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Ma Q, Cheng J, Bao Y, Gao Z, Jiang K, Wang S, Ye Y, Wang Y, Shen Z. Magnetic resonance imaging pelvimetry predicts the technical difficulty of rectal surgery. Asian J Surg 2021; 45:2626-2632. [PMID: 34961711 DOI: 10.1016/j.asjsur.2021.12.022] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2021] [Revised: 11/10/2021] [Accepted: 12/17/2021] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND The relationships between the pelvimetry and technical difficulties in performing rectal surgery for mid-low rectal cancer remain unclear. METHODS Two hundred and twenty-one cases of mid-low rectal cancer patients who underwent sphincter-preserved total mesorectum excision (TME) were analyzed. The data of the pelvimetry and the relative position between trocar site and tumor were measured with magnetic resonance imaging (MRI). RESULTS Univariate analysis showed that the interspinous diameter, the sacrococcygeal distance, and the angle of sacral promontory inclination were significantly associated with the technical difficulty during laparoscopic surgery, but only the interspinous diameter remained an independent risk factor in multivariate analysis. The simulated trocar angle θ was an independent risk factor affecting the operation time during laparoscopic surgery, simulated trocar angle η was significantly related to intraoperative blood loss in both laparoscopic surgery and transanal TME (taTME) surgery groups. CONCLUSION Interspinous diameter can predict difficulty in laparoscopic surgery and may provide useful information for preoperative planning and consideration of approach.
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Affiliation(s)
- Quanmin Ma
- Department of Gastroenterological Surgery, Peking University People's Hospital, Beijing, 100044, PR China; Laboratory of Surgical Oncology, Beijing Key Laboratory of Colorectal Cancer Diagnosis and Treatment Research, Peking University People's Hospital, Beijing, 100044, PR China
| | - Jin Cheng
- Department of Radiology, Peking University People's Hospital, Beijing, 100044, PR China
| | - Yudi Bao
- Department of Gastroenterological Surgery, Peking University People's Hospital, Beijing, 100044, PR China; Laboratory of Surgical Oncology, Beijing Key Laboratory of Colorectal Cancer Diagnosis and Treatment Research, Peking University People's Hospital, Beijing, 100044, PR China
| | - Zhidong Gao
- Department of Gastroenterological Surgery, Peking University People's Hospital, Beijing, 100044, PR China; Laboratory of Surgical Oncology, Beijing Key Laboratory of Colorectal Cancer Diagnosis and Treatment Research, Peking University People's Hospital, Beijing, 100044, PR China
| | - Kewei Jiang
- Department of Gastroenterological Surgery, Peking University People's Hospital, Beijing, 100044, PR China; Laboratory of Surgical Oncology, Beijing Key Laboratory of Colorectal Cancer Diagnosis and Treatment Research, Peking University People's Hospital, Beijing, 100044, PR China
| | - Shan Wang
- Department of Gastroenterological Surgery, Peking University People's Hospital, Beijing, 100044, PR China; Laboratory of Surgical Oncology, Beijing Key Laboratory of Colorectal Cancer Diagnosis and Treatment Research, Peking University People's Hospital, Beijing, 100044, PR China
| | - Yingjiang Ye
- Department of Gastroenterological Surgery, Peking University People's Hospital, Beijing, 100044, PR China; Laboratory of Surgical Oncology, Beijing Key Laboratory of Colorectal Cancer Diagnosis and Treatment Research, Peking University People's Hospital, Beijing, 100044, PR China
| | - Yi Wang
- Department of Radiology, Peking University People's Hospital, Beijing, 100044, PR China.
| | - Zhanlong Shen
- Department of Gastroenterological Surgery, Peking University People's Hospital, Beijing, 100044, PR China; Laboratory of Surgical Oncology, Beijing Key Laboratory of Colorectal Cancer Diagnosis and Treatment Research, Peking University People's Hospital, Beijing, 100044, PR China.
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Risk factors for suboptimal laparoscopic surgery in rectal cancer patients. Langenbecks Arch Surg 2020; 406:309-318. [PMID: 33244719 DOI: 10.1007/s00423-020-02029-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2020] [Accepted: 11/05/2020] [Indexed: 12/11/2022]
Abstract
PURPOSE Laparoscopic surgery for rectal cancer is technically complex. This study aimed to identify risk factors for suboptimal laparoscopic surgery (involved margins, incomplete mesorectal excision, and/or conversion to open surgery) in patients with rectal cancer. METHODS We included patients undergoing laparoscopic anterior resection for rectal cancer between June 2009 and June 2018. We defined the outcome variable suboptimal laparoscopic surgery as conversion to open surgery or inadequate histopathological specimens (margins < 1 mm or involved and/or poor-quality mesorectal excision). To identify independent predictors of suboptimal laparoscopic surgery, we analyzed 15 prospectively recorded demographic, clinical, and anthropometric variables obtained from our rectal cancer unit's database. Subanalyses examined the same variables with respect to conversion and to inadequate histopathological specimens. RESULTS Of the 323 patients included, 91 (28.2%) had suboptimal laparoscopic surgery. In the multivariate analysis, the independent factors associated with all suboptimal laparoscopic surgery were tumor location ≤ 5 cm from the anal verge (OR = 2.95, 0.95% CI 1.32-6.60; p = 0.008) and the intertuberous distance (OR = 0.79, 0.95% CI 0.65-0.96; p = 0.019). In the subanalyses, the promontorium-retropubic axis was an independent predictor of conversion (OR 0.70, 0.95% CI 0.51-0.96; p = 0.026), and tumor location ≤ 5 cm from the anal verge (OR 3.71, 0.95% 1.51-9.15; p = 0.004) was an independent predictor of inadequate histopathological specimens. CONCLUSIONS Predictive factors for suboptimal laparoscopic anterior resection for rectal cancer were tumor location and the intertuberous distance. These results could help surgeons decide whether to use other surgical approaches in complex cases. TRIAL REGISTRATION The study was registered at Clinicaltrials.org (No. NCT03107650).
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Amin-Tai H, Elnaim ALK, Wong MPK, Sagap I. Acquiring Advanced Laparoscopic Colectomy Skills - The Issues. Malays J Med Sci 2020; 27:24-35. [PMID: 33154699 PMCID: PMC7605826 DOI: 10.21315/mjms2020.27.5.3] [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: 03/24/2020] [Accepted: 05/14/2020] [Indexed: 10/28/2022] Open
Abstract
Colorectal surgery has been revolutionised towards minimally invasive surgery with the emergence of enhanced recovery protocol after surgery initiatives. However, laparoscopic colectomy has yet to be widely adopted, due mainly to the steep learning curve. We aim to review and discuss the methods of overcoming these learning curves by accelerating the competency level of the trainees without compromising patient safety. To provide this mini review, we assessed 70 articles in PubMed that were found through a search comprised the keywords laparoscopic colectomy, minimal invasive colectomy, learning curve and surgical education. We found England's Laparoscopic Colorectal National Training Programme (LAPCO-NTP) England to be by far the most structured programme established for colorectal surgeons, which involves pre-clinical and clinical phases that end with an assessment. For budding colorectal trainees, learning may be accelerated by simulator-based training to achieve laparoscopic dexterity coupled with an in-theatre proctorship by field experts. Task-specific checklists and video recordings are essential adjuncts to gauge progress and performance. As competency is established, careful case selections with the proctor are essential to maintain motivation and ensure safe performances. A structured programme to establish competency is vital to help both the proctor and trainee gauge real-time progress and performance. However, training systems both inside and outside the operating theatre (OT) are equally useful to achieve the desired performance.
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Affiliation(s)
- Hizami Amin-Tai
- Department of Surgery, Universiti Putra Malaysia, Kuala Lumpur, Malaysia
| | | | - Michael Pak Kai Wong
- School of Medical Sciences, Universiti Sains Malaysia, Kubang Kerian, Kelantan, Malaysia
| | - Ismail Sagap
- Universiti Kebangsaan Malaysia Medical Centre, Kuala Lumpur, Malaysia
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Brescia A, Mari FS, Favi F, Milillo A, Nigri G, Dall'Oglio A, Pancaldi A, Masoni L. Laparoscopic Lower Anterior Rectal Resection Using a Curved Stapler: Original Technique and Preliminary Experience. Am Surg 2020. [DOI: 10.1177/000313481307900322] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Laparoscopic low anterior rectal resection (LLAR), allowing better visualization and rectal mobilization, can reduce postoperative pain and recovery. A Contour Curved Stapler (CCS) is a very helpful device because of its curved profile that consents better access into the pelvic cavity and allows to perform rectal closure and section in one shot, especially in the presence of a narrow pelvis, complex anatomy, or large tumors. We developed an original technique of laparoscopic rectal resection using CCS. Between 2005 and 2009, in 36 cases, we performed LLAR with a three-trocar technique, starting with mobilization of left colonic flexure followed by the section of inferior mesenteric vessels. The rectum was prepared up to the levator ani with total mesorectal excision. The Lapdisc® was inserted trough a suprapubic midline incision, allowing the CCS stapler placement into the pelvic cavity. After the rectal section, the anastomosis was then performed with a circular stapler. Ileostomy was performed if neoadjuvant radiotherapy and chemotherapy have been carried out or if the anastomosis was below 4 cm from the anal verge. Mean operative time was 135 minutes and no intra- or postoperative bleeding occurred. In 27 patients we performed temporary ileostomy. In two cases we observed anastomotic leakage; one of these patients already had ileostomy. No anastomotic stenosis occurred after one-year follow-up. This procedure simplifies the section of the lower rectum, reduces leaking rate resulting from technical difficulties, and does not nullify the benefits of laparoscopy.
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Affiliation(s)
- Antonio Brescia
- From the Faculty of Medicine and Psychology, University “Sapienza” of Rome, St. Andreas Hospital of Rome, Rome, Italy
| | - Francesco Saverio Mari
- From the Faculty of Medicine and Psychology, University “Sapienza” of Rome, St. Andreas Hospital of Rome, Rome, Italy
| | - Francesco Favi
- From the Faculty of Medicine and Psychology, University “Sapienza” of Rome, St. Andreas Hospital of Rome, Rome, Italy
| | - Andrea Milillo
- From the Faculty of Medicine and Psychology, University “Sapienza” of Rome, St. Andreas Hospital of Rome, Rome, Italy
| | - Giuseppe Nigri
- From the Faculty of Medicine and Psychology, University “Sapienza” of Rome, St. Andreas Hospital of Rome, Rome, Italy
| | - Anna Dall'Oglio
- From the Faculty of Medicine and Psychology, University “Sapienza” of Rome, St. Andreas Hospital of Rome, Rome, Italy
| | - Alessandra Pancaldi
- From the Faculty of Medicine and Psychology, University “Sapienza” of Rome, St. Andreas Hospital of Rome, Rome, Italy
| | - Luigi Masoni
- From the Faculty of Medicine and Psychology, University “Sapienza” of Rome, St. Andreas Hospital of Rome, Rome, Italy
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Khilkov YS, Ponomarenko AA, Rybakov EG, Shelygin YA. OPEN, LAPAROSCOPIC AND TRANSANAL TOTAL MESORECTAL EXCISION: A SYSTEMATIC LITERATURE REVIEW AND NETWORK META ANALYSIS. ACTA ACUST UNITED AC 2019. [DOI: 10.33878/2073-7556-2019-18-4-37-85] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
AIM: to compare the effectiveness of different methods of total mesorectumectomy (TME).MATERIALS AND METHODS: the systematic review performed in accordance with PRISMA practice and recommendations.RESULTS: Forty-one papers were included in the analysis. Fourteen studies were for transanal total mesorectumectomy (TA TME) (n=480) compared with laparoscopic (LA TME), 26 – for LA TME vs open (n=6820), 1 – for open vs TA TME. There was no significant difference between open TME, LA TME and TA TME in grade 3 quality of mesorectumectomy by Quirke. The positive circular resection margin (CRM) is less often in TA TME group, then LA TME (OR=2.58, CI 1.34-4.97, p=0.005). There was significantly lower positive CRM rate in LA TME then open TME (OR=0.73, CI 0.63-0.85, p<0.0001). There were no significant differences in postoperative complications rates between LA TME and TA TME (p=0.72). Network meta-analysis showed less postoperative complications followed LA TME than open TME (OR=0.75, CI 0.65-0.84).CONCLUSION: TA TME is comparable with laparoscopic and open TME in short term results. Rates of positive CRM, the quality of Grade 1 mesorectal excision, the conversion rate, the postoperative urinary dysfunction, may have better results in TA TME.
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Affiliation(s)
- Yu. S. Khilkov
- State Scientific Centre of Coloproctology of the Ministry of Healthcare of Russia
| | - A. A. Ponomarenko
- State Scientific Centre of Coloproctology of the Ministry of Healthcare of Russia
| | - E. G. Rybakov
- State Scientific Centre of Coloproctology of the Ministry of Healthcare of Russia
| | - Yu. A. Shelygin
- State Scientific Centre of Coloproctology of the Ministry of Healthcare of Russia
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Toda S, Kuroyanagi H, Matoba S, Hiramatsu K, Okazaki N, Tate T, Tomizawa K, Hanaoka Y, Moriyama J. Laparoscopic treatment of rectal cancer and lateral pelvic lymph node dissection: are they obsolete? MINERVA CHIR 2018; 73:558-573. [PMID: 29795062 DOI: 10.23736/s0026-4733.18.07704-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Laparoscopic surgery for rectal cancer offers favorable short-term results without compromising long term oncological outcomes so far, according to the data from major trials. For this reason, it is currently considered as a standard option for rectal cancer surgery. The learning curve of laparoscopic rectal cancer surgery is generally longer compared to colon cancer. Appropriate standardization and training of laparoscopic rectal cancer surgery is required. Several RCTs suggested the potential negative effect on quality of resected specimen, which can increase local recurrence. The long-term outcomes - especially local recurrence rate - of these RCTs are awaited. Lateral pelvic lymph node dissection (LPLND) has a certain effect of reducing local recurrence of rectal cancer even after neoadjuvant radiotherapy. Since LPLND is associated with postoperative morbidity, we should carefully select the candidate to maximize the effect of LPLND and minimize the morbidity caused by LPLND. Recent advancements in imaging study such as CT and MRI enable us to find the suitable candidates for LPLND. The morbidity caused by LPLND could be reduced by minimally invasive surgeries such as laparoscopic surgery and robotic surgery. We have to improve oncological outcomes and reduce morbidity by the multidisciplinary strategy for rectal cancer including total mesorectal excision, neoadjuvant chemoradiotherapy and LPLND together with laparoscopic surgery.
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Affiliation(s)
- Shigeo Toda
- Department of Gastroenterological Surgery, Toranomon Hospital, Tokyo, Japan -
| | - Hiroya Kuroyanagi
- Department of Gastroenterological Surgery, Toranomon Hospital, Tokyo, Japan
| | - Shuichiro Matoba
- Department of Gastroenterological Surgery, Toranomon Hospital, Tokyo, Japan
| | - Kosuke Hiramatsu
- Department of Gastroenterological Surgery, Toranomon Hospital, Tokyo, Japan
| | - Naoto Okazaki
- Department of Gastroenterological Surgery, Toranomon Hospital, Tokyo, Japan
| | - Tomohiro Tate
- Department of Gastroenterological Surgery, Toranomon Hospital, Tokyo, Japan
| | - Kenji Tomizawa
- Department of Gastroenterological Surgery, Toranomon Hospital, Tokyo, Japan
| | - Yutaka Hanaoka
- Department of Gastroenterological Surgery, Toranomon Hospital, Tokyo, Japan
| | - Jin Moriyama
- Department of Gastroenterological Surgery, Toranomon Hospital, Tokyo, Japan
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Allaix ME, Giraudo G, Ferrarese A, Arezzo A, Rebecchi F, Morino M. 10-Year Oncologic Outcomes After Laparoscopic or Open Total Mesorectal Excision for Rectal Cancer. World J Surg 2017; 40:3052-3062. [PMID: 27417110 DOI: 10.1007/s00268-016-3631-x] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
BACKGROUND Only few studies have compared laparoscopic total mesorectal excision (LTME) and open total mesorectal excision (OTME) for rectal cancer with follow-up longer than 5 years. The aim of this study was to compare 10-year oncologic outcomes after LTME and OTME for nonmetastatic rectal cancer. METHODS We conducted a retrospective analysis of a prospective database of rectal cancer patients undergoing LTME or OTME. Statistical analyses were performed on an ''intention-to-treat'' basis and by actual treatment. Overall survival (OS) and disease-free survival (DFS) were compared by using the Kaplan-Meier method. A multivariable analysis was performed to identify predictors of poor survival. RESULTS Between April 1994 and August 2005, a total of 153 LTME patients and 154 OTME patients were included. Similarly, 10-year OS and DFS after LTME and OTME were observed: 76.8 versus 70.6 % (P = 0.138) and 69.1 versus 67.6 % (P = 0.508), respectively. Conversion to OTME did not adversely affect OS and DFS. Stage-by-stage comparison showed no significant differences between LTME and OTME. No significant differences were observed in local recurrence rates after LTME and OTME (6.5 vs. 7.8 %, P = 0.837). Median time until local recurrence was 24.5 (range, 12-56) months after LTME and 22 (6-64) months after OTME (P = 0.777). Poor tumor differentiation, lymphovascular invasion, and a lymph node ratio of 0.25 or more were the independent predictors of poorer OS and DFS. CONCLUSION This retrospective study with long follow-up did not show significant differences between the two groups in OS and DFS.
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Affiliation(s)
- Marco E Allaix
- Department of Surgical Sciences, University of Torino, Corso Dogliotti 14, 10126, Torino, Italy.
| | - Giuseppe Giraudo
- Department of Surgical Sciences, University of Torino, Corso Dogliotti 14, 10126, Torino, Italy
| | - Alessia Ferrarese
- Department of Surgical Sciences, University of Torino, Corso Dogliotti 14, 10126, Torino, Italy
| | - Alberto Arezzo
- Department of Surgical Sciences, University of Torino, Corso Dogliotti 14, 10126, Torino, Italy
| | - Fabrizio Rebecchi
- Department of Surgical Sciences, University of Torino, Corso Dogliotti 14, 10126, Torino, Italy
| | - Mario Morino
- Department of Surgical Sciences, University of Torino, Corso Dogliotti 14, 10126, Torino, Italy
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Zheng J, Feng X, Yang Z, Hu W, Luo Y, Li Y. The comprehensive therapeutic effects of rectal surgery are better in laparoscopy: a systematic review and meta-analysis. Oncotarget 2017; 8:12717-12729. [PMID: 28038460 PMCID: PMC5355048 DOI: 10.18632/oncotarget.14215] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2016] [Accepted: 12/20/2016] [Indexed: 12/16/2022] Open
Abstract
Background Laparoscopic-assisted radical resection of rectal cancer was reported as advantageous compared to laparotomy resection. However, this finding remains controversial, especially given the two recent randomized controlled trials published on The Journal of the American Medical Association (JAMA). Objective To perform a meta-analysis that compares the short-term and long-term outcomes of laparoscopic and open surgery for rectal cancer. Data source To identify clinical trials comparing laparoscopic and open surgery for rectal cancer published by August 2016, we searched the PubMed, Cochrane Library, Springer Link and Clinicaltrials.gov databases by combining various key words. Data were extracted from every identified study to perform a meta-analysis using the Review Manager 5.3 software. Results A total of 43 articles from 38 studies with a total of 13408 patients were included. Although laparoscopic radical rectectomy increased operation time (MD = 37.23, 95% CI: 28.88 to 45.57, P < 0.0001), it can significantly decrease the blood loss (MD = –143.13, 95% CI: –183.48 to –102.78, P < 0.0001), time to first bowel movement (MD = –0.97, 95% CI: –1.35 to –0.59, P < 0.0001), length of hospital stay (MD = –2.40, 95% CI: –3.10 to –1.70, P < 0.0001), postoperative complications (OR = 0.78, 95% CI: 0.72 to 0.86, P < 0.0001), mortality (OR = 0.40, 95% CI: 0.28 to 0.57, P < 0.0001) and the CRM positive rate (OR = 0.64, 95% CI: 0.55 to 0.75, P < 0.0001). No significant difference were noted between the groups regarding intraoperative complications, TME completeness and harvesting of lymph nodes. Regarding the long-term survival data, the laparoscopic group was not inferior to laparotomy. Some pooled data, such as 3-year DFS, 5-year OS and 5-year local recurrence were even superior for the laparoscopic group. Conclusions Given the definite benefits in short-term outcomes and trending benefits in long-term outcomes that were observed, we recommend laparoscopic surgery be used for rectal cancer resection.
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Affiliation(s)
- Jiabin Zheng
- Department of General Surgery, Guangdong General Hospital and Guangdong Academy of Medical Sciences, Guangzhou, 510080, China
| | - Xingyu Feng
- Department of General Surgery, Guangdong General Hospital and Guangdong Academy of Medical Sciences, Guangzhou, 510080, China
| | - Zifeng Yang
- Department of General Surgery, Guangdong General Hospital and Guangdong Academy of Medical Sciences, Guangzhou, 510080, China
| | - Weixian Hu
- Department of General Surgery, Guangdong General Hospital and Guangdong Academy of Medical Sciences, Guangzhou, 510080, China.,Southern Medical University, Guangzhou, 510515, China
| | - Yuwen Luo
- Department of General Surgery, Guangdong General Hospital and Guangdong Academy of Medical Sciences, Guangzhou, 510080, China.,Southern Medical University, Guangzhou, 510515, China
| | - Yong Li
- Department of General Surgery, Guangdong General Hospital and Guangdong Academy of Medical Sciences, Guangzhou, 510080, China
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9
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Risk Factors for Conversion and Morbidity During Initial Experience in Laparoscopic Proctectomies: a Retrospective Study. Indian J Surg 2017; 79:90-95. [PMID: 28442832 DOI: 10.1007/s12262-015-1426-1] [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: 08/25/2015] [Accepted: 12/23/2015] [Indexed: 10/22/2022] Open
Abstract
The aim of this study was to determine the predictable factors for conversion during laparoscopic proctectomies, and for postoperative morbidity, in order to assist in defining the best candidates of patients for initial experience in laparoscopic proctectomies for rectal adenocarcinoma. A retrospective analysis of consecutive patients who underwent laparoscopic rectal resection for rectal adenocarcinoma operated by a single surgeon, between 2005 and 2012, were performed. Predictive factors for conversion and for postoperative morbidity were analyzed using univariate and multivariate analysis. Sixty-nine patients were included. There were 35 (50.7 %) men with a median age of 53 years. Forty-seven patients had tumors located below 8 cm from the anal verge, and sphincter-preserving surgery was performed in 52 (75.4 %) patients. Thirty-four patients were operated in the early period (before 2009). Conversion rate was 17.4 %. In multivariate analysis, the independent predictive factors for conversion were time period (before 2009) (p = 0.007, Exp. 19.9; CI (95 %) 2.2-177.4) and tumors located 8 cm above the anal verge (p = 0.028, Exp. 5.23, CI (95 %) 1.2-22.8). Twenty-two patients (31.9 %) had a complicated postoperative course. Only male gender was associated with postoperative complications (p = 0.01, CI (95 %) 1.3-11.8). Our study showed that conversion rate is influenced by surgeon's experience, and height of the tumor and that male gender is a predisposing factor for a higher morbidity rate. These results suggest that women with low rectal tumors requiring colo-anal anastomosis or abdomino-perineal resection would be the best candidates for early surgeons' experience in laparoscopic proctectomies for rectal adenocarcinoma.
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Otani T, Isohata N, Kumamoto K, Endo S, Utano K, Nemoto D, Aizawa M, Lefor AK, Togashi K. An evidence-based medicine approach to the laparoscopic treatment of colorectal cancer. Fukushima J Med Sci 2016; 62:74-82. [PMID: 27477991 DOI: 10.5387/fms.2016-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
During the 1990s, laparoscopic resection was established as a treatment for gastrointestinal malignant tumors. A number of randomized controlled trials comparing laparoscopic-assisted colorectal surgery with conventional open colorectal surgery for colon cancer have been conducted. These trials have shown short-term benefits, and the vast majority demonstrated no significant difference in long-term outcomes. Laparoscopic-assisted colorectal surgery is widely performed for the treatment of colon cancer, whereas laparoscopic-assisted colorectal surgery for rectal cancer is less commonly performed. In recent years, there have been an increasing number of reports of laparoscopic-assisted colorectal surgery for rectal cancer, where improving short-term outcomes was shown, but no definitive effect on long-term survival has been shown to date. Randomized controlled trials focusing on long-term survival are currently ongoing.
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Affiliation(s)
- Taisuke Otani
- Department of Coloproctology, Aizu Medical Center, Fukushima Medical University
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11
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Comparison of short-term and oncologic outcomes of robotic and laparoscopic resection for mid- and distal rectal cancer. Surg Endosc 2016; 31:2798-2807. [PMID: 27785627 DOI: 10.1007/s00464-016-5289-8] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2016] [Accepted: 10/13/2016] [Indexed: 12/14/2022]
Abstract
PURPOSE Laparoscopic rectal resection with total mesorectal excision is a technically challenging procedure, and there are limitations in conventional laparoscopy. A surgical robotic system may help to overcome some of the limitations. This study aimed to compare the short-term operative as well as oncologic outcomes of laparoscopic and robotic rectal resection. METHODS This study was based on a prospectively collected database of patients with mid- to distal rectal cancer (up to 12 cm from the anal verge) undergoing either laparoscopic or robotic low anterior resection from January 2008 to June 2015. Data on patient demographics, intraoperative parameters and short-term outcomes were analyzed. Patient survival and recurrence were also compared. RESULTS During the study period, 171 and 220 consecutive patients underwent laparoscopic and robotic rectal resection, respectively. The median age was 65 years (range 23-96). The median tumor distance was 8 and 7 cm from the anal verge in the laparoscopic and robotic groups, respectively (p = 0.06). Significantly more male patients and more patients with comorbidities and preoperative radiation underwent robotic surgery. The median operating time for robotic resection was significantly longer, 260 versus 225 min (p < 0.001). Conversion rates of laparoscopic and robotic resection were 3.5 and 0.8 %, respectively (p = 0.308). The median hospital stay was 6 days in both groups (p = 0.29). There was no difference in the overall complication rate, but the incidence of urinary retention was significantly less in the robotic group (4.1 vs. 10.5 %, p = 0.024). With a median follow-up of 31 months, there was no difference in local recurrence, overall survival and disease-specific survival between the two groups. CONCLUSIONS In the treatment of mid- to low rectal cancer, robotic resection can achieve operative results and oncologic outcomes comparable to laparoscopic resection. The postoperative urinary retention rate is lower following robotic surgery.
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12
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Foo CC, Law WL. The Learning Curve of Robotic-Assisted Low Rectal Resection of a Novice Rectal Surgeon. World J Surg 2016; 40:456-62. [PMID: 26423674 DOI: 10.1007/s00268-015-3251-x] [Citation(s) in RCA: 57] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND With the increasing availability of the surgical robotic system, the young generation colorectal surgeons may learn robotic-assisted rectal surgery upfront. There are currently very limited studies evaluating the learning curve of novice rectal surgeons. OBJECTIVE This study aimed to evaluate the learning curve of a surgeon who had limited experience in open and laparoscopic rectal surgery. METHODS Thirty-nine consecutive robotic-assisted total mesorectal excisions were performed from March 2013 to October 2014. All cases were performed by a single surgeon whose prior experience in open or laparoscopic low rectal cancer resections was <5 cases. The learning curve was analyzed using the cumulative sum method. RESULTS Thirty-four low anterior resections, four abdomino-perineal resections, and one Hartmann's operation were performed. The mean total operating time was 397.2 ± 184.3 min. There was no conversion. The major complication rate was 10.3 %. When total operating time was analyzed with the CUSUM method, three phases could be identified. They are the initial eight cases, middle 17 cases, and the final 14 cases. The first phase consisted of more proximal tumors (86.3 ± 20.7 vs. 58.0 ± 34.9 mm from anal verge, p = 0.04) and was associated with a shorter total operating time (243.5 ± 38.0 vs. 540.9 ± 133.4 min, p = 0.000) and less estimated blood loss (81.3 ± 25.9 vs. 168.8 ± 99.5 ml, p = 0.02) compared to the second phase. When the third phase is compared with the first and second phase, it has shorter total operating time (310.6 ± 164.5 vs. 44 5.7 ± 179.8 min, p = 0.03). Complications rate were 12.5, 17.6, and 0 % for phase one, two, and three respectively. CONCLUSIONS In this study, the learning curve for a novice rectal surgeon was 25 cases. This is comparable to those who have already mastered the technique with laparoscopic or open approach. Surgical robotic system may have a role in shortening the learning curve for low rectal resection.
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Affiliation(s)
- Chi Chung Foo
- Division of Colorectal Surgery, Department of Surgery, University of Hong Kong, Queen Mary Hospital, Pok Fu Lam, Hong Kong.
| | - Wai Lun Law
- Division of Colorectal Surgery, Department of Surgery, University of Hong Kong, Queen Mary Hospital, Pok Fu Lam, Hong Kong
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Anthuber M, Kriening B, Schrempf M, Geißler B, Märkl B, Rüth S. [Laparoscopic rectal resection technique]. Chirurg 2016; 87:560-6. [PMID: 27277556 DOI: 10.1007/s00104-016-0196-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
The quality of radical oncological operations for patients with rectal cancer determines the rate of local recurrence and long-term survival. Neoadjuvant chemoradiotherapy for locally advanced tumors, a standardized surgical procedure for rectal tumors less than 12 cm from the anus with total mesorectal excision (TME) and preservation of the autonomous nerve system for sexual and bladder function have significantly improved the oncological results and quality of life of patients. The TME procedure for rectal resection has been performed laparoscopically in Germany for almost 20 years; however, no reliable data are available on the frequency of laparoscopic procedures in rectal cancer patients in Germany. The rate of minimally invasive procedures is estimated to be less than 20 %. A prerequisite for using the laparoscopic approach is implicit adherence to the described standards of open surgery. Available data from prospective randomized trials, systematic reviews and meta-analyses indicate that in the early postoperative phase the generally well-known positive effects of the minimally invasive approach to the benefit of patients can be realized without any long-term negative impact on the oncological results; however, the results of many of these studies are difficult to interpret because it could not be confirmed whether the hospitals and surgeons involved had successfully completed the learning curve. In this article we would like to present our technique, which we have developed over the past 17 years in more than 1000 patients. Based on our experiences the laparoscopic approach can be highly recommended as a suitable alternative to the open procedure.
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Affiliation(s)
- M Anthuber
- Klinik für Allgemein-, Viszeral- und Transplantationschirurgie, Klinikum Augsburg, Stenglinstr.2, 86156, Augsburg, Deutschland.
| | - B Kriening
- Klinik für Allgemein-, Viszeral- und Transplantationschirurgie, Klinikum Augsburg, Stenglinstr.2, 86156, Augsburg, Deutschland
| | - M Schrempf
- Klinik für Allgemein-, Viszeral- und Transplantationschirurgie, Klinikum Augsburg, Stenglinstr.2, 86156, Augsburg, Deutschland
| | - B Geißler
- Klinik für Allgemein-, Viszeral- und Transplantationschirurgie, Klinikum Augsburg, Stenglinstr.2, 86156, Augsburg, Deutschland
| | - B Märkl
- Institut für Pathologie, Klinikum Augsburg, Augsburg, Deutschland
| | - S Rüth
- Klinik für Allgemein-, Viszeral- und Transplantationschirurgie, Klinikum Augsburg, Stenglinstr.2, 86156, Augsburg, Deutschland
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Schietroma M, Pessia B, Carlei F, Cecilia EM, Amicucci G. Gut barrier function and systemic endotoxemia after laparotomy or laparoscopic resection for colon cancer: A prospective randomized study. J Minim Access Surg 2016; 12:254-9. [PMID: 27279398 PMCID: PMC4916753 DOI: 10.4103/0972-9941.169982] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
PURPOSE: The gut barrier is altered in certain pathologic conditions (shock, trauma, or surgical stress), resulting in bacterial and/or endotoxin translocation from the gut lumen into the systemic circulation. In this prospective randomized study, we investigated the effect of surgery on intestinal permeability (IP) and endotoxemia in patients undergoing elective colectomy for colon cancer by comparing the laparoscopic with the open approach. PATIENTS AND METHODS: A hundred twenty-three consecutive patients underwent colectomy for colon cancer: 61 cases were open resection (OR) and 62 cases were laparoscopic resection (LR). IP was measured preoperatively and at days 1 and 3 after surgery. Serial venous blood sample were taken at 0, 30, 60, 90, 120, and 180 min, and at 12, 24, and 48 h after surgery for endotoxin measurement. RESULTS: IP was significantly increased in the open and closed group at day 1 compared with the preoperative level (P < 0.05), but no difference was found between laparoscopic and open surgery group. The concentration endotoxin systemic increased significantly in the both groups during the course of surgery and returned to baseline levels at the second day. No difference was found between laparoscopic and open surgery. A significant correlation was observed between the maximum systemic endotoxin concentration and IP measured at day 1 in the open group and in the laparoscopic group. CONCLUSION: An increase in IP, and systemic endotoxemia were observed during the open and laparoscopic resection for colon cancer, without significant statistically difference between the two groups.
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Affiliation(s)
| | - Beatrice Pessia
- Department of Surgery, University of L'Aquila, L'Aquila, Italy
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Shin DW, Shin JY, Oh SJ, Park JK, Yu H, Ahn MS, Bae KB, Hong KH, Ji YI. The Prognostic Value of Circumferential Resection Margin Involvement in Patients with Extraperitoneal Rectal Cancer. Am Surg 2016. [DOI: 10.1177/000313481608200421] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
The prognostic influence of circumferential resection margin (CRM) status in extraperitoneal rectal cancer probably differs from that of intraperitoneal rectal cancer because of its different anatomical and biological behaviors. However, previous reports have not provided the data focused on extraperitoneal rectal cancer. Therefore, the aim of this study was to examine the prognostic significance of the CRM status in patients with extraperitoneal rectal cancer. From January 2005 to December 2008, 248 patients were treated for extraperitoneal rectal cancer and enrolled in a pro-spectively collected database. Extraperitoneal rectal cancer was defined based on tumors located below the anterior peritoneal reflection, as determined intraoperatively by a surgeon. Cox model was used for multivariate analysis to examine risk factors of recurrence and mortality in the 248 patients, and multivariate logistic regression analysis was performed to identify predictors of recurrence and mortality in 135 patients with T3 rectal cancer. CRM involvement for extraperitoneal rectal cancer was present in 29 (11.7%) of the 248 patients, and was the identified predictor of local recurrence, overall recurrence, and death by multivariate Cox analysis. In the 135 patients with T3 cancer, CRM involvement was found to be associated with higher probability of local recurrence and mortality. In extraperitoneal rectal cancer, CRM involvement is an independent risk factor of recurrence and survival. Based on the results of the present study, it seems that CRM involvement in extraperitoneal rectal cancer is considered an indicator for (neo)adjuvant therapy rather than conventional TN status.
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Affiliation(s)
- Dong Woo Shin
- Department of Surgery, Haeundae Paik Hospital, College of Medicine, Inje University, Haeundae-ro, Haeundae-gu, Pusan, Korea
| | - Jin Yong Shin
- Department of Surgery, Haeundae Paik Hospital, College of Medicine, Inje University, Haeundae-ro, Haeundae-gu, Pusan, Korea
| | - Sung Jin Oh
- Department of Surgery, Haeundae Paik Hospital, College of Medicine, Inje University, Haeundae-ro, Haeundae-gu, Pusan, Korea
| | - Jong Kwon Park
- Department of Surgery, Haeundae Paik Hospital, College of Medicine, Inje University, Haeundae-ro, Haeundae-gu, Pusan, Korea
| | - Hyeon Yu
- Department of Surgery, Haeundae Paik Hospital, College of Medicine, Inje University, Haeundae-ro, Haeundae-gu, Pusan, Korea
| | - Min Sung Ahn
- Department of Surgery, Pusan Paik Hospital, College of Medicine, Inje University, Pusan, Korea
| | - Ki Beom Bae
- Department of Surgery, Pusan Paik Hospital, College of Medicine, Inje University, Pusan, Korea
| | - Kwan Hee Hong
- Department of Surgery, Pusan Paik Hospital, College of Medicine, Inje University, Pusan, Korea
| | - Yong Il Ji
- Department of Gynecology and Obstetrics, Haeundae Paik Hospital, College of Medicine, Inje University, Haeundae-ro, Haeundae-gu, Pusan, Korea
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16
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BERALDO FB, YUSUF SAI, PALMA RT, KHARMANDAYAN S, GONÇALVES JE, WAISBERG J. URINARY DYSFUNCTION AFTER SURGICAL TREATMENT FOR RECTAL CANCER. ARQUIVOS DE GASTROENTEROLOGIA 2015; 52:180-5. [DOI: 10.1590/s0004-28032015000300005] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/01/2015] [Accepted: 03/06/2015] [Indexed: 01/21/2023]
Abstract
BackgroundThe impact on quality of life attributed to treatment for rectal cancer remains high. Deterioration of the urinary function is a relevant complication within that context.ObjectiveTo detect the presence of urinary dysfunction and its risk factors among individuals underwent surgical treatment for rectal cancer.MethodsThe present prospective study analyzed 42 patients from both genders underwent surgical treatment for rectal adenocarcinoma with curative intent. The version of the International Prostatic Symptom Score (IPSS) questionnaire validated for the Portuguese language was applied at two time-points: immediately before and 6 months after surgery. Risk factors for urinary dysfunction were analysed by means of logistic regression and Student’s t-test.ResultsEight (19%) participants exhibited moderate-to-severe urinary dysfunction 6 months after surgery; the average IPSS increased from 1.43 at baseline to 4.62 six months after surgery (P<0.001). None of the variables assessed as potential risk factors exhibited statistical significance, i.e., age, gender, distance from tumour to anal margin, neoadjuvant therapy, adjuvant therapy, type of surgery, surgical approach (laparoscopy or laparotomy), and duration of surgery.ConclusionThis study identified an incidence of 19% of moderate to severe urinary dysfuction after 6 months surveillance. No risk factor for urinary dysfunction was identified in this population.
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Affiliation(s)
| | | | - Rogério Tadeu PALMA
- Hospital do Servidor Público Estadual de São Paulo, Brazil; Faculdade de Medicina do ABC, Brazil
| | | | | | - Jaques WAISBERG
- Hospital do Servidor Público Estadual de São Paulo, Brazil; Faculdade de Medicina do ABC, Brazil
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17
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Mohamed ZK, Law WL. Outcome of tumor-specific mesorectal excision for rectal cancer: the impact of laparoscopic resection. World J Surg 2015; 38:2168-74. [PMID: 24671302 DOI: 10.1007/s00268-014-2533-z] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
OBJECTIVE The study aimed to compare the outcomes of laparoscopic and open resection for rectal cancer in 1,063 consecutive cases in a single center. METHODS We performed an analysis of 11 years of experience in rectal cancer surgery and compared the outcome of laparoscopic and open surgery. Multivariate and subgroup analysis was performed to look at the effect of the level of tumor and stage of disease on short-term outcomes like conversion rate, anastomotic leak rate, length of stay, complication rate, 30-day mortality, and long-term outcomes like local recurrence and survival. RESULTS A total of 1,063 patients underwent rectal resection with 470 (44.2%) patients undergoing the laparoscopic approach. Groups were comparable in terms of age, sex, or co-morbidities, and the operating time was longer in the laparoscopic group (210 vs. 150 min; p value < 0.001). A conversion rate of 6.8% was noted, with an anastomotic leak rate of 3.87% in the open group and 2.97% in the laparoscopic group. The laparoscopic group had a lower blood loss (100 vs. 350 ml; p < 0.001), lower complication rates, and shorter length of stay (6 vs. 9 days). The local recurrence rate was comparable, and the laparoscopic approach had better overall and cancer-specific survival, even after adjusting for stages. The laparoscopic approach was an independent factor associated with better overall and cancer-specific survival on multivariate analysis. CONCLUSION We confirmed the oncological safety of laparoscopic rectal cancer surgery. Laparoscopic surgery also showed superiority in the short-term and long-term outcomes of rectal cancer.
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Affiliation(s)
- Zakir K Mohamed
- Division of Colorectal Surgery, Department of Surgery, The University of Hong Kong, Queen Mary Hospital, 102 Pokfulam Road, Hong Kong, China
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18
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Zhou ZX, Zhao LY, Lin T, Liu H, Deng HJ, Zhu HL, Yan J, Li GX. Long-term oncologic outcomes of laparoscopic vs open surgery for stages II and III rectal cancer: A retrospective cohort study. World J Gastroenterol 2015; 21:5505-5512. [PMID: 25987773 PMCID: PMC4427672 DOI: 10.3748/wjg.v21.i18.5505] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2014] [Accepted: 02/13/2015] [Indexed: 02/06/2023] Open
Abstract
AIM: To evaluate the 5-year survival after laparoscopic surgery vs open surgery for stages II and III rectal cancer.
METHODS: This study enrolled 406 consecutive patients who underwent curative resection for stages II and III rectal cancer between January 2000 and December 2009 [laparoscopic rectal resection (LRR), n = 152; open rectal resection (ORR), n = 254]. Clinical characteristics, operative outcomes, pathological outcomes, postoperative recovery, and 5-year survival outcomes were compared between the two groups.
RESULTS: Most of the clinical characteristics were similar except age (59 years vs 55 years, P = 0.033) between the LRR group and ORR group. The proportion of anterior resection was higher in the LRR group than that in the ORR group (81.6% vs 66.1%, P = 0.001). The LRR group had less estimated blood loss (50 mL vs 200 mL, P < 0.001) and a lower rate of blood transfusion (4.6% vs 11.8%, P = 0.019) compared to the ORR group. The pathological outcomes of the two groups were comparable. The LRR group was associated with faster recovery of bowel function (2.8 d vs 3.7 d, P < 0.001) and shorter postoperative hospital stay (11.7 d vs 13.7 d, P < 0.001). The median follow-up time was 63 mo in the LRR group and 65 mo in the ORR group. As for the survival outcomes, the 5-year local recurrence rate (16.0% vs 16.4%, P = 0.753), 5-year disease-free survival (DFS) rate (63.0% vs 63.1%, P = 0.589), and 5-year overall survival (OS) rate (68.1% vs 63.5%, P = 0.682) were comparable between the LRR group and the ORR group. Stage by stage, there were also no statistical differences between the LRR group and the ORR group in terms of the 5-year local recurrence rate (stage II: 6.3% vs 8.7%, P = 0.623; stage III: 26.4% vs 23.2%, P = 0.747), 5-year DFS rate (stage II: 77.5% vs 77.6%, P = 0.462; stage III: 46.5% vs 50.9%, P = 0.738), and 5-year OS rate (stage II: 81.4% vs 74.3%, P = 0.242; stage III: 53.9% vs 54.1%, P = 0.459).
CONCLUSION: LRR for stages II and III rectal cancer can yield comparable long-term survival while achieving short-term benefits compared to open surgery.
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The Role of the Laparoscopy on Circumferential Resection Margin Positivity in Patients With Rectal Cancer. Surg Laparosc Endosc Percutan Tech 2015; 25:129-37. [DOI: 10.1097/sle.0000000000000060] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
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20
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Transanal total mesorectal excision of rectal carcinoma: evidence to learn and adopt the technique. Ann Surg 2015; 261:234-6. [PMID: 25565121 DOI: 10.1097/sla.0000000000000886] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
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21
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Xiong B, Ma L, Huang W, Zhao Q, Cheng Y, Liu J. Robotic versus laparoscopic total mesorectal excision for rectal cancer: a meta-analysis of eight studies. J Gastrointest Surg 2015; 19:516-26. [PMID: 25394387 DOI: 10.1007/s11605-014-2697-8] [Citation(s) in RCA: 95] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2013] [Accepted: 11/02/2014] [Indexed: 01/31/2023]
Abstract
BACKGROUND Robotic surgery has been used successfully in many branches of surgery, but there is little evidence in the literature on its use in rectal cancer (RC). We conducted this meta-analysis of randomized controlled trials (RCTs) and non-randomized controlled trials (NRCTs) to evaluate whether the safety and efficacy of robotic total mesorectal excision (RTME) in patients with RC are equivalent to those of laparoscopic TME (LTME). METHODS Pubmed, Embase, Cochrane Library, Ovid, and Web of Science databases were searched. Studies clearly documenting a comparison of RTME with LTME for RC were selected. Operative and recovery outcomes, early postoperative morbidity, and oncological parameters were evaluated. RESULTS Eight studies were identified that included 1229 patients in total, 554 (45.08 %) in the RTME group and 675 (54.92 %) in the LTME group. Compared with LTME, RTME was associated with lower conversion rate (OR 0.23, 95 % CI [0.10, 0.52]; P = 0.0004), lower positive rate of circumferential resection margins (CRM) (2.74 % vs 5.78 %, OR 0.44, 95 % CI [0.20, 0.96], P = 0.04), and lesser incidence of erectile dysfunction (ED) (OR 0.09, 95 % CI [0.02, 0.41]; P = 0.002). Operation time, estimated blood loss, recovery outcome, postoperative morbidity and mortality, length of hospital stay, number of lymph nodes harvested, distal resection margin (DRM), proximal resection margin (PRM), and local recurrence had no significant differences between the two groups. CONCLUSIONS RTME is safe and feasible and may be an alternative treatment for RC. More international multicenter prospective large sample RCTs investigating the long-term oncological and functional outcomes are needed to determine the advantages of RTME over LTME in RC.
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Affiliation(s)
- Binghong Xiong
- Department of General Surgery, Peking University Shougang Hospital, No 9 Jinyuanzhuang Road, Shijingshan District, 100144, Beijing, People's Republic of China,
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22
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Cho MS, Kim CW, Baek SJ, Hur H, Min BS, Baik SH, Lee KY, Kim NK. Minimally invasive versus open total mesorectal excision for rectal cancer: Long-term results from a case-matched study of 633 patients. Surgery 2015; 157:1121-9. [PMID: 25737005 DOI: 10.1016/j.surg.2015.01.010] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2014] [Revised: 01/01/2015] [Accepted: 01/20/2015] [Indexed: 02/09/2023]
Abstract
BACKGROUND This study compared the long-term oncologic outcomes of patients with rectal cancer who underwent either laparoscopic or robotic total mesorectal excision (TME) via minimally invasive surgery (MIS) to those patient who underwent open TME. METHODS This study was a retrospective, case-control study; patients in the 2 groups were matched according to age, sex, MIS vs open operation, body mass index, tumor location, pathologic TNM stage (ie, tumor-node-metastasis), neoadjuvant treatment, and adjuvant treatment. RESULTS A total of 633 patients (MIS, n = 211; open, n = 422) were assessed. The median follow-up period was 64 (2-124) months. Patient characteristics did not differ between the groups. Overall postoperative complication rates did not differ between the groups (16.0% [MIS]; 17.0% [open]; P = .76). Rates of the involvement of the circumferential resection margin did not differ between the groups (4.0% [MIS]; 5.0% [open]; P = .84). The 5-year overall survival, disease-specific survival, disease-free survival, and local recurrence rates were not different between the MIS and open groups (overall survival = 88.4% vs 85.3%, P = .23; disease-specific survival = 88.8% vs 87.4%, P = .53, disease-free survival = 80.7% vs 78.4%, P = .74; local recurrence = 5.7% vs 5.1%, P = .95). In subgroup analysis, no differences were found in terms of the long-term, oncologic outcomes, oncologic adequacy, and postoperative complications among 3 groups. CONCLUSION We found no differences in the oncologic outcomes between MIS and open surgery, suggesting that MIS for rectal cancer is a safe option for rectal cancer that does not increase the risk of serious complications.
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Affiliation(s)
- Min Soo Cho
- Section of Colon and Rectal Surgery, Department of Surgery, Yonsei University College of Medicine, Seoul, Korea
| | - Chang Woo Kim
- Section of Colon and Rectal Surgery, Department of Surgery, Yonsei University College of Medicine, Seoul, Korea
| | - Se Jin Baek
- Section of Colon and Rectal Surgery, Department of Surgery, Yonsei University College of Medicine, Seoul, Korea
| | - Hyuk Hur
- Section of Colon and Rectal Surgery, Department of Surgery, Yonsei University College of Medicine, Seoul, Korea
| | - Byung Soh Min
- Section of Colon and Rectal Surgery, Department of Surgery, Yonsei University College of Medicine, Seoul, Korea
| | - Seung Hyuk Baik
- Section of Colon and Rectal Surgery, Department of Surgery, Yonsei University College of Medicine, Seoul, Korea
| | - Kang Young Lee
- Section of Colon and Rectal Surgery, Department of Surgery, Yonsei University College of Medicine, Seoul, Korea
| | - Nam Kyu Kim
- Section of Colon and Rectal Surgery, Department of Surgery, Yonsei University College of Medicine, Seoul, Korea.
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Martellucci J, Bergamini C, Bruscino A, Prosperi P, Tonelli P, Todaro A, Valeri A. Laparoscopic total mesorectal excision for extraperitoneal rectal cancer: long-term results. Int J Colorectal Dis 2014; 29:1493-9. [PMID: 25248320 DOI: 10.1007/s00384-014-2017-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/16/2014] [Indexed: 02/08/2023]
Abstract
UNLABELLED The long-term role of laparoscopy in the treatment of rectal cancer is still controversial. The aim of the present study was to evaluate the safety, the feasibility, the perioperative outcome, and the long-term results of laparoscopic total mesorectal excision (TME) for extraperitoneal rectal cancer considering a single center series. METHODS Data about 186 unselected consecutive patients that underwent laparoscopic TME for middle and low rectal cancer between January 2001 and December 2011 were prospectively recorded and were included in the present study. RESULTS Distribution of TNM stage was 5 % T1, 37 % T2, 52.5 % T3, and 6 % T4. Fifty-one percent of patients have lymph node metastases. The average duration of surgery was 234 min. Fourteen patients required conversion (7.5 %). A complete microscopic excision was achieved in 169 patients (91 %). The mean hospital stay was 9 days. The overall postoperative morbidity rate was 24 %. Surgical-related complications were reported in 19 %. Overall mortality was 0.5 %. Sex, tumor level, and the presence of a stoma were the only statistically significant independent risk factors for anastomotic leakage. Median follow-up was 71 months. The 5-year overall survival rate was 77 %, with 89 % for stage 1, 81 % for stage 2, 43 % for stage 3, and 10 % for stage 4. The 5-year disease-free survival rate was 66 %. The 10-year survival rate was 54 %. Nine patients (4.8 %) experienced a pelvic recurrence. Late metastases developed in 31 patients (17.2 %). CONCLUSIONS The study confirms the oncological safety of laparoscopic TME in a long follow-up period.
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Affiliation(s)
- Jacopo Martellucci
- General, Emergency and Mini-invasive Surgery, Careggi University Hospital, largo Brambilla 3, 50134, Florence, Italy,
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Shearer R, Gale M, Aly OE, Aly EH. Have early postoperative complications from laparoscopic rectal cancer surgery improved over the past 20 years? Colorectal Dis 2014; 15:1211-26. [PMID: 23711242 DOI: 10.1111/codi.12302] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2012] [Accepted: 01/21/2013] [Indexed: 02/01/2023]
Abstract
AIM Laparoscopic rectal cancer surgery has been increasingly used since 1991 following the publication of the first case series. Since then, several studies have confirmed that laparoscopic surgery for rectal cancer is challenging with associated morbidity and mortality. The aim of this study was to determine if the rates of early postoperative complications in laparoscopic rectal cancer surgery have improved over the past 20 years. METHOD A literature search of the EMBASE and MEDLINE databases between August 1991 and August 2011 was conducted using the keywords laparoscopy, rectal cancer and postoperative complications. Data were analysed using linear regression ANOVA performed in GNUMERICS software. RESULTS Ninety-seven studies were included for analysis. Over the last 20 years there has been no significant change in the rate of any early postoperative complications (anastomotic leak, conversion, sexual, urinary or faecal dysfunction, wound infection, overall morbidity or mortality). However, in the last 3 years, the rate of positive resection margins has decreased significantly (P = 0.01). CONCLUSION There was no evidence of a statistically significant change in early postoperative complications until 3 years ago. This may reflect the inherent morbidity associated with rectal surgery regardless of the approach used, the limitations of the current laparoscopic instrumentation or the relatively long learning curve. With increasing experience, a repeat analysis in the near future following the publication of ongoing randomized clinical trials might show improved outcomes.
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Affiliation(s)
- R Shearer
- Laparoscopic Colorectal Surgery and Training Unit, Aberdeen Royal Infirmary, Aberdeen, UK
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25
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Shussman N, Wexner SD. Current status of laparoscopy for the treatment of rectal cancer. World J Gastroenterol 2014; 20:15125-15134. [PMID: 25386061 PMCID: PMC4223246 DOI: 10.3748/wjg.v20.i41.15125] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2014] [Revised: 05/23/2014] [Accepted: 06/23/2014] [Indexed: 02/07/2023] Open
Abstract
Surgery for rectal cancer in complex and entails many challenges. While the laparoscopic approach in general and specific to colon cancer has been long proven to have short term benefits and to be oncologically safe, it is still a debatable topic for rectal cancer. The attempt to benefit rectal cancer patients with the known advantages of the laparoscopic approach while not compromising their oncologic outcome has led to the conduction of many studies during the past decade. Herein we describe our technique for laparoscopic proctectomy and assess the current literature dealing with short term outcomes, immediate oncologic measures (such as lymph node yield and specimen quality) and long term oncologic outcomes of laparoscopic rectal cancer surgery. We also briefly evaluate the evolving issues of robotic assisted rectal cancer surgery and the current innovations and trends in the minimally invasive approach to rectal cancer surgery.
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Arezzo A, Passera R, Salvai A, Arolfo S, Allaix ME, Schwarzer G, Morino M. Laparoscopy for rectal cancer is oncologically adequate: a systematic review and meta-analysis of the literature. Surg Endosc 2014; 29:334-48. [PMID: 25007974 DOI: 10.1007/s00464-014-3686-4] [Citation(s) in RCA: 63] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2014] [Accepted: 06/10/2014] [Indexed: 12/18/2022]
Abstract
BACKGROUND This review of cancer outcomes is based on key literature searches of the medical databases and meta-analysis of short-term benefits of laparoscopy in rectal cancer treatment. METHODS We carried out a systematic review of randomized clinical trials (RCTs) and prospective non-randomized controlled trials (non-RCTs) published between January 2000 and September 2013 listed in the MEDLINE and EMBASE databases (PROSPERO Registration number: CRD42013005076). The primary endpoint was clearance of the circumferential resection margin. Meta-analysis was performed using a fixed-effect model, and sensitivity analysis by a random-effect model; subgroup analysis was performed on subsets of patients with extraperitoneal cancer of the rectum. Relative risk (RR) and mean difference (MD) were used as outcome measures. RESULTS Twenty-seven studies (10,861 patients) met the inclusion criteria; eight were RCTs (2,659 patients). The RCTs reported involvement of the circumferential margin in 7.9 % of patients who underwent laparoscopic and in 6.9 % of those undergoing open surgery; the overall RR was 1.00 (95 % confidence interval 0.73-1.35) with no heterogeneity. Subgroup analysis of patients with extraperitoneal cancer showed equivalent involvement of the circumferential margin in the two treatment groups. Although significantly more lymph nodes were retrieved in the surgical specimen after open surgery, the MD of -0.56 was of marginal clinical significance. The sensitivity and subgroup analyses revealed no other significant differences between laparoscopic and open surgery in the rate of R0 resections, distal margin clearance, mesorectal fascia integrity, or local recurrence at 5 years. CONCLUSIONS Based on the evidence from RCTs and non-RCTs, the short-term benefit and oncological adequacy of laparoscopic rectal resection appear to be equivalent to open surgery, with some evidence potentially pointing to comparable long-term outcomes and oncological adequacy in selected patients with primary resectable rectal cancer.
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Affiliation(s)
- Alberto Arezzo
- Department of Surgical Sciences, University of Torino, Corso Dogliotti 14, 10126, Turin, Italy,
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Arezzo A, Passera R, Scozzari G, Verra M, Morino M. Laparoscopy for extraperitoneal rectal cancer reduces short-term morbidity: Results of a systematic review and meta-analysis. United European Gastroenterol J 2014; 1:32-47. [PMID: 24917939 DOI: 10.1177/2050640612473753] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2012] [Accepted: 12/12/2012] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND The role of laparoscopy in the treatment of extraperitoneal rectal cancer is still controversial. The aim of the study was to evaluate differences in safety of laparoscopic rectal resection for extraperitoneal cancer, compared with open surgery. MATERIALS AND METHODS A systematic review from 2000 to July 2012 was performed searching the MEDLINE and EMBASE databases (PROSPERO registration number CRD42012002406). We included randomized and prospective controlled clinical studies comparing laparoscopic and open resection for rectal cancer. Primary endpoints were 30-day mortality and morbidity. Then a meta-analysis was conducted by a fixed-effect model, performing a sensitivity analysis by a random-effect model. Relative risk (RR) was used as an indicator of treatment effect. RESULTS Eleven studies, representing 1684 patients, met the inclusion criteria: four were randomized for a total of 814 patients. Mortality was observed in 1.2% of patients in the laparoscopic group and in 2.3% of patients in the open group, with an RR of 0.56 (95% CI 0.19-1.64, p = 0.287). The overall incidence of short-term complications was lower in the laparoscopic group (31.5%) compared to the open group (38.2%), with an RR of 0.83 (95% CI 0.73-0.94, p = 0.004). Surgical complications, wound complications, blood loss and the need for blood transfusion, time for bowel movement recovery, food intake recovery, and hospital stay were significantly lower or less frequent in the laparoscopic group. The incidence of intra-operative injuries, anastomotic leakages, and surgical re-interventions was similar in the two groups. Only operative time was in favour of the open group. CONCLUSIONS Based on the evidence of both randomized and prospective controlled series, mortality was lower after laparoscopy although not significantly so, while the short-term morbidity RR, including subgroup analysis, was significantly lower after laparoscopy for extraperitoneal rectal cancer compared to open surgery.
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Affiliation(s)
- Alberto Arezzo
- Department of Surgical Sciences, University of Turin, Turin, Italy
| | - Roberto Passera
- Division of Nuclear Medicine, University of Turin, Turin, Italy
| | - Gitana Scozzari
- Department of Surgical Sciences, University of Turin, Turin, Italy
| | - Mauro Verra
- Department of Surgical Sciences, University of Turin, Turin, Italy
| | - Mario Morino
- Department of Surgical Sciences, University of Turin, Turin, Italy
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Long-term oncologic outcomes of laparoscopic versus open surgery for rectal cancer: a pooled analysis of 3 randomized controlled trials. Ann Surg 2014; 259:139-47. [PMID: 23598381 DOI: 10.1097/sla.0b013e31828fe119] [Citation(s) in RCA: 54] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
OBJECTIVE To compare long-term oncologic outcomes between laparoscopic and open surgery for rectal cancer and to identify independent predictors of survival. BACKGROUND Few randomized trials comparing laparoscopic and open surgery for rectal cancer have reported long-term survival data. METHODS Data from the 3 randomized controlled trials comparing curative laparoscopic (n=136) and open surgery (n=142) for upper, mid, and low rectal cancer conducted at the Prince of Wales Hospital, Hong Kong, between September 1993 and August 2007 were pooled together for this analysis. Survival and disease status were updated to February 2012. Survival was calculated using the Kaplan-Meier method, and independent predictors of survival were determined using the Cox regression analysis. RESULTS The demographic data of the 2 groups were comparable. The median follow-up time of living patients was 124.5 months in the laparoscopic group and 136.6 months in the open group. At 10 years, there were no significant differences in locoregional recurrence (5.5% vs. 9.3%; P=0.296), cancer-specific survival (82.5% vs. 77.6%; P=0.443), and overall survival (63.0% vs. 61.1%; P=0.505) between the laparoscopic and open groups. There was a trend toward lower recurrence rate at 10 years in the laparoscopic group than in the open group among patients with stage III cancer (P=0.078). The Cox regression analysis showed that stage III cancer, lymphovascular permeation, and blood transfusion, but not the operative approach, were independent predictors of poorer cancer-specific survival. CONCLUSIONS This pooled analysis with a follow-up of more than 10 years confirms the long-term oncologic safety of laparoscopic surgery for rectal cancer.
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Chen H, Zhao L, An S, Wu J, Zou Z, Liu H, Li G. Laparoscopic versus open surgery following neoadjuvant chemoradiotherapy for rectal cancer: a systematic review and meta-analysis. J Gastrointest Surg 2014; 18:617-26. [PMID: 24424713 DOI: 10.1007/s11605-014-2452-1] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/17/2013] [Accepted: 01/02/2014] [Indexed: 01/31/2023]
Abstract
BACKGROUND This meta-analysis aimed to evaluate the short-term and pathological outcomes of laparoscopic surgery (LS) versus open surgery (OS) following neoadjuvant chemoradiotherapy (NCRT) for rectal cancer. METHODS PubMed, Embase, Web of Science, Cochrane Library, and Chinese Biomedicine Literature databases were searched for eligible studies published up to July 2013. The rates of postoperative complication, positive circumferential resection margin (CRM), and the number of lymph nodes harvested were evaluated. RESULTS Three randomized controlled trials (RCTs) and five non-RCTs enrolling 953 patients were included. Compared to OS, LS had similar rate of postoperative complication [odds ratio (OR) 0.86; 95% confidence interval (CI), 0.60 to 1.22], comparable rate of positive CRM (OR 0.41; 95% CI, 0.16 to 1.02), and smaller number of lymph nodes (weighted mean difference -0.8; 95% CI, -1.1 to -0.5). LS also had significantly less blood loss, faster bowel movement recovery, and shorter postoperative hospitalization than those of OS. CONCLUSION LS is associated with favorable short-term benefits, similar postoperative complication rate, and comparable pathological outcomes for rectal cancer after NCRT compared to OS despite a slight difference in the number of lymph nodes. Additional high-quality studies are needed to validate long-term outcomes of LS following NCRT.
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Affiliation(s)
- Hao Chen
- Department of General Surgery, Nanfang Hospital, Southern Medical University, No.1838, North Guangzhou Avenue, Guangzhou, 510515, China
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Xiong B, Ma L, Zhang C, Cheng Y. Robotic versus laparoscopic total mesorectal excision for rectal cancer: a meta-analysis. J Surg Res 2014; 188:404-14. [PMID: 24565506 DOI: 10.1016/j.jss.2014.01.027] [Citation(s) in RCA: 65] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2013] [Revised: 01/05/2014] [Accepted: 01/16/2014] [Indexed: 12/15/2022]
Abstract
BACKGROUND Robotic surgery has been used successfully in many branches of surgery; but there is little evidence in the literature on its use in rectal cancer (RC). We conducted this meta-analysis that included randomized controlled trials and nonrandomized controlled trials of robotic total mesorectal excision (RTME) versus laparoscopic total mesorectal excision (LTME) to evaluate whether the safety and efficacy of RTME in patients with RC are equivalent to those of LTME. MATERIALS AND METHODS Pubmed, Embase, Cochrane Library, Ovid, and Web of Science databases were searched. Studies clearly documenting a comparison of RTME with LTME for RC were selected. Operative and recovery outcomes, early postoperative morbidity, and oncological parameters were evaluated. RESULTS Eight studies were identified that included 1229 patients in total, 554 (45.08%) in the RTME and 675 (54.92%) in the LTME. Meta-analysis suggested that the conversion rate to open surgery in RTME was significantly lower than in LTME (P = 0.0004). There were no significant differences in operation time, estimated blood loss, recovery outcome, postoperative morbidity and mortality, length of hospital stay, and the oncological accuracy of resection and local recurrence between the two groups. The positive rate of circumferential resection margins (P = 0.04) and the incidence of erectile dysfunction (P = 0.002) were lower in RTME compared with LTME. CONCLUSIONS RTME for RC is safe and feasible, and the short- and medium-term oncological and functional outcomes are equivalent or preferable to LTME. It may be an alternative treatment for RC. More multicenter randomized controlled trials investigating the long-term oncological and functional outcomes are required to determine the advantages of RTME over LTME in RC.
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Affiliation(s)
- Binghong Xiong
- Department of General Surgery, the First Affiliated Hospital of Chongqing Medical University, Chongqing, People's Republic of China.
| | - Li Ma
- Department of Internal Medicine, Chongqing Huaxi Hospital, Chongqing, People's Republic of China
| | - CaiQuan Zhang
- Department of General Surgery, the First Affiliated Hospital of Chongqing Medical University, Chongqing, People's Republic of China
| | - Yong Cheng
- Department of General Surgery, the First Affiliated Hospital of Chongqing Medical University, Chongqing, People's Republic of China.
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Toda S, Kuroyanagi H. Laparoscopic surgery for rectal cancer: current status and future perspective. Asian J Endosc Surg 2014; 7:2-10. [PMID: 24355022 DOI: 10.1111/ases.12074] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2013] [Revised: 10/01/2013] [Accepted: 10/04/2013] [Indexed: 01/14/2023]
Abstract
Although laparoscopic surgery for colon cancer is accepted in the treatment guidelines, the laparoscopic approach for rectal cancer is recommended only in clinical trials. Thus far, several trials have shown favorable short-term results such as early recovery and short hospital stay, but long-term results remain a critical concern for laparoscopic rectal cancer surgery. To date, no randomized control trials have shown an increased local recurrence after laparoscopic surgery for rectal cancer. Additionally, according to previous studies, open conversion, which is more frequent in laparoscopic rectal surgery than in laparoscopic colon surgery, may affect short-term and long-term survival. The evidence on male sexual function has been contradictory. Long-term results from ongoing multicenter trials will be available within several years. Based on accumulated evidence from well-organized clinical trials, laparoscopic surgery will likely be accepted as a treatment choice for rectal cancer. In the future, extended laparoscopic rectal surgery might be feasible for additional procedures such as laparoscopic lateral pelvic lymph node dissection and laparoscopic total pelvic exenteration for rectal cancer invading the adjacent pelvic organ.
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Affiliation(s)
- Shigeo Toda
- Department of Gastroenterological Surgery, Toranomon Hospital, Tokyo, Japan
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Rausei S, Iovino D, Tenconi S, Mangano A, Inversini D, Boni L, Rovera F, Dionigi G, Dionigi R. Impact of lymph node ratio on survival of colorectal cancer patients. Int J Surg 2013; 11 Suppl 1:S95-9. [DOI: 10.1016/s1743-9191(13)60026-6] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
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Hur H, Bae SU, Kim NK, Min BS, Baik SH, Lee KY, Kim YT, Choi YD. Comparative study of voiding and male sexual function following open and laparoscopic total mesorectal excision in patients with rectal cancer. J Surg Oncol 2013; 108:572-8. [DOI: 10.1002/jso.23435] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2013] [Accepted: 08/22/2013] [Indexed: 12/13/2022]
Affiliation(s)
- Hyuk Hur
- Department of Surgery, Obstetrics and Gynecology, Severance Hospital; Yonsei University College of Medicine; Seoul Korea
| | - Sung Uk Bae
- Department of Surgery, Obstetrics and Gynecology, Severance Hospital; Yonsei University College of Medicine; Seoul Korea
| | - Nam Kyu Kim
- Department of Surgery, Obstetrics and Gynecology, Severance Hospital; Yonsei University College of Medicine; Seoul Korea
| | - Byung Soh Min
- Department of Surgery, Obstetrics and Gynecology, Severance Hospital; Yonsei University College of Medicine; Seoul Korea
| | - Seung Hyuk Baik
- Department of Surgery, Obstetrics and Gynecology, Severance Hospital; Yonsei University College of Medicine; Seoul Korea
| | - Kang Young Lee
- Department of Surgery, Obstetrics and Gynecology, Severance Hospital; Yonsei University College of Medicine; Seoul Korea
| | - Young Tae Kim
- Department of Obsterics and Gynecology, Severance Hospital; Yonsei University College of Medicine; Seoul Korea
| | - Young Deuk Choi
- Department of Urology, Severance Hospital; Yonsei University College of Medicine; Seoul Korea
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Influence of conversion on the perioperative and oncologic outcomes of laparoscopic resection for rectal cancer compared with primarily open resection. Surg Endosc 2013; 27:4675-83. [PMID: 23943120 DOI: 10.1007/s00464-013-3108-z] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2013] [Accepted: 07/04/2013] [Indexed: 02/06/2023]
Abstract
BACKGROUND This study aimed to evaluate the influence of conversion on perioperative and short- and long-term oncologic outcomes in laparoscopic resection for rectal cancer and to compare these with those for an open control group. METHODS The data of 276 consecutive patients who underwent surgery for rectal cancer between 2006 and 2010 at a single institution were prospectively collected. Of the 276 patients, 114 underwent primarily open surgery, and 162 underwent laparoscopic surgery (on an intention-to-treat basis). Of the 162 laparoscopic patients, 38 (23.5%) underwent conversion to open surgery. The three groups of patients were compared: the conversion surgery group, the open surgery group, and the completed laparoscopy surgery group. RESULTS The converted patients had more wound infections (18.4 vs 4.8%, p = 0.009), but the wound infection rate in the primarily open group also was significantly higher than in the laparoscopic resection group (p = 0.007). No further differences in perioperative morbidity, including anastomotic leakage, were found. The perioperative 30-day mortality rate was comparable between all the groups (0.6 vs 2.6 vs 2.6%, nonsignificant difference). The oncologic parameters such as number of harvested lymph nodes and rate of R0 resection were equal in all the groups. The completed laparoscopy group had a shorter hospital stay [12 vs 16 days in the primarily open group (p = 0.02) vs 15 days in the converted group (p = 0.03)]. The rates for survival, local recurrence (4.5 vs 3 vs 3%), and metachronous metastasis (10.1 vs 9.3 vs 9%) did not differ significantly between the three groups after a period of 3 years. CONCLUSION Conversion to open surgery in laparoscopic rectal resection has no negative effect on perioperative or long-term oncologic outcome.
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Park JS, Choi GS, Jun SH, Park SY, Kim HJ. Long-term outcomes after laparoscopic surgery versus open surgery for rectal cancer: a propensity score analysis. Ann Surg Oncol 2013; 20:2633-40. [PMID: 23709099 DOI: 10.1245/s10434-013-2981-y] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2012] [Indexed: 12/25/2022]
Abstract
BACKGROUND The aim of this study was to compare the long-term outcomes of laparoscopy-assisted surgery (LAP) with those for open surgery (OS) when excising nonmetastatic rectal cancers. METHODS We reviewed the prospectively collected records of all patients (n = 1,009) undergoing OS or LAP from January 2000 to November 2008 at Kyungpook National University Hospital. We undertook propensity score analyses and compared outcomes for the OS and LAC groups in a 1:1 matched cohort. Covariates in the model for propensity scores included age, gender, preoperative tumor marker level, preoperative chemoradiation status, tumor height from the anal verge, and clinical tumor stage. Subgroup analysis was conducted to evaluate the oncologic safety of LAP in patients with extraperitoneal rectal cancers. RESULTS There were no significant differences in mortality, morbidity, and pathological quality in the propensity-matched cohort (n = 812). The combined 3-year local recurrence rate for all tumor stages was 3.8 % (95 % confidence intervals [95 % CI], 1.9-5.7 %) in the LAP group and 5.9 % (95 % CI, 3.9-8.3 %) in the OS group (P = .089 by log-rank test). The combined 3-year disease-free survival for all stages was 80.5 % (95 % CI, 76.6-84.4 %) in the LAP group and 82.9 % (95 % CI 79.2-86.6 %) in the OS group (P = .516 by log-rank test). Similar results were confirmed for the subgroup of patients with extraperitoneal rectal cancers. CONCLUSIONS Laparoscopic rectal excision for rectal cancer is feasible and safe with acceptable oncologic outcomes. Further prospective multicenter trials are warranted before incorporating this technology into routine surgical care.
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Affiliation(s)
- Jun Seok Park
- Colorectal Cancer Center, Kyungpook National University Medical Center, School of Medicine, Kyungpook National University, Daegu, South Korea
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de Manzini N, Leon P, Tarchi P, Giacca M. Surgical Strategy: Indications. Updates Surg 2013. [DOI: 10.1007/978-88-470-2670-4_13] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Lim SB, Kim JC. Surgical issues in locally advanced rectal cancer treated by preoperative chemoradiotherapy. JOURNAL OF THE KOREAN SURGICAL SOCIETY 2012; 84:1-8. [PMID: 23323229 PMCID: PMC3539104 DOI: 10.4174/jkss.2013.84.1.1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 11/07/2012] [Revised: 11/10/2012] [Accepted: 11/11/2012] [Indexed: 12/16/2022]
Abstract
The standard treatment for patients with locally advanced rectal cancer is preoperative chemoradiotherapy followed by total mesorectal excision. This approach is supported by randomized trials, but there are still many unanswered questions about the multimodal management of rectal cancer. In surgical terms, these include the optimal time interval between completion of chemoradiotherapy and surgery; adequate distal resection margin and circumferential radial margin; sphincter preservation; laparoscopic surgery; and conservative management, including a 'wait and see' policy and local excision. This review considers these controversial issues in preoperative chemoradiotherapy.
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Affiliation(s)
- Seok-Byung Lim
- Department of Surgery, Asan Medical Center, Institute of Innovative Cancer Research, University of Ulsan College of Medicine, Seoul, Korea
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Allaix ME, Arezzo A, Cassoni P, Mistrangelo M, Giraudo G, Morino M. Metastatic lymph node ratio as a prognostic factor after laparoscopic total mesorectal excision for extraperitoneal rectal cancer. Surg Endosc 2012; 27:1957-67. [DOI: 10.1007/s00464-012-2694-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2012] [Accepted: 10/23/2012] [Indexed: 12/11/2022]
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Krane MK, Fichera A. Laparoscopic rectal cancer surgery: Where do we stand? World J Gastroenterol 2012; 18:6747-55. [PMID: 23239912 PMCID: PMC3520163 DOI: 10.3748/wjg.v18.i46.6747] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2012] [Revised: 10/10/2012] [Accepted: 10/16/2012] [Indexed: 02/06/2023] Open
Abstract
Large comparative studies and multiple prospective randomized control trials (RCTs) have reported equivalence in short and long-term outcomes between the open and laparoscopic approaches for the surgical treatment of colon cancer which has heralded widespread acceptance for laparoscopic resection of colon cancer. In contrast, laparoscopic total mesorectal excision (TME) for the treatment of rectal cancer has been welcomed with significantly less enthusiasm. While it is likely that patients with rectal cancer will experience the same benefits of early recovery and decreased postoperative pain from the laparoscopic approach, whether the same oncologic clearance, specifically an adequate TME can be obtained is of concern. The aim of the current study is to review the current level of evidence in the literature on laparoscopic rectal cancer surgery with regard to short-term and long-term oncologic outcomes. The data from 8 RCTs, 3 meta-analyses, and 2 Cochrane Database of Systematic Reviews was reviewed. Current data suggests that laparoscopic rectal cancer resection may benefit patients with reduced blood loss, earlier return of bowel function, and shorter hospital length of stay. Concerns that laparoscopic rectal cancer surgery compromises short-term oncologic outcomes including number of lymph nodes retrieved and circumferential resection margin and jeopardizes long-term oncologic outcomes has not conclusively been refuted by the available literature. Laparoscopic rectal cancer resection is feasible but whether or not it compromises short-term or long-term results still needs to be further studied.
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Arezzo A, Passera R, Scozzari G, Verra M, Morino M. Laparoscopy for rectal cancer reduces short-term mortality and morbidity: results of a systematic review and meta-analysis. Surg Endosc 2012. [PMID: 23183871 DOI: 10.1007/s00464-012-2649-x] [Citation(s) in RCA: 103] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND Although definitive long-term results are not yet available, the global safety of laparoscopic surgery for rectal cancer treatment remains controversial. We evaluated differences in the safety of laparoscopic rectal resection versus open surgery for cancer. METHODS A systematic review from 2000 to 2011 was performed searching the Medline and Embase databases (prospero registration CRD42012002406). We included randomized and prospective controlled clinical studies comparing laparoscopic and open resection for rectal cancer. Primary end points were 30-day mortality and overall morbidity. Then a meta-analysis was conducted by a fixed-effect model, performing a sensitivity analysis by a random-effect model. Relative risk (RR) was used as an indicator of treatment effect; a RR of less than 1.0 was in favor of laparoscopy. Publication bias was assessed by funnel plot and heterogeneity by the I (2) test and subgroup analysis on surgical and medical complications. RESULTS Twenty-three studies, representing 4,539 patients, met the inclusion criteria; eight were randomized for a total of 1,746 patients. Mortality was observed in 1.0 % of patients in the laparoscopic group and in 2.4 % of patients in the open group. The overall RR was 0.46 (95 % confidence interval 0.21-0.99, p = 0.048). The raw incidence of overall complications was lower in the laparoscopic group (31.8 %) compared to the open group (35.4 %). The overall RR was 0.83 (95 % confidence interval 0.76-0.91, p < 0.001). CONCLUSIONS On the basis of evidence of both randomized and prospective controlled series, mortality and morbidity RR, including subgroup analysis, were significantly lower after laparoscopic compared to open surgery.
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Affiliation(s)
- Alberto Arezzo
- Department of Surgical Sciences, University of Turin, Turin, Italy.
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Mari FS, Gasparrini M, Nigri G, Berardi G, Laracca GG, Flora B, Pancaldi A, Brescia A. Can a curved stapler made for open surgery be useful in laparoscopic lower rectal resections? Technique and experience of a single centre. Surgeon 2012. [PMID: 23182656 DOI: 10.1016/j.surge.2012.10.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
BACKGROUND The use of laparoscopy to perform lower anterior rectal resection is increasing worldwide because it allows better visualisation and rectal mobilisation and also reduces postoperative pain and recovery. The Contour Curved Stapler (CCS) is a very helpful device because of its curved profile that enables better access into the pelvic cavity and allows rectal closure and section to be performed in one shot. In this paper, we present an original technique to use this device, made for open surgery, in laparoscopy and the results of our experience. METHODS We retrospectively evaluated the data of all patients who underwent lower laparoscopic anterior rectal resection and in which the CCS was used to perform section of the rectum between September 2005 and September 2011. To perform section of the rectum a Lapdisc(®) was inserted through a 6-7 cm supra-pubic midline incision to allow placement of the CCS into the pelvic cavity. Patients' biographical and surgical data such as sex, age, indication for surgery, infection, anastomotic leakage or stenosis and staple-line bleeding were prospectively collected in a computerised database and evaluated. RESULTS Between September 2005 and September 2011, we performed 45 laparoscopic lower rectal resection using CCS, 27 male and 18 female with a mean age of 61 years (range 40-82 years) and a mean body mass index (BMI) of 26.5 kg/m(2) (range 16.5-35 kg/m(2)). In 29 cases a temporary ileostomy was performed. Mean operative time was 131 min (range 97-210 min). In all cases it was possible to perform a lower section of the rectum with CCS. No intraoperative or postoperative staple line bleeding occurred. In two patients we observed anastomotic leaks and in one of these a temporary ileostomy was performed. None of the patients showed an anastomotic stenosis at 1-year follow-up colonoscopy. CONCLUSIONS This study shows that CCS enables section of the lower rectum to be easily performed, especially in adverse anatomical condition, and the technique proposed by us allows the use of this stapler without giving up the benefits of laparoscopic access.
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Affiliation(s)
- Francesco Saverio Mari
- Department of Surgery, St. Andrea Hospital, School of Medicine and Psychology, University Sapienza of Rome, Rome, Italy.
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Chan AC, Law WL. Outcome of laparoscopic surgery in colorectal cancer: a critical appraisal. Expert Rev Pharmacoecon Outcomes Res 2012; 7:479-89. [PMID: 20528393 DOI: 10.1586/14737167.7.5.479] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Despite the wide application of laparoscopic surgery for various common surgical conditions, the development of laparoscopic colorectal surgery has been slow. The obstacle for its advancement is formed by a steep learning curve and concerns about the oncologic safety in cases of malignant diseases. With refinement in instrumentation and improvement in surgical techniques in recent years, laparoscopic colectomy has become a safe and feasible procedure. The short-term advantages in terms of quicker recovery of bowel function, less postoperative pain and shorter hospital stay of laparoscopic colectomy over conventional treatment seem to be indisputable. Results from large prospective randomized trials revealed the oncologic outcome to be comparable between the two treatments. Furthermore, the incidence of port-site metastasis was shown to be similar between the two approaches. For rectal cancer, laparoscopic-assisted total mesorectal excision has been shown to be a safe and feasible procedure. The incidence of postoperative morbidity including anastomotic leakage appears to be comparable between the two treatments. However, the long-term outcome especially for local recurrence and overall survival remains uncertain. Prospective randomized study with long follow-up is required to elucidate this issue.
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Affiliation(s)
- Albert Cy Chan
- University of Hong Kong Medical Centre, Department of Surgery, Queen Mary Hospital, Pokfulam Road, Hong Kong.
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Araujo SEA, Seid VE, Kim NJ, Bertoncini AB, Nahas SC, Cecconello I. Assessing the extent of colon lengthening due to splenic flexure mobilization techniques: a cadaver study. ARQUIVOS DE GASTROENTEROLOGIA 2012; 49:219-22. [DOI: 10.1590/s0004-28032012000300010] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/30/2012] [Accepted: 05/16/2012] [Indexed: 11/22/2022]
Abstract
CONTEXT: Failure of a colorectal anastomosis represents a life-threatening complication of colorectal surgery. Splenic flexure mobilization may contribute to reduce the occurrence of anastomotic complications due to technical flaws. There are no published reports measuring the impact of splenic flexure mobilization on the length of mobilized colon viable to construct a safe colorectal anastomosis. OBJECTIVE: The aim of the present study was to determine the effect of two techniques for splenic flexure mobilization on colon lengthening during open left-sided colon surgery using a cadaver model. DESIGN: Anatomical dissections for left colectomy and colorectal anastomosis at the sacral promontory level were conducted in 20 fresh cadavers by the same team of four surgeons. The effect of partial and full splenic flexure mobilization on the extent of mobilized left colon segment was determined. SETTING: University of Sao Paulo Medical School, Sao Paulo, SP, Brazil. Tertiary medical institution and university hospital. PARTICIPANTS: A team of four surgeons operated on 20 fresh cadavers. RESULTS: The length of resected left colon enabling a tension-free colorectal anastomosis at the level of sacral promontory achieved without mobilizing the splenic flexure was 46.3 (35-81) cm. After partial mobilization of the splenic flexure, an additionally mobilized colon segment measuring 10.7 (2-30) cm was obtained. After full mobilization of the distal transverse colon, a mean 28.3 (10-65) cm segment was achieved. CONCLUSION: Splenic flexure mobilization techniques are associated to effective left colon lengthening for colorectal anastomosis. This result may contribute to decision-making during rectal surgery and low colorectal and coloanal anastomosis.
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Abstract
The role of laparoscopic proctectomy in rectal cancer has not clearly been defined. Publications on long-term outcomes after laparoscopic proctectomy is lacking and there is a wide variation of practice patterns of rectal cancer management. Current data supports the feasibility of laparoscopic proctectomy for rectal cancer but due to surgeon, patient and tumor related factors open technique may be favored. Current series suggest that laparoscopic proctectomy can be performed with similar oncologic adequacy with regards to, circumferential resection margin, distal margin, local recurrence and quality of life. Ongoing trials will provide evidence clarifying the role of laparoscopic proctectomy in rectal cancer. Until then, high-level laparoscopic skills and meticulous preoperative evaluation of both patient and tumor can identify appropriate candidates.
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Laparoscopic Surgery for Benign and Malignant Colorectal Diseases. Surg Laparosc Endosc Percutan Tech 2012; 22:165-74. [DOI: 10.1097/sle.0b013e31824be7ba] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
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Akmal Y, Baek JH, McKenzie S, Garcia-Aguilar J, Pigazzi A. Robot-assisted total mesorectal excision: is there a learning curve? Surg Endosc 2012; 26:2471-6. [PMID: 22437950 DOI: 10.1007/s00464-012-2216-5] [Citation(s) in RCA: 60] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2011] [Accepted: 12/04/2011] [Indexed: 12/17/2022]
Abstract
BACKGROUND Laparoscopic total mesorectal excision (TME) is associated with a steep learning curve, but the learning curve for robotic TME is unknown. This study aimed to evaluate the learning curve for robotic TME. METHODS Between November 2004 and April 2009, 80 patients underwent robotic TME performed by a single surgeon. The operative experience was divided into two groups: group 1 (the first 40 cases) and group 2 (the subsequent 40 cases). Patient demographics, operative characteristics, and morbidities were compared. RESULTS The two patient populations selected did not differ statistically in age, body mass index (BMI), preoperative risk assessment, stage, preoperative chemoradiotherapy, or tumor location. The mean operative times in group 1 (310 min) and group 2 (297 min) were similar (p = 0.55), and the mean robotic TME time did not differ between the two groups (60 vs. 64 min; p = 0.65). In addition, the operative times did not improve during the course of the study. There were no differences in EBL, margin status, or number of lymph nodes harvested. Furthermore, there were no differences in conversion rate, time to resumption of diet, length of hospital stay, or postoperative complications. CONCLUSION Robot-assisted TME may attenuate the learning curve for laparoscopic rectal cancer resection. Further studies are necessary to establish the role of robotic surgery in minimally invasive rectal operations.
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Affiliation(s)
- Yasir Akmal
- Department of General and Oncologic Surgery, City of Hope National Medical Center, 1500 East Duarte Road, Duarte, CA 91010, USA
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Current status of laparoscopic total mesorectal excision. Am J Surg 2012; 203:230-41. [DOI: 10.1016/j.amjsurg.2011.03.011] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2010] [Revised: 03/28/2011] [Accepted: 03/28/2011] [Indexed: 12/11/2022]
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Abstract
BACKGROUND Laparoscopic surgery for colorectal cancer has undergone tremendous advancement in the last two decades, with maturation of techniques and integration into current practice. SOURCES OF DATA Worldwide English-language literature on laparoscopic surgery for the management of colon and rectal cancer was reviewed. AREAS OF AGREEMENT A large body of evidence has attested to the improved short-term outcomes and long-term oncological safety of laparoscopic surgery for colon cancer. Laparoscopic colectomy can be recommended to suitable patients where expertise is available. Laparoscopic resection for rectal cancer is feasible, with good evidence of faster post-operative recovery and adequate surgical quality, but requires more data on long-term oncological outcomes. This review examines the evidence and current practice of laparoscopic surgery for colorectal cancer. AREAS OF CONTROVERSY Does laparoscopic surgery confer a survival advantage for colorectal cancer patients? GROWING POINTS The role of single-incision laparoscopic surgery and robotic surgery in colorectal cancer. AREAS TIMELY FOR DEVELOPING RESEARCH Barriers to the adoption of the laparoscopic technique.
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Affiliation(s)
- J H Lai
- Department of Surgery, The University of Hong Kong, Queen Mary Hospital, Hong Kong
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Fistula between anterior rectum wall and seminal vesicles as a rare complication of low-anterior resection of the rectum. Wideochir Inne Tech Maloinwazyjne 2011; 7:63-6. [PMID: 23256004 PMCID: PMC3516961 DOI: 10.5114/wiitm.2011.25715] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2011] [Revised: 09/08/2011] [Accepted: 09/13/2011] [Indexed: 12/23/2022] Open
Abstract
Laparoscopic surgery has become a frequently used modality for rectal tumour surgery. A fistula between the rectum and lower urinary tract is one of the possible complications, with rectovesical fistulas occurring most frequently. This case report presents a 66-year-old man who underwent a laparoscopic low-anterior resection of the rectum due to the presence of a polyp with a high risk of malignant transformation. At the time of discharge on the eleventh postoperative day, the patient returned to the hospital with a fever, scrotal swelling and pain in the right hemiscrotum. These symptoms began four hours after discharge from the hospital. There was no sign of faecaluria. The presence of gas in the urinary bladder was confirmed after catheter insertion. The patient was diagnosed with a fistula between the anterior wall of the rectum and seminal vesicles. The diagnosis was based on cystoscopy findings, X-ray and computed tomography irrigography. The condition was treated conservatively by suprapubic insertion of a catheter and antibiotics. The total length of the treatment, including management of subsequent complications, was 4 months. Twelve months after the complication developed, the patient is symptom free, without urinary tract infection recurrence, and is under the care of both surgery and urology clinics. We describe the clinical symptoms, possibilities of treatment and the result of treatment of this rare complication of rectum low-anterior resection, which has never been described in the literature before.
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Simorov A, Reynoso JF, Dolghi O, Thompson JS, Oleynikov D. Comparison of perioperative outcomes in patients undergoing laparoscopic versus open abdominoperineal resection. Am J Surg 2011; 202:666-70; discussion 670-2. [PMID: 21983001 DOI: 10.1016/j.amjsurg.2011.06.029] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2011] [Revised: 06/04/2011] [Accepted: 06/04/2011] [Indexed: 12/30/2022]
Abstract
BACKGROUND The aim of this study was to retrospectively compare the outcomes of laparoscopic abdominoperineal resection (APR) and open APR. METHODS A multicenter, retrospective analysis was performed. The University HealthSystem Consortium database was accessed and searched for International Classification of Diseases, Ninth Revision, codes between October 2008 and January 2010. Discharge data were collected on patients undergoing laparoscopic APR and open APR. RESULTS Six hundred sixty-seven patients underwent laparoscopic APR, and 2,443 underwent open APR. When lower risk patient groups with minor or moderate severity of illness were compared, laparoscopic APR showed lower morbidity, reduced length of stay, reduced cost, and reduced incidence of intensive care unit admission. Comparative analysis showed no significant difference in mortality rate or 30-day readmission. When higher risk patients were compared, there were significantly reduced costs and reduced incidence of intensive care unit cases in the laparoscopic group. CONCLUSIONS Patients undergoing laparoscopic APR had overall superior perioperative outcomes compared with those undergoing open APR. Laparoscopic APR demonstrates excellent perioperative outcomes in appropriately selected patients.
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Affiliation(s)
- Anton Simorov
- Department of Surgery, University of Nebraska Medical Center, Omaha, NE, USA
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