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Mahmoodzadeh H, Omranipour R, Borjian A, Borjian MA. Study of therapeutic results, lymph node ratio, short-term and long-term complications of lateral lymph node dissection in rectal cancer patients. Turk J Surg 2020; 36:224-228. [PMID: 33015568 DOI: 10.5578/turkjsurg.4593] [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: 08/22/2019] [Accepted: 12/30/2019] [Indexed: 11/15/2022]
Abstract
Objectives This study aimed to assess disease free survival, lymph node ratio (LNR) and complication rate among advanced mid to low rectal cancer patients (stage 2-3) who underwent total mesorectal excision (TME) and lateral lymph node dissection (LLND) at the Iran Cancer Institute in 2016-2018. Material and Methods The study was carried out on 32 patients treated by curative surgery and lateral lymph node dissection at the Iran Cancer Institute from 2016 March to 2018 March. Chi-square test was used to assess the distribution of dichotomous clinical outcomes by sex. We also used Breslow test in Kaplan-Meier approach to estimate 1-year disease free survival and corresponding 95% confidence intervals (CI). Results Of the 279 dissected lymph nodes by TME, 42 nodes (in mesorectal) and of the 232 dissected lymph nodes by LLND, 7 nodes (in iliac, para-iliac and obturator) were positive for metastasis. Higher local recurrence was observed in men (three patients) compared to women (one patient) which was not statistically significant (p= 0.878). We also observed higher 1-year disease free survival rate in women (1-year disease free survival= 93.3%) compared to men (1-year disease free survival= 82.4%), which also was not statistically significant (p= 0.356). 1-year disease free survival rate in patient with negative lymph nodes was 95.5% while respective number in patients with positive lymph nodes was 70% (p= 0.047). Conclusion TME with LLND could prolong survival and reduce local recurrence in patients with advanced low rectal cancer. However, large-scale clinical trials are required to evaluate such procedure as a standard in Iran.
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Affiliation(s)
| | - Ramesh Omranipour
- Tehran University of Medical Science, Cancer Institute, Tehran, Iran
| | - Anahita Borjian
- Tehran University of Medical Science, Cancer Institute, Tehran, Iran
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Bu J, Li N, He S, Deng HY, Wen J, Yuan HJ, Zhang CM, Hu M, Wu XT. Effect of laparoscopic surgery for colorectal cancer with N. O. S. E. on recovery and prognosis of patients. MINIM INVASIV THER 2020; 31:230-237. [PMID: 32940092 DOI: 10.1080/13645706.2020.1799410] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
OBJECTIVE To investigate the effect of laparoscopic surgery in colorectal cancer (CRC) patients with natural orifice specimen extraction (NOSE) on the recovery and quality of life (QOL) of patients. MATERIAL AND METHODS Ninety-two eligible patients were randomly assigned into two groups: the traditional laparoscopy group (L group, n = 46) and the laparoscopic transanal specimen extraction group (NL group, n = 46). General data, surgery-related indicators, postoperative recovery, and prognosis were compared and analyzed between the two groups. RESULTS A total of 46 patients in each group were enrolled in this study. The general data and surgery-related indicators were comparable between the two groups (all p > .05). There were no significant differences in the time of first flatus, bleeding, obstruction, constipation, and infectious complications between the two groups (all p > .05). The differences in the incidence of postoperative diarrhea, pain degree, and satisfaction on the aesthetics of the abdominal wall showed significant differences (χ2 = 6.133, p = .013; χ2 = 12.116, p = .017; χ2 = 13.463, p = .004). The postoperative follow-up time was 3-53 months. There were no significant differences in the postoperative hospital stay, medical costs, hospital readmission rate, incidence of incisional hernia, overall survival, disease-free survival, and QOL between the two groups (all p > .05). Conclusion: Laparoscopic surgery with NOSE for eligible patients with CRC was a feasible choice.
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Affiliation(s)
- Jun Bu
- Department of General Surgery, Chengdu second people's Hospital, Chengdu, China
| | - Nian Li
- Department of General Surgery, Chengdu second people's Hospital, Chengdu, China
| | - Shan He
- Department of General Surgery, Chengdu second people's Hospital, Chengdu, China
| | - Heng-Yi Deng
- Department of General Surgery, Chengdu second people's Hospital, Chengdu, China
| | - Jing Wen
- Department of General Surgery, Chengdu second people's Hospital, Chengdu, China
| | - Hong-Jun Yuan
- Department of General Surgery, Chengdu second people's Hospital, Chengdu, China
| | - Chuan-Ming Zhang
- Department of Digestive Medicine, Chengdu second people's Hospital, Chengdu, China
| | - Man Hu
- Department of Digestive Medicine, Chengdu second people's Hospital, Chengdu, China
| | - Xiao-Ting Wu
- Department of Gastrointestinal Surgery Center, West China Hospital, Sichuan University, Chengdu, China
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Lin Z, Jiang ZL, Chen DY, Chen MF, Chen LH, Zhou P, Xia AX, Zhu YW, Jin H, Ge QQ. Short- and long-term outcomes of laparoscopic versus open surgery for rectal cancer: A systematic review and meta-analysis of randomized controlled trials. Medicine (Baltimore) 2018; 97:e13704. [PMID: 30558085 PMCID: PMC6320083 DOI: 10.1097/md.0000000000013704] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/04/2018] [Accepted: 11/26/2018] [Indexed: 12/16/2022] Open
Abstract
OBJECTIVES The present meta-analysis aimed to evaluate the short- and long-term outcomes of laparoscopic surgery (LS) versus open surgery (OS) for rectal cancer. METHODS PubMed, Web of Science, and Cochrane Library, were searched for eligible randomized controlled trials (RCTs) published up to June 2017. Operation related index, postoperative complication, and long-term survival rate and disease-free survival rate were evaluated by meta-analytical techniques. RESULT Nine RCTs enrolling 4126 patients were included in the present meta-analysis. Compared to OS, LS had similar positive circumferential resection margin (CRM) and number of lymph nodes extracted (LNE) as well as long term 5 years survival rate and disease-free survival rate, but of which the risk tendency was higher in LS group. The short-term outcomes of major and total postoperative complication were lower in LS group. CONCLUSIONS LS for rectal cancer was as safe and effective as OS in terms of long-term outcomes, but with lower postoperative complication.
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Affiliation(s)
- Zhong Lin
- Department of Clinical Pharmacy, Taizhou Hospital of Zhejiang Province, Linhai
| | - Zheng-Li Jiang
- Department of Clinical Pharmacy, Taizhou Hospital of Zhejiang Province, Linhai
| | - Dan-Yang Chen
- Rehabilitation Department, Taizhou Hospital of Zhejiang Province
| | - Min-Fang Chen
- Department of Surgery, Wenlin Chinese Medicine Hospital, Wenlin, Zhejiang Province, China
| | | | - Peng Zhou
- Department of Clinical Pharmacy, Taizhou Hospital of Zhejiang Province, Linhai
| | - Ai-Xiao Xia
- Department of Clinical Pharmacy, Taizhou Hospital of Zhejiang Province, Linhai
| | - Yan-Wu Zhu
- Department of Clinical Pharmacy, Taizhou Hospital of Zhejiang Province, Linhai
| | - Hui Jin
- Department of Clinical Pharmacy, Taizhou Hospital of Zhejiang Province, Linhai
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Rotholtz NA, Canelas AG, Bun ME, Laporte M, Sadava EE, Ferrentino N, Guckenheimer SA. Laparoscopic approach in complicated diverticular disease. World J Gastrointest Surg 2016; 8:308-314. [PMID: 27152137 PMCID: PMC4840170 DOI: 10.4240/wjgs.v8.i4.308] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/25/2015] [Revised: 11/27/2015] [Accepted: 02/16/2016] [Indexed: 02/06/2023] Open
Abstract
AIM: To analyze the results of laparoscopic colectomy in complicated diverticular disease.
METHODS: This was a retrospective cohort study conducted at an academic teaching hospital. Data were collected from a database established earlier, which comprise of all patients who underwent laparoscopic colectomy for diverticular disease between 2000 and 2013. The series was divided into two groups that were compared: Patients with complicated disease (abscess, perforation, fistula, or stenosis) (G1) and patients undergoing surgery for recurrent diverticulitis (G2). Recurrent diverticulitis was defined as two or more episodes of diverticulitis regardless of patient age. Data regarding patient demographics, comorbidities, prior abdominal operations, history of acute diverticulitis, classification of acute diverticulitis at index admission and intra and postoperative variables were extracted. Univariate analysis was performed in both groups.
RESULTS: Two hundred and sixty patients were included: 28% (72 patients) belonged to G1 and 72% (188 patients) to G2. The mean age was 57 (27-89) years. The average number of episodes of diverticulitis before surgery was 2.1 (r 0-10); 43 patients had no previous inflammatory pathology. There were significant differences between the two groups with respect to conversion rate and hospital stay (G1 18% vs G2 3.2%, P = 0.001; G1: 4.7 d vs G2 3.3 d, P < 0.001). The anastomotic dehiscence rate was 2.3%, with no statistical difference between the groups (G1 2.7% vs G2 2.1%, P = 0.5). There were no differences in demographic data (body mass index, American Society of Anesthesiology and previous abdominal surgery), operative time and intraoperative and postoperative complications between the groups. The mortality rate was 0.38% (1 patient), represented by a death secondary to septic shock in G2.
CONCLUSION: The results support that the laparoscopic approach in any kind of complicated diverticular disease can be performed with low morbidity and acceptable conversion rates when compared with patients undergoing laparoscopic surgery for recurrent diverticulitis.
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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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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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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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Quality-of-life impairment after endoluminal locoregional resection and laparoscopic total mesorectal excision. Surg Endosc 2013; 28:227-34. [PMID: 24002918 DOI: 10.1007/s00464-013-3166-2] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2013] [Accepted: 07/31/2013] [Indexed: 12/16/2022]
Abstract
BACKGROUND For selected patients with rectal cancer, endoluminal locoregional resection (ELRR) by transanal endoscopic microsurgery (TEM) may be an alternative treatment option to laparoscopic total mesorectal excision (LTME). Few data are available on quality of life (QoL) after LTME and TEM. This study aimed to compare short- and medium-term QoL for T1 rectal cancer patients undergoing LTME or ELRR by TEM. METHODS This study investigated 35 patients with T1N0 rectal cancer who underwent TEM (n = 17) or LTME (n = 18). Quality of life was evaluated by European Organization for Research and Treatment of Cancer (EORTC) QLQ-C30 and QLQ-C38 questionnaires preoperatively and then 1, 6, and 12 months after surgery. RESULTS Observation 1 month after LTME showed worsening in all items of both questionnaires. After ELRR, the QLQ-CR38 showed worsening of gastrointestinal (p = 0.005) and defecation problems (p = 0.001), and the QLQ-C30 showed worsening of global health status (p = 0.014), physical functioning (p = 0.02) role functioning (p = 0.003), fatigue (p = 0.002), and pain (p = 0.001). The QLQ-CR38 6 months after LTME showed worsening of body image (p = 0.009), micturition (p = 0.035), and gastrointestinal problems (p = 0.011), and the QLQ-C30 showed worsening of physical functioning (p = 0.003), role functioning (p = 0.002), fatigue (p = 0.004), and nausea/vomiting (p = 0.030). After ELRR, neither the QLQ-CR38 nor the QLQ-C30 questionnaire showed any worsening but demonstrated improvement in global health status and physical functioning. The QLQ-CR38 12 months after LTME showed significant improvement in defecation problems (p = 0.004) and weight loss (p = 0.003), and the QLQ-C30 showed significant improvement in global health status (p = 0.001), nausea and vomiting (p = 0.003), and pain (p = 0.005). After ELRR, the QLQ-C30 showed improvement in emotional functioning (p = 0.012), whereas no significant difference was observed by the QLQ-C38. CONCLUSIONS Functional sequelae are present up to 1 month only after ELRR by TEM and up to 6 months after LTME. At 12 months, neither procedure showed a significant difference in QoL compared with preoperative status.
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Lezoche E, Baldarelli M, Lezoche G, Paganini AM, Gesuita R, Guerrieri M. Randomized clinical trial of endoluminal locoregional resection versus laparoscopic total mesorectal excision for T2 rectal cancer after neoadjuvant therapy. Br J Surg 2012; 99:1211-8. [PMID: 22864880 DOI: 10.1002/bjs.8821] [Citation(s) in RCA: 217] [Impact Index Per Article: 18.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
BACKGROUND In selected patients with early low rectal cancer, locoregional excision combined with neoadjuvant therapy may be an alternative treatment option to total mesorectal excision (TME). METHODS This prospective randomized trial compared endoluminal locoregional resection (ELRR) by transanal endoscopic microsurgery versus laparoscopic TME in the treatment of patients with small non-advanced low rectal cancer. Patients with rectal cancer staged clinically as cT2 N0 M0, histological grade G1-2, with a tumour less than 3 cm in diameter, within 6 cm of the anal verge, were randomized to ELRR or TME. All patients underwent long-course neoadjuvant chemoradiotherapy. RESULTS Fifty patients in each group were analysed. Overall tumour downstaging and downsizing rates after neoadjuvant chemoradiotherapy were 51 and 26 per cent respectively, and were similar in both groups. All patients had R0 resection with tumour-free resection margins. At long-term follow-up, local recurrence had developed in four patients (8 per cent) after ELRR and three (6 per cent) after TME. Distant metastases were observed in two patients (4 per cent) in each group. There was no statistically significant difference in disease-free survival (P = 0·686). CONCLUSION In selected patients, ELRR had similar oncological results to TME. Unique Protocol ID: URBINO-LEZ-1995; registration number: NCT01609504 (http://www.clinicaltrials.gov).
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Affiliation(s)
- E Lezoche
- Department of General Surgery, Surgical Specialities and Organ Transplantation Paride Stefanini at University of Rome, Rome, Italy
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Westerholm J, Garcia-Osogobio S, Farrokhyar F, Cadeddu M, Anvari M. Midterm outcomes of laparoscopic surgery for rectal cancer. Surg Innov 2012; 19:81-8. [PMID: 22604576 DOI: 10.1177/1553350611415868] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
In this study, the authors examine midterm survival and recurrence after laparoscopic and open surgery for rectal cancer. This is a retrospective review of a prospective database for rectal cancer surgeries performed at the authors' institution, with follow-up data obtained through chart review. In all, 74 patients in this study had open surgery, and 93 had laparoscopic surgery. The 5-year overall survival was 73.6% ± 12.0% in the open group and 80.0% ± 12.8% in the laparoscopic group (P = .159). Disease-free survival at 5 years was better in the laparoscopic group (71.0% ± 13.4%) than in the open group (50.3% ± 12.7%), with a P value of .01. Laparoscopic surgery remained an independent predictor of disease-free survival in the multivariate analysis. Results of prospective randomized trials are awaited, and the authors expect that the laparoscopic approach will be shown to be a safe and effective option for the management of rectal cancer.
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Guerrieri M, Campagnacci R, De Sanctis A, Lezoche G, Massucco P, Summa M, Gesuita R, Capussotti L, Spinoglio G, Lezoche E. Laparoscopic versus open colectomy for TNM stage III colon cancer: results of a prospective multicenter study in Italy. Surg Today 2012; 42:1071-7. [PMID: 22903270 DOI: 10.1007/s00595-012-0292-8] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2011] [Accepted: 08/28/2011] [Indexed: 12/15/2022]
Abstract
BACKGROUND AND PURPOSE There is still debate about the practicality of performing laparoscopic colectomy instead of open colectomy for patients with curable cancer, although laparoscopic surgery is now being performed even for patients with advanced colon cancer. We compared the long-term results of laparoscopic versus open colectomy for TNM stage III carcinoma of the colon in a large series of patients followed up for at least 3 years. METHODS The subjects of this prospective non-randomized multicentric study were 290 consecutive patients, who underwent open surgery (OS group; n = 164) or laparoscopic surgery (LS group; n = 126) between 1994 and 2005, at one of the four surgical centers. The same surgical techniques were used for the laparoscopic and open approaches to right and left colectomy. The distribution of TNM substages (III A, III B, IIIC) as well as the grading of carcinomas (G1, G2, G3) were similar in each arm of the study. The median follow-up periods were 76.9 and 58.0 months after OS and LS, respectively. RESULTS There were 10 (6.1 %) versus 9 (7.1 %) deaths unrelated to cancer, 15 (9.1 %) versus 5 (4 %) cases of local recurrence, 7 (4.2 %) versus 5 (4 %) cases of peritoneal carcinosis, and 37 (22.5 %) versus 14 (11.1 %) cases of metastases in the OS and LS groups, respectively. There was also one case of port-site recurrence after LS (0.8 %). The OS group had a significantly higher probability of local recurrence and metastases (p < 0.001) with a significant higher probability of cancer-related death (p = 0.001) than the LS group. CONCLUSIONS These findings support that LS is safe and effective for advanced carcinoma of the colon. Although the LS group in this study had a significantly better long-term outcome than the OS group, further investigations are needed to draw a definitive conclusion.
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Affiliation(s)
- Mario Guerrieri
- Clinica di Chirurgia Generale e Metodologia Chirurgica, Ospedali Riuniti Ancona-Università Politecnica delle Marche, via Conca 1, 60121, Ancona, Italy
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Kye BH, Kim JG, Cho HM, Lee JH, Kim HJ, Suh YJ, Chun CS. The effect of laparoscopic surgery in stage II and III right-sided colon cancer: a retrospective study. World J Surg Oncol 2012; 10:89. [PMID: 22594580 PMCID: PMC3449202 DOI: 10.1186/1477-7819-10-89] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2012] [Accepted: 04/08/2012] [Indexed: 02/07/2023] Open
Abstract
Background This retrospective study compared the clinicopathological results among three groups divided by time sequence to evaluate the impact of introducing laparoscopic surgery on long-term oncological outcomes for right-sided colon cancer. Methods From April 1986 to December 2006, 200 patients who underwent elective surgery with stage II and III right-sided colon cancer were analyzed. The period for group I referred back to the time when laparoscopic approach had not yet been introduced. The period for group II was designated as the time when first laparoscopic approach for right colectomy was carried out until we overcame its learning curve. The period for group III was the period after overcoming this learning curve. Results When groups I and II, and groups II and III were compared, overall survival (OS) did not differ significantly whereas disease-free survival (DFS) in groups I and III were statistically higher than in group II (P = 0.042 and P = 0.050). In group III, laparoscopic surgery had a tendency to provide better long-term OS ( P = 0.2036) and DFS ( P = 0.2356) than open surgery. Also, the incidence of local recurrence in group III (2.6%) was significantly lower than that in groups II (7.4%) and I (12.1%) ( P = 0.013). Conclusions Institutions should standardize their techniques and then provide fellowship training for newcomers of laparoscopic colon cancer surgery. This technique once mastered will become the gold standard approach to colon surgery as it is both safe and feasible considering the oncological and technical aspects.
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Affiliation(s)
- Bong-Hyeon Kye
- St. Vincent's Hospital, The Catholic University of Korea, Suwon-Si, Gyeonggi-do, South Korea
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Glancy DG, Chaudhray BN, Greenslade GL, Dixon AR. Laparoscopic total mesorectal excision can be performed on a nonselective basis in patients with rectal cancer with excellent medium-term results. Colorectal Dis 2012; 14:453-7. [PMID: 21689350 DOI: 10.1111/j.1463-1318.2011.02682.x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
AIM Concerns exist regarding laparoscopic rectal cancer surgery due to increased rates of open conversion, complications and circumferential resection margin positivity. This study reports medium-term results from consecutive unselected cases in a single surgeon series. METHOD The results of laparoscopic total mesorectal excision (TME) for rectal cancer over a 9-year period within the context of an evolving 'enhanced recovery protocol' (ERP) were reviewed from analysis of a prospectively maintained database. RESULTS One hundred and fifty patients (91 male, median age 69 years, median BMI 26) underwent laparoscopic TME over 9 years. Median follow up was 28.5 months (range 0-88). Sixteen (10.6%) patients underwent neoadjuvant radiotherapy. Six (4.0%) required open conversion and 13 (9.0%) had an anastomotic leakage. The proportion of Dukes stages were: A, 33.3%; B, 30.7%; C, 31.3%; D, 4.7%. Five (3.3%) patients had an R1 and one an R2 resection. Median length of postoperative stay was 6 days. Three (2.0%) patients died within 30 days. Four (2.7%) developed local recurrence and 14 (9.3%) developed distant metastases. Predicted 5-year disease-free and overall survival rates by Kaplan-Meier analysis were 85.8% and 78.7%, respectively. CONCLUSION Laparoscopic TME surgery can safely be offered to unselected patients with rectal cancer with excellent medium-term results.
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Affiliation(s)
- D G Glancy
- Department of Colorectal Surgery, Bristol Royal Infirmary, University Hospitals, Bristol, UK.
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Lee JE, Joh YG, Yoo SH, Jeong GY, Kim SH, Chung CS, Lee DG, Kim SH. Long-term Outcomes of Laparoscopic Surgery for Colorectal Cancer. JOURNAL OF THE KOREAN SOCIETY OF COLOPROCTOLOGY 2011; 27:64-70. [PMID: 21602964 PMCID: PMC3092077 DOI: 10.3393/jksc.2011.27.2.64] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/22/2010] [Accepted: 03/29/2011] [Indexed: 12/21/2022]
Abstract
Purpose The long-term results of a laparoscopic resection for colorectal cancer have been reported in several studies, but reports on the results of laparoscopic surgery for rectal cancer are limited. We investigated the long-term outcomes, including the five-year overall survival, disease-free survival and recurrence rate, after a laparoscopic resection for colorectal cancer. Methods Using prospectively collected data on 303 patients with colorectal cancer who underwent a laparoscopic resection between January 2001, and December 2003, we analyzed sex, age, stage, complications, hospital stay, mean operation time and blood loss. The overall survival rate, disease-free survival rate and recurrence rate were investigated for 271 patients who could be followed for more than three years. Results Tumor-node-metastasis (TNM) stage I cancer was present in 55 patients (18.1%), stage II in 116 patients (38.3%), stage III in 110 patients (36.3%), and stage IV in 22 patients (7.3%). The mean operative time was 200 minutes (range, 100 to 535 minutes), and the mean blood loss was 97 mL (range, 20 to 1,200 mL). The mean hospital stay was 11 days and the mean follow-up period was 54 months. The mean numbers of resected lymph nodes were 26 and 21 in the colon and the rectum, respectively, and the mean distal margins were 10 and 3 cm. The overall morbidity rate was 26.1%. The local recurrence rates were 2.2% and 4.4% in the colon and the rectum, respectively, and the distant recurrence rates were 7.8% and 22.5%. The five-year overall survival rates were 86.1% in the colon (stage I, 100%; stage II, 97.6%; stage III, 77.5%; stage IV, 16.7%) and 68.8% in the rectum (stage I, 90.2%; stage II, 84.0%; stage III, 57.6; stage IV, 13.3%). The five-year disease-free survival rates were 89.8% in the colon (stage I, 100%; stage II, 97.7%; stage III, 74.2%) and 74.5% in the rectum (stage I, 90.0%; stage II, 83.9%; stage III, 59.2%). Conclusion Laparoscopic surgery for colorectal cancer is a good alternative method to open surgery with tolerable oncologic long-term results.
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Affiliation(s)
- Jeong-Eun Lee
- Department of Surgery, Hansol Hospital, Seoul, Korea
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Predictive Risk Factors for Intra- and Postoperative Complications in 526 Laparoscopic Sigmoid Resections due to Recurrent Diverticulitis: A Multivariate Analysis. World J Surg 2010; 35:677-83. [DOI: 10.1007/s00268-010-0889-2] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Ellis-Clark JM, Lumley JW, Stevenson ARL, Stitz RW. Laparoscopic restorative proctectomy - hybrid approach or totally laparoscopic? ANZ J Surg 2010; 80:807-12. [DOI: 10.1111/j.1445-2197.2010.05335.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
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Abstract
Laparoscopic surgery as an alternative to traditional open surgery, has been accepted by an increasing number of surgeons and patients. In this paper, we review the advances in laparoscopic surgery for colorectal cancer and summarize its pros and cons by comparing with open surgery, including patient inclusion and exclusion, intraoperative outcomes, and short- and long-term outcomes. Furthermore, we provide an initial overview of the Da Vinci robotic system and the single-port laparoscopic surgery.
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Angst E, Hiatt JR, Gloor B, Reber HA, Hines OJ. Laparoscopic surgery for cancer: a systematic review and a way forward. J Am Coll Surg 2010; 211:412-23. [PMID: 20800199 DOI: 10.1016/j.jamcollsurg.2010.05.019] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2009] [Revised: 05/21/2010] [Accepted: 05/26/2010] [Indexed: 12/18/2022]
Affiliation(s)
- Eliane Angst
- Department of Surgery, UCLA David Geffen School of Medicine, Los Angeles, CA, USA
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Laparoscopic TME in rectal cancer--electronic supplementary: op-video. Langenbecks Arch Surg 2010; 395:181-3. [PMID: 20076969 PMCID: PMC2814039 DOI: 10.1007/s00423-009-0556-y] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2009] [Accepted: 09/16/2009] [Indexed: 02/04/2023]
Abstract
Background Laparoscopic total mesorectal excision (TME) for rectal cancer has been proved in various studies. The minimal invasive procedure is feasible and safe which was demonstrated in many studies. However, the results of prospective, randomized studies providing valuable evidence are still not available. Compared to conventional surgery, the laparoscopic technique has short-term advantages including less pain, shorter duration of postoperative ileus, less fatigue, better pulmonary function, and less blood loss (Leung et al., Lancet 363:1187–1192, 2004; Braga et al., Dis Colon Rectum 48:217–223, 2005; Jayne et al., J Clin Oncol 25:3061–3068, 2007; Agha et al., Surg Endosc 22:2229–2237, 2008). Methods The autonomic nerve sparing TME technique is the gold standard in rectal cancer resection even in conventional or laparoscopic procedure. With regard of the oncological dimension, the laparoscopic TME technique is not different compared to the open procedure. However, a standardized laparoscopic step-by-step procedure may simplify the operation and can reduce operation time. Results There are no studies available which compare different types of TME procedures. Most surgeons start the operation left laterally mobilizing the sigmoid colon first. In the laparoscopic technique, we recommend the medial to lateral approach starting the operation at the right side of the rectum and sigmoid colon. A nerve sparing TME technique can be performed easier, and the identification of the left ureter may be simplified. After multiple workshops and extensive discussion with national and international experts, we developed a standardized laparoscopic “10 step TME procedure.” Reviewing the results of laparoscopic TME the studies do not allow firm conclusions as to the questions of whether the safety and efficacy of laparoscopic TME is equal or superior to open TME (Breukink et al. 2006). Actually, we are waiting for large prospective randomized studies comparing laparoscopic TME with the traditional open procedure (Bonjer et al., Dan Med Bull 56:89–91, 2009). Conclusion Laparoscopic TME appears to have clinically measurable short-term advantages in patients with primary resectable rectal cancer based on evidence mainly from nonrandomized studies (Breukink et al. 5). In nearly all published studies, the efficacy and technical feasibility of laparoscopic surgery for rectal cancer could be demonstrated regarding perioperative morbidity and oncological outcome. A standardized laparoscopic TME technique can be strongly recommended. Electronic supplementary material The online version of this article (doi:10.1007/s00423-009-0556-y) contains supplementary material, which is available to authorized users.
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Abstract
BACKGROUND Laparoscopic resection for the cure of rectal cancer is still a matter of debate. Laparoscopic approach is more complex and with a long learning curve, which may results in an increase in morbidity and mortality. This study aimed to retrospectively analyze the impact of laparoscopic resection for rectal cancer on operative outcome of a hospital in a developing country. METHODS All patients presenting with rectal cancer surgically managed by laparoscopic approach were enrolled. Exclusion criteria were total coloproctectomy, palliative procedures, and metastatic disease. The following parameters were accessed: general characteristics, technical details, mortality, and the outcome. RESULTS From January 2000 to January 2008, 60 patients with histologically proven rectal cancer were enrolled, and 43 were excluded. Mean age, 58.5 +/- 15.9 years. A 76.6% of patients had cancer-advanced stages. There were 20 anterior resections, 31 abdomino-perineal resections, and nine pull-through procedures. Conversion rate was 3.3%, and there had 3.3% of operative complications. No procedure-related death. With the mean follow-up of 33 months, 77.8% patients are alive and disease-free, 5.6% are alive with disease: distant metastasis in 2.8%, and local recurrence in 2.8%. About 16.7% have died from cancer-related causes. No port site or wound metastasis have occurred. CONCLUSIONS This study showed the favorable short-term operative results in patients who underwent laparoscopic resection for rectal cancer. The low conversion rate of 3.3%, 3.3% complication rate, and 0% of a 30-day mortality attributed to confirm the feasibility of laparoscopic approach in the surgical treatment of rectal cancer.
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Kim JG, Heo YJ, Son GM, Lee YS, Lee IK, Suh YJ, Cho HM, Chun CS. Impact of laparoscopic surgery on the long-term outcomes for patients with rectal cancer. ANZ J Surg 2009; 79:817-23. [DOI: 10.1111/j.1445-2197.2009.05109.x] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Conversion from laparoscopic to open colonic cancer resection - associated factors and their influence on long-term oncological outcome. Eur J Surg Oncol 2009; 35:1273-9. [PMID: 19615848 DOI: 10.1016/j.ejso.2009.06.006] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2008] [Revised: 06/08/2009] [Accepted: 06/11/2009] [Indexed: 01/31/2023] Open
Abstract
PURPOSE Comparisons of open and laparoscopic colon cancer resection have shown that laparoscopy offers an oncologically safe option. However, there are no data on long-term influence of converted resection, despite conversion rates of up to 30% and the general observation that short-term outcome is significantly worsened. The aim was to compare the long-term results of primary open resection (OR), purely laparoscopic resection (LR-p) and converted resection (LR-c). METHODS In a prospective study at 282 German hospitals demographic, tumor- and treatment-related data and disease-free survival were compared in the three groups. RESULTS 8015 of 8307 patients with OR, 280 of 290 patients with LR-p and 55 of 56 patients with LR-c were followed for 39.5 months (median). Overall, no statistically significant differences were seen for five-year DFS (74.8%, 81.3% and 65.6%). However, for patients in stage II with conversion, the five-year DFS was significantly poorer (43.3%) than for OR (80.5%; p=0.003) and LR-p patients (92.5%; p=0.001). For stages I and III no differences were observed. CONCLUSION Conversion of laparoscopic colon cancer resection worsens DFS in locally advanced stage II carcinoma. There is a need to reduce the conversion rate by adequate patient selection for laparoscopic resection by experienced surgeons.
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Wu ZY, Wan J, Zhao G, Peng L, Du JL, Yao Y, Liu QF, Lin HH. Risk factors for local recurrence of middle and lower rectal carcinoma after curative resection. World J Gastroenterol 2008; 14:4805-9. [PMID: 18720544 PMCID: PMC2739345 DOI: 10.3748/wjg.14.4805] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
AIM: To explore the risk factors for local recurrence of middle and lower rectal carcinoma after curative resection.
METHODS: Specimens of middle and lower rectal carcinoma from 56 patients who received curative resection at the Department of General Surgery of Guangdong Provincial People’s Hospital were studied. A large slice technique was used to detect mesorectal metastasis and evaluate circumferential resection margin status. The relations between clinicopathologic characteristics, mesorectal metastasis and circumferential resection margin status were identified in patients with local recurrence of middle and lower rectal carcinoma.
RESULTS: Local recurrence of middle and lower rectal carcinoma after curative resection occurred in 7 of the 56 patients (12.5%), and was significantly associated with family history (χ2 = 3.929, P = 0.047), high CEA level (χ2 = 4.964, P = 0.026), cancerous perforation (χ2 = 8.503, P = 0.004), tumor differentiation (χ2 = 9.315, P = 0.009) and vessel cancerous emboli (χ2 = 11.879, P = 0.001). In contrast, no significant correlation was found between local recurrence of rectal carcinoma and other variables such as age (χ2 = 0.506, P = 0.477), gender (χ2 = 0.102, χ2 = 0.749), tumor diameter (χ2 = 0.421, P = 0.516), tumor infiltration (χ2 = 5.052, P = 0.168), depth of tumor invasion (χ2 = 4.588, P = 0.101), lymph node metastases (χ2 = 3.688, P = 0.055) and TNM staging system (χ2 = 3.765, P = 0.152). The local recurrence rate of middle and lower rectal carcinoma was 33.3% (4/12) in patients with positive circumferential resection margin and 6.8% (3/44) in those with negative circumferential resection margin. There was a significant difference between the two groups (χ2 = 6.061, P = 0.014). Local recurrence of rectal carcinoma occurred in 6 of 36 patients (16.7%) with mesorectal metastasis, and in 1 of 20 patients (5.0%) without mesorectal metastasis. However, there was no significant difference between the two groups (χ2 = 1.600, P = 0.206).
CONCLUSION: Family history, high CEA level, cancerous perforation, tumor differentiation, vessel cancerous emboli and circumferential resection margin status are the significant risk factors for local recurrence of middle and lower rectal carcinoma after curative resection. Local recurrence may be more frequent in patients with mesorectal metastasis than in patients without mesorectal metastasis.
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Agha A, Fürst A, Hierl J, Iesalnieks I, Glockzin G, Anthuber M, Jauch KW, Schlitt HJ. Laparoscopic surgery for rectal cancer: oncological results and clinical outcome of 225 patients. Surg Endosc 2008; 22:2229-37. [DOI: 10.1007/s00464-008-0028-4] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2007] [Revised: 03/22/2008] [Accepted: 04/10/2008] [Indexed: 12/14/2022]
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Lordan JT, Tilney HS, Shirol S, Jourdan I, Gudgeon AM. Does the laparoscopic colorectal surgery learning curve adversely affect the results of colorectal cancer resection? A 3-year prospective study in a district general hospital. Colorectal Dis 2008; 10:363-9. [PMID: 17949448 DOI: 10.1111/j.1463-1318.2007.01332.x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
INTRODUCTION Laparoscopic colorectal surgery is slowly being adopted across the UK. We present a 3-year prospective study of laparoscopic colorectal cancer resections in a district general hospital. METHOD Data relating to premorbid, operative and postoperative parameters were recorded for all patients undergoing laparoscopic, open, planned converted (laparoscopic assisted) and unplanned converted resections prospectively from April 2003 to April 2006. RESULTS A total of 238 colorectal resections were performed, 153 of which were for cancer. Of these 44 (29%) were open, 77 (50%) were laparoscopic and 32 (21%) were converted [26 (17%) planned and six (4%) unplanned]. Blood loss was less in the laparoscopic group compared with the open group (P = 0.02) as was intra-operative fluid replacement (P = 0.01). Time to requiring oral analgesia alone was shorter (P = 0.001) and bowel function returned earlier (P = 0.001) in the laparoscopic group. This is reflected in a trend towards a shorter hospital stay for the laparoscopic group compared with the open group (P = 0.049). The operating time of the laparoscopic group was not significantly longer (P = 0.38). The complication rate was similar between groups (P = 0.31) and the mortality in the laparoscopic group was 1.3%. CONCLUSION Changing from open to laparoscopic dissection for colorectal cancer is safe even during the initial learning curve. There are clear potential short-term benefits for patients and the technique can be introduced without penalties in terms of reduced surgical throughput.
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Affiliation(s)
- J T Lordan
- Department of Colorectal Surgery, Frimley Park Hospital NHS Foundation Trust, Frimley, Surrey, UK.
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Asoglu O, Matlim T, Karanlik H, Atar M, Muslumanoglu M, Kapran Y, Igci A, Ozmen V, Kecer M, Parlak M. Impact of laparoscopic surgery on bladder and sexual function after total mesorectal excision for rectal cancer. Surg Endosc 2008; 23:296-303. [PMID: 18398647 DOI: 10.1007/s00464-008-9870-7] [Citation(s) in RCA: 80] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2007] [Revised: 01/15/2008] [Accepted: 02/02/2008] [Indexed: 10/22/2022]
Abstract
BACKGROUND Bladder and sexual dysfunction are well-documented complications of rectal cancer surgery. This study aimed to determine whether laparoscopy can improve the outcome of these dysfunctions or not. METHODS The study included 63 of the 116 patients who underwent surgery for rectal cancer between 2002 and 2006. Bladder and male sexual function were studied by means of a questionnaire on the basis of the International Prostatic Symptom Score (IPSS) and International Index of Erectile Function (IIEF). In addition, bladder function was determined by means of postvoid residual urine measurement and uroflowmetry. Postoperative functions were compared with the preoperative data to detect subjective functional deterioration. Outcomes were compared between patients who underwent open (group 1, n = 29) and laparoscopic (group 2, n = 34) total mesorectal excision. RESULTS Only minor disturbances of bladder function were reported for one patient (3%) in group 1 and three patients (9%) in group 2 (p > 0.05). Impotency after surgery was experienced by 6 of 17 preoperatively sexually active males (29%) in group 1 and 1 of 18 males (5%) in group 2 (p = 0.04). Similarly, 5 of 10 women (50 %) in group 1 and 1 of 14 women (7%) in group 2 felt that their overall level of sexual function had decreased as a result of surgery (p = 0.03). CONCLUSIONS Open rectal cancer resection is associated with a higher rate of sexual dysfunction, but not bladder dysfunction, compared with laparoscopic surgery. Laparoscopic rectal cancer surgery offers a significant advantage with regard to preservation of postoperative sexual function and constitutes a true advance in rectal cancer surgery compared with the open technique. The proposed advantages can be attributed to improvement in visibility by the magnification feature of laparoscopic surgery.
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Affiliation(s)
- Oktar Asoglu
- Department of Surgery, Istanbul Medical School, Istanbul University, Akyildiz sitesi, Birlik sokak, B Blok, 1 Levent, Istanbul, Turkey.
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Wu ZY, Wan J, Li JH, Zhao G, Yao Y, Du JL, Liu QF, Peng L, Wang ZD, Huang ZM, Lin HH. Prognostic value of lateral lymph node metastasis for advanced low rectal cancer. World J Gastroenterol 2008; 13:6048-52. [PMID: 18023098 PMCID: PMC4250889 DOI: 10.3748/wjg.v13.45.6048] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
AIM To evaluate the risk factors for lateral lymph node metastasis in patients with advanced low rectal cancer, in order to make the effective selection of patients who could benefit from lateral lymph node dissection, as well as the relationship of lateral lymph node metastasis with local recurrence and survival of patients with advanced low rectal cancer. METHODS A total of 96 consecutive patients who underwent curative surgery with lateral pelvic lymphadenectomy for advanced lower rectal cancer were retrospectively analyzed. The relation of lateral lymph node metastasis with clinicopathologic characteristics, local recurrence and survival of patients was identified. RESULTS Lateral lymph node metastasis was observed in 14.6% (14/96) of patients with advanced low rectal cancer. Lateral lymph node metastasis was detected in 10 (25.0%) of 40 patients with tumor diameter >or= 5 cm and in 4 (7.1%) of 56 patients with tumor diameter < 5 cm. The difference between the two groups was statistically significant (c2 = 5.973, P = 0.015). Lateral lymph node metastasis was more frequent in patients with 4/4 diameter of tumor infiltration (7 of 10 cases, 70.0%), compared with patients with 3/4, 2/4 and 1/4 diameter of tumor infiltration (3 of 25 cases, 12.0%; 3 of 45 cases, 6.7%; 1 of 16 cases, 6.3%) (c2 = 27.944, P = 0.0001). The lateral lymph node metastasis rate was 30.0% (9 of 30 cases), 9.1% (4 of 44 cases) and 4.5% (1 of 22 cases) for poorly, moderately and well-differentiated carcinoma, respectively. The difference between the three groups was statistically significant (c2 = 8.569, P = 0.014). Local recurrence was 18.8% (18 of 96 cases), 64.3% (9 of 14 cases), and 11.0% (9 of 82 cases) in patients with advanced low rectal cancer, in those with and without lateral lymph node metastasis, respectively. The difference between the two groups was statistically significant (c2 = 22.308, P = 0.0001). Kaplan-Meier survival analysis showed significant improvements in median survival (80.9 +/- 2.1 m, 95% CI: 76.7-85.1 m vs 38 +/- 6.7 m, 95% CI: 24.8-51.2 m) of patients without lateral lymph node metastasis compared with those with lateral lymph node metastasis (log-rank, P = 0.0001). CONCLUSION Tumor diameter, infiltration and differentiation are significant risk factors for lateral lymph node metastasis. Lateral pelvic lymphadenectomy should be performed following surgery for patients with tumor diameter >or= 5 cm. Lateral lymph node metastasis is an important predictor for local recurrence and survival in patients with advanced low rectal cancer.
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Affiliation(s)
- Ze-Yu Wu
- Department of General Surgery, Guangdong Provincial People's Hospital, Guangzhou 510080, Guangdong Province, China
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Anderson C, Uman G, Pigazzi A. Oncologic outcomes of laparoscopic surgery for rectal cancer: a systematic review and meta-analysis of the literature. Eur J Surg Oncol 2008; 34:1135-42. [PMID: 18191529 DOI: 10.1016/j.ejso.2007.11.015] [Citation(s) in RCA: 94] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2007] [Accepted: 11/28/2007] [Indexed: 12/11/2022] Open
Abstract
AIM To review and compare the oncologic outcomes in patients with rectal cancer undergoing laparoscopic vs. open rectal surgery. METHODS An electronic literature search was performed for trials reporting oncologic outcomes for laparoscopic rectal resections. Variables of interest were survival, recurrence rates, margin status and nodal retrieval. Trials were excluded if variables were not specifically analysed for rectal resections. A meta-analysis was performed to assess the difference in oncologic outcomes between the two treatment approaches. RESULTS Data on a total of 1403 laparoscopic (LG) and 1755 open (OG) rectal resections were gathered from 24 publications. Overall survival at 3 years (LG=76%, OG=69%) was not statistically different between the two treatment groups. The mean local recurrence rates were 7% for laparoscopic and 8% for open procedures (NS). There was no difference in radial margin positivity, 5% of patients undergoing laparoscopic surgery compared to 8% for open surgery. Laparoscopic procedures harvested a mean of 10 nodes as compared to 12 for open procedures, p=0.001. CONCLUSIONS Data gathered in this meta-analysis indicate that there are no oncologic differences between laparoscopic and open resections for treatment of primary rectal cancer.
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Affiliation(s)
- C Anderson
- Department of General Oncologic Surgery, City of Hope Medical Center, 1500 Duarte Road, Duarte, CA 91010, USA
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Lee GJ, Lee JN, Oh JH, Baek JH. Mid-term Results of Laparoscopic Surgery and Open Surgery for Radical Treatment of Colorectal Cancer. JOURNAL OF THE KOREAN SOCIETY OF COLOPROCTOLOGY 2008. [DOI: 10.3393/jksc.2008.24.5.373] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Affiliation(s)
- Gil Jae Lee
- Department of Surgery, Gachon University of Medicine and Science, Gil Medical Center, Incheon, Korea
| | - Jung Nam Lee
- Department of Surgery, Gachon University of Medicine and Science, Gil Medical Center, Incheon, Korea
| | - Jae Hwan Oh
- Department of Surgery, Gachon University of Medicine and Science, Gil Medical Center, Incheon, Korea
| | - Jeong-Heum Baek
- Department of Surgery, Gachon University of Medicine and Science, Gil Medical Center, Incheon, Korea
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Abstract
AIM: To evaluate the risk factors for lateral lymph node metastasis in patients with advanced low rectal cancer, in order to make the effective selection of patients who could benefit from lateral lymph node dissection, as well as the relationship of lateral lymph node metastasis with local recurrence and survival of patients with advanced low rectal cancer.
METHODS: A total of 96 consecutive patients who underwent curative surgery with lateral pelvic lymphadenectomy for advanced lower rectal cancer were retrospectively analyzed. The relation of lateral lymph node metastasis with clinicopathologic characteristics, local recurrence and survival of patients was identified.
RESULTS: Lateral lymph node metastasis was observed in 14.6% (14/96) of patients with advanced low rectal cancer. Lateral lymph node metastasis was detected in 10 (25.0%) of 40 patients with tumor diameter ≥ 5 cm and in 4 (7.1%) of 56 patients with tumor diameter < 5 cm. The difference between the two groups was statistically significant (χ2 = 5.973, P = 0.015). Lateral lymph node metastasis was more frequent in patients with 4/4 diameter of tumor infiltration (7 of 10 cases, 70.0%), compared with patients with 3/4, 2/4 and 1/4 diameter of tumor infiltration (3 of 25 cases, 12.0%; 3 of 45 cases, 6.7%; 1 of 16 cases, 6.3%) (χ2 = 27.944, P = 0.0001). The lateral lymph node metastasis rate was 30.0% (9 of 30 cases), 9.1% (4 of 44 cases) and 4.5% (1 of 22 cases) for poorly, moderately and well-differentiated carcinoma, respectively. The difference between the three groups was statistically significant (χ2 = 8.569, P = 0.014). Local recurrence was 18.8% (18 of 96 cases), 64.3% (9 of 14 cases), and 11.0% (9 of 82 cases) in patients with advanced low rectal cancer, in those with and without lateral lymph node metastasis, respectively. The difference between the two groups was statistically significant (χ2 = 22.308, P = 0.0001). Kaplan-Meier survival analysis showed significant improvements in median survival (80.9 ± 2.1 m, 95% CI: 76.7-85.1 m vs 38 ± 6.7 m, 95% CI: 24.8-51.2 m) of patients without lateral lymph node metastasis compared with those with lateral lymph node metastasis (log-rank, P = 0.0001).
CONCLUSION: Tumor diameter, infiltration and differentiation are significant risk factors for lateral lymph node metastasis. Lateral pelvic lymphadenectomy should be performed following surgery for patients with tumor diameter ≥ 5 cm. Lateral lymph node metastasis is an important predictor for local recurrence and survival in patients with advanced low rectal cancer.
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Hamada M, Nishioka Y, Kurose Y, Nishimura T, Furukita Y, Ozaki K, Nakamura T, Fukui Y, Taniki T, Horimi T. New laparoscopic double-stapling technique. Dis Colon Rectum 2007; 50:2247-51. [PMID: 17712593 DOI: 10.1007/s10350-007-9035-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
BACKGROUND Laparoscopic surgery for colon cancer has been shown by several randomized, controlled trials to be an acceptable alternative to open surgery; however, laparoscopic rectal surgery has not been evaluated in a randomized trial. One of the most serious problems associated with laparoscopic rectal surgery are bowel clamping, irrigation, and transection of the rectum, and laparoscopic rectal surgery has not been as reliable as open rectal surgery. MATERIALS AND METHODS We present our new technique, the laparoscopic double-stapling technique, which eliminates these problems. This technique uses curved Doyen forceps introduced through the wound just above pubis symphysis for clamping the rectal wall at the anal side of the tumor. An endolinear stapler (length 60 mm) is inserted through the same wound, applied at the rectal wall parallel and caudal to the Doyen forceps, and transects the rectum under pneumoperitoneum. We used this technique for eight cases of rectal surgery. RESULTS AND DISCUSSION The laparoscopic double-stapling technique provided secure bowel clamping and rectal irrigation. The number of cartridges used in laparoscopic double-stapling technique cases was not more than 2, with an average of 1.6 per patient. None of the laparoscopic double-stapling technique cases experienced major complications. CONCLUSION We consider that many cases of rectal cancer that are suitable for laparoscopic low anterior resection can undergo laparoscopic surgery by using this technique, which will improve the quality of rectal surgery.
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Affiliation(s)
- Madoka Hamada
- Department of General and Digestive Surgery, Kochi Health Sciences Center, Kochi, Japan.
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Hinojosa MW, Murrell ZA, Konyalian VR, Mills S, Nguyen NT, Stamos MJ. Comparison of laparoscopic vs open sigmoid colectomy for benign and malignant disease at academic medical centers. J Gastrointest Surg 2007; 11:1423-9; discussion 1429-30. [PMID: 17786529 DOI: 10.1007/s11605-007-0269-x] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2007] [Accepted: 07/19/2007] [Indexed: 01/31/2023]
Abstract
Few studies have examined outcomes of laparoscopic and open sigmoid colectomy performed at US academic centers. Using ICD-9 diagnosis and procedural codes, data was obtained from the University HealthSystem Consortium (UHC) Clinical Database of 10,603 patients who underwent laparoscopic or open sigmoid colectomy for benign and malignant disease between 2003-2006. A total of 1,092 patients (10.3%) underwent laparoscopic sigmoid colectomy. Laparoscopic sigmoid colectomy was associated with a significantly shorter length of stay (5.4 vs 7.4 days), lower overall complication rate (19.7 vs 26.0%), lower 30-day readmission rate (3.4 vs 4.6), and a lower hospital cost ($13,814 vs $15,626). When a subset analysis of malignant and benign groups was performed, a significantly shorter length of stay in both the malignant laparoscopic group (6.4 +/- 6.4 vs 7.8 +/- 6.6 days) and in the benign laparoscopic groups (5.1 +/- 3.5 vs 7.2 +/- 7.6) exists. A lower wound complication rate (2.1 vs 5.5%, malignant and 4.0 vs 6.1, benign) is also evident. Laparoscopic sigmoid colectomy was associated with a shorter length of stay, less complications, and a lower 30-day readmission rate. The shorter length of stay and wound infection rate maintain significance when comparing laparoscopic vs open sigmoid resections for malignant and benign disease.
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Affiliation(s)
- Marcelo W Hinojosa
- Department of Surgery, University of California Irvine Medical Center, Orange, CA, USA
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Lezoche G, Baldarelli M, Guerrieri M, Mario, Paganini AM, De Sanctis A, Bartolacci S, Lezoche E. A prospective randomized study with a 5-year minimum follow-up evaluation of transanal endoscopic microsurgery versus laparoscopic total mesorectal excision after neoadjuvant therapy. Surg Endosc 2007. [PMID: 17943364 DOI: 10.1007/s00464-007-9714-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
BACKGROUND This study aimed to compare the oncologic results for local excision via transanal endoscopic microsurgery (TEM) and those for laparoscopic resection (LR) via total mesorectal excision in the treatment of T(2) N(0), G(1-2 )rectal cancer after neoadjuvant therapy with both treatments, incorporating a 5-year minimum follow-up period. METHODS The study enrolled 70 patients whose malignancy was staged at admission as T(2) N(0), G(1-2 )rectal cancer located within 6 cm of the anal verge with a tumor diameter less than 3 cm. Of these patients, 35 were randomized to TEM and 35 to LR. The patients in both groups previously had undergone high-dose radiotherapy (5,040 cGy in 28 fractions over 5 weeks) combined with continuous infusion of 5-flurouracil (200 mg/m(2)/day). RESULTS The median follow-up period was 84 months (range, 72-96 months). Two local recurrences (5.7%) were observed after TEM and 1 (2.8%) after LR. Distant metastases (2.8%) occurred in one case each after TEM and LR. The probability of survival for rectal cancer was 94% for TEM and 94% for LR. CONCLUSIONS The study shows similar results between the two treatments in terms of local recurrences, distant metastases, and probability of survival for rectal cancer.
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Affiliation(s)
- G Lezoche
- Department of Surgery Paride Stefanini, II Clinica Chirurgica, University of Rome La Sapienza, Viale del Policlinico, 00161, Rome, Italy.
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Lezoche G, Baldarelli M, Guerrieri M, Paganini AM, De Sanctis A, Bartolacci S, Lezoche E. A prospective randomized study with a 5-year minimum follow-up evaluation of transanal endoscopic microsurgery versus laparoscopic total mesorectal excision after neoadjuvant therapy. Surg Endosc 2007; 22:352-8. [PMID: 17943364 DOI: 10.1007/s00464-007-9596-y] [Citation(s) in RCA: 190] [Impact Index Per Article: 11.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2007] [Revised: 06/06/2007] [Accepted: 07/05/2007] [Indexed: 02/06/2023]
Abstract
BACKGROUND This study aimed to compare the oncologic results for local excision via transanal endoscopic microsurgery (TEM) and those for laparoscopic resection (LR) via total mesorectal excision in the treatment of T(2) N(0), G(1-2 )rectal cancer after neoadjuvant therapy with both treatments, incorporating a 5-year minimum follow-up period. METHODS The study enrolled 70 patients whose malignancy was staged at admission as T(2) N(0), G(1-2 )rectal cancer located within 6 cm of the anal verge with a tumor diameter less than 3 cm. Of these patients, 35 were randomized to TEM and 35 to LR. The patients in both groups previously had undergone high-dose radiotherapy (5,040 cGy in 28 fractions over 5 weeks) combined with continuous infusion of 5-flurouracil (200 mg/m(2)/day). RESULTS The median follow-up period was 84 months (range, 72-96 months). Two local recurrences (5.7%) were observed after TEM and 1 (2.8%) after LR. Distant metastases (2.8%) occurred in one case each after TEM and LR. The probability of survival for rectal cancer was 94% for TEM and 94% for LR. CONCLUSIONS The study shows similar results between the two treatments in terms of local recurrences, distant metastases, and probability of survival for rectal cancer.
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Affiliation(s)
- G Lezoche
- Department of Surgery Paride Stefanini, II Clinica Chirurgica, University of Rome La Sapienza, Viale del Policlinico, 00161, Rome, Italy.
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Naitoh T, Tsuchiya T, Honda H, Oikawa M, Saito Y, Hasegawa Y. Clinical outcome of the laparoscopic surgery for stage II and III colorectal cancer. Surg Endosc 2007; 22:950-4. [PMID: 17705076 DOI: 10.1007/s00464-007-9528-x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2007] [Revised: 06/20/2007] [Accepted: 07/07/2007] [Indexed: 01/08/2023]
Abstract
BACKGROUND Laparoscopic colorectal cancer surgery has become widely accepted recently. However, the oncological validity of this surgery has not yet been well analyzed, especially for advanced cancer. The aim of this study is to assess the clinical outcome of laparoscopic surgery for stage II/III colorectal cancer in our hospital. PATIENTS AND METHODS Between June 1999 and August 2006, 321 patients underwent laparoscopic colorectal cancer surgery in our hospital; of those 121 cases whose pathological findings revealed stage II/III were included in this study. Among these cases, we assessed a short-term outcome and a medium-term outcome in terms of survival evaluation. RESULTS The male:female ratio was 73:48, and mean age of patients was 62.4 years. Thirteen tumors were located in the cecum, 29 in the ascending colon, five in the transverse colon, one in the descending colon, 43 in the sigmoid colon, and 30 in the rectum. Average duration of operation was 184 minutes, and mean estimated blood loss was 53.5 ml. Five patients (4.1%) were converted to open procedures. No intraoperative complication was observed but eight complications (6.6%) occurred postoperatively. Forty-two cases were classified as stage II, 62 as stage IIIA /B, and 17 as stage IIIC. Five patients died of cancer relapse (4.1%), and 18 cases had recurrence of disease (14.9%), to date. No port-site recurrence was detected. Overall five-year survival was 95.7% in stage II, 84.1% in stage IIIA/B, 70.0% in stage IIIC. Meanwhile disease-free five-year survival was 75.6% in stage II, 80.1% in stage IIIA/B, and 66.8% in stage IIIC. No significant difference was observed between stages, in terms of either overall or disease-free survival. CONCLUSION Although further evaluation is required, laparoscopic surgery for stage II/III colorectal cancer is safe and would be an oncologically adequate procedure.
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Affiliation(s)
- Takeshi Naitoh
- Department of Surgery, Sendai City Medical Center, 5-22-1, Tsurugaya, Miyagino-ku, Sendai, 983-0824, Japan.
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Katsinelos P, Chatzimavroudis G, Zavos C, Pilpilidis I, Lazaraki G, Papaziogas B, Paroutoglou G, Kountouras J, Paikos D. Cecal lipoma with pseudomalignant features: A case report and review of the literature. World J Gastroenterol 2007; 13:2510-3. [PMID: 17552037 PMCID: PMC4146772 DOI: 10.3748/wjg.v13.i17.2510] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Colonic lipoma is a well-documented benign neoplasia, endoscopically appearing as a smooth round yellowish polyp with a thick stalk or broad-based attachment. We describe a 63-year old woman with persistent abdominal pain, in whom colonoscopy revealed a cecal mass with malignant features. Based on the colonoscopy findings, right hemicolectomy was laparoscopically performed for a presumptive diagnosis of a cecal adenocarcinoma, but histological examination revealed a colonic lipoma with overlying mucosal ulceration.
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Affiliation(s)
- Panagiotis Katsinelos
- Department of Endoscopy and Motility Unit, Central Hospital, Ethnikis Aminis 41, 54635, Thessaloniki, Greece.
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Tobalina Aguirrezábal E, Múgica Alcorta I, Portugal Porras V, Sarabia García S. Implantación de la cirugía laparoscópica de colon en un servicio de cirugía general. Cir Esp 2007; 81:134-8. [PMID: 17349237 DOI: 10.1016/s0009-739x(07)71284-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
OBJECTIVE To evaluate the viability, safety and short-term results of laparoscopic colon surgery during the first few years after its introduction in our department. METHOD Between January 2002 and December 2005, laparoscopic surgery was performed in patients with surgical indication for benign colon disease. After 2003, patients with malignant disease were also included. A database was created and demographic data, surgical indication, technique, conversion rate, morbidity and postoperative length of stay were recorded. All patients were operated on by the same team of three surgeons. RESULTS Ninety consecutive patients, with a mean age of 59.2 years (20-88) underwent laparoscopic surgery. Of these, 53 were men (59%). In total, 32 patients had previously undergone one or more open laparotomies (35.5%). Surgery was indicated for benign disease in 60 patients (66%). Distribution was left colon in 79 patients and right colon in 11 patients. The most frequent technique was sigmoidectomy (67.7%). The conversion rate was 12.2%. Operating time was 199 min. (120-340) and length of postoperative stay was 7.5 days (4-57). Morbidity was 18.8% and mortality was 1.1%. CONCLUSIONS Laparoscopic surgery of the colon is safe and reproducible. Our short-term results are similar to those of previous studies. We believe that prior experience of laparoscopic surgery is important and that a stable surgical team minimizes the effect of the learning curve.
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Jackson TD, Kaplan GG, Arena G, Page JH, Rogers SO. Laparoscopic Versus Open Resection for Colorectal Cancer: A Metaanalysis of Oncologic Outcomes. J Am Coll Surg 2007; 204:439-46. [PMID: 17324779 DOI: 10.1016/j.jamcollsurg.2006.12.008] [Citation(s) in RCA: 108] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2006] [Revised: 11/26/2006] [Accepted: 12/04/2006] [Indexed: 02/06/2023]
Affiliation(s)
- Timothy D Jackson
- Department of Surgery, McMaster University, Hamilton, Ontario, Canada
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Campagnacci R, de Sanctis A, Baldarelli M, Rimini M, Lezoche G, Guerrieri M. Electrothermal bipolar vessel sealing device vs. ultrasonic coagulating shears in laparoscopic colectomies: a comparative study. Surg Endosc 2007; 21:1526-31. [PMID: 17287913 DOI: 10.1007/s00464-006-9143-2] [Citation(s) in RCA: 60] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2006] [Revised: 08/22/2006] [Accepted: 08/30/2006] [Indexed: 01/15/2023]
Abstract
BACKGROUND Many devices are available for vascular control during laparoscopic colorectal procedures. Ultrasonic coagulating shears (UCS), vascular staplers, titanium or plastic clips, and electrothermal bipolar vessel sealing (EBVS) are currently used according to the surgeon's preference. This study aimed to compare EBVS Ligasure with UCS. METHODS We report the outcome of 200 consecutive unselected patients who underwent laparoscopic colorectal resections of which 100 were performed with EBVS Ligasure (from September 2004 to December 2005, group 1) and 100 with UCS harmonic scalpel (from December 2002 to June 2004, group 2). Only the following three types of operation were performed: right colectomy (RC), left colectomy (LC), and low anterior resections (LAR). Emergency procedures have been excluded. The same attending surgical teams performed or supervised all procedures. Operating time, blood loss, complications, and postoperative hospital stay were investigated. RESULTS Age, gender, previous surgical abdominal procedures, and ASA risk were similar between the two groups, as well as was the percentage of malignant cases (74% vs. 71%, respectively). There were 32 vs. 37 RC, 50 vs. 47 LC, and 18 vs. 16 LAR in groups 1 and 2, respectively. There was no mortality in either group. A conversion to open surgery and two major complications occurred in group 2. There were no statistically significant differences in mean operating time (111 vs. 133, 140 vs. 176, and 153 vs. 201 min) and in the mean postoperative hospital stay (5.2 vs. 6.1, 6.5 vs. 7.1, and 6.8 vs 7.3 days) for RC, LC, and LAR between group 1 and 2, respectively. We do report interesting data about statistically significant differences in the blood loss: 115 vs. 370, 150 vs. 455, and 185 vs. 495 ml for RC (p < 0.001), LC (p < 0.001), and LAR (p = 0.002) between group 1 and group 2, respectively. CONCLUSIONS In our laparoscopic colorectal experience, EBVS Ligasure has proven safe and effective in vessel sealing. Patients in whom this device was used had less blood loss and slight advantages in operating time and postoperative hospital stay.
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Affiliation(s)
- Roberto Campagnacci
- Clinica di Chirurgia Generale e Metodologia Chirurgica, Ospedali Riuniti, University of Ancona, via Conca 1, 60121, Ancona, Italy.
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