Veins draining into vessels other than the SMV were defined as accessory colic veins (aICV, aRCV or aMCV). RESULTS The GCT, aRCV, and aMCV were found in 86, 89, and 15 patients, respectively. In 66 patients with one aRCV, drainage was split as the anterior superior pancreaticoduodenal vein (ASPDV) in 12, the right gastroepiploic vein (RGEV) in 7, and the GCT in 47. In 23 patients with two aRCVs, drainage was split as the ASPDV in 4, the RGEV in 1, the GCT in 11, and the ASPDV and GCT in 7. In 14 patients with one aMCV, drainage was split as the GCT in 8, the splenic vein in 5, and the first jejunal vein (FJV) in 1. One patient had two aMCVs, draining into the GCT and the FJV. CONCLUSIONS The findings of our evaluation of vascular anatomy, focusing on confluences of the colic veins, provides useful information for colorectal surgeons.
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Affiliation(s)
- Mitsuyoshi Tei
- Department of Surgery, Osaka Rosai Hospital, 1179-3 Nagasonecho, Kita-ku, Sakai, 591-8025, Japan.
| | - Yozo Suzuki
- Department of Surgery, Toyonaka Municipal Hospital, Toyonaka, Japan
| | | | - Yukihiro Yoshikawa
- Department of Surgery, Osaka Rosai Hospital, 1179-3 Nagasonecho, Kita-ku, Sakai, 591-8025, Japan
| | - Toshinori Sueda
- Department of Surgery, Osaka Rosai Hospital, 1179-3 Nagasonecho, Kita-ku, Sakai, 591-8025, Japan
| | | | - Junichi Hasegawa
- Department of Surgery, Osaka Rosai Hospital, 1179-3 Nagasonecho, Kita-ku, Sakai, 591-8025, Japan
| | - Hiroki Akamatsu
- Department of Surgery, Osaka Minato Central Hospital, Osaka, Japan
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25
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Iguchi K, Numata M, Shiozawa M, Kazama K, Sawazaki S, Katayama Y, Numata K, Sato S, Higuchi A, Sugano N, Mushiake H, Rino Y. Laparoscopic extended right hemicolectomy versus laparoscopic transverse colectomy for mid-transverse colon cancer: a multicenter retrospective study from Kanagawa Yokohama Colorectal Cancer (KYCC) study group. Int J Colorectal Dis 2022; 37:1011-9. [PMID: 35384494 DOI: 10.1007/s00384-022-04128-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/07/2022] [Indexed: 02/04/2023]
Abstract
PURPOSE The laparoscopic surgery approach for mid-transverse colon cancer (MTC) varies depending on tumor characteristics and the guidelines implemented by each surgeon; the optimal surgical procedure for MTC has not been established. This study aimed to compare the surgical outcomes of laparoscopic extended right hemicolectomy (Lap-ERHC) and laparoscopic transverse colectomy (Lap-TC) for MTC. METHODS This was a multicenter, retrospective study. We surveyed eight hospitals, by questionnaire, on MTC surgery policies and retrospectively compared the short- and long-term surgical outcomes for patients with MTC who underwent Lap-ERHC or Lap-TC between January 2008 and December 2019. RESULTS A total of 129 patients were enrolled, of whom 35 underwent Lap-ERHC and 94 underwent Lap-TC. There were no significant differences in tumor progression between the two groups. Operation time was significantly longer (202 min vs. 185 min, p = 0.026). We observed a higher complication rate (≥ grade 3) in the Lap-ERHC group than in the Lap-TC group (11.4% vs. 3.2%, p = 0.086). Three patients (8.6%) who underwent Lap-ERHC developed anastomotic leakage; none of the patients who underwent Lap-TC had this complication (p = 0.018). The 3-year overall survival rates (stage I: 100% vs. 91.9%, p = 0.64; stage II: 100% vs. 95.5%, p = 0.46; stage III: 100% vs. 88.2%, p = 0.91, respectively) were similar between the two groups. CONCLUSION Lap-ERHC for MTC has the same long-term outcomes as Lap-TC. However, Lap-ERHC for MTC has a higher complication rate. Therefore, Lap-TC may be recommended for patients with MTC. TRIAL REGISTRATION UMIN000042674.
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26
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Baqar AR, Wilkins S, Wang WC, Oliva K, Centauri S, Yap R, McMurrick P. A comparison of extracorporeal side to side or end to side anastomosis following a laparoscopic right hemicolectomy for colon cancer. ANZ J Surg 2022; 92:1472-1479. [PMID: 35403808 PMCID: PMC9324090 DOI: 10.1111/ans.17701] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2021] [Revised: 03/18/2022] [Accepted: 03/30/2022] [Indexed: 12/11/2022]
Abstract
Background This study aimed to investigate whether an extracorporeal side‐to‐side (SS) or end‐to‐side (ES) stapled anastomosis impacts short‐term and long‐term outcomes after an oncological laparoscopic right hemicolectomy. Methods A retrospective cohort study of prospectively collected data from two Victorian tertiary referral hospitals was performed. Patients who underwent oncological resection for colorectal cancer between February 2010 and September 2020 were selected from the colorectal neoplasia database. Patients were divided into two groups depending on the type of stapled anastomosis: Group 1 (functional end‐to‐end/side‐to‐side (SS)); and Group 2 (end‐to‐side (ES)). Primary outcomes were anastomotic leak, postoperative ileus, mortality and morbidity, length of stay post‐surgery, readmission to hospital, and 30‐day mortality. Results This large case series of 1040 patients (SS = 625, ES = 415) demonstrated that the type of stapling technique impacted operative duration and postoperative ileus rates. Patients in the SS group had a faster operation of 108 min rather than 130 min in the ES group (p < 0.001). The SS group were more likely to experience a post‐operative ileus (p < 0.001) with no impact on length of stay (SS, 7 days versus ES, 7 days; p = 0.14). There were no differences between the two groups with respect to lymph node yield, lymph node ratio, anastomotic leaks, return to theatre, 30‐day mortality and 5‐year overall survival. Discussion The type of extracorporeal stapled anastomosis following an oncological laparoscopic right hemicolectomy has minimal impact on morbidity and survival outcomes; however, a side‐to‐side stapled anastomosis is more likely to be a faster operation with a higher postoperative ileus rate.
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Affiliation(s)
- Ali Riaz Baqar
- Cabrini Monash University Department of Surgery, Cabrini Hospital, Melbourne, Victoria, Australia
| | - Simon Wilkins
- Cabrini Monash University Department of Surgery, Cabrini Hospital, Melbourne, Victoria, Australia.,Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Wei Chun Wang
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia.,Cabrini Institute, Melbourne, Victoria, Australia
| | - Karen Oliva
- Cabrini Monash University Department of Surgery, Cabrini Hospital, Melbourne, Victoria, Australia
| | - Suellyn Centauri
- Cabrini Monash University Department of Surgery, Cabrini Hospital, Melbourne, Victoria, Australia
| | - Raymond Yap
- Cabrini Monash University Department of Surgery, Cabrini Hospital, Melbourne, Victoria, Australia
| | - Paul McMurrick
- Cabrini Monash University Department of Surgery, Cabrini Hospital, Melbourne, Victoria, Australia
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Lin L, Yuan SB, Guo H. Does cranial-medial mixed dominant approach have a unique advantage for laparoscopic right hemicolectomy with complete mesocolic excision? World J Gastrointest Surg 2022; 14:221-235. [PMID: 35432765 PMCID: PMC8984517 DOI: 10.4240/wjgs.v14.i3.221] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2021] [Revised: 11/14/2021] [Accepted: 03/06/2022] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Complete mesocolic excision (CME) with central vascular ligation (CVL) was proposed by Hohenberger in 2009. The CME principle has gradually become the technical standard for colon cancer surgery. How to achieve CME with CVL in laparoscopic right hemicolectomy (LRH) is controversial, and a unified standard approach is not yet available. In recent years, the authors’ team has integrated the theory of membrane anatomy, tried to combine the cephalic approach with the classic medial approach (MA) for technical optimization, and proposed a cranial-medial mixed dominant approach (CMA).
AIM To explore the feasibility of operational approaches for LRH with CME.
METHODS In this retrospective cohort study, the clinical data of 57 patients with right-sided colon cancer (TNM stage I, II, or III) who underwent LRH with CME from January 2016 to June 2020 were collected and summarized. There were 31 patients in the traditional MA group and 26 in the CMA group.
RESULTS There were no significant differences in baseline data between the two groups. The operation was shorter and the number of lymph nodes dissected was higher in the CMA group than in the MA group, but there was no significant difference in the number of positive lymph nodes, intraoperative blood loss, postoperative exhaust time, feeding time, postoperative hospital stay or postoperative complication incidence.
CONCLUSION Our study shows that the CMA is a safe and feasible procedure for LRH with CME and has a unique advantage.
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Affiliation(s)
- Li Lin
- Department of Gastrointestinal Surgery and Xiamen City Key Laboratory of Gastrointestinal Cancer, Zhongshan Hospital, Xiamen University, Xiamen 361000, Fujian Province, China
| | - Si-Bo Yuan
- Department of Gastrointestinal Surgery and Xiamen City Key Laboratory of Gastrointestinal Cancer, Zhongshan Hospital, Xiamen University, Xiamen 361000, Fujian Province, China
| | - Huan Guo
- Department of Gastrointestinal Surgery and Xiamen City Key Laboratory of Gastrointestinal Cancer, Zhongshan Hospital, Xiamen University, Xiamen 361000, Fujian Province, China
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Wang K, Li W, Liu N, Cai J, Zhang Y. Safety and oncological outcomes of natural orifice specimen extraction surgery compared with conventional laparoscopic surgery for right hemicolectomy: a systematic review and meta-analysis. Updates Surg 2022; 74:833-842. [PMID: 35304899 DOI: 10.1007/s13304-022-01276-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2021] [Accepted: 03/06/2022] [Indexed: 11/29/2022]
Abstract
Natural orifice specimen extraction surgery (NOSES) is a new technique and uses natural orifice as the delivery route for specimen extraction to avoid supererogatory incision, and the safety and oncological outcomes of NOSES for right hemicolectomy are still inconclusive, so a meta-analysis was performed to compare these to conventional laparoscopic surgery (CLS). Related literature comparing NOSES with CLS for right hemicolectomy, whether randomized controlled trials (RCTs) or retrospective studies, were systematically searched. A random-effect model or fixed-effect model was used based on the I2 value. A total of six studies (all retrospective trials) involving 609 participants were included. Compared with CLS, NOSES was more preponderant than CLS in terms of surgical morbidity [odds ratio (OR) = 0.31; P = 0.0002], length of hospital stay [weighted mean difference (WMD) = - 1.52; P = 0.006], time to first flatus (WMD = - 0.82; P = 0.0008) and liquid intake (WMD = - 1.40; P < 0.00001), pain score of POD1 (WMD = - 1.99; P < 0.00001) and POD3 (WMD = - 1.15; P = 0.02), and cosmetic result (WMD = 1.84; P < 0.00001), while operative time of NOSES was prolonged (WMD = 18.29; P = 0.04). The number of dissected lymph nodes, recurrence, and 3-year overall survival (3-year OS) in NOSES group were comparable to the CLS group. Despite the lack of enough evidence, NOSES for right hemicolectomy has demonstrated comparable safety and oncological outcomes as CLS with less postoperative morbidity and pain, better cosmetic effect, and rapider recovery.
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Affiliation(s)
- Kang Wang
- Departments of Gastrointestinal Surgery, Zhongshan Hospital of Xiamen University, Xiamen, 361000, China.,Gastrointestinal Oncology Center of Xiamen University, Xiamen, 361000, China.,Medical College of Xiamen University, Xiamen, 361000, China
| | - Wenya Li
- Departments of Gastrointestinal Surgery, Zhongshan Hospital of Xiamen University, Xiamen, 361000, China.,Gastrointestinal Oncology Center of Xiamen University, Xiamen, 361000, China.,Medical College of Xiamen University, Xiamen, 361000, China
| | - Ningquan Liu
- Departments of Gastrointestinal Surgery, Zhongshan Hospital of Xiamen University, Xiamen, 361000, China.,Gastrointestinal Oncology Center of Xiamen University, Xiamen, 361000, China.,Medical College of Xiamen University, Xiamen, 361000, China
| | - Jianchun Cai
- Departments of Gastrointestinal Surgery, Zhongshan Hospital of Xiamen University, Xiamen, 361000, China. .,Gastrointestinal Oncology Center of Xiamen University, Xiamen, 361000, China. .,Medical College of Xiamen University, Xiamen, 361000, China.
| | - Yiyao Zhang
- Departments of Gastrointestinal Surgery, Zhongshan Hospital of Xiamen University, Xiamen, 361000, China. .,Gastrointestinal Oncology Center of Xiamen University, Xiamen, 361000, China. .,Medical College of Xiamen University, Xiamen, 361000, China.
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Huang X. Laparoscopic segmental colectomy with extensive D3 lymph node dissection: a good choice for right transverse colon cancer. World J Surg Oncol 2022; 20:85. [PMID: 35292062 PMCID: PMC8922826 DOI: 10.1186/s12957-022-02530-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2022] [Accepted: 02/16/2022] [Indexed: 11/12/2022] Open
Abstract
Background Previous research was yet to establish a definite operation for transverse colon cancer (TCC); surgical procedure was often dictated by the surgeon’s preference in clinical practice. The main surgical methods could be summarized in two main points: segmental colectomy (transverse colectomy) and right hemicolectomy. Method The first patient was a 78-year-old woman, who was diagnosed with right TCC. Computed tomography revealed a right TCC and a very long transverse colon; laparoscopic exploration revealed an enlarged apical lymph node surrounding the ileocolic vessels. We performed a segmental colectomy with extensive apical lymph node dissection along the superior mesenteric vessels and its main branches for her. To distinguish it from the previous radical operations for TCC, we called this operation a segmental colectomy with extensive D3 lymph node dissection. Then, this surgical intervention was performed on 8 other TCC patients. Results The total operating time was 158 min. Pathological examination confirmed 2 apical lymph node metastases; among them, one apical lymph node metastasis was in group No.203. For all 9 patients, the median operative time was 160 min (range, 140–185 min), the average number of lymph node retrieval was 30 (range, 25–39), and the average number of apical lymph node (No.203, No.213, and No.223) retrieval was 5.9 (range, 0–11). Because of the preservation of the ileocecal junction and part of the ascending colon, all patients recovered uneventfully after surgery, and long-term diarrhea, water-electrolyte imbalance, and other Clavien–Dindo grade III or greater postoperative complications did not occur. Conclusions Our procedure combined the advantages of segmental colectomy and right hemicolectomy and gave consideration to oncological and functional outcomes. It may be an optimal choice for TCC patients with a very long transverse colon and preoperative diagnosis of lymph node metastasis. Supplementary Information The online version contains supplementary material available at 10.1186/s12957-022-02530-4.
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Affiliation(s)
- Xing Huang
- The First Department of General Surgery (Department of Colorectal and Anal Surgery), Hunan Provincial People's Hospital (The First Affiliated Hospital of Hunan Normal University), No. 61 Jiefang West Road, Changsha, Hunan, China.
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30
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Zhang X, Zhang J, Ma P, Cao Y, Liu C, Li S, Li Z, Zhao Y. Tunnel versus medial approach in laparoscopic radical right hemicolectomy for right colon cancer: a retrospective cohort study. BMC Surg 2022; 22:27. [PMID: 35081941 PMCID: PMC8793186 DOI: 10.1186/s12893-022-01491-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2021] [Accepted: 01/20/2022] [Indexed: 11/10/2022] Open
Abstract
PURPOSE This study aimed to explore the feasibility and safety of the tunnel approach in laparoscopic radical right hemicolectomy for colon cancer. METHODS From July 2016 to October 2018, a total of 106 consecutive patients with colon cancer who underwent laparoscopic radical right hemicolectomy at the Affiliated Cancer Hospital of Zhengzhou University were enrolled. The patients were stratified into either a tunnel approach (TA) (n = 56) group or traditional medial approach (MA) (n = 50) group according to the surgical technique performed. The baseline demographics, perioperative outcomes and oncologic outcomes were compared between the two groups. RESULTS The baseline characteristics did not differ between groups. The TA group had significantly less blood loss [20.0 (10.0-40.0) vs. 100 (100.0-150.0) ml, p < 0.001] and a shorter operation time [128.4 ± 16.7 vs. 145.6 ± 20.3 min, p < 0.001] than the MA group. The time to first flatus and postoperative hospital stay were similar [3.0 (2.0-4.0) vs. 3.0 (3-4.0) days, p = 0.329; 10.4 ± 2.6 vs. 10.7 ± 3.0 days, p = 0.506] between the two groups. The conversion to laparotomy and complication rates were similar between groups (0 vs. 6.0%, p = 0.203; 14.3% vs. 18.0%, p = 0.603, respectively). No treatment-related deaths occurred in either group. The TA group did not have significantly better survival outcomes than the MA group (p = 0.372). CONCLUSIONS The TA seems to allow for more favourable results in terms of blood loss and operative time than the MA, with similar results regarding time to first flatus, hospital stay, postoperative complication rate, conversion rate and oncologic outcomes; moreover, the TA is easier for beginners to master.
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Affiliation(s)
- Xijie Zhang
- Department of General Surgery, Affiliated Cancer Hospital of Zhengzhou University, 127 Dong Ming Road, Zhengzhou, 450008, Henan, China
| | - Junli Zhang
- Department of General Surgery, Affiliated Cancer Hospital of Zhengzhou University, 127 Dong Ming Road, Zhengzhou, 450008, Henan, China
| | - Pengfei Ma
- Department of General Surgery, Affiliated Cancer Hospital of Zhengzhou University, 127 Dong Ming Road, Zhengzhou, 450008, Henan, China
| | - Yanghui Cao
- Department of General Surgery, Affiliated Cancer Hospital of Zhengzhou University, 127 Dong Ming Road, Zhengzhou, 450008, Henan, China
| | - Chenyu Liu
- Department of General Surgery, Affiliated Cancer Hospital of Zhengzhou University, 127 Dong Ming Road, Zhengzhou, 450008, Henan, China
| | - Sen Li
- Department of General Surgery, Affiliated Cancer Hospital of Zhengzhou University, 127 Dong Ming Road, Zhengzhou, 450008, Henan, China
| | - Zhi Li
- Department of General Surgery, Affiliated Cancer Hospital of Zhengzhou University, 127 Dong Ming Road, Zhengzhou, 450008, Henan, China
| | - Yuzhou Zhao
- Department of General Surgery, Affiliated Cancer Hospital of Zhengzhou University, 127 Dong Ming Road, Zhengzhou, 450008, Henan, China.
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Affiliation(s)
- Bo Tang
- Department of General Surgery, The First Affiliated Hospital of Nanchang University, Nanchang, 330006 Jiangxi China
| | - Yahang Liang
- Department of General Surgery, The First Affiliated Hospital of Nanchang University, Nanchang, 330006 Jiangxi China
| | - Jun Shi
- Department of General Surgery, The First Affiliated Hospital of Nanchang University, Nanchang, 330006 Jiangxi China
| | - Taiyuan Li
- Department of General Surgery, The First Affiliated Hospital of Nanchang University, Nanchang, 330006 Jiangxi China
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32
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Sunder T, Raghunath KJ, Thangaraj PR, Kumar KM, Chinnasamy S. Caecal bascule following lung transplantation. Indian J Thorac Cardiovasc Surg 2022; 38:75-9. [PMID: 34898880 DOI: 10.1007/s12055-021-01259-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2021] [Revised: 08/17/2021] [Accepted: 08/18/2021] [Indexed: 01/03/2023] Open
Abstract
Caecal bascule refers to a rare condition wherein the caecum folds upon the ascending colon causing intestinal obstruction. We describe a case report of caecal bascule following lung transplantation which required right hemicolectomy. It was initially thought to be due to post-operative paralytic ileus which is, not uncommonly, seen following lung transplantation. While most cases of paralytic ileus respond to conservative measures, it is important to maintain a close watch-keeping in mind a high degree of suspicion for possible surgically correctable causes, which can be a lifesaving intervention. The clinical dilemma in subjecting a heavily immunosuppressed patient, soon after lung transplantation (where painless abdominal distention is not uncommon), to a major abdominal surgery in the background of minimal clinical signs of acute abdomen is discussed. The thought process behind the surgical strategy, including the pros and cons of various surgical options and the management of nutrition and immunosuppression in this patient, is elaborated.
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33
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Teo RM, Choo XY, Tay KV. Caecal bascule - A variant of caecal volvulus: Review of diagnostic challenges and approaches. Surgeon 2021:S1479-666X(21)00161-X. [PMID: 34789426 DOI: 10.1016/j.surge.2021.09.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2020] [Revised: 08/13/2021] [Accepted: 09/21/2021] [Indexed: 11/21/2022]
Abstract
Caecal volvulus is a rare cause of intestinal obstruction, of which the caecal bascule is the most uncommonly encountered subtype. Definitive radiological diagnosis of a caecal bascule can be challenging. Lack of familiarity with this rare condition can contribute to delayed diagnosis and treatment, which may result in unnecessary morbidity. This article highlights the case of a patient who presented with a diagnostic challenge, and also discusses the pathogenesis and diagnostic features of caecal bascules. Various options in the surgical management of caecal bascules are reviewed, including the feasibility of laparoscopic-assisted approaches in the emergency setting.
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Ramser M, Kwok AMF, Maeda Y, Potter MA. Oncological and clinical outcomes after conventional right hemicolectomy. Langenbecks Arch Surg 2021; 406:2781-2788. [PMID: 34505198 DOI: 10.1007/s00423-021-02320-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2021] [Accepted: 08/27/2021] [Indexed: 12/19/2022]
Abstract
PURPOSE Complete mesocolic excision (CME) has been proposed for better local control of colon cancer and to improve cancer-specific survival (CSS). However, CME may be associated with increased morbidity from bleeding during central vascular ligation. This study aimed to investigate the outcome of conventional right hemicolectomy, a traditional anatomical dissection along anatomical planes with radical excision of the central lymph nodes at the level of the origin of colic artery but without exposure of superior mesenteric vein and artery (SMV/SMA). METHOD This was a retrospective review of a cohort of all elective right hemicolectomies performed at a specialist tertiary unit during a five-year period (2011-2015). RESULTS Five-hundred-nineteen patients (271 female, a median age of 73.0 years (interquartile range (IQR) 65.0-80.0)) were included (Stage I disease: 2.7%, stage II: 53.2%, stage III: 33.3%, stage IV: 10.8%). At the latest follow-up (a median 47 months (IQR 29-67)), local recurrence occurred in 34 patients (6.6%). Three-year overall survival was 74.4% and 3-year CSS was 85.9%. Subgroup analysis for stage I-III showed local recurrence in 6.0%, sole distant recurrence in 7.6% while 19 patients (4.1%) suffered concomitant local and distant recurrence. The anastomotic leak rate was 1.0% and perioperative bleeding occurred in 1.2%. CONCLUSIONS Oncological outcomes comparable to those of CME can be achieved by conventional surgery but with low rates of bleeding complications and anastomotic leakage. The proposed advantages of CME should be carefully considered and balanced against patients' co-morbidities and potential complications.
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Affiliation(s)
- Michaela Ramser
- Department of Colorectal Surgery, Western General Hospital, Crewe Rd South, Edinburgh, EH4 2XU, UK.,Department of General Surgery, Kantonsspital Olten, Olten, Switzerland
| | - Allan M F Kwok
- Department of Colorectal Surgery, Western General Hospital, Crewe Rd South, Edinburgh, EH4 2XU, UK
| | - Yasuko Maeda
- Department of Colorectal Surgery, Western General Hospital, Crewe Rd South, Edinburgh, EH4 2XU, UK. .,Department of Clinical Surgery, University of Edinburgh, Edinburgh, UK.
| | - Mark A Potter
- Department of Colorectal Surgery, Western General Hospital, Crewe Rd South, Edinburgh, EH4 2XU, UK.,Department of Clinical Surgery, University of Edinburgh, Edinburgh, UK
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Ferri V, Vicente E, Quijano Y, Duran H, Diaz E, Fabra I, Malave L, Agresott R, Isernia R, Cardinal-Fernandez P, Ruiz P, Nola V, de Nobili G, Ielpo B, Caruso R. Right-side colectomy with complete mesocolic excision vs conventional right-side colectomy in the treatment of colon cancer: a systematic review and meta-analysis. Int J Colorectal Dis 2021; 36:1885-904. [PMID: 33983451 DOI: 10.1007/s00384-021-03951-5] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/04/2021] [Indexed: 02/04/2023]
Abstract
BACKGROUND This meta-analysis aims to investigate the role of complete mesocolic excision (CME) in the treatment of right-side colon cancer when compared with standard right-side hemicolectomy, focusing on oncological outcomes, mortality and morbidity rates. MATERIALS AND METHODS A systematic literature search was performed on MEDLINE and EMBASE archives, including studies on CME in right-side colon cancer. Primary outcomes were five-year disease-free survival and five-year overall survival. Secondary outcomes investigated were mortality and morbidity rates, intraoperative blood loss, anastomotic leakage, postoperative ileus, day of postoperative flatus, pulmonary infection, duration of hospital stay and number of lymph nodes harvested. RESULTS Seventeen studies have been included in this meta-analysis for a total of 3918 patients. The five-year disease-free survival (DFS) and overall survival (OS) results improved in the CME group with respect to conventional right-side colectomy with an OR 1.88 (95% CI 1.02-3.45) and OR 2.77 (95% CI 1.33-5.74), respectively. The incidence of mortality and morbidity was comparable between the two groups. Moreover, conventional surgery time was faster than CME (MD 33.69 min, 95% CI 12.79-54.59), while no significant differences were reported in mean blood loss and hospital stay. Furthermore, the CME group showed a higher mean number of harvested lymph nodes (MD 7.08 lymph nodes 95% CI 4.90-9.27). CONCLUSION Complete mesocolic excision of the right-side colectomy improves oncological outcomes without increasing mortality and morbidity rates compared to standard right-side hemicolectomy. CME should therefore be routinely performed in the treatment of right-side colon cancer.
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Masuda T, Takamori H, Ogawa K, Shimizu K, Karashima R, Nitta H, Matsumoto K, Okino T, Baba H. C-reactive protein level on postoperative day 3 as a predictor of anastomotic leakage after elective right-sided colectomy. Surg Today 2021. [PMID: 34370104 DOI: 10.1007/s00595-021-02351-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2021] [Accepted: 05/24/2021] [Indexed: 10/20/2022]
Abstract
PURPOSE To investigate the factors predictive of anastomotic leakage in patients undergoing elective right-sided colectomy. METHODS The subjects of this retrospective study were 247 patients who underwent elective right hemicolectomy or ileocecal resection with ileocolic anastomosis between April 2012 and March 2019, at our institution. RESULTS Anastomotic leakage occurred in 9 of the 247 patients (3.6%) and was diagnosed on median postoperative day (POD) 7 (range POD 3-12). There were no significant differences in the background factors or preoperative laboratory data between the patients with anastomotic leakage (anastomotic leakage group) and those without anastomotic leakage (no anastomotic leakage group). Open surgery was significantly more common than laparoscopic surgery (P = 0.027), and end-to-side anastomosis was less common (P = 0.025) in the anastomotic leakage group. The C-reactive protein (CRP) level in the anastomotic leakage group was higher than that in the no anastomotic leakage group on PODs 3 (P < 0.001) and 5 (P < 0.001). ROC curve analysis revealed that anastomotic leakage was significantly more frequent in patients with a serum CRP level ≥ 11.8 mg/dL [area under the curve (AUC) 0.83]. CONCLUSION A serum CRP level ≥ 11.8 mg/dL on POD 3 was predictive of anastomotic leakage being detected on median POD 7.
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Hannan E, Feeney G, Ullah MF, Ryan C, McNamara E, Waldron D, Condon E, Coffey JC, Peirce C. Robotic versus laparoscopic right hemicolectomy: a case-matched study. J Robot Surg 2021; 16:641-647. [PMID: 34338996 PMCID: PMC9135878 DOI: 10.1007/s11701-021-01286-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2021] [Accepted: 07/20/2021] [Indexed: 12/02/2022]
Abstract
The current gold standard surgical treatment for right colonic malignancy is the laparoscopic right hemicolectomy (LRH). However, laparoscopic surgery has limitations which can be overcome by robotic surgery. The benefits of robotics for rectal cancer are widely accepted but its use for right hemicolectomy remains controversial. The aim of this study was to compare outcomes in patients undergoing robotic right hemicolectomy (RRH) and LRH in a university teaching hospital. Demographic, perioperative and postoperative data along with early oncological outcomes of patients who underwent RRH and LRH with extracorporeal anastomosis (ECA) were identified from a prospectively maintained database. A total of 70 patients (35 RRH, 35 LRH) were identified over a 4-year period. No statistically significant differences in estimated blood loss, conversion to open surgery, postoperative complications, anastomotic leak, 30-day reoperation, 30-day mortality, surgical site infection or lengths of stay were demonstrated. Surgical specimen quality in both groups was favourable. The mean duration of surgery was longer in RRH (p < < 0.00001). A statistically significant proportion of RRH patients had a higher BMI and ASA grade. The results demonstrate that RRH is safe and feasible when compared to LRH, with no statistical difference in postoperative morbidity, mortality and early oncological outcomes. A difference was noted in operating time, however was influenced by training residents in docking the robot and a technically challenging cohort of patients. Operative time has shortened with further experience. Incorporating an intracorporeal anastomosis technique in RRH offers the potential to improve outcomes compared to LRH.
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Affiliation(s)
- Enda Hannan
- Department of Colorectal Surgery, University Hospital Limerick, St Nessan's Road, Dooradoyle Co, Limerick, Ireland.
| | - Gerard Feeney
- Department of Colorectal Surgery, University Hospital Limerick, St Nessan's Road, Dooradoyle Co, Limerick, Ireland
| | - Mohammad Fahad Ullah
- Department of Colorectal Surgery, University Hospital Limerick, St Nessan's Road, Dooradoyle Co, Limerick, Ireland
| | - Claire Ryan
- Department of Colorectal Surgery, University Hospital Limerick, St Nessan's Road, Dooradoyle Co, Limerick, Ireland
| | - Emma McNamara
- Department of Colorectal Surgery, University Hospital Limerick, St Nessan's Road, Dooradoyle Co, Limerick, Ireland
| | - David Waldron
- Department of Colorectal Surgery, University Hospital Limerick, St Nessan's Road, Dooradoyle Co, Limerick, Ireland
| | - Eoghan Condon
- Department of Colorectal Surgery, University Hospital Limerick, St Nessan's Road, Dooradoyle Co, Limerick, Ireland
| | - John Calvin Coffey
- Department of Colorectal Surgery, University Hospital Limerick, St Nessan's Road, Dooradoyle Co, Limerick, Ireland.,School of Medicine, University of Limerick, Limerick, Ireland
| | - Colin Peirce
- Department of Colorectal Surgery, University Hospital Limerick, St Nessan's Road, Dooradoyle Co, Limerick, Ireland.,School of Medicine, University of Limerick, Limerick, Ireland
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Huang SF, Chiang CL, Lee MH. Suture granuloma mimicking local recurrence of colon cancer after open right hemicolectomy: a case report. Surg Case Rep 2021; 7:164. [PMID: 34259947 PMCID: PMC8280259 DOI: 10.1186/s40792-021-01251-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2021] [Accepted: 07/09/2021] [Indexed: 11/16/2022] Open
Abstract
Background Foreign body granuloma is a rare surgery-related complication that can masquerade as cancer recurrence during postoperative surveillance. It may therefore deceive clinicians and lead to unnecessary interventions. The case presented herein demonstrates how a foreign body granuloma can be misleading in preoperative radiological studies and why this condition should not be ignored in differential diagnoses during surveillance of patients with previous history of abdominal surgery of any kind. Case presentation We report a case of suture granuloma mistaken for recurrent colon cancer, including the clinical history, imaging data, and histopathological photographs. A 60-year-old man was followed up at our institution after open right hemicolectomy 2 years earlier for ascending colon carcinoma. Contrast-enhanced computed tomography and magnetic resonance imaging revealed an infiltrative heterogeneous soft tissue lesion at the right mesenteric root, adjacent to the ileocolic anastomosis. Local recurrence was therefore suspected. We performed exploratory laparotomy, excised the tumor, and sent it for histopathological examination, which confirmed suture granuloma. Conclusions Foreign body granuloma is a rare surgery-related complication that should be considered during surveillance following colectomy. Its radiological features may mimic recurrent lesions, thus misleading clinicians and causing unnecessary interventions or further complications.
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Affiliation(s)
- Shih-Feng Huang
- Department of Surgery, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan, ROC
| | - Chia-Ling Chiang
- Department of Radiology, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan, ROC.,School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC
| | - Ming-Hung Lee
- Division of Colorectal Surgery, Department of Surgery, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan, ROC.
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Tschann P, Seitinger G, Lechner D, Adler S, Feurstein B, Girotti PNC, Schmölzer T, Szeverinski P, Aigner F, Königsrainer I. Reduced port versus open right hemicolectomy for colorectal cancer: a retrospective comparison study of two centers. Int J Colorectal Dis 2021; 36:1469-77. [PMID: 33825027 DOI: 10.1007/s00384-021-03923-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/01/2021] [Indexed: 02/04/2023]
Abstract
PURPOSE The concept of complete mesocolic excision (CME) in right-sided colorectal cancer is well known for open and laparoscopic surgery. The aim of this study was to evaluate and compare perioperative and oncological outcomes of reduced port and open surgery for right-sided colorectal cancer. METHODS One hundred forty-one patients received elective surgery for right-sided colonic cancer between January 2015 and December 2019 and were included in a retrospective database. RESULTS We observed longer operation time in the RP-CME group (145 min vs. 119.43 min, p<0.01). Hospital stay (8 days vs. 14 days, p<0.01) and time to first intestinal passage (42 h. vs. 59 h, p<0.01) were significantly shorter in the reduced port group. Postoperative complications were more likely to be observed in the O-CME group (7.2% vs. 14.1%, p=0.28); anastomotic leakage rate was low in both groups (1.8% vs. 2.4%, p=1.00). Specimen scores (score 1= good: 93.8% vs. 91.7%, p=1.00) and average number of retrieved lymph nodes were comparable (24 vs. 23 p=0.69). In O-CME patients, we observed more advanced tumor stages (UICC III: 21.4% vs. 45.9%, p<0.01). CONCLUSION To our knowledge, this is the first study comparing reduced port to open surgery for right-sided colorectal cancer. We could demonstrate that this technique is feasible for oncological right hemicolectomy with observation of shorter hospital stay and lower morbidity rates compared to open surgery. The oncological outcome did not differ in the present study.
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Gilani M, Iskaros M, Nahidi SM, Mehta N, Ahmed L. Appendiceal carcinoma presenting as a rapidly enlarging abdominal mass. Int J Surg Case Rep 2021; 84:106148. [PMID: 34218018 PMCID: PMC8258854 DOI: 10.1016/j.ijscr.2021.106148] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2021] [Revised: 06/26/2021] [Accepted: 06/26/2021] [Indexed: 11/28/2022] Open
Abstract
Introduction Appendiceal adenocarcinomas, although rare, usually present as slow-growing masses. Rarely, do they rapidly enlarge into large abdominal masses over a short period of time. Generally, we attribute rapidly growing abdominal masses to sarcomas, desmoid tumors, or gynecological masses. We present a case of a rapidly growing appendiceal adenocarcinoma in an elderly patient. Case presentation We report a case of an 83-year-old-male who presented with a one-month history of abdominal pain. A computer tomography (CT) scan identified a lower pelvic mass measuring 7.39 cm × 5.40 cm. A biopsy was done which revealed appendiceal carcinoma. A plan for radiotherapy to reduce the tumor size was made and the patient was discharged. However, the patient returned after three weeks due to worsening abdominal pain and a CT scan identified a significant enhancement in the tumor size. The patient underwent debulking surgery. Pathology of the specimen identified adenocarcinoma of the appendix. Discussion A rapidly growing carcinoma of the appendix is rare as they are known to have a slow growth rate. A swift diagnosis and intervention are required as these rapidly enhancing neoplasms in the abdomen can become unresectable and metastasize. Although there are various methods of treatment for appendiceal carcinomas, the rapid growth rate and lack of response to radiation required debulking surgery. Conclusion There exist a myriad of differential diagnoses for a rapidly growing mass in the abdomen. We are presenting the first documented case of a rapidly growing appendiceal adenocarcinoma. Surgeons should be aware of the variety of differentials in such cases. Appendiceal carcinomas with such a rapid enhancement in size are quite rare. Having an appendiceal carcinoma for a rapid gastrointestinal tumor can facilitate immediate management in such cases. The array of differentials in such cases could lead to delays in management and treatment.
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Affiliation(s)
- Mohammad Gilani
- Department of Surgery, Wyckoff Heights Medical Center, Brooklyn 11237, NY, USA
| | - Mina Iskaros
- Department of Surgery, Wyckoff Heights Medical Center, Brooklyn 11237, NY, USA
| | | | - Nisarg Mehta
- Department of Surgery, Wyckoff Heights Medical Center, Brooklyn 11237, NY, USA
| | - Leaque Ahmed
- Department of Surgery, Wyckoff Heights Medical Center, Brooklyn 11237, NY, USA
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Yu H, Zhuang Y, Jian J, Yang C. Predictive value of computed tomography with coronal reconstruction in right hemicolectomy with complete mesocolic excision for right colon cancers: a retrospective study. World J Surg Oncol 2021; 19:189. [PMID: 34183028 PMCID: PMC8240319 DOI: 10.1186/s12957-021-02307-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2021] [Accepted: 06/17/2021] [Indexed: 12/16/2022] Open
Abstract
Background Understanding the vascular anatomy is critical for performing central vascular ligation (CVL) in right hemicolectomy with complete mesocolic excision (CME). This study aimed to investigate the predictive value of multi-slice spiral computed tomography (MSCT) with coronal reconstruction in right hemicolectomy with CME. Methods This is a retrospective descriptive study. Eighty patients with right colon cancer who underwent right hemicolectomy from December 2015 to January 2020 were included. The intraoperative reports (including imaging data) and MSCT images with coronal reconstruction were analysed and compared. The detection rates of the ileocolic vein (ICV) and ileocolic artery (ICA) roots and the accuracy in predicting their anatomical relationship were analysed. The detection rate and accuracy in predicting the location of the gastrocolic trunk of Henle (GTH), middle colic artery (MCA) and middle colic vein (MCV) were analysed. The distance from the ICV root to the GTH root (ICV-GTH distance) was measured and analysed. The maximum distance from the left side of the superior mesenteric artery (SMA) to the right side of the superior mesenteric vein (SMV), named the ‘lsSMA-rsSMV distance’, was also measured and analysed. Results In seventy-four (92.5%) patients, both the ICV and ICA roots were located; their anatomical relationship was determined by MSCT, and the accuracy of the prediction was 97.2% (72/74). The GTH was located by MSCT in 75 (93.7%) patients, and the accuracy of the prediction was 97.33% (73/75). The MCA was located by MSCT in 47 (58.75%) patients, and the accuracy was 78.72% (37/47). The MCV was located by MSCT in 51 (63.75%) patients, and the accuracy of the prediction was 84.31% (43/51). The ICV-GTH distance was measured in 73 (91.2%) patients, and the mean distance was 4.28 ± 2.5 cm. The lsSMA-rsSMV distance was measured in 76 (95%) patients, and the mean distance was 2.21 ± 0.6 cm. Conclusions With its satisfactory accuracy in predicting and visualising the information of key anatomical sites, MSCT with coronary reconstruction has some predictive value in CME with CVL in right hemicolectomy.
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Affiliation(s)
- Hui Yu
- Department of Gastrointestinal Surgical Oncology, Fujian Cancer Hospital & Fujian Medical University Cancer Hospital, 420 Fuma Street, Jinan, Fuzhou, Fujian, 350014, P.R. China.
| | - Yong Zhuang
- Department of Gastrointestinal Surgical Oncology, Fujian Cancer Hospital & Fujian Medical University Cancer Hospital, 420 Fuma Street, Jinan, Fuzhou, Fujian, 350014, P.R. China
| | - Jinliang Jian
- Department of Gastrointestinal Surgical Oncology, Fujian Cancer Hospital & Fujian Medical University Cancer Hospital, 420 Fuma Street, Jinan, Fuzhou, Fujian, 350014, P.R. China
| | - Chunkang Yang
- Department of Gastrointestinal Surgical Oncology, Fujian Cancer Hospital & Fujian Medical University Cancer Hospital, 420 Fuma Street, Jinan, Fuzhou, Fujian, 350014, P.R. China
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Shah MF, Naeem A, Haq IU, Riaz S, Shakeel O, Panteleimonitis S, Khattak S, Syed AA, Parvaiz A. Laparoscopy Offers Better Clinical Outcomes and Long-term Survival in Patients With Right Colon Cancer: Experience From National Cancer Center. Ann Coloproctol 2021; 38:223-229. [PMID: 34167186 PMCID: PMC9263301 DOI: 10.3393/ac.2021.00045.0006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2021] [Accepted: 03/09/2021] [Indexed: 11/12/2022] Open
Abstract
Purpose Laparoscopic approach to colonic tumor requires skill set and resources to be established as routine standard of care in most centers around the world. It presents particular challenge in country like Pakistan due to economic constrain and lack of teaching and training opportunities available for surgeons to be trained to deliver such service. The aim of this study is to look into changing practice of our institution from conventional approach of open to laparoscopic surgery for right colon cancer. Methods Consecutive patients between January 2010 to December 2018 who presented to Shaukat Khanum Memorial Cancer Hospital and Research Centre with diagnosis of right colon (cecum, ascending and transverse colon) adenocarcinoma and underwent surgical resections were included in this study. Results A total of 230 patients with adenocarcinoma of the right colon underwent curative resections during the study period. Of these, 141 patients (61.3%) underwent laparoscopic surgery while open resection was performed in 89 patients (38.7%). Five-year disease-free survival (DFS) of patients with American Joint Committee on Cancer (AJCC) stage III (80.9% vs. 54.8%, P = 0.021) was significantly better if these patients underwent laparoscopic surgery while a trend toward better DFS (96.7% vs. 84.1%, P = 0.111) was also observed in AJCC stage II patients, although this difference was not significant. Conclusion This study demonstrates the adoption of a laparoscopic approach for right colon cancer over 10 years. With a standardized approach and using the principle of oncological surgery, we incorporated this in our minimally invasive surgery practice at our institution.
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Affiliation(s)
- Muhammad Fahd Shah
- Department of Surgical Oncology, Shaukat Khanum Memorial Cancer Hospital and Research Centre, Lahore, Pakistan
| | - Awais Naeem
- Department of Surgical Oncology, Shaukat Khanum Memorial Cancer Hospital and Research Centre, Lahore, Pakistan
| | - Ihtisham Ul Haq
- Department of Surgical Oncology, Shaukat Khanum Memorial Cancer Hospital and Research Centre, Lahore, Pakistan
| | - Shehryar Riaz
- Department of Surgical Oncology, Shaukat Khanum Memorial Cancer Hospital and Research Centre, Lahore, Pakistan
| | - Osama Shakeel
- Department of Surgical Oncology, Shaukat Khanum Memorial Cancer Hospital and Research Centre, Lahore, Pakistan
| | - Sofoklis Panteleimonitis
- Department of Surgery, School of Health and Care Professions, University of Portsmouth, Portsmouth, United Kingdom
| | - Shahid Khattak
- Department of Surgical Oncology, Shaukat Khanum Memorial Cancer Hospital and Research Centre, Lahore, Pakistan
| | - Aamir Ali Syed
- Department of Surgical Oncology, Shaukat Khanum Memorial Cancer Hospital and Research Centre, Lahore, Pakistan
| | - Amjad Parvaiz
- Department of Surgical Oncology, Shaukat Khanum Memorial Cancer Hospital and Research Centre, Lahore, Pakistan.,Department of Surgery, School of Health and Care Professions, University of Portsmouth, Portsmouth, United Kingdom.,Department of Surgery, Poole Hospital NHS Trust, Poole, United Kingdom
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43
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Xiao Y. [Risk factors and prevention measures of anastomotic leak after right hemicolectomy for cancer]. Zhonghua Wei Chang Wai Ke Za Zhi 2021; 24:487-492. [PMID: 34148313 DOI: 10.3760/cma.j.cn.441530-20210225-00082] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
The incidence of anastomotic leak after right hemicolectomy for cancer is relatively low, but it may be misjudged. In recent years, the results of some multi-center or nationwide registration studies in Europe have shown that the incidence of anastomotic leak is significantly higher than that of eastern countries. The reasons of these differences may be the different nature of the studies, the lack of rigor in diagnostic criteria or diagnostic methods, the difference in the level of specialization of hospitals or surgeons, and so on. Timely treatment of preoperative comorbidities, reasonable selection of preoperative bowel preparation and anastomotic technique/method might reduce the occurrence of anastomotic leak. The current evidence shows complete mesocolic excision (CME) does not increase the risk of anastomotic leak. The clinical features of ileo-colic anastomotic leak are different from those of rectal surgery. The mild cases can be treated conservatively, and the severe cases are suggested to receive timely diverting ileostomy.
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Affiliation(s)
- Y Xiao
- Department of General Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100730, China
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44
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Zhang HY, Wang ZJ, Han JG. [Influencing factors of anastomotic leak after right hemicolon surgery and progress in diagnosis and treatment strategies]. Zhonghua Wei Chang Wai Ke Za Zhi 2021; 24:544-549. [PMID: 34148320 DOI: 10.3760/cma.j.issn.441530-20210220-00071] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Anastomotic leak is one of the most severe complications following right hemicolectomy but rarely happens, which should be diagnosed based on clinical manifestations, laboratory and radiographic examinations. Influencing factors of anastomotic leak after right hemicolectomy include bowel preparation, emergency surgery, anastomotic procedure (side-to-side anastomosis vs. end-to-side anastomosis, instrument anastomosis vs. manual technigue and intracorporeal vs. extracorporeal anastomosis), surgical resection range and patient's characteristics. The occurrence of anastomotic leak might be avoided by standardized operations and indocyanine green fluorescence imaging. Active treatment is recommended once anastomotic leak is diagnosed. Most patients can be cured by non-surgical treatments such as adequate drainage and anti-infection therapy. When severe sepsis happens or non-surgical treatment fails, surgical treatment should be carried out in time.
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Affiliation(s)
- H Y Zhang
- Department of General Surgery, Beijing Chaoyang Hosptial, Capital Medical University, Beijing 100020, China
| | - Z J Wang
- Department of General Surgery, Beijing Chaoyang Hosptial, Capital Medical University, Beijing 100020, China
| | - J G Han
- Department of General Surgery, Beijing Chaoyang Hosptial, Capital Medical University, Beijing 100020, China
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Dong J, Tian Y. Low-grade appendiceal mucinous neoplasm. Clin Res Hepatol Gastroenterol 2021; 45:101647. [PMID: 33588100 DOI: 10.1016/j.clinre.2021.101647] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2021] [Revised: 01/20/2021] [Accepted: 01/21/2021] [Indexed: 02/04/2023]
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46
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De Simoni O, Barina A, Sommariva A, Tonello M, Gruppo M, Mattara G, Toniato A, Pilati P, Franzato B. Complete mesocolic excision versus conventional hemicolectomy in patients with right colon cancer: a systematic review and meta-analysis. Int J Colorectal Dis 2021; 36:881-92. [PMID: 33170319 DOI: 10.1007/s00384-020-03797-3] [Citation(s) in RCA: 33] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/05/2020] [Indexed: 02/08/2023]
Abstract
PURPOSE Complete mesocolic excision (CME) has introduced a promising surgical approach for treatment of right colon cancer. However, benefits of CME are still a matter of debate. We conducted a systematic review and meta-analysis to assess safety and long-term outcomes of CME versus conventional right hemicolectomy (CRH). METHODS We systematically searched MEDLINE, the Cochrane Database of Systematic Reviews, Scopus, Web of Science, and Embase for retrieving studies comparing CME with CRH in right colon cancer. After data extraction from the included studies, meta-analysis was performed to compare postoperative complications, anastomotic leakage, 30-day mortality, number of lymph node yield, disease-free survival (DFS), and overall survival (OS). RESULTS Eight studies met the inclusion criteria with a total of 1871 patients enrolled. No difference was observed in postoperative complications (OR 1.13, 95% CI 0.88-1.47, p = 0.34). CME was associated with significantly higher number of lymph nodes retrieved (MD 9.17, CI 4.67-13.68, p < 0.001). CME also improved 3-year OS (OR 1.57, 95% CI 1.17-2.11, p = 0.003), 5-year OS (OR 1.41, 95% CI 1.06-1.89, p = 0.02), and 5-year DFS (OR 1.99, 95% CI 1.29-3.07, p = 0.002). A sub-group analysis for patients with stage III colon cancer showed no significant impact of CME on 3-year and 5-year OS (OR 2.47, 95% CI 0.86-7.06, p = 0.09; OR 1.23, 95% CI 0.78-1.94, p = 0.38). CONCLUSION Although with limited evidence, CME shows similar postoperative complication rates and an improved survival outcome compared with CRH.
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Conti C, Pedrazzani C, Turri G, Fernandes E, Lazzarini E, De Luca R, Valdegamberi A, Ruzzenente A, Guglielmi A. Comparison of Short-term Results after Laparoscopic Complete Mesocolic Excision and Standard Colectomy for Right-Sided Colon Cancer: Analysis of a Western Center Cohort. Ann Coloproctol 2021; 37:166-173. [PMID: 33887816 PMCID: PMC8273717 DOI: 10.3393/ac.2020.05.18] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2020] [Accepted: 05/18/2020] [Indexed: 12/30/2022] Open
Abstract
Purpose Laparoscopic complete mesocolic excision (CME) right colectomy is a technically demanding procedure infrequently employed in Western centers. This retrospective cohort study aims to analyze the safety of laparoscopic CME colectomy compared to standard colectomy for right-sided colon cancer in a Western series. Methods Prospectively collected data from 60 patients who underwent laparoscopic CME right colectomy were compared to the ones of 55 patients who underwent laparoscopic standard right colectomy. Results No differences in clinical characteristics were observed between the CME and standard right colectomy groups. No differences were demonstrated in terms of blood loss (P = 0.060), intraoperative complications (P = 1), conversion rate (P = 0.102), and operative time (P = 0.473). No deaths were observed in either group, while complication rate was 40.0% in the CME and 49.1% in the standard group (P = 0.353). Severe complications occurred in 10.0% vs. 9.1% (P = 0.842), redo surgery in 5.0% vs. 7.3% (P = 0.708), and unplanned readmission in 5.0% vs. 5.5% (P = 1) after CME and standard colectomy, respectively. A significant difference in favor of CME was observed in the total length of specimen (P < 0.001), proximal (P = 0.018), and distal margins (P = 0.037). The number of lymph nodes harvested was significantly higher in the CME group (27 vs. 22, P = 0.037). Conclusion In Western series, where patients have less favorable clinical characteristics, laparoscopic CME allows to obtain better quality surgical specimens and comparable short-term outcomes compared to standard right colectomy.
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Affiliation(s)
- Cristian Conti
- Division of General and Hepatobiliary Surgery, Department of Surgical Sciences, Dentistry, Gynecology, and Pediatrics, University of Verona Hospital Trust, University of Verona, Italy
| | - Corrado Pedrazzani
- Division of General and Hepatobiliary Surgery, Department of Surgical Sciences, Dentistry, Gynecology, and Pediatrics, University of Verona Hospital Trust, University of Verona, Italy
| | - Giulia Turri
- Division of General and Hepatobiliary Surgery, Department of Surgical Sciences, Dentistry, Gynecology, and Pediatrics, University of Verona Hospital Trust, University of Verona, Italy
| | - Eduardo Fernandes
- Division of Minimally Invasive, General and Robotic Surgery, University of Illinois at Chicago, Chicago, IL, USA
| | - Enrico Lazzarini
- Division of General and Hepatobiliary Surgery, Department of Surgical Sciences, Dentistry, Gynecology, and Pediatrics, University of Verona Hospital Trust, University of Verona, Italy
| | - Raffaele De Luca
- Department of Surgical Oncology, IRCCS-ISTITUTO TUMORI "G. Paolo II", Bari, Italy
| | - Alessandro Valdegamberi
- Division of General and Hepatobiliary Surgery, Department of Surgical Sciences, Dentistry, Gynecology, and Pediatrics, University of Verona Hospital Trust, University of Verona, Italy
| | - Andrea Ruzzenente
- Division of General and Hepatobiliary Surgery, Department of Surgical Sciences, Dentistry, Gynecology, and Pediatrics, University of Verona Hospital Trust, University of Verona, Italy
| | - Alfredo Guglielmi
- Division of General and Hepatobiliary Surgery, Department of Surgical Sciences, Dentistry, Gynecology, and Pediatrics, University of Verona Hospital Trust, University of Verona, Italy
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Gopalakrishnan G, Srinivas BH, Pottakkat B, Gnanasekaran S, Kalayarasan R. Perforated High-Grade Mixed Neuroendocrine Nonneuroendocrine Neoplasm of Cecum: Unusual Presentation of Rare Disease. Gastrointest Tumors 2021; 8:128-133. [PMID: 34307311 DOI: 10.1159/000512237] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2020] [Accepted: 09/21/2020] [Indexed: 11/19/2022] Open
Abstract
Mixed neuroendocrine nonneuroendocrine neoplasms (MiNENs) are rare neoplasms of the gastrointestinal tract, where the neuroendocrine as well as the nonneuroendocrine components each comprise at least 30% of the tumor. Of all cases of colorectal malignancies, MiNENs constitute around 3-9.6%, with only a few cases reported to be arising in the cecum. Since majority present with nonspecific clinical and radiological findings, its diagnosis preoperatively is almost impossible and these are usually diagnosed after histopathological examination of the resected specimen. Owing to the rarity of these tumors as well as lack of complete molecular characterization, optimal treatment remains unestablished. We, here, report a rare case of MiNENs of the cecum infiltrating the right psoas muscle and presenting with perforation for which right hemicolectomy and en bloc excision of the involved psoas muscle was done followed by adjuvant chemotherapy.
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Affiliation(s)
- Gunasekaran Gopalakrishnan
- Department of Surgical Gastroenterology, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India
| | | | - Biju Pottakkat
- Department of Surgical Gastroenterology, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India
| | - Senthil Gnanasekaran
- Department of Surgical Gastroenterology, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India
| | - Raja Kalayarasan
- Department of Surgical Gastroenterology, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India
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Larach JT, Flynn J, Wright T, Rajkomar AKS, McCormick JJ, Kong J, Smart PJ, Heriot AG, Warrier SK. Robotic complete mesocolic excision versus conventional robotic right colectomy for right-sided colon cancer: a comparative study of perioperative outcomes. Surg Endosc 2021; 36:2113-2120. [PMID: 33844084 DOI: 10.1007/s00464-021-08498-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2020] [Accepted: 03/30/2021] [Indexed: 10/21/2022]
Abstract
AIM This study aims to compare the short-term outcomes of robotic complete mesocolic excision (RCME) versus conventional robotic right colectomy (RRC) for right-sided colon cancer. METHODS Consecutive patients who underwent robotic surgery for right-sided colon cancer in a public quaternary and a private tertiary healthcare centre between November 2018 and June 2020 were included. Clinical, perioperative and histopathological variables were collected and analysed. RESULTS Fifty-one patients were included; 25 (49%) of them had an RCME. The groups were evenly distributed in terms of demographic characteristics and tumour location. Operative time was similar between both groups, and no patients required conversion to open surgery. There were no differences in overall complications (16% in RCME vs. 26.9% in RRC; p = 0.499) or their profile between groups. There were no anastomotic leaks recorded, and the reoperation rates were similar (0% for RCME versus 3.8% for RRC; p = 1). In addition, the median length of hospital stay was similar in between the RCME and the RRC groups (4 [4-6] days versus 5 [3-8.5] days, respectively; p = 0.891). Whilst there were no differences in the TNM staging, the mean number of lymph nodes harvested with RCME was 37.7 (±12.9) compared to 21.8 (±7.5) with RCC (p < 0.001). CONCLUSION In our series, RCME was associated with a higher lymph node harvest and a similar morbidity profile compared to RCC. Further studies are required to validate these results and provide long-term oncologic outcomes.
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Affiliation(s)
- José Tomás Larach
- Division of Cancer Surgery, Peter MacCallum Cancer Centre, Victorian Comprehensive Cancer Centre, 305 Grattan Street, Melbourne, VIC, 3000, Australia. .,Department of Digestive Surgery, Pontificia Universidad Católica de Chile, Santiago, Chile.
| | - Julie Flynn
- General Surgery and Gastrointestinal Clinical Institute, Epworth Healthcare, Melbourne, Australia
| | - Timothy Wright
- Division of Cancer Surgery, Peter MacCallum Cancer Centre, Victorian Comprehensive Cancer Centre, 305 Grattan Street, Melbourne, VIC, 3000, Australia
| | - Amrish K S Rajkomar
- General Surgery and Gastrointestinal Clinical Institute, Epworth Healthcare, Melbourne, Australia
| | - Jacob J McCormick
- Division of Cancer Surgery, Peter MacCallum Cancer Centre, Victorian Comprehensive Cancer Centre, 305 Grattan Street, Melbourne, VIC, 3000, Australia.,Division of Cancer Research, Peter MacCallum Cancer Centre, Victorian Comprehensive Cancer Centre, Melbourne, Australia.,General Surgery and Gastrointestinal Clinical Institute, Epworth Healthcare, Melbourne, Australia
| | - Joseph Kong
- Division of Cancer Surgery, Peter MacCallum Cancer Centre, Victorian Comprehensive Cancer Centre, 305 Grattan Street, Melbourne, VIC, 3000, Australia.,Division of Cancer Research, Peter MacCallum Cancer Centre, Victorian Comprehensive Cancer Centre, Melbourne, Australia.,University of Melbourne, Melbourne, Australia
| | - Philip J Smart
- General Surgery and Gastrointestinal Clinical Institute, Epworth Healthcare, Melbourne, Australia.,Department of Surgery, Austin Health, Melbourne, Australia
| | - Alexander G Heriot
- Division of Cancer Surgery, Peter MacCallum Cancer Centre, Victorian Comprehensive Cancer Centre, 305 Grattan Street, Melbourne, VIC, 3000, Australia.,Division of Cancer Research, Peter MacCallum Cancer Centre, Victorian Comprehensive Cancer Centre, Melbourne, Australia.,University of Melbourne, Melbourne, Australia.,General Surgery and Gastrointestinal Clinical Institute, Epworth Healthcare, Melbourne, Australia
| | - Satish K Warrier
- Division of Cancer Surgery, Peter MacCallum Cancer Centre, Victorian Comprehensive Cancer Centre, 305 Grattan Street, Melbourne, VIC, 3000, Australia.,Division of Cancer Research, Peter MacCallum Cancer Centre, Victorian Comprehensive Cancer Centre, Melbourne, Australia.,University of Melbourne, Melbourne, Australia.,General Surgery and Gastrointestinal Clinical Institute, Epworth Healthcare, Melbourne, Australia
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Portale G, Cipollari C, Pedon S, Benacchio L, Fiscon V. A novel and simple technique to close the enterotomy after intracorporeal anastomosis in laparoscopic right hemicolectomy. Updates Surg 2021; 73:1435-1442. [PMID: 33840070 DOI: 10.1007/s13304-021-01025-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2020] [Accepted: 11/09/2020] [Indexed: 11/28/2022]
Abstract
We developed a new technique to reduce the length of the enteric defect to be closed during intracorporeal anastomosis in laparoscopic right hemicolectomy (LRH), also avoiding the need to suture the first part of the anastomosis in a deep space with an acute angle. From January 2017, after the ileo-colic anastomosis was completed, an additional stapler cartridge was applied starting at the colonic rim and including the small bowel part of the anastomosis. The isoperistaltic fashion of the ileo-colonic anastomosis was maintained. The remaining defect left to be closed was 2-3 cm. We compared the results of the novel technique with those of the 'standard' closure (full-length enterotomy). In the last 30 months, this technique was successfully used in 32 patients (Group A), compared with 33 patients (2012-2016) operated with 'standard' closure (Group B). Age, BMI and post-operative stage distribution were similar. The mean operative time was 175.2 min (± 36.7) in Group A and 165.9 min (± 42.5) in Group B (p = ns), with 53.1% and 27.3% of associated procedures (cholecystectomy, ovariectomy, etc.), respectively (p < 0.05). Overall morbidity rate was 28.1% and 30.3% (Group A vs Group B, p = ns), with no anastomotic bleeding/leak in either group. This technique, which simplifies the closure of the enteric defect after LRH with intracorporeal anastomosis is safe, reproducible and easy to learn. It might help more surgeons to perform a fully laparoscopic procedure in right hemicolectomy, offering the advantages of intracorporeal anastomosis to their patients.
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Affiliation(s)
- Giuseppe Portale
- Department of General Surgery, Azienda Euganea ULSS 6, Via Casa di Ricovero, 40, 35013, Cittadella, Padova, Italy.
| | - Chiara Cipollari
- Department of General Surgery, Azienda Euganea ULSS 6, Via Casa di Ricovero, 40, 35013, Cittadella, Padova, Italy
| | - Sabrina Pedon
- Department of General Surgery, Azienda Euganea ULSS 6, Via Casa di Ricovero, 40, 35013, Cittadella, Padova, Italy
| | - Luca Benacchio
- Department of Epidemiology, Azienda Euganea ULSS 6, Padua, Italy
| | - Valentino Fiscon
- Department of General Surgery, Azienda Euganea ULSS 6, Via Casa di Ricovero, 40, 35013, Cittadella, Padova, Italy
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