Laparoscopic versus open resection for stage II/III rectal cancer in obese patients: A multicenter propensity score-based analysis of short- and long-term outcomes

Breaking Myths: Comparable Outcomes in Lymph Node Analysis Across Surgical Methods

BACKGROUND/OBJECTIVES

Colorectal cancer is the third most common cancer worldwide, making lymph node recovery critical for treatment decisions and prognosis. The relationship between body mass index (BMI) and the number of lymph nodes retrieved during laparoscopic and open surgeries remains controversial. This study aimed to evaluate whether surgical approach and BMI influence lymph node retrieval in colon cancer surgeries.

METHODS

A retrospective analysis was conducted on 560 patients who underwent colon cancer surgery at a single institution between 2018 and 2023. The average number of lymph nodes retrieved during laparoscopic and open procedures was compared. Distribution analysis using violin plots was performed to assess the pattern of lymph node yield between surgical approaches. Additionally, the impact of BMI on lymph node recovery was assessed. All surgeries were performed by a standardized surgical team using consistent fat clearance techniques.

RESULTS

The mean number of lymph nodes retrieved was 15.89 ± 0.84 for laparoscopic surgeries and 15.98 ± 0.50 for open surgeries, with no statistically significant difference (p = 0.9166). The violin plot analysis confirmed overlapping distributions between the two surgical approaches, with no significant difference (p = 0.6270). BMI also showed no significant effect on the number of lymph nodes removed during surgery. The consistency in outcomes was attributed to standardized surgical practices across all cases.

CONCLUSIONS

Laparoscopic and open surgical approaches yield comparable lymph node recovery in colon cancer surgeries, both in terms of mean values and overall distribution patterns, regardless of patient BMI. These findings emphasize the importance of standardized surgical techniques in ensuring reliable outcomes and suggest that both approaches are equally effective in meeting oncological standards for lymph node retrieval.

Impact of depth of body cavity at the upper-right portion of the abdomen on open and laparoscopic liver resection of segment 7

PURPOSE

The impact of body-cavity depth on open (OLR) and laparoscopic liver resection (LLR) of segment 7 remains unclear. Therefore, we investigated the influence of body-cavity depth at the upper-right portion of the abdomen on LLR and OLR of segment 7.

METHODS

In total, 101 patients who underwent segment-7 liver resection over 2010-2023 were included. Body-cavity depth was measured from the abdominal-wall surface to the deepest site on the right side of the liver. Patients were categorized into shallow (< 18.4 cm) and deep (≥ 18.4 cm) populations based on median body-cavity depth. We compared surgical outcomes between OLR and LLR in shallow and deep populations after propensity-score adjustments.

RESULTS

In OLR and LLR groups, 27 and 22 patients in the shallow population, respectively, and 26 and 26 patients were included in the deep population, respectively, were included. The OLR group in the deep population had significantly greater blood loss than the corresponding LLR group (difference: 144 mL, 95% confidence interval (CI): [50, 238], P = 0.004). Other surgical outcomes, including operative time, were similar between groups. In the shallow population, the OLR group had significantly shorter operative time (difference: - 54 mL, 95% CI: [-101, - 6], P = 0.028) and similar blood loss than the LLR group.

CONCLUSIONS

For segment-7 liver resection, LLR is likely favorable for patients with a deep body cavity, with similar operative time and lower blood loss compared to OLR. Body-cavity depth could be a useful indicator for determining the suitable surgical approach for segment-7 liver resection.

Laparoscopic vs. open surgery for rectal cancer in patients with obesity: short-term outcomes and relapse-free survival across age groups

PURPOSE

To investigate the efficacy of laparoscopic surgery for rectal cancer in obese and older patients, who are often characterized by a higher prevalence of comorbidities and physical decline.

METHODS

This large-scale multicenter retrospective cohort study included 524 patients with a body mass index of 25 or higher who underwent either open or laparoscopic surgery for stage II or III rectal cancer between 2009 and 2013. We assessed the short-term outcomes and relapse-free survival by comparing these surgical modalities. The patients were stratified into 404 non-elderly (< 70 years) and 120 elderly (≥ 70 years) patients.

RESULTS

In both patient groups, laparoscopic surgery was associated with a significantly reduced blood loss (non-elderly: 41 vs. 545 ml; elderly: 50 vs. 445 ml) and shorter hospital stays (non-elderly: 10 vs. 19 days; elderly: 15 vs. 20 days) than open surgery. The overall complications and relapse-free survival showed no significant differences between the two surgical techniques in either age group. Additionally, the impact of the laparoscopic procedure on the relapse-free survival remained consistent between the age groups.

CONCLUSION

Laparoscopic surgery offers short-term benefits for patients with obesity and rectal cancer compared to open surgery, regardless of age, without influencing the long-term prognosis.

Comparison of laparoscopic and open surgery for colorectal malignancy in obese patients: a propensity score-weighted cohort study

BACKGROUND

Insufficient evidence exists to ascertain the long-term prognosis in patients with obesity undergoing laparoscopic surgery versus open surgery for colorectal cancer.

METHODS

Employing an institutional database from 2009 to 2019, we assessed individuals with a BMI of greater than or equal to 30 kg/m 2 who underwent surgery for primary stage I-III colorectal adenocarcinoma. The authors used propensity score-weighted analysis to compare short-term and oncologic outcomes between laparoscopic and open surgical approaches.

RESULTS

This study enrolled 473 patients (open vs. laparoscopic surgery: 220 vs. 253; median follow-up period, 60 months). The laparoscopy group showed a significantly longer operative time (252 vs. 212 min), a higher anastomotic-leakage rate (5.14% vs. 0.91%), and a greater proportion of Clavien-Dindo class greater than III complications (5.93% vs. 1.82%). The open group showed a higher wound infection rate (7.27% vs. 3.16%) and a higher readmission rate (6.36% vs. 2.37%). After propensity score weighting, laparoscopy was inferior to open surgery in terms of long-term overall survival (hazard ratio: 1.43), disease-free survival (1.39), and recurrence rate (21.1% vs. 14.5%). In the subgroup analysis, female patients, older individuals, stage III patients, patients with rectal cancer, and those who underwent surgery after 2014 showed inferior long-term outcomes after laparoscopy.

CONCLUSIONS

Laparoscopic colorectal cancer surgery for patients with obesity requires significant caution. Despite good short-term outcomes, this procedure is associated with hidden risks and poor long-term prognoses. In female patients, older individuals, stage III patients, patients with rectal cancer, and those treated in the late surgery era subgroups, caution is advised when performing laparoscopic surgery.

Risk factors for anastomotic leakage after low anterior resection for obese patients with rectal cancer

PURPOSE

We aimed to analyze the risk factors for anastomotic leakage (AL) after low anterior resection (LAR) in obese patients (body mass index [BMI] ≥ 25 kg/m2) with rectal cancer.

METHODS

Data were collected from four hundred two obese patients who underwent LAR for rectal cancer in 51 institutions.

RESULTS

Forty-six (11.4%) patients had clinical AL. The median BMI (27 kg/m2) did not differ between the AL and non-AL groups. In the AL group, comorbid respiratory disease was more common (p = 0.025), and the median tumor size was larger (p = 0.002). The incidence of AL was 11.5% in the open surgery subgroup and 11.4% in the laparoscopic surgery subgroup. Among the patients who underwent open surgery, the AL group showed a male predominance (p = 0.04) in the univariate analysis, but it was not statistically significant in the multivariate analysis. Among the patients who underwent laparoscopic surgery, the AL group included a higher proportion of patients with comorbid respiratory disease (p = 0.003) and larger tumors (p = 0.007).

CONCLUSION

Comorbid respiratory disease and tumor size were risk factors for AL in obese patients with rectal cancer. Careful perioperative respiratory management and appropriate selection of surgical procedures are required for obese rectal cancer patients with respiratory diseases.

Risk factors of bleeding during rectal cancer surgery in obese patients in Japan

BACKGROUND

According to several clinical trials for patients with rectal cancer, laparoscopic surgery significantly reduces intraoperative complications and bleeding compared with laparotomy and demonstrated comparable long-term results. However, obesity is considered one of the risk factors for increased surgical difficulty, including complication rate, prolonged operation time, and bleeding.

METHODS

Patients with clinical pathological stage II/III rectal cancer and a body mass index of ≥25 kg/m2 who underwent laparotomy or laparoscopic surgery between January 2009 and December 2013 at 51 institutions participating in the Japan Society of Laparoscopic Colorectal Surgery were included. These patients were divided into major bleeding (>500 mL) group and minor bleeding (≤500 mL) group. The risk factors of major bleeding were evaluated by univariate and multivariate analyses.

RESULTS

This study included 517 patients, of which 74 (19.9%) experienced major bleeding. Patient characteristics did not significantly differ between the two groups. The major bleeding group had a longer operative time (p < 0.001) and a larger tumor size than the minor bleeding group (p = 0.011). In the univariate analysis, age >65 years, laparotomy, operative time >300 min, and multivisceral resection were significantly associated with intraoperative massive bleeding. In the multivariate analysis, age >65 years (odds ratio [OR], 2.29; 95% confidence interval [CI], 1.13-4.82), laparotomy (OR, 20.82; 95% CI, 11.56-39.75), operative time >300 min (OR, 5.39; 95% CI, 1.67-132), and multivisceral resection (OR, 10.72; 95% CI, 2.47-64.0) showed to be risk factors for massive bleeding.

CONCLUSION

Age >65 years, laparotomy, operative time >300 min, and multivisceral resection were risk factors for massive bleeding during rectal cancer surgery in patients with obesity.

The risk of postoperative complications is higher in stage I-III colorectal cancer patients with previous abdominal surgery: a propensity score matching analysis

PURPOSE

The aim of this study is to investigate whether previous abdominal surgery (PAS) affected stage I-III colorectal cancer (CRC) patients who underwent radical resection.

METHODS

Stage I-III CRC patients who received surgery at a single clinical center from Jan 2014 to Dec 2022 were retrospectively included in this study. Baseline characteristics and short-term outcomes were compared between the PAS group and the non-PAS group. Univariate and multivariate logistic regression analyses were used to find risk factors for overall complications and major complications. A 1:1 ratio propensity score matching (PSM) was used to minimize the selection bias between the two groups. Statistical analysis was performed using SPSS (version 22.0) software.

RESULTS

A total of 5895 stage I-III CRC patients were included according to the inclusion and exclusion criteria. The PAS group had 1336 (22.7%) patients, and the non-PAS group had 4559 (77.3%) patients. After the PSM, there were 1335 patients in each group, and no significant difference was found in all baseline characteristics between the two groups (P > 0.05). After comparing the short-term outcomes, the PAS group had a longer operation time (before PSM, P < 0.01; after PSM, P < 0.01) and more overall complications (before PSM, P = 0.027; after PSM, P = 0.022) whether before or after PSM. In univariate and multivariate logistic regression analyses, PAS was an independent risk factor for overall complications (univariate analysis, P = 0.022; multivariate analysis, P = 0.029) but not for major complications (univariate analysis, P = 0.688).

CONCLUSION

Stage I-III CRC patients with PAS might experience longer operation time and have a higher risk of postoperative overall complications. However, it did not appear to significantly affect the major complications. Surgeons should take steps to improve surgical outcomes for patients with PAS.

Impact of laparoscopic surgery on short-term and long-term outcomes in elderly obese patients with colon cancer

Background

Laparoscopic surgery is reported to be useful in obese or elderly patients with colon cancer, who are at increased risk of postoperative complications because of comorbidities and physical decline. However, its usefulness is less clear in patients who are both elderly and obese and may be at high risk of complications.

Methods

Data for obese patients (body mass index ≥25) who underwent laparoscopic or open surgery for stage II or III colon cancer between January 2009 and December 2013 were collected by the Japan Society of Laparoscopic Colorectal Surgery. Surgical outcomes, postoperative complications, and relapse-free survival (RFS) were compared between patients who underwent open surgery and those who underwent laparoscopic surgery according to whether they were elderly (≥70 y) or nonelderly (<70 y).

Results

Data of 1549 patients (elderly, n = 598; nonelderly, n = 951) satisfied the selection criteria for analysis. Length of stay was shorter and surgical wound infection was less common in elderly obese patients who underwent laparoscopic surgery than in those underwent open surgery. There were no significant between-group differences in overall complications, anastomotic leakage, ileus/small bowel obstruction, or RFS. There were also no significant differences in RFS after laparoscopic surgery according to patient age.

Conclusion

Laparoscopic surgery is safe in elderly obese patients with colon cancer and does not worsen their prognosis. There was no significant difference in the effectiveness of laparoscopic surgery between obese patients who were elderly and those who were nonelderly.