• Abdominoperineal resection
• Laparoscopic
• Rectal cancer

• Humans
• Rectal Neoplasms/surgery
• Rectal Neoplasms/pathology
• Rectal Neoplasms/mortality
• Propensity Score
• Laparoscopy/methods
• Laparoscopy/adverse effects
• Male
• Female
• Middle Aged
• Aged
• Proctectomy/methods
• Proctectomy/adverse effects
• Postoperative Complications/epidemiology
• Retrospective Studies
• Disease-Free Survival
• Margins of Excision
• Treatment Outcome
• Adult
• Perineum/surgery

• Circumferential resection margin
• Conventional laparoscopic surgery
• Meta-analysis
• Rectal cancer
• Robotic surgery

• Humans
• Laparoscopy/methods
• Margins of Excision
• Proctectomy/methods
• Rectal Neoplasms/surgery
• Rectal Neoplasms/pathology
• Robotic Surgical Procedures/methods

• Humans
• Rectal Neoplasms/therapy
• Practice Guidelines as Topic

• C-reactive protein
• Colon cancer
• Complications
• Inflammation
• LS surgery
• Minimally invasive surgery
• Outcomes
• Rectal cancer
• Robotic surgery

• Humans
• Robotic Surgical Procedures/methods
• Female
• Male
• Retrospective Studies
• Aged
• Middle Aged
• C-Reactive Protein/metabolism
• C-Reactive Protein/analysis
• Postoperative Complications/epidemiology
• Postoperative Complications/etiology
• Laparoscopy/methods
• Rectal Neoplasms/surgery
• Treatment Outcome
• Colectomy/methods
• Proctectomy/methods
• Proctectomy/adverse effects
• Length of Stay/statistics & numerical data
• Stress, Physiological

• Abdominal muscles
• Colorectal surgery
• Local anesthetics
• Meta-analysis
• Neuromuscular block

• Humans
• Abdominal Muscles/innervation
• Analgesics, Opioid/administration & dosage
• Analgesics, Opioid/therapeutic use
• Colorectal Surgery/methods
• Laparoscopy/methods
• Nerve Block/methods
• Pain, Postoperative/prevention & control
• Randomized Controlled Trials as Topic
• Ultrasonography, Interventional/methods

• Laparoscopic total mesorectal excision
• Local recurrence
• Rectal cancer
• Survival
• Transanal total mesorectal excision

• Humans
• Cohort Studies
• Propensity Score
• Retrospective Studies
• Proctectomy
• Rectal Neoplasms/surgery

• anastomoticleakage
• inferior mesenteric artery ligation
• quality of life
• rectal cancer surgery

• Local recurrence
• Peritoneal lavage
• Rectal neoplasms
• Transanal total mesorectal excision

• laparoscopy
• rectal cancer
• total mesorectal excision

• Individual participant data meta-analysis
• Kaplan-Meier estimate
• Laparoscopic surgery
• Randomized controlled trials
• Rectal neoplasms

• laparoscopic rectal resection
• locally advanced rectal cancer

• colorectal surgery
• minimally invasive surgery
• older persons
• persons 65 years and older
• rectal cancer
• robotic surgery

The effect of antithrombotic drugs on intraoperative operative blood loss volume in patients undergoing emergency surgery for generalized peritonitis is not well defined. The purpose of this study was to investigate the effect of antithrombotic drugs on intraoperative blood loss in patients with generalized peritonitis using a nationwide surgical registry in Japan.

This retrospective cohort study used a nationwide surgical registry data from 2011 to 2017 in Japan. Propensity score matching for the use of antithrombotic drugs was used for the adjustment of age, gender, comorbidities, frailty, preoperative state, types of surgery, surgical approach, laboratory data, and others. The main outcome was intraoperative blood loss: comparison of intraoperative blood loss, ratio of intraoperative blood loss after adjusted for confounding factors, and variable importance of all covariates.

A total of 70,105 of the eligible 75,666 patients were included in this study, and 2947 patients were taking antithrombotic drugs. Propensity score matching yielded 2864 well-balanced pairs. The blood loss volume was slightly higher in the antithrombotic drug group (100 [10–349] vs 70 [10–299] ml). After adjustment for confounding factors, the use of antithrombotic drugs was related to a 1.30-fold increase in intraoperative blood loss compared to non-use of antithrombotic drugs (95% CI, 1.16–1.45). The variable importance revealed that the effect of the use of antithrombotic drugs was minimal compared with surgical approach or type of surgery.

This study shows that while taking antithrombotic drugs is associated with a slight increase in intraoperative blood loss in patients undergoing emergency surgery for generalized peritonitis, the effect is likely of minimal clinical significance.

The online version contains supplementary material available at 10.1186/s13017-021-00374-z.

• Antithrombotic drug
• Emergency gastrointestinal surgery
• Generalized peritonitis
• Intraoperative blood loss

• colorectal cancer
• drug-delivery systems
• liposomes
• nanomedicine
• nanoparticles
• target therapy

• PN-III-P1-1.1-PD-2019-0955 Romanian Ministry of Education and Research, CNCS - UEFISCDI

• Anatomy
• CT angiography
• Inferior mesenteric vein
• Laparoscopy
• Left-sided colorectal cancer

• Adult
• Aged
• Aged, 80 and over
• Colorectal Neoplasms/diagnostic imaging
• Colorectal Neoplasms/surgery
• Computed Tomography Angiography/methods
• Digestive System Surgical Procedures/adverse effects
• Digestive System Surgical Procedures/methods
• Female
• Humans
• Imaging, Three-Dimensional/methods
• Laparoscopy/adverse effects
• Laparoscopy/methods
• Male
• Mesenteric Veins/anatomy & histology
• Mesenteric Veins/diagnostic imaging
• Middle Aged
• Postoperative Complications/etiology
• Postoperative Complications/prevention & control
• Retrospective Studies
• Surgery, Computer-Assisted/methods

• Failure to rescue
• Laparoscopy
• Open
• Proctectomy
• Rectal cancer

Although surgical resection is the main treatment for rectal cancer, the optimal surgical protocol for elderly patients with rectal cancer remains controversial. This study evaluated the feasibility of robot-assisted surgery in elderly patients with rectal cancer.

This retrospective study enrolled 156 patients aged 28–93 years diagnosed with Stage I–III rectal cancer, who underwent robot-assisted surgery between May 2013 and December 2018 at a single institution.

In total, 156 patients with rectal cancer, including 126 non-elderly (aged < 70 years) and 30 elderly (aged ≥70 years) patients, who underwent robot-assisted surgery were recruited. Between the patient groups, the post-operative length of hospital stay did not differ statistically significantly (P = 0.084). The incidence of overall post-operative complications was statistically significantly lower in the elderly group (P = 0.002). The disease-free and overall survival did not differ statistically significantly between the two groups (P = 0.719 and 0.390, respectively).

Robot-assisted surgery for rectal cancer was well tolerated by elderly patients, with similar results to the non-elderly patients. Oncological outcomes and survival did not depend on patient age, suggesting that robot-assisted surgery is a feasible surgical modality for treating operable rectal cancer and leads to age-independent post-operative outcomes in elderly patients.

• Elderly patients
• rectal cancer
• robot-assisted surgery

• colorectal surgery
• cost analysis
• laparoscopy

• Brazil
• Cohort Studies
• Colorectal Neoplasms/economics
• Colorectal Neoplasms/surgery
• Conversion to Open Surgery
• Digestive System Surgical Procedures
• Female
• Health Care Costs
• Humans
• Laparoscopy
• Male
• Middle Aged
• Postoperative Complications
• Retrospective Studies
• Treatment Outcome

• Developing country
• Laparoscopic colorectal surgery
• Regional hospital

• Colorectal cancer with liver metastases
• Minimally invasive surgery
• Simultaneous liver resection

Tissue-derived RNA, DNA and protein samples become more and more crucial for molecular detection in clinical research, personalized and targeted cancer therapy. This study evaluated how to biobanking colorectal tissues through examining the influences of cold ischemic time and freeze-thaw cycles on RNA, DNA and protein integrity. Here, 144 pairs of tumor and normal colorectal tissues were used to investigate the impact of cold ischemic times (0-48h) on RNA, DNA and protein integrity at on ice or room temperature conditions. Additionally, 45 pairs of tissues experienced 0-9 freeze-thaw cycles, and then the RNA, DNA and protein quality were analyzed. On ice, RNA, DNA and protein from colorectal tumor and normal tissues were all stable up to 48h after surgery. At room temperature, RNA in colorectal tumor and normal tissues began to degrade at 8h and 24h, respectively. Meanwhile, the tumor tissues DNA degradation occurred at 24h after surgery at room temperature. Similarly, the protein expression level of tumor and normal tissues began to change at 24h after the surgery at room temperature. Interestingly, tissue RNA and DNA remained stable even after 9 freeze-thaw cycles, whereas the proteins levels were remarkably changed after 7 freeze-thaw cycles. This study provided a useful evidence on how to store human colorectal tissues for biobanking. Preserving the surgical colorectal tissue on ice was an effective way to prevent RNA, DNA and protein degradation. Importantly, more than 7 repeated freeze-thaw cycles were not recommended for colorectal tissues.

• DNA integrity
• RNA integrity
• colorectal tissue bank
• protein expression.
• quality control

• Hybrid minimally invasive/open approach
• Length of stay
• Rectal cancer
• Totally minimally invasive approach

Surgical procedure has immense impact on the immune balance. However, little is known about perioperative changes in T regulatory and Th17 lymphocyte subpopulations in patients undergoing colorectal resection. Patients with resectable colon cancer were enrolled in the study. Blood samples were obtained on two occasions, i.e. before the procedure and two days after the surgery. We also recruited a control group of young, healthy individuals. Lymphocyte subpopulations were analyzed with the use of flow cytometry. Investigated subpopulations consisted of total lymphocyte count, CD4+, CD8+, T regulatory Foxp3+ (Tregs), Th17 lymphocytes and white blood cell (WBC) count. There were significant differences in immune cell levels before and after the surgery. Reduction was recorded in the CD4+, CD8+, Tregs and total lymphocyte counts (p=0.002, p=0.01, p=0.008 and p=0.001, respectively). Increase was observed in total WBC and Th17 cells, however, Th17 lymphocytes did not reach statistical significance (p=0.01 and p=0.5, respectively). In conclusion, surgical intervention caused changes in all lymphocyte subpopulations investigated in patients undergoing surgery for colorectal cancer. However, it seemed to be an effect of perioperative trauma. Further studies are needed to investigate the impact of surgical intervention on lymphocyte subpopulations.

• Colorectal surgery
• Lymphocyte count
• Lymphocyte subsets
• T-lymphocytes, regulatory
• Th17 cells

• ERAS
• Enhanced
• colon
• fast-track
• laparoscopic
• recovery
• review
• surgery

• Colectomy/adverse effects
• Colectomy/methods
• Female
• Humans
• Laparoscopy/adverse effects
• Laparoscopy/methods
• Male
• Patient Outcome Assessment
• Postoperative Care/methods
• Postoperative Care/standards
• Recovery of Function
• Time Factors

A recent study shows that a multifaceted strategy using an individualised intra-abdominal pressure titration strategy during colorectal laparoscopic surgery results in an acceptable workspace at low intra-abdominal pressure in most patients. The multifaceted strategy, focused on lower to individualised intra-abdominal pressures, includes prestretching the abdominal wall during initial insufflation, deep neuromuscular blockade, low tidal volume ventilation settings and a modified lithotomy position. The study presented here tests the hypothesis that this strategy improves outcomes of patients scheduled for colorectal laparoscopic surgery.

The Individualized Pneumoperitoneum Pressure in Colorectal Laparoscopic Surgery versus Standard Therapy (IPPCollapse-II) study is a multicentre, two-arm, parallel-group, single-blinded randomised 1:1 clinical study that runs in four academic hospitals in Spain. Patients scheduled for colorectal laparoscopic surgery with American Society of Anesthesiologists classification I to III who are aged > 18 years and are without cognitive deficits are randomised to an individualised pneumoperitoneum pressure strategy (the intervention group) or to a conventional pneumoperitoneum pressure strategy (the control group). The primary outcome is recovery assessed with the Post-operative Quality of Recovery Scale (PQRS) at postoperative day 1. Secondary outcomes include PQRS score in the post anaesthesia care unit and at postoperative day 3, postoperative complications until postoperative day 28, hospital length of stay and process-related outcomes.

The IPPCollapse-II study will be the first randomised clinical study that assesses the impact of an individualised pneumoperitoneum pressure strategy focused on working with the lowest intra-abdominal pressure during colorectal laparoscopic surgery on relevant patient-centred outcomes. The results of this large study, to be disseminated through conference presentations and publications in international peer-reviewed journals, are of ultimate importance for optimising the care and safety of laparoscopic abdominal surgery. Selection of patient-reported outcomes as the primary outcome of this study facilitates the translation into clinical practice. Access to source data will be made available through anonymised datasets upon request and after agreement of the Steering Committee of the IPPCollapse-II study.

ClinicalTrials.gov, NCT02773173. Registered on 16 May 2016. EudraCT, 2016-001693-15. Registered on 8 August 2016.

The online version of this article (10.1186/s13063-019-3255-1) contains supplementary material, which is available to authorized users.

• Abdominal laparoscopy
• Colorectal surgery
• Outcome
• Pneumoperitoneum pressure
• Post-operative Quality of Recovery Scale (PQRS)
• Postoperative complications
• Safety

• Colorectal cancer
• Laparoscopic surgery
• Over 80s

Introduction: The TaTME surgery has been developed to overcome the difficulties encountered in the practice of laparoscopic surgery for rectal cancer, especially in male, obese patients with a narrow pelvis and mid and low rectal tumours. Although the TaTME shows some promising results regarding oncological and operative outcomes, some pitfalls have been indicated. Thus, the real benefits of this novel technique over the laparoscopic surgery remain unknown. The aim of the present study was to perform a systematic review and meta-analysis of the currently available literature on the outcomes of TaTME in comparison with laparoscopic procedure.

Methods: A systematic literature search was conducted using the web-based databases MEDLINE, EMBASE, and Cochrane CENTRAL, followed by a manual search of the references of the initially identified articles. The study information, patient characteristics, oncological outcomes, perioperative outcomes, as well as short- and long-term postoperative outcomes were collected and critically evaluated.

Results: Nine retrospective cohort studies were identified, comprising 751 patients (348 with TaTME, 403 with LaTME). The positive circumferential resection margin (P = 0.01) was better in patients treated with TaTME; whereas the quality of mesorectum, circumferential resection margin, distal resection margin, and harvested lymph nodes were comparable. The TaTME was associated with shorter operative time (P = 0.05; P = 0.0006 in subgroup analysis), less blood loss (P = 0.02), less conversion (P = 0.007), and shorter hospital stay (P = 0.06; P = 0.003 in subgroup analysis). The intraoperative complications were similar. As for the postoperative outcomes, the overall postoperative complications (P = 0.02) and the readmission (P = 0.003) were found less in patients treated with TaTME; however, the individual postoperative complications were found comparable.

Conclusion: The present systematic review and meta-analysis suggested some advantages of TaTME, in terms of circumferential resection margin involvement, operative time, blood loss, conversion, hospital stay, overall postoperative complications, and readmission. It appears that the TaTME procedure achieved a better resection quality and smoother recovery in selected patients, without compromising the short-term safety. Nevertheless, it is too early to draw any conclusion, since results of high quality clinical evidence from randomized controlled trials have to be awaited. As it is technically demanding, the procedure needs to be taught and learned systematically to ensure safe implementation.

• comparison
• laparoscopic
• meta-analysis
• rectal cancer
• systematic review
• transanal total mesorectal excision

• Colorectal surgery
• ERAS
• Fast-track surgery

• Laparoscopy
• Rectal cancer
• Robotic surgery
• Transanal

To compare outcomes in patients undergoing rectal resection by robotic total meso-rectal excision (RTME) vs laparoscopic total meso-rectal excision (LTME).

Standard medical electronic databases such as PubMed, MEDLINE, EMBASE and Scopus were searched to find relevant articles. The data retrieved from all types of included published comparative trials in patients undergoing RTME vs LTME was analysed using the principles of meta-analysis. The operative, post-operative and oncological outcomes were evaluated to assess the effectiveness of both techniques of TME. The summated outcome of continuous variables was expressed as standardized mean difference (SMD) and dichotomous data was presented in odds ratio (OR).

One RCT (ROLARR trial) and 27 other comparative studies reporting the non-oncological and oncological outcomes following RTME vs LTME were included in this review. In the random effects model analysis using the statistical software Review Manager 5.3, the RTME was associated with longer operation time (SMD, 0.46; 95%CI: 0.25, 0.67; z = 4.33; P = 0.0001), early passage of first flatus (P = 0.002), lower risk of conversion (P = 0.00001) and shorter hospitalization (P = 0.01). The statistical equivalence was seen between RTME and LTME for non-oncological variables like blood loss, morbidity, mortality and re-operation risk. The oncological variables such as recurrence (P = 0.96), number of harvested nodes (P = 0.49) and positive circumferential resection margin risk (P = 0.53) were also comparable in both groups. The length of distal resection margins was similar in both groups.

RTME is feasible and oncologically safe but failed to demonstrate any superiority over LTME for many surgical outcomes except early passage of flatus, lower risk of conversion and shorter hospitalization.

• Diverticular disease
• Colorectal resections
• Multi-incision laparoscopic surgery
• Colorectal cancer
• Single incision laparoscopic surgery

• Colorectal cancer
• Elderly
• Laparoscopy
• Open surgery
• Outcome

• hand-assisted
• laparoscopic-assisted
• laparoscopy
• low anterior resection
• rectal neoplasms

• APE
• APR
• Abdominoperineal excision
• Abdominoperineal resection
• ELAPE
• Extralevator abdominoperineal excision
• Rectal cancer
• Total mesorectal excision

The benefits of minimally invasive approaches in oncologic surgery are increasingly recognized, and laparoscopic liver surgery has become increasingly widespread. In light of the complexity and technical challenges of hepatobiliary procedures, robotic approaches are also employed. The utility, safety, and oncologic integrity of these methods in the management of primary liver cancers are reported. PubMed was used to search the medical literature for studies and articles pertaining to laparoscopic and robotic liver surgery. Studies that particularly addressed hepatocellular carcinoma and cholangiocarcinoma were identified and reviewed. Laparoscopic liver surgery, including for major resections, has been shown to be safe in experienced hands without any compromise of oncologic outcomes for either hepatocellular carcinoma or intrahepatic cholangiocarcinoma. Some studies show improved clinical outcomes including shorter hospital stays and lower complication rates when compared to open surgery, particularly for patients with cirrhosis. Robotic liver surgeries seem to have equally acceptable clinical outcomes; however, there is limited data regarding oncologic integrity and considerable additional expense. Laparoscopic and robotic liver resections are both feasible and safe for the management of primary liver tumors. Future studies should aim to clarify specific indications and optimize applications of these approaches.

• laparoscopic liver resection
• liver resection
• minimally invasive liver surgery
• robotic hepatectomy

• Medical Knowledge
• Practice-Based Learning and Improvement
• Systems-Based Practice
• decision-making
• human information processing
• laparoscopic surgery
• medical device design
• surgical education

• Clinical Competence
• Colorectal Surgery/education
• Competency-Based Education/methods
• Education, Medical, Graduate/methods
• Electronic Data Processing
• Female
• Humans
• Ireland
• Laparoscopy/education
• Male

• Colorectal cancer
• Laparoscopic surgery
• Minimally invasive surgery
• Rectal cancer
• Robotic surgery

• comparative effectiveness research
• cost
• laparoscopic surgery
• open surgery
• rectal cancer
• robotic surgery

• Adult
• Clinical Competence
• Female
• Gynecology/education
• Humans
• Laparoscopy/adverse effects
• Laparoscopy/education
• Retrospective Studies
• Tissue Adhesions/etiology
• Tissue Adhesions/prevention & control
• Uterine Myomectomy/adverse effects

To assess the impact of multi-disciplinary teams (MDTs) management in optimising the outcome for rectal cancers.

We undertook a retrospective review of a prospectively maintained database of patients with rectal cancers (defined as tumours ≤ 15 cm from anal verge) discussed at our MDT between Jan 2008 and Jan 2011. The data was validated against the national database to ensure completeness of dataset. The clinical course and follow-up data was validated using the institution’s electronic patient records. The data was analysed in terms of frequencies and percentages. Significance of any differences were analysed using χ² test. A Kaplan-Meier analysis was performed for overall survival and disease free survival.

Following appropriate staging, one hundred and thirty-three patients were suitable for potentially curative resections. Seventy two (54%) were upper rectal cancer (URC) - tumour was > 6 cm from the anal verge and 61 (46%) were lower rectal cancers (LRC) - lower extent of the tumour was palpable ≤ 6 cm. Circumferential resection margin (CRM) appeared threatened on pre-operative MRI in 19/61 (31%) patients with LRC requiring neo-adjuvant therapy (NAT). Of the 133 resections, 118 (89%) were attempted laparoscopically (5% conversion rate). CRM was positive in 9 (6.7%) patients; Median lymph node harvest was 12 (2-37). Major complications occurred in 8 (6%) patients. Median follow-up was 53 mo (0-82). The 90-d mortality was 2 (1.5%). Over the follow-up period, disease related mortality was 11 (8.2%) and overall mortality was 39 (29.3%). Four (3%) patients had local recurrence and 22 (16.5%) patients had distant metastases.

Management of rectal cancers can be optimized with multi-disciplinary input to attain acceptable long-term oncological outcomes even when incorporating a laparoscopic approach to rectal cancer resection.

• Rectal cancer
• Multi-disciplinary management
• Laparoscopic rectal resection outcomes