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Manisundaram N, Childers CP, Hu CY, Uppal A, Konishi T, Bednarski BK, White MG, Peacock O, You YN, Chang GJ. Rise in Minimally Invasive Surgery for Colorectal Cancer Is Associated With Adoption of Robotic Surgery. Dis Colon Rectum 2025; 68:426-436. [PMID: 39745312 DOI: 10.1097/dcr.0000000000003617] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/14/2025]
Abstract
BACKGROUND Minimally invasive surgery is associated with improved short-term outcomes and similar long-term oncologic outcomes for patients with colorectal cancer compared with open surgery. Although the robotic approach has ergonomic and technical benefits, how it has impacted the utilization of traditional laparoscopic surgery and minimally invasive surgery overall is unclear. OBJECTIVE Describe trends in open, robotic, and laparoscopic approaches for colorectal cancer resections and examine factors associated with minimally invasive surgery. DESIGN Retrospective cohort study using data from the National Cancer Database from 2010 to 2020. SETTING Commission on Cancer-accredited US facilities. PATIENTS Patients diagnosed with nonmetastatic colon or rectal adenocarcinoma. MAIN OUTCOME MEASURES Surgical approach rates (open, robotic, and laparoscopic). RESULTS We identified 475,001 patients diagnosed with nonmetastatic colorectal adenocarcinoma, of whom 192,237 (40.5%) underwent open surgery, 64,945 (13.7%) underwent robotic surgery, and 217,819 (45.9%) underwent laparoscopic surgery. For colon cancer, laparoscopic minimally invasive surgery use steadily increased, with a peak prevalence of 54.0% in 2016, and total minimally invasive surgery (robotic + laparoscopic) was performed more often than open surgery from 2013 through 2020. For rectal cancer, laparoscopic minimally invasive surgery had a peak prevalence of 37.2% in 2014 and declined from 2014 through 2020; robotic surgery prevalence increased throughout the study period (5.5% in 2010, 24.7% in 2015, and 48.8% in 2020). Minimally invasive surgery use increased in facilities performing robotic surgery every year during the study period. For both colon and rectal cancer, the use of open surgery decreased across all facilities throughout the study period. LIMITATIONS This study used the National Cancer Database, which may not be generalizable to non-Commission on Cancer institutions. CONCLUSIONS Minimally invasive surgery steadily increased across all facilities from 2010 through 2020. Open resections declined, laparoscopic resections plateaued, and robotic resections increased for colon and rectal cancer. Minimally invasive surgery increases may be driven by increases in robot-assisted surgery. See Video Abstract. EL AUMENTO DE LA CIRUGA MNIMAMENTE INVASIVA PARA EL CNCER COLORRECTAL SE ASOCIA CON LA ADOPCIN A LA CIRUGA ROBTICA ANTECEDENTES:La cirugía mínimamente invasiva se asocia con mejores resultados a corto plazo y resultados oncológicos similares a largo plazo para pacientes con cáncer colorrectal en comparación con la cirugía abierta. Aunque el abordaje robótico tiene beneficios ergonómicos y técnicos, no está claro cómo ha afectado la utilización de la cirugía laparoscópica tradicional y la cirugía mínimamente invasiva en general.OBJETIVO:Describir las tendencias en los abordajes abiertos, robóticos y laparoscópicos para las resecciones de cáncer colorrectal y examinar los factores asociados con la cirugía mínimamente invasiva.DISEÑO:Estudio de cohorte retrospectivo utilizando datos de la Base de Datos Nacional del Cáncer desde 2010 hasta 2020.ESCENARIO:Centros estadounidenses acreditados por la Comisión sobre el Cáncer.PACIENTES:Pacientes diagnosticados con adenocarcinoma de colon o recto no metastásico.PRINCIPALES MEDIDAS DE VALORACIÓN:Tasas de abordaje quirúrgico (abierto, robótico, laparoscópico).RESULTADOS:Identificamos 475.001 pacientes con diagnóstico de adenocarcinoma colorrectal no metastásico, de los cuales 192.237 (40,5%) se sometieron a cirugía abierta, 64.945 (13,7%) se sometieron a cirugía robótica y 217.819 (45,9%) se sometieron a cirugía laparoscópica. Para el cáncer de colon, el uso de cirugía mínimamente invasiva laparoscópica aumentó de manera constante, con una prevalencia máxima del 54,0% en 2016, y la cirugía mínimamente invasiva total (robótica + laparoscópica) se realizó con mayor frecuencia que la cirugía abierta desde 2013 hasta 2020. Para el cáncer de recto, la cirugía mínimamente invasiva laparoscópica tuvo una prevalencia máxima del 37,2% en 2014 y disminuyó desde 2014 hasta 2020; La prevalencia de la cirugía robótica aumentó durante el período de estudio (5,5 % en 2010, 24,7 % en 2015, 48,8 % en 2020). El uso de cirugía mínimamente invasiva aumentó en los centros que realizan cirugía robótica cada año durante el período de estudio. Tanto para el cáncer de colon como para el cáncer de recto, el uso de cirugía abierta disminuyó en todos los centros durante el período de estudio.LIMITACIONES:Se utilizó la base de datos nacional sobre el cáncer, que puede no ser generalizable a instituciones que no pertenecen a la Comisión sobre el Cáncer.CONCLUSIONES:La cirugía mínimamente invasiva aumentó de manera constante en todos los centros entre 2010 y 2020. Las resecciones abiertas disminuyeron, las resecciones laparoscópicas se estabilizaron y las resecciones robóticas aumentaron para el cáncer de colon y recto. Los aumentos de la cirugía mínimamente invasiva pueden estar impulsados por aumentos en la cirugía asistida por robot. (Traducción--Ingrid Melo ).
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Affiliation(s)
- Naveen Manisundaram
- Department of Colon and Rectal Surgery, The University of Texas MD Anderson Cancer Center, Houston, Texas
- Department of Surgery, Baylor College of Medicine, Houston, Texas
| | - Christopher P Childers
- Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Chung-Yuan Hu
- Department of Colon and Rectal Surgery, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Abhineet Uppal
- Department of Surgery, Emory University School of Medicine, Atlanta, Georgia
| | - Tsuyoshi Konishi
- Department of Colon and Rectal Surgery, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Brian K Bednarski
- Department of Colon and Rectal Surgery, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Michael G White
- Department of Colon and Rectal Surgery, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Oliver Peacock
- Department of Colon and Rectal Surgery, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Y Nancy You
- Department of Colon and Rectal Surgery, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - George J Chang
- Department of Colon and Rectal Surgery, The University of Texas MD Anderson Cancer Center, Houston, Texas
- Department of Health Services Research, The University of Texas MD Anderson Cancer Center, Houston, Texas
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Jarry C, Varas J, Inzunza M, Escalona G, Machuca E, Vela J, Bellolio F, Larach JT. Design and validation of a simulation-based training module for ileo-transverse intracorporeal anastomosis. Surg Endosc 2025; 39:1397-1405. [PMID: 39806177 DOI: 10.1007/s00464-024-11516-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2024] [Accepted: 12/30/2024] [Indexed: 01/16/2025]
Abstract
BACKGROUND The benefits of the totally laparoscopic right hemicolectomy have been established, but its adoption has been limited by the challenges of intracorporeal suturing. While simulation is effective for training advanced surgical skills, no dedicated simulation-based course exists for intracorporeal ileo-transverse anastomosis (ICA). This study aimed to develop and validate a simulation module for training in ICA. METHODS This study employed a proof-of-concept design for an educational tool. Key aspects of the anastomosis were identified using the team's surgical experience, surgical videos, and existing evidence. Surgeons were recruited to test and refine successive simulation models through an iterative process until a functional prototype was achieved and assessed. Subsequently, surgeons with varying experience levels were invited to perform an ICA in the model. Performance was evaluated by two blinded surgeons through video recordings, utilizing a modified Objective Structured Assessment of Technical Skills (OSATS), a Specific Rating Score (SRS), and operative time measurements. Non-parametric descriptive and analytical methods were applied, with results presented as median [IQR]. RESULTS An ex vivo based model was developed. Seventeen participants evaluated the model. Eighty-three percent declared acceptable or maximum fidelity regarding the colon. Resemblance to the surgical scenario in terms of ergonomic and anatomical similarity was highlighted. All participants found the model useful to train intracorporeal suturing. Thirteen subjects performed the ICA. Experts achieved significantly higher OSATS scores (22.3 [22-22.5] vs 18 [16-19.5]; p = .013), exhibited a trend toward higher SRS, and obtained shorter operative times (21.5 vs 36 min; p = .039). CONCLUSION An ex vivo simulation module for ICA was developed, demonstrating acceptable fidelity in replicating the surgical environment. The simulated scenario could successfully distinguish between levels of surgical experience, as evidenced by significant differences in OSATS scores and operative times, thereby confirming its construct validity.
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Affiliation(s)
- Cristián Jarry
- Center for Simulation and Experimental Surgery, Faculty of Medicine, Pontificia Universidad Católica de Chile, Uc-Christus Health Network, Santiago, Chile
- Colorectal Surgery Unit, Department of Digestive Surgery, Pontificia Universidad Católica de Chile, Uc-Christus Health Network, Santiago, Chile
| | - Julián Varas
- Center for Simulation and Experimental Surgery, Faculty of Medicine, Pontificia Universidad Católica de Chile, Uc-Christus Health Network, Santiago, Chile
- Department of Digestive Surgery, Pontificia Universidad Católica de Chile, Uc-Christus Health Network, Diagonal Paraguay 362, 4th Floor, 8330077, Santiago, Chile
| | - Martín Inzunza
- Center for Simulation and Experimental Surgery, Faculty of Medicine, Pontificia Universidad Católica de Chile, Uc-Christus Health Network, Santiago, Chile
- Department of Digestive Surgery, Pontificia Universidad Católica de Chile, Uc-Christus Health Network, Diagonal Paraguay 362, 4th Floor, 8330077, Santiago, Chile
| | - Gabriel Escalona
- Center for Simulation and Experimental Surgery, Faculty of Medicine, Pontificia Universidad Católica de Chile, Uc-Christus Health Network, Santiago, Chile
| | - Eduardo Machuca
- Center for Simulation and Experimental Surgery, Faculty of Medicine, Pontificia Universidad Católica de Chile, Uc-Christus Health Network, Santiago, Chile
| | - Javier Vela
- Center for Simulation and Experimental Surgery, Faculty of Medicine, Pontificia Universidad Católica de Chile, Uc-Christus Health Network, Santiago, Chile
- Colorectal Surgery Unit, Department of Digestive Surgery, Pontificia Universidad Católica de Chile, Uc-Christus Health Network, Santiago, Chile
| | - Felipe Bellolio
- Colorectal Surgery Unit, Department of Digestive Surgery, Pontificia Universidad Católica de Chile, Uc-Christus Health Network, Santiago, Chile
| | - José Tomás Larach
- Colorectal Surgery Unit, Department of Digestive Surgery, Pontificia Universidad Católica de Chile, Uc-Christus Health Network, Santiago, Chile.
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Fujii Y, Kobayashi K, Sawai H, Yamamoto S, Uehara S, Miyai H, Takahashi H, Takiguchi S. Short-term Outcomes of Intracorporeal Versus Extracorporeal Totally Stapled Anastomosis after Laparoscopic Colectomy: A Propensity Score-matched Cohort Study. J Anus Rectum Colon 2025; 9:95-104. [PMID: 39882225 PMCID: PMC11772801 DOI: 10.23922/jarc.2024-010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/25/2024] [Accepted: 10/07/2024] [Indexed: 01/31/2025] Open
Abstract
Objectives To describe detailed surgical techniques for totally stapled intracorporeal anastomosis (TSIA) and determine their feasibility and safety by comparing short-term outcomes with those of conventional totally stapled extracorporeal anastomosis (TSEA). Methods In total, 59 consecutive patients who underwent laparoscopic colectomy between June 2018 and August 2021 were retrospectively assessed. Linear staplers were used for all anastomoses. The TSIA and TSEA groups included 23 and 36 patients, respectively. Following a comprehensive description of each surgical technique, propensity score matching analysis was conducted to compare matched groups on the basis of clinicopathological characteristics, surgical and perioperative outcomes, complications, and postoperative inflammatory reactions. After matching, 17 cases each were analyzed in the TSIA and TSEA groups. Results Both groups were well matched. The TSIA group had significantly lesser blood loss than did the TSEA group (10 versus 20 mL, p=0.002), although this result was not clinically significant. The skin excision length (4 versus 6 cm, p<0.001) and postoperative hospital stay length (6 versus 7 days, p<0.001) were significantly shorter in the TSIA group than in the TSEA group. Increasing C-reactive protein (CRP) values at 1, 3, and 6 postoperative days were significantly lower in the TSIA group than in the TSEA group (p=0.016, p=0.011, and p=0.012, respectively). Conclusions TSIA is a simple, feasible, and efficient surgical technique; compared with TSEA, it is less invasive and associated with lesser blood loss, shorter skin incision lengths, shorter postoperative hospital stays, and lower CRP level increases.
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Affiliation(s)
- Yoshiaki Fujii
- Department of Gastroenterological Surgery, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
| | - Kenji Kobayashi
- Department of Surgery, Kariya Toyota General Hospital, Kariya, Japan
| | - Hirozumi Sawai
- Department of Surgery, Narita Memorial Hospital, Toyohashi, Japan
| | - Seiya Yamamoto
- Department of Gastroenterological Surgery, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
| | - Shuhei Uehara
- Department of Gastroenterological Surgery, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
| | - Hirotaka Miyai
- Department of Surgery, Kariya Toyota General Hospital, Kariya, Japan
| | - Hiroki Takahashi
- Department of Gastroenterological Surgery, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
| | - Shuji Takiguchi
- Department of Gastroenterological Surgery, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
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Yin TC, Chen YC, Su WC, Chang TK, Chen PJ, Li CC, Tsai HL, Huang CW, Wang JY. Innovative needle-assisted technique for intracorporeal anastomosis: Simplifying closure of common enterotomy in laparoscopic gastrointestinal surgery. Surg Endosc 2024; 38:7621-7626. [PMID: 39433589 PMCID: PMC11615047 DOI: 10.1007/s00464-024-11292-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2024] [Accepted: 09/13/2024] [Indexed: 10/23/2024]
Abstract
BACKGROUND Intracorporeal anastomosis offers notable advantages over extracorporeal techniques, including reduced tissue manipulation leading to faster recovery and potentially lower risks of surgical site infections and complications. However, it also involves several challenges, such as increased operative time and the need for experienced assistants and multiple trocars. Our novel technique addresses these problems. METHODS We present a novel approach for closing common enterotomies during intracorporeal anastomosis by using a linear stapler. This technique involves the use of a 6-cm straight needle, which facilitates closure of the common enterotomy. The technique can be performed independently by a single surgeon without the need for additional trocars or assistants. RESULTS This technique was applied for 20 patients undergoing laparoscopic gastrointestinal surgery between June 2023 and February 2024. The median age of the enrolled patients was 65 years, with laparoscopic right hemicolectomy with intracorporeal ileocolostomy being the most common procedure (60% of cases). The median anastomosis time was 22.5 min. No occurrence of anastomotic leakage was reported, and only one patient (5%) developed temporary postoperative bowel obstruction, which was managed conservatively. CONCLUSIONS Our technique enables efficient and safe closure of common enterotomies during intracorporeal anastomosis, minimizing reliance on additional trocars and experienced assistants. It simplifies the procedure and ensures fullthickness stapling, potentially reducing the likelihood of complications. Because of its broad applicability across various laparoscopic surgeries, this technique offers substantial benefits and is worth recommending for intracorporeal anastomosis.
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Affiliation(s)
- Tzu-Chieh Yin
- Division of General and Digestive Surgery, Department of Surgery, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
- Department of Surgery, Kaohsiung Municipal Tatung Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
- Division of Colorectal Surgery, Department of Surgery, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
- Department of Surgery, Faculty of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Yen-Cheng Chen
- Division of Colorectal Surgery, Department of Surgery, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
- Department of Surgery, Faculty of Post-Baccalaureate Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Wei-Chih Su
- Division of Colorectal Surgery, Department of Surgery, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
- Department of Surgery, Faculty of Post-Baccalaureate Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Tsung-Kun Chang
- Division of Colorectal Surgery, Department of Surgery, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
- Department of Surgery, Faculty of Post-Baccalaureate Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
- Graduate Institute of Clinical Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Po-Jung Chen
- Division of Colorectal Surgery, Department of Surgery, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Ching-Chun Li
- Division of Colorectal Surgery, Department of Surgery, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
- Department of Surgery, Kaohsiung Municipal Hsiaokang Hospital, Kaohsiung, Taiwan
| | - Hsiang-Lin Tsai
- Division of Colorectal Surgery, Department of Surgery, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
- Department of Surgery, Faculty of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Ching-Wen Huang
- Division of Colorectal Surgery, Department of Surgery, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan.
- Department of Surgery, Faculty of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan.
| | - Jaw-Yuan Wang
- Division of Colorectal Surgery, Department of Surgery, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan.
- Department of Surgery, Faculty of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan.
- Graduate Institute of Clinical Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan.
- Graduate Institute of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan.
- Center for Cancer Research, Kaohsiung Medical University, Kaohsiung, Taiwan.
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Vela J, Riquoir C, Silva F, Jarry C, Urrejola G, Molina ME, Miguieles R, Bellolio F, Larach JT. Multidimensional assessment of the learning curve of intracorporeal anastomosis during laparoscopic right colectomy. Langenbecks Arch Surg 2024; 409:357. [PMID: 39585454 DOI: 10.1007/s00423-024-03551-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2024] [Accepted: 11/17/2024] [Indexed: 11/26/2024]
Abstract
PURPOSE After resection during a laparoscopic right colectomy (LRC), reconstruction can be conducted with an intracorporeal (IA) or extracorporeal anastomosis. Although IA benefits are well documented, its implementation has been slow due to a steep learning curve (LC) mainly associated with intracorporeal suturing. The aim of this study is to assess the LC of IA in LRC. METHODS Consecutive patients undergoing a LRC with IA between January 2016 and June 2023 were included. Clinical, perioperative, and histopathological variables were collected. Correlation and cumulative sum (CUSUM) analyses between the operating time and case number were performed. 'Surgical success' as a composite outcome was also analysed by performing a CUSUM plot. Completion LC case number was determined based on these analyses. Pre-LC and post-LC perioperative outcomes were compared. RESULTS Two-hundred-and-ninety patients underwent a LRC during the study period. Sixty-seven met inclusion criteria. Correlation analysis identified a significant operating time reduction with increasing case numbers (p = 0.034). Total complications during implementation period were 25,3%, with 6% of severe complications. Operative time CUSUM analysis identified a consistent downwards trend after case 36 and surgical success CUSUM analysis after case 37. Two phases were established: pre-LC (case 0-37th) and post-LC (38th-67). Pre-LC and post-LC revealed a significant decrease in operative time (187vs177.8 min;p = 0.016), and length of stay (4vs3 days;p < 0.001). No difference between overall complications, severe complication, or reoperation rates were detected. CONCLUSION The LC of laparoscopic IA can be achieved after 37 cases in centres with experience in advanced laparoscopic surgery. Further studies will be required to confirm these results.
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Affiliation(s)
- Javier Vela
- Colorectal Surgery Unit, Department of Digestive Surgery, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Christophe Riquoir
- Colorectal Surgery Unit, Department of Digestive Surgery, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Felipe Silva
- Colorectal Surgery Unit, Department of Digestive Surgery, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Cristián Jarry
- Colorectal Surgery Unit, Department of Digestive Surgery, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Gonzalo Urrejola
- Colorectal Surgery Unit, Department of Digestive Surgery, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - María Elena Molina
- Colorectal Surgery Unit, Department of Digestive Surgery, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Rodrigo Miguieles
- Colorectal Surgery Unit, Department of Digestive Surgery, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Felipe Bellolio
- Colorectal Surgery Unit, Department of Digestive Surgery, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - José Tomás Larach
- Colorectal Surgery Unit, Department of Digestive Surgery, Pontificia Universidad Católica de Chile, Santiago, Chile.
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Gonçalves GF, Villarim PVDO, Marinho VRD, Abreu CA, Pereira LHM, Pereira LHM, Gurgel SE, Rêgo ACM, de Medeiros KS, Araújo-Filho I. Robotic surgery versus conventional laparoscopy in colon cancer patients: a systematic review and meta-analysis. Acta Cir Bras 2024; 39:e397224. [PMID: 39476069 PMCID: PMC11506681 DOI: 10.1590/acb397224] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2024] [Accepted: 08/31/2024] [Indexed: 11/02/2024] Open
Abstract
PURPOSE To compare robotic versus laparoscopic colectomies in colon cancer patients in general complications. METHODS Nine databases were searched for randomized controlled trials (RCT) investigating patients with colon cancer, submitted to robotic surgery (RS) compared to a laparoscopic (LC) approach. The risk of bias was assessed using RoB 2.0 tool, and certainty of the evidence was evaluated by Grading of Recommendations, Assessment, Development and Evaluation (GRADE). Data synthesis was performed using the software R. The meta-analysis of the included studies was carried out using the fixed-effects model (DerSimonian and Laird). Heterogeneity was measured using I2 analysis. RESULTS A total of four studies were used with 293 patients. Three studies were used in this comparative LC vs. RS when evaluating infection rates on surgical wound sites. The odds ratio (OR) appeared to be slightly favorable to LC (OR = 3.05; 95% confidence interval-95%CI 0.78-11.96). In the hospitalization rates analysis, two randomized controlled trials were used, and the mean differences slightly favored the RS (MD = -0.54; 95%CI -2.28-1.19). GRADE evaluation detected a serious risk of bias due to RCT format and RoB-2 concurred. CONCLUSION Both types of procedures seem to have their own benefits, risks, and limitations. They seem close to equal in terms of postsurgical infection and hospitalization.
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Affiliation(s)
- Giuliana Fulco Gonçalves
- Instituto de Ensino, Pesquisa e Inovação Liga Contra o Câncer – Natal (RN) – Brazil
- Universidade Potiguar – Department of Medicine – Natal (RN) – Brazil
| | - Pedro Vilar de Oliveira Villarim
- Instituto de Ensino, Pesquisa e Inovação Liga Contra o Câncer – Natal (RN) – Brazil
- Universidade Federal do Rio Grande do Norte – Department of Medicine – Natal (RN), Brazil
| | - Vitória Ribeiro Dantas Marinho
- Instituto de Ensino, Pesquisa e Inovação Liga Contra o Câncer – Natal (RN) – Brazil
- Universidade Potiguar – Department of Medicine – Natal (RN) – Brazil
| | - Clarissa Amaral Abreu
- Instituto de Ensino, Pesquisa e Inovação Liga Contra o Câncer – Natal (RN) – Brazil
- Universidade Potiguar – Department of Medicine – Natal (RN) – Brazil
| | - Luiz Henrique Moreira Pereira
- Instituto de Ensino, Pesquisa e Inovação Liga Contra o Câncer – Natal (RN) – Brazil
- Universidade Federal do Rio Grande do Norte – Department of Medicine – Natal (RN), Brazil
| | - Luiz Henrique Moreira Pereira
- Instituto de Ensino, Pesquisa e Inovação Liga Contra o Câncer – Natal (RN) – Brazil
- Universidade Federal do Rio Grande do Norte – Department of Medicine – Natal (RN), Brazil
| | | | - Amália Cínthia Meneses Rêgo
- Instituto de Ensino, Pesquisa e Inovação Liga Contra o Câncer – Natal (RN) – Brazil
- Universidade Potiguar – Department of Medicine – Natal (RN) – Brazil
- Universidade Federal do Rio Grande do Norte – Postgraduate Program in Health Sciences – Natal (RN), Brazil
| | - Kleyton Santos de Medeiros
- Instituto de Ensino, Pesquisa e Inovação Liga Contra o Câncer – Natal (RN) – Brazil
- Universidade Federal do Rio Grande do Norte – Postgraduate Program in Health Sciences – Natal (RN), Brazil
- Universidade Federal do Rio Grande do Norte – Department of Nursing – Natal (RN), Brazil
| | - Irami Araújo-Filho
- Instituto de Ensino, Pesquisa e Inovação Liga Contra o Câncer – Natal (RN) – Brazil
- Universidade Potiguar – Department of Medicine – Natal (RN) – Brazil
- Universidade Federal do Rio Grande do Norte – Department of Medicine – Natal (RN), Brazil
- Universidade Federal do Rio Grande do Norte – Postgraduate Program in Health Sciences – Natal (RN), Brazil
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Kuroyanagi H, Hida K, Ishii Y, Yamamoto S, Hasegawa S, Takahashi K, Saida Y, Inomata M, Nakamura M, Sakai Y. Practice guidelines on endoscopic surgery for qualified surgeons by the endoscopic surgical skill qualification system: Large intestine. Asian J Endosc Surg 2024; 17:e13364. [PMID: 39079698 DOI: 10.1111/ases.13364] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2024] [Accepted: 07/08/2024] [Indexed: 09/15/2024]
Affiliation(s)
| | - Koya Hida
- Department of Surgery, Kyoto University Hospital, Kyoto, Japan
| | - Yoshiyuki Ishii
- Department of General and Gastrointestinal Surgery, Kitasato University Kitasato Institute Hospital, Tokyo, Japan
| | - Seiichiro Yamamoto
- Department of Gastroenterological Surgery, Tokai University School of Medicine, Isehara, Japan
| | - Suguru Hasegawa
- Department of Gastroenterological Surgery, Fukuoka University Hospital, Fukuoka, Japan
| | - Kenichi Takahashi
- Department of Colorectal Surgery, Tohoku Rosai Hospital, Sendai, Japan
| | - Yoshihisa Saida
- Department of Surgery, Toho University Ohashi Medical Center, Tokyo, Japan
| | - Masafumi Inomata
- Department of Gastroenterological and Pediatric Surgery, OITA University Faculty of Medicine, Oita, Japan
| | - Masafumi Nakamura
- Department of Surgery and Oncology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Yoshiharu Sakai
- Department of Gastrointestinal Surgery, Red Cross Hospital Osaka, Osaka, Japan
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Dehne S, Kirschner L, Strowitzki MJ, Kilian S, Kummer LC, Schneider MA, Michalski CW, Büchler MW, Weigand MA, Larmann J. Low intraoperative end-tidal carbon dioxide levels are associated with improved recurrence-free survival after elective colorectal cancer surgery. J Clin Anesth 2024; 96:111495. [PMID: 38733708 DOI: 10.1016/j.jclinane.2024.111495] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2023] [Revised: 04/24/2024] [Accepted: 05/04/2024] [Indexed: 05/13/2024]
Abstract
STUDY OBJECTIVE Higher levels of carbon dioxide (CO2) increase the invasive abilities of colon cancer cells in vitro. Studies assessing target values for end-tidal CO2 concentrations (EtCO2) to improve surgical outcome after colorectal cancer surgery are lacking. Therefore, we evaluated whether intraoperative EtCO2 was associated with differences in recurrence-free survival after elective colorectal cancer (CRC) surgery. DESIGN Single center, retrospective analysis. SETTING Anesthesia records, surgical databases and hospital information system of a tertiary university hospital. PATIENTS We analyzed 528 patients undergoing elective resection of colorectal cancer at Heidelberg University Hospital between 2009 and 2018. INTERVENTIONS None. MEASUREMENTS Intraoperative mean EtCO2 values were calculated. The study cohort was equally stratified into low-and high-EtCO2 groups. The primary endpoint measure was recurrence-free survival until last known follow-up. Groups were compared using Kaplan-Meier analysis. Cox-regression analysis was used to control for covariates. Sepsis, reoperations, surgical site infections and cardiovascular events during hospital stay, and overall survival were secondary outcomes. MAIN RESULTS Mean EtCO2 was 33.8 mmHg ±1.2 in the low- EtCO2 group vs. 37.3 mmHg ±1.6 in the high-EtCO2 group. Median follow-up was 3.8 (Q1-Q3, 2.5-5.1) years. Recurrence-free survival was higher in the low-EtCO2 group (log-rank-test: p = .024). After correction for confounding factors, lower EtCO2 was associated with increased recurrence-free survival (HR = 1.138, 95%-CI:1.015-1.276, p = .027); the hazard for the primary outcome decreased by 12.1% per 1 mmHg decrease in mean EtCO2. 1-year and 5-year survival was also higher in the low-EtCO2 group. We did not find differences in the other secondary endpoints. CONCLUSIONS Lower intraoperative EtCO2 target values in CRC surgery might benefit oncological outcome and should be evaluated in confirmative studies.
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Affiliation(s)
- Sarah Dehne
- Heidelberg University, Medical Faculty Heidelberg, Department of Anesthesiology, Heidelberg, Germany
| | - Lina Kirschner
- Heidelberg University, Medical Faculty Heidelberg, Department of Anesthesiology, Heidelberg, Germany
| | - Moritz J Strowitzki
- Heidelberg University, Medical Faculty Heidelberg, Department of General, Visceral, and Transplantation Surgery, Heidelberg, Germany
| | - Samuel Kilian
- Heidelberg University, Medical Faculty Heidelberg, Institute of Medical Biometry, Heidelberg, Germany
| | - Laura Christine Kummer
- Heidelberg University, Medical Faculty Heidelberg, Department of Anesthesiology, Heidelberg, Germany
| | - Martin A Schneider
- Heidelberg University, Medical Faculty Heidelberg, Department of General, Visceral, and Transplantation Surgery, Heidelberg, Germany
| | - Christoph W Michalski
- Heidelberg University, Medical Faculty Heidelberg, Department of General, Visceral, and Transplantation Surgery, Heidelberg, Germany
| | - Markus W Büchler
- Heidelberg University, Medical Faculty Heidelberg, Department of General, Visceral, and Transplantation Surgery, Heidelberg, Germany
| | - Markus A Weigand
- Heidelberg University, Medical Faculty Heidelberg, Department of Anesthesiology, Heidelberg, Germany
| | - Jan Larmann
- Heidelberg University, Medical Faculty Heidelberg, Department of Anesthesiology, Heidelberg, Germany.
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Muhammad S, Jiang Z, Fan T, Tang Q, Hai Y, Ehsan SBE, Bilal M, Zubayraeva AA, Gao Y, He J. Advancing mid-rectal cancer surgery: Unveiling the potential of natural orifice specimen extraction surgery in comparison to conventional laparoscopic-assisted resection. Cancer Rep (Hoboken) 2024; 7:e2003. [PMID: 38703000 PMCID: PMC11069103 DOI: 10.1002/cnr2.2003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2023] [Revised: 12/28/2023] [Accepted: 02/05/2024] [Indexed: 05/06/2024] Open
Abstract
BACKGROUND Mid-rectal cancer treatment traditionally involves conventional laparoscopic-assisted resection (CLAR). This study aimed to assess the clinical and therapeutic advantages of Natural Orifice Specimen Extraction Surgery (NOSES) over CLAR. AIMS To compare the clinical outcomes, intraoperative metrics, postoperative recovery, complications, and long-term prognosis between NOSES and CLAR groups. MATERIALS & METHODS A total of 136 patients were analyzed, with 92 undergoing CLAR and 44 undergoing NOSES. Clinical outcomes were evaluated, and propensity score matching (PSM) was employed to control potential biases. RESULTS The NOSES group exhibited significant improvements in postoperative recovery, including lower pain scores on days 1, 3, and 5 (p < .001), reduced need for additional analgesics (p = .02), shorter hospital stays (10.8 ± 2.3 vs. 14.2 ± 5.3 days; p < .001), and decreased intraoperative blood loss (48.1 ± 52.7 mL vs. 71.0 ± 55.0 mL; p = .03). Patients undergoing NOSES also reported enhanced satisfaction with postoperative abdominal appearance and better quality of life. Additionally, the NOSES approach resulted in fewer postoperative complications. CONCLUSION While long-term outcomes (overall survival, disease-free survival, and local recurrence rates) were comparable between the two methods, NOSES demonstrated superior postoperative outcomes compared to CLAR in mid-rectal cancer treatment, while maintaining similar long-term oncological safety. These findings suggest that NOSES could serve as an effective alternative to CLAR without compromising long-term results.
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Affiliation(s)
- Shan Muhammad
- Department of Thoracic SurgeryNational Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical CollegeBeijingChina
- Laboratory of Translational Medicine, National Cancer Center/National Clinical Research Center for Cancer/Cancer HospitalChinese Academy of Medical Sciences and Peking Union Medical CollegeBeijingChina
- Department of Colorectal SurgeryNational Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences & Peking Union Medical CollegeBeijingChina
- Department of Colorectal SurgeryThe Second Affiliated Hospital of Harbin Medical UniversityHarbinChina
| | - Zheng Jiang
- Department of Colorectal SurgeryNational Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences & Peking Union Medical CollegeBeijingChina
| | - Tao Fan
- Department of Thoracic SurgeryNational Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical CollegeBeijingChina
- Laboratory of Translational Medicine, National Cancer Center/National Clinical Research Center for Cancer/Cancer HospitalChinese Academy of Medical Sciences and Peking Union Medical CollegeBeijingChina
| | - QingChao Tang
- Department of Colorectal SurgeryThe Second Affiliated Hospital of Harbin Medical UniversityHarbinChina
| | - Yang Hai
- Department of Children's and Adolescent HealthPublic Health College of Harbin Medical UniversityHarbinChina
| | - Sundas Bint E. Ehsan
- Department of Colorectal SurgeryThe Second Affiliated Hospital of Harbin Medical UniversityHarbinChina
| | - Maimoona Bilal
- Department of General SurgerySecond Affiliated Hospital of Chongqing Medical UniversityChongqingChina
| | - Albina A. Zubayraeva
- Department of General SurgeryI.M. Sechenov Affiliated Hospital of I.M. Sechenov First Moscow State Medical University (Sechenov University)MoscowRussia
| | - YiBo Gao
- Department of Thoracic SurgeryNational Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical CollegeBeijingChina
- Laboratory of Translational Medicine, National Cancer Center/National Clinical Research Center for Cancer/Cancer HospitalChinese Academy of Medical Sciences and Peking Union Medical CollegeBeijingChina
| | - Jie He
- Department of Thoracic SurgeryNational Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical CollegeBeijingChina
- Laboratory of Translational Medicine, National Cancer Center/National Clinical Research Center for Cancer/Cancer HospitalChinese Academy of Medical Sciences and Peking Union Medical CollegeBeijingChina
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10
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Huang Z, Huang S, Huang Y, Luo R, Liang W. Comparison of robotic-assisted versus conventional laparoscopic surgery in colorectal cancer resection: a systemic review and meta-analysis of randomized controlled trials. Front Oncol 2023; 13:1273378. [PMID: 37965455 PMCID: PMC10641393 DOI: 10.3389/fonc.2023.1273378] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2023] [Accepted: 09/25/2023] [Indexed: 11/16/2023] Open
Abstract
Introduction There is still controversy on whether or not robot-assisted colorectal surgery (RACS) have advantages over laparoscopic-assisted colorectal surgery(LACS). Materials and methods The four databases (PubMed, Embase, Web of Science and Cochrane Library)were comprehensively searched for randomized controlled trials (RCTs) comparing the outcomes of RACS and LACS in the treatment of colorectal cancer from inception to 22 July 2023. Results Eleven RCTs were considered eligible for the meta-analysis. Compared with LACS,RACS has significantly longer operation time(MD=5.19,95%CI: 18.00,39.82, P<0.00001), but shorter hospital stay(MD=2.97,95%CI:-1.60,-0.33,P = 0.003),lower conversion rate(RR=3.62,95%CI:0.40,0.76,P = 0.0003), lower complication rate(RR=3.31,95%CI:0.64,0.89,P=0.0009),fewer blood loss(MD=2.71,95%CI:-33.24,-5.35,P = 0.007),lower reoperation rate(RR=2.12, 95%CI:0.33,0.96,P=0.03)and longer distal resection margin(MD=2.16, 95%CI:0.04,0.94, P = 0.03). There was no significantly difference in harvested lymph nodes, the time of first flatus, the time of first defecation,the time of first resume diet, proximal resection margin, readmission rates, mortalities and CRM+ rates between two group. Conclusions Our study indicated that RACS is a feasible and safe technique that can achieve better surgical efficacy compared with LACS in terms of short-term outcomes. Systematic review registration https://www.crd.york.ac.uk/prospero/, identifier CRD42023447088.
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Affiliation(s)
- Zhilong Huang
- The First Affiliated Hospital of Guangxi University of Science and Technology, Guangxi University of Science and Technology, Liuzhou, Guangxi, China
| | - Shibo Huang
- The First Affiliated Hospital of Guangxi University of Science and Technology, Guangxi University of Science and Technology, Liuzhou, Guangxi, China
| | - Yanping Huang
- The First Affiliated Hospital of Guangxi University of Science and Technology, Guangxi University of Science and Technology, Liuzhou, Guangxi, China
| | - Raoshan Luo
- The First Affiliated Hospital of Guangxi University of Science and Technology, Guangxi University of Science and Technology, Liuzhou, Guangxi, China
| | - Weiming Liang
- The First Affiliated Hospital of Guangxi University of Science and Technology, Guangxi University of Science and Technology, Liuzhou, Guangxi, China
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11
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Nicolais L, Mohamed A, Fitzgerald TL. Minimally invasive distal pancreatectomy for adenocarcinoma of the pancreas. Surg Oncol 2023; 50:101970. [PMID: 37459676 DOI: 10.1016/j.suronc.2023.101970] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2023] [Revised: 06/07/2023] [Accepted: 07/01/2023] [Indexed: 09/26/2023]
Abstract
INTRODUCTION Minimally invasive (MI) surgery has been widely adopted to treat left-sided pancreatic cancer. However, outcomes are not clearly defined. MATERIALS Retrospective cohort study utilizing NCDB and NSQIP data. RESULTS Patients undergoing distal pancreatectomy for pancreatic adenocarcinoma from 2004 to 2016 were included (n = 7347). Utilizing NSQIP (n = 2406), patients were divided into two groups: intention-to-treat (ITT) MI (including MI converted to open, n = 929) and open (n = 1477). Patients undergoing open pancreatectomy were more likely to have longer length of stay (6 vs. 5 days, p=<0.001). On multivariate analysis, open procedures were not associated with mortality (OR 1.24; CI 0.51-3.30, p = 0.64), serious complications (OR 1.03; CI 0.90-1.37, p = 0.79), and any complications (OR 1.07; CI 0.86-1.32, p = 0.56). NCDB patients (n = 4941) were also divided into two groups, ITT MI (n = 1,769, 36%) and open group (n = 3,172, 64%). The median survival was lower in open procedure patients, 23 vs. 27.1 months (p < 0.001). This finding was maintained on multivariable analysis (HR 1.16; CI 1.03-1.32, p = 0.017). CONCLUSION Based on these data, MI distal pancreatectomy could be considered a standard of care for pancreatic cancer when technically feasible. Although morbidity and mortality were similar, the laparoscopic approach had a shorter length of stay and could hasten recovery.
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Affiliation(s)
- Laura Nicolais
- Division of Surgical Oncology, Tufts University School of Medicine-Maine Medical Center, Portland, ME, USA
| | - Abdimajid Mohamed
- Division of Surgical Oncology, Tufts University School of Medicine-Maine Medical Center, Portland, ME, USA
| | - Timothy L Fitzgerald
- Division of Surgical Oncology, Tufts University School of Medicine-Maine Medical Center, Portland, ME, USA.
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12
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O'Brien LP, Hannan E, Antao B, Peirce C. Paediatric robotic surgery: a narrative review. J Robot Surg 2023; 17:1171-1179. [PMID: 36645643 PMCID: PMC10374698 DOI: 10.1007/s11701-023-01523-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2022] [Accepted: 01/02/2023] [Indexed: 01/17/2023]
Abstract
The benefits of minimally invasive surgery (MIS) compared with traditional open surgery, including reduced postoperative pain and a reduced length of stay, are well recognised. A significant barrier for MIS in paediatric populations has been the technical challenge posed by laparoscopic surgery in small working spaces, where rigid instruments and restrictive working angles act as barriers to safe dissection. Thus, open surgery remains commonplace in paediatrics, particularly for complex major surgery and for surgical oncology. Robotic surgical platforms have been designed to overcome the limitations of laparoscopic surgery by offering a stable 3-dimensional view, improved ergonomics and greater range of motion. Such advantages may be particularly beneficial in paediatric surgery by empowering the surgeon to perform MIS in the smaller working spaces found in children, particularly in cases that may demand intracorporeal suturing and anastomosis. However, some reservations have been raised regarding the utilisation of robotic platforms in children, including elevated cost, an increased operative time and a lack of dedicated paediatric equipment. This article aims to review the current role of robotics within the field of paediatric surgery.
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Affiliation(s)
- Lukas Padraig O'Brien
- Department of Paediatric Surgery, Children's Health Ireland at Crumlin, Dublin, Ireland
| | - Enda Hannan
- Department of Colorectal Surgery, University Hospital Limerick, St Nessan's Road, Dooradoyle, Limerick, Co Limerick, Ireland.
| | - Brice Antao
- Department of Paediatric Surgery, Children's Health Ireland at Crumlin, Dublin, Ireland
| | - Colin Peirce
- Department of Colorectal Surgery, University Hospital Limerick, St Nessan's Road, Dooradoyle, Limerick, Co Limerick, Ireland
- School of Medicine, University of Limerick, Limerick, Ireland
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13
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Savu E, Vasile L, Serbanescu MS, Alexandru DO, Gheonea IA, Pirici D, Paitici S, Mogoanta SS. Clinicopathological Analysis of Complicated Colorectal Cancer: A Five-Year Retrospective Study from a Single Surgery Unit. Diagnostics (Basel) 2023; 13:2016. [PMID: 37370913 DOI: 10.3390/diagnostics13122016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2023] [Revised: 05/15/2023] [Accepted: 06/07/2023] [Indexed: 06/29/2023] Open
Abstract
Patients with primary colorectal cancer can present with obstructions, tumor bleeding, or perforations, which represent acute complications. This paper aimed to analyze and compare the clinical and pathological profiles of two patient groups: one with colorectal cancer and a related complication and another without any specific complication. We performed a five-year retrospective study on colorectal cancer patients admitted to a surgery unit and comparatively explored the main clinical and pathological features of the tumors belonging to the two groups. A total of 250 patients with colorectal cancer were included in the analysis. Of these, 117 (46.8%) had presented a type of complication. The comparative analysis that examined several clinical and pathological parameters showed a statistically significant difference for unfavorable prognosis factors in the group with complications. This was evident for features such as vascular and perineural invasion, lymph node involvement, pathological primary tumor stage, and TNM stage. Colorectal cancers with a related complication belonged to a group of tumors with a more aggressive histopathologic profile and more advanced stages. Furthermore, the comparable incidence of cases in the two groups of patients warrants further efforts to be made in terms of early detection and prognosis prediction of colorectal cancer.
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Affiliation(s)
- Elena Savu
- Doctoral School, University of Medicine and Pharmacy of Craiova, 200349 Craiova, Romania
- Department of Oncopediatrics, Clinical Emergency County Hospital, 200642 Craiova, Romania
| | - Liviu Vasile
- Department of Surgical Semiology, Faculty of Medicine, University of Medicine and Pharmacy of Craiova, 200349 Craiova, Romania
- Third General Surgery Department, Clinical Emergency County Hospital, 200642 Craiova, Romania
| | - Mircea-Sebastian Serbanescu
- Department of Medical Informatics, Faculty of Medicine, University of Medicine and Pharmacy of Craiova, 200349 Craiova, Romania
| | - Dragos Ovidiu Alexandru
- Department of Biostatistics, Faculty of Medicine, University of Medicine and Pharmacy of Craiova, 200349 Craiova, Romania
| | - Ioana Andreea Gheonea
- Department of Radiology and Medical Imaging, Faculty of Medicine, University of Medicine and Pharmacy of Craiova, 200349 Craiova, Romania
| | - Daniel Pirici
- Department of Histology, Faculty of Medicine, University of Medicine and Pharmacy of Craiova, 200349 Craiova, Romania
| | - Stefan Paitici
- Third General Surgery Department, Clinical Emergency County Hospital, 200642 Craiova, Romania
- Department of General Surgery, Faculty of Dental Medicine, University of Medicine and Pharmacy of Craiova, 200349 Craiova, Romania
| | - Stelian Stefanita Mogoanta
- Third General Surgery Department, Clinical Emergency County Hospital, 200642 Craiova, Romania
- Department of General Surgery, Faculty of Dental Medicine, University of Medicine and Pharmacy of Craiova, 200349 Craiova, Romania
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14
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Chok AY, Tan IEH, Zhao Y, Chee MYM, Chen HLR, Ang KA, Au MKH, Tan EJKW. Clinical outcomes and cost comparison of laparoscopic versus open surgery in elderly colorectal cancer patients over 80 years. Int J Colorectal Dis 2023; 38:160. [PMID: 37278975 DOI: 10.1007/s00384-023-04459-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/30/2023] [Indexed: 06/07/2023]
Abstract
PURPOSE The growth of Singapore's geriatric population, coupled with the rise in colorectal cancer (CRC), has increased the number of colorectal surgeries performed on elderly patients. This study aimed to compare the clinical outcomes and costs of laparoscopic versus open elective colorectal resections in elderly CRC patients over 80 years. METHODS A retrospective cohort study using data from the American College of Surgeons National Surgery Quality Improvement Program (ACS-NSQIP) identified patients over 80 years undergoing elective colectomy and proctectomy between 2018 and 2021. Patient demographics, length of stay (LOS), 30-day postoperative complications, and mortality rates were analysed. Cost data in Singapore dollars were obtained from the finance database. Univariate and multivariate regression models were used to determine cost drivers. The 5-year overall survival (OS) for the entire octogenarian CRC cohort with and without postoperative complications was estimated using the Kaplan-Meier curves. RESULTS Of the 192 octogenarian CRC patients undergoing elective colorectal surgery between 2018 and 2021, 114 underwent laparoscopic resection (59.4%), while 78 underwent open surgery (40.6%). The proportion of proctectomy cases was similar between laparoscopic and open groups (24.6% vs. 23.1%, P = 0.949). Baseline characteristics, including Charlson Comorbidity Index, albumin level, and tumour staging, were comparable between both groups. Median operative duration was 52.5 min longer in the laparoscopic group (232.5 vs. 180.0 min, P < 0.001). Both groups had no significant differences in postoperative complications and 30-day and 1-year mortality rates. Median LOS was 6 days in the laparoscopic group compared to 9 days in the open group (P < 0.001). The mean total cost was 11.7% lower in the laparoscopic group (S$25,583.44 vs. S$28,970.85, P = 0.012). Proctectomy (P = 0.024), postoperative pneumonia (P < 0.001) and urinary tract infection (P < 0.001), and prolonged LOS > 6 days (P < 0.001) were factors contributing to increased costs in the entire cohort. The 5-year OS of octogenarians with minor or major postoperative complications was significantly lower than those without complications (P < 0.001). CONCLUSION Laparoscopic resection is associated with significantly reduced overall hospitalization costs and decreased LOS compared to open resection among octogenarian CRC patients, with comparable postoperative outcomes and 30-day and 1-year mortality rates. The extended operative time and higher consumables costs from laparoscopic resection were mitigated by the decrease in other inpatient hospitalization costs, including ward accommodation, daily treatment fees, investigation costs, and rehabilitation expenditures. Comprehensive perioperative care and optimised surgical approach to mitigate the impact of postoperative complications can improve survival in elderly patients undergoing CRC resection.
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Affiliation(s)
- Aik Yong Chok
- Department of Colorectal Surgery, Singapore General Hospital, Singapore, 169608, Singapore
| | - Ivan En-Howe Tan
- Group Finance Analytics, Singapore Health Services, Singapore, 168582, Singapore
| | - Yun Zhao
- Department of Colorectal Surgery, Singapore General Hospital, Singapore, 169608, Singapore
- Group Finance Analytics, Singapore Health Services, Singapore, 168582, Singapore
| | - Madeline Yen Min Chee
- Department of Colorectal Surgery, Singapore General Hospital, Singapore, 169608, Singapore
| | | | - Kwok Ann Ang
- Finance, Singapore General Hospital, Singapore, 169608, Singapore
| | - Marianne Kit Har Au
- Group Finance Analytics, Singapore Health Services, Singapore, 168582, Singapore
- Finance, Singhealth Community Hospitals, Singapore, 168582, Singapore
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15
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Mota BBL, Macedo TJB, Parra RS, Rocha JJRDA, Feres O, Feitosa MR. Retrospective analysis of surgical and oncological results of laparoscopic surgeries performed by residents of coloproctology. Rev Col Bras Cir 2023; 50:e20233404. [PMID: 37222382 PMCID: PMC10508675 DOI: 10.1590/0100-6991e-20233404-en] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2022] [Accepted: 08/29/2022] [Indexed: 05/25/2023] Open
Abstract
INTRODUCTION with the improvement and wide acceptance of laparoscopy in colorectal operations, there was a need for specific training of surgeons in training. There are few studies evaluating the postoperative results of laparoscopic colectomies performed by resident physicians and their impact on patient safety. PURPOSE to analyze the surgical and oncological results of laparoscopic colectomies performed by coloproctology residents and compare them with data in the literature. METHODS this is a retrospective analysis of patients undergoing laparoscopic colorectal surgery performed by resident physicians at the Hospital das Clínicas de Ribeirão Preto, between 2014 and 2018. The clinical characteristics of the patients were studied, as well as the main surgical and oncological aspects in a period of one year. RESULTS we analyzed 191 operations, whose main surgical indication was adenocarcinoma, most of them stage III. The mean duration of surgeries was 210±58 minutes. There was a need for a stoma in 21.5% of the patients, mainly loop colostomy. The conversion rate was 23%, with 79.5% due to technical difficulties, and the main predictors of conversion were obesity and intraoperative accidents. The median length of stay was 6 days. Preoperative anemia was associated with a higher rate of complications (11.5%) and reoperations (12%). Surgical resection margins were compromised in 8.6% of cases. The one-year recurrence rate was 3.2% and the mortality rate was 6.3%. CONCLUSIONS videolaparoscopic colorectal surgery performed by residents showed efficacy and safety similar to data found in the literature.
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Affiliation(s)
- Bárbara Bianca Linhares Mota
- - Hospital das Clínicas da Faculdade de Medicina de RIbeirão Preto - USP, Departamento de anatomia e cirurgia, divisão de coloproctologia - Ribeirao Preto - SP - Brasil
| | - Tarcísio Junior Bittencourt Macedo
- - Hospital das Clínicas da Faculdade de Medicina de RIbeirão Preto - USP, Departamento de anatomia e cirurgia, divisão de coloproctologia - Ribeirao Preto - SP - Brasil
| | - Rogério Serafim Parra
- - Hospital das Clínicas da Faculdade de Medicina de RIbeirão Preto - USP, Departamento de anatomia e cirurgia, divisão de coloproctologia - Ribeirao Preto - SP - Brasil
| | - José Joaquim Ribeiro DA Rocha
- - Hospital das Clínicas da Faculdade de Medicina de RIbeirão Preto - USP, Departamento de anatomia e cirurgia, divisão de coloproctologia - Ribeirao Preto - SP - Brasil
| | - Omar Feres
- - Hospital das Clínicas da Faculdade de Medicina de RIbeirão Preto - USP, Departamento de anatomia e cirurgia, divisão de coloproctologia - Ribeirao Preto - SP - Brasil
| | - Marley Ribeiro Feitosa
- - Hospital das Clínicas da Faculdade de Medicina de RIbeirão Preto - USP, Departamento de anatomia e cirurgia, divisão de coloproctologia - Ribeirao Preto - SP - Brasil
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16
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Villarim PVO, Marinho VRD, Abreu CA, Moura ACMA, Silva TCL, Alves HPM, Rêgo ACM, Medeiros KS, Araújo-Filho I. Incidence of colonic fistulas in patients with colon cancer submitted to robotic surgery versus laparoscopic colorectal surgery: a systematic review and meta-analysis protocol. BMJ Open 2023; 13:e065011. [PMID: 37173111 DOI: 10.1136/bmjopen-2022-065011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/15/2023] Open
Abstract
INTRODUCTION Up to the present time, the laparoscopic approach for colon cancer is considered the gold standard. However, robotic surgery has been appraised in modern medicine. It is essential to evaluate the differences between laparoscopic and robotic surgery, owing to the significant impact they cause in postoperative morbidity and mortality. This article aims to perform a systematic review and meta-analysis of the literature to compare robotic versus laparoscopic colectomies in patients with colon cancer in terms of the incidence of colonic fistulas. METHODS AND ANALYSIS PubMed, Embase, Scopus, Web of Science, Science Direct, Cochrane Central Register of Controlled Trials, CINAHL, LILACS and Clinical trials databases will be searched for randomised clinical trials investigating the incidence of colonic fistulas in patients with colonic cancer, submitted to robotic surgery compared with a laparoscopic approach. No language or publication period restrictions will be imposed. The primary outcome will be the incidence of colonic fistulas in patients with colon cancer in different surgical approaches. The secondary outcomes will be the incidence of infection, sepsis, mortality, length of hospitalisation and malnutrition. Three independent reviewers will select the studies and extract data from the original publications. The risk of bias will be assessed using The Risk of Bias 2 tool, and the evidence's certainty will be made using the Grading of Recommendations Assessment, Development and Evaluation. Data synthesis will be performed using the Review Manager software (RevMan V.5.2.3). To assess heterogeneity. We will compute the I2 statistics. In addition, a quantitative synthesis will be performed if the included studies are sufficiently homogeneous. ETHICS AND DISSEMINATION This study will review the published data; thus, it is not necessary to obtain ethical approval. The findings of this systematic review will be published in a peer-reviewed journal. PROSPERO REGISTRATION NUMBER CRD42021295313.
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Affiliation(s)
| | | | | | | | | | - Higor Paiva Mendonça Alves
- Department of Nutrition and Dietetics, Federal University of Rio Grande do Norte, Natal, Rio Grande do Norte, Brazil
| | | | - Kleyton Santos Medeiros
- Instituto de Ensino, Pesquisa e Inovação, Liga Contra o Câncer, Natal, Rio Grande do Norte, Brazil
- Postgraduate Program in Health Sciences, Federal University of Rio Grande do Norte, Natal, Rio Grande do Norte, Brazil
| | - Irami Araújo-Filho
- Department of Medicine, Federal University of Rio Grande do Norte, Natal, Rio Grande do Norte, Brazil
- Instituto de Ensino, Pesquisa e Inovação, Liga Contra o Câncer, Natal, Rio Grande do Norte, Brazil
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17
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Chok AY, Zhao Y, Tan IEH, Au MKH, Tan EJKW. Cost-effectiveness comparison of minimally invasive, robotic and open approaches in colorectal surgery: a systematic review and bayesian network meta-analysis of randomized clinical trials. Int J Colorectal Dis 2023; 38:86. [PMID: 36988723 DOI: 10.1007/s00384-023-04361-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/28/2023] [Indexed: 03/30/2023]
Abstract
PURPOSE This study compares the cost-effectiveness of open, laparoscopic (LAP), laparoscopic-assisted (LAPA), hand-assisted laparoscopic (HAL), and robotic colorectal surgery using a network meta-analysis. METHODS Randomized clinical trials (RCTs) evaluating the cost-effectiveness of comparing the five different approaches in colorectal surgery were included in a literature search until September 2022. Bayesian network meta-analysis was conducted, and surface under cumulative ranking area (SUCRA) values, odds ratio (OR), and 95% credible intervals (CrIs) were reported for total costs, surgical costs, operating time, length of stay (LOS), and postoperative outcomes. Cluster analysis was performed to examine the similarity and classification of surgical approaches into homogeneous clusters. The cophenetic correlation coefficient (cc) was evaluated to identify the most cost-effective clustering method. The primary outcomes assessed were: costs-morbidity, costs-mortality, and costs-efficacy, measuring total costs against postoperative complications, mortality rate, and LOS, respectively. RESULTS 22 RCTs with 4239 patients were included. Open surgery had the lowest total costs, surgical costs, and operating time but the longest LOS and most postoperative complications. LOS was significantly decreased in LAP compared to open surgery (OR 0.67, 95% CrI 0.46-0.96). Robotic surgery resulted in the highest total costs, surgical costs, and most extended operative duration but the shortest LOS and lowest mortality. LAPA and robotic surgery were superior in the costs-morbidity analysis. HAL was associated with the worst costs-mortality profile. LAP, LAPA, and HAL were better in terms of costs-efficacy. CONCLUSION Overall, LAP and LAPA are the most cost-effective approaches for colorectal surgery in terms of overall postoperative complications, mortality, and LOS.
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Affiliation(s)
- Aik Yong Chok
- Department of Colorectal Surgery, Singapore General Hospital, Academia, 20 College Road, 169856, Singapore, Singapore
| | - Yun Zhao
- Department of Colorectal Surgery, Singapore General Hospital, Academia, 20 College Road, 169856, Singapore, Singapore
- Group Finance Analytics, Singapore Health Services, Singapore, 168582, Singapore
| | - Ivan En-Howe Tan
- Group Finance Analytics, Singapore Health Services, Singapore, 168582, Singapore
| | - Marianne Kit Har Au
- Group Finance Analytics, Singapore Health Services, Singapore, 168582, Singapore
| | - Emile John Kwong Wei Tan
- Department of Colorectal Surgery, Singapore General Hospital, Academia, 20 College Road, 169856, Singapore, Singapore.
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18
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Udayasiri DK, Hiscock R, Jones IT, Skandarajah A, Hayes IP. Overall survival comparing laparoscopic to open surgery for right-sided colon cancer: propensity score inverse probability weighting population study. ANZ J Surg 2023. [PMID: 36797227 DOI: 10.1111/ans.18338] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2022] [Revised: 02/04/2023] [Accepted: 02/07/2023] [Indexed: 02/18/2023]
Abstract
BACKGROUND This retrospective cohort study reports on overall survival and short-term complications, comparing laparoscopic to open resection for right-sided colon cancers. It is one of the largest studies in the field with generalizable population-level results. METHOD This study on right sided colon cancers used prospectively collected administrative data linked to a death registry over 5 years from 2014 to 2018. Exclusion criteria were private patients, patients aged less than 10 years, synchronous and metachronous cancers. Propensity score weighting was used to balance cohorts and Cox proportional hazards regression was used to assess the hazard of death. In addition, logistic regression analysis was used to assess secondary outcomes. For completeness, unweighted data was similarly analysed. RESULTS There were 3603 patients identified for the analysis: 1729 open patients and 1874 laparoscopic patients. Cox proportional hazards regression analysis of the weighted data showed no evidence of a statistically significant effect of laparoscopic surgery compared to open surgery on overall survival for right-sided colon cancers (HR 0.86, 95% CI 0.71-1.04, P = 0.112). The weighted data showed lower odds of prolonged length of stay, return to theatre and discharge destination other than home in the laparoscopic cohort compared to the open cohort. There was no difference in inpatient mortality. Unweighted results were similar. CONCLUSION This study validates the use of laparoscopic surgery for right-sided colon cancer, showing similar long-term overall survival and inpatient mortality compared to open surgery. It is superior to open surgery for the short-term outcomes of LOS, return to theatre and discharge destination other than home.
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Affiliation(s)
- Dilshan K Udayasiri
- Colorectal Surgical Unit, The Royal Melbourne Hospital, Melbourne, Victoria, Australia.,Department of General Surgical Specialties, The Royal Melbourne Hospital, Melbourne, Victoria, Australia.,Department of Surgery, The University of Melbourne, Melbourne, Victoria, Australia
| | - Richard Hiscock
- Department of Anaesthetics, Mercy Hospital for Women, Melbourne, Victoria, Australia.,Department of Obstetrics and Gynaecology, The University of Melbourne, Melbourne, Victoria, Australia
| | - Ian T Jones
- Colorectal Surgical Unit, The Royal Melbourne Hospital, Melbourne, Victoria, Australia.,Department of General Surgical Specialties, The Royal Melbourne Hospital, Melbourne, Victoria, Australia.,Department of Surgery, The University of Melbourne, Melbourne, Victoria, Australia
| | - Anita Skandarajah
- Department of General Surgical Specialties, The Royal Melbourne Hospital, Melbourne, Victoria, Australia.,Department of Surgery, The University of Melbourne, Melbourne, Victoria, Australia
| | - Ian P Hayes
- Colorectal Surgical Unit, The Royal Melbourne Hospital, Melbourne, Victoria, Australia.,Department of General Surgical Specialties, The Royal Melbourne Hospital, Melbourne, Victoria, Australia.,Department of Surgery, The University of Melbourne, Melbourne, Victoria, Australia
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19
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Jadid KD, Cao Y, Petersson J, Sjövall A, Angenete E, Matthiessen P. Long-term oncological outcomes for minimally invasive surgery versus open surgery for colon cancer-a population-based nationwide study with a non-inferiority design. Colorectal Dis 2023; 25:954-963. [PMID: 36762443 DOI: 10.1111/codi.16512] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2022] [Revised: 01/20/2023] [Accepted: 01/29/2023] [Indexed: 02/11/2023]
Abstract
AIM The study aimed to compare 5-year overall survival in a national cohort of patients undergoing curative abdominal resection for colon cancer by minimally invasive surgery (MIS) or by the open (OPEN) technique. METHODS All patients diagnosed between 2010 and 2016 in Sweden with pathological Union International Contre le Cancer Stages I-III colon cancer localized in the caecum, ascending colon, hepatic flexure or sigmoid colon and those who underwent curative right sided hemicolectomy, sigmoid resection or high anterior resection by MIS or OPEN were included. Patients were identified in the Swedish Colorectal Cancer Registry from which all data were retrieved. The analyses were performed as intention-to-treat and the relationship between surgical technique (MIS or OPEN) and overall mortality within 5 years was analysed. For the primary research question a non-inferiority hypothesis was assumed with a statistical power of 90%, a one-side type I error of 2.5% and a non-inferiority margin of 2%. For the secondary analyses, multilevel survival regression models with the patients matched by propensity scores were employed, adjusted for patient- and tumour-related variables. RESULTS A total of 11 605 pathological Union International Contre le Cancer Stages I-III patients were included with 3297 MIS (28.4%) and 8308 OPEN (71.6%) and were followed until 31 December 2020. The primary analysis demonstrated superiority for MIS compared to OPEN. The multilevel survival regression analyses confirmed that 5-year overall survival was higher in MIS with a hazard ratio of 0.874 (95% confidence interval 0.791-0.965), and if excluding pT4 the outcome was similar, with a hazard ratio of 0.847 (95% confidence interval 0.756-0.948). CONCLUSION This observational study demonstrated that MIS was favourable to OPEN with regard to 5-year overall survival. These results support the use of laparoscopic colon cancer surgery in routine practice.
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Affiliation(s)
- Kaveh Dehlaghi Jadid
- Department of Surgery, Örebro University Hospital, Örebro, Sweden.,Department of Surgery, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
| | - Yang Cao
- Clinical Epidemiology and Biostatistics, School of Medical Sciences, Örebro University, Örebro, Sweden
| | - Josefin Petersson
- SSORG-Scandinavian Surgical Outcomes Research Group, Department of Surgery, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.,Region Västra Götaland, Department of Surgery, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Annika Sjövall
- Gastrointestinal Oncology and Colorectal Surgery Unit, Department of Pelvic Cancer, Karolinska University Hospital, Stockholm, Sweden
| | - Eva Angenete
- SSORG-Scandinavian Surgical Outcomes Research Group, Department of Surgery, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.,Region Västra Götaland, Department of Surgery, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Peter Matthiessen
- Department of Surgery, Örebro University Hospital, Örebro, Sweden.,Department of Surgery, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
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20
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DeAngelis EJ, Zebley JA, Ileka IS, Ganguli S, Panahi A, Amdur RL, Vaziri K, Lee J, Jackson HT. Trends in utilization of laparoscopic colectomy according to race: an analysis of the NIS database. Surg Endosc 2023; 37:1421-1428. [PMID: 35731300 DOI: 10.1007/s00464-022-09381-w] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2022] [Accepted: 06/05/2022] [Indexed: 11/30/2022]
Abstract
BACKGROUND Laparoscopic colectomy has been associated with improved recovery and decreased complications when compared to an open approach. Consequently, the rates of laparoscopic colectomy have increased. Race has been identified as a factor that influences a patient's likelihood of undergoing laparoscopic colectomy. Therefore, the purpose of this study is to analyze the rates of laparoscopic colectomy stratified by race over time. METHODS Patients were selected using procedure codes for colectomy within the National Inpatient Sample (NIS) database from 2009 to 2018. The primary independent variable was race (Black, BL; Hispanic, HI; White, WH), and the primary outcome was surgical approach (laparoscopic vs open). Covariates included age, sex, case complexity, insurance status, income, year of surgery, urbanicity, region, bedsize, and teaching status. We examined the univariable association of race with laparoscopic vs open colectomy with chi-square. We used multivariable logistic regression to examine the association of race with procedure type adjusting for covariates. All analyses were done using SAS (version 9.4, Cary, NC) with p < .05 considered significant. RESULTS 267,865 patients (25,000 BL, 19,685 HI, and 223,180 WH) were identified. Laparoscopy was used in 47% of cases, and this varied significantly by race (BL 44%, HI 49%, WH 47%, p < .0001). After adjusting for covariates, Black patients had significantly lower adjusted odds of undergoing laparoscopic colectomy vs White patients (aOR 0.92, p < 0.0001). Utilization of laparoscopy was similar in Hispanic compared to White patients (aOR 1.00, p = 0.9667). Racial disparity in the adjusted odds of undergoing laparoscopic colectomy was persistent over time. CONCLUSION Race was independently associated with the rate of laparoscopic colectomy, with Black patients less likely to receive laparoscopic surgery than White patients. This disparity persisted over a decade. Attention should be paid to increasing the rates of laparoscopic colectomy in under-represented populations in order to optimize surgical care and address racial disparities.
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Affiliation(s)
- Erik J DeAngelis
- Department of Surgery, George Washington University, 2150 Pennsylvania Avenue, NW, Suite 6B, Washington, DC, 20037, USA.
| | - James A Zebley
- Department of Surgery, George Washington University, 2150 Pennsylvania Avenue, NW, Suite 6B, Washington, DC, 20037, USA
| | - Ikechukwu S Ileka
- Department of Surgery, George Washington University, 2150 Pennsylvania Avenue, NW, Suite 6B, Washington, DC, 20037, USA
| | - Sangrag Ganguli
- Department of Surgery, George Washington University, 2150 Pennsylvania Avenue, NW, Suite 6B, Washington, DC, 20037, USA
| | - Armon Panahi
- Department of Surgery, George Washington University, 2150 Pennsylvania Avenue, NW, Suite 6B, Washington, DC, 20037, USA
| | - Richard L Amdur
- Department of Surgery, George Washington University, 2150 Pennsylvania Avenue, NW, Suite 6B, Washington, DC, 20037, USA
| | - Khashayar Vaziri
- Department of Surgery, George Washington University, 2150 Pennsylvania Avenue, NW, Suite 6B, Washington, DC, 20037, USA
| | - Juliet Lee
- Department of Surgery, George Washington University, 2150 Pennsylvania Avenue, NW, Suite 6B, Washington, DC, 20037, USA
| | - Hope T Jackson
- Department of Surgery, George Washington University, 2150 Pennsylvania Avenue, NW, Suite 6B, Washington, DC, 20037, USA
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21
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Giesen LJX, Dekker JWT, Verseveld M, Crolla RMPH, van der Schelling GP, Verhoef C, Olthof PB. Implementation of robotic rectal cancer surgery: a cross-sectional nationwide study. Surg Endosc 2023; 37:912-920. [PMID: 36042043 PMCID: PMC9945537 DOI: 10.1007/s00464-022-09568-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2022] [Accepted: 08/14/2022] [Indexed: 11/30/2022]
Abstract
AIM An increasing number of centers have implemented a robotic surgical program for rectal cancer. Several randomized controls trials have shown similar oncological and postoperative outcomes compared to standard laparoscopic resections. While introducing a robot rectal resection program seems safe, there are no data regarding implementation on a nationwide scale. Since 2018 robot resections are separately registered in the mandatory Dutch Colorectal Audit. The present study aims to evaluate the trend in the implementation of robotic resections (RR) for rectal cancer relative to laparoscopic rectal resections (LRR) in the Netherlands between 2018 and 2020 and to compare the differences in outcomes between the operative approaches. METHODS Patients with rectal cancer who underwent surgical resection between 2018 and 2020 were selected from the Dutch Colorectal Audit. The data included patient characteristics, disease characteristics, surgical procedure details, postoperative outcomes. The outcomes included any complication within 90 days after surgery; data were categorized according to surgical approach. RESULTS Between 2018 and 2020, 6330 patients were included in the analyses. 1146 patients underwent a RR (18%), 3312 patients a LRR (51%), 526 (8%) an open rectal resection, 641 a TaTME (10%), and 705 had a local resection (11%). The proportion of males and distal tumors was higher in the RR compared to the LRR. Over time, the proportion of robotic procedures increased from 15% (95% confidence intervals (CI) 13-16%) in 2018 to 22% (95% CI 20-24%) in 2020. Conversion rate was lower in the robotic group [4% (95% CI 3-5%) versus 7% (95% CI 6-8%)]. Anastomotic leakage rate was similar with 16%. Defunctioning ileostomies were more common in the RR group [42% (95% CI 38-46%) versus 29% (95% CI 26-31%)]. CONCLUSION Rectal resections are increasingly being performed through a robot-assisted approach in the Netherlands. The proportion of males and low rectal cancers was higher in RR compared to LRR. Overall outcomes were comparable, while conversion rate was lower in RR, the proportion of defunctioning ileostomies was higher compared to LRR.
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Affiliation(s)
- L J X Giesen
- Department of Surgery, Erasmus MC Cancer Institute, Rotterdam, The Netherlands.
- Department of Surgery, Franciscus Gasthuis & Vlietland, Rotterdam, The Netherlands.
| | - J W T Dekker
- Department of Surgery, Reinier de Graaf Gasthuis, Delft, The Netherlands
| | - M Verseveld
- Department of Surgery, Erasmus MC Cancer Institute, Rotterdam, The Netherlands
- Department of Surgery, Franciscus Gasthuis & Vlietland, Rotterdam, The Netherlands
| | - R M P H Crolla
- Department of Surgery, Amphia Hospital, Breda, The Netherlands
| | | | - C Verhoef
- Department of Surgery, Erasmus MC Cancer Institute, Rotterdam, The Netherlands
| | - P B Olthof
- Department of Surgery, Erasmus MC Cancer Institute, Rotterdam, The Netherlands
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22
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Chen P, Zhou H, Chen C, Qian X, Yang L, Zhou Z. Laparoscopic vs. open colectomy for T4 colon cancer: A meta-analysis and trial sequential analysis of prospective observational studies. Front Surg 2022; 9:1006717. [DOI: 10.3389/fsurg.2022.1006717] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2022] [Accepted: 10/10/2022] [Indexed: 11/06/2022] Open
Abstract
BackgroundTo evaluate short- and long-term outcomes of laparoscopic colectomy (LC) vs. open colectomy (OC) in patients with T4 colon cancer.MethodsThree authors independently searched PubMed, Web of Science, Embase, Cochrane Library, and Clinicaltrials.gov for articles before June 3, 2022 to compare the clinical outcomes of T4 colon cancer patients undergoing LC or OC.ResultsThis meta-analysis included 7 articles with 1,635 cases. Compared with OC, LC had lesser blood loss, lesser perioperative transfusion, lesser complications, lesser wound infection, and shorter length of hospital stay. Moreover, there was no significant difference between the two groups in terms of 5-year overall survival (5y OS), and 5-year disease-free survival (5y DFS), R0 resection rate, positive resection margin, lymph nodes harvested ≥12, and recurrence. Trial Sequential Analysis (TSA) results suggested that the potential advantages of LC on perioperative transfusion and the comparable oncological outcomes in terms of 5y OS, 5y DFS, lymph nodes harvested ≥12, and R0 resection rate was reliable and no need of further study.ConclusionsLaparoscopic surgery is safe and feasible in T4 colon cancer in terms of short- and long-term outcomes. TSA results suggested that future studies were not required to evaluate the 5y OS, 5y DFS, R0 resection rate, positive resection margin status, lymph nodes harvested ≥12 and perioperative transfusion differences between LC and OC.Systematic Review Registration:https://www.crd.york.ac.uk/PROSPERO/, identifier: CRD42022297792.
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23
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Bukhari S, Leth MF, Laursen CCW, Larsen M, Tornøe AS, Jakobsen JC, Maagaard M, Mathiesen O. Risks of serious adverse events associated with non-steroidal anti-inflammatory drugs in gastrointestinal surgery. A protocol for a systematic review with meta-analysis and trial sequential analysis. Acta Anaesthesiol Scand 2022; 66:1266-1273. [PMID: 35989476 DOI: 10.1111/aas.14143] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2022] [Accepted: 08/17/2022] [Indexed: 11/29/2022]
Abstract
BACKGROUND Post-operative pain is frequent following gastrointestinal surgery and may result in prolonged hospitalisation, delayed recovery, and lower quality of life. Non-steroidal anti-inflammatory drugs (NSAIDs) are effective analgesics and recommended by Enhanced Recovery After Surgery guidelines as part of opioid-sparing multimodal treatment. However, perioperative NSAID treatment may be associated with increased risk of harm. We will investigate the risks of serious adverse events associated with perioperative NSAID treatment in patients undergoing gastrointestinal surgery. METHODS This protocol uses the recommendations of the Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols. We wish to assess the effects of NSAIDs versus placebo, usual care, or no intervention on the incidence of serious adverse in patients undergoing gastrointestinal surgery. We will include all randomised trials. To identify trials, we will search the medical literature analysis and retrieval system online, excerpta medica database, cochrane central register of controlled trials, web of science core collection, and BIOSIS. Two authors will screen the literature and extract data. We will use the 'Risk of Bias 2 tool' to assess the risks of systematic errors. We will perform meta-analyses using R. We will use Trial Sequential Analysis to account for the risks of random errors. We will create a "Summary of Findings"-table in which we will present our primary and secondary outcome results. We will assess the certainty of the evidence using grading of recommendations assessment, development and evaluation. DISCUSSION This systematic review can potentially elucidate the risks of perioperative NSAID treatment in gastrointestinal surgery and inform the already established non-opioid multimodal pain treatment regimen recommended by enhanced recovery after surgery guidelines.
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Affiliation(s)
- Shaheer Bukhari
- Centre for Anaesthesiological Research, Department of Anaesthesiology, Zealand University Hospital, Køge, Denmark
| | - Morten Fiil Leth
- Centre for Anaesthesiological Research, Department of Anaesthesiology, Zealand University Hospital, Køge, Denmark
| | | | - Mia Larsen
- Department of Anaesthesiology, Juliane Marie Centre, Copenhagen, Denmark
| | | | - Janus C Jakobsen
- Copenhagen Trial Unit, Centre for Clinical Intervention Research, Copenhagen University Hospital, Copenhagen, Denmark
- Department of Regional Health Research, The Faculty of Health Sciences, University of Southern Denmark, Odense, Denmark
| | - Mathias Maagaard
- Centre for Anaesthesiological Research, Department of Anaesthesiology, Zealand University Hospital, Køge, Denmark
| | - Ole Mathiesen
- Centre for Anaesthesiological Research, Department of Anaesthesiology, Zealand University Hospital, Køge, Denmark
- Department of Clinical Medicine, Copenhagen University, Copenhagen, Denmark
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24
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Drews G, Bohnsteen B, Knolle J, Gradhand E, Würl P. Laparoscopic surgery for colorectal cancer in an elderly population with high comorbidity: a single centre experience. Int J Colorectal Dis 2022; 37:1963-1973. [PMID: 35931782 DOI: 10.1007/s00384-022-04229-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/29/2022] [Indexed: 02/04/2023]
Abstract
PURPOSE The use of laparoscopic surgery for colorectal cancer in elderly patients with high comorbidity is a controversial subject. This retrospective analysis aims to compare two different age groups with respect to short and long term clinical and oncological outcomes. METHODS All laparoscopic colorectal resections for cancer performed between February 2011 and October 2017 with curative or palliative intention were evaluated. RESULTS Among 128 completed resections, the rate of major complications, length of hospital stays, 30-day mortality, 2-year recurrence rate, and the survival after palliative surgery were comparable between group A (< 75 years; n = 76) and B (≥ 75 years; n = 52). Patients in group B showed an extraordinarily high proportion of ASA III stage (73.1% vs. A: 35.5%; p < 0.01) and, in this context, an increased rate of minor postoperative complications (17.3% vs. A: 6.6%; p < 0.05) and lower overall 2 and 5-year survival rates. Within the first 2 years, they died sooner in the event of recurrence (57.1% vs. A: 18.2%; p < 0.05), and their survival after rectal resection, especially for low rectal carcinoma, was significantly reduced (58.8% vs. A: 96.7%; p < 0.001). CONCLUSION Laparoscopic surgery for colorectal cancer can be strongly advocated for elderly patients even in the face of high comorbidity. Whether very old patients with low rectal carcinoma also benefit from minimally invasive surgery or should undergo alternative therapies would need to be clarified primarily by examining the quality of life.
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Affiliation(s)
- Gerald Drews
- Department of General, Visceral and Thoracic Surgery, Municipal Hospital Dessau, Städtisches Klinikum Dessau, and Brandenburg Medical School Theodor Fontane, Auenweg 38, 06847, Dessau, Germany.
| | - Beatrix Bohnsteen
- Oncological Outpatient Department, Kastanienhof 1, 06847, Dessau, Germany
| | - Jürgen Knolle
- Institute of Pathology, Martha-Maria Hospital Halle-Dölau, Röntgenstraße 1, 06120, Halle (Saale), Germany
| | - Elise Gradhand
- Institute of Pathology, University Hospital, Theodor-Stern-Kai 7, 60590, Frankfurt/Main, Germany
| | - Peter Würl
- Department of General, Visceral and Thoracic Surgery, Municipal Hospital Dessau, Städtisches Klinikum Dessau, and Brandenburg Medical School Theodor Fontane, Auenweg 38, 06847, Dessau, Germany
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25
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Mora López L, Pallisera Lloveras A, Serracant Barrera A, Garcia-Nalda A, Caraballo Angeli M, Pino Pérez O, Navarro Soto S, Serra Aracil X. Robotic left hemicolectomy with intracorporeal anastomosis: Description of the technique and initial results. Colorectal Dis 2022; 24:1080-1083. [PMID: 35437870 DOI: 10.1111/codi.16146] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2022] [Revised: 03/27/2022] [Accepted: 04/03/2022] [Indexed: 02/08/2023]
Abstract
AIM The aim was to describe the robot-assisted intracorporeal anastomosis technique in left colon surgery (rLCS) and report the initial results. METHOD The rLCS was performed in 25 consecutive patients, starting with a Pfannenstiel incision and introducing a prepared anvil. The robot was docked and the affected segment resected. Colotomy was performed and the anvil was introduced in the proximal segment. End-to-end anastomosis was performed and reinforced. An air-leak test was performed. RESULTS The results varied in terms of patient's age, American Society of Anesthesiologists grade, weight and the technique performed. Most patients had cancer. There was no suture failure or mortality, and the mean hospital stay was 3 days. CONCLUSIONS The rLCS is a safe, reproducible technique with good initial results. Prospective studies should be performed to demonstrate its advantages.
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Affiliation(s)
- Laura Mora López
- Coloproctology Unit, General Surgery Department, Hospital Universitari Parc Tauli, Sabadell, Barcelona, Spain
| | - Anna Pallisera Lloveras
- Coloproctology Unit, General Surgery Department, Hospital Universitari Parc Tauli, Sabadell, Barcelona, Spain
| | - Anna Serracant Barrera
- Coloproctology Unit, General Surgery Department, Hospital Universitari Parc Tauli, Sabadell, Barcelona, Spain
| | - A Garcia-Nalda
- Coloproctology Unit, General Surgery Department, Hospital Universitari Parc Tauli, Sabadell, Barcelona, Spain
| | - M Caraballo Angeli
- Coloproctology Unit, General Surgery Department, Hospital Universitari Parc Tauli, Sabadell, Barcelona, Spain
| | - Oriol Pino Pérez
- Coloproctology Unit, General Surgery Department, Hospital Universitari Parc Tauli, Sabadell, Barcelona, Spain
| | - Salvador Navarro Soto
- Coloproctology Unit, General Surgery Department, Hospital Universitari Parc Tauli, Sabadell, Barcelona, Spain
| | - Xavier Serra Aracil
- Coloproctology Unit, General Surgery Department, Hospital Universitari Parc Tauli, Sabadell, Barcelona, Spain
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26
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Wang LM, Jong BK, Liao CK, Kou YT, Chern YJ, Hsu YJ, Hsieh PS, Tsai WS, You JF. Comparison of short-term and medium-term outcomes between intracorporeal anastomosis and extracorporeal anastomosis for laparoscopic left hemicolectomy. World J Surg Oncol 2022; 20:270. [PMID: 36030250 PMCID: PMC9419322 DOI: 10.1186/s12957-022-02735-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2022] [Accepted: 08/17/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Few studies have evaluated the feasibility and safety of intracorporeal anastomosis (IA) for left hemicolectomy. Here, we aimed to investigate the potential advantages and disadvantages of laparoscopic left hemicolectomy with IA and compare the short- and medium-term outcomes between IA and extracorporeal anastomosis (EA). METHODS We retrospectively analyzed 133 consecutive patients who underwent laparoscopic left hemicolectomies from July 2016 to September 2019 and categorized them into the IA and EA groups. Patients with stage 4 disease and conversion to laparotomy or those lost to follow-up were excluded. Postoperative outcomes between IA and EA groups were compared. Short-term outcomes included postoperative pain score, bowel function recovery, complications, duration of hospital stay, and pathological outcome. Medium outcomes included overall survival and disease-free survival for at least 2 years. RESULTS After excluding ineligible patients, the remaining 117 underwent IA (n = 40) and EA (n = 77). The IA group had a shorter hospital stay, a shorter time to tolerate liquid or soft diets, and higher serum C-reactive protein level on postoperative day 3. There was no difference between two groups in operative time, postoperative pain, specimen length, or nearest margin. A 2-year overall survival (IA vs. EA: 95.0% vs. 93.5%, p = 0.747) and disease-free survival (IA vs. EA: 97.5% vs. 90.9%, p = 0.182) rates were comparable between two groups. CONCLUSIONS Laparoscopic left hemicolectomy with IA was technically feasible, with better short-term outcomes, including shorter hospital stays and shorter time to tolerate liquid or soft diets. The IA group had higher postoperative serum C-reactive protein level; however, no complications were observed. Regarding medium-term outcomes, the overall survival and disease-free survival rates were comparable between IA and EA procedures.
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Affiliation(s)
- Li-Ming Wang
- Division of Colon and Rectal Surgery, Department of Surgery, Chang Gung Memorial Hospital at Linkou, Chang Gung University College of Medicine, No. 5, Fuxing Street, Guishan District, Taoyuan City, Taiwan
| | - Bor-Kang Jong
- Division of Colon and Rectal Surgery, Department of Surgery, Chang Gung Memorial Hospital at Linkou, Chang Gung University College of Medicine, No. 5, Fuxing Street, Guishan District, Taoyuan City, Taiwan
| | - Chun-Kai Liao
- Division of Colon and Rectal Surgery, Department of Surgery, Chang Gung Memorial Hospital at Linkou, Chang Gung University College of Medicine, No. 5, Fuxing Street, Guishan District, Taoyuan City, Taiwan
| | - Ya-Ting Kou
- Division of Colon and Rectal Surgery, Department of Surgery, Chang Gung Memorial Hospital at Linkou, Chang Gung University College of Medicine, No. 5, Fuxing Street, Guishan District, Taoyuan City, Taiwan
| | - Yih-Jong Chern
- Division of Colon and Rectal Surgery, Department of Surgery, Chang Gung Memorial Hospital at Linkou, Chang Gung University College of Medicine, No. 5, Fuxing Street, Guishan District, Taoyuan City, Taiwan
| | - Yu-Jen Hsu
- Division of Colon and Rectal Surgery, Department of Surgery, Chang Gung Memorial Hospital at Linkou, Chang Gung University College of Medicine, No. 5, Fuxing Street, Guishan District, Taoyuan City, Taiwan
| | - Pao-Shiu Hsieh
- Division of Colon and Rectal Surgery, Department of Surgery, Chang Gung Memorial Hospital at Linkou, Chang Gung University College of Medicine, No. 5, Fuxing Street, Guishan District, Taoyuan City, Taiwan
| | - Wen-Sy Tsai
- Division of Colon and Rectal Surgery, Department of Surgery, Chang Gung Memorial Hospital at Linkou, Chang Gung University College of Medicine, No. 5, Fuxing Street, Guishan District, Taoyuan City, Taiwan
| | - Jeng-Fu You
- Division of Colon and Rectal Surgery, Department of Surgery, Chang Gung Memorial Hospital at Linkou, Chang Gung University College of Medicine, No. 5, Fuxing Street, Guishan District, Taoyuan City, Taiwan.
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27
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O'Connell S, Islam S, Sewell B, Farr A, Knight L, Bashir N, Harries R, Jones S, Cleves A, Fegan G, Watkins A, Torkington J. Hughes abdominal closure versus standard mass closure to reduce incisional hernias following surgery for colorectal cancer: the HART RCT. Health Technol Assess 2022; 26:1-100. [PMID: 35938554 DOI: 10.3310/cmwc8368] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Incisional hernias can cause chronic pain and complications and affect quality of life. Surgical repair requires health-care resources and has a significant associated failure rate. A prospective, multicentre, single-blinded randomised controlled trial was conducted to investigate the clinical effectiveness and cost-effectiveness of the Hughes abdominal closure method compared with standard mass closure following surgery for colorectal cancer. The study randomised, in a 1 : 1 ratio, 802 adult patients (aged ≥ 18 years) undergoing surgical resection for colorectal cancer from 28 surgical departments in UK centres. INTERVENTION Hughes abdominal closure or standard mass closure. MAIN OUTCOME MEASURES The primary outcome was the incidence of incisional hernias at 1 year, as assessed by clinical examination. Within-trial cost-effectiveness and cost-utility analyses over 1 year were conducted from an NHS and a social care perspective. A key secondary outcome was quality of life, and other outcomes included the incidence of incisional hernias as detected by computed tomography scanning. RESULTS The incidence of incisional hernia at 1-year clinical examination was 50 (14.8%) in the Hughes abdominal closure arm compared with 57 (17.1%) in the standard mass closure arm (odds ratio 0.84, 95% confidence interval 0.55 to 1.27; p = 0.4). In year 2, the incidence of incisional hernia was 78 (28.7%) in the Hughes abdominal closure arm compared with 84 (31.8%) in the standard mass closure arm (odds ratio 0.86, 95% confidence interval 0.59 to 1.25; p = 0.43). Computed tomography scanning identified a total of 301 incisional hernias across both arms, compared with 100 identified by clinical examination at the 1-year follow-up. Computed tomography scanning missed 16 incisional hernias that were picked up by clinical examination. Hughes abdominal closure was found to be less cost-effective than standard mass closure. The mean incremental cost for patients undergoing Hughes abdominal closure was £616.45 (95% confidence interval -£699.56 to £1932.47; p = 0.3580). Quality of life did not differ significantly between the study arms at any time point. LIMITATIONS As this was a pragmatic trial, the control arm allowed surgeon discretion in the approach to standard mass closure, introducing variability in the techniques and equipment used. Intraoperative randomisation may result in a loss of equipoise for some surgeons. Follow-up was limited to 2 years, which may not have been enough time to see a difference in the primary outcome. CONCLUSIONS Hughes abdominal closure did not significantly reduce the incidence of incisional hernias detected by clinical examination and was less cost-effective at 1 year than standard mass closure in colorectal cancer patients. Computed tomography scanning may be more effective at identifying incisional hernias than clinical examination, but the clinical benefit of this needs further research. FUTURE WORK An extended follow-up using routinely collected NHS data sets aims to report on incisional hernia rates at 2-5 years post surgery to investigate any potential mortality benefit of the closure methods. Furthermore, the proportion of incisional hernias identified by a computed tomography scan (at 1 and 2 years post surgery), but not during clinical examination (occult hernias), proceeding to surgical repair within 3-5 years after the initial operation will be explored. TRIAL REGISTRATION This trial is registered as ISRCTN25616490. FUNDING This project was funded by the National Institute for Health and Care Research (NIHR) Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 26, No. 34. See the NIHR Journals Library website for further project information.
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Affiliation(s)
- Susan O'Connell
- Cedar Healthcare Technology Research Centre, Cardiff and Vale University Health Board, Cardiff, UK
| | - Saiful Islam
- Swansea Trials Unit, Swansea University, Swansea, UK
| | - Bernadette Sewell
- Swansea Centre for Health Economics, Swansea University, Swansea, UK
| | - Angela Farr
- Swansea Centre for Health Economics, Swansea University, Swansea, UK
| | - Laura Knight
- Cedar Healthcare Technology Research Centre, Cardiff and Vale University Health Board, Cardiff, UK
| | - Nadim Bashir
- Swansea Trials Unit, Swansea University, Swansea, UK
| | - Rhiannon Harries
- Department of Colorectal Surgery, Swansea Bay University Health Board, Swansea, UK
| | | | - Andrew Cleves
- Cedar Healthcare Technology Research Centre, Cardiff and Vale University Health Board, Cardiff, UK
| | - Greg Fegan
- Swansea Trials Unit, Swansea University, Swansea, UK
| | - Alan Watkins
- Swansea Trials Unit, Swansea University, Swansea, UK
| | - Jared Torkington
- Cardiff and Vale University Health Board, University Hospital of Wales, Cardiff, UK
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28
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Gagner M. Alarmists at the Gates: Esophageal Adenocarcinoma after Sleeve Gastrectomy is Not Different than with Other Bariatric/Metabolic Surgeries. Obes Surg 2022. [PMID: 35278190 DOI: 10.1007/s11695-022-05992-3.)] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/23/2023]
Affiliation(s)
- Michel Gagner
- Hôpital du Sacre Coeur, Montreal, Canada.
- Westmount Square Surgical Center, Westmount, Canada.
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29
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Vogelsang RP, Fransgaard T, Falk Klein M, Gögenur I. Long-term oncological outcomes in patients undergoing laparoscopic versus open surgery for colon cancer: A nationwide cohort study. Colorectal Dis 2022; 24:439-448. [PMID: 34905273 DOI: 10.1111/codi.16022] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2021] [Revised: 11/01/2021] [Accepted: 12/07/2021] [Indexed: 02/08/2023]
Abstract
AIM To estimate the effect of laparoscopy versus laparotomy on recurrence status in patients undergoing intended curative resection for stage I-III colon cancer using nationwide data. METHOD A retrospective cohort study using prospectively collected nationwide quality assurance data on all patients undergoing elective, intended curative surgery for UICC stage I-III colon cancer in Denmark from 1 January 2010, through 31 December 2013. The association between laparoscopic versus open surgery and recurrence status was investigated using cause-specific hazard and subdistribution hazard models with death from any cause as a competing event. RESULTS In total, 4369 patients undergoing elective intended curative surgery for colon cancer were included in the analysis. Overall, 3243 (74.2%) patients underwent laparoscopic surgery. During a median follow-up time of 84 months, 1191 (27.2%) patients experienced recurrence, and 1304 (29.8%) patients died. The cause-specific hazard of recurrence following laparoscopic versus open surgery was HRCS = 1.08, 95% CI: 0.90-1.28, p = 0.422. The subdistribution hazard of recurrence following laparoscopic versus open surgery was HRSD =0.99, 95% CI: 0.84-1.16, p = 0.880. CONCLUSION Elective laparoscopic resection for UICC stage I-III colon cancer is oncologically safe and comparable with open resection. These results confirm the external validity of previous RCTs in everyday clinical settings.
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Affiliation(s)
| | - Tina Fransgaard
- Department of Surgery, Center for Surgical Science, Zealand University Hospital, Koege, Denmark
| | - Mads Falk Klein
- Department of Surgery, Herlev University Hospital, Herlev, Denmark
| | - Ismail Gögenur
- Department of Surgery, Center for Surgical Science, Zealand University Hospital, Koege, Denmark.,Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
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30
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Alarmists at the Gates: Esophageal Adenocarcinoma after Sleeve Gastrectomy is Not Different than with Other Bariatric/Metabolic Surgeries. Obes Surg 2022; 32:2457-2459. [PMID: 35278190 DOI: 10.1007/s11695-022-05992-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2022] [Revised: 02/13/2022] [Accepted: 03/07/2022] [Indexed: 12/16/2022]
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31
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Law CK, Stevenson ARL, Solomon M, Hague W, Wilson K, Simes JR, Morton RL. Healthcare Costs of Laparoscopic versus Open Surgery for Rectal Cancer Patients in the First 12 Months: A Secondary Endpoint Analysis of the Australasian Laparoscopic Cancer of the Rectum Trial (ALaCaRT). Ann Surg Oncol 2021; 29:1923-1934. [PMID: 34713371 DOI: 10.1245/s10434-021-10902-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2021] [Accepted: 09/20/2021] [Indexed: 12/31/2022]
Abstract
BACKGROUND Laparoscopic-assisted surgery for rectal cancer is widely used, however the healthcare costs are thought to be higher than for open resection. This secondary endpoint analysis of a randomized controlled trial aimed to evaluate total healthcare costs of laparoscopic-assisted surgery compared with open resection for rectal cancer over a 12-month period. METHODS Patients in the Australasian Laparoscopic Cancer of the Rectum Trial (ALaCaRT) were included in a prospective costing analysis. All healthcare use for the index surgery and hospital admission, readmissions, and follow-up care over 12 months were included. Unit costs were valued in Australian dollars (AUD$) using scheduled Medicare fees and hospital cost weights. The primary outcome was mean per patient cost. Non-parametric bootstrapping with 10,000 replications was undertaken for robustness checks. RESULTS Data from 468 patients indicated that the laparoscopic-assisted surgical procedure incurred a mean cost of AUD$4542 (standard deviation [SD] AUD$1050)-AUD$521 higher than the open procedure mean cost of AUD$4021 (SD AUD$804) due to longer operative time and involvement of more costly equipment (95% confidence interval [CI] AUD$354-AUD$692). At 12 months, the average cost for the laparoscopic-assisted and open groups was AUD$43,288 (SD AUD$40,883) and AUD$45,384 (SD AUD$38,659), respectively, due to the shorter subsequent hospital stays. No overall significant cost difference between groups was found (95% CI -AUD$9358 to AUD$5003). One-way sensitivity analyses confirmed the robustness of the results. CONCLUSION While initially higher, the costs of laparoscopic-assisted surgery for rectal cancer were similar to open resection at 12 months. Clinicians may choose a surgical approach based on clinical need. TRIAL REGISTRATION The Australasian Gastro-Intestinal Trials Group (AGITG) was the legal sponsor and trial coordination was performed by the NHMRC Clinical Trials Centre. The trial was registered with the Australian and New Zealand Clinical Trial Registry (ACTRN12609000663257).
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Affiliation(s)
- Chi Kin Law
- NHMRC Clinical Trials Centre, Medical Foundation Building, University of Sydney, Camperdown, NSW, 2050, Australia.
| | - Andrew R L Stevenson
- Faculty of Medicine, University of Queensland, Brisbane, QLD, Australia.,Department of Colon and Rectal Surgery, Royal Brisbane and Women's Hospital, Brisbane, QLD, Australia.,St Vincent's Private Hospital Northside, Brisbane, QLD, Australia
| | - Michael Solomon
- Department of Colorectal Surgery, Royal Prince Alfred Hospital, Sydney, NSW, Australia.,Surgical Outcomes Research Centre (SOuRCe), Royal Prince Alfred Hospital, University of Sydney and Sydney Local Health District, Sydney, NSW, Australia.,RPA Institute of Academic Surgery, Sydney Local Health District, Sydney, NSW, Australia.,Faculty of Medicine and Health, Central Clinical School, The University of Sydney, Sydney, NSW, Australia
| | - Wendy Hague
- NHMRC Clinical Trials Centre, Medical Foundation Building, University of Sydney, Camperdown, NSW, 2050, Australia
| | - Kate Wilson
- NHMRC Clinical Trials Centre, Medical Foundation Building, University of Sydney, Camperdown, NSW, 2050, Australia
| | - John R Simes
- NHMRC Clinical Trials Centre, Medical Foundation Building, University of Sydney, Camperdown, NSW, 2050, Australia
| | - Rachael L Morton
- NHMRC Clinical Trials Centre, Medical Foundation Building, University of Sydney, Camperdown, NSW, 2050, Australia
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32
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Differences in effectiveness and use of laparoscopic surgery in locally advanced colon cancer patients. Sci Rep 2021; 11:10022. [PMID: 33976338 PMCID: PMC8113575 DOI: 10.1038/s41598-021-89554-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2020] [Accepted: 04/27/2021] [Indexed: 01/20/2023] Open
Abstract
Patients with locally advanced colon cancer have worse outcomes. Guidelines of various organizations are conflicting about the use of laparoscopic colectomy (LC) in locally advanced colon cancer. We determined whether patient outcomes of LC and open colectomy (OC) for locally advanced (T4) colon cancer are comparable in all colon cancer patients, T4a versus T4b patients, obese versus non-obese patients, and tumors located in the ascending, descending, and transverse colon. We used data from the 2013–2015 American College of Surgeons’ National Surgical Quality Improvement Program. Patients were diagnosed with nonmetastatic pT4 colon cancer, with or without obstruction, and underwent LC (n = 563) or OC (n = 807). We used a composite outcome score (mortality, readmission, re-operation, wound infection, bleeding transfusion, and prolonged postoperative ileus); length of stay; and length of operation. Patients undergoing LC exhibited a composite outcome score that was 9.5% lower (95% CI − 15.4; − 3.5) versus those undergoing OC. LC patients experienced a 11.3% reduction in postoperative ileus (95% CI − 16.0; − 6.5) and an average of 2 days shorter length of stay (95% CI − 2.9; − 1.0). Patients undergoing LC were in the operating room an average of 13.5 min longer (95% CI 1.5; 25.6). We found no evidence for treatment heterogeneity across subgroups (p > 0.05). Patients with locally advanced colon cancer who receive LC had better overall outcomes and shorter lengths of stay compared with OC patients. LC was equally effective in obese/nonobese patients, in T4a/T4b patients, and regardless of the location of the tumor.
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The impact of body mass index on outcomes in robotic colorectal surgery: a single-centre experience. J Robot Surg 2021; 16:279-285. [PMID: 33813713 DOI: 10.1007/s11701-021-01235-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2021] [Accepted: 03/29/2021] [Indexed: 12/19/2022]
Abstract
Obesity is an independent risk factor for postoperative morbidity and mortality in laparoscopic colorectal surgery (LCRS). The technological advantages of robotic colorectal surgery (RCRS) may allow surgeons to overcome the limitations of LCRS in obese patients, but it is largely unknown if this translates to superior outcomes. The aim of this study was to compare perioperative, postoperative and short-term oncological outcomes in obese (BMI ≥ 30.0 kg/m2) and non-obese (BMI < 30 kg/m2) patients undergoing RCRS in a university teaching hospital. Demographic, perioperative and postoperative data along with short-term oncological outcomes of obese and non-obese patients that underwent RCRS for both benign and malignant colorectal disease were identified from a prospectively maintained database. A total of 107 patients (34 obese, 73 non-obese) underwent RCRS over a 4-year period. No statistically significant differences in the incidence of complications, 30-day reoperation, 30-day mortality, conversion to open surgery, anastomotic leak or length of inpatient stay were demonstrated. Obese patients had a significantly higher rate of surgical site infection (SSI) (p < 0.0001). Short-term oncological outcomes in both groups were favourable. There was no statistically significant difference in median duration of surgery between the two cohorts. The results demonstrate that obese patients undergoing RCRS in this institution experience similar outcomes to non-obese patients. These results suggest that RCRS is safe and feasible in obese patients and may be superior to LCRS in this cohort, where the literature suggests a higher complication rate compared to non-obese patients. The inherent advantages of robotic surgical platforms, such as improved visualisation, dexterity and ergonomics likely contribute to the improved outcomes in this challenging patient population.
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34
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Larach JT, Flynn J, Kong J, Waters PS, McCormick JJ, Murphy D, Stevenson A, Warrier SK, Heriot AG. Robotic colorectal surgery in Australia: evolution over a decade. ANZ J Surg 2021; 91:2330-2336. [PMID: 33438361 DOI: 10.1111/ans.16554] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2020] [Revised: 12/24/2020] [Accepted: 12/24/2020] [Indexed: 12/13/2022]
Abstract
BACKGROUND Despite reports of increasing adoption of robotics in colorectal surgery worldwide, data regarding its uptake in Australasia are lacking. This study examines the trends of robotic colorectal surgery in Australia during the last 10 years. METHODS Data from patients undergoing robotic colorectal surgery with the da Vinci robotic platform between 2010 and 2019 were obtained. Overall, numbers of specific colorectal procedures across Australia were obtained from the Medicare Benefit Schedule data over the same period. Pearson's correlation analysis was used to determine the statistical trends of overall and specific robotic colorectal procedures over time. RESULTS A total of 6110 robotic general surgery procedures were performed across Australia during the study period. Of these, 3522 (57.6%) were robotic colorectal procedures. An increasing trend of overall robotic colorectal procedures was seen over 10 years (Pearson's coefficient of 0.875; P = 0.001). While this applied to both the public and private sectors, 90.7% of the procedures were undertaken in the private sector. Restorative rectal resections, rectopexies, and right hemicolectomies accounted for 82.6% of the robotic colorectal procedures performed during this period with an increasing trend seen over time for each intervention. Moreover, a robotic approach was utilized in 12.5%, 41.0% and 9.0% of all restorative rectal resections, rectopexies and right hemicolectomies undertaken in Australia during 2019, respectively. CONCLUSION Robotic colorectal surgery has increased dramatically in Australia over the last 10 years, especially in the private sector. Penetration of robotic colorectal surgery in the public healthcare system will require focussed cost-benefit evaluations and governmental investment.
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Affiliation(s)
- José Tomás Larach
- Division of Cancer Surgery, Peter MacCallum Cancer Centre, Victorian Comprehensive Cancer Centre, Melbourne, Victoria, Australia.,Division of Cancer Research, Peter MacCallum Cancer Centre, Victorian Comprehensive Cancer Centre, Melbourne, Victoria, Australia.,Sir Peter MacCallum Department of Oncology, University of Melbourne, Melbourne, Victoria, Australia.,Department of Digestive Surgery, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Julie Flynn
- Division of Cancer Surgery, Peter MacCallum Cancer Centre, Victorian Comprehensive Cancer Centre, Melbourne, Victoria, Australia.,Division of Cancer Research, Peter MacCallum Cancer Centre, Victorian Comprehensive Cancer Centre, Melbourne, Victoria, Australia.,Sir Peter MacCallum Department of Oncology, University of Melbourne, Melbourne, Victoria, Australia.,General Surgery and Gastrointestinal Clinical Institute, Epworth Healthcare, Melbourne, Victoria, Australia
| | - Joseph Kong
- Division of Cancer Surgery, Peter MacCallum Cancer Centre, Victorian Comprehensive Cancer Centre, Melbourne, Victoria, Australia.,Division of Cancer Research, Peter MacCallum Cancer Centre, Victorian Comprehensive Cancer Centre, Melbourne, Victoria, Australia.,Sir Peter MacCallum Department of Oncology, University of Melbourne, Melbourne, Victoria, Australia
| | - Peadar S Waters
- Division of Cancer Surgery, Peter MacCallum Cancer Centre, Victorian Comprehensive Cancer Centre, Melbourne, Victoria, Australia.,Division of Cancer Research, Peter MacCallum Cancer Centre, Victorian Comprehensive Cancer Centre, Melbourne, Victoria, Australia.,Sir Peter MacCallum Department of Oncology, University of Melbourne, Melbourne, Victoria, Australia
| | - Jacob J McCormick
- Division of Cancer Surgery, Peter MacCallum Cancer Centre, Victorian Comprehensive Cancer Centre, Melbourne, Victoria, Australia.,Division of Cancer Research, Peter MacCallum Cancer Centre, Victorian Comprehensive Cancer Centre, Melbourne, Victoria, Australia.,Sir Peter MacCallum Department of Oncology, University of Melbourne, Melbourne, Victoria, Australia.,General Surgery and Gastrointestinal Clinical Institute, Epworth Healthcare, Melbourne, Victoria, Australia
| | - Declan Murphy
- Division of Cancer Surgery, Peter MacCallum Cancer Centre, Victorian Comprehensive Cancer Centre, Melbourne, Victoria, Australia.,Division of Cancer Research, Peter MacCallum Cancer Centre, Victorian Comprehensive Cancer Centre, Melbourne, Victoria, Australia.,Sir Peter MacCallum Department of Oncology, University of Melbourne, Melbourne, Victoria, Australia.,General Surgery and Gastrointestinal Clinical Institute, Epworth Healthcare, Melbourne, Victoria, Australia
| | - Andrew Stevenson
- Royal Brisbane and Women's Hospital, University of Queensland, Brisbane, Queensland, Australia
| | - Satish K Warrier
- Division of Cancer Surgery, Peter MacCallum Cancer Centre, Victorian Comprehensive Cancer Centre, Melbourne, Victoria, Australia.,Division of Cancer Research, Peter MacCallum Cancer Centre, Victorian Comprehensive Cancer Centre, Melbourne, Victoria, Australia.,Sir Peter MacCallum Department of Oncology, University of Melbourne, Melbourne, Victoria, Australia.,General Surgery and Gastrointestinal Clinical Institute, Epworth Healthcare, Melbourne, Victoria, Australia
| | - Alexander G Heriot
- Division of Cancer Surgery, Peter MacCallum Cancer Centre, Victorian Comprehensive Cancer Centre, Melbourne, Victoria, Australia.,Division of Cancer Research, Peter MacCallum Cancer Centre, Victorian Comprehensive Cancer Centre, Melbourne, Victoria, Australia.,Sir Peter MacCallum Department of Oncology, University of Melbourne, Melbourne, Victoria, Australia.,General Surgery and Gastrointestinal Clinical Institute, Epworth Healthcare, Melbourne, Victoria, Australia
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35
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Law CK, Brewer K, Brown C, Wilson K, Bailey L, Hague W, Simes JR, Stevenson A, Solomon M, Morton RL. Return to work following laparoscopic-assisted resection or open resection for rectal cancer: Findings from AlaCaRT-Australasian Laparoscopic Cancer of the Rectum Trial. Cancer Med 2021; 10:552-562. [PMID: 33280266 PMCID: PMC7877361 DOI: 10.1002/cam4.3623] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2020] [Revised: 10/27/2020] [Accepted: 10/28/2020] [Indexed: 01/02/2023] Open
Abstract
BACKGROUND Maintaining employment for adults with cancer is important, however, little is known about the impact of surgery for rectal cancer on an individual's capacity to return to work (RTW). This study aimed to determine the impact of laparoscopic vs. open resection on RTW at 12 months. METHODS Analyses were undertaken among participants randomized in the Australian Laparoscopic Cancer of the Rectum Trial (ALaCaRT), with work status available at baseline (presurgery), and 12 months. Multivariable logistic regression, adjusted for sociodemographic and clinical characteristics estimated the effect of surgery on RTW in any capacity, or return to preoperative work status at 12 months. RESULTS About 228 of 449 (51%) surviving trial participants at 12 months completed work status questionnaires; mean age was 62 years, 66% males, 117 of these received laparoscopic resection (51%). Of 228, 120 were employed at baseline (90 full-time, 30 part-time). Overall RTW in 120 participants in paid work at baseline was 78% (84% laparoscopic, 70% open surgery). Those employed full-time were more likely to RTW at 12 months (OR, 3.55; 95% CI, 1.02-12.31). Those with distant metastases at baseline were less likely to RTW (OR, 0.07; 95% CI, <0.01-0.83). Laparoscopic surgery was associated with a higher rate of RTW but did not reach statistical significance (OR 2.88; 95% CI, 0.95-8.76). CONCLUSIONS Full-time work presurgery and the presence of metastatic disease predicts RTW status at 12 months. A laparoscopic-assisted surgical approach to rectal cancer may facilitate more patients to RTW, however, larger sample sizes are likely needed to confirm this result.
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Affiliation(s)
- Chi Kin Law
- NHMRC Clinical Trials CentreThe University of SydneyCamperdownNSWAustralia
| | - Kate Brewer
- NHMRC Clinical Trials CentreThe University of SydneyCamperdownNSWAustralia
| | - Chris Brown
- NHMRC Clinical Trials CentreThe University of SydneyCamperdownNSWAustralia
| | - Kate Wilson
- NHMRC Clinical Trials CentreThe University of SydneyCamperdownNSWAustralia
| | - Lisa Bailey
- NHMRC Clinical Trials CentreThe University of SydneyCamperdownNSWAustralia
| | - Wendy Hague
- NHMRC Clinical Trials CentreThe University of SydneyCamperdownNSWAustralia
| | - John R. Simes
- NHMRC Clinical Trials CentreThe University of SydneyCamperdownNSWAustralia
| | - Andrew Stevenson
- Faculty of Medicine and Biomedical SciencesUniversity of QueenslandHerstonQldAustralia
| | - Michael Solomon
- Institute of Academic SurgeryRoyal Prince Alfred HospitalUniversity of SydneySydneyNSWAustralia
| | - Rachael L. Morton
- NHMRC Clinical Trials CentreThe University of SydneyCamperdownNSWAustralia
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36
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Favorable short-term oncologic outcomes following laparoscopic surgery for small T4 colon cancer: a multicenter comparative study. World J Surg Oncol 2020; 18:299. [PMID: 33187538 PMCID: PMC7666454 DOI: 10.1186/s12957-020-02074-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2020] [Accepted: 10/29/2020] [Indexed: 12/14/2022] Open
Abstract
Background Laparoscopic surgery for T4 colon cancer may be safe in selected patients. We hypothesized that small tumor size might preoperatively predict a good laparoscopic surgery outcome. Herein, we compared the clinicopathologic and oncologic outcomes of laparoscopic and open surgery in small T4 colon cancer. Methods In a retrospective multicenter study, we reviewed the data of 449 patients, including 117 patients with tumors ≤ 4.0 cm who underwent surgery for T4 colon cancer between January 2014 and December 2017. We compared the clinicopathologic and 3-year oncologic outcomes between the laparoscopic and open groups. Survival curves were estimated using the Kaplan–Meier method and compared using the log-rank test. Univariate and multivariate analyses were performed using the Cox proportional hazards model. A p < 0.05 was considered statistically significant. Results Blood loss, length of hospital stay, and postoperative morbidity were lower in the laparoscopic group than in the open group (median [range], 50 [0–700] vs. 100 [0–4000] mL, p < 0.001; 8 vs. 10 days, p < 0.001; and 18.0 vs. 29.5%, p = 0.005, respectively). There were no intergroup differences in 3-year overall survival or disease-free survival (86.6 vs. 83.2%, p = 0.180, and 71.7 vs. 75.1%, p = 0.720, respectively). Among patients with tumor size ≤ 4.0 cm, blood loss was significantly lower in the laparoscopic group than in the open group (median [range], 50 [0–530] vs. 50 [0–1000] mL, p = 0.003). Despite no statistical difference observed in the 3-year overall survival rate (83.3 vs. 78.7%, p = 0.538), the laparoscopic group had a significantly higher 3-year disease-free survival rate (79.2 vs. 53.2%, p = 0.012). Conclusions Laparoscopic surgery showed similar outcomes to open surgery in T4 colon cancer patients and may have favorable short-term oncologic outcomes in patients with tumors ≤ 4.0 cm. Supplementary Information The online version contains supplementary material available at 10.1186/s12957-020-02074-5.
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Chakrabarti S, Peterson CY, Sriram D, Mahipal A. Early stage colon cancer: Current treatment standards, evolving paradigms, and future directions. World J Gastrointest Oncol 2020; 12:808-832. [PMID: 32879661 PMCID: PMC7443846 DOI: 10.4251/wjgo.v12.i8.808] [Citation(s) in RCA: 70] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2020] [Revised: 05/16/2020] [Accepted: 08/01/2020] [Indexed: 02/05/2023] Open
Abstract
Colon cancer continues to be one of the leading causes of mortality and morbidity throughout the world despite the availability of reliable screening tools and effective therapies. The majority of patients with colon cancer are diagnosed at an early stage (stages I to III), which provides an opportunity for cure. The current treatment paradigm of early stage colon cancer consists of surgery followed by adjuvant chemotherapy in a select group of patients, which is directed at the eradication of minimal residual disease to achieve a cure. Surgery alone is curative for the vast majority of colon cancer patients. Currently, surgery and adjuvant chemotherapy can achieve long term survival in about two-thirds of colon cancer patients with nodal involvement. Adjuvant chemotherapy is recommended for all patients with stage III colon cancer, while the benefit in stage II patients is not unequivocally established despite several large clinical trials. Contemporary research in early stage colon cancer is focused on minimally invasive surgical techniques, strategies to limit treatment-related toxicities, precise patient selection for adjuvant therapy, utilization of molecular and clinicopathologic information to personalize therapy and exploration of new therapies exploiting the evolving knowledge of tumor biology. In this review, we will discuss the current standard treatment, evolving treatment paradigms, and the emerging biomarkers, that will likely help improve patient selection and personalization of therapy leading to superior outcomes.
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Affiliation(s)
- Sakti Chakrabarti
- Division of Hematology/Oncology, Medical College of Wisconsin, Milwaukee, WI 53226, United States
| | - Carrie Y Peterson
- Department of Surgery, Medical College of Wisconsin, Milwaukee, WI 53226, United States
| | - Deepika Sriram
- Division of Hematology/Oncology, Medical College of Wisconsin, Milwaukee, WI 53226, United States
| | - Amit Mahipal
- Division of Medical Oncology, Mayo Clinic, Rochester, MN 55905, United States
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Brown RF, Cleary RK. Intracorporeal anastomosis versus extracorporeal anastomosis for minimally invasive colectomy. J Gastrointest Oncol 2020; 11:500-507. [PMID: 32655928 DOI: 10.21037/jgo.2019.12.02] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
Outcomes advantages for the minimally invasive approach to colon and rectal surgery have been clearly described since the original report of a laparoscopic colectomy in 1991. Advancements in minimally invasive options for colon and rectal surgery have produced the need for critical evaluation of alternative and evolving techniques. The evolution and increased adoption of the minimally invasive robotic platform has allowed the intracorporeal anastomosis, previously described with the laparoscopic approach, to be more widely available to surgeon skill sets because of robotic articulating instruments and ergonomic advantages. Studies comparing intra- and extracorporeal techniques for laparoscopic right colectomy have demonstrated some outcomes advantages for the intracorporeal approach that include fewer conversions-to-open, fewer postoperative complications, and shorter hospital length of stay. Recent robotic-assisted comparisons have also shown an intracorporeal advantage and have extended the analysis to left-sided colorectal resections. Further upgrades in minimally invasive options and techniques warrant further evidence-based considerations for surgeons choosing between these options and techniques.
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Affiliation(s)
- Rebecca F Brown
- Department of Colon and Rectal Surgery, St. Joseph Mercy Ann Arbor Hospital, Ann Arbor, MI, USA
| | - Robert K Cleary
- Department of Colon and Rectal Surgery, St. Joseph Mercy Ann Arbor Hospital, Ann Arbor, MI, USA
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Implementation of intracorporeal anastomosis in laparoscopic right colectomy is safe and associated with a shorter hospital stay. Updates Surg 2020; 73:93-100. [PMID: 32607844 DOI: 10.1007/s13304-020-00840-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2020] [Accepted: 06/21/2020] [Indexed: 10/24/2022]
Abstract
Reconstruction after laparoscopic right colectomy (LRC) can be achieved by performing an intracorporeal (IA) or an extracorporeal anastomosis (EA). This study aims to assess the safety of implementing IA in LRC, and to compare its perioperative outcomes with EA during an institution's learning curve. Patients undergoing elective LRC with IA or EA in a teaching university hospital between January 2015 and December 2018 were included. Demographic, clinical, perioperative and histopathological data were collated and outcomes investigated. One hundred and twenty-two patients were included; forty-three (35.2%) had an IA. The main indication for surgery was cancer in both groups (83.7% for IA and 79.8% for EA; p = 0.50). Operative time was longer for IA (180 [150-205] versus 150 [120-180] minutes; p < 0.001). A Pfannenstiel incision was used as extraction site in 97.7% of patients receiving an IA; while a midline incision was used in 97.5% of patients having an EA (p < 0.001). Hospital stay was significantly shorter for IA (3 [3, 4] versus 4 [3-6] days; p = 0.003). There were no differences in postoperative complications rates between groups. There was a 4.7% and 3.8% anastomotic leak rate in the IA and EA group, respectively (p = 1). Re-intervention and readmission rates were similar between groups, and there was no mortality during the study period. The implementation of IA in LRC is safe. Despite longer operative times, IA is associated with a shorter hospital stay when compared to EA in the setting of an institution's learning curve.
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Factors influencing the application of transrectal natural orifice specimen extraction performed laparoscopically for colorectal cancer: A retrospective study. Asian J Surg 2020; 44:164-168. [PMID: 32513636 DOI: 10.1016/j.asjsur.2020.04.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2020] [Revised: 04/22/2020] [Accepted: 04/30/2020] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND A few factors influence the feasibility of transrectal natural orifice specimen extraction (NOSE) surgery for colorectal cancers. However, little is known about the underlying factors of NOSE surgery. METHODS Consecutive patients with rectal and sigmoid colon cancers treated laparoscopically between January 2014 and April 2017 were enrolled in this study. The transrectal NOSE performed laparoscopically was the first choice of all patients. When NOSE failed, the specimen was removed through a midline abdominal wall incision. Univariate and multivariate logistic regression analyses were performed to identify challenging factors influencing the intraoperative specimen extraction. RESULTS Overall, 412 consecutive patients were included. NOSE performed laparoscopically was successful in 278 patients (75.5%) and unsuccessful in 90 patients (24.5%). The multivariate analyses indicated that body mass index (BMI; odds ratio [OR] = 3.510, 95% confidence interval [CI]: 1.333-9.243, p = 0.011), mesenteric thickness (OR = 1.069, 95% CI: 1.032-1.107, p < 0.001), maximum tumor diameter (OR = 2.827, 95% CI: 1.094-7.302, p = 0.032), and tumor T stage (OR = 2.831, 95% CI: 1.258-6.369, p = 0.012) were the factors influencing the feasibility of NOSE surgery. CONCLUSION A successful transrectal NOSE surgery was associated with a lower BMI, thinner mesentery, lesser tumor diameter, and earlier tumor T stage.
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Intracorporeal Anastomoses in Minimally Invasive Right Colectomies Are Associated With Fewer Incisional Hernias and Shorter Length of Stay. Dis Colon Rectum 2020; 63:685-692. [PMID: 32168093 PMCID: PMC7148181 DOI: 10.1097/dcr.0000000000001612] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
BACKGROUND Intracorporeal anastomosis is associated with several short-term benefits. However, it is a technically challenging procedure with potential risk OBJECTIVE:: The purpose of this study was to investigate differences in short-term complications and long-term incisional hernia rates after robotic right colectomy with intracorporeal versus extracorporeal anastomoses and standardized extraction sites. DESIGN This was a historical cohort study. SETTINGS The study was conducted at a single institution. PATIENTS All of the patients undergoing robotic right colectomy with intracorporeal anastomosis and a Pfannenstiel extraction site or extracorporeal anastomosis with a vertical midline extraction site from 2013 to 2017 were eligible. Exclusion criteria were conversion to laparotomy for tumor-related reasons or lack of follow-up. INTERVENTION Intracorporeal or extracorporeal anastomosis was performed, based on availability of the robotic stapler and appropriate bedside assistance. MAIN OUTCOME MEASURES The primary outcome was incisional hernia, diagnosed either clinically or on postoperative imaging, and analyzed using time-to-event analysis. A Cox proportional hazards model was used for multivariable analysis. Secondary outcomes were analyzed using parametric and nonparametric tests. Statistical significance was set at p < 0.05. RESULTS Of 164 patients who met all inclusion criteria, 67 had intracorporeal and 97 had extracorporeal anastomoses. Median follow-up time was similar in both groups (14 vs 15 mo; p = 0.73). The 1-year estimated incisional hernia rate was 12% for extracorporeal and 2% for intracorporeal anastomoses (p = 0.007); this difference was confirmed by multivariable modeling. The severity of postoperative complications was similar between the groups, but there was an increase in incisional infections and a shorter length of stay (1 day) for intracorporeal cases. LIMITATIONS The study was limited by its retrospective, single-surgeon nature. CONCLUSIONS Right colectomy with intracorporeal anastomosis and a Pfannenstiel extraction site may reduce the rate of incisional hernias compared with extracorporeal anastomosis with a vertical midline extraction site. The intracorporeal approach was also associated with a decreased length of stay but an increase in incisional surgical site infections. These findings have implications for healthcare use and patient-centered outcomes. See Video Abstract at http://links.lww.com/DCR/B147. ANASTOMOSIS INTRACORPÓREAS EN COLECTOMÍAS DERECHAS MÍNIMAMENTE INVASIVAS SE ASOCIAN CON MENOS HERNIAS INCISIONALES Y UNA ESTADÍA HOSPITALARIA MÁS BREVE: nastomosis intracorpórea se asocia con varios beneficios a corto plazo. Sin embargo, es un procedimiento técnicamente desafiante con riesgos potenciales.nvestigar las diferencias en las complicaciones a corto plazo y las tasas de hernia incisional a largo plazo después de la colectomía robótica derecha con anastomosis intracorpórea versus extracorpórea y sitios de extracción estandarizados.Estudio de cohorte histórico.cirujano individual, institución única.Todos los pacientes sometidos a colectomía robótica derecha con anastomosis intracorpórea y un sitio de extracción de Pfannenstiel o anastomosis extracorpórea con un sitio de extracción vertical de la línea media de 2013-2017 fueron elegibles. Los criterios de exclusión fueron la conversión a laparotomía por razones relacionadas con el tumor o la falta de seguimiento.nastomosis intracorpórea o extracorpórea, según la disponibilidad de grapadora robótica y la asistencia adecuada quirúrgica.El resultado primario fue la hernia incisional, diagnosticada clínicamente o en imágenes postoperatorias, y analizada mediante análisis de tiempo hasta el evento. Se usó un modelo de riesgos proporcionales de Cox para el análisis multivariable. Los resultados secundarios se analizaron mediante pruebas paramétricas y no paramétricas. La significación estadística se estableció en p < 0,05.De 164 pacientes que cumplieron con todos los criterios de inclusión, 67 tenían anastomosis intracorpóreas y 97 tenían anastomosis extracorpóreas. La mediana del tiempo de seguimiento fue similar en ambos grupos (14 versus 15 meses, p = 0,73). La tasa de hernia incisional estimada para un año fue del 12% para las anastomosis extracorpóreas y del 2% para las anastomosis intracorpóreas (p = 0,007); esta diferencia fue confirmada por el modelado multivariable. La gravedad de las complicaciones postoperatorias fue similar entre los grupos, pero hubo un aumento de las infecciones incisionales y una estancia más corta (un día) para los casos intracorpóreos.Retrospectiva, cirujano único.a colectomía derecha con anastomosis intracorpórea y un sitio de extracción de Pfannenstiel puede reducir la tasa de hernias incisionales en comparación con la anastomosis extracorpórea con un sitio de extracción vertical en la línea media. El enfoque intracorpóreo también se asoció con una disminución de la duración de la estadía, pero con un aumento de las infecciones del sitio quirúrgico incisional. Estos hallazgos tienen implicaciones para la utilización de recursos médicos y beneficios para pacientes. Consulte Video Resumen en http://links.lww.com/DCR/B147. (Traducción-Dr. Adrian Ortega).
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Qiu H, Yu D, Ye S, Shan R, Ai J, Shi J. Long-term oncological outcomes in robotic versus laparoscopic approach for rectal cancer: A systematic review and meta-analysis. Int J Surg 2020; 80:225-230. [PMID: 32251720 DOI: 10.1016/j.ijsu.2020.03.009] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2019] [Revised: 03/02/2020] [Accepted: 03/05/2020] [Indexed: 12/16/2022]
Abstract
BACKGROUND Short-term outcomes of robotic mesorectal excision for rectal cancer resection seem comparable to those of conventional laparoscopic mesorectal excision. However, the long-term oncological outcomes of robot mesorectal excision require further investigation. MATERIALS AND METHODS The PubMed, EMBASE, Medline, and Cochrane Library databases were searched from the date of database inception to March 31, 2019 for all available trials; the results of robotic and laparoscopic mesorectal excision for rectal cancer surgery were compared. Survival parameters, including overall survival (OS) and disease-free survival (DFS), were independently extracted by two investigators. Hazard ratios (HRs) were calculated using random- or fixed-effects models. The presence of heterogeneity was assessed using Q test, and the extent of heterogeneity was quantified by I2 index. The meta-analysis was performed using Review Manager software, version 5.3. RESULTS A total of seven studies including 2593 patients (1362 treated by robotic mesorectal excision and 1231 by laparoscopic mesorectal excision) were included. Pooled analyses showed no significant difference in OS (HR = 0.94, 95% confidence interval [CI]: 0.63 to 1.39, P = 0.75) or DFS (HR = 0.93, 95% CI: 0.79 to 1.10, P = 0.85) between the robotic and laparoscopic mesorectal excision for treatment of rectal cancer. CONCLUSION Regarding long-term survival, robotic mesorectal excision for rectal cancer is comparable to laparoscopic mesorectal excision. More prospective, multicenter randomized trials with longer follow-up periods are needed to determine the long-term outcomes of patients undergoing robotic mesorectal excision.
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Affiliation(s)
- Hua Qiu
- Department of General Surgery, First Affiliated Hospital of Nanchang University, Nanchang, 330006, Jiangxi Province, China; Jiangxi Medical College of Nanchang University, Nanchang University Health Science Center, Nanchang, 330006, Jiangxi Province, China
| | - Dongjun Yu
- Department of Anesthesiology, First Affiliated Hospital of Nanchang University, Nanchang, 330006, Jiangxi Province, China
| | - Shanping Ye
- Department of General Surgery, First Affiliated Hospital of Nanchang University, Nanchang, 330006, Jiangxi Province, China; Jiangxi Medical College of Nanchang University, Nanchang University Health Science Center, Nanchang, 330006, Jiangxi Province, China
| | - Renfeng Shan
- Department of General Surgery, First Affiliated Hospital of Nanchang University, Nanchang, 330006, Jiangxi Province, China
| | - Junhua Ai
- Department of General Surgery, First Affiliated Hospital of Nanchang University, Nanchang, 330006, Jiangxi Province, China
| | - Jun Shi
- Department of General Surgery, First Affiliated Hospital of Nanchang University, Nanchang, 330006, Jiangxi Province, China.
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Laparoscopic Compared With Open Resection for Colorectal Cancer and Long-term Incidence of Adhesional Intestinal Obstruction and Incisional Hernia: A Systematic Review and Meta-analysis. Dis Colon Rectum 2020; 63:101-112. [PMID: 31804272 DOI: 10.1097/dcr.0000000000001540] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
BACKGROUND Incisional hernia and adhesional intestinal obstruction are important complications of laparoscopic and open resection for colorectal cancer. This is the largest systematic review of comparative studies on this topic. OBJECTIVE This study aimed to investigate whether laparoscopic surgery decreases the incidence of incisional hernia and adhesional intestinal obstruction compared to open surgery for colorectal cancer. DATA SOURCES Online databases PubMed, EMBASE, and the Cochrane Library were searched. Abstracts from the annual meetings of the American Society of Colon and Rectal Surgeons and the European Society of Coloproctology were performed to cover gray literature. STUDY SELECTION We included both randomized and nonrandomized comparative studies. INTERVENTIONS Laparoscopic resection was compared to open resection for patients with colorectal cancer. MAIN OUTCOMES MEASURES The primary outcomes measured were incisional hernia and adhesional intestinal obstruction. RESULTS Fifteen studies met inclusion criteria (6 randomized comparative studies/9 nonrandomized comparative studies); 84,172 patients. Meta-analysis showed decreased odds of developing incisional hernia in the laparoscopic cohort (OR, 0.79; 95% CI, 0.66-0.95; p = 0.01) but no difference in requirement for surgery (OR, 1.07; 95% CI, 0.64-1.79; p = 0.79). Similarly, there were decreased odds of developing adhesional intestinal obstruction in the laparoscopic cohort (OR, 0.81; 95% CI, 0.72-0.92, p = 0.001), but no difference in requirement for surgery (OR, 0.84; 95% CI, 0.53-1.35; p = 0.48). LIMITATIONS Incisional hernia and adhesional intestinal obstruction were poorly defined in many studies. CONCLUSION Laparoscopic surgery is associated with decreased odds of incisional hernias and adhesional intestinal obstructions compared with open surgery for colorectal cancer.
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Dean HF, Carter F, Francis NK. Modern perioperative medicine - past, present, and future. Innov Surg Sci 2019; 4:123-131. [PMID: 33977121 PMCID: PMC8059350 DOI: 10.1515/iss-2019-0014] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2019] [Accepted: 09/16/2019] [Indexed: 12/11/2022] Open
Abstract
Modern perioperative medicine has dramatically altered the care for patients undergoing major surgery. Anaesthetic and surgical practice has been directed at mitigating the surgical stress response and reducing physiological insult. The development of standardised enhanced recovery programmes combined with minimally invasive surgical techniques has lead to reduction in length of stay, morbidity, costs, and improved outcomes. The enhanced recovery after surgery (ERAS) society and its national chapters provide a means for sharing best practice in this field and developing evidence based guidelines. Research has highlighted persisting challenges with compliance as well as ensuring the effectiveness and sustainability of ERAS. There is also a growing need for increasingly personalised care programmes as well as complex geriatric assessment of frailer patients. Continuous collection of outcome and process data combined with machine learning, offers a potentially powerful solution to delivering bespoke care pathways and optimising individual management. Long-term data from ERAS programmes remain scarce and further evaluation of functional recovery and quality of life is required.
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Affiliation(s)
- Harry F. Dean
- Department of General Surgery, Yeovil District Hospital, Higher Kingston, Yeovil, UK
| | - Fiona Carter
- Enhanced Recovery after Surgery Society (UK) c.i.c., Yeovil, UK
| | - Nader K. Francis
- Department of General Surgery, Yeovil District Hospital, Higher Kingston, Yeovil BA21 4AT, UK
- Enhanced Recovery after Surgery Society (UK) c.i.c., Yeovil BA20 2RH, UK
- School of Social and Community Medicine, University of Bristol, Canynge Hall, 39 Whatley Road, Bristol BS8 2PS, UK, Tel.: (01935) 384244
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Li W, Dong B, Peng B, Lu J, Wu Z, Li G, Cao J. Glove single-port laparoscopy-assisted transanal total mesorectal excision for low rectal cancer: a preliminary report. World J Surg Oncol 2019; 17:202. [PMID: 31785614 PMCID: PMC6885307 DOI: 10.1186/s12957-019-1744-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2019] [Accepted: 11/06/2019] [Indexed: 11/10/2022] Open
Abstract
PURPOSE Glove single-port laparoscopy-assisted transanal total mesorectal excision (TaTME) has been successfully carried out in our medical center. The purpose of this study is to evaluate the feasibility of this emerging operation. METHODS This technique was performed by self-made glove single-port laparoscopic platform to radically resect low rectal cancer. Short-term postoperative results, including complications, length of hospital stay, and follow-up results were collected and analyzed statistically. RESULTS There are five consecutive patients (three males, two females) who underwent this surgery and included in this study. The mean distance from the tumor to the anal verge was 4.8 cm (range 4.0-6.0). The surgery was completed in all cases, and the rectal tumor was removed successfully without conversion; circumferential margins of all the excised specimens were negative. The mean time of operation was 338.00 min (range 280-400). The average number of lymph node dissection was 12.20. The average postoperative hospital stay was 8.60 days. During the follow-up (14.80 ± 1.92 months), all preventive ileostomies were successfully closed in about 3 months after the surgery, all patients had satisfactory anal function, and no tumor recurrence was found. CONCLUSION Glove single-port laparoscopy-assisted TaTME has a significant effect in specific patients with low rectal cancer, with rapid recovery and high safety. Prospective randomized studies involving more case counts and long-term follow-up results, especially oncologic outcomes, are needed to validate this technique.
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Affiliation(s)
- Wanglin Li
- Department of Colorectal Surgery, Guangzhou First People's Hospital, School of Medicine, South China University of Technology, No.1 Panfu Road, Guangzhou, 510180, Guangdong, China.
| | - Boye Dong
- Department of Gastrointestinal Surgery, Shunde Hospital of Southern Medical University, Shunde, Foshan, China
| | - Baifu Peng
- Department of Colorectal Surgery, Guangzhou First People's Hospital, Guangzhou Medical University, School of Medicine, Guangzhou, Guangdong, China
| | - Jiabao Lu
- Department of Colorectal Surgery, Guangzhou First People's Hospital, Guangzhou Medical University, School of Medicine, Guangzhou, Guangdong, China
| | - Zixin Wu
- Department of Colorectal Surgery, Guangzhou First People's Hospital, School of Medicine, South China University of Technology, No.1 Panfu Road, Guangzhou, 510180, Guangdong, China
| | - Guanwei Li
- Department of Colorectal Surgery, Guangzhou First People's Hospital, School of Medicine, South China University of Technology, No.1 Panfu Road, Guangzhou, 510180, Guangdong, China
| | - Jie Cao
- Department of Colorectal Surgery, Guangzhou First People's Hospital, School of Medicine, South China University of Technology, No.1 Panfu Road, Guangzhou, 510180, Guangdong, China.
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Kim SI, Lee M, Lee S, Suh DH, Kim HS, Kim K, Chung HH, No JH, Kim JW, Park NH, Song YS, Kim YB. Impact of laparoscopic radical hysterectomy on survival outcome in patients with FIGO stage IB cervical cancer: A matching study of two institutional hospitals in Korea. Gynecol Oncol 2019; 155:75-82. [PMID: 31383569 DOI: 10.1016/j.ygyno.2019.07.019] [Citation(s) in RCA: 44] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2019] [Revised: 07/18/2019] [Accepted: 07/18/2019] [Indexed: 12/24/2022]
Abstract
OBJECTIVE To compare survival outcomes of primary laparoscopic radical hysterectomy (LRH) and open radical hysterectomy (ORH) in patients with FIGO stage IB cervical cancer. METHODS We retrospectively identified stage IB1-IB2 cervical cancer patients who received either LRH (n = 343) or ORH (n = 222) at two tertiary institutional hospitals between 2000 and 2018. To adjust for confounders, we conducted Mahalanobis distance-based sample matching for stage, histology, cervical mass size, parametrial invasion, and lymph node metastasis. Then, survival outcomes were compared between the matched groups. Through the independent matching processes, we narrowed the study population to stage IB1 patients and stage IB1 patients with tumor size ≤2 cm on pre-operative MRI. RESULTS After matching, LRH group showed poorer progression-free survival (PFS) than ORH group (3-year: 85.4% vs. 91.8%; P = 0.036), whereas no significant difference in overall survival (OS) was found. Regarding recurrence patterns, no significant differences in the incidences of pelvic, retroperitoneal lymph node and abdominal recurrences, or distant metastasis were observed between the two groups. Among the matched patients with stage IB1 who had cervical mass size ≤2 cm, the LRH and ORH groups showed similar PFS (3-year: 90.0% vs. 93.1%; P = 0.8) and OS (5-year: 98.6% vs. 96.4%; P = 0.6). CONCLUSIONS Despite the retrospective design, our matched cohort study suggests that ORH might be preferable for the surgical treatment of FIGO stage IB cervical cancer. However, in stage IB1 patients with tumor size ≤2 cm, LRH might be applicable, as equivalent outcomes were found regardless of the surgical approach. Further prospective studies are warranted.
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Affiliation(s)
- Se Ik Kim
- Department of Obstetrics and Gynecology, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Maria Lee
- Department of Obstetrics and Gynecology, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Sungyoung Lee
- Center for Precision Medicine, Seoul National University Hospital, Seoul, Republic of Korea
| | - Dong Hoon Suh
- Department of Obstetrics and Gynecology, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
| | - Hee Seung Kim
- Department of Obstetrics and Gynecology, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Kidong Kim
- Department of Obstetrics and Gynecology, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
| | - Hyun Hoon Chung
- Department of Obstetrics and Gynecology, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Jae Hong No
- Department of Obstetrics and Gynecology, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
| | - Jae-Weon Kim
- Department of Obstetrics and Gynecology, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Noh Hyun Park
- Department of Obstetrics and Gynecology, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Yong-Sang Song
- Department of Obstetrics and Gynecology, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Yong Beom Kim
- Department of Obstetrics and Gynecology, Seoul National University Bundang Hospital, Seongnam, Republic of Korea.
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Freischlag K, Adam M, Turner M, Watson J, Ezekian B, Schroder PM, Mantyh C, Migaly J. With widespread adoption of MIS colectomy for colon cancer, does hospital type matter? Surg Endosc 2019; 33:159-168. [PMID: 29946919 DOI: 10.1007/s00464-018-6289-7] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2018] [Accepted: 06/18/2018] [Indexed: 01/21/2023]
Abstract
BACKGROUND Recent studies have shown that hospital type impacts patient outcomes, but no studies have examined hospital differences in outcomes for patients undergoing minimally invasive surgery (MIS) for segmental colectomies. METHODS The 2010-2014 National Cancer Data Base was queried for patients undergoing segmental colectomy for non-metastatic colon adenocarcinoma. Descriptive statistics characterized MIS utilization by hospital type. Multivariable models were used to examine the effect of hospital type on outcomes after MIS. Survival probability was plotted using the Kaplan-Meier method. RESULTS 80,922 patients underwent MIS segmental colectomy for colon cancer from 2010 to 2014. From 2010 to 2014, the number of MIS segmental colectomies increased by 157% at academic hospitals, 151% at comprehensive hospitals, and 153% at community hospitals. Compared to academic hospitals, community and comprehensive hospitals had greater adjusted odds of positive margins (Community OR 1.525, 95% Confidence Interval 1.233-1.885; Comprehensive OR 1.216, 95% CI 1.041-1.42), incomplete number of lymph nodes analyzed (< 12 LNs) from surgery (Community OR 2.15, 95% CI 1.98-2.32; Comprehensive OR 1.42, 95% CI 1.34-1.51), and greater 30-day mortality (Community OR 1.43, 95% CI 1.14-1.78; Comprehensive OR 1.36, 95% CI 1.17-1.59). Patient survival probability was higher at academic hospitals at 5 years (Academic 69% vs. Comprehensive 66% vs. Community 63%, p < 0.001). Community hospitals and comprehensive hospitals had significantly higher risk of adjusted long-term mortality (Community HR 1.28; 95% CI 1.19-1.37; p < 0.001; Comprehensive HR 1.14; 95% CI 1.09-1.20; p < 0.001). CONCLUSIONS Despite widespread use of laparoscopic oncologic surgery, short- and long-term outcomes from MIS for segmental colectomy are superior at academic hospitals. This difference may be due to superior perioperative oncologic technique and surgical outcomes at academic hospitals. Our data provide important information for patients, referring physicians, and surgeons about the significance of hospital type in management of colon cancer.
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Affiliation(s)
- K Freischlag
- Duke University School of Medicine, Durham, NC, USA.
| | - M Adam
- Duke University Medical Center, Surgery, Durham, NC, USA
| | - M Turner
- Duke University Medical Center, Surgery, Durham, NC, USA
| | - J Watson
- Duke University Medical Center, Surgery, Durham, NC, USA
| | - B Ezekian
- Duke University Medical Center, Surgery, Durham, NC, USA
| | - P M Schroder
- Duke University Medical Center, Surgery, Durham, NC, USA
| | - C Mantyh
- Duke University Medical Center, Surgery, Durham, NC, USA
| | - J Migaly
- Duke University Medical Center, Surgery, Durham, NC, USA
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Abstract
PURPOSE Optical surgical navigation (OSN) will be a potent tool to help surgeons more accurately and efficiently remove tumors. The purpose of this study was to evaluate a novel humanized 3E8 antibody (3E8 MAb) fragment site-specifically conjugated with IR800, 3E8.scFv.Cys-IR800, as a potential OSN agent to target colorectal adenocarcinoma. PROCEDURES An engineered single-chain variable fragment of 3E8 MAb (targeted to TAG-72), appending a C-terminal cysteine residue (3E8.scFv.Cys), was created and reacted with IRDye800-maleimide. 3E8.scFv.Cys-IR800 identity and purity were verified by MALDI-TOF mass spectra and 800 nm detected size exclusion column HPLC. In vitro human colon adenocarcinoma LS-174 T cells binding and competition assay validated biological functionality. We further evaluated the imaging ability and receptor-specific binding of 3E8.scFv.Cys-IR800 in an orthotopic LS-174 T mouse model. RESULTS A 1:1 dye to protein conjugate was achieved at greater than 90 % HPLC purity. A 1 nmol dose of 3E8.scFv.Cys-IR800 via intraperitoneal injection administration was sufficient to produce high tumor to background fluorescence contrast. Blocking competition studies both in vitro and in vivo using a different blocking protein, 3E8ΔCH2, demonstrated 3E8.scFv.Cys-IR800 binding specificity for TAG-72 antigen. CONCLUSIONS 3E8.scFv.Cys-IR800 shows properties useful in a clinically viable OSN agent for colorectal cancer.
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Wu B, Wang W, Hao G, Song G. Effect of cancer characteristics and oncological outcomes associated with laparoscopic colorectal resection converted to open surgery: A meta-analysis. Medicine (Baltimore) 2018; 97:e13317. [PMID: 30557980 PMCID: PMC6319867 DOI: 10.1097/md.0000000000013317] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND Although laparoscopic colorectal cancer resection is an oncologically safe procedure equivalent to open resection,the effects of conversion of a laparoscopic approach to an open approach remain unclear.This study evaluated the cancer characteristic and oncological outcomes associated with conversion of laparoscopic colorectal resection to open surgery. METHOD We conducted searches on PubMed, EMBASE, MEDLINE, and the Cochrane Central Register of Controlled Trials. We included the literature published until 2018 that examined the impact of laparoscopic conversion to open colorectal resection. Only randomized control trials and prospective studies were included. Each study was reviewed and the data were extracted. Fixed-effects methods were used to combine data, and 95% confidence intervals (CIs) were used to evaluate the outcomes. RESULTS Twelve studies with 5427 patients were included. Of these, 4672 patients underwent complete laparoscopic resection with no conversion (LAP group), whereas 755 underwent conversion to an open resection (CONV group). The meta-analysis showedsignificant differences between the LAP group and converted (CONV) group with respect to neoadjuvant therapy (P = .002), location of the rectal cancer (P = .01), and recurrence (P = .01). However, no difference in local recurrence (P = .17) was noted between both groups. CONCLUSION Conversion of laparoscopic to open colorectal cancer resection is influenced by tumor characteristics. Conversion of laparoscopic surgery for colorectal cancer is associated with a worse oncological outcome.
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Affiliation(s)
- Bo Wu
- Mudanjiang Medical University
| | - Wei Wang
- Hongqi affiliated Hospital to Mudanjiang Medical University, No 3, Tongxiang street, Aimin regional, Mudanjiang city
| | - Guangjie Hao
- Chengde Medical University, Chengde city, Hebei province
| | - Guoquan Song
- Hongqi affiliated Hospital to Mudanjiang Medical University, No 3, Tongxiang street, Aimin regional, Mudanjiang city, China
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50
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Goumard C, Nancy You Y, Okuno M, Kutlu O, Chen HC, Simoneau E, Vega EA, Chun YS, David Tzeng C, Eng C, Vauthey JN, Conrad C. Minimally invasive management of the entire treatment sequence in patients with stage IV colorectal cancer: a propensity-score weighting analysis. HPB (Oxford) 2018; 20:1150-1156. [PMID: 30005993 DOI: 10.1016/j.hpb.2018.05.011] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/26/2017] [Revised: 05/11/2018] [Accepted: 05/19/2018] [Indexed: 12/12/2022]
Abstract
BACKGROUND In patients with stage IV colorectal cancer (CRC), minimally invasive surgery (MIS) may offer optimal oncologic outcome with low morbidity. However, the relative benefit of MIS compared to open surgery in patients requiring multistage resections has not been evaluated. METHODS Patients who underwent totally minimally invasive (TMI) or totally open (TO) resections of CRC primary and liver metastases (CLM) in 2009-2016 were analyzed. Inverse probability of weighted adjustment by propensity score was performed before analyzing risk factors for complications and survival. RESULTS The study included 43 TMI and 121 TO patients. Before and after adjustment, TMI patients had significantly less cumulated postoperative complications (41% vs. 59%, p = 0.001), blood loss (median 100 vs. 200 ml, p = 0.001) and shorter length of hospital stay (median 4.5 vs. 6.0 days, p < 0.001). Multivariate analysis identified TO approach vs. MIS (OR = 2.4, p < 0.001), major liver resection (OR = 4.4, p < 0.001), and multiple CLM (OR = 2.3, p = 0.001) as independent risk factors for complications. 5-year overall survival was comparable (81% vs 68%, p = 0.59). CONCLUSION In patients with CRC undergoing multistage surgical treatment, MIS resection contributes to optimal perioperative outcomes without compromise in oncologic outcomes.
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Affiliation(s)
- Claire Goumard
- Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Y Nancy You
- Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Masayuki Okuno
- Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Onur Kutlu
- Department of Surgery, University of Miami, Miami, FL, USA
| | - Hsiang-Chun Chen
- Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Eve Simoneau
- Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Eduardo A Vega
- Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Yun-Shin Chun
- Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - C David Tzeng
- Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Cathy Eng
- Department of Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Jean-Nicolas Vauthey
- Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Claudius Conrad
- Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.
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