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Min ZY, Zhou J, Zhu ZW, Fa ZZ. Efficacy of laparoscopic radical resection of colorectal cancer in older patients and its effects on inflammatory factors. World J Gastrointest Surg 2025; 17:103065. [DOI: 10.4240/wjgs.v17.i5.103065] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2025] [Revised: 02/27/2025] [Accepted: 03/31/2025] [Indexed: 05/23/2025] Open
Abstract
BACKGROUND Currently, open surgery for colorectal cancer (CRC) exhibits certain therapeutic efficacy; however, it may also hinder postoperative recovery in patients. Therefore, more advanced surgical methods are required to ensure smoother postoperative recovery.
AIM To analyze the efficacy of laparoscopic radical resection of CRC (LRRCC) in treating older patients with CRC and the effect of this procedure on inflammatory factors.
METHODS The study included 104 older patients with CRC admitted from August 2022 to August 2024. Participants undergoing open radical resection of CRC were categorized as the control group (50 patients), whereas those receiving LRRCC were classified as the research group (54 patients). Subsequently, comparative analyses involved data on efficacy, postoperative complications (ileus, incision infection, anastomotic fistula, and pulmonary infection), surgery-related parameters (operation duration and intraoperative bleeding volume), postoperative recovery-related indicators (time to first postoperative passage of flatus and defecation and length of hospital stay), and inflammatory factors (tumor necrosis factor-α, high-sensitivity C-reactive protein, and interleukin-6).
RESULTS Data revealed markedly superior therapeutic efficacy and a lower overall postoperative complication rate in the research group compared to the control group. The research group demonstrated substantially less intraoperative bleeding, less time to first postoperative passage of flatus and defecation, and a shorter length of hospital stay despite a notably longer operation duration compared to the control group. Further, tumor necrosis factor-α, high-sensitivity C-reactive protein, and interleukin-6 levels in the research group were significantly reduced 3 days postoperatively compared to both the preoperative and control group values.
CONCLUSION LRRCC for older patients with CRC exhibited superior therapeutic efficacy compared to open radical resection and significantly suppressed postoperative stress-related inflammatory responses, which merits clinical application and promotion.
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Affiliation(s)
- Zhen-Yu Min
- Department of General Surgery, Wujin Hospital Affiliated to Jiangsu University, Changzhou 213004, Jiangsu Province, China
| | - Jie Zhou
- Department of General Surgery, Wujin Hospital Affiliated to Jiangsu University, Changzhou 213004, Jiangsu Province, China
| | - Zhong-Wei Zhu
- Department of General Surgery, Wujin Hospital Affiliated to Jiangsu University, Changzhou 213004, Jiangsu Province, China
| | - Zhen-Zhong Fa
- Department of General Surgery, Wujin Hospital Affiliated to Jiangsu University, Changzhou 213004, Jiangsu Province, China
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Liu B, Yao C, Li H. Laparoscopic Radical Resection of Colorectal Cancer in the Treatment of Elderly Colorectal Cancer and Its Effect on Gastrointestinal Function. Front Surg 2022; 9:840461. [PMID: 35284487 PMCID: PMC8907596 DOI: 10.3389/fsurg.2022.840461] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2021] [Accepted: 01/06/2022] [Indexed: 12/01/2022] Open
Abstract
Objective To explore the efficacy and safety of laparoscopic radical resection of colorectal cancer in the elderly patients and its impact on gastrointestinal function. Methods A total of 122 elderly patients with colorectal cancer admitted to our hospital from March 2020 to June 2021 were selected as the research subjects, and they were divided into the control group (n = 61) and the observation group (n = 61). The control group was treated with traditional laparotomy, and the observation group was treated with laparoscopic radical resection of colorectal cancer. The clinical data of operation time, incision length, intraoperative bleeding volume, and hospitalization time in the two groups were recorded. Serum motilin (MTL) and gastrin (GAS) levels were measured pre- and post-operatively. The duration of abdominal distension, the time for the abdominal sound to return to normal, the time for the anal exhaust to normal, and the time for normal food intake were recorded after operation. The patients were followed up for 6 months post-operatively, and the complications during follow-up were recorded. Results The total response rate of the observation group (95.08%) was higher than that of the control group (81.97%) (P < 0.05). The operation time, incision length, intraoperative bleeding volume, and hospitalization time of the observation group were lower than those of the control group (P < 0.05). The duration of abdominal distension, the time for bowel sounds to return to normal, the time for the anus to exhaust gas to normal, and the normal eating time in the observation group were all lower than those in the control group (P < 0.05). After surgery, the levels of MTL and GAS in the two groups were lower than those before surgery, and those in the observation group were lower than those in the control group (P < 0.05). The total incidence of complications in the observation group (3.28%) was lower than that in the control group (13.12%) (P < 0.05). Conclusion Laparoscopic radical resection of colorectal cancer in the elderly patients has good effect, short operation time, less trauma, less blood loss during operation, short hospital stay, good recovery of gastrointestinal function, fewer complications, and high safety.
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Affiliation(s)
- Biao Liu
- The Third Department of Surgery, Cangxian Hospital, Cangzhou, China
- *Correspondence: Biao Liu
| | - Chuanhui Yao
- The First Department of Surgery, Cangxian Hospital, Cangzhou, China
| | - Haiying Li
- Department of Medical Affairs, Cangxian Hospital, Cangzhou, China
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Bracale U, Di Nuzzo MM, Bracale UM, Del Guercio L, Panagrosso M, Serra R, Terracciano RM, De Werra C, Corcione F, Peltrini R, Sodo M. Sequential Minimally Invasive Treatment of Concomitant Abdominal Aortic Aneurysm and Colorectal Cancer: A Single-Center Experience. Ann Vasc Surg 2022; 78:226-232. [PMID: 34492315 DOI: 10.1016/j.avsg.2021.07.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2021] [Revised: 07/03/2021] [Accepted: 07/06/2021] [Indexed: 12/19/2022]
Abstract
BACKGROUND The surgical management of concomitant occurrence of abdominal aortic aneurysm (AAA) and colorectal cancer (CRC) is still controversial. Conversely, benefits from a minimally invasive approach are well known concerning the treatment of both AAA and CRC. The aim of this study is to assess safety and feasibility of a sequential 2-staged minimally invasive during the same recovery by endovascular aneurysm repair (EVAR) technique and laparoscopic colorectal resection. METHODS From January 2008 to December 2020, all patients with concomitant AAA and CRC were consecutively treated by EVAR and laparoscopic colorectal resection. Perioperative data were retrospectively collected in order to evaluate short- and long-term outcomes following the sequential 2-staged procedures. RESULTS A total of 24 patients were included. The localization of the aneurysm was infrarenal abdominal aortic in 23 cases and in one case of common iliac artery. EVAR procedure has always been performed first. In 18 patients, a percutaneous access has been used while in 6 patients a surgical access has been adopted. Twelve patients had cancer in the left colon, 9 in the right colon, and 3 patients had rectal cancer. No conversions or intraoperative complications had occurred during laparoscopic surgery. The major complications rate after EVAR and CRC surgery was 8.3% and 12.5%, respectively. The mean interval between EVAR and CRC treatment was 7.8 ± 1 and the mean length of stay was 15.4 ± 3.6. No deaths occurred during hospitalization and between the procedures. Overall mortality was 20.8% with a mean follow-up of 39.41 ± 19.2 months. CONCLUSION Elective sequential 2-staged minimally invasive treatment is a safe and feasible approach with acceptable morbidity and mortality rates and it should be adopted in current clinical practice to manage concomitant AAA and CRC.
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Affiliation(s)
- Umberto Bracale
- Department of Public Health, Minimally Invasive General and Oncological Surgery Unit, University of Naples Federico II, Naples, Italy
| | - Maria Michela Di Nuzzo
- Department of Public Health, Minimally Invasive General and Oncological Surgery Unit, University of Naples Federico II, Naples, Italy
| | - Umberto Marcello Bracale
- Department of Public Health, Vascular Surgery Unit, University of Naples Federico II, Naples, Italy
| | - Luca Del Guercio
- Department of Public Health, Vascular Surgery Unit, University of Naples Federico II, Naples, Italy
| | - Marco Panagrosso
- Department of Public Health, Vascular Surgery Unit, University of Naples Federico II, Naples, Italy
| | - Raffaele Serra
- Department of Medical and Surgical Sciences, University of Catanzaro, Catanzaro, Italy
| | - Rosa Maria Terracciano
- Department of Public Health, Minimally Invasive General and Oncological Surgery Unit, University of Naples Federico II, Naples, Italy
| | - Carlo De Werra
- Department of Public Health, Minimally Invasive General and Oncological Surgery Unit, University of Naples Federico II, Naples, Italy
| | - Francesco Corcione
- Department of Public Health, Minimally Invasive General and Oncological Surgery Unit, University of Naples Federico II, Naples, Italy
| | - Roberto Peltrini
- Department of Public Health, Minimally Invasive General and Oncological Surgery Unit, University of Naples Federico II, Naples, Italy.
| | - Maurizio Sodo
- Department of Public Health, Minimally Invasive General and Oncological Surgery Unit, University of Naples Federico II, Naples, Italy
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Peltrini R, Imperatore N, Carannante F, Cuccurullo D, Capolupo GT, Bracale U, Caricato M, Corcione F. Age and comorbidities do not affect short-term outcomes after laparoscopic rectal cancer resection in elderly patients. A multi-institutional cohort study in 287 patients. Updates Surg 2021; 73:527-537. [PMID: 33586089 PMCID: PMC8005386 DOI: 10.1007/s13304-021-00990-z] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2020] [Accepted: 01/28/2021] [Indexed: 12/13/2022]
Abstract
Postoperative complications and mortality rates after rectal cancer surgery are higher in elderly than in non-elderly patients. The aim of this study is to evaluate whether, like in open surgery, age and comorbidities affect postoperative outcomes limiting the benefits of a laparoscopic approach. Between April 2011 and July 2020, data of 287 patients with rectal cancer submitted to laparoscopic rectal resection from different institutions were collected in an electronic database and were categorized into two groups: < 75 years and ≥ 75 years of age. Perioperative data and short-term outcomes were compared between these groups. Risk factors for postoperative complications were determined on multivariate analysis, including age groups and previous comorbidities as variables. Seventy-seven elderly patients had both higher ASA scores (p < 0.001) and cardiovascular disease rates (p = 0.02) compared with 210 non-elderly patients. There were no significative differences between groups in terms of overall postoperative complications (p = 0.3), number of patients with complications (p = 0.2), length of stay (p = 0.2) and death during hospitalization (p = 0.9). The only independent variables correlated with postoperative morbidity were male gender (OR 2.56; 95% CI 1.53-3.68, p < 0.01) and low-medium localization of the tumor (OR 2.12; 75% CI 1.43-4.21, p < 0.01). Although older people are more frail patients, short-term postoperative outcomes in patients ≥ 75 years of age were similar to those of younger patients after laparoscopic surgery for rectal cancer. Elderly patients benefit from laparoscopic rectal resection as well as non-elderly patient, despite advanced age and comorbidities.
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Affiliation(s)
- Roberto Peltrini
- Department of Public Health, School of Medicine and Surgery, University of Naples Federico II, Via Pansini 5, 80131 Naples, Italy
| | - Nicola Imperatore
- Department of Clinical Medicine and Surgery, University of Naples Federico II, Naples, Italy
- Gastroenterology and Endoscopy Unit, AORN Antonio Cardarelli, Naples, Italy
| | - Filippo Carannante
- Colorectal Surgery Unit, Campus BioMedico University Hospital, Rome, Italy
| | | | | | - Umberto Bracale
- Department of Public Health, School of Medicine and Surgery, University of Naples Federico II, Via Pansini 5, 80131 Naples, Italy
| | - Marco Caricato
- Colorectal Surgery Unit, Campus BioMedico University Hospital, Rome, Italy
| | - Francesco Corcione
- Department of Public Health, School of Medicine and Surgery, University of Naples Federico II, Via Pansini 5, 80131 Naples, Italy
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Peltrini R, Luglio G, Cassese G, Amendola A, Caruso E, Sacco M, Pagano G, Sollazzo V, Tufano A, Giglio MC, Bucci L, Palma GDD. Oncological Outcomes and Quality of Life After Rectal Cancer Surgery. Open Med (Wars) 2019; 14:653-662. [PMID: 31565674 PMCID: PMC6744610 DOI: 10.1515/med-2019-0075] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2019] [Accepted: 07/16/2019] [Indexed: 12/16/2022] Open
Abstract
Surgery for rectal cancer has been completely revolutionized thanks to the adoption of new technologies and up-to-date surgical procedures that have been applied to the traditional milestone represented by Total Mesorectal Excision (TME). The multimodal and multidisciplinary approach, with new technologies increased the patients' life expectancies; nevertheless, they have placed the surgeon in front of newer issues, represented by both oncological outcomes and the patients' need of a less destructive surgery and improved quality of life. In this review we will go through laparoscopic, robotic and transanal TME surgery, to show how the correct choice of the most appropriate technique, together with a deep knowledge of oncological principles and pelvic anatomy, is crucial to pursue an optimal cancer treatment. Novel technologies might also help to decrease the patients' fear of surgery and address important issues such as cosmesis and improved preservation of postoperative functionality.
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Affiliation(s)
- Roberto Peltrini
- Department of Clinical Medicine and Surgery. University of Naples “Federico II”, 80131Naples, Via Pansini 5, Italy
| | - Gaetano Luglio
- Department of Public Health. University of Naples “Federico II”, Naples, Italy
| | - Gianluca Cassese
- Department of Clinical Medicine and Surgery. University of Naples “Federico II”, 80131Naples, Via Pansini 5, Italy
| | - Alfonso Amendola
- Department of Clinical Medicine and Surgery. University of Naples “Federico II”, 80131Naples, Via Pansini 5, Italy
| | - Emanuele Caruso
- Department of Clinical Medicine and Surgery. University of Naples “Federico II”, 80131Naples, Via Pansini 5, Italy
| | - Michele Sacco
- Department of Clinical Medicine and Surgery. University of Naples “Federico II”, 80131Naples, Via Pansini 5, Italy
| | - Gianluca Pagano
- Department of Clinical Medicine and Surgery. University of Naples “Federico II”, 80131Naples, Via Pansini 5, Italy
| | - Viviana Sollazzo
- Department of Clinical Medicine and Surgery. University of Naples “Federico II”, 80131Naples, Via Pansini 5, Italy
| | - Antonio Tufano
- Department of Urology, University of Rome “La Sapienza”, 00161Roma RMItaly
| | - Mariano Cesare Giglio
- Department of Clinical Medicine and Surgery. University of Naples “Federico II”, 80131Naples, Via Pansini 5, Italy
| | - Luigi Bucci
- Department of Public Health. University of Naples “Federico II”, Naples, Italy
| | - Giovanni Domenico De Palma
- Department of Clinical Medicine and Surgery. University of Naples “Federico II”, 80131Naples, Via Pansini 5, Italy
- Center of Excellence for Technical Innovation in Surgery (CEITC). University of Naples Federico II, 80131Naples, Italy
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Port site metastases after minimally invasive resection for colorectal cancer: A retrospective study of 13 patients. Surg Oncol 2019; 29:20-24. [DOI: 10.1016/j.suronc.2019.02.008] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2018] [Revised: 01/10/2019] [Accepted: 02/11/2019] [Indexed: 01/27/2023]
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Lee YF, Albright J, Akram WM, Wu J, Ferraro J, Cleary RK. Unplanned Robotic-Assisted Conversion-to-Open Colorectal Surgery is Associated with Adverse Outcomes. J Gastrointest Surg 2018; 22:1059-1067. [PMID: 29450825 DOI: 10.1007/s11605-018-3706-0] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2018] [Accepted: 01/30/2018] [Indexed: 01/31/2023]
Abstract
BACKGROUND Laparoscopic conversion-to-open colorectal surgery is associated with worse outcomes when compared to operations completed without conversion. Consequences of robotic conversion have not yet been determined. The purpose of this study is to compare short-term outcomes of converted robotic colorectal cases with those that are completed without conversion, as well as with cases done by the open approach. METHODS The ACS-NSQIP database was queried for patients who underwent robotic completed, robotic converted-to-open, and open colorectal resection between 2012 and 2015. Propensity scores were estimated using gradient-boosted machines and converted to weights. Generalized linear models were fit using propensity score-weighted data. RESULTS A total of 25,253 patients met inclusion criteria-21,356 (84.5%) open, 3663 (14.5%) robotic completed, and 234 (0.9%) conversions. Conversion rate was 6.0%. Converted cases had significantly higher 30-day mortality rate, higher complication rate, and longer hospital length of stay than completed cases. Converted patients also had significantly higher rates of the following complications: surgical site infections, cardiac complications, deep venous thrombosis, postoperative ileus, postoperative re-intubation, renal failure, and 30-day reoperation. Compared to the open approach, converted patients had significantly more cardiac complications, postoperative reintubation, and longer operating times with no significant difference in 30-day mortality. CONCLUSIONS Unplanned robotic conversion-to-open is associated with worse outcomes than completed cases and outcomes that more closely resemble traditional open colorectal surgery. Patients should be counseled with regard to minimally invasive conversion rates and outcomes. The continued pursuit of technological advancements that decrease the risk for conversion in minimally invasive colorectal surgery is clearly warranted.
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Affiliation(s)
- Yongjin F Lee
- Colon and Rectal Surgery, St Joseph Mercy Hospital Ann Arbor, 5325 Elliott Dr. Suite #104, Ann Arbor, MI, 48106, USA
| | - Jeremy Albright
- Colon and Rectal Surgery, St Joseph Mercy Hospital Ann Arbor, 5325 Elliott Dr. Suite #104, Ann Arbor, MI, 48106, USA
| | - Warqaa M Akram
- Colon and Rectal Surgery, St Joseph Mercy Hospital Ann Arbor, 5325 Elliott Dr. Suite #104, Ann Arbor, MI, 48106, USA
| | - Juan Wu
- Colon and Rectal Surgery, St Joseph Mercy Hospital Ann Arbor, 5325 Elliott Dr. Suite #104, Ann Arbor, MI, 48106, USA
| | - Jane Ferraro
- Colon and Rectal Surgery, St Joseph Mercy Hospital Ann Arbor, 5325 Elliott Dr. Suite #104, Ann Arbor, MI, 48106, USA
| | - Robert K Cleary
- Colon and Rectal Surgery, St Joseph Mercy Hospital Ann Arbor, 5325 Elliott Dr. Suite #104, Ann Arbor, MI, 48106, USA.
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