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Dietz S, Fritzmann J, Weidlich A, Schaser KD, Weitz J, Kirchberg J. [Treatment strategies for recurrent rectal cancer]. CHIRURGIE (HEIDELBERG, GERMANY) 2024; 95:495-509. [PMID: 38739162 DOI: 10.1007/s00104-024-02087-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 04/02/2024] [Indexed: 05/14/2024]
Abstract
Multimodal treatment approaches with neoadjuvant radiotherapy and chemotherapy followed by oncological and total mesorectal excision (TME) have significantly reduced the recurrence rate even in locally advanced rectal cancer. Nevertheless, up to 10% of patients develop a local relapse. Surgical R0 resection is the only chance of a cure in the treatment of locally recurrent rectal cancer (LRRC). Due to the altered anatomy and physiology of the true pelvis as a result of the pretreatment and operations as well as the localization and extent of the recurrence, the treatment decision is individualized and remains a challenge for the interdisciplinary team. Even locally advanced tumors with involvement of adjacent structures can be treated in designated centers using multimodal treatment concepts with potentially curative intent.
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Affiliation(s)
- Sophia Dietz
- Klinik und Poliklinik für Viszeral‑, Thorax- und Gefäßchirurgie, Universitätsklinikum Carl Gustav Carus an der Technischen Universität Dresden, Fetscherstraße 74, 01307, Dresden, Deutschland
- Nationales Centrum für Tumorerkrankungen Dresden (NCT/UCC): Deutsches Krebsforschungszentrum (DKFZ), Universitätsklinikum Carl Gustav Carus Dresden, Medizinische Fakultät der Technischen Universität Dresden, Helmholtz-Zentrum Dresden-Rossendorf (HZDR), Fetscherstraße 74, 01307, Dresden, Deutschland
| | - Johannes Fritzmann
- Klinik und Poliklinik für Viszeral‑, Thorax- und Gefäßchirurgie, Universitätsklinikum Carl Gustav Carus an der Technischen Universität Dresden, Fetscherstraße 74, 01307, Dresden, Deutschland
- Nationales Centrum für Tumorerkrankungen Dresden (NCT/UCC): Deutsches Krebsforschungszentrum (DKFZ), Universitätsklinikum Carl Gustav Carus Dresden, Medizinische Fakultät der Technischen Universität Dresden, Helmholtz-Zentrum Dresden-Rossendorf (HZDR), Fetscherstraße 74, 01307, Dresden, Deutschland
| | - Anne Weidlich
- Nationales Centrum für Tumorerkrankungen Dresden (NCT/UCC): Deutsches Krebsforschungszentrum (DKFZ), Universitätsklinikum Carl Gustav Carus Dresden, Medizinische Fakultät der Technischen Universität Dresden, Helmholtz-Zentrum Dresden-Rossendorf (HZDR), Fetscherstraße 74, 01307, Dresden, Deutschland
- UniversitätsCentrum für Orthopädie, Unfall- & Plastische Chirurgie, Universitätsklinikum Carl Gustav Carus an der Technischen Universität Dresden, Fetscherstraße 74, 01307, Dresden, Deutschland
| | - Klaus-Dieter Schaser
- Nationales Centrum für Tumorerkrankungen Dresden (NCT/UCC): Deutsches Krebsforschungszentrum (DKFZ), Universitätsklinikum Carl Gustav Carus Dresden, Medizinische Fakultät der Technischen Universität Dresden, Helmholtz-Zentrum Dresden-Rossendorf (HZDR), Fetscherstraße 74, 01307, Dresden, Deutschland
- UniversitätsCentrum für Orthopädie, Unfall- & Plastische Chirurgie, Universitätsklinikum Carl Gustav Carus an der Technischen Universität Dresden, Fetscherstraße 74, 01307, Dresden, Deutschland
| | - Jürgen Weitz
- Klinik und Poliklinik für Viszeral‑, Thorax- und Gefäßchirurgie, Universitätsklinikum Carl Gustav Carus an der Technischen Universität Dresden, Fetscherstraße 74, 01307, Dresden, Deutschland
- Nationales Centrum für Tumorerkrankungen Dresden (NCT/UCC): Deutsches Krebsforschungszentrum (DKFZ), Universitätsklinikum Carl Gustav Carus Dresden, Medizinische Fakultät der Technischen Universität Dresden, Helmholtz-Zentrum Dresden-Rossendorf (HZDR), Fetscherstraße 74, 01307, Dresden, Deutschland
| | - Johanna Kirchberg
- Klinik und Poliklinik für Viszeral‑, Thorax- und Gefäßchirurgie, Universitätsklinikum Carl Gustav Carus an der Technischen Universität Dresden, Fetscherstraße 74, 01307, Dresden, Deutschland.
- Nationales Centrum für Tumorerkrankungen Dresden (NCT/UCC): Deutsches Krebsforschungszentrum (DKFZ), Universitätsklinikum Carl Gustav Carus Dresden, Medizinische Fakultät der Technischen Universität Dresden, Helmholtz-Zentrum Dresden-Rossendorf (HZDR), Fetscherstraße 74, 01307, Dresden, Deutschland.
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Tirelli F, Lorenzon L, Biondi A, Neri I, Santoro G, Persiani R. Conversion rate to open surgery during transanal total mesorectal excision (TaTME) for rectal cancer: a single-center experience. Updates Surg 2024; 76:943-947. [PMID: 38679626 DOI: 10.1007/s13304-024-01844-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2024] [Accepted: 04/08/2024] [Indexed: 05/01/2024]
Abstract
Minimally invasive techniques for rectal cancer have demonstrated considerable advantages in terms of faster recovery and less post-operative complications. However, due to the complex anatomy and a limited surgical field, conversion to open surgery is still sometimes required, with a negative impact on the short-and long-term outcomes. The purpose of this study was to analyse the conversion rate to open abdominal surgery during laparoscopic transanal total mesorectal excision (TaTME) procedures performed at a high-volume Italian referral center. All consecutive TaTME performed for mid-to-low rectal cancer between 2015 and 2023 were reviewed, independently if treated with a primary anastomosis (with/without a diverting ostomy) or an end stoma. All procedures were performed using a standardized approach by the same surgical team. Patients with benign diagnosis that underwent different-from rectal resection procedures and cases pre-operatively scheduled for open surgery were excluded. The primary outcome of interest was the rate of conversion, defined as an un-planned intraoperative switch to open surgery using a midline laparotomy. Secondary aims included the comparison of patients who had a longer vs shorter operative time. Out of 220 patients, 210 were selected. In 187 cases, a primary anastomosis was performed, while 23 patients received a terminal colostomy (1 in the converted group; 22 in the full MIS- TaTME group, 10.6%). A surgical approach modification occurred in two cases, with a conversion rate of 0.95%. Median operative time was 281 min. Reasons for conversions included intra-operative difficulties impairing the mini-invasive procedure without intra-operative complications in one case, and difficulties in the laparoscopic control of an intraoperative bleeding due to a splenic lesion in another patient. Male sex and a higher BMI were found to be statistically significantly associated to longer operative time (respectively: p = 0.001 and p = 0.0025). In a high-volume center, a standardized TaTME is associated to a low conversion rate to open abdominal surgery.
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Affiliation(s)
- Flavio Tirelli
- General Surgery Unit, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Laura Lorenzon
- General Surgery Unit, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Alberto Biondi
- General Surgery Unit, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy.
- Catholic University, Largo Francesco Vito 1, 00168, Rome, Italy.
| | - Ilaria Neri
- General Surgery Unit, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Gloria Santoro
- General Surgery Unit, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Roberto Persiani
- General Surgery Unit, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
- Catholic University, Largo Francesco Vito 1, 00168, Rome, Italy
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Feng Q, Wang SA, Ning B, Xie J, Ding J, Liu S, Ai S, Li F, Wang X, Guan W. Evaluation of the tumor-targeting specific imaging and killing effect of a CEA-targeting nanoparticle in colorectal cancer. Biochem Biophys Res Commun 2024; 719:150084. [PMID: 38733742 DOI: 10.1016/j.bbrc.2024.150084] [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: 03/07/2024] [Revised: 04/23/2024] [Accepted: 05/07/2024] [Indexed: 05/13/2024]
Abstract
INTRODUCTION Colorectal cancer (CRC) is a prevalent digestive malignancy with significant global mortality and morbidity rates. Improving diagnostic capabilities for CRC and investigating novel therapeutic approaches are pressing clinical imperatives. Additionally, carcinoembryonic antigen (CEA) has emerged as a highly promising candidate for both colorectal tumor imaging and treatment. METHODS A novel active CEA-targeting nanoparticle, CEA(Ab)-MSNs-ICG-Pt, was designed and synthesized, which served as a tumor-specific fluorescence agent to help in CRC near-infrared (NIR) fluorescence imaging. In cell studies, CEA(Ab)-MSNs-ICG-Pt exhibited specific targeting to RKO cells through specific antibody-antigen binding of CEA, resulting in distribution both within and around these cells. The tumor-targeting-specific imaging capabilities of the nanoparticle were determined through in vivo fluorescence imaging experiments. Furthermore, the efficacy of the nanoparticle in delivering chemotherapeutics and its killing effect were evaluated both in vitro and in vivo. RESULTS The CEA(Ab)-MSNs-ICG-Pt nanoparticle, designed as a novel targeting agent for carcinoembryonic antigen (CEA), exhibited dual functionality as a targeting fluorescent agent. This CEA-targeting nanoparticle showed exceptional efficacy in eradicating CRC cells in comparison to individual treatment modalities. Furthermore, it exhibits exceptional biosafety and biocompatibility properties. CEA(Ab)-MSNs-ICG-Pt exhibits significant promise due to its ability to selectively target tumors through NIR fluorescence imaging and effectively eradicate CRC cells with minimal adverse effects in both laboratory and in vivo environments. CONCLUSION The favorable characteristics of CEA(Ab)-MSNs-ICG-Pt offer opportunities for its application in chemotherapeutic interventions, tumor-specific NIR fluorescence imaging, and fluorescence-guided surgical procedures.
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Affiliation(s)
- Qingzhao Feng
- Department of General Surgery, Nanjing Drum Tower Hospital Clinical College of Nanjing Medical University, Nanjing, Jiangsu, 210008, China; Department of General Surgery, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing, Jiangsu, 210008, China
| | - Shu-An Wang
- Department of Clinic Nutrition, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing, Jiangsu, 210008, China
| | - Beibei Ning
- Department of Pediatrics, The Second Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu, 210011, China
| | - Jixian Xie
- State Key Laboratory of Materials-Oriented Chemical Engineering, College of Chemical Engineering, Nanjing Tech University, Nanjing, Jiangsu, 211816, China
| | - Jie Ding
- Department of General Surgery, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing, Jiangsu, 210008, China
| | - Song Liu
- Department of General Surgery, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing, Jiangsu, 210008, China
| | - Shichao Ai
- Department of General Surgery, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing, Jiangsu, 210008, China
| | - Fuchao Li
- Department of Gerontology, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing, Jiangsu, 210008,China
| | - Xuerui Wang
- State Key Laboratory of Materials-Oriented Chemical Engineering, College of Chemical Engineering, Nanjing Tech University, Nanjing, Jiangsu, 211816, China.
| | - Wenxian Guan
- Department of General Surgery, Nanjing Drum Tower Hospital Clinical College of Nanjing Medical University, Nanjing, Jiangsu, 210008, China; Department of General Surgery, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing, Jiangsu, 210008, China.
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Gomaa I, Aboelmaaty S, Narasimhan AL, Bhatt H, Day CN, Harmsen WS, Rumer KK, Perry WR, Mathis KL, Larson DW. The Impact of Enhanced Recovery on Long-Term Survival in Rectal Cancer. Ann Surg Oncol 2024; 31:3233-3241. [PMID: 38381207 DOI: 10.1245/s10434-024-14998-3] [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: 11/24/2023] [Accepted: 01/18/2024] [Indexed: 02/22/2024]
Abstract
INTRODUCTION Implementing perioperative interventions such as enhanced recovery pathways (ERPs) has improved short-term outcomes and minimized length of stay. Preliminary evidence suggests that adherence to the enhanced recovery after surgery protocol may also enhance 5-year cancer-specific survival (CSS) in colorectal cancer surgery. This retrospective study presents long-term survival outcomes and disease recurrence from a high-volume, single-center practice. METHODS All patients over 18 years of age diagnosed with rectal adenocarcinoma and undergoing elective minimally invasive surgery (MIS) were retrospectively reviewed between February 2005 and April 2018. Relevant data were extracted from Mayo electronic records and securely stored in a database. Short-term morbidity and long-term oncological outcomes were compared between patients enrolled in ERP and those who received non-enhanced care. RESULTS Overall, 600 rectal cancer patients underwent MIS, of whom 320 (53.3%) were treated according to the ERP and 280 (46.7%) received non-enhanced care. ERP was associated with a decrease in length of stay (3 vs. 5 days; p < 0.001) and less overall complications (34.7 vs. 54.3%; p < 0.001). The ERP group did not show an improvement in overall survival (OS) or disease-free survival (DFS) compared with non-enhanced care on multivariable (non-ERP vs. ERP OS: hazard ratio [HR] 1.268, 95% confidence interval [CI] 0.852-1.887; DFS: HR 1.050, 95% CI 0.674-1.635) analysis. CONCLUSION ERP was found to be associated with a reduction in short-term morbidity, with no impact on long-term oncological outcomes, such as OS, CSS, and DFS.
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Affiliation(s)
- Ibrahim Gomaa
- Division of Colon and Rectal Surgery, Mayo Clinic, Rochester, MN, USA
| | - Sara Aboelmaaty
- Division of Colon and Rectal Surgery, Mayo Clinic, Rochester, MN, USA
| | | | - Himani Bhatt
- Division of Colon and Rectal Surgery, Mayo Clinic, Rochester, MN, USA
| | - Courtney N Day
- Department of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, MN, USA
| | - William S Harmsen
- Department of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, MN, USA
| | - Kristen K Rumer
- Division of Colon and Rectal Surgery, Mayo Clinic, Rochester, MN, USA
| | - William R Perry
- Division of Colon and Rectal Surgery, Mayo Clinic, Rochester, MN, USA
| | - Kellie L Mathis
- Division of Colon and Rectal Surgery, Mayo Clinic, Rochester, MN, USA
| | - David W Larson
- Division of Colon and Rectal Surgery, Mayo Clinic, Rochester, MN, USA.
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Yang H, Zhou L. The urinary and sexual outcomes of robot-assisted versus laparoscopic rectal cancer surgery: a systematic review and meta-analysis. Surg Today 2024; 54:397-406. [PMID: 36943447 DOI: 10.1007/s00595-023-02671-3] [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: 08/10/2022] [Accepted: 01/21/2023] [Indexed: 03/23/2023]
Abstract
To compare the urinary and sexual outcomes between robot-assisted rectal cancer (RC) surgery (RRCS) and laparoscopic RC surgery (LRCS) using a meta-analysis, searches were conducted of the Embase, PubMed, Cochrane Library, CNKI, and Wanfang databases. The International Prostate Symptom Score (IPSS) was the primary outcome. Eleven studies (790 patients with RRCS and 888 with LRCS) were included. The IPSS scores were significantly lower for RRCS than LRCS from baseline to 3 months (weighted mean difference [WMD] = - 1.21, 95% confidence interval [CI]: - 1.8,-0.62, I2 = 89.9%), to 6 months (WMD = - 1.13, 95% CI: - 1.74, - 0.52, I2 = 93.3%), and to 12 months (WMD = - 0.93, 95% CI: - 1.59, - 0.26, I2 = 93.8%). The International Index of Erectile Function (IIEF) scores were significantly higher for RRCS than LRCS from baseline to 3 months (WMD = 3.36, 95% CI: 1.28, 5.44, I2 = 92.7%). The female sexual function index (FSFI) scores were significantly higher for RRCS than LRCS from baseline to 3 months (WMD = 1.31, 95% CI: 0.87, 1.76, I2 = 0), to 6 months (WMD = 2.36, 95% CI: 1.93, 2.79, I2 = 24.3%), and to 12 months (WMD = 1.67, 95% CI: 0.41, 2.93, I2 = 90.9%). RRCS also achieved a better recovery of the urological and sexual function than LRCS for patients with RC. Larger-scale prospective randomized control trials are needed to verify these results.
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Affiliation(s)
- Hua Yang
- Department of General Surgery, China-Japan Friendship Hospital, Beijing, 100029, China
| | - Lei Zhou
- Department of General Surgery, China-Japan Friendship Hospital, Beijing, 100029, China.
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Alkhamis A, Soliman D, Alkandari O, Alrashed A, Alansari M, Alsadder K, Chamkha Z, Souza D, AlShaban B, Alsafran S, Almazeedi S. Outcomes in robotic-assisted compared to laparoscopic-assisted colorectal surgery in a newly established colorectal tertiary center: a retrospective comparative cohort study. J Robot Surg 2024; 18:152. [PMID: 38564083 DOI: 10.1007/s11701-024-01908-8] [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: 01/28/2024] [Accepted: 03/09/2024] [Indexed: 04/04/2024]
Abstract
The robotic platform matches or surpasses laparoscopic surgery in postoperative results. However, limited date and slow adoption are noticed in the middle east. We aimed to report outcomes of robotic and laparoscopic colorectal surgery performed by fellowship-trained robotic colorectal surgeons and compare it to larger more experienced centers. Retrospective review of prospectively collected data between 2021 and 2023 of 107 patients who had robotic-assisted or laparoscopic-assisted colorectal surgery was included in the study. The outcomes were overall morbidity, serious morbidity, mortality, conversion to open, length of hospital stay, and the quality of oncological specimen. Of 107 patients, 57 were in the robotic and 50 were in the laparoscopic surgery groups. Overall, there were no significant differences in overall morbidity (46.8 vs. 53.2%, p = 0.9), serious morbidity (10.5 vs. 8%, p = 0.7), or mortality (0 vs. 4%, p = 0.2). Regarding oncological outcomes, there were no significant difference between the two groups regarding the number of lymph node harvested (17.7 ± 6.9 vs 19.0 ± 9.7, p = 0.5), R0 resections (92.7 vs. 87.1%, p = 0.5), and the rate of complete mesorectal excision (92.7 vs. 71.4%, p = 0.19). The study found that the robotic group had an 86% reduction in conversion rate to open surgery compared to the laparoscopic group, despite including more obese and physically dependent patients (OR = 0.14, 95% CI 0.03-0.7, p = 0.01). Robotic surgery appears to be a safe and effective as laparoscopic surgery in smaller colorectal surgery programs led by fellowship-trained robotic surgeons, with outcomes comparable to those of larger programs.
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Affiliation(s)
- Ahmed Alkhamis
- Department of Surgery, Faculty of Medicine, Health Sciences Center, Kuwait University, State of Kuwait, Kuwait City, Kuwait.
- Colorectal and Robotics Surgery Unit, Department of Surgery, Jaber Al-Ahmed Hospital, State of Kuwait, Kuwait City, Kuwait.
| | - Diaa Soliman
- Colorectal and Robotics Surgery Unit, Department of Surgery, Jaber Al-Ahmed Hospital, State of Kuwait, Kuwait City, Kuwait
- Department of General Surgery, University of Arizona, Tucson, AZ, USA
| | - Omar Alkandari
- Kuwait Institute for Medical Specialization, Ministry of Health, Kuwait City, Kuwait
| | - Ahmad Alrashed
- Colorectal and Robotics Surgery Unit, Department of Surgery, Jaber Al-Ahmed Hospital, State of Kuwait, Kuwait City, Kuwait
| | - Mohammad Alansari
- Colorectal and Robotics Surgery Unit, Department of Surgery, Jaber Al-Ahmed Hospital, State of Kuwait, Kuwait City, Kuwait
| | - Khaled Alsadder
- Colorectal and Robotics Surgery Unit, Department of Surgery, Jaber Al-Ahmed Hospital, State of Kuwait, Kuwait City, Kuwait
| | - Zeinab Chamkha
- Colorectal and Robotics Surgery Unit, Department of Surgery, Jaber Al-Ahmed Hospital, State of Kuwait, Kuwait City, Kuwait
| | - Dante Souza
- Department of Surgery, TriHealth Good Samaritan Hospital, Cincinnati, OH, USA
| | - Bader AlShaban
- Colorectal and Robotics Surgery Unit, Department of Surgery, Jaber Al-Ahmed Hospital, State of Kuwait, Kuwait City, Kuwait
| | - Salman Alsafran
- Department of Surgery, Faculty of Medicine, Health Sciences Center, Kuwait University, State of Kuwait, Kuwait City, Kuwait
- Endocrine Surgery Unit, Department of Surgery, Jaber Al-Ahmed Hospital, State of Kuwait, Kuwait City, Kuwait
| | - Sulaiman Almazeedi
- Colorectal and Robotics Surgery Unit, Department of Surgery, Jaber Al-Ahmed Hospital, State of Kuwait, Kuwait City, Kuwait
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Muhammed SH, Asad NM, Dewana AM, Ahmed BS, Al-Dabbagh A. Surgical and Oncological Outcome of Laparoscopic Resection of Colorectal Cancers: A Single-Center Experience. Cureus 2024; 16:e58849. [PMID: 38784322 PMCID: PMC11115474 DOI: 10.7759/cureus.58849] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/23/2024] [Indexed: 05/25/2024] Open
Abstract
BACKGROUND Laparoscopy is one of the major advances in surgery in the last 30 years and has many benefits. Although laparoscopy was initially used for resection of benign colon lesions, it is now widely used for colorectal cancer resections after strong evidence has confirmed its safety and efficacy. We aim to report both the surgical and oncological outcomes of our first series of laparoscopic colorectal cancer resections. METHODS In 2013, a laparoscopic colorectal resection service was established in northern Iraq at Zheen Hospital, Erbil. Data from all consecutive colorectal cancers were collected. Patients with locally advanced diseases and those who required emergency operations for bowel obstruction or perforation were excluded. We analyzed demographic, operative, postoperative, and histopathological data for all patients who were included in the study. RESULTS A total of 124 patients with colorectal cancers presented to our unit between January 2013 and January 2023. Only 112 patients fulfilled the inclusion criteria and underwent laparoscopic resections. The median age of the patients was 54.5 years. The majority of patients were men (n=62; 55.4%). In 39 patients (35%), the cancer was located in the sigmoid; in 33 patients (29.5%) the cancer was in the rectum. Laparoscopic anterior resection was the most common procedure (n=50; 45%), followed by right hemicolectomy in 17 cases (15.1%). The conversion rate to open surgery was 8% (nine cases). The most common causes of conversion to open surgery were dilated bowel loops and tumour adherence to other structures. The mean operative time was 190 minutes and the mean hospital stay was three days. No complications were reported in 94 patients (84%). Among the complications, wound infection was seen in seven patients (7.8%). There were six anastomotic leaks (6.7%). The mean number of lymph nodes harvested was 13. In 70 patients (62.5%), the lymph node count was ≥12 with a median of 13. The mean distal resection margin was 6 cm and 2.5 cm for colon and rectal resections, respectively. CONCLUSION This study reveals that laparoscopic resection for colorectal cancers is surgically practicable and safe with the benefits of a short hospital stay, adequate resection margins, and adequate lymph node yield.
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Affiliation(s)
- Sarhang H Muhammed
- General Surgery, Hawler Medical University, College of Medicine, Erbil, IRQ
- General Surgery, Rizgary Teaching Hospital, Erbil, IRQ
- General Surgery, Zheen International Hospital, Erbil, IRQ
| | - Neyan M Asad
- General Surgery, Hawler Medical University, College of Medicine, Erbil, IRQ
- General Surgery, Rizgary Teaching Hospital, Erbil, IRQ
- General Surgery, Zheen International Hospital, Erbil, IRQ
| | - Azhy M Dewana
- General Surgery, Hawler Medical University, College of Medicine, Erbil, IRQ
- General Surgery, Rizgary Teaching Hospital, Erbil, IRQ
| | - Baderkhan S Ahmed
- General Surgery, Hawler Medical University, College of Medicine, Erbil, IRQ
- General Surgery, Rizgary Teaching Hospital, Erbil, IRQ
| | - Ali Al-Dabbagh
- General Surgery, Hawler Medical University, College of Medicine, Erbil, IRQ
- General Surgery, Rizgary Teaching Hospital, Erbil, IRQ
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McFeetors C, O'Connell LV, Choy M, Dundon N, Regan M, Joyce M, Meshkat B, Hogan A, Nugent E. Influence of neoadjuvant treatment strategy on perioperative outcomes in locally advanced rectal cancer. Colorectal Dis 2024; 26:684-691. [PMID: 38424706 DOI: 10.1111/codi.16929] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2023] [Revised: 11/20/2023] [Accepted: 12/28/2023] [Indexed: 03/02/2024]
Abstract
AIM Neoadjuvant chemoradiotherapy (nCRT) in locally advanced rectal cancer facilitates tumour downstaging and complete pathological response (pCR). The goal of neoadjuvant systemic chemotherapy (total neoadjuvant chemotherapy, TNT) is to further improve local and systemic control. While some patients forgo surgery, total mesorectal excision (TME) remains the standard of care. While TNT appears to be noninferior to nCRT with respect to short-term oncological outcomes few data exist on perioperative outcomes. Perioperative morbidity including anastomotic leaks is associated with a negative effect on oncological outcomes, probably due to a delay in proceeding to adjuvant therapy. Thus, we aimed to compare conversion rates, rates of sphincter-preserving surgery and anastomosis formation rates in patients undergoing rectal resection after either TNT or standard nCRT. METHODS An institutional colorectal oncology database was searched from January 2018 to July 2023. Inclusion criteria comprised patients with histologically confirmed rectal cancer who had undergone neoadjuvant therapy and TME. Exclusion criteria comprised patients with a noncolorectal primary, those operated on emergently or who had local excision only. Outcomes evaluated included rates of conversion to open, sphincter-preserving surgery, anastomosis formation and anastomotic leak. RESULTS A total of 119 patients were eligible for inclusion (60 with standard nCRT, 59 with TNT). There were no differences in rates of sphincter preservation or primary anastomosis formation between the groups. However, a significant increase in conversion to open (p = 0.03) and anastomotic leak (p = 0.03) was observed in the TNT cohort. CONCLUSION In this series TNT appears to be associated with higher rates of conversion to open surgery and higher anastomotic leak rates. While larger studies will be required to confirm these findings, these factors should be considered alongside oncological benefits when selecting treatment strategies.
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Affiliation(s)
- Carson McFeetors
- Department of Colorectal Surgery, University Hospital Galway, Co. Galway, Ireland
| | - Lauren V O'Connell
- Department of Colorectal Surgery, University Hospital Galway, Co. Galway, Ireland
| | - Megan Choy
- Department of Colorectal Surgery, University Hospital Galway, Co. Galway, Ireland
| | - Niamh Dundon
- Department of Colorectal Surgery, University Hospital Galway, Co. Galway, Ireland
| | - Mark Regan
- Department of Colorectal Surgery, University Hospital Galway, Co. Galway, Ireland
| | - Myles Joyce
- Department of Colorectal Surgery, University Hospital Galway, Co. Galway, Ireland
| | - Babak Meshkat
- Department of Colorectal Surgery, University Hospital Galway, Co. Galway, Ireland
| | - Aisling Hogan
- Department of Colorectal Surgery, University Hospital Galway, Co. Galway, Ireland
| | - Emmeline Nugent
- Department of Colorectal Surgery, University Hospital Galway, Co. Galway, Ireland
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Mori S, Kita Y, Baba K, Tanabe K, Wada M, Yoshino S, Nishida N, Iino S, Setoyama T, Maemura K, Ohtsuka T. A sutureless overlapped anastomosis technique using linear staplers with reinforced bioabsorbable material in robotic right colectomy with intracorporeal anastomosis. Colorectal Dis 2024; 26:754-759. [PMID: 38443753 DOI: 10.1111/codi.16880] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2023] [Accepted: 01/01/2024] [Indexed: 03/07/2024]
Abstract
AIM Creation of an overlapped anastomosis using handsewn sutures for common enterotomy is very popular in robotic right colectomy (RRC) with intracorpareal anastomosis (IA). The aim of this study is to present a simple method for constructing a sutureless overlapped anastomosis using a 60 mm linear stapler with a reinforced bioabsorbable material in RRC with IA. METHOD The distal ileum and proximal colon were put in overlapping positions. Enterotomies were created 2 cm proximal to the ileal stump and 8 cm distal to the colonic stump on the antimesenteric side. Subsequently, a 60 mm linear stapler with a reinforced bioabsorbable material was inserted into each lumen and fired. Finally, the bowel was elevated while holding the bioabsorbable material, and the common enterotomy was grasped with the robotic instrument in the middle and closed using a linear stapler with a reinforced bioabsorbable material. RESULTS This technique was applied to 10 patients with tumours of the caecum, ascending colon, or transverse colon. The median operating time, anastomosis construction time, blood loss, and postoperative stay were 281 min (range 228-459 min), 12 min (range 11-17 min), 10 mL (range 0-110 mL), and 10 days (range 8-15 days), respectively. No adverse intraoperative events were observed. Postoperatively, one patient developed chylous ascites, but there were no other complications. CONCLUSION The simple technique for constructing a sutureless overlapped anastomosis using a 60 mm linear stapler with a reinforced bioabsorbable material in robotic right colectomy with intracorporeal anastomosis appears to be safe and feasible.
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Affiliation(s)
- Shinichiro Mori
- Department of Digestive Surgery, Kagoshima City Hospital, Kagoshima, Japan
| | - Yoshiaki Kita
- Department of Digestive Surgery, Kagoshima City Hospital, Kagoshima, Japan
| | - Kenji Baba
- Department of Digestive Surgery, Graduate School of Medicine, Kagoshima University, Kagoshima, Japan
| | - Kan Tanabe
- Department of Digestive Surgery, Graduate School of Medicine, Kagoshima University, Kagoshima, Japan
| | - Masumi Wada
- Department of Digestive Surgery, Graduate School of Medicine, Kagoshima University, Kagoshima, Japan
| | - Shunichiro Yoshino
- Department of Digestive Surgery, Kagoshima City Hospital, Kagoshima, Japan
| | - Nanako Nishida
- Department of Digestive Surgery, Kagoshima City Hospital, Kagoshima, Japan
| | - Satoshi Iino
- Department of Digestive Surgery, Kagoshima City Hospital, Kagoshima, Japan
| | - Tetsuro Setoyama
- Department of Digestive Surgery, Kagoshima City Hospital, Kagoshima, Japan
| | - Kosei Maemura
- Department of Digestive Surgery, Kagoshima City Hospital, Kagoshima, Japan
| | - Takao Ohtsuka
- Department of Digestive Surgery, Graduate School of Medicine, Kagoshima University, Kagoshima, Japan
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10
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Li Z, Liu H, Luo S, Hou Y, Zhou Y, Zheng X, Zhang X, Huang L, Zeng Z, Kang L. Long-term oncological outcomes of transanal versus laparoscopic total mesorectal excision for mid-low rectal cancer: a retrospective analysis of 2502 patients. Int J Surg 2024; 110:1611-1619. [PMID: 38091943 PMCID: PMC10942237 DOI: 10.1097/js9.0000000000000992] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2023] [Accepted: 11/27/2023] [Indexed: 03/16/2024]
Abstract
BACKGROUND Transanal total mesorectal resection (taTME) has recently emerged as a promising surgical approach for the treatment of mid-low rectal cancer. However, there is limited evidence on the long-term survival outcomes associated with taTME. This retrospective study aimed to compare the overall survival (OS), disease-free survival (DFS), and cancer-specific survival of taTME and laparoscopic TME (laTME) in patients with mid-low rectal cancer. MATERIALS AND METHODS From July 2014 to June 2022, a total of 3627 patients were identified from two prospective cohorts: the laparoscopic rectal surgery cohort and the CNTAES cohort. To balance the baseline characteristics between the taTME and laTME groups, propensity score matching (PSM) was performed. RESULTS A total of 2502 patients were included in the study. Prior to PSM, the laTME group comprised 1853 patients, while the taTME group comprised 649 patients. The 5-year OS (82.9% vs. 80.4%, P =0.202) and 5-year DFS (74.4% vs. 72.5%, P =0.167) were comparable between the taTME and laTME groups. After PSM, the taTME group showed no statistically significant difference in the 5-year OS (83.1% vs. 79.2%, P =0.101) and 5-year DFS (74.8% vs. 72.1%, P =0.135) compared to the laTME group. Subgroup analysis further suggested that taTME may potentially reduce the risk of death [hazard ratio 0.652; (95% CI, 0.452-0.939)] and disease recurrence [hazard ratio 0.736; (95% CI, 0.562-0.965)] specifically in patients with low rectal cancer. CONCLUSION In this study, taTME demonstrated comparable oncologic safety to laTME in patients with mid-low rectal cancer. Moreover, the results indicate that taTME may confer potential survival benefits for patients with low rectal cancer.
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Affiliation(s)
- Ze Li
- Department of General Surgery (Colorectal Surgery)
- Guangdong Provincial Key Laboratory of Colorectal and Pelvic Floor Diseases
- Biomedical Innovation Center, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Huashan Liu
- Department of General Surgery (Colorectal Surgery)
- Guangdong Provincial Key Laboratory of Colorectal and Pelvic Floor Diseases
- Biomedical Innovation Center, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Shuangling Luo
- Department of General Surgery (Colorectal Surgery)
- Guangdong Provincial Key Laboratory of Colorectal and Pelvic Floor Diseases
- Biomedical Innovation Center, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Yujie Hou
- Department of General Surgery (Colorectal Surgery)
- Guangdong Provincial Key Laboratory of Colorectal and Pelvic Floor Diseases
- Biomedical Innovation Center, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Yebohao Zhou
- Department of General Surgery (Colorectal Surgery)
- Guangdong Provincial Key Laboratory of Colorectal and Pelvic Floor Diseases
- Biomedical Innovation Center, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Xiaobin Zheng
- Department of General Surgery (Colorectal Surgery)
- Guangdong Provincial Key Laboratory of Colorectal and Pelvic Floor Diseases
- Biomedical Innovation Center, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Xingwei Zhang
- Department of General Surgery (Colorectal Surgery)
- Guangdong Provincial Key Laboratory of Colorectal and Pelvic Floor Diseases
- Biomedical Innovation Center, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Liang Huang
- Department of General Surgery (Colorectal Surgery)
- Guangdong Provincial Key Laboratory of Colorectal and Pelvic Floor Diseases
- Biomedical Innovation Center, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Ziwei Zeng
- Department of General Surgery (Colorectal Surgery)
- Guangdong Provincial Key Laboratory of Colorectal and Pelvic Floor Diseases
- Biomedical Innovation Center, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
- University Clinic Mannheim, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Liang Kang
- Department of General Surgery (Colorectal Surgery)
- Guangdong Provincial Key Laboratory of Colorectal and Pelvic Floor Diseases
- Biomedical Innovation Center, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
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11
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Keller DS, Reif de Paula T, Ikner TP, Saidi H, Schoonyoung H, H Marks J. Perioperative outcomes for single-port robotic versus single-incision laparoscopic surgery: a comparative analysis in colorectal cancer surgery. Surg Endosc 2024; 38:1568-1575. [PMID: 38177611 DOI: 10.1007/s00464-023-10629-2] [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: 04/01/2023] [Accepted: 11/29/2023] [Indexed: 01/06/2024]
Abstract
BACKGROUND Single-incision laparoscopic surgery (SILS) may offer improved cosmesis, reduced postoperative pain and faster recovery than conventional platforms, but widespread implementation was limited by technical demands. A single-port robotic platform was recently introduced, with components that further enhance SILS benefits without the technical challenges. No study to date has compared the two platforms to validate benefits. Our goal was to compare outcomes of SP robotics and SILS in colorectal cancer (CRC). METHODS A prospective cancer registry was reviewed for CRC patients undergoing curative resection through a SILS or SP robotic approach from 2010 to 2022. Patient and cancer demographics, intraoperative, and postoperative outcomes were compared in a 1:1 propensity score-matched cohort, adjusting for baseline characteristics. The main outcome measures were complications, operative time, and oncologic quality measures. RESULTS Matching resulted 50 SP robotic and 50 SILS patients. Cohorts were well matched in all demographics, but SP robotic rectal cancer cases were significantly closer to the anorectal ring than SILS (1.8 cm vs. 3.4 cm, p = 0.018). SP robotic and SILS platforms had similar operative times. Intraoperative conversions was comparable, but more SILS cases required additional ports to be placed (p = 0.040). The intraoperative complications rate, complete total mesorectal excision rates, and lymph node yield were not statistically significantly different. There were no positive margins in either group. Postoperatively, groups had analogous day of return of bowel function, comparable morbidity, and discharge destination. There was no mortality in either group. The length of stay was significantly shorter with SP robotics than SILS (mean 4.135 vs. 5.282 days, median 4 (2-8) vs. 5 (2-14) days; p = 0.045). CONCLUSIONS Single-port robotics provided high quality oncologic surgery, adding the technical benefits of robotics to clinical and cosmetic benefits of single-port surgery. There were comparable operative time, complication rates, and oncologic outcomes in CRC cases, with shorter hospital stays with SP robotics. This early data is encouraging for expansion SP robotic technology.
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Affiliation(s)
- Deborah S Keller
- Lankenau Institute for Medical Research, Marks Colorectal Surgical Associates, Department of Surgery, Lankenau Medical Center, Wynnewood, PA, 19096, USA
| | - Thais Reif de Paula
- Lankenau Institute for Medical Research, Marks Colorectal Surgical Associates, Department of Surgery, Lankenau Medical Center, Wynnewood, PA, 19096, USA
| | - Taylor P Ikner
- Lankenau Institute for Medical Research, Marks Colorectal Surgical Associates, Department of Surgery, Lankenau Medical Center, Wynnewood, PA, 19096, USA
| | - Hela Saidi
- Lankenau Institute for Medical Research, Marks Colorectal Surgical Associates, Department of Surgery, Lankenau Medical Center, Wynnewood, PA, 19096, USA
| | - Henry Schoonyoung
- Lankenau Institute for Medical Research, Marks Colorectal Surgical Associates, Department of Surgery, Lankenau Medical Center, Wynnewood, PA, 19096, USA
| | - John H Marks
- Lankenau Institute for Medical Research, Marks Colorectal Surgical Associates, Department of Surgery, Lankenau Medical Center, Wynnewood, PA, 19096, USA.
- Department of Surgery, Lankenau Medical Center, Medical Science Building, Suite 375, 100 East Lancaster Avenue, Wynnewood, PA, 19096, USA.
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12
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Xu Z, Bao M, Cai Q, Wang Q, Xing W, Liu Q. Optimization of treatment strategies based on preoperative imaging features and local recurrence areas for locally advanced lower rectal cancer after lateral pelvic lymph node dissection. Front Oncol 2024; 13:1272808. [PMID: 38375201 PMCID: PMC10876287 DOI: 10.3389/fonc.2023.1272808] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2023] [Accepted: 11/20/2023] [Indexed: 02/21/2024] Open
Abstract
Purpose Local recurrence (LR) is the main cause of treatment failure in locally advanced lower rectal cancer (LALRC). This study evaluated the preoperative risk factors for LR in patients with LALRC to improve the therapeutic strategies. Patients and Methods LALRC patients who underwent total mesorectal excision (TME) with lateral pelvic lymph node (LPN) dissection (LPND) from January 2012 to December 2019 were reviewed. The log-rank test was used to assess local recurrence-free survival (LRFS), and multivariate Cox regression was used to identify the prognostic risk factors for LRFS. Follow-up imaging data were used to classify LR according to the location. Results Overall, 376 patients were enrolled, and 8.8% (n=33) of these patients developed LR after surgery. Multivariate analysis identified positive clinical circumferential resection margin (cCRM) as an independent prognostic factor for LRFS (HR: 4.94; 95% CI, 1.75-13.94; P=0.003). The most common sites for LR were the pelvic plexus and internal iliac area (PIA) (54.5%), followed by the central pelvic area (CPA) (39.4%) and obturator area (OA) (6.1%). Following a subgroup analysis, LR in the OA was not associated with positive cCRM. Patients treated with upfront surgery (n=35, 14.1%) had a lower cCRM positive rate when compared with patients treated with neoadjuvant chemoradiotherapy (nCRT) (n=12, 23.5%). However, the LR rate in the nCRT group was still lower (n=28, 36.4%) than that in the upfront surgery group (n=35, 14.%). Among patients with positive cCRM, the LR rate in patients with nCRT remained low (n=3, 10.7%). Conclusion Positive cCRM is an independent risk factor for LR after TME plus LPND in LALRC patients. LPND is effective and adequate for local control within the OA regardless of cCRM status. However, for LALRC patients with positive cCRM, nCRT should be considered before LPND to further reduce LR in the PIA and CPA.
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Affiliation(s)
- Zhao Xu
- Department of General Surgery, Hebei Province Hospital of Chinese Medicine, Affiliated Hospital of Hebei University of Chinese Medicine, Shijiazhuang, China
| | - Mandula Bao
- 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, China
| | - Qiang Cai
- Department of Gastric and Colorectal Surgery, General Surgery Center, The First Hospital of Jilin University, Changchun, China
| | - Qian Wang
- Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
| | - Wei Xing
- Department of General Surgery, Hebei Province Hospital of Chinese Medicine, Affiliated Hospital of Hebei University of Chinese Medicine, Shijiazhuang, China
| | - Qian 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, China
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Bohne A, Grundler E, Knüttel H, Völkel V, Fürst A. Impact of laparoscopic versus open surgery on humoral immunity in patients with colorectal cancer: a systematic review and meta-analysis. Surg Endosc 2024; 38:540-553. [PMID: 38102395 PMCID: PMC10830603 DOI: 10.1007/s00464-023-10582-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2023] [Accepted: 11/04/2023] [Indexed: 12/17/2023]
Abstract
BACKGROUND Laparoscopic surgery (LS) is hypothesized to result in milder proinflammatory reactions due to less severe operative trauma, which may contribute to the observed clinical benefits after LS. However, previous systematic reviews and meta-analyses on the impact of LS on immunocompetence are outdated, limited and heterogeneous. Therefore, the humoral response after laparoscopic and open colorectal cancer (CRC) resections was evaluated in a comprehensive systematic review and meta-analysis. METHODS Included were randomized controlled trials (RCTs) measuring parameters of humoral immunity after LS compared to open surgery (OS) in adult patients with CRC of any stage. MEDLINE, Embase, Web of Science (SCI-EXPANDED), Cochrane Library, Google Scholar, ClinicalTrials.gov and ICTRP (World Health Organization) were systematically searched. Risk of bias (RoB) was assessed using the Cochrane RoB2 tool. Weighted inverse variance meta-analysis of mean differences was performed for C-reactive protein (CRP), interleukin (IL)-6, IL-8, tumour necrosis factor (TNF)α and vascular endothelial growth factor (VEGF) using the random-effects method. Methods were prospectively registered in PROSPERO (CRD42021264324). RESULTS Twenty RCTs with 1131 participants were included. Narrative synthesis and meta-analysis up to 8 days after surgery was performed. Quantitative synthesis found concentrations to be significantly lower after LS at 0-2 h after surgery (IL-8), at 3-9 h (CRP, IL-6, IL-8, TNFα) and at postoperative day 1 (CRP, IL-6, IL-8, VEGF). At 3-9 h, IL-6 was notably lower in the LS group by 86.71 pg/ml (mean difference [MD] - 86.71 pg/ml [- 125.05, - 48.37], p < 0.00001). Combined narratively, 13 studies reported significantly lower concentrations of considered parameters in LS patients, whereas only one study reported lower inflammatory markers (for CRP and IL-6) after OS. CONCLUSION The increase in postoperative concentrations of several proinflammatory parameters was significantly less pronounced after LS than after OS in this meta-analysis. Overall, the summarized evidence reinforces the view of a lower induction of inflammation due to LS.
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Affiliation(s)
- A Bohne
- Universität Regensburg, Universitätsstraße 31, 93053, Regensburg, Germany.
| | - E Grundler
- Universität Regensburg, Universitätsstraße 31, 93053, Regensburg, Germany
| | - H Knüttel
- Universität Regensburg, Universitätsbibliothek Regensburg, Universitätsstraße 31, 93053, Regensburg, Germany
| | - V Völkel
- Tumorzentrum Regensburg - Zentrum für Qualitätssicherung und Versorgungsforschung, Universität Regensburg, Am Biopark 9, 93053, Regensburg, Germany
| | - A Fürst
- Caritas Krankenhaus St. Josef Regensburg, Klinik Für Allgemein-, Viszeral-, Thoraxchirurgie und Adipositasmedizin, Landshuter Str. 65, 93053, Regensburg, Germany
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14
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Kerber KM, Hetjens S, Reißfelder C, Herrle F, Seyfried S. Oncological right hemicolectomy in a trimodal comparison: open surgery versus laparoscopic procedures with extra- and intracorporeal anastomosis technique. Int J Colorectal Dis 2024; 39:14. [PMID: 38168001 PMCID: PMC10761430 DOI: 10.1007/s00384-023-04587-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/21/2023] [Indexed: 01/05/2024]
Abstract
PURPOSE This study aimed to investigate the surgical short- and mid-term outcomes, as well as the impact on quality of life and recovery, following oncological right hemicolectomy. To accomplish this, three patient cohorts were examined, which included laparotomy OA), laparoscopy with intracorporeal anastomosis (LIA), and laparoscopy with extracorporeal anastomosis (LEA). Our hypothesis was that the group undergoing intracorporeal anastomosis would demonstrate superior outcomes compared to the other cohorts. METHODS The analysis included a total of 135 patients who were enrolled between 2015 and 2020. In addition to retrospectively collected data, we conducted follow-up surveys using a validated Gastrointestinal Quality of Life Index (GIQLI) questionnaire and semi-structured interviews. These surveys were conducted between July and September 2021 to gather comprehensive information regarding the patients' quality of life. RESULTS The study cohort was divided into OA (n = 67), LEA (n = 14), and LIA (n = 54). The duration of surgery was significantly longer in the laparoscopic groups (median = 200.5 (LEA) and 184.0 (LIA) min vs 170.0 min (OA); p = 0.007), while the length of hospital stay was significantly shorter (median = 6.0 and 7.0 days vs 9.0 days; p = 0.005). The overall postoperative complication rate was significantly higher in the laparotomy group compared to the intracorporeal group (64.2% vs 35.2%; p = 0.006), with the extracorporeal group having a rate of 42.9%. Reoperation within 30 days occurred exclusively in the open surgery group (n = 9; 13.43%; p = 0.007). The overall response rate to the survey was 75%. Overall, the GIQLI score was comparable among the three groups, and there were no significant differences in the questions related to recovery, regained function, and contentment. CONCLUSION The laparoscopic approaches demonstrated significantly lower complication rates compared to laparotomy, while no significant differences were observed between the two laparoscopic techniques.
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Affiliation(s)
- Kerstin M Kerber
- Department of Surgery, Universitätsmedizin Mannheim, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Svetlana Hetjens
- Department of Medical Statistics and Biomathematics, Medical Faculty Mannheim, University Heidelberg, Mannheim, Germany
| | - Christoph Reißfelder
- Department of Surgery, Universitätsmedizin Mannheim, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Florian Herrle
- Department of Surgery, Universitätsmedizin Mannheim, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Steffen Seyfried
- Department of Surgery, Universitätsmedizin Mannheim, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany.
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15
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Morton AJ, Simpson A, Humes DJ. Regional variations and deprivation are linked to poorer access to laparoscopic and robotic colorectal surgery: a national study in England. Tech Coloproctol 2023; 28:9. [PMID: 38078978 PMCID: PMC10713759 DOI: 10.1007/s10151-023-02874-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2023] [Accepted: 10/18/2023] [Indexed: 12/18/2023]
Abstract
BACKGROUND Laparoscopic and now robotic colorectal surgery has rapidly increased in prevalence; however, little is known about how uptake varies by region and sociodemographics. The aim of this study was to quantify the uptake of minimally invasive colorectal surgery (MIS) over time and variations by region, sociodemographics and ethnicity. METHODS Retrospective analysis of routinely collected healthcare data (Clinical Practice Research Datalink linked to Hospital Episode Statistics) for all adults having elective colorectal resectional surgery in England from 1 January 2006 to 31 March 2020. Sociodemographics between modalities were compared and the association between sociodemographic factors, region and year on MIS was compared in multivariate logistic regression analysis. RESULTS A total of 93,735 patients were included: 52,098 open, 40,622 laparoscopic and 1015 robotic cases. Laparoscopic surgery surpassed open in 2015 but has plateaued; robotic surgery has rapidly increased since 2017, representing 3.2% of cases in 2019. Absolute differences up to 20% in MIS exist between regions, OR 1.77 (95% CI 1.68-1.86) in South Central and OR 0.75 (95% CI 0.72-0.79) in the North West compared to the largest region (West Midlands). MIS was less common in the most compared to least deprived (14.6% of MIS in the most deprived, 24.8% in the least, OR 0.85 95% CI 0.81-0.89), with a greater difference in robotic surgery (13.4% vs 30.5% respectively). Female gender, younger age, less comorbidity, Asian or 'Other/Mixed' ethnicity and cancer indication were all associated with increased MIS. CONCLUSIONS MIS has increased over time, with significant regional and socioeconomic variations. With rapid increases in robotic surgery, national strategies for procurement, implementation, equitable distribution and training must be created to avoid worsening health inequalities.
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Affiliation(s)
- A J Morton
- Department of Colorectal Surgery, Nottingham University Hospitals NHS Trust, Nottingham, UK.
- NIHR Nottingham BRC, University of Nottingham and Nottingham University Hospitals NHS Trust, Nottingham, UK.
| | - A Simpson
- Department of Colorectal Surgery, Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - D J Humes
- Department of Colorectal Surgery, Nottingham University Hospitals NHS Trust, Nottingham, UK
- NIHR Nottingham BRC, University of Nottingham and Nottingham University Hospitals NHS Trust, Nottingham, UK
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16
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Xie F, Lu P, Chen Y, Liu X, Zou Z, Gan J. Laparoscopic radical surgery for locally advanced T4 transverse colon cancer and prognostic factors analysis: Evidence from multi-center databases. Medicine (Baltimore) 2023; 102:e36242. [PMID: 38050292 PMCID: PMC10695505 DOI: 10.1097/md.0000000000036242] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2023] [Accepted: 10/31/2023] [Indexed: 12/06/2023] Open
Abstract
The safety and efficacies of laparoscopic radical procedures are still controversial for locally advanced pathological T4 (pT4) TCC (transverse colon cancer). Therefore, the aim of this study is to evaluate the oncologic and perioperative outcomes and to recognize the prognostic factors in radical resection for pT4 TCC derived from multi-center databases. 314 patients with TCC who underwent radical resection between January 2004 and May 2017, including 139 laparoscopic resections and 175 open resections, were extracted from multicenter databases. Oncological as well as perioperative outcomes were investigated. The baseline characteristics of the 2 groups did not differ significantly. Nevertheless, the laparoscopic technique was found to be linked with a significantly longer duration of surgery (208.96 vs 172.89 minutes, P = .044) and a significantly shorter postoperative hospital stay (12.23 vs 14.48 days, P = .014) when compared to the conventional open approach. In terms of oncological outcomes, lymph node resection (16.10 vs 13.66, P = .886), 5-year overall survival (84.7% vs 82.7%, P = .393), and disease-free survival (82.7% vs 83.9%, P = .803) were similar between the 2 approaches. Based on multivariate analysis, it was determined that differentiation and N classification were both independent prognostic factors for overall survival. However, it was found that only N classification was an independent prognostic factor for disease-free survival. These findings underscore the significance of differentiation and N classification as key determinants of patient outcomes in this context. Overall, the laparoscopic approach may offer advantages in terms of shorter hospital stays, while maintaining comparable oncological outcomes. Laparoscopic radical procedure can gain a couple of short-term benefits without reducing long-term oncological survival for patients with pT4 TCC.
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Affiliation(s)
- Feng Xie
- Department of General Surgery, The Second Affiliated Hospital of Nanchang University, Jiangxi, People’s Republic of China
| | - Pingfan Lu
- Department of General Surgery, The Second Affiliated Hospital of Nanchang University, Jiangxi, People’s Republic of China
| | - Yuming Chen
- Department of General Surgery, The Second Affiliated Hospital of Nanchang University, Jiangxi, People’s Republic of China
| | - Xiangjun Liu
- Department of General Surgery, The Second Affiliated Hospital of Nanchang University, Jiangxi, People’s Republic of China
| | - Zhenhong Zou
- Department of General Surgery, The Second Affiliated Hospital of Nanchang University, Jiangxi, People’s Republic of China
| | - Jinheng Gan
- Department of General Surgery, The Second Affiliated Hospital of Nanchang University, Jiangxi, People’s Republic of China
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Aliyev V, Piozzi GN, Shadmanov N, Guven K, Bakır B, Goksel S, Asoglu O. Robotic and laparoscopic sphincter-saving resections have similar peri-operative, oncological and functional outcomes in female patients with rectal cancer. Updates Surg 2023; 75:2201-2209. [PMID: 37955804 DOI: 10.1007/s13304-023-01686-2] [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: 12/05/2022] [Accepted: 10/25/2023] [Indexed: 11/14/2023]
Abstract
BACKGROUND This study aimed to compare perioperative, long-term oncological, and anorectal functional outcomes of robotic total mesorectal excision (R-TME) and laparoscopic total mesorectal excision (L-TME) sphincter-saving total mesorectal excision in female patients with rectal cancer. METHODS Retrospective analysis of prospectively maintained database was performed. Sixty-eight cases (L-TME, n = 34; R-TME, n = 34) were performed by a single surgeon (January 2014-January 2019). Patient characteristics, perioperative recovery, postoperative complications, pathology results, and oncological outcomes were compared between the two groups. RESULTS Clinical characteristics did not differ between the groups. Mean operating time was longer in R-TME (165.50 ± 95.50 vs. 124.50 ± 82.60 min, p < 0.001). There was no conversion to open surgery in both groups. Mesorectal integrity was complete in both groups (100%). Length of distal and circumferential resection margins (CRM) did not differ between groups. CRM involvement was observed in 1 (2.8%) and 1 (2.8%) in L-TME and R-TME patients, respectively. Incidence of anastomotic leakage was 5.8% (n = 2) in L-TME and 8.8% (n = 3) in R-TME, respectively. Mean length of follow-up was 62.5 (36-102) months for R-TME and 63 (36-103) months for L-TME. Five-year overall survival rates were 92.8% in L-TME and 89.6% in R-TME. Disease-free survival rates were 87.5% in L-TME and 89.6% in R-TME. Local recurrence rates were 3.0% for both groups. Mean Wexner score for L-TME and R-TME patients was: 9.42 ± 8.23 and 9.22 ± 3.64 (p = 0.685), respectively. Daily stool frequency was similar between groups. CONCLUSION Robotic total mesorectal excision (R-TME) and laparoscopic TME (L-TME) have similar perioperative, oncological, and anorectal functional results in female patients with rectal cancer. The robotic approach for rectal cancers in female patients could be not as critical as for male patients.
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Affiliation(s)
- Vusal Aliyev
- Bogazici Academy for Clinical Sciences, Acısu Street, Apart. No 16, 34357/Beşiktaş, Istanbul, Turkey
| | | | - Niyaz Shadmanov
- Bogazici Academy for Clinical Sciences, Acısu Street, Apart. No 16, 34357/Beşiktaş, Istanbul, Turkey
| | - Koray Guven
- Department of Radiology, Mehmet Ali Aydınlar Acibadem University, Istanbul, Turkey
| | - Barıs Bakır
- Department of Radiology, Istanbul Medical Faculty, Istanbul University, Istanbul, Turkey
| | - Suha Goksel
- Department of Pathology, Maslak Acibadem Hospital, Istanbul, Turkey
| | - Oktar Asoglu
- Bogazici Academy for Clinical Sciences, Acısu Street, Apart. No 16, 34357/Beşiktaş, Istanbul, Turkey.
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18
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Pham TD, Larach T, Othman B, Rajkomar A, Heriot AG, Warrier SK, Smart P. Robotic natural orifice specimen extraction surgery (NOSES) for anterior resection. Ann Coloproctol 2023; 39:526-530. [PMID: 38109927 PMCID: PMC10781600 DOI: 10.3393/ac.2022.00458.0065] [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: 06/23/2022] [Revised: 03/05/2023] [Accepted: 03/12/2023] [Indexed: 12/20/2023] Open
Abstract
Minimally invasive colorectal surgery is currently well-accepted, with open techniques being reserved for very difficult cases. Laparoscopic colectomy has been proven to have lower mortality, complication, and ostomy rates; a shorter median length of stay; and lower overall costs when compared to its open counterpart. This trend is seen in both benign and malignant indications. Natural orifice specimen extraction surgery (NOSES) in colorectal surgery was first described in the early 1990s. Three recent meta-analyses comparing transabdominal extraction against NOSES concluded that NOSES was superior in terms of overall postoperative complications, recovery of gastrointestinal function, postoperative pain, aesthetics, and hospital stay. However, NOSES was associated with a longer operative time. Herein, we present our technique of robotic NOSES anterior resection using the da Vinci Xi platform in diverticular disease and sigmoid colon cancers.
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Affiliation(s)
- Toan Duc Pham
- Department of Surgery, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
- Department of Cancer Research, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
- General Surgery and Gastroenterology Clinical Institute, Epworth HealthCare, Melbourne, Victoria, Australia
- Sir Peter MacCallum Department of Oncology, University of Melbourne, Melbourne, Victoria, Australia
| | - Tomas Larach
- Department of Surgery, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
| | - Bushra Othman
- General Surgery and Gastroenterology Clinical Institute, Epworth HealthCare, Melbourne, Victoria, Australia
| | - Amrish Rajkomar
- General Surgery and Gastroenterology Clinical Institute, Epworth HealthCare, Melbourne, Victoria, Australia
| | - Alexander G. Heriot
- Department of Surgery, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
- Department of Cancer Research, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
- General Surgery and Gastroenterology Clinical Institute, Epworth HealthCare, Melbourne, Victoria, Australia
- Sir Peter MacCallum Department of Oncology, University of Melbourne, Melbourne, Victoria, Australia
| | - Satish K. Warrier
- Department of Surgery, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
- General Surgery and Gastroenterology Clinical Institute, Epworth HealthCare, Melbourne, Victoria, Australia
- Sir Peter MacCallum Department of Oncology, University of Melbourne, Melbourne, Victoria, Australia
- Department of Surgery, Monash University, Melbourne, Victoria, Australia
| | - Philip Smart
- General Surgery and Gastroenterology Clinical Institute, Epworth HealthCare, Melbourne, Victoria, Australia
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19
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Marks JH, Yang J, Spitz EM, Salem J, Agarwal S, de Paula TR, Schoonyoung HP, Keller DS. A prospective phase II clinical trial/IDEAL Stage 2a series of single-port robotic colorectal surgery for abdominal and transanal cases. Colorectal Dis 2023; 25:2335-2345. [PMID: 37907449 DOI: 10.1111/codi.16788] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2023] [Revised: 08/30/2023] [Accepted: 09/17/2023] [Indexed: 11/02/2023]
Abstract
AIM Slow laparoscopy adoption accelerated the uptake of robotic surgery. However, the current robotic platforms have limitations in transanal applications and multiple port sites. The da Vinci single-port (SP) robot is currently used on trial for colorectal surgery, and broad assessment of outcomes is needed. We aimed to report findings of a phase II clinical trial of SP robotic colorectal surgery. METHODS A sequentially reported prospective case series was performed on patients using SP robotics at a tertiary referral centre from 1 October 2018 to 31 August 2021. Cases were stratified into abdominal and transanal cohorts. Demographics, intra-operative variables and 30-day postoperative outcomes were evaluated. Univariate analysis was performed, with statistical process control for the docking process. Main outcomes were conversion rates, morbidity, mortality and point of standardization of docking. RESULTS In all, 133 patients were included: 93 (69.92%) abdominal and 40 (30.08%) transanal. The main diagnosis was rectal cancer (n = 59) and the procedure performed a robotic transanal abdominal transanal radical proctosigmoidectomy (n = 30). There were no conversions to open surgery. Two abdominal (2.15%) and three transanal cases (7.50%) were converted to laparoscopy. All colorectal adenocarcinomas had negative margins, proper lymph node harvest and complete mesorectal excision, as appropriate. Docking became a standardized process at cases 34 (abdominal) and 23 (anorectal). After surgery, bowel function returned on mean day 2 (abdominal) and 1 (transanal). The morbidity rate was 15.05% (abdominal) and 27.50% (transanal). There were two major morbidities in each cohort. Overall, there were three (2.65%) readmissions, one reoperation and no mortality. CONCLUSIONS Single-port robotics is feasible for all types of colorectal procedures, with good clinical and oncological outcomes. With this development in colorectal surgery, further studies can develop best practices with this novel technology.
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Affiliation(s)
- John H Marks
- Lankenau Institute for Medical Research and Division of Colon and Rectal Surgery, Department of Surgery, Lankenau Medical Center, Wynnewood, Pennsylvania, USA
| | - Jane Yang
- Division of Colon and Rectal Surgery, Department of Surgery, Lankenau Medical Center, Wynnewood, Pennsylvania, USA
| | - Elizabeth M Spitz
- Lankenau Institute for Medical Research, Lankenau Medical Center, Wynnewood, Pennsylvania, USA
| | - Jean Salem
- Department of Surgery, Saline Health System, Benton, Arkansas, USA
| | - Samir Agarwal
- Department of Surgery, Physician First Group, Sarasota Memorial Health Care System, Sarasota, Florida, USA
| | - Thais Reif de Paula
- Lankenau Institute for Medical Research, Lankenau Medical Center, Wynnewood, Pennsylvania, USA
| | - Henry P Schoonyoung
- Lankenau Institute for Medical Research and Division of Colon and Rectal Surgery, Department of Surgery, Lankenau Medical Center, Wynnewood, Pennsylvania, USA
| | - Deborah S Keller
- Lankenau Institute for Medical Research and Division of Colon and Rectal Surgery, Department of Surgery, Lankenau Medical Center, Wynnewood, Pennsylvania, USA
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20
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Vaghiri S, Prassas D, Krieg S, Knoefel WT, Krieg A. Intracorporeal Versus Extracorporeal Colo-colic Anastomosis in Minimally-invasive Left Colectomy: a Systematic Review and Meta-analysis. J Gastrointest Surg 2023; 27:3024-3037. [PMID: 37698813 PMCID: PMC10837220 DOI: 10.1007/s11605-023-05827-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Accepted: 08/26/2023] [Indexed: 09/13/2023]
Abstract
PURPOSE The primary aim was to investigate the operative outcomes of intracorporeal (IA) and extracorporeal (EA) anastomosis in left-sided minimally-invasive colectomy. METHODS A comprehensive literature search was conducted for studies comparing operative outcomes and follow-up data of IA versus EA in minimally-invasive left colectomy. Studies that investigated recto-sigmoid resections using transanal circular staplers were excluded. Data from eligible studies were extracted, qualitatively assessed, and included in a meta-analysis. Odds ratios (ORs) and mean differences with 95 per cent confidence intervals were calculated. RESULTS Eight studies with a total of 750 patients were included (IA n = 335 versus EA n = 415). IA was associated with significantly lower overall morbidity (OR 0.40, 95% CI 0.26-0.61, p < 0.0001) and less frequent surgical site infection (SSI) (OR 0.27, 95% CI 0.12-0.61, p = 0.002) as primary outcomes compared to EA. Of the secondary outcomes, length of incision (SMD -2.51, 95% CI -4.21 to -0.81, p = 0.004), time to first oral diet intake (SMD -0.49, 95% CI -0.76 to -0.22, p = 0. 0004) and time to first bowel movement (SMD -0.40, 95% CI -0.71 to -0.09, p = 0.01) were significantly in favor of IA, while operative time was significantly shorter in the EA group (SMD 0.36, 95% CI 0.14-0.59, p = 0.001). CONCLUSIONS IA proves to be a safe and feasible option as it demonstrates benefits in terms of lower overall morbidity, fewer rates of SSI, smaller incision length, and faster postoperative gastrointestinal recovery despite a longer operative time compared to EA.
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Affiliation(s)
- Sascha Vaghiri
- Department of Surgery (A), Heinrich-Heine-University and University Hospital Duesseldorf, Moorenstr. 5, Bldg. 12.46, 40225, Duesseldorf, Germany
| | - Dimitrios Prassas
- Department of Surgery (A), Heinrich-Heine-University and University Hospital Duesseldorf, Moorenstr. 5, Bldg. 12.46, 40225, Duesseldorf, Germany
| | - Sarah Krieg
- Clinic for Gastroenterology, Hepatology and Infectious Diseases, Heinrich-Heine-University and University Hospital Duesseldorf, Duesseldorf, Germany
| | - Wolfram Trudo Knoefel
- Department of Surgery (A), Heinrich-Heine-University and University Hospital Duesseldorf, Moorenstr. 5, Bldg. 12.46, 40225, Duesseldorf, Germany
| | - Andreas Krieg
- Department of Surgery (A), Heinrich-Heine-University and University Hospital Duesseldorf, Moorenstr. 5, Bldg. 12.46, 40225, Duesseldorf, Germany.
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21
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Wu M, Wang H, Zhang X, Shi J, Lan X, Mou T, Wang Y. Short-term and long-term outcomes of single-incision plus one-port laparoscopic surgery for colorectal cancer: a propensity-matched cohort study with conventional laparoscopic surgery. BMC Gastroenterol 2023; 23:420. [PMID: 38030976 PMCID: PMC10687908 DOI: 10.1186/s12876-023-03058-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2023] [Accepted: 11/22/2023] [Indexed: 12/01/2023] Open
Abstract
BACKGROUND Single-incision plus one-port laparoscopic surgery (SILS + 1) has been demonstrated to be minimally invasive while possessing better cosmesis and less pain compared with conventional laparoscopic surgery (CLS). However, SILS + 1 as an alternative to CLS for colorectal cancer is still controversial. METHODS A total of 1071 patients who underwent curative laparoscopic surgery for colon cancer between 2015 and 2018 were included. Of these patients, 258 SILS + 1 cases and 516 CLS cases were analyzed using propensity score matching. The baseline characteristics, surgical outcomes, pathologic findings and recovery course, morbidity and mortality within postoperative 30 days and 3-year disease-free and overall survival were compared. RESULTS Baseline characteristics were balanced between the groups. The mean operating time was significantly shorter in SILS + 1 group, with less estimated blood loss. Tumor size, tumor differentiation, number of harvested lymph nodes, resection margin and pathologic T, N, TNM stage was similar between the groups. There was no significant difference in overall perioperative complications. Uni- and multivariate analyses revealed that SILS + 1 was not a risk factor for complications. Postoperatively, SILS + 1 group showed faster recovery than CLS group in terms of ambulation, bowel function, oral intake and discharge. The 3-year disease-free survival rates of SILS + 1 and CLS groups were 90.1% and 87.3%(p = 0.59), respectively and the 3-year overall survival rates were 93.3% vs. 89.8%(p = 0.172). DISCUSSION Our study revealed that SILS + 1 is safe, feasible, oncologically efficient, and may be considered as a surgical option for selected patients with colorectal cancer.
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Affiliation(s)
- Mingyi Wu
- Department of General Surgery & Guangdong Provincial Key Laboratory of Precision Medicine for Gastrointestinal Cancer, Nanfang Hospital, Southern Medical University, 1838, North Guangzhou Avenue, Guangzhou, 510515, China
| | - Hao Wang
- First Department of Gastrointestinal Surgery, Hainan General Hospital, Hainan Affiliated Hospital of Hainan Medical University, Haikou, 570311, China
| | - Xuehua Zhang
- Department of General Surgery & Guangdong Provincial Key Laboratory of Precision Medicine for Gastrointestinal Cancer, Nanfang Hospital, Southern Medical University, 1838, North Guangzhou Avenue, Guangzhou, 510515, China
| | - Jiaolong Shi
- Department of General Surgery & Guangdong Provincial Key Laboratory of Precision Medicine for Gastrointestinal Cancer, Nanfang Hospital, Southern Medical University, 1838, North Guangzhou Avenue, Guangzhou, 510515, China
| | - Xiaoliang Lan
- Department of General Surgery & Guangdong Provincial Key Laboratory of Precision Medicine for Gastrointestinal Cancer, Nanfang Hospital, Southern Medical University, 1838, North Guangzhou Avenue, Guangzhou, 510515, China
| | - Tingyu Mou
- Department of General Surgery & Guangdong Provincial Key Laboratory of Precision Medicine for Gastrointestinal Cancer, Nanfang Hospital, Southern Medical University, 1838, North Guangzhou Avenue, Guangzhou, 510515, China.
| | - Yanan Wang
- Department of General Surgery & Guangdong Provincial Key Laboratory of Precision Medicine for Gastrointestinal Cancer, Nanfang Hospital, Southern Medical University, 1838, North Guangzhou Avenue, Guangzhou, 510515, China.
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22
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Huang Z, Huang S, Huang Y, Luo R, Liang W. Comparison of robotic-assisted versus conventional laparoscopic surgery in colorectal cancer resection: a systemic review and meta-analysis of randomized controlled trials. Front Oncol 2023; 13:1273378. [PMID: 37965455 PMCID: PMC10641393 DOI: 10.3389/fonc.2023.1273378] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2023] [Accepted: 09/25/2023] [Indexed: 11/16/2023] Open
Abstract
Introduction There is still controversy on whether or not robot-assisted colorectal surgery (RACS) have advantages over laparoscopic-assisted colorectal surgery(LACS). Materials and methods The four databases (PubMed, Embase, Web of Science and Cochrane Library)were comprehensively searched for randomized controlled trials (RCTs) comparing the outcomes of RACS and LACS in the treatment of colorectal cancer from inception to 22 July 2023. Results Eleven RCTs were considered eligible for the meta-analysis. Compared with LACS,RACS has significantly longer operation time(MD=5.19,95%CI: 18.00,39.82, P<0.00001), but shorter hospital stay(MD=2.97,95%CI:-1.60,-0.33,P = 0.003),lower conversion rate(RR=3.62,95%CI:0.40,0.76,P = 0.0003), lower complication rate(RR=3.31,95%CI:0.64,0.89,P=0.0009),fewer blood loss(MD=2.71,95%CI:-33.24,-5.35,P = 0.007),lower reoperation rate(RR=2.12, 95%CI:0.33,0.96,P=0.03)and longer distal resection margin(MD=2.16, 95%CI:0.04,0.94, P = 0.03). There was no significantly difference in harvested lymph nodes, the time of first flatus, the time of first defecation,the time of first resume diet, proximal resection margin, readmission rates, mortalities and CRM+ rates between two group. Conclusions Our study indicated that RACS is a feasible and safe technique that can achieve better surgical efficacy compared with LACS in terms of short-term outcomes. Systematic review registration https://www.crd.york.ac.uk/prospero/, identifier CRD42023447088.
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Affiliation(s)
- Zhilong Huang
- The First Affiliated Hospital of Guangxi University of Science and Technology, Guangxi University of Science and Technology, Liuzhou, Guangxi, China
| | - Shibo Huang
- The First Affiliated Hospital of Guangxi University of Science and Technology, Guangxi University of Science and Technology, Liuzhou, Guangxi, China
| | - Yanping Huang
- The First Affiliated Hospital of Guangxi University of Science and Technology, Guangxi University of Science and Technology, Liuzhou, Guangxi, China
| | - Raoshan Luo
- The First Affiliated Hospital of Guangxi University of Science and Technology, Guangxi University of Science and Technology, Liuzhou, Guangxi, China
| | - Weiming Liang
- The First Affiliated Hospital of Guangxi University of Science and Technology, Guangxi University of Science and Technology, Liuzhou, Guangxi, China
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23
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Myrseth E, Gjessing PF, Nymo LS, Kørner H, Kvaløy JT, Norderval S. Laparoscopic rectal cancer resection yields comparable clinical and oncological results with shorter hospital stay compared to open access: a 5-year national cohort. Int J Colorectal Dis 2023; 38:247. [PMID: 37792088 PMCID: PMC10550871 DOI: 10.1007/s00384-023-04529-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/08/2023] [Indexed: 10/05/2023]
Abstract
PURPOSE Although widely applied, the results following laparoscopic rectal resection (LRR) compared to open rectal resection (ORR) are still debated. The aim of this study was to assess clinical short- and long-term results as well as oncological resection quality following LRR or ORR for cancer in a 5-year national cohort. METHODS Data from the Norwegian Registry for Gastrointestinal Surgery and the Norwegian Colorectal Cancer Registry were retrieved from January 2014 to December 2018 for patients who underwent elective resection for rectal cancer. Primary end point was 5-year overall survival. Secondary end points were local recurrence rates within 5 years, oncological resection quality, and short-term outcome measures. RESULTS A total of 1796 patients were included, of whom 1284 had undergone LRR and 512 ORR. There was no difference in 5-year survival rates between the groups after adjusting for relevant covariates with Cox regression analyses. Crude 5-year survival was 77.1% following LRR compared to 74.8% following ORR (p = 0.015). The 5-year local recurrence rates were 3.1% following LRR and 4.1% following ORR (p = 0.249). Length of hospital stay was median 8.0 days (quartiles 7.0-13.0) after ORR compared to 6.0 (quartiles 4.0-8.0) days after LRR. After adjusting for relevant covariates, estimated additional length of stay after ORR was 3.1 days (p < 0.001, 95% CI 2.3-3.9). Rates of positive resection margins and number of harvested lymph nodes were similar. There were no other significant differences in short-term outcomes between the groups. CONCLUSION LRR was performed with clinical and oncological outcomes similar to ORR, but with shorter hospital stay.
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Affiliation(s)
- Elisabeth Myrseth
- Department of Gastrointestinal Surgery, University Hospital of North Norway, 9019, Tromsø, Norway.
- Institute of Clinical Medicine, Faculty of Health Science, UiT, The Arctic University of Norway, 9019, Tromsø, Norway.
| | - Petter Fosse Gjessing
- Department of Gastrointestinal Surgery, University Hospital of North Norway, 9019, Tromsø, Norway
- Institute of Clinical Medicine, Faculty of Health Science, UiT, The Arctic University of Norway, 9019, Tromsø, Norway
| | - Linn Såve Nymo
- Department of Gastrointestinal Surgery, University Hospital of North Norway, 9019, Tromsø, Norway
- Institute of Clinical Medicine, Faculty of Health Science, UiT, The Arctic University of Norway, 9019, Tromsø, Norway
| | - Hartwig Kørner
- Department of Gastrointestinal Surgery, Stavanger University Hospital, 4068, Stavanger, Norway
- Institute of Clinical Medicine, University of Bergen, 5020, Bergen, Norway
| | - Jan Terje Kvaløy
- Department of Mathematics and Physics, University of Stavanger, 4036, Stavanger, Norway
- Department of Research, Stavanger University Hospital, 4068, Stavanger, Norway
| | - Stig Norderval
- Department of Gastrointestinal Surgery, University Hospital of North Norway, 9019, Tromsø, Norway
- Institute of Clinical Medicine, Faculty of Health Science, UiT, The Arctic University of Norway, 9019, Tromsø, Norway
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24
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Yuval JB, Thompson HM, Verheij FS, Fiasconaro M, Patil S, Widmar M, Wei IH, Pappou EP, Smith JJ, Nash GM, Weiser MR, Paty PB, Garcia-Aguilar J. Comparison of Robotic, Laparoscopic, and Open Resections of Nonmetastatic Colon Cancer. Dis Colon Rectum 2023; 66:1347-1358. [PMID: 36649145 PMCID: PMC10369538 DOI: 10.1097/dcr.0000000000002637] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
BACKGROUND Laparoscopic resection for colon cancer has not been associated with improvements in oncological outcomes in comparison to open resection. Robotic resections are associated with increased lymph node yield and radicality of mesenteric resection in patients with right-sided tumors. It is unclear whether lymph node yield is higher in robotic resections in other parts of the colon and whether higher lymph node yield is associated with improved survival. OBJECTIVE To compare survival rates between robotic, laparoscopic, and open resections in a large cohort of patients with nonmetastatic colon cancer. DESIGN This is a retrospective observational study. SETTING A single comprehensive cancer center. PATIENTS Patients who underwent resection of nonmetastatic primary colon cancer between January 2006 and December 2018. MAIN OUTCOME MEASURES Univariable and multivariable models were used to identify predictors of disease-free and overall survival. Lymph node yield and perioperative outcomes were compared between operative approaches. RESULTS There were 2398 patients who met the inclusion criteria: 699 (29%) underwent open, 824 (34%) underwent laparoscopic, and 875 (36%) underwent robotic resection. The median follow-up was 3.8 years (45.4 months). Robotic surgery was associated with higher lymph node yield and radicality of mesenteric resection. On multivariable analysis, the surgical approach was not associated with a difference in disease-free or overall survival. Minimally invasive colectomy was associated with fewer complications and shorter length of stay in comparison to open surgery. In a direct comparison between the 2 minimally invasive approaches, robotic colectomy was associated with fewer complications, shorter length of stay, and lower conversion rate than laparoscopy. LIMITATIONS This was a single-center retrospective study. CONCLUSIONS Our data indicate that the 3 surgical approaches are similarly effective in treating primary resectable colon cancer and that differences in outcomes are observed primarily in the early postoperative period. See Video Abstract at http://links.lww.com/DCR/C115 . COMPARACIN DE RESECCIONES ROBTICAS, LAPAROSCPICAS Y ABIERTAS DE CNCER DE COLON NO METASTSICO ANTECEDENTES:La resección laparoscópica para el cáncer de colon no se ha asociado con mejoras en los resultados oncológicos en comparación con la resección abierta. Las resecciones robóticas se asocian con un mayor rendimiento de los ganglios linfáticos y la radicalidad de la resección mesentérica en pacientes con tumores del lado derecho. No está claro si la cosecha ganglionar es mayor en las resecciones robóticas en otras partes del colon y si un mayor rendimiento de los ganglios linfáticos se asocia con una mejor supervivencia.OBJETIVO:Comparar las tasas de supervivencia entre resecciones robóticas, laparoscópicas y abiertas en una gran cohorte de pacientes con cáncer de colon no metastásico.DISEÑO:Este es un estudio observacional retrospectivo.ESCENARIO:Este estudio se realizó en un único centro oncológico integral.PACIENTES:Pacientes que se sometieron a resección de cáncer de colon primario no metastásico entre enero de 2006 y diciembre de 2018.PRINCIPALES MEDIDAS DE RESULTADO:Se utilizaron modelos univariables y multivariables para identificar predictores de supervivencia libre de enfermedad y global. La cosecha ganglionar y los resultados perioperatorios se compararon entre los abordajes quirúrgicos.RESULTADOS:Hubo 2398 pacientes que cumplieron con los criterios de inclusión: 699 (29%) se sometieron a cirugía abierta, 824 (34%) se sometieron a resección laparoscópica y 875 (36%) se sometieron a resección robótica. La mediana de seguimiento fue de 3,8 años (45,4 meses). La cirugía robótica se asoció con una mayor cosecha ganglionar y la radicalidad de la resección mesentérica. En el análisis multivariable, el abordaje quirúrgico no se asoció con una diferencia en la supervivencia general o libre de enfermedad. La colectomía mínimamente invasiva se asoció con menos complicaciones y una estancia más corta en comparación con la cirugía abierta. En una comparación directa entre los dos enfoques mínimamente invasivos, la colectomía robótica se asoció con menos complicaciones, una estancia más corta y una tasa de conversión más baja que la laparoscopia.LIMITACIONES:Este fue un estudio retrospectivo de un solo centro.CONCLUSIONES:Nuestros datos indican que los tres enfoques quirúrgicos son igualmente efectivos en el tratamiento del cáncer de colon resecable primario y que las diferencias en los resultados se observan principalmente en el período posoperatorio temprano. Consulte Video Resumen en http://links.lww.com/DCR/C115 . (Traducción-Dr. Felipe Bellolio ).
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Affiliation(s)
- Jonathan B. Yuval
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Hannah M. Thompson
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Floris S. Verheij
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Megan Fiasconaro
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Sujata Patil
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Maria Widmar
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Iris H. Wei
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Emmanouil P. Pappou
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York
| | - J. Joshua Smith
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Garrett M. Nash
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Martin R. Weiser
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Philip B. Paty
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Julio Garcia-Aguilar
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York
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Li X, Zhang H, Hou X. Laparoscopic versus open surgical management in elderly patients with rectal cancer aged 70 and older. J Minim Access Surg 2023; 19:504-510. [PMID: 37282434 PMCID: PMC10695322 DOI: 10.4103/jmas.jmas_243_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2022] [Revised: 10/17/2022] [Accepted: 03/10/2023] [Indexed: 06/08/2023] Open
Abstract
Background This retrospective study aimed to compare the short- and long-term surgical outcomes of laparoscopic surgery versus open surgery in elderly patients with rectal cancer. Patients and Methods Elderly patients (≥70 years old) with rectal cancer who received radical surgery were retrospectively analysed. Patients were matched (1:1 ratio) using propensity score matching (PSM), with age, sex, body mass index, American Society of Anesthesiologists score and tumour-node-metastasis staging included as covariates. Baseline characteristics, post-operative complications, short- and long-term surgical outcomes and overall survival (OS) were compared between the two matched groups. Results Sixty-one pairs were selected after PSM. Patients with laparoscopic surgery had a longer duration of operation time, lower estimated blood loss, shorter duration of post-operative analgesics administered, time to first flatus, time to first oral diet and post-operative hospitalisation stay than those observed in patients with open surgery (All P < 0.05). The incidence of post-operative complications in the open surgery group was numerically higher than that occurred in the laparoscopic surgery group (30.6% vs. 17.7%). Median OS was 67.0 months (95% confidence interval [CI], 62.2-71.8) in the laparoscopic surgery group and 65.0 months (95% CI, 59.9-70.1) in the open surgery group, however, Kaplan-Meier curves indicated that no significant differences in OS (Log-rank test, P = 0.535) were noted between the two matched groups. Conclusions Compared with the open surgery, laparoscopic surgery had the advantages of less trauma and faster recovery, and provided similar long-term prognostic outcome in elderly patients with rectal cancer.
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Affiliation(s)
- Xiaolong Li
- Department of General Surgery, First Hospital of Lanzhou University, Lanzhou, Gansu Province, China
| | - Hengwei Zhang
- Department of General Surgery, First Hospital of Lanzhou University, Lanzhou, Gansu Province, China
| | - Xudong Hou
- Department of General Surgery, First Hospital of Lanzhou University, Lanzhou, Gansu Province, China
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Huynh Thanh L, Dao Bui Quy Q, Nguyen Manh K, Nguyen Huu D, Nguyen Trung K, Le Viet T. Preoperative urine neutrophil gelatinase-associated lipocalin predicts mortality in colorectal cancer patients after laparoscopic surgery: A single-center study. Health Sci Rep 2023; 6:e1612. [PMID: 37808929 PMCID: PMC10556407 DOI: 10.1002/hsr2.1612] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2023] [Revised: 09/18/2023] [Accepted: 09/22/2023] [Indexed: 10/10/2023] Open
Abstract
Purpose To determine the rate of acute kidney injury (AKI) after laparoscopic colorectal cancer (CRC) surgery and the predictive value of urine neutrophil gelatinase-associated lipocalin (uNGAL) for postoperative AKI and mortality during 3 years of follow-up. Methods A total of 216 CRC patients who had undergone laparoscopic surgery were included in our study. We divided all patients into two groups, including group 1 (n = 31) with postoperative AKI and group 2 (n = 185) without postoperative AKI. Urine NGAL was measured using the ELISA technique. Clinical and laboratory data were collected the day before surgery. Postoperative AKI included events occurring within 7 days of the index operation, and mortality was obtained during 3 years of follow-up. Results The ratio of postoperative AKI was 14.35% (31/216 patients). The urine NGAL level in group 1 was significantly higher than in group 2, p < 0.001. At cut-off value = 14.94 ng/mL, uNGAL has a predictive value for AKI (area under the curve [AUC] = 0.858, p < 0.001). After 3 years of follow-up, the total mortality rate was 7.9%. The mortality rate in group 1 (45.2%) was significantly higher than in group 2 (1.6%) with p < 0.001). At cut-off value = 19.85 ng/mL, uNGAL has a predictive value for mortality (AUC = 0.941, p < 0.001). Conclusions The rate of acute kidney injury after laparoscopic CRC surgery was 14.35%. Preoperative urine NGAL has a good predictive value for postoperative acute kidney injury and mortality during 3 years of follow-up.
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Affiliation(s)
- Long Huynh Thanh
- Nguyen Tri Phuong HospitalHo Chi MinhVietnam
- Nguyen Tat Thanh UniversityHo Chi MinhVietnam
| | | | | | | | - Kien Nguyen Trung
- Military Hospital 103Ha NoiVietnam
- Vietnam Military Medical UniversityHa NoiVietnam
| | - Thang Le Viet
- Military Hospital 103Ha NoiVietnam
- Vietnam Military Medical UniversityHa NoiVietnam
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27
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Pathak A, Wanjari M. Minimally Invasive Colorectal Surgery Techniques. Cureus 2023; 15:e47203. [PMID: 38021760 PMCID: PMC10652800 DOI: 10.7759/cureus.47203] [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: 10/03/2023] [Accepted: 10/17/2023] [Indexed: 12/01/2023] Open
Abstract
Colorectal surgery has witnessed a transformative shift with the advent of minimally invasive techniques, offering patients reduced postoperative discomfort, shorter hospital stays, and accelerated recovery compared to conventional open surgery. This comprehensive review aims to assess the current state of minimally invasive approaches in colorectal surgery, encompassing various techniques such as single-incision laparoscopic surgery, robot-assisted surgery, and conventional laparoscopic surgery. The article meticulously explores the benefits and drawbacks of each technique, delves into the established criteria for their application, delineates cautious circumstances, and analyzes the outcomes of minimally invasive colorectal surgery. Additionally, the integration of virtual reality and augmented reality for surgical planning and training is discussed, shedding light on the future trajectory of this field. Surgeons and researchers striving to enhance patient care and surgical outcomes in colorectal surgery will find this review article an invaluable resource, presenting crucial components of minimally invasive colorectal surgery and paving the way for continued advancements in the field.
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Affiliation(s)
- Akash Pathak
- Community Medicine, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Mayur Wanjari
- Research and Development, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
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Dohrn N, Klein MF. Colorectal cancer: current management and future perspectives. Br J Surg 2023; 110:1256-1259. [PMID: 37079890 DOI: 10.1093/bjs/znad095] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2023] [Revised: 03/19/2023] [Accepted: 03/21/2023] [Indexed: 04/22/2023]
Affiliation(s)
- Niclas Dohrn
- Department of Surgery, Copenhagen University Hospital-Herlev and Gentofte, Copenhagen, Denmark
| | - Mads Falk Klein
- Department of Surgery, Copenhagen University Hospital-Herlev and Gentofte, Copenhagen, Denmark
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Liu Y, Du W, Guo Y, Tian Z, Shen W. Identification of high-risk factors for recurrence of colon cancer following complete mesocolic excision: An 8-year retrospective study. PLoS One 2023; 18:e0289621. [PMID: 37566586 PMCID: PMC10420346 DOI: 10.1371/journal.pone.0289621] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2023] [Accepted: 07/21/2023] [Indexed: 08/13/2023] Open
Abstract
BACKGROUND Colon cancer recurrence is a common adverse outcome for patients after complete mesocolic excision (CME) and greatly affects the near-term and long-term prognosis of patients. This study aimed to develop a machine learning model that can identify high-risk factors before, during, and after surgery, and predict the occurrence of postoperative colon cancer recurrence. METHODS The study included 1187 patients with colon cancer, including 110 patients who had recurrent colon cancer. The researchers collected 44 characteristic variables, including patient demographic characteristics, basic medical history, preoperative examination information, type of surgery, and intraoperative information. Four machine learning algorithms, namely extreme gradient boosting (XGBoost), random forest (RF), support vector machine (SVM), and k-nearest neighbor algorithm (KNN), were used to construct the model. The researchers evaluated the model using the k-fold cross-validation method, ROC curve, calibration curve, decision curve analysis (DCA), and external validation. RESULTS Among the four prediction models, the XGBoost algorithm performed the best. The ROC curve results showed that the AUC value of XGBoost was 0.962 in the training set and 0.952 in the validation set, indicating high prediction accuracy. The XGBoost model was stable during internal validation using the k-fold cross-validation method. The calibration curve demonstrated high predictive ability of the XGBoost model. The DCA curve showed that patients who received interventional treatment had a higher benefit rate under the XGBoost model. The external validation set's AUC value was 0.91, indicating good extrapolation of the XGBoost prediction model. CONCLUSION The XGBoost machine learning algorithm-based prediction model for colon cancer recurrence has high prediction accuracy and clinical utility.
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Affiliation(s)
- Yuan Liu
- Department of General Surgery, Wuxi People’s Hospital Affiliated to Nanjing Medical University, Wuxi, China
| | - Wenyi Du
- Department of General Surgery, Wuxi People’s Hospital Affiliated to Nanjing Medical University, Wuxi, China
| | - Yi Guo
- Department of General Practice, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, Shandong Province, China
| | - Zhiqiang Tian
- Department of General Surgery, Wuxi People’s Hospital Affiliated to Nanjing Medical University, Wuxi, China
| | - Wei Shen
- Department of General Surgery, Wuxi People’s Hospital Affiliated to Nanjing Medical University, Wuxi, China
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Ryan OK, Doogan KL, Ryan ÉJ, Donnelly M, Reynolds IS, Creavin B, Davey MG, Kelly ME, Kennelly R, Hanly A, Martin ST, Winter DC. Comparing minimally invasive surgical and open approaches to pelvic exenteration for locally advanced or recurrent pelvic malignancies - Systematic review and meta-analysis. EUROPEAN JOURNAL OF SURGICAL ONCOLOGY 2023; 49:1362-1373. [PMID: 37087374 DOI: 10.1016/j.ejso.2023.04.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2023] [Revised: 03/30/2023] [Accepted: 04/05/2023] [Indexed: 04/24/2023]
Abstract
INTRODUCTION Pelvic exenteration (PE) is a complex multivisceral surgical procedure indicated for locally advanced or recurrent pelvic malignancies. It poses significant technical challenges which account for the high risk of morbidity and mortality associated with the procedure. Developments in minimally invasive surgical (MIS) approaches and enhanced peri-operative care have facilitated improved long term outcomes. However, the optimum approach to PE remains controversial. METHODS A systematic literature search was conducted in accordance with PRISMA guidelines to identify studies comparing MIS (robotic or laparoscopic) approaches for PE versus the open approach for patients with locally advanced or recurrent pelvic malignancies. The methodological quality of the included studies was assessed systematically and a meta-analysis was conducted. RESULTS 11 studies were identified, including 2009 patients, of whom 264 (13.1%) underwent MIS PE approaches. The MIS group displayed comparable R0 resections (Risk Ratio [RR] 1.02, 95% Confidence Interval [95% CI] 0.98, 1.07, p = 0.35)) and Lymph node yield (Weighted Mean Difference [WMD] 1.42, 95% CI -0.58, 3.43, p = 0.16), and although MIS had a trend towards improved towards improved survival and recurrence outcomes, this did not reach statistical significance. MIS was associated with prolonged operating times (WMD 67.93, 95% CI 4.43, 131.42, p < 0.00001) however, this correlated with less intra-operative blood loss, and a shorter length of post-operative stay (WMD -3.89, 955 CI -6.53, -1.25, p < 0.00001). Readmission rates were higher with MIS (RR 2.11, 95% CI 1.11, 4.02, p = 0.02), however, rates of pelvic abscess/sepsis were decreased (RR 0.45, 95% CI 0.21, 0.95, p = 0.04), and there was no difference in overall, major, or specific morbidity and mortality. CONCLUSION MIS approaches are a safe and feasible option for PE, with no differences in survival or recurrence outcomes compared to the open approach. MIS also reduced the length of post-operative stay and decreased blood loss, offset by increased operating time.
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Affiliation(s)
- Odhrán K Ryan
- Department of Surgery, St Vincent's University Hospital, Elm Park, Dublin, Ireland
| | - Katie L Doogan
- Department of Surgery, St Vincent's University Hospital, Elm Park, Dublin, Ireland
| | - Éanna J Ryan
- Department of Surgery, St Vincent's University Hospital, Elm Park, Dublin, Ireland.
| | - Mark Donnelly
- Department of Surgery, St Vincent's University Hospital, Elm Park, Dublin, Ireland
| | - Ian S Reynolds
- Department of Surgery, Royal College of Surgeons in Ireland, 123. St. Stephen's Green, Dublin 2, Ireland
| | - Ben Creavin
- Department of Surgery, St Vincent's University Hospital, Elm Park, Dublin, Ireland
| | - Matthew G Davey
- Department of Surgery, Royal College of Surgeons in Ireland, 123. St. Stephen's Green, Dublin 2, Ireland
| | - Michael E Kelly
- Department of Surgery, St Vincent's University Hospital, Elm Park, Dublin, Ireland
| | - Rory Kennelly
- Department of Surgery, St Vincent's University Hospital, Elm Park, Dublin, Ireland; Centre for Colorectal Disease, St Vincent's University Hospital, Elm Park, Dublin 4, Ireland
| | - Ann Hanly
- Department of Surgery, St Vincent's University Hospital, Elm Park, Dublin, Ireland; Centre for Colorectal Disease, St Vincent's University Hospital, Elm Park, Dublin 4, Ireland
| | - Seán T Martin
- Department of Surgery, St Vincent's University Hospital, Elm Park, Dublin, Ireland; Centre for Colorectal Disease, St Vincent's University Hospital, Elm Park, Dublin 4, Ireland
| | - Des C Winter
- Department of Surgery, St Vincent's University Hospital, Elm Park, Dublin, Ireland; Centre for Colorectal Disease, St Vincent's University Hospital, Elm Park, Dublin 4, Ireland; School of Medicine, University College, Dublin, Dublin 4, Ireland
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Horvath P, Steidle C, Yurttas C, Baur I, Königsrainer A, Königsrainer I. Possible Advantages of Minimal-Invasive Approaches in Rectal Cancer Surgery: A Nationwide Analysis. J Clin Med 2023; 12:4765. [PMID: 37510880 PMCID: PMC10381625 DOI: 10.3390/jcm12144765] [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: 05/05/2023] [Revised: 07/11/2023] [Accepted: 07/12/2023] [Indexed: 07/30/2023] Open
Abstract
(1) Background: Laparoscopic resection for colon and rectal cancer was introduced in the early 1990s; the aim of this analysis was to show possible advantages of minimal-invasive approaches in rectal cancer surgery. (2) Methods: From 2016 to 2020, all patients undergoing open, laparoscopic or robotic-assisted rectal cancer surgery in Germany were retrospectively analyzed regarding sex distribution, conversion rates and in-hospital mortality rates according to nationwide hospital billing data based on diagnosis-related groups (DRGs). (3) Results: In total, 68,112 patients were analyzed, and most commonly, low anterior rectal resections with primary anastomosis (n = 25,824) were performed with an increase of minimal-invasive procedures over the years (open: 51% to 27%; laparoscopic: 47% to 63% and robotic: 2% to 10%). In-hospital mortality rate was 2.95% (n = 2012). In total, 4.61%, 1.77%, 1.14% and 3.95% of patients with open, laparoscopic, robotic and converted-to-open surgery died during hospital stay, respectively (open vs. laparoscopic p < 0.0001; open vs. robotic p < 0.00001; laparoscopic vs. robotic p = 0.001). Conversion rates were significantly more favorable in the robotic compared to the laparoscopic group. (11.94% vs. 2.53%; p < 0.0001). (4) Conclusion: Minimal-invasive rectal cancer surgery might have some advantages in terms of a reduced in-hospital mortality, and an improved conversion rate for the robotic approach.
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Affiliation(s)
- Philipp Horvath
- Department of General, Visceral and Transplant Surgery, Comprehensive Cancer Center, University of Tübingen, 72074 Tübingen, Germany
- Department of General, Visceral and Thoracic Surgery, Academic Teaching Hospital Feldkirch, Carinagasse 47, 6807 Feldkirch, Austria
| | - Christoph Steidle
- Department of General, Visceral and Transplant Surgery, Comprehensive Cancer Center, University of Tübingen, 72074 Tübingen, Germany
| | - Can Yurttas
- Department of General, Visceral and Transplant Surgery, Comprehensive Cancer Center, University of Tübingen, 72074 Tübingen, Germany
| | - Isabella Baur
- Department of General, Visceral and Transplant Surgery, Comprehensive Cancer Center, University of Tübingen, 72074 Tübingen, Germany
| | - Alfred Königsrainer
- Department of General, Visceral and Transplant Surgery, Comprehensive Cancer Center, University of Tübingen, 72074 Tübingen, Germany
| | - Ingmar Königsrainer
- Department of General, Visceral and Thoracic Surgery, Academic Teaching Hospital Feldkirch, Carinagasse 47, 6807 Feldkirch, Austria
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Iwamoto H, Matsuda K, Takifuji K, Tamura K, Mitani Y, Mizumoto Y, Nakamura Y, Sakanaka T, Yokoyama S, Hotta T, Yamaue H. Randomized controlled trial comparing cosmetic results of midline incision versus off-midline incision for specimen extraction in laparoscopic colectomy. Langenbecks Arch Surg 2023; 408:281. [PMID: 37460849 DOI: 10.1007/s00423-023-03018-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2023] [Accepted: 07/11/2023] [Indexed: 07/20/2023]
Abstract
PURPOSE A notable advantage of laparoscopic colorectal surgery is that only a small incision at the extraction site is necessary, which is considered to be cosmetically beneficial. Meanwhile, the optimal extraction site for the resected specimen in laparoscopic colectomy is controversial in terms of cosmetic benefit. This randomized controlled trial compares midline and off-midline extraction sites in laparoscopic colectomy in patients with colon cancer, with consideration of cosmetic benefits as the primary endpoint. METHODS Included were patients that underwent elective laparoscopic colectomy at WMUH between October 2014 and February 2017. Patients were randomly assigned to either midline incision group or off-midline incision group. Prospectively collected data included cosmetic results (patients and observer assessment scale) and complications including incidence of incisional hernia, SSI, and pain. This trial was registered with UMIN Clinical Trials (UMIN000028943). RESULTS Finally, 98 patients with colorectal cancer were analyzed. No significant differences were found between the two groups in patient and observer assessment scales of cosmetic results (midline 8 ± 1.1 vs off-midline 11 ± 5.9 p = 0.16, midline 13.5 ± 6.6 vs off-midline 15 ± 11 p = 0.58, respectively) or in postoperative pain. However, incisional hernia occurred in four cases in the midline group (8%), which was significantly higher than that in the off-midline group (no cases, 0%). CONCLUSION There was no significant difference in terms of cosmetic benefit, the primary endpoint, between the two groups. In this study, only the extraction site location was compared; future studies will examine differences depending on the incisional direction, including the incidence of incisional hernia.
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Affiliation(s)
- Hiromitsu Iwamoto
- Second Department of Surgery, School of Medicine, Wakayama Medical University, 811-1 Kimiidera, Wakayama, 641-8510, Japan
| | - Kenji Matsuda
- Second Department of Surgery, School of Medicine, Wakayama Medical University, 811-1 Kimiidera, Wakayama, 641-8510, Japan
| | - Katsunari Takifuji
- Second Department of Surgery, School of Medicine, Wakayama Medical University, 811-1 Kimiidera, Wakayama, 641-8510, Japan
| | - Koichi Tamura
- Second Department of Surgery, School of Medicine, Wakayama Medical University, 811-1 Kimiidera, Wakayama, 641-8510, Japan
| | - Yasuyuki Mitani
- Second Department of Surgery, School of Medicine, Wakayama Medical University, 811-1 Kimiidera, Wakayama, 641-8510, Japan
| | - Yuki Mizumoto
- Second Department of Surgery, School of Medicine, Wakayama Medical University, 811-1 Kimiidera, Wakayama, 641-8510, Japan
| | - Yuki Nakamura
- Second Department of Surgery, School of Medicine, Wakayama Medical University, 811-1 Kimiidera, Wakayama, 641-8510, Japan
| | - Toshihiro Sakanaka
- Second Department of Surgery, School of Medicine, Wakayama Medical University, 811-1 Kimiidera, Wakayama, 641-8510, Japan
| | - Shozo Yokoyama
- Second Department of Surgery, School of Medicine, Wakayama Medical University, 811-1 Kimiidera, Wakayama, 641-8510, Japan
| | - Tsukasa Hotta
- Second Department of Surgery, School of Medicine, Wakayama Medical University, 811-1 Kimiidera, Wakayama, 641-8510, Japan
| | - Hiroki Yamaue
- Second Department of Surgery, School of Medicine, Wakayama Medical University, 811-1 Kimiidera, Wakayama, 641-8510, Japan.
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Lai J, Ye P, Yang J, Feng Y, Qiu K, Wei S. A propensity score matching investigation of short-term results of single-incision laparoscopic low anterior rectal resection via ileostomy site. J Minim Access Surg 2023; 19:371-377. [PMID: 36695238 PMCID: PMC10449036 DOI: 10.4103/jmas.jmas_163_22] [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: 06/04/2022] [Revised: 07/29/2022] [Accepted: 08/05/2022] [Indexed: 01/22/2023] Open
Abstract
Aims The study was performed to verify the results of single-incision laparoscopic surgery (SILS) through the ileostomy site for low rectal cancer compared with conventional laparoscopic surgery (CLS). Materials and Methods From January 2019 to November 2021, 133 patients with low rectal cancer underwent single-incision (n = 27) or conventional (n = 106) methods of low anterior rectal resection surgery with ileostomy. All patients were balanced by propensity score matching for basic information in a ratio of 1:2, resulting in 27 and 54 in SILS and CLS groups, respectively. Results Relative to the CLS group, the SILS group exhibited fewer leucocyte changes, shorter time to first exhaust and first bowel sounds, shorter length of hospital stay and lower Visual Analogue Score on post-operative days (POD2) and POD3. Intraoperative or post-operative complications or readmissions were comparable between the two groups. The oncologic results remained consistent between the two groups other than the number of lymph nodes dissected in group no. 253. Conclusions Single-incision laparoscopic low rectal resection surgery through the ileostomy site has advantages in terms of reduced post-operative pain, shorter post-operative exhaust time and length of hospital stay while also achieving oncologic outcomes similar to those of conventional laparoscopy. It can be an alternative procedure for patients with low rectal cancer who require ileostomy.
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Affiliation(s)
- Jianxiong Lai
- Department of General Surgery, Affiliated Hospital of North Sichuan Medical College, Nanchong, Sichuan Province, China
- Department of General Surgery, The Third Hospital of Mianyang, Sichuan Mental Health Center, Mianyang, Sichuan Province, China
| | - Pengcheng Ye
- Department of General Surgery, Affiliated Hospital of North Sichuan Medical College, Nanchong, Sichuan Province, China
| | - Junsong Yang
- Department of General Surgery, Affiliated Hospital of North Sichuan Medical College, Nanchong, Sichuan Province, China
| | - Yanchao Feng
- Department of General Surgery, The Third Hospital of Mianyang, Sichuan Mental Health Center, Mianyang, Sichuan Province, China
| | - Kai Qiu
- Department of General Surgery, Affiliated Hospital of North Sichuan Medical College, Nanchong, Sichuan Province, China
| | - Shoujiang Wei
- Department of General Surgery, Affiliated Hospital of North Sichuan Medical College, Nanchong, Sichuan Province, China
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Zheng J, Zhao S, Chen W, Zhang M, Wu J. Comparison of robotic right colectomy and laparoscopic right colectomy: a systematic review and meta-analysis. Tech Coloproctol 2023:10.1007/s10151-023-02821-2. [PMID: 37184773 DOI: 10.1007/s10151-023-02821-2] [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: 05/05/2022] [Accepted: 05/04/2023] [Indexed: 05/16/2023]
Abstract
BACKGROUND For right colon surgery, there is an increasing body of literature comparing the safety of robotic right colectomy (RRC) with laparoscopic right colectomy (LRC). The aim of the present systematic review and meta-analysis is to assess the safety and efficacy of RRC versus LRC, including homogeneous subgroup analyses for extracorporeal anastomosis (EA) and intracorporeal anastomosis (IA). METHODS PubMed, Web of Science, Embase, and Cochrane Library databases were searched for studies published between January 2000 and January 2022. Length of hospital stay, operation time, rate of conversion to laparotomy, time to first flatus, number of harvested lymph nodes, estimated blood loss, rate of overall complication, ileus, anastomotic leakage, wound infection, and total costs were measured. RESULTS Forty-two studies (RRC: 2772 patients; LRC: 12,469 patients) were evaluated. Regardless of the type of anastomosis, RRC showed shorter length of hospital stay, lower rate of conversion to laparotomy, shorter time to first flatus, lower rate of overall complications, and a higher number of harvested lymph nodes compared with LRC, but longer operative time and higher total costs. In the IA subgroup, RRC had a shorter length of hospital stay, longer operative time, and lower rate of conversion to laparotomy compared with LRC, with no difference for the remaining outcomes. In the EA subgroup, RRC had a longer operative time, lower estimated blood loss, lower rate of overall complications, and higher total costs compared with LRC, with the other outcomes being similar. CONCLUSION The safety and efficacy of RRC is superior to LRC, especially when an intracorporeal anastomosis is performed. Most included articles were retrospective, offering low-quality evidence and limited conclusions.
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Affiliation(s)
- Jianchun Zheng
- Department of Emergency, The Second Hospital of Jiaxing: The Second Affiliated Hospital of Jiaxing University, Jiaxing, Zhejiang Province, China
| | - Shuai Zhao
- Department of General Surgery, Northern Jiangsu People's Hospital Affiliated to Medical School of Nanjing University, Yangzhou, Jiangsu Province, China
| | - Wei Chen
- Department of Emergency, The Second Hospital of Jiaxing: The Second Affiliated Hospital of Jiaxing University, Jiaxing, Zhejiang Province, China
| | - Ming Zhang
- Department of Emergency, The Second Hospital of Jiaxing: The Second Affiliated Hospital of Jiaxing University, Jiaxing, Zhejiang Province, China
| | - Jianxiang Wu
- Department of Emergency, The Second Hospital of Jiaxing: The Second Affiliated Hospital of Jiaxing University, Jiaxing, Zhejiang Province, China.
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Lee S, Han SW, Lee MR, Kim CY, Ha GW. The effect on incisional hernia of absorbable barbed suture for midline fascial closure in minimally invasive surgery for colorectal and gastric cancers: study protocol for a randomized controlled trial. Trials 2023; 24:311. [PMID: 37149610 PMCID: PMC10164296 DOI: 10.1186/s13063-023-07324-x] [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: 01/10/2023] [Accepted: 04/24/2023] [Indexed: 05/08/2023] Open
Abstract
BACKGROUND Incisional hernia following abdominal surgery is a frequent complication of midline laparotomy. This complication is strongly associated with the technique and material used for suture. While a monofilament absorbable suture is recommended to prevent incisional hernia, it can lead to suture loosening or surgical-knot breakage. Although barbed sutures can be an alternative suture material in abdominal fascial closure, evidence for its safety and effectiveness is lacking. Therefore, we designed a prospective randomized trial to evaluate the safety and efficacy of absorbable barbed sutures for midline fascia closure in minimally invasive surgery for colorectal and gastric cancers in comparison with conventional absorbable monofilament sutures. METHODS A total of 312 patients who underwent minimally invasive surgery for colorectal and gastric cancers will be randomly allocated to either the absorbable barbed or monofilament suture group for abdominal fascia closure in a 1:1 ratio. The primary outcome is incisional hernia rate within 3 years after surgery, as verified by physical examination and computed tomography. Postoperative complications, including surgical site infection, postoperative pain, and quality of life, will be compared between two groups as secondary outcomes. The investigator will examine the patients until discharge and at 6, 12, 18, 24, and 36 months postoperatively. DISCUSSION This is the first randomized controlled trial to compare absorbable barbed sutures with monofilament sutures for midline fascia closure in minimally invasive surgery. If absorbable barbed sutures demonstrate superior results to those of monofilament sutures, this type of suture material may be recommended as an alternative option for abdominal fascia closure. TRIAL REGISTRATION KCT0007069. Registered on January 30, 2023.
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Affiliation(s)
- Sejin Lee
- Research Institute of Clinical Medicine of Jeonbuk National University-Biomedical Research Institute of Jeonbuk National University Hospital, Jeonju, Republic of Korea
| | - Se Wung Han
- Research Institute of Clinical Medicine of Jeonbuk National University-Biomedical Research Institute of Jeonbuk National University Hospital, Jeonju, Republic of Korea
| | - Min Ro Lee
- Research Institute of Clinical Medicine of Jeonbuk National University-Biomedical Research Institute of Jeonbuk National University Hospital, Jeonju, Republic of Korea
| | - Chan-Young Kim
- Research Institute of Clinical Medicine of Jeonbuk National University-Biomedical Research Institute of Jeonbuk National University Hospital, Jeonju, Republic of Korea
| | - Gi Won Ha
- Research Institute of Clinical Medicine of Jeonbuk National University-Biomedical Research Institute of Jeonbuk National University Hospital, Jeonju, Republic of Korea.
- Department of Surgery, Jeonbuk National University Hospital, 20 Geonji-Ro, Deokjin-Gu, Jeonju, 54907, Republic of Korea.
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Takagawa Y, Suzuki M, Yamaguchi H, Seto I, Azami Y, Machida M, Takayama K, Tominaga T, Murakami M. Outcomes and Prognostic Factors for Locally Recurrent Rectal Cancer Treated With Proton Beam Therapy. Adv Radiat Oncol 2023; 8:101192. [PMID: 36896217 PMCID: PMC9991532 DOI: 10.1016/j.adro.2023.101192] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2022] [Accepted: 01/29/2023] [Indexed: 02/09/2023] Open
Abstract
Purpose Our objective was to report the outcome and prognostic factors for patients with locally recurrent rectal cancer (LRRC) treated with proton beam therapy (PBT) at our institution. Methods and Materials The study included PBT-treated patients with LRRC between December 2008 and December 2019. Treatment response was stratified using an initial imaging test after PBT. Overall survival (OS), progression-free survival (PFS), and local control (LC) were estimated using the Kaplan-Meier method. Each outcome's prognostic factors were verified using the Cox proportional hazards model. Results Twenty-three patients were enrolled (median follow-up, 37.4 months). There were 11 patients with complete response (CR) or complete metabolic response (CMR), 8 with partial response or partial metabolic response, 2 with stable disease or stable metabolic response, and 2 with progressive disease or progressive metabolic disease. Three- and 5-year OS, PFS, and LC were 72.1% and 44.6%, 37.9% and 37.9%, and 55.0% and 47.2%, respectively, with 54.4 months' median survival time. The maximum standardized uptake value of fluorine-18-fluorodeoxyglucose-positron emission tomography-computed tomography (18F-FDG-PET/CT) before PBT (cutoff value, 10) showed significant differences in OS (P = .03), PFS (P = .027), and LC (P = .012). The patients who achieved CR or CMR after PBT had significantly better LC than those with non-CR or non-CMR (hazard ratio, 4.49; 95% confidence interval, 1.14-17.63; P = .021). Older patients (aged ≥65 years) had significantly higher LC and PFS rates. Patients with pain before PBT and larger tumors (≥30 mm) also had significantly lower PFS. Of 23 patients, 12 (52%) experienced further local recurrence after PBT. One patient developed grade 2 acute radiation dermatitis. Regarding late toxicity, grade 4 late gastrointestinal toxic effects were recorded in 3 patients, in 2 of whom reirradiation was associated with further local recurrence after PBT. Conclusions The results showed that PBT may have potential to be a good treatment option for LRRC. 18F-FDG-PET/CT before and after PBT may be useful for assessing tumor response and predicting outcomes.
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Affiliation(s)
- Yoshiaki Takagawa
- Department of Minimally Invasive Surgical and Medical Oncology, Fukushima Medical University, Fukushima, Japan
- Department of Radiation Oncology, Southern TOHOKU Proton Therapy Center, Fukushima, Japan
- Corresponding author: Yoshiaki Takagawa, MD
| | - Motohisa Suzuki
- Department of Radiation Oncology, Southern TOHOKU Proton Therapy Center, Fukushima, Japan
| | - Hisashi Yamaguchi
- Department of Minimally Invasive Surgical and Medical Oncology, Fukushima Medical University, Fukushima, Japan
- Department of Radiation Oncology, Southern TOHOKU Proton Therapy Center, Fukushima, Japan
| | - Ichiro Seto
- Department of Radiation Oncology, Southern TOHOKU Proton Therapy Center, Fukushima, Japan
| | - Yusuke Azami
- Department of Radiation Oncology, Southern TOHOKU Proton Therapy Center, Fukushima, Japan
| | - Masanori Machida
- Department of Radiation Oncology, Southern TOHOKU Proton Therapy Center, Fukushima, Japan
| | - Kanako Takayama
- Department of Radiation Oncology, Southern TOHOKU Proton Therapy Center, Fukushima, Japan
| | - Takuya Tominaga
- Department of Radiation Oncology, Southern TOHOKU Proton Therapy Center, Fukushima, Japan
| | - Masao Murakami
- Department of Radiation Oncology, Southern TOHOKU Proton Therapy Center, Fukushima, Japan
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Zhang KH, Li JZ, Zhang HB, Hu RH, Cui XM, Du T, Zheng L, Zhang S, Song C, Xu MD, Jiang XH. Assessment of Autologous Blood marker localIzation and intraoperative coLonoscopy localIzation in laparoscopic colorecTal cancer surgery (ABILITY): a randomized controlled trial. BMC Cancer 2023; 23:204. [PMID: 36869328 PMCID: PMC9985272 DOI: 10.1186/s12885-023-10669-w] [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: 11/01/2022] [Accepted: 02/21/2023] [Indexed: 03/05/2023] Open
Abstract
BACKGROUND Laparoscopic colorectal surgery has been proved to have similar oncological outcomes with open surgery. Due to the lack of tactile perception, surgeons may have misjudgments in laparoscopic colorectal surgery. Therefore, the accurate localization of a tumor before surgery is important, especially in the early stages of cancer. Autologous blood was thought a feasible and safe tattooing agent for preoperative endoscopic localization but its benefits remain controversial. We therefore proposed this randomized trial to the accuracy and safety of autogenous blood localization in small, serosa-negative lesion which will be resected by laparoscopic colectomy. METHODS The current study is a single-center, open-label, non-inferiority, randomized controlled trial. Eligible participants would be aged 18-80 years and diagnosed with large lateral spreading tumors that could not be treated endoscopically, malignant polyps treated endoscopically that required additional colorectal resection, and serosa-negative malignant colorectal tumors (≤ cT3). A total of 220 patients would be randomly assigned (1:1) to autologous blood group or intraoperative colonoscopy group. The primary outcome is the localization accuracy. The secondary endpoint is adverse events related to endoscopic tattooing. DISCUSSION This trial will investigate whether autologous blood marker achieves similar localization accuracy and safety in laparoscopic colorectal surgery compared to intraoperative colonoscopy. If our research hypothesis is statistically proved, the rational introduction of autologous blood tattooing in preoperative colonoscopy can help improve identification of the location of tumors for laparoscopic colorectal cancer surgery, performing an optimal resection, and minimizing unnecessary resections of normal tissues, thereby improving the patient's quality of life. Our research data will also provide high quality clinical evidence and data support for the conduction of multicenter phase III clinical trials. TRIAL REGISTRATION This study is registered with ClinicalTrials.gov, NCT05597384. Registered 28 October 2022.
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Affiliation(s)
- Ke-Hui Zhang
- Department of Gastrointestinal Surgery, Shanghai East Hospital, Tongji University, Shanghai, P. R. China, 200120
| | - Jing-Ze Li
- Center of Digestive Endoscopy, Shanghai East Hospital, Tongji University, Shanghai, China
| | - Hai-Bin Zhang
- Center of Digestive Endoscopy, Shanghai East Hospital, Tongji University, Shanghai, China
| | - Ren-Hao Hu
- Department of Gastrointestinal Surgery, Shanghai East Hospital, Tongji University, Shanghai, P. R. China, 200120
| | - Xi-Mao Cui
- Department of Gastrointestinal Surgery, Shanghai East Hospital, Tongji University, Shanghai, P. R. China, 200120
| | - Tao Du
- Department of Gastrointestinal Surgery, Shanghai East Hospital, Tongji University, Shanghai, P. R. China, 200120
| | - Liang Zheng
- Research Center for Translational Medicine, Shanghai East Hospital, Tongji University, Shanghai, China
| | - Shun Zhang
- Department of Gastrointestinal Surgery, Shanghai East Hospital, Tongji University, Shanghai, P. R. China, 200120.
| | - Chun Song
- Department of Gastrointestinal Surgery, Shanghai East Hospital, Tongji University, Shanghai, P. R. China, 200120
| | - Mei-Dong Xu
- Center of Digestive Endoscopy, Shanghai East Hospital, Tongji University, Shanghai, China
| | - Xiao-Hua Jiang
- Department of Gastrointestinal Surgery, Shanghai East Hospital, Tongji University, Shanghai, P. R. China, 200120.
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Patient-Reported Bowel, Urinary, and Sexual Outcomes After Laparoscopic-Assisted Resection or Open Resection for Rectal Cancer: The Australasian Laparoscopic Cancer of the Rectum Randomized Clinical Trial (ALaCart). Ann Surg 2023; 277:449-455. [PMID: 35166265 DOI: 10.1097/sla.0000000000005412] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE The aim of this study was to compare patient-reported urinary, bowel, and sexual functioning of ALaCaRT Trial participants randomized to open or laparoscopic surgery for rectal cancer. SUMMARY BACKGROUND DATA The primary endpoint, noninferiority of laparoscopic surgical resection adequacy, was not established. METHODS Participants completed QLQ-CR29 at baseline, 3, and 12 months post-surgery. Additionally, women completed Rosen's Female Sexual Functioning Index (FSFI). Men completed the International Index of Erectile Function (IIEF) and QLQ-PR25. We compared the proportions of participants in each group who experienced moderate/severe symptoms/dysfunction at each time-point and compared mean difference scores from baseline to 12 months between groups. All analyses were intention-to-treat. Sexual functioning analyses included only the participants who expressed sexual interest at baseline. RESULTS Baseline PRO compliance of 475 randomized participants was 88%. At 12 months, a lower proportion of open surgery participants experienced moderate-severe fecal incontinence and sore skin, compared to Laparoscopic participants, and a lower proportion of men randomized to open surgery experienced moderate-severe urinary symptoms. There were no differences at 3 months for bowel or urinary symptoms. Sexual functioning among sexually interested participants was similar between groups at 3 and 12 months; however, a lower proportion of women reported moderate to severe sexual dissatisfaction at 3 months in the open as compared to the laparoscopic group, (Rebecca.mercieca@sydney.edu.au., 95% CI 0.03-0.39). DISCUSSION Despite the slightly lower proportions of open surgery participants self-reporting moderate-severe symptoms for 3 of 16 urinary/bowel domains, and lack of differences in sexual domains, it remains difficult to recommend one surgical approach over another for rectal resection.
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Udayasiri DK, Hiscock R, Jones IT, Skandarajah A, Hayes IP. Overall survival comparing laparoscopic to open surgery for right-sided colon cancer: propensity score inverse probability weighting population study. ANZ J Surg 2023. [PMID: 36797227 DOI: 10.1111/ans.18338] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2022] [Revised: 02/04/2023] [Accepted: 02/07/2023] [Indexed: 02/18/2023]
Abstract
BACKGROUND This retrospective cohort study reports on overall survival and short-term complications, comparing laparoscopic to open resection for right-sided colon cancers. It is one of the largest studies in the field with generalizable population-level results. METHOD This study on right sided colon cancers used prospectively collected administrative data linked to a death registry over 5 years from 2014 to 2018. Exclusion criteria were private patients, patients aged less than 10 years, synchronous and metachronous cancers. Propensity score weighting was used to balance cohorts and Cox proportional hazards regression was used to assess the hazard of death. In addition, logistic regression analysis was used to assess secondary outcomes. For completeness, unweighted data was similarly analysed. RESULTS There were 3603 patients identified for the analysis: 1729 open patients and 1874 laparoscopic patients. Cox proportional hazards regression analysis of the weighted data showed no evidence of a statistically significant effect of laparoscopic surgery compared to open surgery on overall survival for right-sided colon cancers (HR 0.86, 95% CI 0.71-1.04, P = 0.112). The weighted data showed lower odds of prolonged length of stay, return to theatre and discharge destination other than home in the laparoscopic cohort compared to the open cohort. There was no difference in inpatient mortality. Unweighted results were similar. CONCLUSION This study validates the use of laparoscopic surgery for right-sided colon cancer, showing similar long-term overall survival and inpatient mortality compared to open surgery. It is superior to open surgery for the short-term outcomes of LOS, return to theatre and discharge destination other than home.
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Affiliation(s)
- Dilshan K Udayasiri
- Colorectal Surgical Unit, The Royal Melbourne Hospital, Melbourne, Victoria, Australia.,Department of General Surgical Specialties, The Royal Melbourne Hospital, Melbourne, Victoria, Australia.,Department of Surgery, The University of Melbourne, Melbourne, Victoria, Australia
| | - Richard Hiscock
- Department of Anaesthetics, Mercy Hospital for Women, Melbourne, Victoria, Australia.,Department of Obstetrics and Gynaecology, The University of Melbourne, Melbourne, Victoria, Australia
| | - Ian T Jones
- Colorectal Surgical Unit, The Royal Melbourne Hospital, Melbourne, Victoria, Australia.,Department of General Surgical Specialties, The Royal Melbourne Hospital, Melbourne, Victoria, Australia.,Department of Surgery, The University of Melbourne, Melbourne, Victoria, Australia
| | - Anita Skandarajah
- Department of General Surgical Specialties, The Royal Melbourne Hospital, Melbourne, Victoria, Australia.,Department of Surgery, The University of Melbourne, Melbourne, Victoria, Australia
| | - Ian P Hayes
- Colorectal Surgical Unit, The Royal Melbourne Hospital, Melbourne, Victoria, Australia.,Department of General Surgical Specialties, The Royal Melbourne Hospital, Melbourne, Victoria, Australia.,Department of Surgery, The University of Melbourne, Melbourne, Victoria, Australia
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Jadid KD, Cao Y, Petersson J, Sjövall A, Angenete E, Matthiessen P. Long-term oncological outcomes for minimally invasive surgery versus open surgery for colon cancer-a population-based nationwide study with a non-inferiority design. Colorectal Dis 2023; 25:954-963. [PMID: 36762443 DOI: 10.1111/codi.16512] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2022] [Revised: 01/20/2023] [Accepted: 01/29/2023] [Indexed: 02/11/2023]
Abstract
AIM The study aimed to compare 5-year overall survival in a national cohort of patients undergoing curative abdominal resection for colon cancer by minimally invasive surgery (MIS) or by the open (OPEN) technique. METHODS All patients diagnosed between 2010 and 2016 in Sweden with pathological Union International Contre le Cancer Stages I-III colon cancer localized in the caecum, ascending colon, hepatic flexure or sigmoid colon and those who underwent curative right sided hemicolectomy, sigmoid resection or high anterior resection by MIS or OPEN were included. Patients were identified in the Swedish Colorectal Cancer Registry from which all data were retrieved. The analyses were performed as intention-to-treat and the relationship between surgical technique (MIS or OPEN) and overall mortality within 5 years was analysed. For the primary research question a non-inferiority hypothesis was assumed with a statistical power of 90%, a one-side type I error of 2.5% and a non-inferiority margin of 2%. For the secondary analyses, multilevel survival regression models with the patients matched by propensity scores were employed, adjusted for patient- and tumour-related variables. RESULTS A total of 11 605 pathological Union International Contre le Cancer Stages I-III patients were included with 3297 MIS (28.4%) and 8308 OPEN (71.6%) and were followed until 31 December 2020. The primary analysis demonstrated superiority for MIS compared to OPEN. The multilevel survival regression analyses confirmed that 5-year overall survival was higher in MIS with a hazard ratio of 0.874 (95% confidence interval 0.791-0.965), and if excluding pT4 the outcome was similar, with a hazard ratio of 0.847 (95% confidence interval 0.756-0.948). CONCLUSION This observational study demonstrated that MIS was favourable to OPEN with regard to 5-year overall survival. These results support the use of laparoscopic colon cancer surgery in routine practice.
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Affiliation(s)
- Kaveh Dehlaghi Jadid
- Department of Surgery, Örebro University Hospital, Örebro, Sweden.,Department of Surgery, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
| | - Yang Cao
- Clinical Epidemiology and Biostatistics, School of Medical Sciences, Örebro University, Örebro, Sweden
| | - Josefin Petersson
- SSORG-Scandinavian Surgical Outcomes Research Group, Department of Surgery, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.,Region Västra Götaland, Department of Surgery, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Annika Sjövall
- Gastrointestinal Oncology and Colorectal Surgery Unit, Department of Pelvic Cancer, Karolinska University Hospital, Stockholm, Sweden
| | - Eva Angenete
- SSORG-Scandinavian Surgical Outcomes Research Group, Department of Surgery, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.,Region Västra Götaland, Department of Surgery, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Peter Matthiessen
- Department of Surgery, Örebro University Hospital, Örebro, Sweden.,Department of Surgery, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
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Smyth R, Darbyshire A, Mercer S, Khan J, Richardson J. Trends in emergency colorectal surgery: a 7-year retrospective single-centre cohort study. Surg Endosc 2023; 37:3911-3920. [PMID: 36729232 DOI: 10.1007/s00464-023-09876-0] [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: 10/15/2022] [Accepted: 01/06/2023] [Indexed: 02/03/2023]
Abstract
BACKGROUND Emergency colorectal resections carry a higher morbidity and mortality than elective surgery. The use of minimally invasive surgery has now become widespread in elective colorectal surgery, with improved patient outcomes. Laparoscopy is being increasingly used for emergency colorectal resections, but its role is still being defined. Our aim was to observe the uptake of laparoscopy for emergency colorectal surgery in our centre. METHOD A retrospective single-centre cohort study was performed using local National Emergency Laparotomy Audit data from January 2014-December 2020. All patients who had a colorectal resection were included. Trends in the number and type of resections were recorded. Primary outcome was the proportion of cases started and completed laparoscopically. Secondary outcomes included rate of conversion to open, length of stay and 30-day mortality. RESULTS A total 523 colorectal resections were performed. The number of cases attempted and completed laparoscopically steadily increased over the study period (28.3% to 63.3% and 16.3% to 35.4%, respectively). The mean rate of conversion to open was 43.8%. The greatest expansion in laparoscopy was for cases of intestinal obstruction, perforation and peritonitis, and for those undergoing Hartmann's procedure and right hemicolectomy. 30‑day mortality for cases completed laparoscopically was much lower than those converted or started with open surgery (2.1% vs 11.7% and 17.5%, respectively). Laparoscopic approach was independently associated with reduced length of stay. CONCLUSION Laparoscopy has been successfully adopted for emergency colorectal resections in our centre, with half of cases felt to be suitable for minimally invasive surgery.
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Affiliation(s)
- Rachel Smyth
- MRCS Colorectal Surgery, Portsmouth University Hospitals NHS Trust, Portsmouth, UK.
| | - Alexander Darbyshire
- MRCS Upper GI Surgery, Portsmouth University Hospitals NHS Trust, Portsmouth, UK
| | - Stuart Mercer
- FRCS Upper GI Surgery, Portsmouth University Hospitals NHS Trust, Portsmouth, UK
| | - Jim Khan
- FRCS Colorectal Surgery, Portsmouth University Hospitals NHS Trust, Portsmouth, UK
| | - John Richardson
- FRCS Colorectal Surgery, Portsmouth University Hospitals NHS Trust, Portsmouth, UK
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Total 102 natural orifice specimen extraction following laparoscopic colorectal resections. Updates Surg 2023; 75:197-203. [PMID: 36319790 DOI: 10.1007/s13304-022-01412-4] [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: 07/04/2022] [Accepted: 10/23/2022] [Indexed: 01/12/2023]
Abstract
Natural orifice surgery has been used with increasing frequency in colon surgeries since the early 2000's. Our aim was to examine the patients retrospectively who underwent Natural Orifice Specimen Excision (NOSE) following laparoscopic colorectal resection. A total of 102 patients 2013 and 2018 were evaluated. The demographic characteristics, intra-operative and post-operative findings, pathology results, pain, incontinence, sexual dysfunction and cosmetic scores were examined. Mean age was 57.0 ± 14 and 52 of them (51%) were female. Specimen extraction was transanal in 72 (70%) (eventration technique in 10 patients) and transvaginal in the remaining 30 patients. The mean operating time was 272 ± 108 (median 240, range 120-540) minutes, and the mean blood loss was 92 ± 87 ml (median 54, range 5-400). The mean hospital stay was 7.0 ± 4.7 days (median 6, range 3-30). The main pain scores (visual analog score) on days 1-2-3 were 3.9 ± 2.0 (median 4, range 1-9), 3.1 ± 1.7 (median 3, range 0-8), 1.9 ± 1.5 (median 1.5, range 0-7), respectively. The mean cosmetic scores were 9.1 ± 1.5 (median 10, range 3-10). The median Wexner Incontinence score was 0 (0-9). Hospital mortality was 1% and unrelated with the NOSE. The 5-year overall survival and disease-free survival rates for cancer patients were 77.2-63.3%, respectively. NOSE has advantages in laparoscopic colorectal resections. It increases patient comfort and decreases incision related complications. CLINICAL TRIALS: www.clinicaltrials.gov (NCT04394988).
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Liu Y, Song C, Tian Z, Shen W. Identification of High-Risk Patients for Postoperative Myocardial Injury After CME Using Machine Learning: A 10-Year Multicenter Retrospective Study. Int J Gen Med 2023; 16:1251-1264. [PMID: 37057054 PMCID: PMC10089277 DOI: 10.2147/ijgm.s409363] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2023] [Accepted: 04/03/2023] [Indexed: 04/15/2023] Open
Abstract
Purpose The occurrence of myocardial injury, a grave complication post complete mesocolic excision (CME), profoundly impacts the immediate and long-term prognosis of patients. The aim of this inquiry was to conceive a machine learning model that can recognize preoperative, intraoperative and postoperative high-risk factors and predict the onset of myocardial injury following CME. Patients and Methods This study included 1198 colon cancer patients, 133 of whom experienced myocardial injury after surgery. Thirty-six distinct variables were gathered, encompassing patient demographics, medical history, preoperative examination characteristics, surgery type, and intraoperative details. Four machine learning algorithms, namely, extreme gradient boosting (XGBoost), random forest (RF), multilayer perceptron (MLP), and k-nearest neighbor algorithm (KNN), were employed to fabricate the model, and k-fold cross-validation, ROC curve, calibration curve, decision curve analysis (DCA), and external validation were employed to evaluate it. Results Out of the four predictive models employed, the XGBoost algorithm demonstrated the best performance. The ROC curve findings indicated that the XGBoost model exhibited remarkable predictive accuracy, with an area under the curve (AUC) value of 0.997 in the training set and 0.956 in the validation set. For internal validation, the k-fold cross-validation method was utilized, and the XGBoost model was shown to be steady. Furthermore, the calibration curves demonstrated the XGBoost model's high predictive capability. The DCA curve revealed higher benefit rates for patients who underwent interventional treatment under the XGBoost model. The AUC value for the external validation set was 0.74, which indicated that the XGBoost prediction model possessed good extrapolative capacity. Conclusion The myocardial injury prediction model for patients undergoing CME that was developed using the XGBoost machine learning algorithm in this study demonstrates both high predictive accuracy and clinical utility.
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Affiliation(s)
- Yuan Liu
- Department of General Surgery, The Affiliated Wuxi People’s Hospital of Nanjing Medical University, Wuxi, People’s Republic of China
| | - Chen Song
- Department of General Surgery, The Affiliated Wuxi People’s Hospital of Nanjing Medical University, Wuxi, People’s Republic of China
| | - Zhiqiang Tian
- Department of General Surgery, The Affiliated Wuxi People’s Hospital of Nanjing Medical University, Wuxi, People’s Republic of China
| | - Wei Shen
- Department of General Surgery, The Affiliated Wuxi People’s Hospital of Nanjing Medical University, Wuxi, People’s Republic of China
- Correspondence: Wei Shen, Department of General Surgery, The Affiliated Wuxi People’s Hospital of Nanjing Medical University, Wuxi, Jiangsu Province, 214000, People’s Republic of China, Tel +86 13385110723, Email
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Laohawiriyakamol S, Chewatanakornkul S, Wanichsuwan W, Ruangsin S, Sunpaweravong S, Bejrananda T. Urogenital dysfunction after laparoscopic surgery for rectal or sigmoid colon cancer. Asian J Surg 2023; 46:492-500. [PMID: 35717291 DOI: 10.1016/j.asjsur.2022.06.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2021] [Revised: 05/29/2022] [Accepted: 06/01/2022] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND/OBJECTIVE Urogenital dysfunction is a common complication after surgery for sigmoid colon or rectal cancers and may result from various causes. Herein, we evaluated urogenital dysfunction and the associated factors after laparoscopic surgery at different follow-up times. METHODS We conducted a prospective study on 91 patients who were diagnosed with sigmoid colon and rectal cancers and underwent laparoscopic surgery during 2014-2016. Voiding and male and female sexual dysfunctions following surgery were evaluated by the International Prostate Symptom Score (IPSS), International Index of Erectile Function-5 (IIEF-5), and Female Sexual Function Index-6 (FSFI-6), respectively. Urogenital function was compared at pre-surgery and 3 and 12 months postoperatively, and factors associated with urogenital dysfunction were identified. RESULTS The overall urinary function after surgery was better when compared to that at pre-surgery; however, there was deterioration in both male and female sexual functions. The mean preoperative IPSS, IIEF-5, and FSFI-6 scores were 9.35, 12.18, and 6.09, respectively. The mean differences among IPSS, IIEF-5, and FSFI-6 at 12 months postoperatively and pre-surgery were -3.08 (95% confidence interval [CI] -4.77 to -1.40), -2.57 (95% CI -4.33 to -0.80), and -2.58 (95% CI -4.73 to 0.42), respectively. Multivariate analysis demonstrated that age ≤60 years (odds ratio 4.22) and postoperative complications (odds ratio 2.77) were correlated with erectile dysfunction. CONCLUSION Voiding function improved after laparoscopic surgery in both sigmoid colon and rectal cancer patients. However, sexual function in both male and female patients was worse. Age ≤60 years and postoperative complications were strongly associated with male sexual dysfunction.
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Affiliation(s)
- Supparerk Laohawiriyakamol
- Department of Surgery, Faculty of Medicine, Prince of Songkla University, Hat Yai, Songkhla, 90110, Thailand.
| | - Siripong Chewatanakornkul
- Department of Surgery, Faculty of Medicine, Prince of Songkla University, Hat Yai, Songkhla, 90110, Thailand
| | - Worawit Wanichsuwan
- Department of Surgery, Faculty of Medicine, Prince of Songkla University, Hat Yai, Songkhla, 90110, Thailand
| | - Sakchai Ruangsin
- Department of Surgery, Faculty of Medicine, Prince of Songkla University, Hat Yai, Songkhla, 90110, Thailand
| | - Somkiat Sunpaweravong
- Department of Surgery, Faculty of Medicine, Prince of Songkla University, Hat Yai, Songkhla, 90110, Thailand
| | - Tanan Bejrananda
- Urologic Unit, Faculty of Medicine, Prince of Songkla University, Hat Yai, Songkhla, 90110, Thailand
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Takemasa I, Hamabe A, Miyo M, Akizuki E, Okuya K. Essential updates 2020/2021: Advancing precision medicine for comprehensive rectal cancer treatment. Ann Gastroenterol Surg 2022; 7:198-215. [PMID: 36998300 PMCID: PMC10043777 DOI: 10.1002/ags3.12646] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2022] [Revised: 11/16/2022] [Accepted: 11/23/2022] [Indexed: 12/28/2022] Open
Abstract
In the paradigm shift related to rectal cancer treatment, we have to understand a variety of new emerging topics to provide appropriate treatment for individual patients as precision medicine. However, information on surgery, genomic medicine, and pharmacotherapy is highly specialized and subdivided, creating a barrier to achieving thorough knowledge. In this review, we summarize the perspective for rectal cancer treatment and management from the current standard-of-care to the latest findings to help optimize treatment strategy.
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Affiliation(s)
- Ichiro Takemasa
- Department of Surgery, Surgical Oncology and ScienceSapporo Medical UniversitySapporoJapan
| | - Atsushi Hamabe
- Department of Surgery, Surgical Oncology and ScienceSapporo Medical UniversitySapporoJapan
- Department of Gastroenterological Surgery, Graduate School of MedicineOsaka UniversityOsakaJapan
| | - Masaaki Miyo
- Department of Surgery, Surgical Oncology and ScienceSapporo Medical UniversitySapporoJapan
| | - Emi Akizuki
- Department of Surgery, Surgical Oncology and ScienceSapporo Medical UniversitySapporoJapan
| | - Koichi Okuya
- Department of Surgery, Surgical Oncology and ScienceSapporo Medical UniversitySapporoJapan
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Seow W, Dudi-Venkata NN, Bedrikovetski S, Kroon HM, Sammour T. Outcomes of open vs laparoscopic vs robotic vs transanal total mesorectal excision (TME) for rectal cancer: a network meta-analysis. Tech Coloproctol 2022; 27:345-360. [PMID: 36508067 DOI: 10.1007/s10151-022-02739-1] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2022] [Accepted: 11/29/2022] [Indexed: 12/14/2022]
Abstract
BACKGROUND Total mesorectal excision (TME) for rectal cancer can be achieved using open (OpTME), laparoscopic (LapTME), robotic (RoTME), or transanal techniques (TaTME). However, the optimal approach for access remains controversial. The aim of this network meta-analysis was to assess operative and oncological outcomes of all four surgical techniques. METHODS Ovid MEDLINE, EMBASE, and PubMed databases were searched systematically from inception to September 2020, for randomised controlled trials (RCTs) comparing any two TME surgical techniques. A network meta-analysis using a Bayesian random-effects framework and mixed treatment comparison was performed. Primary outcomes were the rate of clear circumferential resection margin (CRM), defined as > 1 mm from the closest tumour to the cut edge of the tissue, and completeness of mesorectal excision. Secondary outcomes included radial and distal resection margin distance, postoperative complications, locoregional recurrence, disease-free survival, and overall survival. Surface under cumulative ranking (SUCRA) was used to rank the relative effectiveness of each intervention for each outcome. The higher the SUCRA value, the higher the likelihood that the intervention is in the top rank or one of the top ranks. RESULTS Thirty-two RCTs with a total of 6151 patients were included. Compared with OpTME, there was no difference in the rates of clear CRM: LapTME RR = 0.99 (95% (Credible interval) CrI 0.97-1.0); RoTME RR = 1.0 (95% CrI 0.96-1.1); TaTME RR = 1.0 (95% CrI 0.96-1.1). There was no difference in the rates of complete mesorectal excision: LapTME RR = 0.98 (95% CrI 0.98-1.1); RoTME RR = 1.1 (95% CrI 0.98-1.4); TaTME RR = 1.0 (95% CrI 0.91-1.2). RoTME was associated with improved distal resection margin distance compared to other techniques (SUCRA 99%). LapTME had a higher rate of conversion to open surgery when compared with RoTME: RoTME RR = 0.23 (95% CrI 0.034-0.70). Length of stay was shortest in RoTME compared to other surgical approaches: OpTME mean difference in days (MD) 3.3 (95% CrI 0.12-6.0); LapTME MD 1.7 (95% CrI - 1.1-4.4); TaTME MD 1.3 (95% CrI - 5.2-7.4). There were no differences in 5-year overall survival (LapTME HR 1.1, 95% CrI 0.74, 1.4; TaTME HR 1.7, 95% CrI 0.79, 3.4), disease-free survival rates (LapTME HR 1.1, 95% CrI 0.76, 1.4; TaTME HR 1.1, 95% CrI 0.52, 2.4), or anastomotic leakage (LapTME RR = 0.92 (95% CrI 0.63, 1.1); RoTME RR = 1.0 (95% CrI 0.48, 1.8); TaTME RR = 0.53 (95% CrI 0.19, 1.2). The overall quality of evidence as per Grading of Recommendations Assessment, Development and Evaluation (GRADE) assessments across all outcomes including primary and secondary outcomes was deemed low. CONCLUSIONS In selected patients eligible for a RCT, RoTME achieved improved distal resection margin distance and a shorter length of hospital stay. No other differences were observed in oncological or recovery parameters between (OpTME), laparoscopic (LapTME), robotic (RoTME), or trans-anal TME (TaTME). However, the overall quality of evidence across all outcomes was deemed low.
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Affiliation(s)
- Warren Seow
- Discipline of Surgery, Faculty of Health and Medical Sciences, School of Medicine, University of Adelaide, 4 North Terrace, Adelaide, South Australia, 5000, Australia
| | - Nagendra N Dudi-Venkata
- Discipline of Surgery, Faculty of Health and Medical Sciences, School of Medicine, University of Adelaide, 4 North Terrace, Adelaide, South Australia, 5000, Australia.
- Colorectal Unit, Department of Surgery, Royal Adelaide Hospital, Adelaide, South Australia, Australia.
| | - Sergei Bedrikovetski
- Discipline of Surgery, Faculty of Health and Medical Sciences, School of Medicine, University of Adelaide, 4 North Terrace, Adelaide, South Australia, 5000, Australia
| | - Hidde M Kroon
- Discipline of Surgery, Faculty of Health and Medical Sciences, School of Medicine, University of Adelaide, 4 North Terrace, Adelaide, South Australia, 5000, Australia
- Colorectal Unit, Department of Surgery, Royal Adelaide Hospital, Adelaide, South Australia, Australia
| | - Tarik Sammour
- Discipline of Surgery, Faculty of Health and Medical Sciences, School of Medicine, University of Adelaide, 4 North Terrace, Adelaide, South Australia, 5000, Australia
- Colorectal Unit, Department of Surgery, Royal Adelaide Hospital, Adelaide, South Australia, Australia
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Paszt A, Ottlakan A, Abraham S, Simonka Z, Vas M, Maraz A, Szepes Z, Tiszlavicz L, Nyari T, Olah J, Lazar G. Clinical benefits of oral capecitabine over intravenous 5-fluorouracyl regimen in case of neoadjuvant chemoradiotherapy followed by surgery for locally advanced rectal cancer. Pathol Oncol Res 2022; 28:1610722. [PMID: 36567978 PMCID: PMC9773127 DOI: 10.3389/pore.2022.1610722] [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: 07/20/2022] [Accepted: 11/23/2022] [Indexed: 12/13/2022]
Abstract
Background: During the last decade, one of the most important treatment options for locally advanced, potencially resectable rectal tumours was neoadjuvant chemoradiotherapy (CRT) followed by surgery. Methods: Effects of the neoadjuvant treatment on surgical outcomes were retrospectively analysed in 185 patients with stage T2-T4 and N0-2, resectable rectal tumour among two patient groups defined by radiosensitizer agents. Group 1 (n = 94) involved radiotherapy (RT) with 50.4 Gy total dose (25 × 1.8 Gy + 3 × 1.8 Gy tumour bed boost), and intravenous 5-fluorouracil (5-FU) (350 mg/m2) with leucovorin (20 mg/m2) on the 1-5 and 21-25 days, while Group 2 (n = 91) RT and orally administrated capecitabine (daily 2 × 825 mg/m2) on RT days. Surgery was carried out after 8-10 weeks. Side effects, perioperative complications, type of surgery, number of removed regional lymph nodes, resection margins and tumour regression grade (TRG) were analysed. Results: More favourable side effects were observed in Group 2. Despite the same rate of diarrhoea (Group 1 vs. Group 2: 54.3% vs. 56.0%), Grade 2-3 diarrhoea ratio was lower (p = 0.0352) after capecitabine (Group 2). Weight loss occurred in 17.0% and 2.2% (p = 0.00067), while nausea and vomiting was described in 38.3% and 15.4% (p = 0.00045) with 5-FU treatment and capecitabine respectively. Anaemia was observed in 33.0% and 22.0% (p = 0.0941). Complete tumour regression occurred in 25.3% after oral- and 13.8% after intravenous treatment (p = 0.049). Ratio of sphincter preservation was higher with laparoscopy than open surgery (72.3% vs. 39.7%) (p = 0.00001). Conclusion: The study confirms advantages of neoadjuvant chemoradiotherapy with oral capecitabine for rectal tumours, such as more favourable side effect profile and overall clinical outcome, with increased rate of complete tumour regression.
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Affiliation(s)
- Attila Paszt
- Department of Surgery, University of Szeged, Szeged, Hungary,*Correspondence: Attila Paszt,
| | - Aurel Ottlakan
- Department of Surgery, University of Szeged, Szeged, Hungary
| | | | - Zsolt Simonka
- Department of Surgery, University of Szeged, Szeged, Hungary
| | - Marton Vas
- Department of Surgery, University of Szeged, Szeged, Hungary
| | - Aniko Maraz
- Department of Oncotherapy, University of Szeged, Szeged, Hungary
| | - Zoltan Szepes
- 1st Department of Internal Medicine, University of Szeged, Szeged, Hungary
| | | | - Tibor Nyari
- Department of Medical Physics and Informatics, University of Szeged, Szeged, Hungary
| | - Judit Olah
- Department of Oncotherapy, University of Szeged, Szeged, Hungary
| | - Gyorgy Lazar
- Department of Surgery, University of Szeged, Szeged, Hungary
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Comment on: Transanal Total Mesorectal Excision Versus Anterior Total Mesorectal Excision for Rectal Cancer: A Propensity Score-Matched, Population-Based Study in Catalonia, Spain. Dis Colon Rectum 2022; 65:e1079. [PMID: 36102840 DOI: 10.1097/dcr.0000000000002602] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
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Widder A, Backhaus J, Wierlemann A, Hering I, Flemming S, Hankir M, Germer CT, Wiegering A, Lock JF, König S, Seyfried F. Optimizing laparoscopic training efficacy by 'deconstruction into key steps': a randomized controlled trial with novice medical students. Surg Endosc 2022; 36:8726-8736. [PMID: 35851816 PMCID: PMC9652220 DOI: 10.1007/s00464-022-09408-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2022] [Accepted: 06/19/2022] [Indexed: 01/06/2023]
Abstract
BACKGROUND Simulator training is an effective way of acquiring laparoscopic skills but there remains a need to optimize teaching methods to accelerate learning. We evaluated the effect of the mental exercise 'deconstruction into key steps' (DIKS) on the time required to acquire laparoscopic skills. METHODS A randomized controlled trial with undergraduate medical students was implemented into a structured curricular laparoscopic training course. The intervention group (IG) was trained using the DIKS approach, while the control group (CG) underwent the standard course. Laparoscopic performance of all participants was video-recorded at baseline (t0), after the first session (t1) and after the second session (t2) nine days later. Two double-blinded raters assessed the videos. The Impact of potential covariates on performance (gender, age, prior laparoscopic experience, self-assessed motivation and self-assessed dexterity) was evaluated with a self-report questionnaire. RESULTS Both the IG (n = 58) and the CG (n = 68) improved their performance after each training session (p < 0.001) but with notable differences between sessions. Whereas the CG significantly improved their performance from t0 -t1 (p < 0.05), DIKS shortened practical exercise time by 58% so that the IG outperformed the CG from t1 -t2, (p < 0.05). High self-assessed motivation and dexterity associated with significantly better performance (p < 0.05). Male participants demonstrated significantly higher overall performance (p < 0.05). CONCLUSION Mental exercises like DIKS can improve laparoscopic performance and shorten practice times. Given the limited exposure of surgical residents to simulator training, implementation of mental exercises like DIKS is highly recommended. Gender, self-assessed dexterity, and motivation all appreciably influence performance in laparoscopic training.
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Affiliation(s)
- A Widder
- Department of General-, Visceral-, Transplant-, Vascular- and Pediatric Surgery, Center of Operative Medicine (ZOM), University Hospital of Wuerzburg, Würzburg, Germany.
| | - J Backhaus
- Institute of Medical Teaching and Medical Education Research, University Hospital of Wuerzburg, Würzburg, Germany.
| | - A Wierlemann
- Department of General-, Visceral-, Transplant-, Vascular- and Pediatric Surgery, Center of Operative Medicine (ZOM), University Hospital of Wuerzburg, Würzburg, Germany
| | - I Hering
- Department of General-, Visceral-, Transplant-, Vascular- and Pediatric Surgery, Center of Operative Medicine (ZOM), University Hospital of Wuerzburg, Würzburg, Germany
| | - S Flemming
- Department of General-, Visceral-, Transplant-, Vascular- and Pediatric Surgery, Center of Operative Medicine (ZOM), University Hospital of Wuerzburg, Würzburg, Germany
| | - M Hankir
- Department of General-, Visceral-, Transplant-, Vascular- and Pediatric Surgery, Center of Operative Medicine (ZOM), University Hospital of Wuerzburg, Würzburg, Germany
| | - C-T Germer
- Department of General-, Visceral-, Transplant-, Vascular- and Pediatric Surgery, Center of Operative Medicine (ZOM), University Hospital of Wuerzburg, Würzburg, Germany
| | - A Wiegering
- Department of General-, Visceral-, Transplant-, Vascular- and Pediatric Surgery, Center of Operative Medicine (ZOM), University Hospital of Wuerzburg, Würzburg, Germany
| | - J F Lock
- Department of General-, Visceral-, Transplant-, Vascular- and Pediatric Surgery, Center of Operative Medicine (ZOM), University Hospital of Wuerzburg, Würzburg, Germany
| | - S König
- Institute of Medical Teaching and Medical Education Research, University Hospital of Wuerzburg, Würzburg, Germany
| | - F Seyfried
- Department of General-, Visceral-, Transplant-, Vascular- and Pediatric Surgery, Center of Operative Medicine (ZOM), University Hospital of Wuerzburg, Würzburg, Germany
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Jung Y, Longo C, Tompa E. Longitudinal Assessment of Labor Market Earnings Among Patients Diagnosed With Cancer in Canada. JAMA Netw Open 2022; 5:e2245717. [PMID: 36547984 PMCID: PMC9857413 DOI: 10.1001/jamanetworkopen.2022.45717] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
IMPORTANCE To our knowledge, there have been no studies that estimated the short-, mid-, and long-term effects on cancer survivors' labor market earnings using administrative data. OBJECTIVE To estimate the change in labor market earnings due to cancer diagnosis stratified by cancer type and age category. DESIGN, SETTING, AND PARTICIPANTS This population-based cohort study used a retrospective analysis of Statistics Canada's administrative linkage file, which includes microdata from the 1991 Census, the Canadian Cancer Registry, mortality records, and personal income tax files. Participants included patients newly diagnosed with cancer from 1992 to 2008. All statistical analyses were finished on September 30, 2020. EXPOSURES Cancer diagnosis using the International Classification of Diseases, Ninth Revision, and the International Classification of Diseases, Tenth Revision. MAIN OUTCOMES AND MEASURES Annual and percent change in labor market earnings. The empirical strategy used a combination of the Mahalanobis distance and propensity score matching method and the difference-in-difference regression method to select a control group similar to the cancer survivors in this study and assess the association of the cancer diagnosis with labor market earnings, respectively. RESULTS A total of 59 532 patients with cancer and 243 446 patients without cancer were included in the main analysis. The mean (SD) age was similar between the matched treatment and control cohort (49.70 [8.1] years vs 49.68 [7.2] years), as was the proportion of females (0.49 vs 0.49), and the individual reported income ($37 937 [$18 645] vs $37 396 [$16 876]). The results showed the negative associations of cancer with labor market earnings. Additionally, the severity of the cancer was associated with labor market earnings, where cancer survivors with a severe type of cancer in terms of the 5-year survival rate are shown to have a larger and more persistent earnings difference compared with the control group. CONCLUSIONS AND RELEVANCE The findings of this cohort study suggest that labor market earnings losses are associated with a cancer diagnosis. A better understanding of the loss of labor market earnings following cancer diagnosis and by cancer type can play an important role in starting a dialogue in future policy initiatives to mitigate the financial burden faced by cancer survivors.
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Affiliation(s)
- Young Jung
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada
- Klick Health, Toronto, Ontario, Canada
| | - Christopher Longo
- DeGroote School of Business, McMaster University, Hamilton, Ontario, Canada
| | - Emile Tompa
- Department of Economic, McMaster University, Hamilton, Ontario, Canada
- Institute for Work and Health, Toronto, Ontario, Canada
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