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Falola AF, Adeyeye A, Shekoni O, Oluwagbemi A, Effiong-John B, Ogbodu E, Dada OS, Ndong A. Robotic and laparoscopic minimally invasive surgery for colorectal cancer in Africa: an outcome comparison endorsed by the Nigerian society for colorectal disorders. Surg Endosc 2025; 39:122-140. [PMID: 39658673 DOI: 10.1007/s00464-024-11416-3] [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: 09/23/2024] [Accepted: 11/03/2024] [Indexed: 12/12/2024]
Abstract
BACKGROUND Minimally invasive surgery for colorectal cancer (CRC) offer superior outcomes compared to open surgery. This study aimed to review the robotic and laparoscopic procedures for CRC performed in Africa, and compare the mean surgery duration, blood loss, hospital stay, rate of conversion, and prevalence of morbidity and mortality. This is the first study to compare the outcomes of robotic and laparoscopic surgeries for CRC in Africa. METHODS A systematic review following the PRISMA guidelines was conducted. PubMed, Google Scholar, Web of Science, AJOL, EMBASE, and CENTRAL were searched, identifying 2,259 publications, 33 of which were deemed eligible. Statistical analysis of outcomes was performed using "R". Methodological quality of the included studies was assessed using the Cochrane ROBINS-I tool. RESULTS The minimally invasive approach has been applied for CRC treatment in seven African countries: Algeria, Cameroon, Egypt, Morocco, Nigeria, Senegal, and South Africa. Laparoscopic surgeries accounted for 1,485 (95%) of cases, while 71 (5%) were robotic. Robotic procedures were associated with a longer surgery duration (256.41 min vs. 190.45 min, p < 0.0001), higher blood loss (226.48 mL vs. 141.55 mL, p < 0.0001), and a shorter hospital stay (4.52 days vs. 6.06 days, p = 0.85). Robotic procedures had a lower rate of conversion (3% vs. 8%, p = 0.29) and a lower prevalence of morbidity (19% vs. 26%, p = 0.26). Wound infection (24.49%) and ileus (57.14%) were the most common complications following laparoscopic and robotic procedures, respectively. There was no mortality from robotic surgeries; however, a prevalence of 0.39% (95% CI: 0;1.19) was recorded from laparoscopy. CONCLUSIONS This study establishes and compares the outcomes of advances in the treatment of CRC in the African setting, providing insights for policymakers, healthcare providers, and international organizations to make decisions regarding optimizing care for CRC patients in Africa.
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Affiliation(s)
- Adebayo Feranmi Falola
- University of Ibadan College of Medicine, Ibadan, Nigeria.
- General Surgery Community, Surgery Interest Group of Africa, Lagos, Nigeria.
| | - Ademola Adeyeye
- Significant Polyp and Early Colorectal Cancer Service, King's College Hospital, London, UK
- Department of Surgery, University of Ilorin Teaching Hospital, Ilorin, Nigeria
- Department of Medicine and Surgery, Afe Babalola University, Ado-Ekiti, Nigeria
| | - Oluwatobi Shekoni
- General Surgery Community, Surgery Interest Group of Africa, Lagos, Nigeria
- Mid and South Essex NHS Foundation Trust, Chelmsford, UK
| | | | - Blessing Effiong-John
- University of Ibadan College of Medicine, Ibadan, Nigeria
- General Surgery Community, Surgery Interest Group of Africa, Lagos, Nigeria
| | - Emmanuella Ogbodu
- General Surgery Community, Surgery Interest Group of Africa, Lagos, Nigeria
- Asaba Specialist Hospital, Asaba, Nigeria
| | - Oluwasina Samuel Dada
- General Surgery Community, Surgery Interest Group of Africa, Lagos, Nigeria
- University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Abdourahmane Ndong
- General Surgery Community, Surgery Interest Group of Africa, Lagos, Nigeria
- Department of Surgery, Gaston Berger University, Saint-Louis, Senegal
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Ishizuka M, Shibuya N, Hachiya H, Nishi Y, Kono T, Takayanagi M, Nemoto T, Ihara K, Shiraki T, Matsumoto T, Mori S, Nakamura T, Aoki T, Mizushima T. Robotic surgery is associated with a decreased risk of circumferential resection margin positivity compared with conventional laparoscopic surgery in patients with rectal cancer undergoing mesorectal excision: A systematic review and meta-analysis. EUROPEAN JOURNAL OF SURGICAL ONCOLOGY 2024; 50:108538. [PMID: 39053042 DOI: 10.1016/j.ejso.2024.108538] [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: 04/26/2024] [Revised: 06/14/2024] [Accepted: 07/07/2024] [Indexed: 07/27/2024]
Abstract
OBJECTIVE To investigate whether robotic surgery (RS) decreases the risk of circumferential resection margin (CRM) positivity compared with conventional laparoscopic surgery (LS) in patients with rectal cancer (RC) undergoing mesorectal excision (ME). BACKGROUND Although it is well known that CRM positivity affects postoperative outcomes in patients with RC undergoing ME, few studies have investigated whether RS is superior to conventional LS for the risk of CRM positivity. METHODS We performed a comprehensive electronic search of the literature up to December 2022 to identify studies that compared the risk of CRM positivity between patients with RC undergoing robotic and conventional laparoscopic surgery. A meta-analysis was performed using random-effects models to calculate risk ratios (RRs) and 95 % confidence intervals (CIs), and heterogeneity was analyzed using I2 statistics. RESULTS Eighteen studies, consisting of 4 randomized controlled trials (RCTs) and 14 propensity score matching (PSM) studies, involved a total of 9203 patients with RC who underwent ME were included in this meta-analysis. The results demonstrated that RS decreased the overall risk of CRM positivity (RR, 0.82; 95 % CI, 0.73-0.92; P = 0.001; I2 = 0 %) compared with conventional LS. Results of a meta-analysis of the 4 selected RCTs also showed that RS decreased the risk of CRM positivity (RR, 0.62; 95 % CI, 0.43-0.91; P = 0.01; I2 = 0 %) compared with conventional LS. CONCLUSIONS This meta-analysis revealed that RS is associated with a decreased risk of CRM positivity compared with conventional LS in patients with RC undergoing ME.
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Affiliation(s)
- Mitsuru Ishizuka
- Department of Colorectal Surgery, Dokkyo Medical University, Tochigi, Japan.
| | - Norisuke Shibuya
- Department of Colorectal Surgery, Dokkyo Medical University, Tochigi, Japan
| | - Hiroyuki Hachiya
- Department of Colorectal Surgery, Dokkyo Medical University, Tochigi, Japan
| | - Yusuke Nishi
- Department of Colorectal Surgery, Dokkyo Medical University, Tochigi, Japan
| | - Takahiro Kono
- Department of Colorectal Surgery, Dokkyo Medical University, Tochigi, Japan
| | - Masashi Takayanagi
- Department of Colorectal Surgery, Dokkyo Medical University, Tochigi, Japan
| | - Tetsutaro Nemoto
- Department of Colorectal Surgery, Dokkyo Medical University, Tochigi, Japan
| | - Keisuke Ihara
- Department of Colorectal Surgery, Dokkyo Medical University, Tochigi, Japan
| | - Takayuki Shiraki
- Department of Hepato-Biliary-Pancreatic Surgery, Dokkyo Medical University, Tochigi, Japan
| | - Takatsugu Matsumoto
- Department of Hepato-Biliary-Pancreatic Surgery, Dokkyo Medical University, Tochigi, Japan
| | - Shozo Mori
- Department of Hepato-Biliary-Pancreatic Surgery, Dokkyo Medical University, Tochigi, Japan
| | - Takatoshi Nakamura
- Department of Colorectal Surgery, Dokkyo Medical University, Tochigi, Japan
| | - Taku Aoki
- Department of Hepato-Biliary-Pancreatic Surgery, Dokkyo Medical University, Tochigi, Japan
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Saraiya S, Darji D. Comparison of Clinical Outcomes Between Laparoscopic and Open Surgery in Colorectal Cancer Patients. JOURNAL OF PHARMACY AND BIOALLIED SCIENCES 2024; 16:S2461-S2463. [PMID: 39346181 PMCID: PMC11426680 DOI: 10.4103/jpbs.jpbs_316_24] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2024] [Revised: 04/02/2024] [Accepted: 04/07/2024] [Indexed: 10/01/2024] Open
Abstract
Aim Our research compares the clinical results of open surgery versus laparoscopic surgery for colorectal malignancies. Materials and Methods Our analysis focused on a database that included data on patients with colorectal cancer who had laparoscopic or open surgery for stages I to III at a prestigious healthcare institute in India. Two groups of 50 patients underwent laparoscopic and 50 underwent conventional open colorectal surgery (OCRS and LCRS, respectively) throughout the same time. Patient demographics, operation data, initial postoperative outcomes, follow-up appointments, pathology results, and cancer stages were examined. Results The LCRS group had a much longer operation time compared to the OCRS. Subjects in the LCRS group experienced a notably accelerated recovery after surgery. The hospital stay for the OCRS group was considerably longer compared to that in the LCRS group. Conclusion Laparoscopic colorectal surgery is a reliable and convenient alternative to the traditional open approach, providing comparable oncological efficacy.
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Affiliation(s)
- Swapnil Saraiya
- Surgical Registrar, University Hospital of North Tees and Hartlepool NHS Foundation Trust, Stockton-on-Tees, England
| | - Dhara Darji
- Department of Anesthesia, Dr. M. K. Shah Medical College and Research Centre and Smt S. M. S. Multispeciality Hospital, Ahmedabad, Gujarat, India
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Liu Y, Chan CW, Chow KM, Zhang B, Zhang X, Wang C, Du G. Nurse-delivered acupressure on early postoperative gastrointestinal function among patients undergoing colorectal cancer surgery. Asia Pac J Oncol Nurs 2023; 10:100229. [PMID: 37213809 PMCID: PMC10199207 DOI: 10.1016/j.apjon.2023.100229] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2022] [Accepted: 03/29/2023] [Indexed: 05/23/2023] Open
Abstract
Objective Postoperative gastrointestinal dysfunction occurred up to 25% of patients who undergo colorectal cancer surgery, which could cause severe complications and increase economic burden. This study aims to evaluate the effectiveness of nurse-delivered acupressure on early postoperative gastrointestinal function among patients undergoing colorectal cancer surgery. Methods A total of 112 adult patients (≥ 18 years) scheduled to receive colorectal cancer surgery were randomized into two groups. Acupressure was practiced at ST36 for five days after operation, while the control group used gently rubbing skin. Primary outcomes were the time to first passage of flatus and defecation, while the secondary outcomes were the degree of abdominal distention and bowel motility. The Student's t-test and Mann-Whitney U test or Chi-square test and regression analyses were used, while for repeated measures of outcomes, area under the curve (AUC) was compared between groups and subgroups. Results After adjusting for potential confounding variables, acupressure significantly shortened the time to have first flatus passage by 11.08 h (95%CI: -19.36 to -2.81; P < 0.01). The first passage time of defecation (mean, 77.00 ± 36.27 h vs. 80.08 ± 28.88 h), abdominal distention (AUC, 5.68 ± 5.24 vs. 5.92 ± 4.03), and bowel motility (AUC, 12.09 ± 4.70 vs. 11.51 ± 3.00) in the intervention group had some improvement although the differences were not statistically significant (P > 0.05). Conclusions This study indicated that acupressure done by trained nurses could be an effective and feasible solution to promote early gastrointestinal function recovery among patients undergoing colorectal cancer surgery. Trial registration Chinese Clinical Trial Registry (ChiCTR-IOR-17012460).
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Affiliation(s)
- Yunhong Liu
- Nursing Department, Qilu Hospital of Shandong University, Jinan, China
| | - Carmen W.H. Chan
- The Nethersole School of Nursing, Faculty of Medicine, The Chinese University of Hong Kong, Shatin, Hong Kong SAR, China
| | - Ka Ming Chow
- The Nethersole School of Nursing, Faculty of Medicine, The Chinese University of Hong Kong, Shatin, Hong Kong SAR, China
| | - Binbin Zhang
- Nursing Department, Qilu Hospital of Shandong University, Jinan, China
| | - Xue Zhang
- Nursing Department, Qilu Hospital of Shandong University, Jinan, China
| | - Chao Wang
- Nursing Department, Qilu Hospital of Shandong University, Jinan, China
| | - Guangzhong Du
- Department of Acupuncture and Tuina, Qilu Hospital of Shandong University, Jinan, China
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Identification of Risk Factors for Sexual Dysfunction after Multimodal Therapy of Locally Advanced Rectal Cancer and Their Impact on Quality of Life: A Single-Center Trial. Cancers (Basel) 2022; 14:cancers14235796. [PMID: 36497279 PMCID: PMC9736520 DOI: 10.3390/cancers14235796] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2022] [Revised: 11/13/2022] [Accepted: 11/22/2022] [Indexed: 11/26/2022] Open
Abstract
PURPOSE Sexual function is crucial for the quality of life and can be highly affected by preoperative therapy and surgery. The aim of this study was to identify potential risk factors for poor sexual function and quality of life. METHODS Female patients were asked to complete the Female Sexual Function Index (FSFI-6). Male patients were demanded to answer the International Index of Erectile Function (IIEF-5). RESULTS In total, 79 patients filled in the questionary, yielding a response rate of 41.57%. The proportion of women was represented by 32.91%, and the median age was 76.0 years (66.0-81.0). Sexual dysfunction appeared in 88.46% of female patients. Severe erectile dysfunction occurred in 52.83% of male patients. Univariate analysis showed female patients (OR: 0.17, 95%CI: 0.05-0.64, p = 0.01), older age (OR: 0.34, 95%CI 0.11-1.01, p = 0.05), tumor localization under 6cm from the anal verge (OR: 4.43, 95%CI: 1.44-13.67, p = 0.01) and extension of operation (APR and ISR) (OR: 0.13, 95%CI: 0.03-0.59, p = 0.01) as significant risk factors for poor outcome. Female patients (OR: 0.12, 95%CI: 0.03-0.62, p = 0.01) and tumors below 6 cm from the anal verge (OR: 4.64, 95%CI: 1.18-18.29, p = 0.03) were shown to be independent risk factors for sexual dysfunction after multimodal therapy in the multivariate analysis. Quality of life was only affected in the case of extensive surgery (p = 0.02). CONCLUSION Higher Age, female sex, distal tumors and extensive surgery (APR, ISR) are revealed risk factors for SD in this study. Quality of life was only affected in the case of APR or ISR.
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Shugaba A, Lambert JE, Bampouras TM, Nuttall HE, Gaffney CJ, Subar DA. Should All Minimal Access Surgery Be Robot-Assisted? A Systematic Review into the Musculoskeletal and Cognitive Demands of Laparoscopic and Robot-Assisted Laparoscopic Surgery. J Gastrointest Surg 2022; 26:1520-1530. [PMID: 35426034 PMCID: PMC9296389 DOI: 10.1007/s11605-022-05319-8] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2021] [Accepted: 03/26/2022] [Indexed: 01/31/2023]
Abstract
BACKGROUND Surgeons are among the most at risk of work-related musculoskeletal health decline because of the physical demands of surgery, which is also associated with cognitive fatigue. Minimally invasive surgery offers excellent benefits to patients but the impact of robotic or laparoscopic surgery on surgeon well-being is less well understood. This work examined the musculoskeletal and cognitive demands of robot-assisted versus standard laparoscopic surgery. METHODS Medline, Embase and Cochrane databases were systematically searched for 'Muscle strain' AND 'musculoskeletal fatigue' AND 'occupational diseases' OR 'cognitive fatigue' AND 'mental fatigue' OR 'standard laparoscopic surgery' AND 'robot-assisted laparoscopic surgery'. Primary outcomes measured were electromyographic (EMG) activity for musculoskeletal fatigue and questionnaires (NASA-TLX, SMEQ, or Borg CR-10) for cognitive fatigue. A systematic review was conducted in accordance with the Synthesis Without Meta-analysis (SWiM) Guidelines. The study was preregistered on Prospero ID: CRD42020184881. RESULTS Two hundred and ninety-eight original titles were identified. Ten studies that were all observational studies were included in the systematic review. EMG activity was consistently lower in robotic than in laparoscopic surgery in the erector spinae and flexor digitorum muscles but higher in the trapezius muscle. This was associated with significantly lower cognitive load in robotic than laparoscopic surgery in 7 of 10 studies. CONCLUSIONS Evidence suggests a reduction in musculoskeletal demands during robotic surgery in muscles excluding the trapezius, and this is associated with most studies reporting a reduced cognitive load. Robotic surgery appears to have less negative cognitive and musculoskeletal impact on surgeons compared to laparoscopic surgery.
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Affiliation(s)
- Abdul Shugaba
- Lancaster Medical School, Lancaster University, Lancaster, LA1 4YG, UK.
- Royal Blackburn Hospital, East Lancashire NHS Hospitals Trust, Blackburn, BB2 3HH, UK.
| | - Joel E Lambert
- Lancaster Medical School, Lancaster University, Lancaster, LA1 4YG, UK
- Royal Blackburn Hospital, East Lancashire NHS Hospitals Trust, Blackburn, BB2 3HH, UK
| | | | - Helen E Nuttall
- Department of Psychology, Lancaster University, Lancaster, LA1 4YG, UK
| | | | - Daren A Subar
- Royal Blackburn Hospital, East Lancashire NHS Hospitals Trust, Blackburn, BB2 3HH, UK
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Mohamedahmed AYY, Albendary M, Patel K, Ayeni AA, Zaman S, Zaman O, Ibrahim R, Mobarak D. Comparison of Omental Patch Closure Versus Simple Closure for Laparoscopic Repair of Perforated Peptic Ulcer: A Systematic Review and Meta-Analysis. Am Surg 2022:31348211067991. [PMID: 35332800 DOI: 10.1177/00031348211067991] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
AIMS To evaluate comparative outcomes of laparoscopic repair of perforated peptic ulcer with omental patch versus without omental patch. METHODS A systematic search of multiple electronic data sources was conducted, and all studies comparing laparoscopic repair of perforated peptic ulcer (PPU) with and without omental patch were included. Operative time, postoperative complications, re-operation and mortality were the evaluated outcome parameters for the meta-analysis. Revman 5.3 was used for data analysis. RESULTS Four observational studies reporting a total number of 438 patients who underwent laparoscopic repair of PPU with (n = 268) or without (n = 170) omental patch were included. Operative time was significantly shorter in no-omental patch group (NOP) when compared to omental patch group (P = .02). There was no significant difference in the risk of postoperative ileus (Odd ratio (OR) .76, P = .61), leakage (OR 1.17, P = .80), wound infection (OR 1.89, P = .34), intra-abdominal abscess (OR 1.17, P = .87), re-operation (OR .00, P = .94) and mortality (OR .55, P = .48). Moreover, length of hospital stay was comparable between the two groups (P = .81). CONCLUSION Laparoscopic repair of PPU with or without omental patch have comparable postoperative complications and mortality rate. However, considering the shorter operative time, no-omental patch approach is an attractive and more favourable choice. Well-designed randomized controlled trials are needed to investigate this comparison.
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Affiliation(s)
| | - Mohamed Albendary
- General surgery department, 1731Sandwell and West Birmingham Hospital NHS trust, Birmingham, UK
| | - Kamlesh Patel
- General surgery department, 1731Sandwell and West Birmingham Hospital NHS trust, Birmingham, UK
| | | | - Shafquat Zaman
- General surgery department, 1731Sandwell and West Birmingham Hospital NHS trust, Birmingham, UK
| | - Osama Zaman
- General surgery department, 1731Sandwell and West Birmingham Hospital NHS trust, Birmingham, UK
| | - Rashid Ibrahim
- General surgery department, 6634University Hospitals Plymouth NHS Trust, Plymouth, UK
| | - Dham Mobarak
- General surgery department, 7714Russells Hall Hospital, Dudley, UK
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Kiguchi G, Sugioka A, Uchida Y, Yoshikawa J, Nakauchi M, Kojima M, Tanahashi Y, Takahara T, Yasuda A, Suda K, Kato Y, Uyama I. Wrapping double-mattress anastomosis for pancreaticojejunostomy in minimally invasive pancreaticoduodenectomy can significantly reduce postoperative pancreatic fistula rate compared with conventional pancreaticojejunostomy in open surgery: An analysis of a propensity score-matched sample. Surg Oncol 2021; 38:101577. [PMID: 33887674 DOI: 10.1016/j.suronc.2021.101577] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2021] [Revised: 03/29/2021] [Accepted: 04/01/2021] [Indexed: 12/17/2022]
Abstract
BACKGROUND Minimally invasive pancreaticoduodenectomy (MIPD), including laparoscopic pancreaticoduodenectomy (LPD) and robotic pancreaticoduodenectomy (RPD), is technically demanding because of pancreaticojejunostomy (PJ). Postoperative pancreatic fistula (POPF) is the most serious complication of MIPD and open pancreaticoduodenectomy (OPD). Contrary to expectations, conventional PJ in MIPD did not improve POPF rate and length of hospital stay. High POPF rates are attributed to technical issues encountered during MIPD, which include motion restriction and insufficient water tightness. Therefore, we developed wrapping double-mattress anastomosis, the Kiguchi method, which is a novel PJ technique that can improve MIPD. Herein, we describe the Kiguchi method for PJ in MIPD and compare the outcomes between this technique and conventional PJ in OPD. METHODS The current retrospective study included 83 patients in whom the complete obstruction of the main pancreatic duct by pancreatic tumors was absent on preoperative imaging. This research was performed from September 2016 to August 2020 at Fujita Health University Hospital. All patients were evaluated as having a soft pancreatic texture, which is the most important factor associated with POPF development. Briefly, 50 patients underwent OPD with conventional PJ (OPD group). Meanwhile, 33 patients, including 15 and 18 who had LPD and RPD, respectively, underwent MIPD using the Kiguchi method (MIPD group). After a 1:1 propensity score matching, 30 patients in the OPD group were matched to 30 patients in the MIPD group. RESULTS The patients' preoperative data did not differ. The grade B/C POPF rate was significantly lower in the MIPD group than in the OPD group (6.7% vs 40.0%, p = 0.002). The MIPD group had a significantly shorter median length of hospital stay than the OPD group (24 vs 30 days, p = 0.004). CONCLUSION The novel Kiguchi method in MIPD significantly reduced the POPF rate in patients without complete obstruction of the main pancreatic duct.
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Affiliation(s)
- Gozo Kiguchi
- Department of Surgery, Fujita Health University, 1-98 Dengakugakubo, Kutsukake-cho, Toyoake, Aichi, 470-1192, Japan.
| | - Atsushi Sugioka
- Department of Surgery, Fujita Health University, 1-98 Dengakugakubo, Kutsukake-cho, Toyoake, Aichi, 470-1192, Japan
| | - Yuichiro Uchida
- Department of Surgery, Fujita Health University, 1-98 Dengakugakubo, Kutsukake-cho, Toyoake, Aichi, 470-1192, Japan
| | - Junichi Yoshikawa
- Department of Surgery, Fujita Health University, 1-98 Dengakugakubo, Kutsukake-cho, Toyoake, Aichi, 470-1192, Japan
| | - Masaya Nakauchi
- Department of Surgery, Fujita Health University, 1-98 Dengakugakubo, Kutsukake-cho, Toyoake, Aichi, 470-1192, Japan
| | - Masayuki Kojima
- Department of Surgery, Fujita Health University, 1-98 Dengakugakubo, Kutsukake-cho, Toyoake, Aichi, 470-1192, Japan
| | - Yoshinao Tanahashi
- Department of Surgery, Fujita Health University, 1-98 Dengakugakubo, Kutsukake-cho, Toyoake, Aichi, 470-1192, Japan
| | - Takeshi Takahara
- Department of Surgery, Fujita Health University, 1-98 Dengakugakubo, Kutsukake-cho, Toyoake, Aichi, 470-1192, Japan
| | - Akira Yasuda
- Department of Surgery, Fujita Health University, 1-98 Dengakugakubo, Kutsukake-cho, Toyoake, Aichi, 470-1192, Japan
| | - Koichi Suda
- Department of Surgery, Fujita Health University, 1-98 Dengakugakubo, Kutsukake-cho, Toyoake, Aichi, 470-1192, Japan
| | - Yutaro Kato
- Department of Surgery, Fujita Health University, 1-98 Dengakugakubo, Kutsukake-cho, Toyoake, Aichi, 470-1192, Japan
| | - Ichiro Uyama
- Department of Surgery, Fujita Health University, 1-98 Dengakugakubo, Kutsukake-cho, Toyoake, Aichi, 470-1192, Japan
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Puntambekar SP, Rajesh KN, Goel A, Hivre M, Bharambe S, Chitale M, Panse M. Colorectal cancer surgery: by Cambridge Medical Robotics Versius Surgical Robot System-a single-institution study. Our experience. J Robot Surg 2021; 16:587-596. [PMID: 34282555 DOI: 10.1007/s11701-021-01282-9] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2021] [Accepted: 07/07/2021] [Indexed: 11/29/2022]
Abstract
With the previous experiences in performing laparoscopic for over a period of 15 years and da Vinci colorectal surgeries from 2010 to 2013, we started operating using the Cambridge Medical Robotics (CMR) Versius Surgical Robot System. The aim of the study is a prospective analysis and evaluation of short-term results of consecutive patients to study the technical feasibility and oncological outcome of robot-assisted low anterior resection (LAR) and ultralow anterior resection (ULAR), using the CMR Versius Surgical Robot System. This study was conducted at single minimal access surgery institute. 31 patients with colorectal adenocarcinoma underwent robot-assisted LAR and ULAR between August 2019 and March 2020. Patient characteristics, perioperative parameters and complications were evaluated. Surgical and pathological outcomes such as quality of Total Mesorectal Excision (TME), free circumferential resection margins and number of lymph nodes dissected were also evaluated. Of 31 patients, 23 were men and 8 women, with mean age of 55.6 years. The mean robotic operative time was 51 min and the mean blood loss was 55 ml. The mean robot docking and undocking time was 17 min and 5 min, respectively. The mean hospital stay was 7 days. The longitudinal and circumferential resection margins were negative in all patients. Histopathological reports of 27 among 31 patients showed complete TME. Splenic flexure of colon mobilization was done laparoscopically. We feel that Versius robot has the qualities in terms of dexterity, vision and intuitive movements, and to translate this technical ability into oncological safety.
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Affiliation(s)
| | - K N Rajesh
- , 1-6, Galaxy Care Laparoscopic Institute, Pune, India.
| | - Arjun Goel
- , 1-6, Galaxy Care Laparoscopic Institute, Pune, India
| | - Mangesh Hivre
- , 1-6, Galaxy Care Laparoscopic Institute, Pune, India
| | | | - Mihir Chitale
- , 1-6, Galaxy Care Laparoscopic Institute, Pune, India
| | - Mangesh Panse
- , 1-6, Galaxy Care Laparoscopic Institute, Pune, India
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Boualila L, Souadka A, Benslimane Z, Amrani L, Benkabbou A, Raouf M, Majbar MA. Comparison of Short-Term and Long-Term outcomes of Laparoscopy Versus Laparotomy in Rectal Cancer: Systematic Review and Meta-analysis of Randomized Controlled Trials. JOURNAL OF MEDICAL AND SURGICAL RESEARCH 2021. [DOI: 10.46327/msrjg.1.000000000000197] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Background and objective: The last randomized controlled trials ,the ACOSOG Z6051 1,2 and the ALaCaRT trial3, 4 could not show the non-inferiority of the laparoscopy in comparison to laparotomy for rectal cancer. In fact, the ten first years of practicing laparoscopy were years when surgeons developed their learning curve. Therefore, by excluding this learning bias, it is possible to end up with a more fair and correct comparison between the two techniques. It is henceforth relevant to pursue a new meta-analysis that compares the two techniques and excludes studies done during the earlier periods of laparoscopic rectal surgery. Results: Six randomized controlled trials met the eligibility criteria, involving a total of 1556 patients in the laparoscopy group and 1188 patients in the laparotomy group. Our meta-analysis was in favor of laparoscopy in a significant way for blood loss, first bowel movement and the number of harvested lymph nodes. It was non-significantly in favour of laparoscopy for 30-days mortality after surgery and length of hospital stay. It was significantly in favor of laparotomy for operative duration. No significant difference was found in anastomotic leakage) , reoperation within 30 days, number of positive CRMs and completeness of mesorectal excision between the two groups. No difference was found in recurrence, disease-free survival and overall survival between laparoscopy group and laparotomy group. Conclusion: The comparison of the randomized controlled trials published before and after 2010, showed no significant difference in outcomes between the learning period and after.
Keywords: Laparoscopy, laparotomy, long-term outcomes, meta-analysis, short-term outcomes, rectal cancer
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Torrijo I, Balciscueta Z, Tabet J, Martín MC, López M, Uribe N. Prospective study of sexual function and analysis of risk factors after rectal cancer surgery. Colorectal Dis 2021; 23:1379-1392. [PMID: 33599035 DOI: 10.1111/codi.15589] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2020] [Revised: 02/08/2021] [Accepted: 02/09/2021] [Indexed: 12/20/2022]
Abstract
AIM The aim of this study was to assess the evolution of sexual function over time after rectal cancer surgery and to identify risk factors that may have an impact on the deterioration of postoperative function. METHOD This was a prospective cohort study of sexual function after rectal cancer surgery using the International Index of Erectile Function (IIEF) and Female Sexual Function Index (FSFI) preoperatively and at 6 and 12 months after surgery. Predictive factors of worsening were identified by univariate and multivariate analysis. RESULTS One hundred and one patients were included (56 men and 45 women). In men, the average IIEF showed decreased erectile function and intercourse satisfaction at 6 months (respectively 21.58 ± 7.18 to 16.60 ± 7.96, p = 0.002 and 10.87 ± 2.94, to 8.09 ± 4.45, p = 0.002) with recovery at 1 year. As a percentage, erectile dysfunction increased from the preoperative value to 6 months (64.5% vs 87.1%, p = 0.022) and was observed in 72% at 1 year. Patients with moderate to severe dysfunction increased from 22% preoperatively to 58% (p = 0.009) at 6 months and 44% at 1 year (p < 0.0001). Neoadjuvant chemoradiotherapy (OR 5.4, 95% CI 0.9-29.6; p = 0.041) and erectile worsening at 6 months (OR 20, 95% CI 1.6-238; p = 0.004) were independent factors for worse function at 6 or 12 months, respectively. No significant worsening of the FSFI was found, although there was an improvement in lubrication and orgasm. CONCLUSION Temporary deterioration of erectile function in men is common at 6 months after surgery and chemoradiotherapy is the only predictive factor. Furthermore, patients who remain dysfunctional show an increase in the severity of symptoms in relation to the preoperative period.
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Affiliation(s)
- Inmaculada Torrijo
- Colorectal Unit, Department of General and Digestive Surgery, Arnau de Vilanova Hospital, Valencia, Spain
| | - Zutoia Balciscueta
- Colorectal Unit, Department of General and Digestive Surgery, Arnau de Vilanova Hospital, Valencia, Spain
| | - Janine Tabet
- Colorectal Unit, Department of General and Digestive Surgery, Arnau de Vilanova Hospital, Valencia, Spain
| | - M Carmen Martín
- Colorectal Unit, Department of General and Digestive Surgery, Arnau de Vilanova Hospital, Valencia, Spain
| | - Manuel López
- Colorectal Unit, Department of General and Digestive Surgery, Arnau de Vilanova Hospital, Valencia, Spain
| | - Natalia Uribe
- Colorectal Unit, Department of General and Digestive Surgery, Arnau de Vilanova Hospital, Valencia, Spain
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Zhu Y, Xiong H, Chen Y, Liu Z, Jiang Z, Huang R, Gao F, Zhang Q, Wang M, Jin Y, Qiao T, Ma T, Hu H, Wang X, Tang Q, Wang G. Comparison of natural orifice specimen extraction surgery and conventional laparoscopic-assisted resection in the treatment effects of low rectal cancer. Sci Rep 2021; 11:9338. [PMID: 33927293 PMCID: PMC8085046 DOI: 10.1038/s41598-021-88790-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2020] [Accepted: 04/14/2021] [Indexed: 02/07/2023] Open
Abstract
Natural orifice specimen extraction surgery (NOSES) is an intra-abdominal procedure that does not require an auxiliary incision to take a surgical sample from the abdominal wall through the natural orifice, but there are few systematic clinical studies on it. The aim of this study was to demonstrate the safety and feasibility of NOSES. We retrospectively analyzed the clinical data and follow-up of 165 patients with low rectal cancer who underwent NOSES or conventional laparoscopic surgery at our center from January 2013 to June 2015. From the perioperative data and postoperative follow-up results of both groups, patients in the NOSES group had less intraoperative bleeding (49.3 ± 55.8 ml vs. 75.1 ± 57.3 ml, p = 0.02), shorter postoperative gastrointestinal recovery (42.3 ± 15.5 h vs. 50.1 ± 17.0 h, p = 0.01), less postoperative analgesic use (35.6% vs. 57.6%, p = 0.02), lower postoperative pain scores, lower rate of postoperative complications (6.8% vs. 25.4%, p = 0.01), better satisfaction of the image and cosmesis of the abdominal wall postoperatively, and higher quality of life. Moreover, there was no significant difference in overall survival (OS) and disease-free survival (DFS) between two groups. Overall, NOSES is a safe and reliable minimally invasive surgical technique for patients with low rectal cancer.
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Affiliation(s)
- Yihao Zhu
- Department of Colorectal Surgery, The Second Affiliated Hospital of Harbin Medical University, Harbin, 150081, China
| | - Huan Xiong
- Department of Colorectal Surgery, The Second Affiliated Hospital of Harbin Medical University, Harbin, 150081, China
| | - Yinggang Chen
- Department of Colorectal Surgery, The Second Affiliated Hospital of Harbin Medical University, Harbin, 150081, China
| | - Zheng Liu
- Department of Colorectal Surgery, National Cancer Center, National Clinical Research Center for Cancer, Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100021, China
| | - Zheng Jiang
- Department of Colorectal Surgery, National Cancer Center, National Clinical Research Center for Cancer, Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100021, China
| | - Rui Huang
- Department of Colorectal Surgery, The Second Affiliated Hospital of Harbin Medical University, Harbin, 150081, China
| | - Feng Gao
- Department of Colorectal Surgery, The Second Affiliated Hospital of Harbin Medical University, Harbin, 150081, China
| | - Qian Zhang
- Department of Colorectal Surgery, The Second Affiliated Hospital of Harbin Medical University, Harbin, 150081, China
- Department of Colorectal Surgery, Zhejiang Cancer Hospital (Affiliated Cancer Hospital of the Chinese Academy of Sciences), Hangzhou, 310022, China
| | - Meng Wang
- Department of Colorectal Surgery, Zhejiang Cancer Hospital (Affiliated Cancer Hospital of the Chinese Academy of Sciences), Hangzhou, 310022, China
| | - Yinghu Jin
- Department of Colorectal Surgery, The Second Affiliated Hospital of Harbin Medical University, Harbin, 150081, China
| | - Tianyu Qiao
- Department of Colorectal Surgery, The Second Affiliated Hospital of Harbin Medical University, Harbin, 150081, China
| | - Tianyi Ma
- Department of Colorectal Surgery, The Second Affiliated Hospital of Harbin Medical University, Harbin, 150081, China
| | - Hanqing Hu
- Department of Colorectal Surgery, The Second Affiliated Hospital of Harbin Medical University, Harbin, 150081, China
| | - Xishan Wang
- Department of Colorectal Surgery, The Second Affiliated Hospital of Harbin Medical University, Harbin, 150081, China
- Department of Colorectal Surgery, National Cancer Center, National Clinical Research Center for Cancer, Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100021, China
| | - Qingchao Tang
- Department of Colorectal Surgery, The Second Affiliated Hospital of Harbin Medical University, Harbin, 150081, China.
| | - Guiyu Wang
- Department of Colorectal Surgery, The Second Affiliated Hospital of Harbin Medical University, Harbin, 150081, China.
- Department of Colorectal Surgery, Zhejiang Cancer Hospital (Affiliated Cancer Hospital of the Chinese Academy of Sciences), Hangzhou, 310022, China.
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Rostirolla R, Fontes P, Pinho M, Pedroso M, Masuko T, Novelli P, Lima R, Sampaio J. The impact of laparoscopic surgery in colorectal cancer resection with respect to the development of liver metastasis in the long-term. JOURNAL OF COLOPROCTOLOGY 2021. [DOI: 10.1016/j.jcol.2015.12.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
AbstractIntroduction Colorectal cancer (CRC) shows high incidence and mortality worldwide, particularly in Western and developed countries. The objective of this study is to evaluate the oncologic results during a minimum follow-up of 2 years of curable CRC patients submitted to laparoscopic resection in our environment, regarding to the development of hepatic metastases.Methods Medical records of 189 colon and rectal patients with potentially curable adenocarcinoma who have been submitted to laparoscopic resection have been reviewed through a retrospective cohort between January 2005 and March 2012 at a single institution regarded as reference to this type of treatment. Pearson's χ 2 and Long-rank tests have been used for statistical analysis and data was analyzed by statistic package STATA version 11.0.Results The eligible population for the study was 146 patients, 91 women (62%), with a mean age of 61 ± 13 years. Minimum follow-up was 24 months, having an mean follow-up of 60 ± 27 months and an mean follow-up of global disease recurrence of 27 ± 11 months. Hepatic metastases occurred in 7.5% of the population, most from stage III, and the mean recurrence period was 25 ± 16 months.Conclusions Laparoscopic resection for potentially curable CRC in this cohort did not change the long-term incidence of hepatic metastases, considering that our results are comparable to large randomized clinical trial results. Laparoscopic resection was effective and safe for analyzed patients, regarding long-term oncologic results.
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Affiliation(s)
- Renata Rostirolla
- Universidade Federal de Ciências da Saúde de Porto Alegre (UFCSPA), Porto Alegre, RS, Brazil
| | - Paulo Fontes
- Universidade Federal de Ciências da Saúde de Porto Alegre (UFCSPA), Porto Alegre, RS, Brazil
| | - Mauro Pinho
- Universidade da Região de Joinville (Univille), Joinville, SC, Brazil
| | - Miguel Pedroso
- General Surgery Service Department, Hospital do Servidor Publico Estadual de São Paulo (HSPESP), São Paulo, SP, Brazil
| | - Tatiana Masuko
- Universidade Federal de Ciências da Saúde de Porto Alegre (UFCSPA), Porto Alegre, RS, Brazil
| | - Paula Novelli
- Lubeck Institute of Research and Education, Lübeck, Germany
| | - Renato Lima
- Lubeck Institute of Research and Education, Lübeck, Germany
| | - José Sampaio
- Universidade Federal de Ciências da Saúde de Porto Alegre (UFCSPA), Porto Alegre, RS, Brazil
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Favorable short-term oncologic outcomes following laparoscopic surgery for small T4 colon cancer: a multicenter comparative study. World J Surg Oncol 2020; 18:299. [PMID: 33187538 PMCID: PMC7666454 DOI: 10.1186/s12957-020-02074-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2020] [Accepted: 10/29/2020] [Indexed: 12/14/2022] Open
Abstract
Background Laparoscopic surgery for T4 colon cancer may be safe in selected patients. We hypothesized that small tumor size might preoperatively predict a good laparoscopic surgery outcome. Herein, we compared the clinicopathologic and oncologic outcomes of laparoscopic and open surgery in small T4 colon cancer. Methods In a retrospective multicenter study, we reviewed the data of 449 patients, including 117 patients with tumors ≤ 4.0 cm who underwent surgery for T4 colon cancer between January 2014 and December 2017. We compared the clinicopathologic and 3-year oncologic outcomes between the laparoscopic and open groups. Survival curves were estimated using the Kaplan–Meier method and compared using the log-rank test. Univariate and multivariate analyses were performed using the Cox proportional hazards model. A p < 0.05 was considered statistically significant. Results Blood loss, length of hospital stay, and postoperative morbidity were lower in the laparoscopic group than in the open group (median [range], 50 [0–700] vs. 100 [0–4000] mL, p < 0.001; 8 vs. 10 days, p < 0.001; and 18.0 vs. 29.5%, p = 0.005, respectively). There were no intergroup differences in 3-year overall survival or disease-free survival (86.6 vs. 83.2%, p = 0.180, and 71.7 vs. 75.1%, p = 0.720, respectively). Among patients with tumor size ≤ 4.0 cm, blood loss was significantly lower in the laparoscopic group than in the open group (median [range], 50 [0–530] vs. 50 [0–1000] mL, p = 0.003). Despite no statistical difference observed in the 3-year overall survival rate (83.3 vs. 78.7%, p = 0.538), the laparoscopic group had a significantly higher 3-year disease-free survival rate (79.2 vs. 53.2%, p = 0.012). Conclusions Laparoscopic surgery showed similar outcomes to open surgery in T4 colon cancer patients and may have favorable short-term oncologic outcomes in patients with tumors ≤ 4.0 cm. Supplementary Information The online version contains supplementary material available at 10.1186/s12957-020-02074-5.
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15
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Ribeiro U, Tayar DO, Ribeiro RA, Andrade P, Junqueira SM. Laparoscopic vs open colorectal surgery: Economic and clinical outcomes in the Brazilian healthcare. Medicine (Baltimore) 2020; 99:e22718. [PMID: 33080727 PMCID: PMC7572007 DOI: 10.1097/md.0000000000022718] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/30/2022] Open
Abstract
Laparoscopic surgery has become the preferred surgical approach of several colorectal conditions. However, the economic results of this are quite controversial. The degree of adoption of laparoscopic technology, as well as the aptitude of the surgeons, can have an influence not only in the clinical outcomes but also in the total procedure cost. The aim of this study was to evaluate the clinical and economic outcomes of laparoscopic colorectal surgeries, compared to open procedures in Brazil.All patients who underwent elective colorectal surgeries between January 2012 and December 2013 were eligible to the retrospective cohort. The considered follow-up period was within 30 days from the index procedure. The outcomes evaluated were the length of stay, blood transfusion, intensive care unit admission, in-hospital mortality, use of antibiotics, the development of anastomotic leakage, readmission, and the total hospital costs including re-admissions.Two hundred eighty patients, who met the eligibility criteria, were included in the analysis. Patients in the laparoscopic group had a shorter length of stay in comparison with the open group (6.02 ± 3.86 vs 9.86 ± 16.27, P < .001). There were no significant differences in other clinical outcomes between the 2 groups. The total costs were similar between the 2 groups, in the multivariate analysis (generalized linear model ratio of means 1.20, P = .074). The cost predictors were the cancer diagnosis and age.Laparoscopic colorectal surgery presents a 17% decrease in the duration of the hospital stay without increasing the total hospitalization costs. The factors associated with increased hospital costs were age and the diagnosis of cancer.
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Affiliation(s)
- Ulysses Ribeiro
- Department of Digestive Surgery, Faculdade de Medicina da Universidade de São Paulo
| | - Daiane Oliveira Tayar
- Department of Health Economics and Market Access, Johnson & Johnson Medical, São Paulo
| | | | - Priscila Andrade
- Department of Health Economics and Market Access, Johnson & Johnson Medical, São Paulo
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Abstract
Minimally invasive techniques continue to transform the field of colorectal surgery. Because traditional surgical approaches for rectal cancer are associated with significant mortality and morbidity, developing less invasive approaches to this disease is paramount. Natural orifice transluminal endoscopic surgery (NOTES), commonly known as "no incision surgery," represents the ultimate minimally invasive approach to disease. Although transgastric and transvaginal approaches for NOTES surgery were the initially explored, a transrectal approach for colorectal disease is intuitive given that it makes use of the resected organ for transluminal access. Furthermore, the transanal approach allows for improved, precise visualization of the presacral mesorectal plane compared with an abdominal viewpoint, particularly in the narrow, male pelvis. Finally, experience with existing transanal platforms that have been used for decades for local excision of rectal disease made the development of a transanal approach to total mesorectal excision (TME) feasible. Here, we will review the evolution of minimally invasive and transanal surgical techniques that allowed for the development of transanal TME and its introduction into clinical practice.
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Affiliation(s)
- Heather Carmichael
- Department of Surgery, University of Colorado School of Medicine, Aurora, Colorado
| | - Patricia Sylla
- Icahn School Medicine at Mount Sinai, New York, New York
- Division of Colon and Rectal Surgery, Department of Surgery, Mount Sinai Hospital, New York, New York
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17
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Carmichael H, D'Andrea AP, Skancke M, Obias V, Sylla P. Feasibility of transanal total mesorectal excision (taTME) using the Medrobotics Flex® System. Surg Endosc 2019; 34:485-491. [PMID: 31350608 DOI: 10.1007/s00464-019-07019-y] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2019] [Accepted: 07/19/2019] [Indexed: 02/07/2023]
Abstract
BACKGROUND The use of transanal total mesorectal excision (taTME) for treatment of rectal cancer is growing, but anatomic constraints prevent access to the proximal rectum with rigid instruments. The articulated instrumentation of current surgical robots is promising in overcoming these limitations, but the bulky size of current platforms inhibits the proximal reach of dissection. Flexible robotic systems could overcome these constraints while maintaining a stable platform for dissection. The goal of this study was to evaluate feasibility of performing taTME using the semi-robotic Flex® System (Medrobotics Corp., Raynham, MA) in human cadavers. METHODS taTME was performed by two surgeons in six fresh human cadaveric specimens using the Flex® System, with or without transabdominal laparoscopic assistance. Both mid- and low-rectal lesions were simulated. Metrics including quality of visualization, maintenance of pneumorectum, maneuverability of instruments, effectiveness of pursestring suture placement, and dissection in an anatomically correct plane were evaluated. RESULTS The semi-robotic endoluminal platform allowed for excellent visualization, insufflation, and dissection during taTME. Adequate pursestring occlusion of the rectum was achieved in all six cases. In cadavers with simulated mid-rectal lesions (N = 4), dissection and anterior peritoneal entry was achieved in all cases, with abdominal assistance utilized in two of four cases. In cadavers with simulated low-rectal lesions (N = 2), dissection was incomplete and aborted due to difficulty maneuvering instruments in close proximity to the rigid transanal port. CONCLUSIONS Use of the Flex® system for taTME is feasible for mid-rectal dissection. Advantages over the traditional multi-armed robot include longer reach of instruments with the ability to dissect up to 17 cm from the anal verge, as well as tactile feedback. The current design of the flexible platform does not permit safe dissection in the distal rectum, although this constraint may be resolved with future adjustments to the equipment.
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Affiliation(s)
| | - Anthony P D'Andrea
- Division of Colon and Rectal Surgery, Department of Surgery, Icahn School of Medicine at Mount Sinai, 5 East 98th Street, Box 1259, New York, NY, 10029, USA
| | - Matthew Skancke
- Department of General Surgery and Colorectal Surgery, George Washington University School of Medicine, Washington, DC, USA
| | - Vincent Obias
- Department of General Surgery and Colorectal Surgery, George Washington University School of Medicine, Washington, DC, USA
| | - Patricia Sylla
- Division of Colon and Rectal Surgery, Department of Surgery, Icahn School of Medicine at Mount Sinai, 5 East 98th Street, Box 1259, New York, NY, 10029, USA.
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Dai J, Yu Z. Comparison of Clinical Efficacy and Complications Between Laparoscopic Versus Open Surgery for Low Rectal Cancer. Comb Chem High Throughput Screen 2019; 22:179-186. [PMID: 30973104 DOI: 10.2174/1386207322666190411113252] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2018] [Revised: 09/20/2018] [Accepted: 12/11/2018] [Indexed: 01/07/2023]
Abstract
Aim:
To compare the surgical outcomes of laparoscopic surgery for lower rectal cancer
with open surgery.
Methods:
The multiple databases including PubMed, Springer, EMBASE, EMBASE, OVID were
adopted to search for the relevant studies, and full-text articles involving the comparison of
unilateral and bilateral PVP surgery were reviewed. Review Manager 5.0 was adopted to estimate
the effects of the results among the selected articles. Forest plots, sensitivity analysis and bias
analysis for the articles included were also conducted.
Results:
Finally, 1186 patients were included in the 10 studies, which eventually satisfied the
eligibility criteria, and laparoscopic and open surgery group were 646 and 540, respectively. The
meta-analysis suggested that there was no significant difference of the operation time between
laparoscopic and open surgery group, while the time to solid intake, hospital stay time, blood loss
and complication rate of laparoscopic group are much less than those of open surgery.
Conclusion:
Although both these two punctures provide similar operation time, we encourage the
use of the laparoscopic surgery as the preferred surgical technique for treatment of lower rectal
cancer due to less time to solid intake, hospital stay time, blood loss and lower complication rate.
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Affiliation(s)
- Jian Dai
- Department of Colorectal and Anal Surgery, Jinhua Municipal Central Hospital, Jinhua Hospital of Zhejiang University, Jinhua 321000, Zhejiang, China
| | - Zhou Yu
- Department of Colorectal and Anal Surgery, Jinhua Municipal Central Hospital, Jinhua Hospital of Zhejiang University, Jinhua 321000, Zhejiang, China
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Short–term outcomes of laparoscopic colorectal cancer surgery in elderly patients. -Is it really safe in elderly patients with severe comorbidities?-. INTERNATIONAL JOURNAL OF SURGERY OPEN 2019. [DOI: 10.1016/j.ijso.2019.02.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Ohtani H, Maeda K, Nomura S, Shinto O, Mizuyama Y, Nakagawa H, Nagahara H, Shibutani M, Fukuoka T, Amano R, Hirakawa K, Ohira M. Meta-analysis of Robot-assisted Versus Laparoscopic Surgery for Rectal Cancer. ACTA ACUST UNITED AC 2018; 32:611-623. [PMID: 29695568 DOI: 10.21873/invivo.11283] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2018] [Revised: 02/12/2018] [Accepted: 02/20/2018] [Indexed: 12/31/2022]
Abstract
BACKGROUND/AIM A meta-analysis was conducted to evaluate and compare the short- and long-term outcomes of robot-assisted (RAS) and conventional laparoscopic surgery (LAS) for rectal cancer. MATERIALS AND METHODS We searched MEDLINE for relevant papers published between 2010 and December 2017 by using specific search terms. We analyzed outcomes over short- and long-term periods. RESULTS We identified 23 papers reporting results that compared RAS for rectal cancer with LAS. Our meta-analysis included 4,348 patients with rectal cancer; 2,068 had undergone RAS, and 2,280 had undergone LAS. In the short- and long-term period, 27 and 7 outcome variables were examined, respectively. RAS for rectal cancer was significantly associated with a greater operative time and a lower conversion rate to open surgery in the short-term, and results in almost similar outcomes in the long-term, compared to LAS. CONCLUSION RAS may be an acceptable surgical treatment option compared to LAS for rectal cancer.
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Affiliation(s)
- Hiroshi Ohtani
- Department of Surgery, Ohno Memorial Hospital, Osaka, Japan
| | - Kiyoshi Maeda
- Department of Surgical Oncology, Osaka City University Graduate School of Medicine, Osaka, Japan
| | - Shinya Nomura
- Department of Surgery, Ohno Memorial Hospital, Osaka, Japan
| | - Osamu Shinto
- Department of Surgery, Ohno Memorial Hospital, Osaka, Japan
| | - Yoko Mizuyama
- Department of Surgery, Ohno Memorial Hospital, Osaka, Japan
| | | | - Hisashi Nagahara
- Department of Surgical Oncology, Osaka City University Graduate School of Medicine, Osaka, Japan
| | - Masatsune Shibutani
- Department of Surgical Oncology, Osaka City University Graduate School of Medicine, Osaka, Japan
| | - Tatsunari Fukuoka
- Department of Surgical Oncology, Osaka City University Graduate School of Medicine, Osaka, Japan
| | - Ryosuke Amano
- Department of Surgical Oncology, Osaka City University Graduate School of Medicine, Osaka, Japan
| | - Kosei Hirakawa
- Department of Surgical Oncology, Osaka City University Graduate School of Medicine, Osaka, Japan
| | - Masaichi Ohira
- Department of Surgical Oncology, Osaka City University Graduate School of Medicine, Osaka, Japan
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21
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Zhao Y, Hou XL, Ding JH, Zhao K, Xu X, Dong GL. Early Urinary Dysfunction after Laparoscopic Rectal Cancer Surgery: Does Surgeons’ Learning Curve Matter? Am Surg 2018. [DOI: 10.1177/000313481808400516] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Poor early urinary outcomes after laparoscopy were reported in studies comparing laparoscopic versus open rectal cancer surgery. One possible explanation was that these studies might include a number of patients on the laparoscopic surgeons’ learning curve. This study aims to evaluate whether the learning curve of laparoscopic rectal cancer surgery influences early postoperative urinary dysfunction. Between September 2009 and December 2014, 208 consecutive patients undergoing laparoscopic rectal resection for rectal cancer were enrolled in the present study. All the clinical data were obtained from a prospectively compiled database. The primary outcomes were the incidences of postoperative urinary retention (POUR) and major urinary dysfunction requiring long-term urinary catheterization. POUR and major urinary dysfunction rate were 20.2 per cent (42/208) and 4.3 per cent (9/208), respectively. The learning curve analysis for operative time using the moving average method showed stabilization at 80 cases. Surgeon experience was divided into two periods: learning curve period (1–80 cases) and experienced period (81–208 cases). Multivariate analysis showed that older age (OR = 3.250, P = 0.006) and learning curve (OR = 2.241, P = 0.024) were independent risk factors for POUR. Learning curve was not significantly associated with increased rates of major urinary dysfunction (OR = 3.378, P = 0.092). Learning curve is a significant risk factor for increased rate of POUR after laparoscopic rectal cancer surgery. Technical training may be key to shorten the learning curve and limit its impact on the postoperative urinary complications.
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Affiliation(s)
- Yong Zhao
- Department of General Surgery, Chinese PLA General Hospital, Beijing, China
- Department of Colorectal Surgery, the General Hospital of the PLA Rocket Force, Beijing, China; and the
| | - Xiao-Ling Hou
- Department of Cardiology, Chinese PLA General Hospital, Beijing, China
| | - Jian-Hua Ding
- Department of Colorectal Surgery, the General Hospital of the PLA Rocket Force, Beijing, China; and the
| | - Ke Zhao
- Department of Colorectal Surgery, the General Hospital of the PLA Rocket Force, Beijing, China; and the
| | - Xiao Xu
- Department of General Surgery, Chinese PLA General Hospital, Beijing, China
| | - Guang-Long Dong
- Department of General Surgery, Chinese PLA General Hospital, Beijing, China
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Li Z, Wang D, Wei Y, Liu P, Xu J. Clinical outcomes of laparoscopic-assisted synchronous bowel anastomoses for synchronous colorectal cancer: initial clinical experience. Oncotarget 2018; 8:10741-10747. [PMID: 27821798 PMCID: PMC5354696 DOI: 10.18632/oncotarget.12899] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2016] [Accepted: 10/17/2016] [Indexed: 01/01/2023] Open
Abstract
The primary aim of this study was to explore the safety and feasibility of laparoscopic-assisted synchronous bowel anastomoses (LSBA) for synchronous colorectal cancer (SCRC). All patients who underwent LSBA for SCRC were retrospectively reviewed and analyzed for clinical and pathological features, technical feasibility and short-term as well as long-term oncological outcomes. Between July 2008 and January 2012, a series of 11 consecutive SCRC patients underwent LSBA. Six patients underwent laparoscopic-assisted right hemicolectomy and anterior resection. Five patients had laparoscopic-assisted right hemicolectomy and sigmoidectomy. There were no intraoperative complications that required open conversions. Mean operation time was 233 (range, 195–285) minutes, and mean estimated blood loss was 224 (range, 100–300) mL. The postoperative course of the patients was uneventful with the mean return to oral intake was 6.9 (range 5–12) days, and mean length of hospital stay was 12.6 (range 9–17) days. All surgical wounds showed good cosmetic outcome, and the mean incision length was 4.1 (range 3.5-5.0) cm. During a median follow-up period of 76 months, no local tumor recurrences were found. LSBA is a potentially feasible and safe procedure for SCRC when performed by an experienced surgeon. Further large clinical controlled trials are warranted to confirm the findings.
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Affiliation(s)
- Zhengtian Li
- Department of General Surgery, The First Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Dawei Wang
- Department of General Surgery, The First Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Yunwei Wei
- Department of General Surgery, The First Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Peng Liu
- Department of Colorectal Surgery, Changhai Hospital, Second Military Medical University, Shanghai, China
| | - Jun Xu
- Department of General Surgery, The First Affiliated Hospital of Harbin Medical University, Harbin, China
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Celentano V, Cohen R, Warusavitarne J, Faiz O, Chand M. Sexual dysfunction following rectal cancer surgery. Int J Colorectal Dis 2017; 32:1523-1530. [PMID: 28497404 DOI: 10.1007/s00384-017-2826-4] [Citation(s) in RCA: 54] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/26/2017] [Indexed: 02/04/2023]
Abstract
INTRODUCTION Sexual and urological problems after surgery for rectal cancer are common, multifactorial, inadequately discussed, and untreated. The urogenital function is dependent on dual autonomic sympathetic and parasympathetic innervation, and four key danger zones exist that are at risk for nerve damage during colorectal surgery: one of these sites is in the abdomen and three are in the pelvis. The aim of this study is to systematically review the epidemiology of sexual dysfunction following rectal cancer surgery, to describe the anatomical basis of autonomic nerve-preserving techniques, and to explore the scientific evidence available to support the laparoscopic or robotic approach over open surgery. METHODS According to the PRISMA guidelines, a comprehensive literature search of studies evaluating sexual function in patients undergoing rectal surgery for cancer was performed in Medline, Scopus, Web of Science, Embase, and Cochrane Central Register of controlled trials. RESULTS An increasing number of studies assessing the incidence and prevalence of sexual dysfunction following multimodality treatment for rectal cancer has been published over the last 30 years. Significant heterogeneity in the prevalence of sexual dysfunction is reported in the literature, with rates between 5 and 90%. CONCLUSIONS There is no evidence to date in favor of any surgical approach (open vs laparoscopic vs robotic). Standardized diagnostic tools should be routinely used to prospectively assess sexual function in patients undergoing rectal surgery.
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Affiliation(s)
- V Celentano
- Department of Colorectal Surgery, Queen Alexandra Hospital, Portsmouth Hospitals NHS Trust, Southwick Hill Rd, Portsmouth, PO6 3LY, UK.
| | - R Cohen
- Department of Colorectal Surgery, University College London Hospitals, 235 Euston Rd, Bloomsbury, London, NW1 2BU, UK
| | | | - O Faiz
- Department of Surgery, St. Mark's Hospital, Harrow, UK
| | - M Chand
- Department of Colorectal Surgery, University College London Hospitals, 235 Euston Rd, Bloomsbury, London, NW1 2BU, UK
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Pache B, Hübner M, Jurt J, Demartines N, Grass F. Minimally invasive surgery and enhanced recovery after surgery: The ideal combination? J Surg Oncol 2017; 116:613-616. [DOI: 10.1002/jso.24787] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2017] [Accepted: 07/06/2017] [Indexed: 01/17/2023]
Affiliation(s)
- Basile Pache
- Department of Visceral Surgery; University Hospital CHUV; Lausanne Switzerland
| | - Martin Hübner
- Department of Visceral Surgery; University Hospital CHUV; Lausanne Switzerland
| | - Jonas Jurt
- Department of Visceral Surgery; University Hospital CHUV; Lausanne Switzerland
| | - Nicolas Demartines
- Department of Visceral Surgery; University Hospital CHUV; Lausanne Switzerland
| | - Fabian Grass
- Department of Visceral Surgery; University Hospital CHUV; Lausanne Switzerland
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25
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Otani T, Isohata N, Kumamoto K, Endo S, Utano K, Nemoto D, Aizawa M, Lefor AK, Togashi K. An evidence-based medicine approach to the laparoscopic treatment of colorectal cancer. Fukushima J Med Sci 2016; 62:74-82. [PMID: 27477991 DOI: 10.5387/fms.2016-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
During the 1990s, laparoscopic resection was established as a treatment for gastrointestinal malignant tumors. A number of randomized controlled trials comparing laparoscopic-assisted colorectal surgery with conventional open colorectal surgery for colon cancer have been conducted. These trials have shown short-term benefits, and the vast majority demonstrated no significant difference in long-term outcomes. Laparoscopic-assisted colorectal surgery is widely performed for the treatment of colon cancer, whereas laparoscopic-assisted colorectal surgery for rectal cancer is less commonly performed. In recent years, there have been an increasing number of reports of laparoscopic-assisted colorectal surgery for rectal cancer, where improving short-term outcomes was shown, but no definitive effect on long-term survival has been shown to date. Randomized controlled trials focusing on long-term survival are currently ongoing.
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Affiliation(s)
- Taisuke Otani
- Department of Coloproctology, Aizu Medical Center, Fukushima Medical University
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26
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Matsunaga R, Nishizawa Y, Saito N, Kobayashi A, Ohdaira T, Ito M. Quantitative evaluation of 3D imaging in laparoscopic surgery. Surg Today 2016; 47:440-444. [DOI: 10.1007/s00595-016-1428-z] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2015] [Accepted: 06/29/2016] [Indexed: 01/02/2023]
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27
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Mik M, Dziki L, Dziki A. Conventional and/or laparoscopic rectal cancer surgery: what is the current evidence? Innov Surg Sci 2016; 1:13-18. [PMID: 31579714 PMCID: PMC6753985 DOI: 10.1515/iss-2016-0006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2016] [Accepted: 08/17/2016] [Indexed: 02/04/2023] Open
Abstract
Despite many years of experience with laparoscopic procedures in rectal cancer, the superiority of minimally invasive approaches has been questioned especially in recent years. This article is a short review of the current knowledge about laparoscopic approaches in comparison to conventional modalities in patients with rectal cancer. To present the current state of the knowledge, we focused on reports that were published in the last few years and compared them to multicenter trials and meta-analyses published last year. Our analysis mainly applied to the primary end-points of these trials. We also included expert opinions that have been published in the last several months.
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Affiliation(s)
- Michal Mik
- Department of General and Colorectal Surgery, Medical University of Lodz, Plac Hallera 1, 90-647 Lodz, Poland
| | - Lukasz Dziki
- Department of General and Colorectal Surgery, Medical University of Lodz, Lodz, Poland
| | - Adam Dziki
- Department of General and Colorectal Surgery, Medical University of Lodz, Lodz, Poland
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28
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Preliminary results of robotic colorectal surgery at the National Cancer Institute, Cairo University. J Egypt Natl Canc Inst 2016; 28:169-74. [DOI: 10.1016/j.jnci.2016.05.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2016] [Revised: 05/08/2016] [Accepted: 05/21/2016] [Indexed: 01/15/2023] Open
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29
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Mukkai Krishnamurty D, Wise PE. Importance of surgical margins in rectal cancer. J Surg Oncol 2016; 113:323-32. [DOI: 10.1002/jso.24136] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2015] [Accepted: 11/18/2015] [Indexed: 12/14/2022]
Affiliation(s)
- Devi Mukkai Krishnamurty
- Section of Colon and Rectal Surgery; Washington University School of Medicine in St. Louis; St. Louis Missouri
| | - Paul E. Wise
- Section of Colon and Rectal Surgery; Washington University School of Medicine in St. Louis; St. Louis Missouri
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30
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Trakarnsanga A, Weiser MR. Minimally invasive surgery of rectal cancer: current evidence and options. Am Soc Clin Oncol Educ Book 2016:214-8. [PMID: 24451737 DOI: 10.14694/edbook_am.2012.32.41] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Minimally invasive surgery (MIS) of colorectal cancer has become more popular in the past two decades. Laparoscopic colectomy has been accepted as an alternative standard approach in colon cancer, with comparable oncologic outcomes and several better short-term outcomes compared to open surgery. Unlike the treatment for colon cancer, however, the minimally invasive approach in rectal cancer has not been established. In this article, we summarize the current status of MIS for rectal cancer and explore the various technical options.
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Affiliation(s)
- Atthaphorn Trakarnsanga
- From the Department of Surgery, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand; Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, NY
| | - Martin R Weiser
- From the Department of Surgery, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand; Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, NY
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31
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Xynos E, Tekkis P, Gouvas N, Vini L, Chrysou E, Tzardi M, Vassiliou V, Boukovinas I, Agalianos C, Androulakis N, Athanasiadis A, Christodoulou C, Dervenis C, Emmanouilidis C, Georgiou P, Katopodi O, Kountourakis P, Makatsoris T, Papakostas P, Papamichael D, Pechlivanides G, Pentheroudakis G, Pilpilidis I, Sgouros J, Triantopoulou C, Xynogalos S, Karachaliou N, Ziras N, Zoras O, Souglakos J. Clinical practice guidelines for the surgical treatment of rectal cancer: a consensus statement of the Hellenic Society of Medical Oncologists (HeSMO). Ann Gastroenterol 2016; 29:103-26. [PMID: 27064746 PMCID: PMC4805730 DOI: 10.20524/aog.2016.0003] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
In rectal cancer management, accurate staging by magnetic resonance imaging, neo-adjuvant treatment with the use of radiotherapy, and total mesorectal excision have resulted in remarkable improvement in the oncological outcomes. However, there is substantial discrepancy in the therapeutic approach and failure to adhere to international guidelines among different Greek-Cypriot hospitals. The present guidelines aim to aid the multidisciplinary management of rectal cancer, considering both the local special characteristics of our healthcare system and the international relevant agreements (ESMO, EURECCA). Following background discussion and online communication sessions for feedback among the members of an executive team, a consensus rectal cancer management was obtained. Statements were subjected to the Delphi methodology voting system on two rounds to achieve further consensus by invited multidisciplinary international experts on colorectal cancer. Statements were considered of high, moderate or low consensus if they were voted by ≥80%, 60-80%, or <60%, respectively; those obtaining a low consensus level after both voting rounds were rejected. One hundred and two statements were developed and voted by 100 experts. The mean rate of abstention per statement was 12.5% (range: 2-45%). In the end of the process, all statements achieved a high consensus. Guidelines and algorithms of diagnosis and treatment were proposed. The importance of centralization, care by a multidisciplinary team, adherence to guidelines, and personalization is emphasized.
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Affiliation(s)
- Evaghelos Xynos
- General Surgery, InterClinic Hospital of Heraklion, Greece (Evangelos Xynos)
| | - Paris Tekkis
- Colorectal Surgery, Chelsea and Westminster NHS Foundation Trust, London, UK (Paris Tekkis, Panagiotis Georgiou)
| | - Nikolaos Gouvas
- General Surgery, Metropolitan Hospital of Piraeus, Greece (Nikolaos Gouvas)
| | - Louiza Vini
- Radiation Oncology, Iatriko Center of Athens, Greece (Louza Vini)
| | - Evangelia Chrysou
- Radiology, University Hospital of Heraklion, Greece (Evangelia Chrysou)
| | - Maria Tzardi
- Pathology, University Hospital of Heraklion, Greece (Maria Tzardi)
| | - Vassilis Vassiliou
- Radiation Oncology, Oncology Center of Bank of Cyprus, Nicosia, Cyprus (Vassilis Vassiliou)
| | - Ioannis Boukovinas
- Medical Oncology, Bioclinic of Thessaloniki, Greece (Ioannis Boukovinas)
| | - Christos Agalianos
- General Surgery, Athens Naval & Veterans Hospital, Greece (Christos Agalianos, George Pechlivanides)
| | - Nikolaos Androulakis
- Medical Oncology, Venizeleion Hospital of Heraklion, Greece (Nikolaos Androulakis)
| | | | | | - Christos Dervenis
- General Surgery, Konstantopouleio Hospital of Athens, Greece (Christos Dervenis)
| | - Christos Emmanouilidis
- Medical Oncology, Interbalkan Medical Center, Thessaloniki, Greece (Christos Emmanouilidis)
| | - Panagiotis Georgiou
- Colorectal Surgery, Chelsea and Westminster NHS Foundation Trust, London, UK (Paris Tekkis, Panagiotis Georgiou)
| | - Ourania Katopodi
- Medical Oncology, Iaso General Hospital, Athens, Greece (Ourania Katopodi)
| | - Panteleimon Kountourakis
- Medical Oncology, Oncology Center of Bank of Cyprus, Nicosia, Cyprus (Panteleimon Kountourakis, Demetris Papamichael)
| | - Thomas Makatsoris
- Medical Oncology, University Hospital of Patras, Greece (Thomas Makatsoris)
| | - Pavlos Papakostas
- Medical Oncology, Ippokrateion Hospital of Athens, Greece (Pavlos Papakostas)
| | - Demetris Papamichael
- Medical Oncology, Oncology Center of Bank of Cyprus, Nicosia, Cyprus (Panteleimon Kountourakis, Demetris Papamichael)
| | - George Pechlivanides
- General Surgery, Athens Naval & Veterans Hospital, Greece (Christos Agalianos, George Pechlivanides)
| | | | - Ioannis Pilpilidis
- Gastroenterology, Theageneion Cancer Hospital, Thessaloniki, Greece (Ioannis Pilpilidis)
| | - Joseph Sgouros
- Medical Oncology, Agioi Anargyroi Hospital of Athens, Greece (Joseph Sgouros)
| | | | - Spyridon Xynogalos
- Medical Oncology, George Gennimatas General Hospital, Athens, Greece (Spyridon Xynogalos)
| | - Niki Karachaliou
- Medical Oncology, Dexeus University Institute, Barcelona, Spain (Niki Karachaliou)
| | - Nikolaos Ziras
- Medical Oncology, Metaxas Cancer Hospital, Piraeus, Greece (Nikolaos Ziras)
| | - Odysseas Zoras
- General Surgery, University Hospital of Heraklion, Greece (Odysseas Zoras)
| | - John Souglakos
- Medical Oncology, University Hospital of Heraklion, Greece (John Souglakos)
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Park EJ, Baik SH, Kang J, Hur H, Min BS, Lee KY, Kim NK. The Impact of Postoperative Complications on Long-term Oncologic Outcomes After Laparoscopic Low Anterior Resection for Rectal Cancer. Medicine (Baltimore) 2016; 95:e3271. [PMID: 27057884 PMCID: PMC4998800 DOI: 10.1097/md.0000000000003271] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
Laparoscopic rectal cancer surgery has technical difficulties with a higher complication rate than colon cancer. However, few studies have examined whether postoperative complications are associated with oncologic outcomes. The aim of this study is to evaluate the impact of postoperative complications on long-term oncologic outcomes after laparoscopic low anterior resection for rectal cancer.Between January 2005 and December 2012, we evaluated 686 consecutive patients who underwent laparoscopic low anterior resection for stage I-III rectal cancer. Patients were divided into complication (n = 175) and noncomplication (n = 511) groups. The median follow-up period was 38 months (range, 2-118). We compared perioperative clinicopathologic outcomes, 5-year survival, and local recurrence between groups and evaluated prognostic factors.Five-year overall survival rates were 91.4% and 89.2% (P = 0.234) and 5-year disease-free survival rates were 83.2% and 77.7% (P = 0.002) in the noncomplication and complication groups for all stages, respectively. For stage I cancer, both the 5-year overall survival and the 5-year disease-free survival rate of the complication group were lower than the noncomplication group. Local recurrence rates were 3.1% and 7.8% in the noncomplication and complication groups, respectively (P = 0.002). In multivariate analysis, the presence of postoperative complications was a significant predictor of 5-year disease-free survival (hazard ratio, 1.65; P = 0.012).Postoperative complications had a negative impact on 5-year disease-free survival after laparoscopic low anterior resection for rectal cancer. The rate of local recurrence in the complication group increased more than the noncomplication group. In particular, postoperative complications were associated with poorer oncologic outcomes for stage I cancer. Laparoscopic surgery is preferred for early-stage rectal cancer so careful attention should be paid to avoid postoperative complications.
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Affiliation(s)
- Eun Jung Park
- From the Division of Colon and Rectal Surgery, Department of Surgery, Yonsei University College of Medicine, Seoul, South Korea
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33
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Bissolati M, Orsenigo E, Staudacher C. Minimally invasive approach to colorectal cancer: an evidence-based analysis. Updates Surg 2016; 68:37-46. [DOI: 10.1007/s13304-016-0350-7] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2015] [Accepted: 02/20/2016] [Indexed: 12/13/2022]
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Laparoscopic Colorectal Cancer Resection in High-Volume Surgical Centers: Long-Term Outcomes from the LAPCOLON Group Trial. World J Surg 2016; 39:2045-51. [PMID: 25820910 DOI: 10.1007/s00268-015-3050-4] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
BACKGROUND Strong evidence has confirmed the benefit of laparoscopy in colorectal cancer resection but remains a challenging procedure. It is not clear that such promising results in selected patients translate into a favorable risk-benefit balance in real practice. We conducted a multicenter national observational registry to assess operative and oncologic long-term outcomes following laparoscopic colorectal cancer resection. METHODS All patients with laparoscopic colorectal cancer resection between 2001 and 2004 were included. Data were extracted from the prospective Italian national database of 10 high-volume centers (≥40 colorectal cancer laparoscopic resections per year). Surgical technique and follow-up were standardized. Survivals were analyzed by Kaplan-Meier method. RESULTS We reported 1832 patients with colon (58.5%) and rectal cancer (41.5%). TNM stage was 0-I-II in 1044 patients (57%) and III-IV in 788 patients (43%). Surgery included a totally laparoscopic procedure in 1820 patients (99.3%). Conversion was 10.5%. Postoperative morbidity and 30-day mortality rates were 17 and 1.2%, respectively. Clinical anastomotic leakage rate was 8.3% (n=152). R0 resection was 95%. With a median follow-up of 54.2 months, cancer recurrence rate was 13.3%. At 5 years, cancer-free survival was 86.7%. Upon multivariate analysis, age (P=0.001) and TNM stage (P<0.001) were associated with cancer-free survival. Predictive factors of cancer recurrence were gender (P=0.029) and TNM stage (P<0.001). CONCLUSIONS In high-volume centers and non-selective patients, laparoscopic colorectal resection for cancer achieves good operative results with satisfactory long-term oncologic results. Even in the laparoscopy era, age, gender, and TNM stage remain the most powerful predictor of oncologic outcomes.
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Outcomes of Open, Laparoscopic, and Robotic Abdominoperineal Resections in Patients With Rectal Cancer. Dis Colon Rectum 2015; 58:1123-9. [PMID: 26544808 DOI: 10.1097/dcr.0000000000000475] [Citation(s) in RCA: 58] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
BACKGROUND There are limited available data comparing open, laparoscopic, and robotic approaches for rectal cancer surgery. OBJECTIVE We sought to investigate outcomes of different surgical approaches to abdominoperineal resection in patients with rectal cancer. DESIGN The nationwide inpatient sample database was used to examine the clinical data of patients with rectal cancer who underwent elective abdominoperineal resection between 2009 and 2012 in the United States. Multivariate regression analysis was performed to compare outcomes of different surgical approaches. SETTINGS A retrospective review according to the national inpatient sample database was designed. PATIENTS We included patients with rectal cancer who underwent elective abdominoperineal resection between 2009 and 2012. MAIN OUTCOME MEASURES Outcomes of different surgical approaches to abdominoperineal resection were investigated. RESULTS We sampled 18,359 patients with rectal cancer who underwent elective abdominoperineal resections. Of these, 69.5% had open surgery, 25.8% had laparoscopic surgery, and 4.7% had robotic surgery. The rate of robotic procedures increased >4-fold, from 2.1% to 8.1%, from 2009 to 2012. The conversion rate in robotic surgery was significantly lower compared with laparoscopic surgery (5.7% vs 13.4%; p < 0.01). After risk adjustment, patients who underwent laparoscopic and robotic approaches had lower morbidity risks compared with those who underwent the open approach (adjusted OR = 0.77 (95% CI, 0.65-0.92), 0.57 (95% CI, 0.40-0.80); p < 0. 01). There were no significant differences in the morbidity rate of patients who underwent laparoscopic or robotic approaches (adjusted OR = 0.79 (95% CI, 0.55-1.14); p = 0.21). However, patients who underwent the robotic approach had significantly higher total hospital charges compared with those who underwent the laparoscopic approach (mean difference, $24,890; p < 0.01). LIMITATIONS We could not adjust the results with some important factors, such as the tumor stage and BMI. CONCLUSIONS The use of robotic and laparoscopic approaches to abdominoperineal resection have increased between 2009 and 2012. Both minimally invasive approaches decrease morbidity rates of patients undergoing abdominoperineal resection. The robotic approach has a significantly lower conversion rate compared with the laparoscopic approach. However, it had significantly higher total hospital charges compared with the laparoscopic approach.
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36
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Lee GC, Sylla P. Shifting Paradigms in Minimally Invasive Surgery: Applications of Transanal Natural Orifice Transluminal Endoscopic Surgery in Colorectal Surgery. Clin Colon Rectal Surg 2015; 28:181-93. [PMID: 26491411 DOI: 10.1055/s-0035-1555009] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
Since the advent of laparoscopy, minimally invasive techniques such as single port laparoscopy, robotics, endoscopically assisted laparoscopy, and transanal endoscopic surgery continue to revolutionize the field of colorectal surgery. Transanal natural orifice transluminal endoscopic surgery (NOTES) represents a further paradigm shift by combining the advantages of these earlier techniques to reduce the size and number of abdominal incisions and potentially optimize rectal dissection, especially with respect to performance of an oncologically adequate total mesorectal excision (TME) for rectal cancer. Since the first experimental report of transanal rectosigmoid resection in 2007, the potential impact of transanal NOTES in colorectal surgery has been extensively investigated in experimental models and recently transitioned to clinical application. There have been 14 clinical trials of transanal TME (taTME) for rectal cancer that have demonstrated the feasibility and preliminary oncologic safety of this approach in carefully selected patients, with results comparable to outcomes after laparoscopic and open TME, including cumulative intraoperative and postoperative complication rates of 5.5 and 35.5%, respectively, 97.3% rate of complete or near-complete specimens, and 93.6% rate of negative margins. Transanal NOTES has also been safely applied to proctectomy and colectomy for benign indications. The consensus among published series suggests that taTME is most safely performed with transabdominal assistance by surgeons experienced with laparoscopic TME, transanal endoscopic surgery, and sphincter-preserving techniques including intersphincteric resection. Future applications of transanal NOTES may include evolution to a pure endoscopic transanal approach for TME, colectomy, and sentinel lymph node biopsy for rectal cancer, with a potential role for robotic assistance.
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Affiliation(s)
- Grace Clara Lee
- Division of Gastrointestinal Surgery, Department of Surgery, Massachusetts General Hospital, Boston, Massachusetts
| | - Patricia Sylla
- Division of Gastrointestinal Surgery, Department of Surgery, Massachusetts General Hospital, Boston, Massachusetts
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Moghadamyeghaneh Z, Hanna MH, Carmichael JC, Pigazzi A, Stamos MJ, Mills S. Comparison of open, laparoscopic, and robotic approaches for total abdominal colectomy. Surg Endosc 2015; 30:2792-8. [DOI: 10.1007/s00464-015-4552-8] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2015] [Accepted: 09/01/2015] [Indexed: 01/24/2023]
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38
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Kuroyanagi H, Inomata M, Saida Y, Hasegawa S, Funayama Y, Yamamoto S, Sakai Y, Watanabe M. Gastroenterological Surgery: Large intestine. Asian J Endosc Surg 2015; 8:246-62. [PMID: 26303730 DOI: 10.1111/ases.12222] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2015] [Revised: 04/10/2015] [Accepted: 04/10/2015] [Indexed: 01/16/2023]
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39
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Management of the Primary Colorectal Cancer and Synchronous Liver Metastases. CURRENT COLORECTAL CANCER REPORTS 2015. [DOI: 10.1007/s11888-015-0273-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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40
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41
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Xiong B, Ma L, Huang W, Zhao Q, Cheng Y, Liu J. Robotic versus laparoscopic total mesorectal excision for rectal cancer: a meta-analysis of eight studies. J Gastrointest Surg 2015; 19:516-26. [PMID: 25394387 DOI: 10.1007/s11605-014-2697-8] [Citation(s) in RCA: 109] [Impact Index Per Article: 10.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2013] [Accepted: 11/02/2014] [Indexed: 01/31/2023]
Abstract
BACKGROUND Robotic surgery has been used successfully in many branches of surgery, but there is little evidence in the literature on its use in rectal cancer (RC). We conducted this meta-analysis of randomized controlled trials (RCTs) and non-randomized controlled trials (NRCTs) to evaluate whether the safety and efficacy of robotic total mesorectal excision (RTME) in patients with RC are equivalent to those of laparoscopic TME (LTME). METHODS Pubmed, Embase, Cochrane Library, Ovid, and Web of Science databases were searched. Studies clearly documenting a comparison of RTME with LTME for RC were selected. Operative and recovery outcomes, early postoperative morbidity, and oncological parameters were evaluated. RESULTS Eight studies were identified that included 1229 patients in total, 554 (45.08 %) in the RTME group and 675 (54.92 %) in the LTME group. Compared with LTME, RTME was associated with lower conversion rate (OR 0.23, 95 % CI [0.10, 0.52]; P = 0.0004), lower positive rate of circumferential resection margins (CRM) (2.74 % vs 5.78 %, OR 0.44, 95 % CI [0.20, 0.96], P = 0.04), and lesser incidence of erectile dysfunction (ED) (OR 0.09, 95 % CI [0.02, 0.41]; P = 0.002). Operation time, estimated blood loss, recovery outcome, postoperative morbidity and mortality, length of hospital stay, number of lymph nodes harvested, distal resection margin (DRM), proximal resection margin (PRM), and local recurrence had no significant differences between the two groups. CONCLUSIONS RTME is safe and feasible and may be an alternative treatment for RC. More international multicenter prospective large sample RCTs investigating the long-term oncological and functional outcomes are needed to determine the advantages of RTME over LTME in RC.
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Affiliation(s)
- Binghong Xiong
- Department of General Surgery, Peking University Shougang Hospital, No 9 Jinyuanzhuang Road, Shijingshan District, 100144, Beijing, People's Republic of China,
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The impact of laparoscopic converted to open colectomy on short-term and oncologic outcomes for colon cancer. J Gastrointest Surg 2015; 19:335-43. [PMID: 25355006 DOI: 10.1007/s11605-014-2685-z] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2014] [Accepted: 10/16/2014] [Indexed: 01/31/2023]
Abstract
PURPOSE This study was designed to evaluate the impact of laparoscopic converted to open colectomy on short-term and oncologic outcomes and to identify risk factors for long-term survival in patients undergoing colectomy for non-metastatic colon cancer. METHODS A prospective database of consecutive operations for non-metastatic colon cancer was reviewed. Patients were grouped as conversion (CONV) group, completed laparoscopic resection (LAP) group, or open resection (OPEN) group. The clinical and perioperative parameters, pathologic features, and oncologic outcomes were collected. Univariate analysis was performed for comparing these data. Patients without evidence of recurrence at last follow-up or still alive at the end of study period were censored. Kaplan-Meier curves were utilized to analyze survival. A multivariate analysis was performed to identify predictors of poor disease-free survival (DFS) and overall survival (OS). RESULTS The conversion rate was 15.2 %. The most common reason for conversion was locally advanced cancer (45.5 %). Converted patients were associated with a longer operative time (188 ± 29.1 min, P < 0.001), greater blood loss (147 ± 14 mL, P < 0.001), and a higher rate of intra-operative complications (15.2 %, P = 0.042) compared to the completely laparoscopic or open patients. Days to flatus, early ambulation, and length of hospitalization were significantly shorter in completed laparoscopic resection (LAP) group (P < 0.001); however, the outcomes were comparable between conversion (CONV) and open resection (OPEN) groups. The incidence of wound infection was significantly higher in the OPEN group than in the LAP group (P = 0.005), whereas there were no significant differences observed between the CONV group and the OPEN group (P = 1.000) or between the LAP group and the CONV group (P = 0.073). The 5-year DFS in CONV patients (46.5 %) was comparable to LAP patients (55.5 %, P = 0.138) and OPEN patients (59.1 %, P = 0.113). Moreover, there were no significant differences noted in terms of the 5-year OS in the CONV group (56.7 %) compared to the LAP group (67.3 %, P = 0.317) or the OPEN group (66.3 %, P = 0.420). The multivariate analysis showed that pT3-4 cancer (P < 0.001) and poor differentiation (P < 0.001) were independent predictors of both lower OS and lower DFS, whereas leakage (P = 0.008) and lack of adjuvant chemotherapy (P = 0.023) were independent risk factors only of lower DFS. CONCLUSION Conversion to open colectomy from an initial laparoscopic approach does not worsen the long-term survival in patients with non-metastatic colon cancer.
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Parisi A, Desiderio J, Trastulli S, Cirocchi R, Ricci F, Farinacci F, Mangia A, Boselli C, Noya G, Filippini A, D'Andrea V, Santoro A. Robotic rectal resection for cancer: A prospective cohort study to analyze surgical, clinical and oncological outcomes. Int J Surg 2014; 12:1456-61. [DOI: 10.1016/j.ijsu.2014.11.012] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2014] [Revised: 11/09/2014] [Accepted: 11/11/2014] [Indexed: 02/06/2023]
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van Vugt JLA, Reisinger KW, Derikx JPM, Boerma D, Stoot JHMB. Improving the outcomes in oncological colorectal surgery. World J Gastroenterol 2014; 20:12445-12457. [PMID: 25253944 PMCID: PMC4168077 DOI: 10.3748/wjg.v20.i35.12445] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2014] [Revised: 03/18/2014] [Accepted: 06/17/2014] [Indexed: 02/06/2023] Open
Abstract
During the last several decades, colorectal cancer surgery has experienced some major perioperative improvements. Preoperative risk-assessment of nutrition, frailty, and sarcopenia followed by interventions for patient optimization or an adapted surgical strategy, contributed to improved postoperative outcomes. Enhanced recovery programs or fast-track surgery also resulted in reduced length of hospital stay and overall complications without affecting patient safety. After an initially indecisive start due to uncertainty about oncological safety, the most significant improvement in intraoperative care was the introduction of laparoscopy. Laparoscopic surgery for colon and rectal cancer is associated with better short-term outcomes, whereas long-term outcomes regarding survival and recurrence rates are comparable. Nevertheless, long-term results in rectal surgery remain to be seen. Early recognition of anastomotic leakage remains a challenge, though multiple improvements have allowed better management of this complication.
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Mizrahi I, Mazeh H. Role of laparoscopy in rectal cancer: A review. World J Gastroenterol 2014; 20:4900-4907. [PMID: 24803801 PMCID: PMC4009521 DOI: 10.3748/wjg.v20.i17.4900] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2013] [Revised: 12/07/2013] [Accepted: 01/15/2014] [Indexed: 02/06/2023] Open
Abstract
Despite established evidence on the advantages of laparoscopy in colon cancer resection, the use of laparoscopy for rectal cancer resection is still controversial. The initial concern was mainly regarding the feasibility of laparoscopy to achieve an adequate total mesorectal excision specimen. These concerns have been raised following early studies demonstrating higher rates of circumferential margins positivity following laparoscopic resection, as compared to open surgery. Similar to colon resection, patients undergoing laparoscopic rectal cancer resection are expected to benefit from a shorter length of hospital stay, less analgesic requirements, and a faster recovery of bowel function. In the past decade there have been an increasing number of large scale clinical trials investigating the oncological and perioperative outcomes of laparoscopic rectal cancer resection. In this review we summarize the current literature available on laparoscopic rectal cancer surgery.
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Tsukahara T, Yamamoto S, Oshiro T, Fujita S, Sakurai H, Watanabe SI. Simultaneous laparoscopic colorectal resection and pulmonary resection by minithoracotomy: report of four cases. Asian J Endosc Surg 2014; 7:160-4. [PMID: 24754879 DOI: 10.1111/ases.12082] [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: 08/23/2013] [Revised: 11/19/2013] [Accepted: 11/27/2013] [Indexed: 11/26/2022]
Abstract
The aim of the present study was to determine the feasibility of simultaneous resection of colorectal cancer by laparoscopy and a pulmonary lesion through minithoracotomy. Four patients underwent laparoscopic resection of colorectal cancer followed by pulmonary resection. The mean operative duration was 390 min and the mean blood loss was 133 mL. The postoperative course was uneventful. The indication for simultaneous resection of colorectal cancer by the laparoscopic approach and a pulmonary lesion is controversial. This method is safe and feasible in selected patients, but whether colorectal resection or pulmonary surgery is performed first should be determined on a case-by-case basis.
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Affiliation(s)
- Tetsuo Tsukahara
- Division of Colorectal Surgery, National Cancer Center Hospital, Tokyo, Japan
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Vennix S, Pelzers L, Bouvy N, Beets GL, Pierie J, Wiggers T, Breukink S. Laparoscopic versus open total mesorectal excision for rectal cancer. Cochrane Database Syst Rev 2014; 2014:CD005200. [PMID: 24737031 PMCID: PMC10875406 DOI: 10.1002/14651858.cd005200.pub3] [Citation(s) in RCA: 98] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
BACKGROUND Colorectal cancer including rectal cancer is the third most common cause of cancer deaths in the western world. For colon carcinoma, laparoscopic surgery is proven to result in faster postoperative recovery, fewer complications and better cosmetic results with equal oncologic results. These short-term benefits are expected to be similar for laparoscopic rectal cancer surgery. However, the oncological safety of laparoscopic surgery for rectal cancer remained controversial due to the lack of definitive long-term results. Thus, the expected short-term benefits can only be of interest when oncological results are at least equal. OBJECTIVES To evaluate the differences in short- and long-term results after elective laparoscopic total mesorectal excision (LTME) for the resection of rectal cancer compared with open total mesorectal excision (OTME). SEARCH METHODS We searched the Cochrane Central Register of Controlled Trials (CENTRAL, The Cochrane Library 2013, Issue 2), MEDLINE (January 1990 to February 2013), EMBASE (January 1990 to February 2013), ClinicalTrials.gov (February 2013) and Current Controlled Trials (February 2013). We handsearched the reference lists of the included articles for missed studies. SELECTION CRITERIA Only randomised controlled trials (RCTs) comparing LTME and OTME, reporting at least one of our outcome measures, was considered for inclusion. DATA COLLECTION AND ANALYSIS Two authors independently assessed study quality according to the CONSORT statement, and resolved disagreements by discussion. We rated the quality of the evidence using GRADE methods. MAIN RESULTS We identified 45 references out of 953 search results, of which 14 studies met the inclusion criteria involving 3528 rectal cancer patients. We did not consider the risk of bias of the included studies to have impacted on the quality of the evidence. Data were analysed according to an intention-to-treat principle with a mean conversion rate of 14.5% (range 0% to 35%) in the laparoscopic group.There was moderate quality evidence that laparoscopic and open TME had similar effects on five-year disease-free survival (OR 1.02; 95% CI 0.76 to1.38, 4 studies, N = 943). The estimated effects of laparoscopic and open TME on local recurrence and overall survival were similar, although confidence intervals were wide, both with moderate quality evidence (local recurrence: OR 0.89; 95% CI 0.57 to1.39 and overall survival rate: OR 1.15; 95% CI 0.87 to1.52). There was moderate to high quality evidence that the number of resected lymph nodes and surgical margins were similar between the two groups.For the short-term results, length of hospital stay was reduced by two days (95% CI -3.22 to -1.10), moderate quality evidence), and the time to first defecation was shorter in the LTME group (-0.86 days; 95% CI -1.17 to -0.54). There was moderate quality evidence that 30 days morbidity were similar in both groups (OR 0.94; 95% CI 0.8 to 1.1). There were fewer wound infections (OR 0.68; 95% CI 0.50 to 0.93) and fewer bleeding complications (OR 0.30; 95% CI 0.10 to 0.93) in the LTME group.There was no clear evidence of any differences in quality of life after LTME or OTME regarding functional recovery, bladder and sexual function. The costs were higher for LTME with differences up to GBP 2000 for direct costs only. AUTHORS' CONCLUSIONS We have found moderate quality evidence that laparoscopic total mesorectal excision (TME) has similar effects to open TME on long term survival outcomes for the treatment of rectal cancer. The quality of the evidence was downgraded due to imprecision and further research could impact on our confidence in this result. There is moderate quality evidence that it leads to better short-term post-surgical outcomes in terms of recovery for non-locally advanced rectal cancer. Currently results are consistent in showing a similar disease-free survival and overall survival, and for recurrences after at least three years and up to 10 years, although due to imprecision we cannot rule out superiority of either approach. We await long-term data from a number of ongoing and recently completed studies to contribute to a more robust analysis of long-term disease free, overall survival and local recurrence.
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Affiliation(s)
- Sandra Vennix
- Academic Medical CenterDepartment of SurgeryMeibergdreef 9AmsterdamNetherlands1105 AZ
| | - Loeki Pelzers
- Maastricht University Medical CentreDepartment of SurgeryPO Box 5800MaastrichtNetherlands6202 AZ
| | - Nicole Bouvy
- Maastricht University Medical CentreDepartment of SurgeryPO Box 5800MaastrichtNetherlands6202 AZ
| | - Geerard L. Beets
- Maastricht University Medical CentreDepartment of SurgeryPO Box 5800MaastrichtNetherlands6202 AZ
| | - Jean‐Pierre Pierie
- Medical Centre LeeuwardenDepartment of SurgeryH. Dunantweg 2LeeuwardenNetherlands8934 AD
| | - Theo Wiggers
- University Medical Centre GroningenDepartment of Surgical OncologyPostbox 30.001RG GroningenNetherlands9700
| | - Stephanie Breukink
- Maastricht University Medical CentreDepartment of SurgeryPO Box 5800MaastrichtNetherlands6202 AZ
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Emhoff IA, Lee GC, Sylla P. Future directions in surgery for colorectal cancer: the evolving role of transanal endoscopic surgery. COLORECTAL CANCER 2014. [DOI: 10.2217/crc.14.8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
SUMMARY The morbidity associated with radical surgery for rectal cancer has launched a revolution in increasingly less-invasive methods of resection, including a recent resurgence in transanal endoscopic surgical approaches. The next evolution in transanal surgery for rectal cancer is natural orifice translumenal endoscopic surgery (NOTES). To date, 14 series of transanal NOTES total mesorectal excision (TME) for rectal cancer have been published (n = 76). Overall, the intraoperative and postoperative complication rates of 8 and 28%, respectively, compare favorably to those expected from laparoscopic and open TME. Short-term follow-up after NOTES TME has yielded no cancer recurrence in average-risk patients. High-risk patients have cancer recurrence rates similar to those after laparoscopic TME. Overall, these early data support transanal NOTES TME as a safe and viable alternative to conventional TME. Advances in instrumentation, surgical expertise and neoadjuvant treatment may expand current indications for NOTES even further.
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Affiliation(s)
- Isha Ann Emhoff
- Department of Surgery, Division of Gastrointestinal Surgery, Massachusetts General Hospital, 15 Parkman Street, Wang 460, Boston, MA 02114, USA
| | - Grace Clara Lee
- Department of Surgery, Division of Gastrointestinal Surgery, Massachusetts General Hospital, 15 Parkman Street, Wang 460, Boston, MA 02114, USA
| | - Patricia Sylla
- Department of Surgery, Division of Gastrointestinal Surgery, Massachusetts General Hospital, 15 Parkman Street, Wang 460, Boston, MA 02114, USA
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Uptake and outcomes of laparoscopically assisted resection for colon and rectal cancer in Australia: a population-based study. Dis Colon Rectum 2014; 57:415-22. [PMID: 24608296 DOI: 10.1097/dcr.0000000000000060] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
BACKGROUND Meta-analyses of randomized controlled trials support the use of laparoscopically assisted resection for colon cancer. The evidence supporting its use in rectal cancer is weak. OBJECTIVE The purpose of this work was to investigate the uptake of laparoscopically assisted resection for colon and rectal cancer and to compare short- and long-term outcomes using population data. DESIGN This was a retrospective cohort study using linked administrative health data. SETTINGS The study encompassed all of the public and private hospitals in New South Wales, Australia, between 2000 and 2008. PATIENTS A total of 27,947 patients with colon or rectal cancer undergoing surgery with curative intent were included in the study. MAIN OUTCOME MEASURES We summarized the proportion of resections performed laparoscopically. Short-term outcomes were extended stay, 28-day readmission, 28-day emergency readmission, 30- and 90-day mortality, and 90-day readmission with pulmonary embolism or deep-vein thrombosis. Long-term outcomes were all-cause and cancer-specific death and admission with obstruction or incisional hernia repair. RESULTS Laparoscopic procedures increased between 2000 and 2008 for colon (1.5%-20.7%) and rectal cancer (0.6%-15.5%). Laparoscopic procedures reduced rates of extended stay (OR, 0.60; 95% CI, 0.49-0.72) and 28-day readmission (OR, 0.86; 95% CI, 0.74-0.99) for colon cancer. For rectal cancer, laparoscopic procedures had lower rates of 28-day readmission (OR, 0.58; 95% CI, 0.42-0.78) and 28-day emergency readmission (OR, 0.54; 95% CI, 0.34-0.85). Laparoscopic procedures improved cancer-specific survival for rectal cancer (HR, 0.71; 95% CI, 0.51-1.00). Survival benefits were observed for laparoscopically assisted colon resection in higher-caseload hospitals but not lower-caseload hospitals. LIMITATIONS It was not possible to identify laparoscopically assisted resections converted to open procedures because of the claims-based nature of the data. CONCLUSIONS Despite increases in laparoscopically assisted resections for colon and rectal cancer, the majority of resections are still treated by open procedures. Our data suggest that laparoscopic resection reduces the lengths of stay and rates of readmission and may result in improved cancer-specific survival for both colon and rectal resections.
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