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Ri M, Hayami M, Ohashi M, Makuuchi R, Irino T, Sano T, Nunobe S. Possibly more favorable short-term outcomes with minimally invasive surgery than with open surgery in total gastrectomy for locally advanced gastric cancer: A single high-volume center study. Ann Gastroenterol Surg 2025; 9:439-447. [PMID: 40385332 PMCID: PMC12080201 DOI: 10.1002/ags3.12881] [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: 07/29/2024] [Revised: 09/11/2024] [Accepted: 10/19/2024] [Indexed: 05/20/2025] Open
Abstract
Background Minimally invasive total gastrectomy (MTG) requires advanced surgical skills and is still associated with a higher rate of postoperative complications than other types of gastrectomy. Additionally, the short-term outcomes of MTG compared to open total gastrectomy (OTG) for locally advanced gastric cancer have yet to be demonstrated. Methods We retrospectively compared short-term outcomes between MTG and OTG for locally advanced gastric and esophago-gastric junctional cancer, performed at the Cancer Institute Hospital, Tokyo, during the period from January 2017 to March 2024. Propensity score matching (PSM) was conducted to adjust for potential confounders. Results In total, 359 patients were included, with 190 remaining after PSM, resulting in 95 in each group. The MTG group experienced a significantly lower incidence of postoperative complications of Clavien-Dindo classification (C-D) ≥3 than the OTG group (3.2% vs. 11.6%, p = 0.026). Moreover, the rate of postoperative intra-abdominal infectious complications (IAIC) was significantly lower in the MTG than in the OTG group (C-D ≥ 2; 7.4% vs. 17.9%, p = 0.029 and C-D ≥ 3; 2.1% vs. 9.5%, p = 0.030, respectively). Subgroup analyses showed the odds ratios for IAIC with C-D ≥ 2 to be more favorable for the MTG than the OTG group in male patients, those ≥70 years of age, patients without esophageal invasion, those without neoadjuvant chemotherapy, those diagnosed with cT≥3, and patients not undergoing combined resection of other organs except for the gallbladder or spleen. Conclusions MTG for locally advanced gastric cancer may provide improved short-term outcomes compared to OTG, when performed or supervised by surgeons with high proficiency in laparoscopic techniques.
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Affiliation(s)
- Motonari Ri
- Department of Gastroenterological Surgery, Cancer Institute HospitalJapanese Foundation for Cancer ResearchTokyoJapan
| | - Masaru Hayami
- Department of Gastroenterological Surgery, Cancer Institute HospitalJapanese Foundation for Cancer ResearchTokyoJapan
| | - Manabu Ohashi
- Department of Gastroenterological Surgery, Cancer Institute HospitalJapanese Foundation for Cancer ResearchTokyoJapan
| | - Rie Makuuchi
- Department of Gastroenterological Surgery, Cancer Institute HospitalJapanese Foundation for Cancer ResearchTokyoJapan
| | - Tomoyuki Irino
- Department of Gastroenterological Surgery, Cancer Institute HospitalJapanese Foundation for Cancer ResearchTokyoJapan
| | - Takeshi Sano
- Department of Gastroenterological Surgery, Cancer Institute HospitalJapanese Foundation for Cancer ResearchTokyoJapan
| | - Souya Nunobe
- Department of Gastroenterological Surgery, Cancer Institute HospitalJapanese Foundation for Cancer ResearchTokyoJapan
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Li W, Wei SJ. Perioperative outcomes of robot-assisted versus laparoscopic distal gastrectomy for gastric cancer: a systematic review and meta-analysis of propensity score matching studies. J Robot Surg 2024; 18:333. [PMID: 39231865 DOI: 10.1007/s11701-024-02038-x] [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: 06/06/2024] [Accepted: 06/30/2024] [Indexed: 09/06/2024]
Abstract
The aim of this meta-analysis was to compare the efficacy of robot distal gastrectomy (RDG) versus laparoscopic distal gastrectomy (LDG) for gastric cancer. Studies included only those that utilized propensity score matching (PSM). A systematic literature search was conducted in several major global databases, including PubMed, Embase, and Google Scholar, up to June 2024. Articles were screened based on predefined inclusion and exclusion criteria. Baseline data and primary and secondary outcome measures (e.g., operative time, estimated blood loss, lymph-node yield dissection, length of hospital stay, and time to first flatus) were extracted. The quality of PSM studies was assessed using the ROBINS-I, and data were analyzed using Review Manager 5.4.1 software. A total of 12 propensity score-matched studies involving 3688 patients were included in this meta-analysis. Robot-assisted surgery resulted in a longer operative time (WMD 30.64 min, 95% CI 15.63 - 45.66; p < 0.0001), less estimated blood loss (WMD 29.54 mL, 95% CI - 47.14 - 11.94; p = 0.001), more lymph-node yield (WMD 5.14, 95% CI 2.39 - 7.88; p = 0.0002), and a shorter hospital stay (WMD - 0.36, 95% CI - 0.60 - 0.12; p = 0.004) compared with laparoscopic surgery. There were no significant differences between the two surgical methods in terms of time to first flatus, overall complications, and major complications. Robot distal gastrectomy for gastric cancer reduces intraoperative blood loss, increases lymph-node yield, and shortens hospital stay compared with laparoscopic surgery, despite a longer operative time. There are no significant differences in time to first flatus and complication rates between the two groups.
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Affiliation(s)
- Wei Li
- Department of Gastrointestinal Surgery, Affiliated Hospital of North Sichuan Medical College, Nanchong, China
| | - Shou-Jiang Wei
- Department of Gastrointestinal Surgery, Affiliated Hospital of North Sichuan Medical College, Nanchong, China.
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Ishida J, Toyama H, Asari S, Goto T, Nanno Y, Yoshida T, So S, Urade T, Fukushima K, Gon H, Tsugawa D, Komatsu S, Yanagimoto H, Kido M, Fukumoto T. Optimal cutoff values of drain amylase for predicting pancreatic fistula are different between open and laparoscopic distal pancreatectomy. Surg Endosc 2024; 38:2699-2708. [PMID: 38528262 DOI: 10.1007/s00464-024-10781-3] [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: 10/09/2023] [Accepted: 03/07/2024] [Indexed: 03/27/2024]
Abstract
BACKGROUND Drainage fluid amylase (DFA) is useful for predicting clinically relevant postoperative pancreatic fistula (CR-POPF) after distal pancreatectomy (DP). However, difference in optimal cutoff value of DFA for predicting CR-POPF between open DP (ODP) and laparoscopic DP (LDP) has not been investigated. This study aimed to identify the optimal cutoff values of DFA for predicting CR-POPF after ODP and LDP. METHODS Data for 294 patients (ODP, n = 127; LDP, n = 167) undergoing DP at Kobe University Hospital between 2010 and 2021 were reviewed. Propensity score matching was performed to minimize treatment selection bias. Receiver operating characteristic (ROC) analysis was performed to determine the optimal cutoff values of DFA for predicting CR-POPF for ODP and LDP. Logistic regression analysis for CR-POPF was performed to investigate the diagnostic value of DFA on postoperative day (POD) three with identified cutoff value. RESULTS In the matched cohort, CR-POPF rates were 24.7% and 7.9% after ODP and LDP, respectively. DFA on POD one was significantly lower after ODP than after LDP (2263 U/L vs 4243 U/L, p < 0.001), while the difference was not significant on POD three (543 U/L vs 1221 U/L, p = 0.171). ROC analysis revealed that the optimal cutoff value of DFA on POD one and three for predicting CR-POPF were different between ODP and LDP (ODP, 3697 U/L on POD one, 1114 U/L on POD three; LDP, 10564 U/L on POD one, 6020 U/L on POD three). Multivariate analysis showed that DFA on POD three with identified cutoff value was the independent predictor for CR-POPF both for ODP and LDP. CONCLUSIONS DFA on POD three is an independent predictor for CR-POPF after both ODP and LDP. However, the optimal cutoff value for it is significantly higher after LDP than after ODP. Optimal threshold of DFA for drain removal may be different between ODP and LDP.
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Affiliation(s)
- Jun Ishida
- Division of Hepato-Biliary-Pancreatic Surgery, Department of Surgery, Kobe University Graduate School of Medicine, 7-5-2 Kusunoki-cho, Chuo-ku, Kobe, 650-0017, Japan
| | - Hirochika Toyama
- Division of Hepato-Biliary-Pancreatic Surgery, Department of Surgery, Kobe University Graduate School of Medicine, 7-5-2 Kusunoki-cho, Chuo-ku, Kobe, 650-0017, Japan.
| | - Sadaki Asari
- Division of Hepato-Biliary-Pancreatic Surgery, Department of Surgery, Kobe University Graduate School of Medicine, 7-5-2 Kusunoki-cho, Chuo-ku, Kobe, 650-0017, Japan
| | - Tadahiro Goto
- Department of Surgery, Konan Medical Center, 1-5-16 Kamokogahara, Higashinada-ku, Kobe, 658-0064, Japan
| | - Yoshihide Nanno
- Division of Hepato-Biliary-Pancreatic Surgery, Department of Surgery, Kobe University Graduate School of Medicine, 7-5-2 Kusunoki-cho, Chuo-ku, Kobe, 650-0017, Japan
| | - Toshihiko Yoshida
- Division of Hepato-Biliary-Pancreatic Surgery, Department of Surgery, Kobe University Graduate School of Medicine, 7-5-2 Kusunoki-cho, Chuo-ku, Kobe, 650-0017, Japan
| | - Shinichi So
- Division of Hepato-Biliary-Pancreatic Surgery, Department of Surgery, Kobe University Graduate School of Medicine, 7-5-2 Kusunoki-cho, Chuo-ku, Kobe, 650-0017, Japan
| | - Takeshi Urade
- Division of Hepato-Biliary-Pancreatic Surgery, Department of Surgery, Kobe University Graduate School of Medicine, 7-5-2 Kusunoki-cho, Chuo-ku, Kobe, 650-0017, Japan
| | - Kenji Fukushima
- Division of Hepato-Biliary-Pancreatic Surgery, Department of Surgery, Kobe University Graduate School of Medicine, 7-5-2 Kusunoki-cho, Chuo-ku, Kobe, 650-0017, Japan
| | - Hidetoshi Gon
- Division of Hepato-Biliary-Pancreatic Surgery, Department of Surgery, Kobe University Graduate School of Medicine, 7-5-2 Kusunoki-cho, Chuo-ku, Kobe, 650-0017, Japan
| | - Daisuke Tsugawa
- Division of Hepato-Biliary-Pancreatic Surgery, Department of Surgery, Kobe University Graduate School of Medicine, 7-5-2 Kusunoki-cho, Chuo-ku, Kobe, 650-0017, Japan
| | - Shohei Komatsu
- Division of Hepato-Biliary-Pancreatic Surgery, Department of Surgery, Kobe University Graduate School of Medicine, 7-5-2 Kusunoki-cho, Chuo-ku, Kobe, 650-0017, Japan
| | - Hiroaki Yanagimoto
- Division of Hepato-Biliary-Pancreatic Surgery, Department of Surgery, Kobe University Graduate School of Medicine, 7-5-2 Kusunoki-cho, Chuo-ku, Kobe, 650-0017, Japan
| | - Masahiro Kido
- Division of Hepato-Biliary-Pancreatic Surgery, Department of Surgery, Kobe University Graduate School of Medicine, 7-5-2 Kusunoki-cho, Chuo-ku, Kobe, 650-0017, Japan
| | - Takumi Fukumoto
- Division of Hepato-Biliary-Pancreatic Surgery, Department of Surgery, Kobe University Graduate School of Medicine, 7-5-2 Kusunoki-cho, Chuo-ku, Kobe, 650-0017, Japan
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Li X, Zhang H, Hou X. Laparoscopic versus open surgical management in elderly patients with rectal cancer aged 70 and older. J Minim Access Surg 2023; 19:504-510. [PMID: 37282434 PMCID: PMC10695322 DOI: 10.4103/jmas.jmas_243_22] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2022] [Revised: 10/17/2022] [Accepted: 03/10/2023] [Indexed: 06/08/2023] Open
Abstract
Background This retrospective study aimed to compare the short- and long-term surgical outcomes of laparoscopic surgery versus open surgery in elderly patients with rectal cancer. Patients and Methods Elderly patients (≥70 years old) with rectal cancer who received radical surgery were retrospectively analysed. Patients were matched (1:1 ratio) using propensity score matching (PSM), with age, sex, body mass index, American Society of Anesthesiologists score and tumour-node-metastasis staging included as covariates. Baseline characteristics, post-operative complications, short- and long-term surgical outcomes and overall survival (OS) were compared between the two matched groups. Results Sixty-one pairs were selected after PSM. Patients with laparoscopic surgery had a longer duration of operation time, lower estimated blood loss, shorter duration of post-operative analgesics administered, time to first flatus, time to first oral diet and post-operative hospitalisation stay than those observed in patients with open surgery (All P < 0.05). The incidence of post-operative complications in the open surgery group was numerically higher than that occurred in the laparoscopic surgery group (30.6% vs. 17.7%). Median OS was 67.0 months (95% confidence interval [CI], 62.2-71.8) in the laparoscopic surgery group and 65.0 months (95% CI, 59.9-70.1) in the open surgery group, however, Kaplan-Meier curves indicated that no significant differences in OS (Log-rank test, P = 0.535) were noted between the two matched groups. Conclusions Compared with the open surgery, laparoscopic surgery had the advantages of less trauma and faster recovery, and provided similar long-term prognostic outcome in elderly patients with rectal cancer.
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Affiliation(s)
- Xiaolong Li
- Department of General Surgery, First Hospital of Lanzhou University, Lanzhou, Gansu Province, China
| | - Hengwei Zhang
- Department of General Surgery, First Hospital of Lanzhou University, Lanzhou, Gansu Province, China
| | - Xudong Hou
- Department of General Surgery, First Hospital of Lanzhou University, Lanzhou, Gansu Province, China
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Miyai H, Fujita K, Saito M, Fujii Y, Saito T, Kato J, Sawai M, Eguchi Y, Hirokawa T, Yamamoto M, Kobayashi K, Takiguchi S. Solo surgery in robot-assisted gastrectomy versus laparoscopic gastrectomy for gastric cancer: a propensity score-matched analysis. Surg Endosc 2023:10.1007/s00464-023-10113-x. [PMID: 37308761 DOI: 10.1007/s00464-023-10113-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2023] [Accepted: 05/03/2023] [Indexed: 06/14/2023]
Abstract
BACKGROUND Robot-assisted gastrectomy (RG) for gastric cancer is still not well standardized. This study aimed to explore the feasibility and effectiveness of solo surgery in robot-assisted gastrectomy (SRG) for gastric cancer compared to laparoscopic gastrectomy (LG). METHODS This was a single-center retrospective comparative study between SRG and conventional LG. Between April 2015 and December 2022, 510 patients underwent gastrectomy, and data from a prospectively collected database were analyzed. We identified 372 patients who underwent LG (n = 267) and SRG (n = 105) and the remaining 138 patients were excluded because of remnant gastric cancer, esophagogastric junction cancer, open gastrectomy, concurrent surgery for concomitant malignancies, RG before starting SRG, or cases in which the author was unable to perform or supervise gastrectomy. Propensity score matching was performed at a ratio of 1:1 to reduce bias from confounding patient-related variables, and short-term outcomes were compared between the groups. RESULTS After propensity score matching, 90 pairs of patients who underwent LG and SRG were selected. In the propensity-matched cohort, the operation time was significantly shorter in the SRG group than that in the LG group (SRG = 305.7 ± 74.0 min vs. LG = 340.3 ± 91.65 min, p < 0.0058), less estimated blood loss was observed in the SRG group than that in the LG group (SRG = 25.6 ± 50.6 mL vs. LG = 76.1 ± 104.2 mL, p < 0.0001) and postoperative hospital stay was shorter in the SRG group than that in the LG group (SRG = 7.1 ± 0.8 days vs. LG = 9.1 ± 7.7 days, p = 0.015). CONCLUSION We found that SRG for gastric cancer was technically feasible and effective with favorable short-term outcomes, including shorter operative time, less estimated blood loss, shorter hospital stays, and lower postoperative morbidity than those in LG.
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Affiliation(s)
- Hirotaka Miyai
- Department of Gastroenterological Surgery, Kariya Toyota General Hospital, Kariya, Aichi, 448-8505, Japan.
| | - Kohei Fujita
- Department of Gastroenterological Surgery, Kariya Toyota General Hospital, Kariya, Aichi, 448-8505, Japan
| | - Masaki Saito
- Department of Gastroenterological Surgery, Nagoya City University Graduate School of Medical Sciences, Nagoya, Aichi, 467-8601, Japan
| | - Yoshiaki Fujii
- Department of Gastroenterological Surgery, Nagoya City University Graduate School of Medical Sciences, Nagoya, Aichi, 467-8601, Japan
| | - Tsuyoshi Saito
- Department of Gastroenterological Surgery, Kariya Toyota General Hospital, Kariya, Aichi, 448-8505, Japan
| | - Jyunki Kato
- Department of Gastroenterological Surgery, Kariya Toyota General Hospital, Kariya, Aichi, 448-8505, Japan
| | - Misato Sawai
- Department of Gastroenterological Surgery, Kariya Toyota General Hospital, Kariya, Aichi, 448-8505, Japan
| | - Yuki Eguchi
- Department of Gastroenterological Surgery, Kariya Toyota General Hospital, Kariya, Aichi, 448-8505, Japan
| | - Takahisa Hirokawa
- Department of Gastroenterological Surgery, Kariya Toyota General Hospital, Kariya, Aichi, 448-8505, Japan
| | - Minoru Yamamoto
- Department of Gastroenterological Surgery, Kariya Toyota General Hospital, Kariya, Aichi, 448-8505, Japan
| | - Kenji Kobayashi
- Department of Gastroenterological Surgery, Kariya Toyota General Hospital, Kariya, Aichi, 448-8505, Japan
| | - Shuji Takiguchi
- Department of Gastroenterological Surgery, Nagoya City University Graduate School of Medical Sciences, Nagoya, Aichi, 467-8601, Japan
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Shigeno T, Kizuki M, Tokunaga M, Fushimi K, Kinugasa Y, Fujiwara T. A comparison of the short-term outcomes between laparoscopic and robotic distal gastrectomy: A retrospective study using a nationwide inpatient database. Surgery 2023; 173:1169-1175. [PMID: 36754740 DOI: 10.1016/j.surg.2022.12.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2022] [Accepted: 12/24/2022] [Indexed: 02/09/2023]
Abstract
BACKGROUND Although the safety of robotic distal gastrectomy has been studied in several single-center trials, the nationwide outcomes of robotic distal gastrectomy that meet the requirements of Japanese national health insurance, such as facility case volume and skill level of the surgeon, are still not clear. The objective of this study was to evaluate the short-term outcomes of robotic distal gastrectomy, which was covered by national health insurance, compared to laparoscopic distal gastrectomy. METHODS We retrieved gastric cancer cases with cStage I to III who underwent laparoscopic distal gastrectomy (15,539 patients) and robotic distal gastrectomy (1,312 patients) between April 2018 and March 2020 from the Diagnosis Procedure Combination database. We compared the frequency of postoperative complications, anesthesia time, and postoperative hospitalization days between laparoscopic distal gastrectomy and robotic distal gastrectomy using propensity score matching analysis. RESULTS The postoperative complication rate were not different between laparoscopic distal gastrectomy and robotic distal gastrectomy (odds ratio = 0.90, 95% confidence interval: 0.66 to 1.23, P = .52). The anesthesia time (minutes) was significantly longer (coefficient = 70.2, 95% confidence interval: 63.8 to 76.7, P < .001) and postoperative hospitalization (days) was significantly shorter (coefficient = -0.89, 95% confidence interval: -1.48 to -0.31, P = .003) in robotic distal gastrectomy than laparoscopic distal gastrectomy. CONCLUSIONS Robotic distal gastrectomy that met strict national health insurance coverage requirements in Japan was performed as safely as laparoscopic distal gastrectomy with reduced hospitalization days.
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Affiliation(s)
- Takashi Shigeno
- Department of Gastrointestinal Surgery, Tokyo Medical and Dental University, Japan
| | - Masashi Kizuki
- Department of Tokyo Metropolitan Health Policy Advisement, Tokyo Medical and Dental University, Japan
| | - Masanori Tokunaga
- Department of Gastrointestinal Surgery, Tokyo Medical and Dental University, Japan
| | - Kiyohide Fushimi
- Department of Health Policy and Informatics, Tokyo Medical and Dental University, Japan
| | - Yusuke Kinugasa
- Department of Gastrointestinal Surgery, Tokyo Medical and Dental University, Japan
| | - Takeo Fujiwara
- Department of Global Health Promotion, Tokyo Medical and Dental University, Japan.
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Huang W, Liu S, Chen J. Surgical and short-term outcomes in robotic and laparoscopic distal gastrectomy for gastric cancer with enhanced recovery after surgery protocol: A propensity score matching analysis. Front Surg 2022; 9:944395. [PMID: 36277282 PMCID: PMC9583927 DOI: 10.3389/fsurg.2022.944395] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2022] [Accepted: 09/14/2022] [Indexed: 11/23/2022] Open
Abstract
OBJECTIVE This study aims to evaluate the short-term surgical outcomes of laparoscopy-assisted distal gastrectomy (LADG) and robot-assisted distal gastrectomy (RADG) for gastric cancer (GC) with enhanced recovery after surgery (ERAS) protocols. METHODS We reviewed the medical records of 202 patients undergoing radical distal gastrectomy; among them, 67 cases were assisted through RADG, while 135 cases were assisted through LADG along with ERAS. We retrospectively collected the medical records in succession from a database (January 2016-March 2019). We adopted propensity score matching to compare surgical and short-term outcomes of both groups. RESULTS After the successful examination of 134 cases, including 67 receiving RADG and 67 undergoing LADG, the operative times were noted as 5.78 ± 0.96 h for the RADG group and 4.47 ± 1.01 h for the LADG group (P < 0.001). The blood loss was noted as 125.52 ± 101.18 ml in the RADG group and 164.93 ± 109.32 ml in the LADG group (P < 0.05). The shorter time to first flatus was 38.82 ± 10.56 h in the RADG group and 42.88 ± 11.25 h in the LADG group (P < 0.05). In contrast, shorter days of postoperative hospital stay were 5.94 ± 1.89 days in the RADG group and 6.64 ± 1.92 days in the LADG group (P < 0.05). Also, the RADG group (84483.03 ± 9487.37) was much more costly than the LADG group (65258.13 ± 8928.33) (P < 0.001). The postoperative overall complication rates, numbers of dissected lymph nodes, visual analogue scale (VAS), and time to start a liquid diet for the RADG group and the LADG group were similar. CONCLUSIONS In this research, we concluded that RADG provides surgical benefits and short-term outcomes compared to LADG for GC with ERAS.
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Affiliation(s)
- Weijia Huang
- Department of Gastrointestinal Gland Surgery, The First Affiliated Hospital of Guangxi Medical University, Nanning, China
- Guangxi Laboratory of Enhanced Recovery after Surgery for Gastrointestinal Cancer, The First Affiliated Hospital of Guangxi Medical University, Nanning, China
- Guangxi Clinical Research Center for Enhanced Recovery after Surgery, The First Affiliated Hospital of Guangxi Medical University, Nanning, China
- Guangxi Zhuang Autonomous Region Engineering Research Center for Artificial Intelligence Analysis of Multimodal Tumor Images, The First Affiliated Hospital of Guangxi Medical University, Nanning, China
| | - Siyu Liu
- Department of Gastrointestinal Gland Surgery, The First Affiliated Hospital of Guangxi Medical University, Nanning, China
- Guangxi Laboratory of Enhanced Recovery after Surgery for Gastrointestinal Cancer, The First Affiliated Hospital of Guangxi Medical University, Nanning, China
- Guangxi Clinical Research Center for Enhanced Recovery after Surgery, The First Affiliated Hospital of Guangxi Medical University, Nanning, China
- Guangxi Zhuang Autonomous Region Engineering Research Center for Artificial Intelligence Analysis of Multimodal Tumor Images, The First Affiliated Hospital of Guangxi Medical University, Nanning, China
| | - Junqiang Chen
- Department of Gastrointestinal Gland Surgery, The First Affiliated Hospital of Guangxi Medical University, Nanning, China
- Guangxi Laboratory of Enhanced Recovery after Surgery for Gastrointestinal Cancer, The First Affiliated Hospital of Guangxi Medical University, Nanning, China
- Guangxi Clinical Research Center for Enhanced Recovery after Surgery, The First Affiliated Hospital of Guangxi Medical University, Nanning, China
- Guangxi Zhuang Autonomous Region Engineering Research Center for Artificial Intelligence Analysis of Multimodal Tumor Images, The First Affiliated Hospital of Guangxi Medical University, Nanning, China
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Carbonari A, Lillo E, Cicirelli V, Sciorsci RL, Rizzo A. The Use of Abdominal Ultrasound to Improve the Cryptorchidectomy of Pigs. Animals (Basel) 2022; 12:ani12141763. [PMID: 35883311 PMCID: PMC9312328 DOI: 10.3390/ani12141763] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2022] [Revised: 07/03/2022] [Accepted: 07/08/2022] [Indexed: 11/28/2022] Open
Abstract
Simple Summary Cryptorchidism is the failure of one or both the testes to descend in the scrotum. In pigs, the incidence of cryptorchidism varies from 4% to 12%, and the most frequent localisation of retained testes is the abdominal region. In other species, transabdominal ultrasound is the most reliable diagnostic tool to localize the retained testis. This study aimed to evaluate the value of ultrasound in correctly identifying the location of retained testes, to improve the cryptorchidectomy in pigs. The ultrasound examination reduced the duration of anaesthesia, surgery, and postoperative pain. Indeed, the technique used is safe, effective, and rapid. To locate the testis, it should recognise the echo structure of the testicle and the mediastinum is well always recognisable for its hyperechogenicity. The routine use of the ultrasound examination is considered a useful alternative before the cryptorchidectomy in the pig because it allows the exact location of the retained testicle, ensuring reduced manipulation of the viscera. Abstract This study aimed to describe a technique to locate retained testes in pigs by means of ultrasound examination and thereafter proceed with cryptorchidectomy. Fifty-two monolateral cryptorchid pigs were enrolled. After anaesthesia, 42 pigs (Group U) underwent ultrasound examination before cryptorchidectomy, and 10 pigs (Group C) were used as control group without ultrasonography. The total duration of anaesthesia, ultrasound examination, and surgery was evaluated. In 10 pigs of Group U and 10 pigs of Group C, the heart rate (HR), respiratory rate (RR), and body temperature (T) were monitored to assess intraoperative pain response. An operator used the Piglet Grimace Scale (PGS) to assess postoperative pain. In Group U, the total time required for anaesthesia and surgery was less than Group C. No intra- or postoperative complications were reported in both groups. For HR, RR, and T, no statistically significant differences were observed. During the postoperative pain assessment, the highest pain scores were recorded at T6 (6 h after surgery). Ultrasound examination was found to be a valid technique for locating the retained testis in the abdomen in cryptorchid pigs and to reduce the duration of the surgery.
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Affiliation(s)
- Alice Carbonari
- Department of Veterinary Medicine, University of Bari 'Aldo Moro', 70121 Bari, Italy
| | - Edoardo Lillo
- Department of Veterinary Medicine, University of Bari 'Aldo Moro', 70121 Bari, Italy
| | - Vincenzo Cicirelli
- Department of Veterinary Medicine, University of Bari 'Aldo Moro', 70121 Bari, Italy
| | | | - Annalisa Rizzo
- Department of Veterinary Medicine, University of Bari 'Aldo Moro', 70121 Bari, Italy
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Ushiku H, Sakuraya M, Washio M, Hosoda K, Niihara M, Harada H, Miura H, Sato T, Nishizawa N, Tajima H, Kaizu T, Kato H, Sengoku N, Tanaka K, Naitoh T, Kumamoto Y, Sangai T, Yamashita K, Hiki N. Pancreas-contactless gastrectomy for gastric cancer prevents postoperative inflammation. Surg Endosc 2022; 36:5644-5651. [PMID: 34981230 DOI: 10.1007/s00464-021-08961-6] [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: 03/28/2021] [Accepted: 12/09/2021] [Indexed: 11/26/2022]
Abstract
BACKGROUND Pancreas-related complications after laparoscopic gastrectomy (LG) for gastric cancer can be fatal. We developed a gastrectomy procedure with no pancreas contact to prevent such complications and herein report the surgical outcomes. METHODS We retrospectively reviewed 182 consecutive patients with gastric cancer who underwent LG at Kitasato University Hospital from January 2017 to January 2020. These patients were divided into a pancreas-contact group (C group) and pancreas-contactless group (CL group) for comparison of postoperative complications, and inflammatory parameters such as body temperature (BT) and C-reactive protein (CRP). RESULTS Postoperative complications of CDc grade ≧ IIIa were significantly fewer in the CL group than in the C group [0/76 (0%) vs. 6/106 (5.7%), P = 0.035]. The median drain amylase (drain-AMY) on postoperative day 1 (POD1) was significantly lower in the CL group than in the C group (641 vs. 1162 IU/L, P = 0.02), as was BT at POD1 (37.4 °C vs. 37.7 °C, P = 0.04), the patient group with a BT above 37.5 °C at POD3 [5/76 (6.5%) vs. 18/106 (17%), P = 0.037], and those showing a CRP above 20.0 mg/dL at POD3 [5/76 (6.5%) vs. 20/106 (19%), P = 0.018]. CONCLUSIONS Our technique to prevent pancreas contact during supra-pancreatic lymph node dissection during LG could minimize the inflammatory response and prevent further postoperative complications. Further large-scale, prospective studies are now required.
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Affiliation(s)
- Hideki Ushiku
- Department of Upper Gastrointestinal Surgery, Kitasato University School of Medicine, Kitasato 1-15-1, Minami-ku, Sagamihara, Kanagawa, 252-0374, Japan.
| | - Mikiko Sakuraya
- Department of Upper Gastrointestinal Surgery, Kitasato University School of Medicine, Kitasato 1-15-1, Minami-ku, Sagamihara, Kanagawa, 252-0374, Japan
| | - Marie Washio
- Department of Upper Gastrointestinal Surgery, Kitasato University School of Medicine, Kitasato 1-15-1, Minami-ku, Sagamihara, Kanagawa, 252-0374, Japan
| | - Kei Hosoda
- Department of Upper Gastrointestinal Surgery, Kitasato University School of Medicine, Kitasato 1-15-1, Minami-ku, Sagamihara, Kanagawa, 252-0374, Japan
| | - Masahiro Niihara
- Department of Upper Gastrointestinal Surgery, Kitasato University School of Medicine, Kitasato 1-15-1, Minami-ku, Sagamihara, Kanagawa, 252-0374, Japan
| | - Hiroki Harada
- Department of Upper Gastrointestinal Surgery, Kitasato University School of Medicine, Kitasato 1-15-1, Minami-ku, Sagamihara, Kanagawa, 252-0374, Japan
| | - Hirohisa Miura
- Department of Lower Gastrointestinal Surgery, Kitasato University School of Medicine, Sagamihara, Japan
| | - Takeo Sato
- Department of Lower Gastrointestinal Surgery, Kitasato University School of Medicine, Sagamihara, Japan
| | - Nobuyuki Nishizawa
- Department of General-Pediatric-Hepatobiliary Pancreatic Surgery, Kitasato University School of Medicine, Sagamihara, Japan
| | - Hiroshi Tajima
- Department of General-Pediatric-Hepatobiliary Pancreatic Surgery, Kitasato University School of Medicine, Sagamihara, Japan
| | - Takashi Kaizu
- Department of General-Pediatric-Hepatobiliary Pancreatic Surgery, Kitasato University School of Medicine, Sagamihara, Japan
| | - Hiroshi Kato
- Department of Breast and Thyroid Surgery, Kitasato University School of Medicine, Sagamihara, Japan
| | - Norihiko Sengoku
- Department of Breast and Thyroid Surgery, Kitasato University School of Medicine, Sagamihara, Japan
| | - Kiyoshi Tanaka
- Division of Pediatric Surgery, Research and Development Center for New Medical Frontiers, Kitasato University School of Medicine, Sagamihara, Japan
| | - Takeshi Naitoh
- Department of Lower Gastrointestinal Surgery, Kitasato University School of Medicine, Sagamihara, Japan
| | - Yusuke Kumamoto
- Department of General-Pediatric-Hepatobiliary Pancreatic Surgery, Kitasato University School of Medicine, Sagamihara, Japan
| | - Takafumi Sangai
- Department of Breast and Thyroid Surgery, Kitasato University School of Medicine, Sagamihara, Japan
| | - Keishi Yamashita
- Division of Advanced Surgical Oncology, Research and Development Center for New Medical Frontiers, Kitasato University School of Medicine, Sagamihara, Japan
| | - Naoki Hiki
- Department of Upper Gastrointestinal Surgery, Kitasato University School of Medicine, Kitasato 1-15-1, Minami-ku, Sagamihara, Kanagawa, 252-0374, Japan.
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10
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Namikawa T, Yamaguchi S, Fujisawa K, Ogawa M, Iwabu J, Munekage M, Uemura S, Maeda H, Kitagawa H, Kobayashi M, Matsuda K, Hanazaki K. Real-time bowel sound analysis using newly developed device in patients undergoing gastric surgery for gastric tumor. JGH Open 2021; 5:454-458. [PMID: 33860095 PMCID: PMC8035471 DOI: 10.1002/jgh3.12515] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2020] [Revised: 01/15/2021] [Accepted: 02/13/2021] [Indexed: 02/05/2023]
Abstract
BACKGROUND AND AIM Objective measurements are not available for determining bowel sounds. The present study sought to evaluate the efficacy of a novel bowel sound monitoring system for perioperative use in patients undergoing gastric surgery. METHODS The study enrolled 14 patients who underwent surgery for gastric cancer at Kochi Medical School from 2017 to 2018. Preoperative and postoperative bowel sounds were recorded using a newly developed real-time analysis system in the operating theater and recovery room. Clinical information and bowel sound count data were obtained to compare preoperative and postoperative measures. RESULTS The median preoperative and postoperative bowel sound counts across all patients were 1.4 and 2.5 counts per minute (cpm), respectively. In patients who underwent laparoscopic gastrectomy, the postoperative bowel sound count was significantly higher than that recorded preoperatively (2.3 vs. 1.6 cpm, P = 0.005). The findings also revealed a significant negative correlation between postoperative bowel sound count and operation time (r = -0.714, P = 0.003). CONCLUSIONS The real-time bowel sound analysis system tested herein presents a promising diagnostic tool to quantitatively evaluate bowel movements associated with surgery. Our results suggested a need for shorter operation times for gastric procedures with respect to peristalsis recovery and supported the use of minimally invasive surgery.
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Affiliation(s)
| | | | | | - Maho Ogawa
- Department of SurgeryKochi Medical SchoolNankokuKochiJapan
| | - Jun Iwabu
- Department of SurgeryKochi Medical SchoolNankokuKochiJapan
| | | | - Sunao Uemura
- Department of SurgeryKochi Medical SchoolNankokuKochiJapan
| | | | | | - Michiya Kobayashi
- Department of Human Health and Medical SciencesKochi Medical SchoolNankokuKochiJapan
| | - Kenichi Matsuda
- Department of Emergency and Critical Care Medicine, Faculty of MedicineUniversity of YamanashiChuoYamanashiJapan
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11
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Ai W, Liang Z, Li F, Yu H. Internal hernia beneath superior vesical artery after pelvic lymphadenectomy for cervical cancer: a case report and literature review. BMC Surg 2020; 20:312. [PMID: 33267803 PMCID: PMC7709390 DOI: 10.1186/s12893-020-00985-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2020] [Accepted: 11/25/2020] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND The common complications of radical hysterectomy and pelvic lymphadenectomy usually include wound infection, hemorrhage or hematomas, lymphocele, uretheral injury, ileus and incisional hernias. However, internal hernia secondary to the orifice associated with the uncovered vessels after pelvic lymphadenectomy is very rare. CASE PRESENTATION We report a case of internal hernia with intestinal perforation beneath the superior vesical artery that occurred one month after laparoscopic pelvic lymphadenectomy for cervical cancer. A partial ileum resection was performed and the right superior vesical artery was transected to prevent recurrence of the internal hernia. CONCLUSIONS Retroperitonealization after the pelvic lymphadenectomy should be considered in patients with tortuous, elongated arteries which could be causal lesions of an internal hernia.
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Affiliation(s)
- Wen Ai
- The First Affiliated Hospital of Shandong First Medical University, Jinan, 250014, Shandong, China
| | - Zhihua Liang
- The First Affiliated Hospital of Shandong First Medical University, Jinan, 250014, Shandong, China
| | - Feng Li
- The First Affiliated Hospital of Shandong First Medical University, Jinan, 250014, Shandong, China
| | - Haihua Yu
- The First Affiliated Hospital of Shandong First Medical University, Jinan, 250014, Shandong, China.
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12
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Vecchio R, Cacciola E, Cacciola RR, Marchese S, Troina G, Intagliata E, Basile F. Hemocoagulative post-operative changes after laparoscopic surgery compared to open surgery: the role of lupus anticoagulant. Updates Surg 2020; 72:1223-1227. [PMID: 32170631 DOI: 10.1007/s13304-020-00724-7] [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: 01/20/2019] [Accepted: 02/12/2020] [Indexed: 10/24/2022]
Abstract
Although still debated, post-operative modification of hemostasis seems to be less pronounced after laparoscopy compared to open surgery. Antiphospholipid antibodies might play a role in the post-operative thromboembolic risk, although their evaluation in surgical patients has never been performed. Post-operative modification of antiphospholipid antibodies could be related to the surgical approach (laparoscopic or open). In this prospective study, the authors statistically compared the pre-operative values and post-operative modification of antiphospholipid antibodies in two homogeneous groups of patients operated on by laparoscopic and open surgery. No statistical differences within each group and between the two groups were shown comparing mean values of pre-operative and post-operative antiphospholipid antibodies. In the open group, there was a significant difference between pre-operative and post-operative LAC means (P < 0.01). In the laparoscopic group, on the contrary, no significant change in LAC values between pre- and post-operative tests (P = 0.55) was observed. Since LAC could be related to coagulation disorders, this study seems to support that laparoscopic surgery might induce a less risk of post-operative thromboembolic disease.
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Affiliation(s)
- Rosario Vecchio
- Department of Surgery, University of Catania, Catania, Italy
| | - Emma Cacciola
- Department of Medical Sciences, Surgical Sciences and Advanced Technologies, Hemostasis Unit, University of Catania, Catania, Italy
| | | | | | - Graziano Troina
- Department of Clinic and Specialist Medicine, University of Palermo, Palermo, Italy
| | - Eva Intagliata
- Department of Surgery, University of Catania, Catania, Italy.
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13
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Yoo D, Song KB, Lee JW, Hwang K, Hong S, Shin D, Hwang DW, Lee JH, Lee W, Kwon J, Park Y, Jun E, Kim SC. A Comparative Study of Laparoscopic versus Open Pancreaticoduodenectomy for Ampulla of Vater Carcinoma. J Clin Med 2020; 9:2214. [PMID: 32668683 PMCID: PMC7408711 DOI: 10.3390/jcm9072214] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2020] [Accepted: 07/09/2020] [Indexed: 12/20/2022] Open
Abstract
Several studies have compared laparoscopic pancreaticoduodenectomy (LPD) and open pancreaticoduodenectomy (OPD) in patients with periampullary carcinoma; however, only a few studies have made such a comparison on patients with ampulla of Vater cancer (AVC). We compared the perioperative and oncologic outcomes between LPD and OPD in patients with AVC using propensity-score-matched analysis. A total of 359 patients underwent PD due to AVC during the study period (76 LPD, 283 OPD). After propensity score matching, the LPD group showed significantly longer operation time than did the OPD group (400.2 vs. 344.6 min, p < 0.001). Nevertheless, the LPD group had fewer painkiller administrations (8.3 vs. 11.1, p < 0.049), fewer Grade II or more severe postoperative complications (15.9% vs. 34.8%, p = 0.012), and shorter postoperative hospital stays (13.7 vs. 17.3 days, p = 0.048), compared with the OPD group. There was no significant difference in recurrence-free outcomes and overall survival between the two groups (p = 0.754 and 0.768, respectively). Compared with OPD, LPD for AVC had comparative oncologic outcomes with less pain, less postoperative morbidity, and shorter hospital stays. LPD may serve as a promising alternative to OPD in patients with AVC.
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Affiliation(s)
| | - Ki Byung Song
- Division of Hepatobiliary and Pancreatic Surgery, Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul 05505, Korea; (D.Y.); (J.W.L.); (K.H.); (S.H.); (D.S.); (D.W.H.); (J.H.L.); (W.L.); (J.K.); (Y.P.); (E.J.); (S.C.K.)
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14
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Hiki N. Why minimally invasive surgery for esophageal cancer is minimally invasive? Ann Gastroenterol Surg 2020; 4:188-189. [PMID: 32490331 PMCID: PMC7240137 DOI: 10.1002/ags3.12346] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2020] [Revised: 04/21/2020] [Accepted: 04/22/2020] [Indexed: 11/09/2022] Open
Affiliation(s)
- Naoki Hiki
- Department of Upper Gastrointestinal Surgery Kitasato University School of Medicine Kanagawa Japan
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15
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Kwon J, Song KB, Park SY, Shin D, Hong S, Park Y, Lee W, Lee JH, Hwang DW, Kim SC. Comparison of Minimally Invasive Versus Open Pancreatoduodenectomy for Pancreatic Ductal Adenocarcinoma: A Propensity Score Matching Analysis. Cancers (Basel) 2020; 12:982. [PMID: 32326595 PMCID: PMC7226374 DOI: 10.3390/cancers12040982] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2020] [Revised: 04/11/2020] [Accepted: 04/13/2020] [Indexed: 12/18/2022] Open
Abstract
Background: Few studies have compared perioperative and oncological outcomes between minimally invasive pancreatoduodenectomy (MIPD) and open pancreatoduodenectomy (OPD) for pancreatic ductal adenocarcinoma (PDAC). Methods: A retrospective review of patients undergoing MIPD and OPD for PDAC from January 2011 to December 2017 was performed. Perioperative, oncological, and survival outcomes were analyzed before and after propensity score matching (PSM). Results: Data from 1048 patients were evaluated (76 MIPD, 972 OPD). After PSM, 73 patients undergoing MIPD were matched with 219 patients undergoing OPD. Operation times were longer for MIPD than OPD (392 vs. 327 min, p < 0.001). Postoperative hospital stays were shorter for MIPD patients than OPD patients (12.4 vs. 14.2 days, p = 0.040). The rate of overall complications and postoperative pancreatic fistula did not differ between the two groups. Adjuvant treatment rates were higher following MIPD (80.8% vs. 59.8%, p = 0.002). With the exception of perineural invasion, no differences were seen between the two groups in pathological outcomes. The median overall survival and disease-free survival rates did not differ between the groups. Conclusions: MIPD showed shorter postoperative hospital stays and comparable perioperative and oncological outcomes to OPD for selected PDAC patients. Future randomized studies will be required to validate these findings.
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Affiliation(s)
- Jaewoo Kwon
- Division of Hepato-Biliary and Pancreatic Surgery, Department of Surgery, University of Ulsan College of Medicine and Asan Medical Center, 88, Olympic-Ro 43-Gil, Songpa-Gu, Seoul 05505, Korea; (J.K.); (K.B.S.); (D.S.); (S.H.); (Y.P.); (W.L.); (J.H.L.); (D.W.H.)
| | - Ki Byung Song
- Division of Hepato-Biliary and Pancreatic Surgery, Department of Surgery, University of Ulsan College of Medicine and Asan Medical Center, 88, Olympic-Ro 43-Gil, Songpa-Gu, Seoul 05505, Korea; (J.K.); (K.B.S.); (D.S.); (S.H.); (Y.P.); (W.L.); (J.H.L.); (D.W.H.)
| | - Seo Young Park
- Department of Clinical Epidemiology and Biostatistics, Asan Medical Center, University of Ulsan College of Medicine, 88, Olympic-Ro 43-Gil, Songpa-Gu, Seoul 05505, Korea;
| | - Dakyum Shin
- Division of Hepato-Biliary and Pancreatic Surgery, Department of Surgery, University of Ulsan College of Medicine and Asan Medical Center, 88, Olympic-Ro 43-Gil, Songpa-Gu, Seoul 05505, Korea; (J.K.); (K.B.S.); (D.S.); (S.H.); (Y.P.); (W.L.); (J.H.L.); (D.W.H.)
| | - Sarang Hong
- Division of Hepato-Biliary and Pancreatic Surgery, Department of Surgery, University of Ulsan College of Medicine and Asan Medical Center, 88, Olympic-Ro 43-Gil, Songpa-Gu, Seoul 05505, Korea; (J.K.); (K.B.S.); (D.S.); (S.H.); (Y.P.); (W.L.); (J.H.L.); (D.W.H.)
| | - Yejong Park
- Division of Hepato-Biliary and Pancreatic Surgery, Department of Surgery, University of Ulsan College of Medicine and Asan Medical Center, 88, Olympic-Ro 43-Gil, Songpa-Gu, Seoul 05505, Korea; (J.K.); (K.B.S.); (D.S.); (S.H.); (Y.P.); (W.L.); (J.H.L.); (D.W.H.)
| | - Woohyung Lee
- Division of Hepato-Biliary and Pancreatic Surgery, Department of Surgery, University of Ulsan College of Medicine and Asan Medical Center, 88, Olympic-Ro 43-Gil, Songpa-Gu, Seoul 05505, Korea; (J.K.); (K.B.S.); (D.S.); (S.H.); (Y.P.); (W.L.); (J.H.L.); (D.W.H.)
| | - Jae Hoon Lee
- Division of Hepato-Biliary and Pancreatic Surgery, Department of Surgery, University of Ulsan College of Medicine and Asan Medical Center, 88, Olympic-Ro 43-Gil, Songpa-Gu, Seoul 05505, Korea; (J.K.); (K.B.S.); (D.S.); (S.H.); (Y.P.); (W.L.); (J.H.L.); (D.W.H.)
| | - Dae Wook Hwang
- Division of Hepato-Biliary and Pancreatic Surgery, Department of Surgery, University of Ulsan College of Medicine and Asan Medical Center, 88, Olympic-Ro 43-Gil, Songpa-Gu, Seoul 05505, Korea; (J.K.); (K.B.S.); (D.S.); (S.H.); (Y.P.); (W.L.); (J.H.L.); (D.W.H.)
| | - Song Cheol Kim
- Division of Hepato-Biliary and Pancreatic Surgery, Department of Surgery, University of Ulsan College of Medicine and Asan Medical Center, 88, Olympic-Ro 43-Gil, Songpa-Gu, Seoul 05505, Korea; (J.K.); (K.B.S.); (D.S.); (S.H.); (Y.P.); (W.L.); (J.H.L.); (D.W.H.)
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16
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Desiderio J, Trastulli S, D'Andrea V, Parisi A. Enhanced recovery after surgery for gastric cancer (ERAS-GC): optimizing patient outcome. Transl Gastroenterol Hepatol 2020; 5:11. [PMID: 32190779 DOI: 10.21037/tgh.2019.10.04] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2019] [Accepted: 10/05/2019] [Indexed: 12/15/2022] Open
Abstract
Significant advances were achieved, in last decades, in the management of surgical patients with gastric cancer. This has led to the concept of enhanced recovery after surgery (ERAS) with the objective of reducing the length of hospital stay, accelerating postoperative recovery and reducing the surgical stress. The ERAS protocols have many items, including the pre-operative patient education, early mobilization and feeding starting from the first postoperative day. This review aims to highlight possible advantages on postoperative functional recovery outcomes after gastrectomy in patients undergoing an ERAS program, current lack of evidences and future perspectives.
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Affiliation(s)
- Jacopo Desiderio
- Department of Digestive Surgery, St. Mary's Hospital, Terni, Italy.,Department of Surgical Sciences, La Sapienza University of Rome, Rome, Italy
| | | | - Vito D'Andrea
- Department of Surgical Sciences, La Sapienza University of Rome, Rome, Italy
| | - Amilcare Parisi
- Department of Digestive Surgery, St. Mary's Hospital, Terni, Italy
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17
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Nagasaki T, Akiyoshi T, Fukunaga Y, Tominaga T, Yamaguchi T, Konishi T, Fujimoto Y, Nagayama S, Ueno M. The Short- and Long-Term Feasibility of Laparoscopic Surgery in Colon Cancer Patients with Bulky Tumors. J Gastrointest Surg 2019; 23:1893-1899. [PMID: 30706379 DOI: 10.1007/s11605-019-04114-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2018] [Accepted: 01/08/2019] [Indexed: 01/31/2023]
Abstract
BACKGROUND Compared to open surgery for colon cancer, randomized controlled trials have shown that laparoscopic approaches have equivalent short- and long-term outcomes. However, the feasibility of laparoscopy for removal of bulky tumors has not been evaluated. The aim of our study was to determine the short- and long-term feasibility of laparoscopic surgery for bulky (> 8 cm) colon cancer. METHODS A total of 80 patients with bulky tumors (defined as greater than 8 cm in diameter) underwent curative resection from July 2004 to July 2014. Short- and long-term outcomes were compared between patients undergoing laparoscopic (n = 48) and open (n = 32) resection. RESULTS Compared to open, the operative time was significantly longer (213 vs. 148 min, p < 0.001), return of bowel function quicker (time to oral intake; 2 vs. 5 days, p < 0.001), and length of stay shorter (10 vs. 13 days, p < 0.001) in the laparoscopic group. Five-year cancer-specific and relapse-free survival was similar with no patients developing local recurrence in either group. CONCLUSIONS Laparoscopic resection of colon cancers greater than 8 cm in diameter is feasible and oncologically safe with better short-term and equivalent long-term outcomes compared to open surgery.
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Affiliation(s)
- Toshiya Nagasaki
- Gastroenterological Center, Department of Gastroenterological Surgery, Cancer Institute Hospital, Japanese Foundation for Cancer Research, 3-8-31 Ariake, Koto-ku, Tokyo, 135-8550, Japan.
| | - Takashi Akiyoshi
- Gastroenterological Center, Department of Gastroenterological Surgery, Cancer Institute Hospital, Japanese Foundation for Cancer Research, 3-8-31 Ariake, Koto-ku, Tokyo, 135-8550, Japan
| | - Yosuke Fukunaga
- Gastroenterological Center, Department of Gastroenterological Surgery, Cancer Institute Hospital, Japanese Foundation for Cancer Research, 3-8-31 Ariake, Koto-ku, Tokyo, 135-8550, Japan
| | - Tetsuro Tominaga
- Gastroenterological Center, Department of Gastroenterological Surgery, Cancer Institute Hospital, Japanese Foundation for Cancer Research, 3-8-31 Ariake, Koto-ku, Tokyo, 135-8550, Japan
| | - Tomohiro Yamaguchi
- Gastroenterological Center, Department of Gastroenterological Surgery, Cancer Institute Hospital, Japanese Foundation for Cancer Research, 3-8-31 Ariake, Koto-ku, Tokyo, 135-8550, Japan
| | - Tsuyoshi Konishi
- Gastroenterological Center, Department of Gastroenterological Surgery, Cancer Institute Hospital, Japanese Foundation for Cancer Research, 3-8-31 Ariake, Koto-ku, Tokyo, 135-8550, Japan
| | - Yoshiya Fujimoto
- Gastroenterological Center, Department of Gastroenterological Surgery, Cancer Institute Hospital, Japanese Foundation for Cancer Research, 3-8-31 Ariake, Koto-ku, Tokyo, 135-8550, Japan
| | - Satoshi Nagayama
- Gastroenterological Center, Department of Gastroenterological Surgery, Cancer Institute Hospital, Japanese Foundation for Cancer Research, 3-8-31 Ariake, Koto-ku, Tokyo, 135-8550, Japan
| | - Masashi Ueno
- Gastroenterological Center, Department of Gastroenterological Surgery, Cancer Institute Hospital, Japanese Foundation for Cancer Research, 3-8-31 Ariake, Koto-ku, Tokyo, 135-8550, Japan
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18
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Robotic Versus Laparoscopic Gastrectomy for Locally Advanced Gastric Cancer. Surg Laparosc Endosc Percutan Tech 2018; 27:428-433. [PMID: 29211699 DOI: 10.1097/sle.0000000000000469] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Robotic gastrectomy (RG) has progressed rapidly in the last decade, overcoming many obstacles in laparoscopic technology. We compared surgical performance and short-term clinical outcomes between RG and laparoscopic gastrectomy (LG). In total, 163 patients with gastric cancer were randomly treated with RG (n=102) or LG (n=61). D2 lymphadenectomy was achieved in all patients. Digestive tract reconstruction in the RG group was performed by intracorporeal hand sewing, but extracorporeal anastomosis in the LG group was performed with a 25-mm circular stapler or linear stapler. Compared with the LG group, the RG group had less intraoperative blood loss (P=0.005) and more lymph nodes retrieved (P=0.000). Postoperative complications between the 2 groups were not significantly different during the 11-month follow-up (P=0.063). Compared with LG, RG is a feasible and safe approach with minimally invasive, satisfactory intracorporeal digestive tract reconstruction, and fast recovery. Multicenter randomized controlled studies of larger numbers of patients are needed.
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19
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Kitaguchi D, Nishizawa Y, Sasaki T, Tsukada Y, Kondo A, Hasegawa H, Ito M. A Rare Complication After Laparoscopic Lateral Lymph Node Dissection for Rectal Cancer: Two Case Reports of Internal Hernia Below the Superior Vesical Artery. JOURNAL OF THE ANUS RECTUM AND COLON 2018; 2:110-114. [PMID: 31559352 PMCID: PMC6752144 DOI: 10.23922/jarc.2017-046] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/20/2017] [Accepted: 04/09/2018] [Indexed: 12/22/2022]
Abstract
Total mesorectal excision or mesorectal excision with lateral lymph node dissection (LLND) is a standard treatment for locally advanced lower rectal cancer in Japan. Although laparoscopic LLND for rectal cancer is technically complex and challenging, previous studies have demonstrated its feasibility, and the procedure is gradually becoming more common. With this increased use, the incidence of new complications specific to laparoscopic LLND is likely to increase, and a greater awareness of these complications is required. Here we report two cases of internal hernia of the small bowel through an orifice of the vesicohypogastric fascia below the superior vesical artery after laparoscopic LLND. There are six previous reports of internal hernia underneath the pelvic blood vessel after pelvic lymph node dissection for urological or gynecological malignancies, but our cases are the first two that occurred after LLND for rectal cancer. Almost all cases, including our two cases, occurred after laparoscopic surgery and required resection of an incarcerated small bowel. Therefore, the incidence of this complication is likely to increase as the number of cases treated with laparoscopic LLND increases. Our cases show that it is important to perform an emergency operation promptly instead of conservative treatment.
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Affiliation(s)
- Daichi Kitaguchi
- Department of Colorectal Surgery, National Cancer Center Hospital East, Chiba, Japan
| | - Yuji Nishizawa
- Department of Colorectal Surgery, National Cancer Center Hospital East, Chiba, Japan
| | - Takeshi Sasaki
- Department of Colorectal Surgery, National Cancer Center Hospital East, Chiba, Japan
| | - Yuichiro Tsukada
- Department of Colorectal Surgery, National Cancer Center Hospital East, Chiba, Japan
| | - Akihiro Kondo
- Department of Colorectal Surgery, National Cancer Center Hospital East, Chiba, Japan
| | - Hiro Hasegawa
- Department of Colorectal Surgery, National Cancer Center Hospital East, Chiba, Japan
| | - Masaaki Ito
- Department of Colorectal Surgery, National Cancer Center Hospital East, Chiba, Japan
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20
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Amouzandeh M, Nowak G, Januszkiewicz A, Wernerman J, Rooyackers O, Norberg Å. Albumin mass balance and kinetics in liver transplantation. CRITICAL CARE : THE OFFICIAL JOURNAL OF THE CRITICAL CARE FORUM 2018; 22:152. [PMID: 29880012 PMCID: PMC5992699 DOI: 10.1186/s13054-018-2053-6] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/21/2017] [Accepted: 04/29/2018] [Indexed: 02/07/2023]
Abstract
Background In major abdominal surgery albumin is shifted from the circulation, presumably leaking into the interstitial space, contributing to a 30–40% decrease in plasma albumin concentration. During and after liver transplantation exogenous albumin is infused for volume substitution and to maintain plasma albumin concentration. Here we used liver transplantation as a model procedure for the study of albumin mass balance and kinetics during major abdominal surgery with albumin substitution. Methods Patients were studied during liver transplantation (n = 16), and until postoperative day 3 (POD 3) (n = 11). Cumulative perioperative albumin shift was assessed by mass balance of albumin and hemoglobin. Synthesis rates of albumin and fibrinogen were estimated by the flooding technique using deuterium-labeled phenylalanine. Albumin distribution was assessed by radioiodinated human serum albumin. Results At the end of surgery, 37 ± 17 g of albumin (p < 0.0001) had shifted from plasma, and this amount was stable until POD 3 (48 ± 33 g, p = 0.0017 versus baseline). There was 91 ± 37 g exogenous albumin infused peroperatively and another 47 ± 35 g was infused postoperatively until POD 3. Absolute synthesis rates of albumin and fibrinogen on POD 3 were 239 ± 84 mg/kg body weight/day and 33 mg/kg body weight/day (range 5–161), respectively. Conclusions Albumin net leakage from plasma progressed until the end of surgery, and was then unaltered until POD 3. This is in contrast with the normalization of the cumulative albumin shift identified at day 3 after non-transplant major abdominal surgery. Liver synthesis of export proteins was high compared to reference values at the third postoperative day, suggesting rapid recovery of synthesis capacity. Trial registration Swedish Medical Product Agency, EudraCT 2015-002568-18. Registered on 15 July 2015.
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Affiliation(s)
- Mariam Amouzandeh
- Perioperative Medicine and Intensive Care, B31, Karolinska University Hospital, Huddinge, SE-141 86, Stockholm, Sweden.,Department of Clinical Science Intervention and Technology (CLINTEC), Karolinska Institutet, Hälsovägen, Stockholm, Sweden
| | - Greg Nowak
- Department of Clinical Science Intervention and Technology (CLINTEC), Karolinska Institutet, Hälsovägen, Stockholm, Sweden.,Trauma and Reparative Medicine, Transplantation Karolinska University Hospital, Huddinge, Stockholm, Sweden
| | - Anna Januszkiewicz
- Perioperative Medicine and Intensive Care, B31, Karolinska University Hospital, Huddinge, SE-141 86, Stockholm, Sweden.,Department of Clinical Science Intervention and Technology (CLINTEC), Karolinska Institutet, Hälsovägen, Stockholm, Sweden
| | - Jan Wernerman
- Perioperative Medicine and Intensive Care, B31, Karolinska University Hospital, Huddinge, SE-141 86, Stockholm, Sweden.,Department of Clinical Science Intervention and Technology (CLINTEC), Karolinska Institutet, Hälsovägen, Stockholm, Sweden
| | - Olav Rooyackers
- Perioperative Medicine and Intensive Care, B31, Karolinska University Hospital, Huddinge, SE-141 86, Stockholm, Sweden.,Department of Clinical Science Intervention and Technology (CLINTEC), Karolinska Institutet, Hälsovägen, Stockholm, Sweden
| | - Åke Norberg
- Perioperative Medicine and Intensive Care, B31, Karolinska University Hospital, Huddinge, SE-141 86, Stockholm, Sweden. .,Department of Clinical Science Intervention and Technology (CLINTEC), Karolinska Institutet, Hälsovägen, Stockholm, Sweden.
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Parisi A, Reim D, Borghi F, Nguyen NT, Qi F, Coratti A, Cianchi F, Cesari M, Bazzocchi F, Alimoglu O, Gagnière J, Pernazza G, D’Imporzano S, Zhou YB, Azagra JS, Facy O, Brower ST, Jiang ZW, Zang L, Isik A, Gemini A, Trastulli S, Novotny A, Marano A, Liu T, Annecchiarico M, Badii B, Arcuri G, Avanzolini A, Leblebici M, Pezet D, Cao SG, Goergen M, Zhang S, Palazzini G, D’Andrea V, Desiderio J. Minimally invasive surgery for gastric cancer: A comparison between robotic, laparoscopic and open surgery. World J Gastroenterol 2017; 23:2376-2384. [PMID: 28428717 PMCID: PMC5385404 DOI: 10.3748/wjg.v23.i13.2376] [Citation(s) in RCA: 64] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2016] [Revised: 01/23/2017] [Accepted: 03/15/2017] [Indexed: 02/06/2023] Open
Abstract
AIM To investigate the role of minimally invasive surgery for gastric cancer and determine surgical, clinical, and oncological outcomes. METHODS This is a propensity score-matched case-control study, comparing three treatment arms: robotic gastrectomy (RG), laparoscopic gastrectomy (LG), open gastrectomy (OG). Data collection started after sharing a specific study protocol. Data were recorded through a tailored and protected web-based system. Primary outcomes: harvested lymph nodes, estimated blood loss, hospital stay, complications rate. Among the secondary outcomes, there are: operative time, R0 resections, POD of mobilization, POD of starting liquid diet and soft solid diet. The analysis includes the evaluation of type and grade of postoperative complications. Detailed information of anastomotic leakages is also provided. RESULTS The present analysis was carried out of 1026 gastrectomies. To guarantee homogenous distribution of cases, patients in the RG, LG and OG groups were 1:1:2 matched using a propensity score analysis with a caliper = 0.2. The successful matching resulted in a total sample of 604 patients (RG = 151; LG = 151; OG = 302). The three groups showed no differences in all baseline patients characteristics, type of surgery (P = 0.42) and stage of the disease (P = 0.16). Intraoperative blood loss was significantly lower in the LG (95.93 ± 119.22) and RG (117.91 ± 68.11) groups compared to the OG (127.26 ± 79.50, P = 0.002). The mean number of retrieved lymph nodes was similar between the RG (27.78 ± 11.45), LG (24.58 ± 13.56) and OG (25.82 ± 12.07) approach. A benefit in favor of the minimally invasive approaches was found in the length of hospital stay (P < 0.0001). A similar complications rate was found (P = 0.13). The leakage rate was not different (P = 0.78) between groups. CONCLUSION Laparoscopic and robotic surgery can be safely performed and proposed as possible alternative to open surgery. The main highlighted benefit is a faster postoperative functional recovery.
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Naito M, Ogura N, Yamanashi T, Sato T, Nakamura T, Miura H, Tsutsui A, Sakamoto Y, Tanaka R, Kumagai Y, Watanabe M. Prospective randomized controlled study on the validity and safety of an absorbable adhesion barrier (Interceed®) made of oxidized regenerated cellulose for laparoscopic colorectal surgery. Asian J Endosc Surg 2017; 10:7-11. [PMID: 27753246 DOI: 10.1111/ases.12334] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2016] [Revised: 07/11/2016] [Accepted: 08/24/2016] [Indexed: 12/16/2022]
Abstract
INTRODUCTION Clinical use of an adhesion barrier made of oxidized, regenerated cellulose, Interceed®, has been reported in the field of obstetrics and gynecology to help prevent adhesions between the peritoneum and the bowel in various types of operations. In gastrointestinal surgery, sodium hyaluronate/carboxymethylcellulose has been reported as an absorbable membrane to reduce postoperative adhesions. The present study was a prospective randomized controlled study to investigate the safety and usefulness of Interceed in laparoscopic colorectal surgery. METHODS We analyzed 99 patients who underwent laparoscopic colorectal surgery from 2013 to 2014. The patients were randomly allocated to the group that used Interceed (Interceed group) or the group that did not (Non-Interceed group). RESULTS Fifty cases used Interceed, and 49 cases did not. The incidence of adverse events was 12.0% in the Interceed group and 16.3% in the Non-Interceed group (P = 0.58). There were no significant differences, and no adhesive bowel obstructions were observed in the Interceed group. CONCLUSION We have shown that using Interceed in laparoscopic colorectal surgery is valid and technically safe.
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Affiliation(s)
- Masanori Naito
- Department of Surgery, Kitasato University School of Medicine, Sagamihara, Japan
| | - Naoto Ogura
- Department of Surgery, Kitasato University School of Medicine, Sagamihara, Japan
| | - Takahiro Yamanashi
- Department of Surgery, Kitasato University School of Medicine, Sagamihara, Japan
| | - Takeo Sato
- Department of Surgery, Kitasato University School of Medicine, Sagamihara, Japan
| | - Takatoshi Nakamura
- Department of Surgery, Kitasato University School of Medicine, Sagamihara, Japan
| | - Hirohisa Miura
- Department of Surgery, Kitasato University School of Medicine, Sagamihara, Japan
| | - Atsuko Tsutsui
- Department of Surgery, Kitasato University School of Medicine, Sagamihara, Japan
| | - Yasutoshi Sakamoto
- Clinical Research Center, Kitasato University School of Medicine, Sagamihara, Japan
| | - Rieko Tanaka
- Clinical Research Center, Kitasato University School of Medicine, Sagamihara, Japan
| | - Yuji Kumagai
- Clinical Research Center, Kitasato University School of Medicine, Sagamihara, Japan
| | - Masahiko Watanabe
- Department of Surgery, Kitasato University School of Medicine, Sagamihara, Japan
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Takahashi R, Sakamoto K, Tomiki Y, Kojima Y, Takahashi M, Sugimoto K, Kawai M, Okazawa Y, Makino Y. Two-stage laparoscopic curative resection for synchronous multiple colorectal cancers: A case report. Asian J Endosc Surg 2016; 9:300-302. [PMID: 27456545 DOI: 10.1111/ases.12293] [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: 09/06/2015] [Revised: 03/10/2016] [Accepted: 03/17/2016] [Indexed: 11/29/2022]
Abstract
A 75-year-old man tested positive for occult blood in the stool. A subsequent examination indicated concurrent locally advanced cancer (cT3) at the hepatic flexure and lower rectum cancer in the external anal sphincter. Because of the locally advanced rectal cancer (cT4), preoperative chemoradiotherapy was administered. First, laparoscopic right hemicolectomy and colostomy were performed at the sigmoid colon. Chemoradiotherapy for rectal cancer was initiated on day 18 after the surgeries. Seven weeks after chemoradiotherapy had been completed, laparoscopic abdominoperineal resection and right lateral pelvic lymph node dissection were performed. This case demonstrated that a second radical surgery for rectal cancer could be performed safely and laparoscopically after laparoscopic colectomy and colostomy.
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Affiliation(s)
- Rina Takahashi
- Department of Coloproctological Surgery, Juntendo University Faculty of Medicine, Tokyo, Japan.
| | - Kazuhiro Sakamoto
- Department of Coloproctological Surgery, Juntendo University Faculty of Medicine, Tokyo, Japan
| | - Yuichi Tomiki
- Department of Coloproctological Surgery, Juntendo University Faculty of Medicine, Tokyo, Japan
| | - Yutaka Kojima
- Department of Coloproctological Surgery, Juntendo University Faculty of Medicine, Tokyo, Japan
| | - Makoto Takahashi
- Department of Coloproctological Surgery, Juntendo University Faculty of Medicine, Tokyo, Japan
| | - Kiichi Sugimoto
- Department of Coloproctological Surgery, Juntendo University Faculty of Medicine, Tokyo, Japan
| | - Masaya Kawai
- Department of Coloproctological Surgery, Juntendo University Faculty of Medicine, Tokyo, Japan
| | - Yu Okazawa
- Department of Coloproctological Surgery, Juntendo University Faculty of Medicine, Tokyo, Japan
| | - Yurika Makino
- Department of Coloproctological Surgery, Juntendo University Faculty of Medicine, Tokyo, Japan
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Chang K, Bourke M, Kavanagh D, Neary P, O'Riordan J. A systematic review of the role of re-laparoscopy in the management of complications following laparoscopic colorectal surgery. Surgeon 2016; 14:287-93. [DOI: 10.1016/j.surge.2015.12.003] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2015] [Revised: 10/06/2015] [Accepted: 12/17/2015] [Indexed: 12/15/2022]
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Full robot-assisted gastrectomy: surgical technique and preliminary experience from a single center. J Robot Surg 2016; 10:297-306. [DOI: 10.1007/s11701-016-0591-y] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2016] [Accepted: 04/24/2016] [Indexed: 12/19/2022]
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Roscio F, Boni L, Clerici F, Frattini P, Cassinotti E, Scandroglio I. Is laparoscopic surgery really effective for the treatment of colon and rectal cancer in very elderly over 80 years old? A prospective multicentric case-control assessment. Surg Endosc 2016; 30:4372-82. [PMID: 26895891 DOI: 10.1007/s00464-016-4755-7] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2015] [Accepted: 01/11/2016] [Indexed: 12/24/2022]
Abstract
BACKGROUND To evaluate the effectiveness of laparoscopic surgery (LCS) for colon and rectal cancer in the very elderly over 80 years old. METHODS We performed a prospective multicentric analysis comparing patients over 80 years (Group A) and patients between 60 and 69 years (Group B) undergoing LCS for cancer from January 2008 to December 2013. Colon and rectal cancers were analyzed separately. Comorbidity and complications were classified using the Charlson comorbidity index (CCI) and the Clavien-Dindo system, respectively. Oncological parameters included tumor-free margins, number of lymph nodes harvested and circumferential resection margin. RESULTS Group A included 96 and 33 patients, and Group B 220 and 82 for colon and rectal cancers, respectively. Groups were similar except for ASA score and CCI, as expected. There was no significant difference in operative time [colon; rectum] (180[IQR 150-200] vs 180[150-210] min; NS-180[160-210] vs 180[165-240] min; NS), estimated blood loss (50[25-75] vs 50[25-120] mL; NS-50[0-150] vs 50[25-108.7] mL; NS) and conversion rate (2.1 vs 2.7 %; NS-3.0 vs 2.4 %; NS). Timing of first stool (3[2-3.25] vs 3[2-5] dd; NS-3[2-4] vs 3[2-5] dd; NS), length of stay (7[6-8] vs 7[6-8] dd; NS-8[8-9] vs 8[7-9] dd; NS) and readmission rate (1.0 vs 0.45 %; NS-6.1 vs 1.2 %; NS) were similar. Tumor-free margins were appropriate, and positivity of CRM is poor (6.1 vs 4.9; NS). We did not record significant differences in complications rate (47.9 vs 43.6 %; NS-63.6 vs 52.4 %; NS). CONCLUSIONS Laparoscopic surgery is effective for the treatment of colorectal cancer even in the very elderly. Age is not a risk factor or a limitation for LCS.
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Affiliation(s)
- Francesco Roscio
- Division of General Surgery, Department of Surgery, Galmarini Hospital, Piazzale A. Zanaboni, 1, 21049, Tradate, Italy.
- PhD Program in Surgery and Surgical Biotechnologies, University of Insubria, Varese, Italy.
| | - Luigi Boni
- PhD Program in Surgery and Surgical Biotechnologies, University of Insubria, Varese, Italy
- Minimally Invasive Surgery Research Center, University of Insubria, Varese, Italy
| | - Federico Clerici
- Division of General Surgery, Department of Surgery, Galmarini Hospital, Piazzale A. Zanaboni, 1, 21049, Tradate, Italy
| | - Paolo Frattini
- Division of General Surgery, Department of Surgery, Galmarini Hospital, Piazzale A. Zanaboni, 1, 21049, Tradate, Italy
| | - Elisa Cassinotti
- Minimally Invasive Surgery Research Center, University of Insubria, Varese, Italy
| | - Ildo Scandroglio
- Division of General Surgery, Department of Surgery, Galmarini Hospital, Piazzale A. Zanaboni, 1, 21049, Tradate, Italy
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Parisi A, Ricci F, Trastulli S, Cirocchi R, Gemini A, Grassi V, Corsi A, Renzi C, De Santis F, Petrina A, Pironi D, D'Andrea V, Santoro A, Desiderio J. Robotic Total Gastrectomy With Intracorporeal Robot-Sewn Anastomosis: A Novel Approach Adopting the Double-Loop Reconstruction Method. Medicine (Baltimore) 2015; 94:e1922. [PMID: 26656323 PMCID: PMC5008468 DOI: 10.1097/md.0000000000001922] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/02/2023] Open
Abstract
Gastric cancer constitutes a major health problem. Robotic surgery has been progressively developed in this field. Although the feasibility of robotic procedures has been demonstrated, there are unresolved aspects being debated, including the reproducibility of intracorporeal in place of extracorporeal anastomosis.Difficulties of traditional laparoscopy have been described and there are well-known advantages of robotic systems, but few articles in literature describe a full robotic execution of the reconstructive phase while others do not give a thorough explanation how this phase was run.A new reconstructive approach, not yet described in literature, was recently adopted at our Center.Robotic total gastrectomy with D2 lymphadenectomy and a so-called "double-loop" reconstruction method with intracorporeal robot-sewn anastomosis (Parisi's technique) was performed in all reported cases.Preoperative, intraoperative, and postoperative data were collected and a technical note was documented.All tumors were located at the upper third of the stomach, and no conversions or intraoperative complications occurred. Histopathological analysis showed R0 resection obtained in all specimens. Hospital stay was regular in all patients and discharge was recommended starting from the 4th postoperative day. No major postoperative complications or reoperations occurred.Reconstruction of the digestive tract after total gastrectomy is one of the main areas of surgical research in the treatment of gastric cancer and in the field of minimally invasive surgery.The double-loop method is a valid simplification of the traditional technique of construction of the Roux-limb that could increase the feasibility and safety in performing a full hand-sewn intracorporeal reconstruction and it appears to fit the characteristics of the robotic system thus obtaining excellent postoperative clinical outcomes.
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Affiliation(s)
- Amilcare Parisi
- From the Department of Digestive Surgery, St. Mary's Hospital, University of Perugia, Terni (AP, JD, ST, RC, FR, VG); Department of General and Oncologic Surgery, University of Perugia, Perugia (AC, CR, AG, FDS, AP); and Department of Surgical Sciences, Sapienza University of Rome, Rome, Italy (DP, VD, AS)
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Inoue Y, Kawamoto A, Okugawa Y, Hiro J, Saigusa S, Toiyama Y, Araki T, Tanaka K, Mohri Y, Kusunoki M. Efficacy and safety of laparoscopic surgery in elderly patients with colorectal cancer. Mol Clin Oncol 2015; 3:897-901. [PMID: 26171203 DOI: 10.3892/mco.2015.530] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2015] [Accepted: 02/26/2015] [Indexed: 01/14/2023] Open
Abstract
Colorectal cancer (CRC) is predominantly a disease of the elderly. Elderly patients may also exhibit poorer outcomes due to the increased burden of comorbidities, functional dependency and limited life expectancy. The aim of this study was to evaluate the outcome of laparoscopic surgery in elderly patients with CRC. A total of 148 patients who underwent laparoscopic surgery at our institution between January, 2000 and December, 2011 were enrolled. We compared the differences between elderly patients (aged >75 years, n=48) and non-elderly patients (aged <75 years, n=100) and evaluated the demographics and disease-related operative and prognostic data. Postoperative complications occurred in 24 (16.2%) of the 148 patients. The American Society of Anesthesiologists score and comorbidity were found to be significantly correlated with complications and the multivariate analysis demonstrated that pulmonary disease, but not age, was an independent factor affecting postoperative complications (odds ratio = 3.21, 95% confidence interval: 1.02-10.14, P=0.0470). Patients with pulmonary comorbidities also exhibited similar rates of postoperative complications compared with 259 matched patients who underwent open surgery during same period (41.2 vs. 46.7%, respectively; P=0.7547). In conclusion, chronological age alone should not be considered a contraindication for laparoscopic surgery for CRC in elderly patients. In addition, selection criteria for laparoscopic CRC surgery in elderly as well as non-elderly patients should include pulmonary comorbidities.
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Affiliation(s)
- Yasuhiro Inoue
- Department of Gastrointestinal and Pediatric Surgery, Division of Reparative Medicine, Institute of Life Sciences, Mie University Graduate School of Medicine, Tsu, Mie 514-8507, Japan
| | - Aya Kawamoto
- Department of Gastrointestinal and Pediatric Surgery, Division of Reparative Medicine, Institute of Life Sciences, Mie University Graduate School of Medicine, Tsu, Mie 514-8507, Japan
| | - Yoshinaga Okugawa
- Department of Gastrointestinal and Pediatric Surgery, Division of Reparative Medicine, Institute of Life Sciences, Mie University Graduate School of Medicine, Tsu, Mie 514-8507, Japan
| | - Junichiro Hiro
- Department of Gastrointestinal and Pediatric Surgery, Division of Reparative Medicine, Institute of Life Sciences, Mie University Graduate School of Medicine, Tsu, Mie 514-8507, Japan
| | - Susumu Saigusa
- Department of Gastrointestinal and Pediatric Surgery, Division of Reparative Medicine, Institute of Life Sciences, Mie University Graduate School of Medicine, Tsu, Mie 514-8507, Japan
| | - Yuji Toiyama
- Department of Gastrointestinal and Pediatric Surgery, Division of Reparative Medicine, Institute of Life Sciences, Mie University Graduate School of Medicine, Tsu, Mie 514-8507, Japan
| | - Toshimitsu Araki
- Department of Gastrointestinal and Pediatric Surgery, Division of Reparative Medicine, Institute of Life Sciences, Mie University Graduate School of Medicine, Tsu, Mie 514-8507, Japan
| | - Koji Tanaka
- Department of Gastrointestinal and Pediatric Surgery, Division of Reparative Medicine, Institute of Life Sciences, Mie University Graduate School of Medicine, Tsu, Mie 514-8507, Japan
| | - Yasuhiko Mohri
- Department of Gastrointestinal and Pediatric Surgery, Division of Reparative Medicine, Institute of Life Sciences, Mie University Graduate School of Medicine, Tsu, Mie 514-8507, Japan
| | - Masato Kusunoki
- Department of Gastrointestinal and Pediatric Surgery, Division of Reparative Medicine, Institute of Life Sciences, Mie University Graduate School of Medicine, Tsu, Mie 514-8507, Japan
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Current status of minimally invasive surgery for gastric cancer: A literature review to highlight studies limits. Int J Surg 2015; 17:34-40. [PMID: 25758348 DOI: 10.1016/j.ijsu.2015.02.021] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2015] [Revised: 02/05/2015] [Accepted: 02/26/2015] [Indexed: 12/14/2022]
Abstract
BACKGROUND Gastric cancer represents a great challenge for health care providers and requires a multidisciplinary approach in which surgery plays the main role. Minimally invasive surgery has been progressively developed, first with the advent of laparoscopy and more recently with the spread of robotic surgery, but a number of issues are currently being investigate, including the limitations in performing effective extended lymph node dissections and, in this context, the real advantages of using robotic systems, the possible role for advanced Gastric Cancer, the reproducibility of completely intracorporeal techniques and the oncological results achievable during follow-up. METHOD Searches of MEDLINE, Embase and Cochrane Central Register of Controlled Trials were performed to identify articles published until April 2014 which reported outcomes of surgical treatment for gastric cancer and that used minimally invasive surgical technology. Articles that deal with endoscopic technology were excluded. RESULTS A total of 362 articles were evaluated. After the review process, data in 115 articles were analyzed. CONCLUSION A multicenter study with a large number of patients is now needed to further investigate the safety and efficacy as well as long-term outcomes of robotic surgery, traditional laparoscopy and the open approach.
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Antoniou SA, Andreou A, Antoniou GA, Bertsias A, Köhler G, Koch OO, Pointner R, Granderath FA. A systematic review and analysis of factors associated with methodological quality in laparoscopic randomized controlled trials. Dig Surg 2015; 32:217-24. [PMID: 25896540 DOI: 10.1159/000381886] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2015] [Accepted: 03/24/2015] [Indexed: 12/10/2022]
Abstract
Several methods for assessment of methodological quality in randomized controlled trials (RCTs) have been developed during the past few years. Factors associated with quality in laparoscopic surgery have not been defined till date. The aim of this study was to investigate the relationship between bibliometric and the methodological quality of laparoscopic RCTs. The PubMed search engine was queried to identify RCTs on minimally invasive surgery published in 2012 in the 10 highest impact factor surgery journals and the 5 highest impact factor laparoscopic journals. Eligible studies were blindly assessed by two independent investigators using the Scottish Intercollegiate Guidelines Network (SIGN) tool for RCTs. Univariate and multivariate analyses were performed to identify potential associations with methodological quality. A total of 114 relevant RCTs were identified. More than half of the trials were of high or acceptable quality. Half of the reports provided information on comparative demo graphic data and only 21% performed intention-to-treat analysis. RCTs with sample size of at least 60 patients presented higher methodological quality (p = 0.025). Upon multiple regression, reporting on preoperative care and the experience level of surgeons were independent factors of quality.
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Hopster-Iversen CCS, Hopster K, Staszyk C, Rohn K, Freeman DE, Rötting AK. Effects of experimental mechanical manipulations on local inflammation in the jejunum of horses. Am J Vet Res 2014; 75:385-91. [PMID: 24669925 DOI: 10.2460/ajvr.75.4.385] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
OBJECTIVE To determine characteristics of the inflammatory reaction in the jejunum of horses in response to various mechanical manipulations. ANIMALS 12 adult warm blood horses without gastrointestinal tract disorders. PROCEDURES The proximal aspect of the jejunum in each horse was divided into 5 segments, and the following manipulations were performed: manual emptying, placement of Doyen forceps, enterotomy alone, enterotomy with mucosal abrasion, and serosal abrasion. Jejunum samples were collected before (control), immediately after, and 30 minutes after the end of manipulations and histologically evaluated to determine distribution of neutrophils and eosinophils. RESULTS Macroscopically, all manipulations resulted in jejunal hemorrhage and edema. Compared with control samples, neutrophil numbers were significantly higher after manipulations in the serosa (after all manipulation types), circular muscle layer (after manual emptying), submucosa (after placement of Doyen forceps), and mucosa (after all manipulations except enterotomy alone). Eosinophil numbers were significantly higher in the submucosa after mechanical abrasion of the serosa and manual emptying versus control samples. CONCLUSIONS AND CLINICAL RELEVANCE Results indicated mechanical manipulation of the jejunum resulted in local inflammatory reactions characterized predominantly by infiltration of neutrophils. This could contribute to the development of postoperative ileus or adhesions in horses without macroscopically detectable injury of the jejunum during surgery.
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Pappas-Gogos G, Tellis CC, Trypsianis G, Tsimogiannis KE, Tsimoyiannis EC, Simopoulos CE, Pitiakoudis M, Tselepis AD. Oxidative stress in multi-port and single-port cholecystectomy. J Surg Res 2014; 194:101-6. [PMID: 25438954 DOI: 10.1016/j.jss.2014.09.020] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2014] [Revised: 08/14/2014] [Accepted: 09/18/2014] [Indexed: 02/07/2023]
Abstract
BACKGROUND This study was designed to analyze and compare plasma levels of 8-isoprostane (8-epiPGF2α), a biomarker of lipid peroxidation, and uric acid (UA), a marker of the antioxidant status, in standard laparoscopic (LC) and laparoendoscopic single-site cholecystectomy (LSSC). MATERIALS AND METHODS Forty patients with noncomplicated cholelithiasis were randomized to undergo either LSSC (n = 20) or LC (n = 20). The patients had body mass index <30, American Society of Anesthesiologists score I or II, and no previous upper gastrointestinal surgery. Blood samples were taken preoperatively and 6 h and 24 h postoperatively. Levels of 8-epiPGF2α were determined using enzyme-linked immunosorbent assay, whereas levels of UA were calculated using automated analyzer. RESULTS No significant differences were observed in operative data among the groups. Levels of 8-epiPGF2α were significantly higher in LSSC compared with LC at 6 h (P = 0.003) and 24 h (P < 0.001). 8-epiPGF2α levels showed significant changes over time in LC (LSSC: P = 0.720, LC: P < 0.001). UA levels were significantly higher in LC compared with LSSC, 24 h postoperatively (P = 0.021). No significant changes over time in the UA levels in both groups (LSSC: P = 0.056, LC: P = 0.205). CONCLUSIONS LSSC is associated with increased oxidative stress compared with LC. Further studies are needed to confirm these results.
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Affiliation(s)
- George Pappas-Gogos
- Department of Surgery, "G. Hatzikosta" General Hospital of Ioannina, Ioannina, Greece.
| | - Constantinos C Tellis
- Chemistry Department, Laboratory of Biochemistry, Ioannina University, Ioannina, Greece
| | - Grigorios Trypsianis
- Department of Statistics, Medical School, Democritus University of Thrace, Alexandroupolis, Greece
| | | | | | | | - Michael Pitiakoudis
- Department of Surgery, Democritus University of Thrace, Alexandroupolis, Greece
| | - Alexandros D Tselepis
- Chemistry Department, Laboratory of Biochemistry, Ioannina University, Ioannina, Greece
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Impact of the perioperative neutrophil-to-lymphocyte ratio on the long-term survival following an elective resection of colorectal carcinoma. Int J Colorectal Dis 2014; 29:1091-9. [PMID: 25048875 DOI: 10.1007/s00384-014-1964-1] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/13/2014] [Indexed: 02/04/2023]
Abstract
PURPOSES The present study was designed to evaluate the prognostic value of the perioperative neutrophil-to-lymphocyte ratio (NLR) for the long-term survival in patients with colorectal cancer. METHODS This was a retrospective study of 524 patients with histologically proven stage II or III colorectal cancer who underwent curative colorectal resection. We classified patients into a low NLR group or high NLR group base on their NLR values at three time points (before surgery (Pre), on the first postoperative day (POD1), and on the third or fourth postoperative day (POD3)) and evaluated the survival according to the group. RESULTS The cancer-specific survival was significantly longer in the groups with a low NLR on POD3. The disease-free survival was significantly longer in the group with a low NLR on Pre. We subsequently allocated a score of 1 to patients with a high NLR at each point and reclassified patients into those with a low perioperative NLR group (score of 0 or 1) and high perioperative NLR group (score of 2 or 3). Both the cancer-specific survival and disease-free survival rates were significantly different between the two perioperative NLR groups. Both univariate and multivariate analyses demonstrated that being in the high perioperative NLR group was an independent risk factor for both the cancer-specific survival and disease-free survival. CONCLUSIONS Not only the preoperative but also the postoperative NTR is thus considered to be a predictor of the long-time survival in patients with colorectal cancer.
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Bellinger J, Munoz-Bongrand N, Pariente B, Baudry C, Chirica M, Gornet JM, Allez M, Cattan P. Endoscopic and Clinical Recurrences After Laparoscopic or Open Ileocolic Resection in Crohn's Disease. J Laparoendosc Adv Surg Tech A 2014; 24:617-22. [DOI: 10.1089/lap.2014.0121] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023] Open
Affiliation(s)
- Justine Bellinger
- Department of General, Digestive, and Endocrine Surgery, University Paris VII Denis-Diderot, Paris, France
| | - Nicolas Munoz-Bongrand
- Department of General, Digestive, and Endocrine Surgery, University Paris VII Denis-Diderot, Paris, France
| | - Benjamin Pariente
- Department of Gastro-enterology, Hôpital Saint-Louis, University Paris VII Denis-Diderot, Paris, France
| | - Clotilde Baudry
- Department of Gastro-enterology, Hôpital Saint-Louis, University Paris VII Denis-Diderot, Paris, France
| | - Mircea Chirica
- Department of General, Digestive, and Endocrine Surgery, University Paris VII Denis-Diderot, Paris, France
| | - Jean-Marc Gornet
- Department of Gastro-enterology, Hôpital Saint-Louis, University Paris VII Denis-Diderot, Paris, France
| | - Matthieu Allez
- Department of Gastro-enterology, Hôpital Saint-Louis, University Paris VII Denis-Diderot, Paris, France
| | - Pierre Cattan
- Department of General, Digestive, and Endocrine Surgery, University Paris VII Denis-Diderot, Paris, France
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Kusano T, Etoh T, Inomata M, Shiraishi N, Kitano S. CO(2) pneumoperitoneum increases secretory IgA levels in the gut compared with laparotomy in an experimental animal model. Surg Endosc 2014; 28:1879-85. [PMID: 24442682 DOI: 10.1007/s00464-013-3408-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2013] [Accepted: 12/22/2013] [Indexed: 12/08/2022]
Abstract
BACKGROUND Secretory immunoglobulin A (s-IgA) plays an important role in both gut and systemic immunity. This study aimed to investigate the production of s-IgA resulting from a CO2 pneumoperitoneum compared with a laparotomy. METHODS Using enzyme-linked immunosorbent assays, s-IgA in stool, malondialdehyde (MDA), and Toll-like receptor 4 (TLR4) in the ileal tissue were evaluated as markers for gut and systemic immune responses in an animal model. The rats were randomly divided into (i) anesthesia-only as the control group; (ii) laparotomy-only as the open group; and (iii) CO2 pneumoperitoneum-only as the pneumoperitoneum group. To evaluate the gut immune system in a time-dependent manner, each group was further divided into short- and long-time subgroups. RESULTS s-IgA levels did not increase in the open group but significantly increased in the pneumoperitoneum group compared with the control group (p < 0.05). In addition, s-IgA levels in the long-time subgroup significantly increased compared with the short-time subgroup of the pneumoperitoneum group (p < 0.05). TLR4 levels steeply and gradually increased in the open and pneumoperitoneum groups, respectively. MDA levels in the pneumoperitoneum group increased during the early phase and were significantly higher than those in the open group at 24 h (p < 0.05). CONCLUSIONS This study demonstrated that s-IgA levels in stool increased in the pneumoperitoneum group compared with the open group, suggesting that CO2 pneumoperitoneum may cause transitory damage to the intestinal mucosa.
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Affiliation(s)
- Toru Kusano
- Department of Gastroenterological and Pediatric Surgery, Faculty of Medicine, Oita University, 1-1 Hasama-machi, Yufu, Oita, 879-5593, Japan,
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Kurihara S, Shibakusa T, Tanaka KA. Cystine and theanine: amino acids as oral immunomodulative nutrients. SPRINGERPLUS 2013; 2:635. [PMID: 24312747 PMCID: PMC3851524 DOI: 10.1186/2193-1801-2-635] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/06/2013] [Accepted: 11/18/2013] [Indexed: 12/20/2022]
Abstract
The decreases in the glutathione (GSH) level in the mouse spleen and liver after immune stimulation are suppressed by the oral administration of cystine and theanine (CT). GSH is considered to be important for the control of immune responses. Antibody production in mice after infection is enhanced by the oral administration of CT. In humans, also, the oral administration of CT has been confirmed to enhance antibody production after vaccination against Flu and also reduce the incidence of cold. However, the GSH level is reduced by intense exercise and surgery. In clinical studies of body-builders and long-distance runners, the intake of CT suppressed excessive inflammatory reactions and a decline in immune functions after intense training. Surgery as well as intense exercise induces excessive inflammatory reactions. In mice, the preoperative administration of CT suppressed excessive inflammatory reactions associated with surgery and promoted the postoperative recovery. Moreover, in clinical studies of gastrectomized patients, CT intake suppressed excessive postoperative inflammatory reactions and induced early recovery. If infection is regarded as invasive stress, CT intake is considered to exhibit an immunomodulatory effect by suppressing the decrease in GSH due to invasive stress. The clarification of their detailed action mechanisms and their application as medical or function foods is anticipated.
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Affiliation(s)
- Shigekazu Kurihara
- Institute for Innovation, Ajinomoto Co, Inc, 1-1 Suzuki-cho, Kawasaki-ku, Kawasaki-shi, Kanagawa, 210-8681 Japan
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Chen Z, Zuo J, Zou J, Sun Y, Liu W, Lai Y, Zhong B, Su C, Tan M, Luo H. Cellular immunity following video-assisted thoracoscopic and open resection for non-thymomatous myasthenia gravis. Eur J Cardiothorac Surg 2013; 45:646-51. [DOI: 10.1093/ejcts/ezt443] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Jeong WK, Park JW, Choi HS, Jeong SY, Oh JH. Comparison of Peristomal Adhesion Formation Between Laparoscopic and Open Low Anterior Resection of Rectal Cancer. World J Surg 2013; 37:2683-7. [DOI: 10.1007/s00268-013-2165-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Pappas-Gogos G, Tellis C, Lasithiotakis K, Tselepis AD, Tsimogiannis K, Tsimoyiannis E, Chalkiadakis G, Chrysos E. Oxidative stress markers in laparoscopic versus open colectomy for cancer: a double-blind randomized study. Surg Endosc 2013; 27:2357-2365. [DOI: 10.1007/s00464-013-2788-8] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2012] [Accepted: 01/07/2013] [Indexed: 02/06/2023]
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Bakhtiari J, Abdi M, Khalaj AR, Asadi F, Niasari-Naslaji A. Comparative evaluation of two reconstructive methods following laparoscopic assisted subtotal gastrectomy in dogs. BMC Res Notes 2012; 5:679. [PMID: 23232040 PMCID: PMC3549722 DOI: 10.1186/1756-0500-5-679] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2012] [Accepted: 11/21/2012] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Laparoscopic gastrectomy is a new and technically challenging surgical procedure with potential benefit. The objective of this study was to investigate clinical and para-clinical consequences following Roux-en-Y and Jejunal Loop interposition reconstructive techniques for subtotal gastrectomy using laparoscopic assisted surgery. RESULTS Following resection of the stomach attachments through a laparoscopic approach, stomach was removed and reconstruction was performed with either standard Roux-en-Y (n = 5) or Jejunal Loop interposition (n = 5) methods. Weight changes were monitored on a daily basis and blood samples were collected on Days 0, 7 and 21 post surgery. A fecal sample was collected on Day 28 after surgery to evaluate fat content. One month post surgery, positive contrast radiography was conducted at 5, 10, 20, 40, 60 and 90 minutes after oral administration of barium sulfate, to evaluate the postoperative complications. There was a gradual decline in body weight in both experimental groups after surgery (P < 0.05). There was no difference in blood parameters at any time after surgery between the two methods (P > 0.05). Fecal fat content increased in the Roux-en-Y compared to the Jejunal loop interposition technique (P < 0.05). No major complications were found in radiographs and gastric emptying time was similar between the two groups (P > 0.05). CONCLUSION Roux-en-Y and Jejunal loop interposition techniques might be considered as suitable approaches for reconstructing gastro-intestinal tract following gastrectomy in dogs. The results of this study warrant further investigation with a larger number of animals.
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Affiliation(s)
- Jalal Bakhtiari
- Faculty of Veterinary Medicine, University of Tehran, Tehran, Iran.
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ten Broek R, Kok- Krant N, Bakkum E, Bleichrodt R, van Goor H. Different surgical techniques to reduce post-operative adhesion formation: a systematic review and meta-analysis. Hum Reprod Update 2012; 19:12-25. [DOI: 10.1093/humupd/dms032] [Citation(s) in RCA: 59] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023] Open
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Gordon AC, Kojima K, Inokuchi M, Kato K, Sugihara K. Long-term comparison of laparoscopy-assisted distal gastrectomy and open distal gastrectomy in advanced gastric cancer. Surg Endosc 2012; 27:462-70. [PMID: 22890478 DOI: 10.1007/s00464-012-2459-1] [Citation(s) in RCA: 52] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2012] [Accepted: 06/12/2012] [Indexed: 02/06/2023]
Abstract
BACKGROUND The use of laparoscopy-assisted distal gastrectomy (LADG) in advanced gastric cancer (AGC) remains a controversial topic, mainly because of doubts about its oncologic validity. To date, literature on the prognosis for AGC after LADG is scarce. This study evaluated the procedure's long-term benefits compared with those of the conventional, open distal gastrectomy (ODG). METHODS This study involved 201 patients, 66 of whom underwent LADG, with a mean follow-up period of 49.2 months, from January 1999 to March 2010. A clear set of criteria was used to select patients (including no evidence of lymph node metastasis) and surgeons (subject to their experience). Survival outcomes were assessed by Kaplan-Meier analysis and log-rank testing. The postoperative recovery and complications of the patients also were monitored. RESULTS No significant difference was observed between LADG and ODG in terms of overall survival or disease-specific survival. The corresponding 5-year survival rates for individual tumor node metastasis stages also were comparable in each group. The number of lymph nodes harvested was similar in the two groups, although the operation time was significantly shorter for ODG. The postoperative hospital stay was shorter for LADG patients (average stay of 8.4 vs. 18.1 days in the ODG group; p < 0.001), and the postoperative complication rate was almost half that for ODG (13.6 vs. 25.0 %; p = 0.048). CONCLUSION The combination of the long- and short-term data indicates that LADG should be considered as a feasible alternative to ODG for the treatment of AGC. Its widespread integration requires the accumulation of similar results across multiple centers worldwide.
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Affiliation(s)
- Andrew C Gordon
- Department of Surgical Oncology, Graduate School of Medicine, Tokyo Medical and Dental University, Yushima Bunkyo-ku, Tokyo, Japan.
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Arung W, Drion P, Cheramy JP, Honoré P, Meurisse M, Defraigne JO, Detry O. Intraperitoneal adhesions after open or laparoscopic abdominal procedure: an experimental study in the rat. J Laparoendosc Adv Surg Tech A 2012; 22:651-7. [PMID: 22746150 DOI: 10.1089/lap.2012.0102] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Adhesion formation is common after abdominal surgery. The incidence and severity of adhesion formation following open or laparoscopic surgery remain controversial. The role of CO(2) pneumoperitoneum is also widely discussed. This study aimed to compare adhesion formation following peritoneal injury by electrocoagulation performed through open or laparoscopic procedures in a rat model. MATERIALS AND METHODS Sixty male rats were randomized to undergo a 1.5-cm peritoneal injury with unipolar cautery under general anesthesia: open surgery (Group A, n=20), laparoscopic surgery with CO(2) pneumoperitoneum (Group B, n=20), and laparoscopic surgery with air pneumoperitoneum (Group C, n=20). Duration of the procedures was fixed at 90 minutes in all groups, and pneumoperitoneum pressure was kept at 10 mm Hg. Ten days later, the animals underwent a secondary laparotomy to score peritoneal adhesions using qualitative and quantitative parameters. RESULTS Forty-five rats developed at least one adhesion: 95% in Group A, 83% in Group B, and 55% in Group C (P<.01; Group C versus Group A, P<.01). According to number, thickness, tenacity, vascularization, extent, type, and grading according to the Zühkle classification, no significant difference was observed between Groups A and B. The distribution of adhesions after open surgery was significantly different than after laparoscopic surgery (P<.001). It is interesting that Group C rats developed significantly fewer adhesions at the traumatized site, and their adhesions had less severe qualitative scores compared with those after open surgery (P<.01). CONCLUSIONS In this animal model, CO(2) laparoscopic surgery did not decrease the formation of postoperative adhesion, compared with open surgery. The difference with the animals operated on with air pneumoperitoneum emphasizes the role of CO(2) in peritoneal injury leading to adhesion formation.
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Affiliation(s)
- Willy Arung
- Department of General Surgery, University of Lubumbashi Clinics, University of Lubumbashi, Lubumbashi, Katanga Province, Democratic Republic of Congo
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Wu Z, Zhou J, Pankaj P, Peng B. Laparoscopic and open splenectomy for splenomegaly secondary to liver cirrhosis: an evaluation of immunity. Surg Endosc 2012; 26:3557-64. [PMID: 22710653 DOI: 10.1007/s00464-012-2366-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2011] [Accepted: 05/02/2012] [Indexed: 02/05/2023]
Abstract
OBJECTIVE We sought to investigate the perioperative inflammatory response and immunological function of patients with portal hypertension-induced splenomegaly who underwent laparoscopic (LS) or open splenectomy (OS). METHODS This prospective study investigated a total of 34 patients with splenomegaly due to portal hypertension who underwent either LS (n = 18) or OS (n = 16) between May 2009 and September 2010. Peripheral venous blood samples were taken from these patients prior to surgery and on postoperative days (POD) 1, 3, and 7. The perioperative clinical outcomes and immunological function results were analyzed and compared within each surgical group. RESULTS The demographics of the two groups did not differ. The patients in the LS group experienced longer operating time, less intraoperative blood loss, earlier resumption of diet, and shorter postoperative hospital stay. Both the open and laparoscopic groups exhibited statistically significant differences in interleukin -6 and C-reactive protein levels, and total lymphocyte, CD4 T, and natural killer cell numbers on POD 1 and 3 compared with pre splenectomy. The immune responses in the LS group were significantly lower than those in the OS group. The LS group exhibited better preserved cellular immune response and faster recovery than the OS group on POD 7. CONCLUSIONS An examination of the inflammatory reaction and cellular immune response after LS and OS demonstrated that there are significant differences in the immune responses observed in the two groups. Further human studies are required to determine the permanent effects of LS on immune function.
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Affiliation(s)
- Zhong Wu
- Department of Hepatopancreatobiliary Surgery, West China Hospital, Sichuan University, Chengdu, 610041, China
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Robotic versus open pancreaticoduodenectomy: a comparative study at a single institution. World J Surg 2012; 35:2739-46. [PMID: 21947494 DOI: 10.1007/s00268-011-1276-3] [Citation(s) in RCA: 147] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
BACKGROUND Minimally invasive pancreaticoduodenectomy (PD) remains one of the most challenging abdominal procedures, and its application is poorly reported in the literature so far. To date, few data are available comparing a minimally invasive approach to open PD. The aim of the present study is to compare the robotic and open approaches for PD at a single institution. METHODS Data from 83 consecutive PD procedures performed between January 2002 and May 2010 at a single institution were retrospectively reviewed. Patients were stratified into two groups: the open group (n = 39; 47%) and the robotic group (n = 44; 53%). RESULTS Patients in the robotic group were statistically older (63 years of age versus 56 years; p = 0.04) and heavier (body mass index: 27.7 vs. 24.8; p = 0.01); and had a higher American Society of Anesthesiologists (ASA) score (2.5 vs. 2.15; p = 0.01) when compared to the open group. Indications for surgery were the same in both groups. The robotic group had a significantly shorter operative time (444 vs. 559 min; p = 0.0001), reduced blood loss (387 vs. 827 ml; p = 0.0001), and a higher number of lymph nodes harvested (16.8 vs. 11; p = 0.02) compared to the open group. There was no significant difference between the two groups in terms of complication rates, mortality rates, and hospital stay. CONCLUSIONS The authors present one of the first studies comparing open and robotic PD. While it is too early to draw definitive conclusions concerning the long-term outcomes, short-term results show a positive trend in favor of the robotic approach without compromising the oncological principles associated with the open approach.
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Shibakusa T, Mikami T, Kurihara S, Chiba Y, Tsuchiya T, Miyachi T, Oyama A, Tanaka KAK, Koyama N. Enhancement of postoperative recovery by preoperative oral co-administration of the amino acids, cystine and theanine, in a mouse surgical model. Clin Nutr 2012; 31:555-61. [PMID: 22348870 DOI: 10.1016/j.clnu.2012.02.001] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2011] [Revised: 12/16/2011] [Accepted: 02/01/2012] [Indexed: 12/15/2022]
Abstract
BACKGROUND & AIMS Glutathione (GSH) is important in the control of immune responses, and its levels decline following trauma. We previously reported that the oral administration of cystine/theanine (CT) increased GSH synthesis and that CT intake inhibited intense exercise-induced inflammation. Based on these results, we hypothesised that CT inhibits surgically induced inflammation and promotes postoperative recovery. Our aim was to confirm this hypothesis using a mouse surgical model. METHODS CT or a vehicle (V) was administered orally to mice once a day for 5 days, until the day of surgery. On the day of surgery, a sham operation or an intestinal manipulation was performed 2 h after the oral administration of CT or V. Levels of IL-6 in the blood and GSH in the intestine were analysed 2 h after surgery. Behavioural analysis was also undertaken after surgery. RESULTS Treatment with CT inhibited the manipulation-induced increase in IL-6 in the blood and decrease in GSH in the intestine. There was a significant negative correlation between IL-6 in the blood and GSH in the intestine. In addition, behavioural analysis revealed that CT administration improved locomotor activity and food intake after surgery. CONCLUSION These results suggest that CT suppresses inflammatory responses by inhibiting the surgically induced decrease in GSH in the small intestine and promotes postoperative recovery.
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Affiliation(s)
- Tetsuro Shibakusa
- Institute for Innovation, Ajinomoto Co, Inc, 1-1 Suzuki-cho, Kawasaki-ku, Kawasaki-shi, Kanagawa 210-8681, Japan.
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Shibao K, Higure A, Nakamoto M, Yamaguchi K. Internal Hernia after Laparoscopic Total Gastrectomy with Roux-en-Y Reconstruction. ACTA ACUST UNITED AC 2012. [DOI: 10.5833/jjgs.45.113] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Kazunori Shibao
- Department of Surgery I, School of Medicine, University of Occupational and Environmental Health
| | - Aiichiro Higure
- Department of Surgery I, School of Medicine, University of Occupational and Environmental Health
| | - Mitsuhiro Nakamoto
- Department of Surgery I, School of Medicine, University of Occupational and Environmental Health
| | - Koji Yamaguchi
- Department of Surgery I, School of Medicine, University of Occupational and Environmental Health
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Abstract
The rapid in development of surgical technology has had a major effect in surgical treatment of colorectal cancer. Laparoscopic colon cancer surgery has been proven to provide better short-term clinical and oncologic outcomes. However this quickly accepted surgical approach is still performed by a minority of colorectal surgeons. The more technically challenging procedure of laparoscopic rectal cancer surgery is also on its way to demonstrating perhaps similar short-term benefits. This article reviews current evidences of both short-term and long-term outcomes of laparoscopic colorectal cancer surgery, including the overall costs comparison between laparoscopic surgery and conventional open surgery. In addition, different surgical techniques for laparoscopic colon and rectal cancer are compared. Also the relevant future challenge of colorectal cancer robotic surgery is reviewed.
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Caruso C, La Torre M, Benini B, Catani M, Crafa F, De Leo A, Neri T, Sacchi M. Is Laparoscopy Safe and Effective in Nontraumatic Acute Abdomen? J Laparoendosc Adv Surg Tech A 2011; 21:589-93. [DOI: 10.1089/lap.2011.0030] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Carlo Caruso
- Department of Biosciences, Tecnopolo di Castel Romano, Rome, Italy
| | - Marco La Torre
- Department of Biosciences, Tecnopolo di Castel Romano, Rome, Italy
| | - Bruno Benini
- Department of Emergency Surgery, Ospedale S. Camillo, Rome, Italy
| | - Marco Catani
- Department of Emergency Surgery, Policlinico Umberto I, “Sapienza” University of Rome, Rome, Italy
| | - Francesco Crafa
- Department of General Surgery, Ospedale Vannini, Rome, Italy
| | - Antonio De Leo
- Department of General Surgery, Ospedale Sandro Pertini, Rome, Italy
| | - Tiziano Neri
- Department of General Surgery, Ospedale Regina Apostolorum, Albano, Italy
| | - Marco Sacchi
- Department of General Surgery, Ospedale S. Maria Goretti, Latina, Italy
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Tavakoli A, Bakhtiari J, Khalaj AR, Gharagozlou MJ, Veshkini A. Single-layer versus double-layer laparoscopic intracorporeally sutured gastrointestinal anastomoses in the canine model. JSLS 2011; 14:509-15. [PMID: 21605513 PMCID: PMC3083040 DOI: 10.4293/108680810x12924466007881] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
This study shows that the 1-layer gastrointestinal suture technique is feasible, safe and has fewer complications compared with a 2-layer suture technique. Objective: The objective of this study was to compare the gross and histopathologic changes following 1- versus 2-layer hand-sewn suture techniques in laparoscopic gastrointestinal anastomosis in dogs. Methods: This was an experimental prospective study of 16 healthy mixed breed male and female dogs. Animals were randomly divided into 2 groups. Two-layer side-to-side hand-sewn laparoscopic gastrojejunostomies were performed in group A, so that simple interrupted sutures were placed in the outer layer and simple continuous suture was used in the inner layer. The 1-layer simple continuous anastomosis between the stomach and jejunum was done in group B precisely. Specimen were collected from the sites of anastomosis, and H&E statining was performed for light microscopic studies. Results: All animals survived the surgery. There was no gross inflammation, ischemia, apparent granulation tissue, abscess or fistula formation, leakage or stricture formation, and all sites of anastomosis were patent. Several adhesion formations were found in the abdomen with the higher incidence in the control group. Mean scores of leukocyte infiltration and granulation tissue formation at the sites of anastomosis were statistically insignificant between groups (P>0.05). Conclusions: Gross and histopathologic findings revealed that hand-sewn laparoscopic gastrointestinal anastomosis with the 1-layer suture technique is comparable to the 2-layer suture technique.
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Affiliation(s)
- Azine Tavakoli
- Department of Clinical Sciences, Islamic Azad University-Garmsar Branch, Iran
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