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Unruh KR, Bastawrous AL, Kanneganti S, Kaplan JA, Moonka R, Rashidi L, Sillah A, Simianu VV. The Impact of Prolonged Operative Time Associated With Minimally Invasive Colorectal Surgery: A Report From the Surgical Care Outcomes Assessment Program. Dis Colon Rectum 2024; 67:302-312. [PMID: 37878484 DOI: 10.1097/dcr.0000000000002925] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2023]
Abstract
BACKGROUND Increased operative time in colorectal surgery is associated with worse surgical outcomes. Laparoscopic and robotic operations have improved outcomes, despite longer operative times. Furthermore, the definition of "prolonged" operative time has not been consistently defined. OBJECTIVE The first objective was to define prolonged operative time across multiple colorectal operations and surgical approaches. The second was to describe the impact of prolonged operative time on length of stay and short-term outcomes. DESIGN A retrospective cohort study. SETTING Forty-two hospitals in the Surgical Care Outcomes Assessment Program from 2011 to 2019. PATIENTS There were a total of 23,098 adult patients (age 18 years or older) undergoing 6 common, elective colorectal operations: right colectomy, left/sigmoid colectomy, total colectomy, low anterior resection, IPAA, or abdominoperineal resection. MAIN OUTCOME MEASURES Prolonged operative time defined as the 75th quartile of operative times for each operation and approach. Outcomes were length of stay, discharge home, and complications. Adjusted models were used to account for factors that could impact operative time and outcomes across the strata of open and minimally invasive approaches. RESULTS Prolonged operative time was associated with longer median length of stay (7 vs 5 days open, 5 vs 4 days laparoscopic, 4 vs 3 days robotic) and more frequent complications (42% vs 28% open, 24% vs 17% laparoscopic, 27% vs 13% robotic) but similar discharge home (86% vs 87% open, 94% vs 94% laparoscopic, 93% vs 96% robotic). After adjustment, each additional hour of operative time above the median for a given operation was associated with 1.08 (1.06-1.09) relative risk of longer length of stay for open operations and 1.07 (1.06-1.09) relative risk for minimally invasive operations. LIMITATIONS Our study was limited by being retrospective, resulting in selection bias, possible confounders for prolonged operative time, and lack of statistical power for subgroup analyses. CONCLUSIONS Operative time has consistent overlap across surgical approaches. Prolonged operative time is associated with longer length of stay and higher probability of complications, but this negative effect is diminished with minimally invasive approaches. See Video Abstract . EL IMPACTO DEL TIEMPO OPERATORIO PROLONGADO ASOCIADO CON LA CIRUGA COLORRECTAL MNIMAMENTE INVASIVA UN INFORME DEL PROGRAMA DE EVALUACIN DE RESULTADOS DE ATENCIN QUIRRGICA ANTECEDENTES:El aumento del tiempo operatorio en la cirugía colorrectal se asocia con peores resultados quirúrgicos. Las operaciones laparoscópicas y robóticas han mejorado los resultados, a pesar de los tiempos operatorios más prolongados. Además, la definición de tiempo operatorio "prolongado" no se ha definido de manera consistente.OBJETIVO:Primero, definir el tiempo operatorio prolongado a través de múltiples operaciones colorrectales y enfoques quirúrgicos. En segundo lugar, describir el impacto del tiempo operatorio prolongado sobre la duración de la estancia y los resultados a corto plazo.DISEÑO:Estudio de cohorte retrospectivo.ESCENARIO:42 hospitales en el Programa de Evaluación de Resultados de Atención Quirúrgica de 2011-2019.PACIENTES:23 098 pacientes adultos (de 18 años de edad y mayores), que se sometieron a seis operaciones colorrectales electivas comunes: colectomía derecha, colectomía izquierda/sigmoidea, colectomía total, resección anterior baja, anastomosis ileoanal con bolsa o resección abdominoperineal.PRINCIPALES MEDIDAS DE RESULTADO:Tiempo operatorio prolongado definido como el cuartil 75 de tiempos operatorios para cada operación y abordaje. Los resultados fueron la duración de la estancia hospitalaria, el alta domiciliaria y las complicaciones. Se usaron modelos ajustados para tener en cuenta los factores que podrían afectar tanto el tiempo operatorio como los resultados en los estratos de abordajes abiertos y mínimamente invasivos.RESULTADOS:El tiempo operatorio prolongado se asoció con una estancia media más prolongada (7 vs. 5 días abiertos, 5 vs. 4 días laparoscópicos, 4 vs. 3 días robóticos), complicaciones más frecuentes (42 % vs. 28 % abiertos, 24 % vs. 17 % laparoscópica, 27% vs. 13% robótica), pero similar alta domiciliaria (86% vs. 87% abierta, 94% vs. 94% laparoscópica, 93% vs. 96% robótica). Después del ajuste, cada hora adicional de tiempo operatorio por encima de la mediana para una operación determinada se asoció con un riesgo relativo de 1,08 (1,06, 1,09) de estancia hospitalaria más larga para operaciones abiertas y un riesgo relativo de 1,07 (1,06, 1,09) para operaciones mínimamente invasivas.LIMITACIONES:Nuestro estudio estuvo limitado por ser retrospectivo, lo que resultó en un sesgo de selección, posibles factores de confusión por un tiempo operatorio prolongado y falta de poder estadístico para los análisis de subgrupos.CONCLUSIONES:El tiempo operatorio tiene una superposición constante entre los enfoques quirúrgicos. El tiempo operatorio prolongado se asocia con una estadía más prolongada y una mayor probabilidad de complicaciones, pero este efecto negativo disminuye con los enfoques mínimamente invasivos. ( Traducción-Dr. Mauricio Santamaria ).
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Affiliation(s)
- Kenley R Unruh
- Department of Surgery, Virginia Mason Franciscan Health, Seattle, Washington
| | - Amir L Bastawrous
- Swedish Cancer Institute, Swedish Medical Center, Seattle, Washington
| | - Shalini Kanneganti
- Franciscan Surgical Associates at St Joseph Hospital, Tacoma, Washington
| | - Jennifer A Kaplan
- Department of Surgery, Virginia Mason Franciscan Health, Seattle, Washington
| | - Ravi Moonka
- Department of Surgery, Virginia Mason Franciscan Health, Seattle, Washington
| | - Laila Rashidi
- MultiCare Colon and Rectal Surgery, Tacoma, Washington
| | - Arthur Sillah
- School of Public Health, University of Washington, Seattle, Washington
- Surgical Care Outcomes Assessment Program, Seattle, Washington
| | - Vlad V Simianu
- Department of Surgery, Virginia Mason Franciscan Health, Seattle, Washington
- Surgical Care Outcomes Assessment Program, Seattle, Washington
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Guidolin K, Ng D, Zorigtbaatar A, Chadi S, Quereshy F. A machine learning model to predict the need for conversion of operative approach in patients undergoing colectomy for neoplasm. Cancer Rep (Hoboken) 2024; 7:e1917. [PMID: 37884442 PMCID: PMC10809191 DOI: 10.1002/cnr2.1917] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2023] [Revised: 09/07/2023] [Accepted: 10/08/2023] [Indexed: 10/28/2023] Open
Abstract
BACKGROUND Studies comparing conversion from laparoscopic to open approaches to colectomy have found an association between conversion and morbidity, mortality, and length of stay, suggesting that certain patients may benefit from an open approach "up-front." AIM The objective of this study was to use machine learning algorithms to develop a model enabling the prediction of which patients are likely to require conversion. METHODS AND RESULTS We used ACS NSQIP data to identify patients undergoing colectomy (2014-2019). We included patients undergoing elective colectomy for colorectal neoplasm via a minimally invasive approach or a converted approach. The outcome of interest was conversion. Variables were included in the model based on their correlation with conversion by logistic regression (p < .05). Two models were used: weighted logistic regression with regularization, and Random Forest classifier. The data was randomly split into training (70%) and test (30%) cohorts, and prediction performance was calculated. 24 327 cases were included (17 028 training, 7299 test). When applied to the test cohort, the models had an accuracy of 0.675 (range 0.65-0.70) in predicting conversion; c-index ranged from 0.62-0.63. This machine learning model achieved a moderate area under the curve and a high negative predictive value, but a low positive predictive value; therefore, this model can predict (with 95% accuracy) whether a colectomy for neoplasm can be successfully completed using a minimally invasive approach. CONCLUSION This model can be used to reassure surgeons of the appropriateness of a minimally invasive approach when planning for an elective colectomy.
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Affiliation(s)
- Keegan Guidolin
- Department of SurgeryUniversity of TorontoTorontoOntarioCanada
- Institute of Biomedical EngineeringUniversity of TorontoTorontoOntarioCanada
- Department of SurgeryUniversity Health NetworkTorontoOntarioCanada
| | - Deanna Ng
- Institute of Medical ScienceUniversity of TorontoTorontoOntarioCanada
- Department of SurgeryMount Sinai HospitalTorontoOntarioCanada
| | | | - Sami Chadi
- Department of SurgeryUniversity of TorontoTorontoOntarioCanada
- Department of SurgeryUniversity Health NetworkTorontoOntarioCanada
| | - Fayez Quereshy
- Department of SurgeryUniversity of TorontoTorontoOntarioCanada
- Department of SurgeryUniversity Health NetworkTorontoOntarioCanada
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Sueda T, Tei M, Nishida K, Yoshikawa Y, Matsumura T, Koga C, Miyagaki H, Tsujie M, Akamaru Y, Hasegawa J. Impact of prior abdominal surgery on short-term outcomes following laparoscopic colorectal cancer surgery: a propensity score-matched analysis. Surg Endosc 2022; 36:4429-4441. [PMID: 34716479 DOI: 10.1007/s00464-021-08794-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2021] [Accepted: 10/17/2021] [Indexed: 01/29/2023]
Abstract
BACKGROUND Whether laparoscopic surgery after prior abdominal surgery (PAS) is safe and feasible for colorectal cancer (CRC) remains controversial. The present study aimed to evaluate the impact of PAS on short-term outcomes following laparoscopic CRC surgery. METHODS We performed retrospective analysis used propensity score-matched analysis to reduce the possibility of selection bias. Participants comprised 1284 consecutive patients who underwent elective laparoscopic CRC surgery between 2010 and 2020. Patients were divided into two groups according to PAS. Patients with PAS were then matched to patients without these conditions. Short-term outcomes were evaluated between groups in the overall cohort and matched cohort, and risk factors for conversion to laparotomy and severe postoperative complications were analyzed. RESULTS After propensity score matching, we enrolled 762 patients (n = 381 in each group). Before matching, significant group-dependent differences were observed in sex, age, primary tumor site, pathological (p) T stage, and type of procedure. No significant difference was found between groups in terms of rate of conversion to laparotomy, estimated blood loss, rate of extended resection, length of postoperative stay, and postoperative complications. After matching, estimated operative time was significantly longer in the PAS group (p = 0.01). Significant differences were found between groups in terms of reason for conversion to laparotomy. Multivariate analyses identified significant risk factors for conversion to laparotomy as pT stage ≥ 3 (odds ratio [OR] 2.36; 95% confidence interval [CI] 1.05-5.26) and body mass index ≥ 25 kg/m2 (OR 3.56; 95% CI 1.07-11.7). Multivariate analyses identified rectum in the primary tumor site as the only significant risk factor for severe postoperative complications (OR 2.37; 95% CI 1.08-5.20). CONCLUSIONS Laparoscopic CRC surgery after PAS showed acceptable short-term outcomes compared to Non-PAS. The laparoscopic approach appears safe and feasible for CRC regardless of whether the patient has a history of PAS.
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Affiliation(s)
- Toshinori Sueda
- Department of Surgery, Osaka Rosai Hospital, 1179-3 Nagasone-kitaku, Sakai, Osaka, 591-8025, Japan.
| | - Mitsuyoshi Tei
- Department of Surgery, Osaka Rosai Hospital, 1179-3 Nagasone-kitaku, Sakai, Osaka, 591-8025, Japan
| | - Kentaro Nishida
- Department of Surgery, Osaka Rosai Hospital, 1179-3 Nagasone-kitaku, Sakai, Osaka, 591-8025, Japan
| | - Yukihiro Yoshikawa
- Department of Surgery, Osaka Rosai Hospital, 1179-3 Nagasone-kitaku, Sakai, Osaka, 591-8025, Japan
| | - Tae Matsumura
- Department of Surgery, Osaka Rosai Hospital, 1179-3 Nagasone-kitaku, Sakai, Osaka, 591-8025, Japan
| | - Chikato Koga
- Department of Surgery, Osaka Rosai Hospital, 1179-3 Nagasone-kitaku, Sakai, Osaka, 591-8025, Japan
| | - Hiromichi Miyagaki
- Department of Surgery, Osaka Rosai Hospital, 1179-3 Nagasone-kitaku, Sakai, Osaka, 591-8025, Japan
| | - Masanori Tsujie
- Department of Surgery, Osaka Rosai Hospital, 1179-3 Nagasone-kitaku, Sakai, Osaka, 591-8025, Japan
| | - Yusuke Akamaru
- Department of Surgery, Osaka Rosai Hospital, 1179-3 Nagasone-kitaku, Sakai, Osaka, 591-8025, Japan
| | - Junichi Hasegawa
- Department of Surgery, Osaka Rosai Hospital, 1179-3 Nagasone-kitaku, Sakai, Osaka, 591-8025, Japan
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Verma A, Kumar S. Laparoscopy in Colonic Cancer. Indian J Surg 2021. [DOI: 10.1007/s12262-019-02054-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
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The impact of obesity on minimally invasive colorectal surgery: A report from the Surgical Care Outcomes Assessment Program collaborative. Am J Surg 2021; 221:1211-1220. [PMID: 33745688 DOI: 10.1016/j.amjsurg.2021.03.019] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2020] [Revised: 02/24/2021] [Accepted: 03/10/2021] [Indexed: 11/24/2022]
Abstract
BACKGROUND Operating on obese patients can increase case complexity and result in worse outcomes. We described the incremental impact of BMI on morbidity and outcomes of colorectal operations and whether laparoscopic and robotic(MIS) approaches mitigate this morbidity differently. METHODS A retrospective cohort of patients undergoing elective colorectal operations in SCOAP was created to examine the association of increasing BMI on surgical outcomes. Additionally, multivariable logistic regression models were constructed. RESULTS From 2011 to 2019, 22,863 elective colorectal operations (mean age 62, 55% female) were performed at 42 hospitals. Patients had BMI≥30 in 7576(33%) and BMI≥40 in 1180(5%) of operations. After risk adjustment, BMI≥40 was associated with increased conversions(OR1.57,95%CI1.26-1.96), increased combined adverse events(CAE)(OR1.32,95%CI1.15-1.52), and death(OR2.24, 95%CI1.41-3.55)(all p < 0.01). MIS approaches were each associated with lower CAE(lap OR0.49,95%CI0.46-0.53; robot OR0.42,95%CI0.37-0.47), and death(lap OR0.24,95%CI0.18-0.33; robot OR0.18,95%CI0.10-0.35)(all p < 0.01). CONCLUSIONS Severe obesity is associated with increased conversion rates and worse short-term outcomes after colorectal surgery, though this trend is partially mitigated with a minimally invasive approach. These findings support the broad application of MIS for colorectal operations in obese patients.
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Efficient and Safe Method for Splenic Flexure Mobilization in Laparoscopic Left Hemicolectomy: A Propensity Score-weighted Cohort Study. Surg Laparosc Endosc Percutan Tech 2020; 31:196-202. [PMID: 33284257 PMCID: PMC8132887 DOI: 10.1097/sle.0000000000000884] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2020] [Accepted: 10/16/2020] [Indexed: 01/20/2023]
Abstract
Supplemental Digital Content is available in the text. Because methods of performing laparoscopic left hemicolectomy differ between surgeons, standardizing the procedure is crucial to reduce complications and secure good oncologic outcomes.
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Effect of preoperative radiotherapy and emergent surgery on conversion in laparoscopic colorectal surgery: A retrospective cohort study. JOURNAL OF SURGERY AND MEDICINE 2020. [DOI: 10.28982/josam.726443] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Robotic-assisted surgery for complicated and non-complicated diverticulitis: a single-surgeon case series. J Robot Surg 2019; 13:765-772. [DOI: 10.1007/s11701-018-00914-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2018] [Accepted: 12/13/2018] [Indexed: 12/14/2022]
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Wang H, Chen X, Liu H, Mou T, Deng H, Zhao L, Li G. Laparoscopy-assisted colectomy as an Oncologically safe alternative for patients with stage T4 Colon Cancer: a propensity-matched cohort study. BMC Cancer 2018; 18:370. [PMID: 29615004 PMCID: PMC5883638 DOI: 10.1186/s12885-018-4269-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2017] [Accepted: 03/20/2018] [Indexed: 12/21/2022] Open
Abstract
Background It is still controversial whether laparoscopy-assisted colectomy (LAC) is suitable for patients with stage T4 colon cancer. This study aimed to compare the short- and long-term outcomes of LAC and open colectomy (OC) for patients with pathologic T4 colon cancer. Methods Data of eligible patients with colon cancer in our institution from March 2004 to September 2014 were retrospectively reviewed. The patients were followed up to September 2016. Propensity score matching was performed to control the bias. Results Two hundred and forty two patients were selected by propensity score matching, with 121 patients in the LAC group and 121 in the OC group. Mean operating time and rate of intraoperative blood transfusion were similar between two groups. In LAC group, shorter time to first flatus and first liquid intake were observed in patients with pT4b stage disease, but not for patients with pT4a stage disease. Less blood loss and shorter length of postoperative hospital stay were examined in LAC group, including pT4a and pT4b stages. Conversion was required in 9.1% (11 out of 121) cases. DFS and OS were similar between LAC and OC groups. The 5-year DFS rate was 64.2% for pT4a stage and 35.5% for pT4b stage in LAC group, and 62.9% and 33.7% in OC group for pT4a (p = 0.374) and pT4b (p = 0.385) stage respectively. For 5-year OS rates, two groups did not differ in pT4a stage (LAC 69.2% vs. OC 66.0%, p = 0.151) and pT4b stage (LAC 37.5% vs. OC 38.1%, p = 0.510). Conclusions Laparoscopic colectomy appears to be safe for selected patients with pT4 colon cancer in centres with expertise in minimally invasive surgery.
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Affiliation(s)
- Hao Wang
- Department of General Surgery, Nanfang Hospital, Southern Medical University, Guangdong Provincial Engineering Technology Research Center of Minimally Invasive Surgery, Guangzhou, 510515, China
| | - Xiaoyu Chen
- Department of General Surgery, Nanfang Hospital, Southern Medical University, Guangdong Provincial Engineering Technology Research Center of Minimally Invasive Surgery, Guangzhou, 510515, China
| | - Hao Liu
- Department of General Surgery, Nanfang Hospital, Southern Medical University, Guangdong Provincial Engineering Technology Research Center of Minimally Invasive Surgery, Guangzhou, 510515, China
| | - Tingyu Mou
- Department of General Surgery, Nanfang Hospital, Southern Medical University, Guangdong Provincial Engineering Technology Research Center of Minimally Invasive Surgery, Guangzhou, 510515, China
| | - Haijun Deng
- Department of General Surgery, Nanfang Hospital, Southern Medical University, Guangdong Provincial Engineering Technology Research Center of Minimally Invasive Surgery, Guangzhou, 510515, China
| | - Liying Zhao
- Department of General Surgery, Nanfang Hospital, Southern Medical University, Guangdong Provincial Engineering Technology Research Center of Minimally Invasive Surgery, Guangzhou, 510515, China.
| | - Guoxin Li
- Department of General Surgery, Nanfang Hospital, Southern Medical University, Guangdong Provincial Engineering Technology Research Center of Minimally Invasive Surgery, Guangzhou, 510515, China.
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Beane JD, Pitt HA, Dolejs SC, Hogg ME, Zeh HJ, Zureikat AH. Assessing the impact of conversion on outcomes of minimally invasive distal pancreatectomy and pancreatoduodenectomy. HPB (Oxford) 2018; 20:356-363. [PMID: 29191691 DOI: 10.1016/j.hpb.2017.10.007] [Citation(s) in RCA: 42] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2017] [Revised: 10/03/2017] [Accepted: 10/21/2017] [Indexed: 02/08/2023]
Abstract
BACKGROUND Our aim was to compare outcomes of patients who undergo conversion to open during minimally invasive distal pancreatectomy (MI-DP) and pancreatoduodenectomy (MI-PD) to those completed in minimally invasive fashion, and to compare outcomes of minimally invasive completions and conversions to planned open pancreatectomy. METHODS Propensity scoring was used to compare outcomes of completed and converted cases from a national cohort, and multivariate regression analysis (MVA) was used to compare minimally invasive completions and conversions to planned open pancreatectomy. RESULTS MI-DP was performed in 43.0%. Conversions (20.2%) had increased morbidity (32.3 vs 42.0%), serious morbidity (11.1 vs 21.2%), and organ space infection (6.2 vs 14.2%). Outcomes of MI-DP conversions were comparable to open. MI-PD was performed in 6.1%. Conversions (25.2%) had increased organ space infection (10.9 vs 26.6%), blood transfusions (17.2 vs 42.2%), and clinically relevant pancreatic fistula (11.5 vs 28.1%). On MVA, conversion of MI-PD was associated with increased mortality (OR 2.84, 95% CI 1.09-7.42), post-operative percutaneous drain placement (OR 2.36, 95% CI 1.32-4.20), and blood transfusions (OR 1.85, 95% CI 1.07-3.21). CONCLUSION Converted cases have increased morbidity compared to completions, and for patients undergoing PD, conversions may be associated with inferior outcomes compared to planned open cases.
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Affiliation(s)
- Joal D Beane
- University of Pittsburgh Medical Center, Division of Surgical Oncology, Pittsburgh, PA, USA
| | - Henry A Pitt
- Lewis Katz School of Medicine at Temple University, Philadelphia, PA, USA
| | - Scott C Dolejs
- Department of Surgery, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Melissa E Hogg
- University of Pittsburgh Medical Center, Division of Surgical Oncology, Pittsburgh, PA, USA
| | - Herbert J Zeh
- University of Pittsburgh Medical Center, Division of Surgical Oncology, Pittsburgh, PA, USA
| | - Amer H Zureikat
- University of Pittsburgh Medical Center, Division of Surgical Oncology, Pittsburgh, PA, USA.
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Toward standardization of laparoscopic resection for colorectal cancer in developing countries: A step by step module. J Egypt Natl Canc Inst 2017; 29:135-140. [PMID: 28668495 DOI: 10.1016/j.jnci.2017.04.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2017] [Revised: 03/19/2017] [Accepted: 04/10/2017] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Despite the proven benefits, laparoscopic colorectal surgery is still underutilized among surgeons especially in developing countries. Also a steep learning is one of the causes of its limited adoption. OBJECTIVE To explore the learning curve of single surgeon experience in laparoscopic colectomy and feasibility of implementing a well standardized step by step operative technique to overcome the beginning technical obstacles. PATIENTS AND METHODS This prospective study included 50 patients with carcinoma of the left colon and rectum recruited from the department of surgical oncology at National Cancer Institute, Cairo University in the period 2012-2016. All the procedures were performed through laparoscopic approach. Intra and post-operative data were recorded and analyzed. RESULTS The mean age was 49.7±10.6years (range: 33-74years). They were 29 males and 21 females. The mean operation time was 180min (range 100-370min), and the mean blood loss was 350ml (60-600ml). Six patients (12%) were converted to a laparotomy. The median lymph nodes harvest was 12 (range 7-25). The mean time of passing flatus after surgery was 2days (1-4days) and the mean time of passing stools was 3.3days (2-5) days. The median hospitalization period after surgery was 4days (3-12). 5 patients (10%) had postoperative morbidity, major morbidity occurred in one patient. CONCLUSION Laparoscopic colorectal surgery for colorectal cancer is safe and oncologically sound, standardized well-structured laparoscopic technique masters the procedure even in early learning curve setting.
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Choi BJ, Jeong WJ, Kim SJ, Lee SC. Impact of obesity on the short-term outcomes of single-port laparoscopic colectomy for colorectal cancer in the Asian population: A retrospective cohort study. Medicine (Baltimore) 2017; 96:e6649. [PMID: 28700463 PMCID: PMC5515735 DOI: 10.1097/md.0000000000006649] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
Single-port laparoscopic surgery (SPLS) is being increasingly performed for treating colorectal cancer. Here, we aimed to assess the safety and feasibility of SPLS for colorectal cancer in obese patients through a comparison of their short-term outcomes with those of nonobese patients.A total of 323 patients who underwent SPLS for colorectal cancer at our center between March 2009 and August 2014 were enrolled. The outcomes were analyzed according to the body mass index (BMI) category: nonobese (BMI < 25), obese I (BMI: 25.0-29.9), and obese II (BMI ≥ 30).Of the 323 patients, 233 (72.1%), 80 (24.8%), and 10 (3.1%), were assigned to the nonobese, obese I, and obese II groups, respectively. The clinicopathologic patient characteristics, such as age, gender, tumor location, and previous laparotomy, were similar among the 3 groups. The mean operative time (nonobese vs obese I vs and obese II groups: 269.2 vs 270.4 vs 342.8 minutes, respectively) and estimated surgical blood loss (277.7 vs 260.5 vs 387.0 mL, respectively) were greater in the obese II group than in the nonobese and obese I groups, although the difference was not significant (P = .247 and P = .205, respectively). However, the time to passage of flatus significantly differed among the groups (P = .040); in particular, this value was significantly longer in the obese II group than in the obese I group (P = .031). None of the other parameters, including conversion to open or conventional laparoscopic surgery and intra- and postoperative morbidity, significantly differed among the 3 groups.SPLS for colorectal cancer can be safely performed in obese Asian patients with equivalent short-term outcomes as compared with that in nonobese patients. Hence, SPLS can be safely recommended for colorectal cancer in obese patients if the surgeon is experienced. Nevertheless, the technique used warrants further investigation, and a large-scale prospective study is required.
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Giglio MC, Luglio G, Sollazzo V, Liccardo F, Peltrini R, Sacco M, Spiezio G, Amato B, De Palma GD, Bucci L. Cancer recurrence following conversion during laparoscopic colorectal resections: a meta-analysis. Aging Clin Exp Res 2017; 29:115-120. [PMID: 27854066 DOI: 10.1007/s40520-016-0674-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2016] [Accepted: 11/03/2016] [Indexed: 12/19/2022]
Abstract
INTRODUCTION Evidence regarding long-term oncological outcomes following conversion to open surgery (COS) during laparoscopic colorectal resection (LCR) is controversial. The aim of this study is to assess the impact on cancer recurrence of a failed laparoscopic attempt. METHODS MEDLINE, Scopus and ISI Web of Knowledge databases were searched for articles reporting data on cancer recurrence in patients undergoing completed LCR and COS. Data were pooled by fixed or random effect modeling, according to the presence of heterogeneity. Primary outcomes were local recurrence (LR) and distance recurrence (DR). RESULTS Seven studies involving 2493 patients (completed LCR, n 2201 and COS, n 292) were included. The pooled analysis showed that COS resections have an higher risk of LR (OR 1.97, 95% CI 1.14-3.42, p = 0.1); no difference was found in DR (OR 1.09, 95% CI 0.67-1.77, p = 0.71). However, an higher rate of T4 tumor was present in the converted group (OR 2.62, 95% CI 1.71-4, p = 0.0). Subgroup analysis including studies with T stage matched populations showed no significant statistical difference in LR rate; however, a trend toward higher recurrence was still clear. CONCLUSION There is no consistent evidence that a failed laparoscopic attempt does not result in a poorer oncological outcome; therefore, a careful selection of patients for LCR for cancer is required.
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Affiliation(s)
- Mariano Cesare Giglio
- Department of Clinical Medicine and Surgery, University of Naples Federico II, Via Sergio Pansini, 5, 80131, Naples, Italy.
| | - Gaetano Luglio
- Department of Clinical Medicine and Surgery, University of Naples Federico II, Via Sergio Pansini, 5, 80131, Naples, Italy
| | - Viviana Sollazzo
- Department of Clinical Medicine and Surgery, University of Naples Federico II, Via Sergio Pansini, 5, 80131, Naples, Italy
| | - Filomena Liccardo
- Department of Clinical Medicine and Surgery, University of Naples Federico II, Via Sergio Pansini, 5, 80131, Naples, Italy
| | - Roberto Peltrini
- Department of Clinical Medicine and Surgery, University of Naples Federico II, Via Sergio Pansini, 5, 80131, Naples, Italy
| | - Michele Sacco
- Department of Clinical Medicine and Surgery, University of Naples Federico II, Via Sergio Pansini, 5, 80131, Naples, Italy
| | - Giovanni Spiezio
- Department of Clinical Medicine and Surgery, University of Naples Federico II, Via Sergio Pansini, 5, 80131, Naples, Italy
| | - Bruno Amato
- Department of Clinical Medicine and Surgery, University of Naples Federico II, Via Sergio Pansini, 5, 80131, Naples, Italy
| | - Giovanni Domenico De Palma
- Department of Clinical Medicine and Surgery, University of Naples Federico II, Via Sergio Pansini, 5, 80131, Naples, Italy
| | - Luigi Bucci
- Department of Clinical Medicine and Surgery, University of Naples Federico II, Via Sergio Pansini, 5, 80131, Naples, Italy
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Massarotti H, Rodrigues F, O'Rourke C, Chadi SA, Wexner S. Impact of surgeon laparoscopic training and case volume of laparoscopic surgery on conversion during elective laparoscopic colorectal surgery. Colorectal Dis 2017; 19:76-85. [PMID: 27234928 DOI: 10.1111/codi.13402] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2015] [Accepted: 04/16/2016] [Indexed: 12/19/2022]
Abstract
AIM The study aimed to determine whether laparoscopic volume and type of training influence conversion during elective laparoscopic colorectal surgery. METHOD An Institutional Review Board-approved prospective database was reviewed for patients who underwent colorectal resection, performed by six colorectal surgeons, for all diagnoses from 2009 to 2014. Surgeons were designated as laparoscopic- or open-trained based on formal laparoscopic colorectal surgery training, and were classified as low laparoscopic volume (LLV) (i.e. had performed < 100 laparoscopic procedures) or high laparoscopic volume (HLV) (i.e. had performed ≥ 100 laparoscopic procedures). Technique was laparoscopic, open or converted (pre-emptive or reactive). Conversion was compared among three groups: LLV, laparoscopic trained (group A); LLV, open trained (group B); and HLV, open trained (group C). RESULTS In total, 159/567 procedures were open and 408 laparoscopic procedures were attempted. Of the 408 laparoscopic procedures, 73 were converted. Among the 567 patients [mean age: 56 ± 17 years (44% male)], the overall conversion rate was 13% (73/567), including 75% pre-emptive and 25% reactive. Conversion rates for groups A, B and C were 17.9%, 42.6% and 14.3%, respectively. Significantly higher conversion was seen in group B compared with group C (P = 0.01), but not between group A and group C (P = 0.85) or between group B and group A (P = 0.11). Converted patients were older (P < 0.001), with lower rates of proctectomy (P = 0.007), higher rates of anastomosis (P < 0.001) and higher body mass index (BMI) (P < 0.001). After adjusting for patient and surgeon factors, training type was not associated with conversion (P = 0.15). Compared with successful laparoscopy, converted patients had a significantly higher incidence of ileus (P < 0.001), length of stay (P = 0.002), time to flatus (OR = 3.21, P < 0.001) and time to solids (P < 0.001). Converted patients experienced increased morbidity. CONCLUSION Training is not associated with conversion. Rather, HLV surgeons, regardless of training, convert less frequently than do LLV surgeons.
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Affiliation(s)
- H Massarotti
- Department of Colorectal Surgery, Cleveland Clinic Florida, Weston, Florida, USA
| | - F Rodrigues
- Department of Colorectal Surgery, Cleveland Clinic Florida, Weston, Florida, USA
| | - C O'Rourke
- Department of Colorectal Surgery, Cleveland Clinic Florida, Weston, Florida, USA
| | - S A Chadi
- Department of Colorectal Surgery, Cleveland Clinic Florida, Weston, Florida, USA
| | - S Wexner
- Department of Colorectal Surgery, Cleveland Clinic Florida, Weston, Florida, USA
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Gorgun E, Benlice C, Abbas MA, Stocchi L, Remzi FH. Conversion in laparoscopic colorectal surgery: Are short-term outcomes worse than with open surgery? Tech Coloproctol 2016; 20:845-851. [DOI: 10.1007/s10151-016-1554-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2016] [Accepted: 11/16/2016] [Indexed: 01/25/2023]
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16
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Current Status of Minimally Invasive Surgery for Rectal Cancer. J Gastrointest Surg 2016; 20:1056-64. [PMID: 26831061 DOI: 10.1007/s11605-016-3085-3] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2015] [Accepted: 01/14/2016] [Indexed: 01/31/2023]
Abstract
Recent randomized controlled data have shown possible limitations to laparoscopic treatment of rectal cancer. The retrospective data, used as the basis for designing the trials, and which showed no problems with the technique, are discussed. The design of the randomized trials is discussed relative to the future meta-analysis of the recent data. The implications of the current findings on practice are discussed as surgeons try to adjust their practice to the new findings. The possible next steps for clinical and research innovations are put into perspective as new technology is considered to compensate for newly identified limitations in the laparoscopic treatment of rectal cancer.
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Vargas GM, Sieloff EP, Parmar AD, Tamirisa NP, Mehta HB, Riall TS. Laparoscopy decreases complications for obese patients undergoing elective rectal surgery. Surg Endosc 2016; 30:1826-32. [PMID: 26286013 PMCID: PMC5291075 DOI: 10.1007/s00464-015-4463-8] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2015] [Accepted: 07/22/2015] [Indexed: 12/13/2022]
Abstract
INTRODUCTION While there are many reported advantages to laparoscopic surgery compared to open surgery, the impact of a laparoscopic approach on postoperative morbidity in obese patients undergoing rectal surgery has not been studied. Our goal was to determine whether obese patients undergoing laparoscopic rectal surgery experienced the same benefits as non-obese patients. METHODS We identified patients undergoing rectal resections using the National Surgical Quality Improvement Project Participant Use Data File. We performed multivariable analyses to determine the independent association between laparoscopy and postoperative complications. RESULTS A total of 26,437 patients underwent rectal resection. The mean age was 58.5 years, 32.6 % were obese, and 47.2 % had cancer. Laparoscopic procedures were slightly less common in obese patients compared to non-obese patients (36.0 vs. 38.2 %, p = 0.0006). In unadjusted analyses, complications were lower with the laparoscopic approach in both obese (18.9 vs. 32.4 %, p < 0.0001) and non-obese (15.6 vs. 25.3 %, p < 0.0001) patients. In a multivariable analysis controlling for potential confounders, the risk of postoperative complications increased as the degree of obesity worsened. The likelihood of experiencing a postoperative complication increased by 25, 45, and 75 % for obese class I, obese class II, and obese class III patients, respectively. A laparoscopic approach was associated with a 40 % decreased odds of a postoperative complication for all patients (OR 0.60, 95 % CI 0.56-0.64). CONCLUSION Laparoscopic rectal surgery is associated with fewer complications when compared to open rectal surgery in both obese and non-obese patients. Obesity was an independent risk factor for postoperative complications. In appropriately selected patients, rectal surgery outcomes may be improved with a minimally invasive approach.
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Affiliation(s)
- Gabriela M Vargas
- Department of Surgery, University of Texas Medical Branch, Galveston, TX, USA.
- Department of Surgery, Louisiana State University Health-Shreveport, Shreveport, LA, USA.
| | - Eric P Sieloff
- Department of Surgery, University of Texas Medical Branch, Galveston, TX, USA
| | - Abhishek D Parmar
- Department of Surgery, University of Texas Medical Branch, Galveston, TX, USA
- The University of California, San Francisco-East Bay, Oakland, CA, USA
| | - Nina P Tamirisa
- Department of Surgery, University of Texas Medical Branch, Galveston, TX, USA
- The University of California, San Francisco-East Bay, Oakland, CA, USA
| | - Hemalkumar B Mehta
- Department of Surgery, University of Texas Medical Branch, Galveston, TX, USA
| | - Taylor S Riall
- Department of Surgery, University of Texas Medical Branch, Galveston, TX, USA
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Moghadamyeghaneh Z, Masoomi H, Mills SD, Carmichael JC, Pigazzi A, Nguyen NT, Stamos MJ. Outcomes of conversion of laparoscopic colorectal surgery to open surgery. JSLS 2016; 18:JSLS.2014.00230. [PMID: 25587213 PMCID: PMC4283100 DOI: 10.4293/jsls.2014.00230] [Citation(s) in RCA: 51] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Objectives: There is limited data regarding the outcomes of patients who undergo conversion to open surgery during a laparoscopic operation in colorectal resection. We sought to identify the outcomes of such patients. Methods: The NIS (National Inpatient Sample) database was used to identify patients who had conversion from laparoscopic to open colorectal surgery during the 2009 to 2012 period. Multivariate regression analysis was performed to identify risk-adjusted outcomes of conversion to open surgery. Results: We sampled 776 007 patients who underwent colorectal resection. 337 732 (43.5%) of the patients had laparoscopic resection. Of these, 48 265 procedures (14.3%) were converted to open surgery. The mortality of converted patients was increased, when compared with successfully completed laparoscopic operations, but was still lower than that of open procedures (0.6% vs. 1.4% vs. 3.9%, respectively; adjusted odds ratio [AOR], 1.61 and 0.58, respectively; P < .01). The most common laparoscopic colorectal procedure was right colectomy (41.2%). The lowest rate of conversion is seen with right colectomy while proctectomy had the highest rate of conversion (31.2% vs. 12.9%, AOR, 2.81, P < .01). Postsurgical complications including intra-abdominal abscess (AOR, 2.64), prolonged ileus (AOR, 1.50), and wound infection (AOR, 2.38) were higher in procedures requiring conversion (P < .01). Conclusions: Conversion of laparoscopic to open colorectal resection occurs in 14.3% of cases. Compared with patients who had laparoscopic operations, patients who had conversion to open surgery had a higher mortality, higher overall morbidity, longer length of hospitalization, and increased hospital charges. The lowest conversion rate was in right colectomy and the highest was in proctectomy procedures. Wound infection in converted procedures is higher than in laparoscopic and open procedures.
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Affiliation(s)
| | - Hossein Masoomi
- Department of Surgery, University of California, Irvine, CA, USA
| | - Steven D Mills
- Department of Surgery, University of California, Irvine, CA, USA
| | | | - Alessio Pigazzi
- Department of Surgery, University of California, Irvine, CA, USA
| | - Ninh T Nguyen
- Department of Surgery, University of California, Irvine, CA, USA
| | - Michael J Stamos
- Department of Surgery, University of California, Irvine, CA, USA
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Conversion during laparoscopic colorectal resections: a complication or a drawback? A systematic review and meta-analysis of short-term outcomes. Int J Colorectal Dis 2015. [PMID: 26194990 DOI: 10.1007/s00384-015-2324-5] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
PURPOSE Several studies compared the outcomes of laparoscopically completed colorectal resections (LCR) to those requiring conversion to open surgery (COS). However, a comparative analysis between COS patients and patients undergoing planned open surgery (POS) would be useful to clarify if the conversion can be considered a simple drawback or a complication, being cause of additional postoperative morbidity. The aim of this study is to perform a meta-analysis of current evidences comparing postoperative outcomes of COS patients to POS patients. METHODS A systematic search of Medline, ISI Web of Knowledge, and Scopus was performed to identify studies reporting short-term outcomes of COS and POS patients. Primary outcomes were 30-day overall morbidity and length of postoperative hospital stay. Data were analyzed with fixed-effect modeling, and sensitivity analyses were performed to test the robustness of the results. RESULTS Twenty studies involving 30,656 patients undergoing POS and 1935 COS patients were selected. The mean conversion rate was 0.17. Similar 30-day overall morbidity and length of postoperative hospital stay were found in COS and POS patients. Wound infection (OR 1.43, 95 % CI 1.12 to 1.83, p < 0.01) was higher in the COS group. Other results were robust. Outcomes were comparable for patients undergoing resection for different natures of the disease (benign vs. malignant) and at different sites (colon vs. rectum). CONCLUSION Conversions from laparoscopic to open procedure during colorectal resection are not associated with a poorer postoperative outcome compared to patients undergoing planned open surgery, except for a higher risk of wound infection.
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Blikkendaal MD, Schepers EM, van Zwet EW, Twijnstra ARH, Jansen FW. Hysterectomy in very obese and morbidly obese patients: a systematic review with cumulative analysis of comparative studies. Arch Gynecol Obstet 2015; 292:723-38. [PMID: 25773357 PMCID: PMC4560773 DOI: 10.1007/s00404-015-3680-7] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2014] [Accepted: 02/25/2015] [Indexed: 12/12/2022]
Abstract
PURPOSE Some studies suggest that also regarding the patient with a body mass index (BMI) ≥35 kg/m(2) the minimally invasive approach to hysterectomy is superior. However, current practice and research on the preference of gynaecologists still show that the rate of abdominal hysterectomy (AH) increases as the BMI increases. A systematic review with cumulative analysis of comparative studies was performed to evaluate the outcomes of AH, laparoscopic hysterectomy (LH) and vaginal hysterectomy (VH) in very obese and morbidly obese patients (BMI ≥35 kg/m(2)). METHODS PubMed and EMBASE were searched for records on AH, LH and VH for benign indications or (early stage) malignancy through October 2014. Included studies were graded on level of evidence. Studies with a comparative design were pooled in a cumulative analysis. RESULTS Two randomized controlled trials, seven prospective studies and 14 retrospective studies were included (2232 patients; 1058 AHs, 959 LHs, and 215 VHs). The cumulative analysis identified that, compared to LH, AH was associated with more wound dehiscence [risk ratio (RR) 2.58, 95 % confidence interval (CI) 1.71-3.90; P = 0.000], more wound infection (RR 4.36, 95 % CI 2.79-6.80; P = 0.000), and longer hospital admission (mean difference 2.9 days, 95 % CI 1.96-3.74; P = 0.000). The pooled conversion rate was 10.6 %. Compared to AH, VH was associated with similar advantages as LH. CONCLUSIONS Compared to AH, both LH and VH are associated with fewer postoperative complications and shorter length of hospital stay. Therefore, the feasibility of LH and VH should be considered prior the abdominal approach to hysterectomy in very obese and morbidly obese patients.
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Affiliation(s)
- Mathijs D. Blikkendaal
- Department of Gynaecology, Leiden University Medical Centre, PO Box 9600, 2300 RC Leiden, The Netherlands
| | - Evelyn M. Schepers
- Department of Gynaecology, Bronovo Hospital, PO Box 96900, 2509 JH The Hague, The Netherlands
| | - Erik W. van Zwet
- Department of Medical Statistics, Leiden University Medical Centre, PO Box 9600, 2300 RC Leiden, The Netherlands
| | - Andries R. H. Twijnstra
- Department of Gynaecology, Leiden University Medical Centre, PO Box 9600, 2300 RC Leiden, The Netherlands
| | - Frank Willem Jansen
- Department of Gynaecology, Leiden University Medical Centre, PO Box 9600, 2300 RC Leiden, The Netherlands
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Risk factors for conversion of laparoscopic colorectal surgery to open surgery: does conversion worsen outcome? World J Surg 2015; 39:1240-7. [PMID: 25631940 DOI: 10.1007/s00268-015-2958-z] [Citation(s) in RCA: 73] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
INTRODUCTION The utilization of laparoscopy in colorectal surgery is increasing. However, conversion to open surgery remains relatively high. OBJECTIVE We evaluated (1) conversion rates in laparoscopic colorectal surgery; (2) the outcomes of converted cases compared with successful laparoscopic and open colorectal operations; (3) predictive risk factors of conversion of laparoscopic colorectal surgery to open surgery. METHODS Using the National Inpatient Sample database, we examined the clinical data of patients who underwent colon and rectal resection from 2009 to 2010. Multivariate regression analysis was performed to identify factors predictive for conversion of laparoscopic to open operation. RESULTS A total of 207,311 patients underwent intended laparoscopic colorectal resection during this period. The conversion rate was 16.6 %. Considering resection type and pathology, the highest conversion rates were observed in proctectomy (31.4 %) and Crohn's disease (20.2 %). Using multivariate regression analysis, Crohn's disease (adjusted odds ratio [AOR], 2.80), prior abdominal surgery (AOR, 2.45), proctectomy (AOR, 2.42), malignant pathology (AOR, 1.90), emergent surgery (AOR, 1.82), obesity (AOR, 1.63), and ulcerative colitis (AOR, 1.60) significantly impacted the risk of conversion. Compared with patients who were successfully completed laparoscopically, converted patients had a significantly higher complication rate (laparoscopic: 23 %; vs. converted: 35.2 % vs. open: 35.3 %), a higher in-hospital mortality rate (laparoscopic: 0.5 %; vs. converted: 0.6 %; vs. open: 1.7 %) and a longer mean hospital stay (laparoscopic: 5.4 days; vs. converted: 8.1 days; vs. open: 8.4 days); however, converted patients had better outcomes compared with the open group. CONCLUSIONS The conversion rate in colorectal surgery was 16.6 %. Converted patients had significantly higher rates of morbidity and mortality compared to successfully completed laparoscopic cases, although lower than open cases. Crohn's disease, prior abdominal surgery, and proctectomy are the strongest predictors for conversion of laparoscopic to open in colorectal operations.
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Laparoscopic sigmoid colectomy for complicated diverticulitis is safe: review of 576 consecutive colectomies. Surg Endosc 2015; 30:1629-34. [PMID: 26275534 DOI: 10.1007/s00464-015-4393-5] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2015] [Accepted: 07/01/2015] [Indexed: 02/07/2023]
Abstract
INTRODUCTION Laparoscopic resection of diverticular disease is typically offered to selected patients. We present the outcomes of laparoscopic colectomy in consecutive patients suffering from either simple diverticulitis (SD) or complicated diverticulitis (CD). PURPOSE To examine the outcomes of laparoscopic sigmoid colectomy for complicated diverticulitis. METHODS Between December 2001 and May 2013, all patients with diverticulitis requiring elective operation were offered laparoscopic sigmoid colectomy as the initial approach. All cases were managed at a large tertiary care center on the colorectal surgery service. Preoperative, intraoperative, and postoperative variables were prospectively entered into the colorectal surgery service database (CRSD) and analyzed retrospectively. RESULTS Of the 576 patients in the CRSD, 139 (24.1%) had CD. The overall conversion rate was 12.8% (n = 74). The average BMI was 29.8 kg/m(2). The conversion rate for CD was 12.2%. The return of bowel function time was delayed in the CD group when compared to the SD group (3.1 vs 3.8 days, p = 0.04). The hospital length of stay (HLOS) was similar between the groups (5.1 vs 5.8 days, p = 0.08). The overall anastomotic leak rate was 2.1% (n = 12). Patients undergoing laparoscopic resection for SD had a postoperative complication rate of 10.0% (n = 38), whereas those with CD had a postoperative morbidity rate of 19.6% (n = 24). CD patients who had conversion to an open procedure had an even higher rate of postoperative complications (29.4%, n = 5, p = 0.35). On non-parsimonious multivariate adjustment, only CD (RR 1.96, 95% CI 1.11-3.46, p = 0.02) was found to be an independent risk factor for the development of postoperative complications. CONCLUSIONS Complicated diverticulitis did not affect the conversion rate to an open procedure. However, patients with CD are prone to postoperative complications. The laparoscopic approach to sigmoid colectomy is safe and preferable in experienced hands.
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Impact of Prior Abdominal Surgery on Rates of Conversion to Open Surgery and Short-Term Outcomes after Laparoscopic Surgery for Colorectal Cancer. PLoS One 2015. [PMID: 26207637 PMCID: PMC4514825 DOI: 10.1371/journal.pone.0134058] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Abstract
Purpose To evaluate the impact of prior abdominal surgery (PAS) on rates of conversion to open surgery and short-term outcomes after laparoscopic surgery for colon and rectal cancers. Methods We compared three groups as follows: colon cancer patients with no PAS (n = 272), major PAS (n = 24), and minor PAS (n = 33), and rectal cancer patients with no PAS (n = 282), major PAS (n=16), and minor PAS (n = 26). Results In patients with colon and rectal cancers, the rate of conversion to open surgery was significantly higher in the major PAS group (25% and 25%) compared with the no PAS group (8.1% and 8.9%), while the conversion rate was similar between the no PAS and minor PAS groups (15.2% and 15.4%). The 30-day complication rate did not differ among the three groups (28.7% and 29.1% in the no PAS group, 29.2% and 25% in the major PAS group, and 27.3% and 26.9% in the minor PAS group). The mean operative time did not differ among the three groups (188 min and 227 min in the no PAS group, 191 min and 210 min in the major PAS group, and 192 min and 248 min in the minor PAS group). The rate of conversion to open surgery was significantly higher in patients with prior gastrectomy or colectomy compared with the no PAS group, while the conversion rate was similar between the no PAS group and patients with prior radical hysterectomy in patients with colon and rectal cancers. Conclusions Our results suggest that colorectal cancer patients with minor PAS or patients with prior radical hysterectomy can be effectively managed with a laparoscopic approach. In addition, laparoscopy can be selected as the primary surgical approach even in patients with major PAS (prior gastrectomy or colectomy) given the assumption of a higher conversion rate.
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Kim IY, Kim BR, Kim YW. The short-term and oncologic outcomes of laparoscopic versus open surgery for T4 colon cancer. Surg Endosc 2015; 30:1508-18. [PMID: 26123346 DOI: 10.1007/s00464-015-4364-x] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2015] [Accepted: 06/19/2015] [Indexed: 12/16/2022]
Abstract
PURPOSE To compare R0 resection rates and short-term and oncologic outcomes between laparoscopy and open surgery for T4 colon cancer. METHODS Patients with non-metastatic T4 colon cancer (n = 117) underwent treatment either through laparoscopy (n = 51) or open surgery (n = 66). Conversion to open surgery occurred in seven cases (13.7%). RESULTS History of abdominal surgery (2.0 vs. 12.1%) and emergency operation (2.1 vs. 24.2%) were less frequent in the laparoscopy group. Conversion to open surgery occurred in seven cases (13.7%). Resection of adjacent organs was less frequently performed in the laparoscopy group (27.5 vs. 53.0%, p = .005). The mean operative time (189 vs. 210 min) and rate of 30-day postoperative complications (12 vs. 24%) were similar between the two groups. Shorter time to soft diet (7 vs. 9 days, p = .018) and hospital stay (14 vs. 18 days, p = .044) were observed in the laparoscopy group. T4b tumor was also less frequent in the laparoscopy group (3.9 vs. 18.2%, p = .018), while R0 resection rates were similar between the laparoscopy (96.1%) and open surgery group (95.5%). The mean number of lymph nodes was 22 in the laparoscopy group and 27 in the open surgery group (p = .021). No differences in 3-year overall survival rate (82.5 vs. 75.7%), recurrence-free survival rate (61.9 vs. 63.5%), and local recurrence-free survival rate (89.8 vs. 88.5%) were observed between the groups. Operation time, blood loss, 30-day complication rate, time to diet, duration of hospital stay, R0 resection rate, 3-year overall and local recurrence-free survival rates showed no difference between the converted and open surgery groups. CONCLUSIONS Our results indicate that laparoscopy is a surgically safe and oncologically acceptable approach and thus could be considered for well-selected patients with T4 colon cancer in order to allow faster short-term recovery.
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Affiliation(s)
- Ik Yong Kim
- Division of Gastrointestinal Surgery, Department of Surgery, Yonsei University Wonju College of Medicine, 20 Ilsan-ro, Wonju-si, Wonju, Gangwon-do, 220-701, Korea
| | - Bo Ra Kim
- Division of Gastroenterology, Department of Internal Medicine, Yonsei University Wonju College of Medicine, Wonju, Korea
| | - Young Wan Kim
- Division of Gastrointestinal Surgery, Department of Surgery, Yonsei University Wonju College of Medicine, 20 Ilsan-ro, Wonju-si, Wonju, Gangwon-do, 220-701, Korea.
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Mino JS, Gandhi NS, Stocchi LL, Baker ME, Liu X, Remzi FH, Monteiro R, Vogel JD. Preoperative risk factors and radiographic findings predictive of laparoscopic conversion to open procedures in Crohn's disease. J Gastrointest Surg 2015; 19:1007-14. [PMID: 25820486 DOI: 10.1007/s11605-015-2802-7] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2014] [Accepted: 03/10/2015] [Indexed: 01/31/2023]
Abstract
INTRODUCTION Laparoscopy is accepted as a standard surgical approach for Crohn's disease. However, the rate of conversion is high, ranging from 15 to 70 % depending on the population. There are also concerns that conversion results in worsened outcomes versus an initial open procedure. METHODS This study evaluated preoperative radiographic findings to determine who is at increased risk of conversion and may therefore benefit from an initial open approach. A case-matched study included patients from 2004 to 2013 with preoperative CTE/MRE who underwent laparoscopic surgery converted to an open approach, and compared them to laparoscopically completed controls with similar age, same surgeon, and number of previous abdominal operations. Studies were reviewed by two blinded radiologists. Variables included abdominal AP diameter, amount of subcutaneous fat, peritoneal versus pelvic location of disease (greater or lesser hemipelvis or abdomen), intestinal location of disease (colon, TI, ileum, jejunum), and presence, length, and location of strictures, simple or complex fistula, phlegmon, or abscess. Conditional logistic regression evaluated relationships between radiographic variables and conversion. Twenty-seven patients meeting study criteria were compared with 81 controls. RESULTS A negative association between conversion and disease in the left lesser pelvis was found (p = 0.019) and neared significance for left abdomen (p = 0.08). Positive correlations were found with pelvic fistulas (p = 0.003), complex fistulas (p = 0.017), and pelvic abscesses (p = 0.009) and neared significance for Society of Abdominal Radiology classification (p = 0.058). CONCLUSION Preoperative imaging in patients with Crohn's disease can help in selecting the most suitable cases to approach laparoscopically and reduce conversion rates and should be evaluated in conjunction with other preoperative factors.
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Affiliation(s)
- Jeffrey S Mino
- Department of General Surgery, Cleveland Clinic Foundation, A100 Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH, 44195, USA,
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Bhama AR, Charlton ME, Schmitt MB, Cromwell JW, Byrn JC. Factors associated with conversion from laparoscopic to open colectomy using the National Surgical Quality Improvement Program (NSQIP) database. Colorectal Dis 2015; 17:257-64. [PMID: 25311007 PMCID: PMC4329054 DOI: 10.1111/codi.12800] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2014] [Accepted: 08/20/2014] [Indexed: 01/06/2023]
Abstract
AIM Conversion rates from laparoscopic to open colectomy and associated factors are traditionally reported in clinical trials or reviews of outcomes from experienced institutions. Indications and selection criteria for laparoscopic colectomy may be more narrowly defined in these circumstances. With the increased adoption of laparoscopy, conversion rates using national data need to be closely examined. The purpose of this study was to use data from the American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) to identify factors associated with conversion of laparoscopic to open colectomy at a national scale in the United States. METHOD The ACS-NSQIP Participant Use Data Files for 2006-2011 were used to identify patients who had undergone laparoscopic colectomy. Converted cases were identified using open colectomy as the primary procedure and laparoscopic colectomy as 'other procedure'. Preoperative variables were identified and statistics were calculated using sas version 9.3. Logistic regression was used to model the multivariate relationship between patient variables and conversion status. RESULTS Laparoscopy was successfully performed in 41 585 patients, of whom 2508 (5.8%) required conversion to an open procedure. On univariate analysis the following factors were significant: age, body mass index (BMI), American Society of Anesthesiologists (ASA) class, presence of diabetes, smoking, chronic obstructive pulmonary disease, ascites, stroke, weight loss and chemotherapy (P < 0.05). The following factors remained significant on multivariate analysis: age, BMI, ASA class, smoking, ascites and weight loss. CONCLUSION Multiple significant factors for conversion from laparoscopic to open colectomy were identified. A novel finding was the increased risk of conversion for underweight patients. As laparoscopic colectomy is become increasingly utilized, factors predictive of conversion to open procedures should be sought via large national cohorts.
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Affiliation(s)
- Anuradha R. Bhama
- Department of Surgery, Division of Gastrointestinal, Minimally-invasive, and Bariatric Surgery, University of Iowa Hospitals and Clinics, Iowa City, IA 52241
| | - Mary E. Charlton
- Department of Epidemiology, University of Iowa College of Public Health, Iowa City, IA 52245
| | - Mary B. Schmitt
- Department of Surgery, Division of Gastrointestinal, Minimally-invasive, and Bariatric Surgery, University of Iowa Hospitals and Clinics, Iowa City, IA 52241
| | - John W. Cromwell
- Department of Surgery, Division of Gastrointestinal, Minimally-invasive, and Bariatric Surgery, University of Iowa Hospitals and Clinics, Iowa City, IA 52241
| | - John C. Byrn
- Department of Surgery, Division of Gastrointestinal, Minimally-invasive, and Bariatric Surgery, University of Iowa Hospitals and Clinics, Iowa City, IA 52241
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Palomba S, Ghezzi F, Falbo A, Mandato VD, Annunziata G, Lucia E, Cromi A, Zannoni L, Seracchioli R, Giorda G, La Sala GB, Zullo F, Franchi M. Conversion in endometrial cancer patients scheduled for laparoscopic staging: a large multicenter analysis. Surg Endosc 2014; 28:3200-9. [DOI: 10.1007/s00464-014-3589-4] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2013] [Accepted: 05/06/2014] [Indexed: 03/12/2023]
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Caputo D, Caricato M, La Vaccara V, Capolupo GT, Coppola R. Conversion in mini-invasive colorectal surgery: the effect of timing on short term outcome. Int J Surg 2014; 12:805-9. [PMID: 25010603 DOI: 10.1016/j.ijsu.2014.06.010] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2014] [Revised: 06/09/2014] [Accepted: 06/18/2014] [Indexed: 01/11/2023]
Abstract
INTRODUCTION Different results have been reported about postoperative outcomes of conversion during laparoscopic colorectal surgery. We aimed to detect the effect of conversion on postoperative outcome and to identify features associated to better outcome after conversion. METHODS Two hundred-fourteen mini-invasive left colonic and rectal resections were retrospectively analysed. Two groups were identified: mini-invasive colorectal surgery (MI) that includes both laparoscopic and robotic resections, and conversion to open surgery. RESULTS Among 214 colorectal procedures, 189 were MI. Conversion rate was 11.7%. Operating time was shorter for MI at overall analysis (p 0.003) and sub-analysis of left colectomies (p 0.001). MI procedures had shorter hospital stay (p 0.000) both in left colectomy and rectal resection (p 0.008 and p 0.001 respectively). A shorter time to first flatus emission was detected in MI group in both overall analysis (p 0.003) and procedure's sub-analysis (left colectomy p 0.032; anterior rectal resection p 0.040). Oral feeding was resumed earlier after mini-invasive rectal resections (p 0.014). Converted procedures required more blood transfusions (p 0.000) and grade II complication rate was lower after MI procedures (p 0.013). Conversion presented higher anastomotic leakage and reoperation rates (p 0.035 and p 0.006 respectively). Conversion before 105 min (early conversion) had a significant lower number of blood transfusions (p 0.047). CONCLUSIONS Conversion is associated to higher rate of blood transfusions, grade II complication and slower recovery. Earlier conversion has better outcomes. Colorectal surgeons should identify any critical aspects that could avoid late conversion allowing reducing negative effects of conversion.
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Affiliation(s)
- Damiano Caputo
- Department of General Surgery, University Campus Bio-Medico di Roma, Via Alvaro del Portillo, 200, 00128 Rome, Italy.
| | - Marco Caricato
- Department of General Surgery, University Campus Bio-Medico di Roma, Via Alvaro del Portillo, 200, 00128 Rome, Italy
| | - Vincenzo La Vaccara
- Department of General Surgery, University Campus Bio-Medico di Roma, Via Alvaro del Portillo, 200, 00128 Rome, Italy
| | - Gabriella Teresa Capolupo
- Department of General Surgery, University Campus Bio-Medico di Roma, Via Alvaro del Portillo, 200, 00128 Rome, Italy
| | - Roberto Coppola
- Department of General Surgery, University Campus Bio-Medico di Roma, Via Alvaro del Portillo, 200, 00128 Rome, Italy
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Xia X, Huang C, Jiang T, Cen G, Cao J, Huang K, Qiu Z. Is laparoscopic colorectal cancer surgery associated with an increased risk in obese patients? A retrospective study from China. World J Surg Oncol 2014; 12:184. [PMID: 24919472 PMCID: PMC4063688 DOI: 10.1186/1477-7819-12-184] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2014] [Accepted: 05/16/2014] [Indexed: 01/14/2023] Open
Abstract
Background The impact of obesity on surgical outcomes after laparoscopic colorectal cancer resection in Chinese patients is still unclear. Methods We retrospectively reviewed the prospectively collected data from 527 consecutive colorectal cancer patients who under went laparoscopic resection from January 2008 to September 2013. Patients were categorized into three groups: nonobese (body mass index (BMI) <25.0 kg/m2), obese I (BMI 25.0 = to 29.9 kg/m2) and obese II (BMI ≥30.0 kg/m2). Clinical characteristics, surgical outcomes and postoperative complications were compared between nonobese, obese I and obese II patients. Results From among the 527 patients, there were 371 patients with in the nonobese group, 142 patients in the obese I group and 14 patients in the obese II group. The patients were well-matched for age, sex and American Society of Anesthesiologists class, except for BMI (P = 0.001). The median operative time correlated highly significantly with increasing weight (median: nonobese = 135 minutes, obese I = 145 minutes, obese II = 162.5 minutes; P = 0.001). There appeared to be a slight tendency toward grade III complications (rated according to the Clavien-Dindo Classification of Surgical Complications) in the obese II group, but this difference was not significant (nonobese = 5.1%, obese I = 3.5% and obese II = 14.3%; P = 0.178). None of the grade III complications which occurred in the obese II group were wound dehiscences that required a stitch. Other aspects, such as estimated blood loss, harvested lymph nodes, operation type, pathological results, conversion rate and overall postoperative complications, were not statistically significant. Conclusion With sufficient experience, laparoscopic colorectal cancer surgery is feasible and safe in obese Chinese patients.
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Affiliation(s)
| | | | | | | | | | - Kejian Huang
- Department of General Surgery, Shanghai Jiaotong University Affiliated First People's Hospital, 100 Hai Ning Road Shanghai 200080 People's Republic of China.
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Minimally invasive approach to chagasic megacolon: laparoscopic rectosigmoidectomy with posterior end-to-side low colorectal anastomosis. Surg Laparosc Endosc Percutan Tech 2014; 24:207-12. [PMID: 24710265 DOI: 10.1097/sle.0000000000000002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
The effectiveness of anterior resection for the surgical treatment of Chagasic megacolon and the advantages of laparoscopy for performing colorectal surgery are well known. However, current experience with laparoscopic surgery for Chagasic megacolon is restricted. Moreover, associated long-term results remain poorly analyzed. The aims of the present study were to ascertain the immediate results of laparoscopic anterior resection for the surgical treatment of Chagasic megacolon, to identify risk factors associated with adverse outcomes, and to settle late results. A retrospective review of a prospective database was conducted. Between November 2000 and September 2012, 44 patients with Chagasic megacolon underwent laparoscopic anterior resection with posterior end-to-side low colorectal anastomosis. Fifteen (34.1%) patients were male. Mean age was 51.6 years (31 to 77 y). The mean body mass index (BMI) was 22.9 kg/m (16.9 to 36.7 kg/m). Thirty-four previous abdominal operations had been performed. Mean operative time was 265 minutes (105 to 500 min). Four surgeons operated on all cases. Surgeon's experience with the operation was not associated with surgical time (P=0.36: linear regression). Mean operative time between patients with and without previous abdominal surgery was similar (237.7 vs. 247.5 min: P=0.78). There was no association between BMI and the duration of the operation (P=0.22). Intraoperative complications occurred in 2 (4.5%) cases. Conversion was necessary in 3 (6.8%) cases. There was no association between conversion and previous abdominal surgery (P=0.56) or between conversion and surgeon's experience (P=0.43). However, a significant association (P=0.01) between BMI and conversion was observed. Postoperative complications occurred in 10 (22.7%) cases. Anastomotic-related complications occurred in 4 cases. Two of them required diversion ileostomy. Restoration of transanal evacuation was achieved in all cases. Mean duration of postoperative hospital stay was 9.8 days (4 to 45 d). Of 19 patients with known clinical late follow-up, only 1 (5.3%) reported use of enemas and 5 (26.3%) reported use of laxatives. Thirteen (68.4%) patients reported daily bowel movements. There was no association between postoperative complications and use of laxatives (P=0.57). It was concluded that laparoscopic anterior resection for Chagasic megacolon is safe. Obesity was a risk factor for conversion. Restoration of transanal evacuation after surgical treatment of infectious complications was achieved. Minimally invasive surgery for Chagasic megacolon is associated with satisfactory late intestinal function with no significant constipation relapse.
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Laparoscopic and converted approaches to rectal cancer resection have superior long-term outcomes: a comparative study by operative approach. Surg Endosc 2014; 28:1940-8. [PMID: 24515259 DOI: 10.1007/s00464-014-3419-8] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2013] [Accepted: 01/04/2014] [Indexed: 02/07/2023]
Abstract
BACKGROUND AND OBJECTIVES The goal of this study was to evaluate outcomes for rectal cancer resection by operative approach. Our hypothesis is that laparoscopic (LAP) and LAP converted to open (OPEN) rectal cancer resections have excellent patient and oncologic outcomes. METHODS Review of a prospective database identified curative rectal cancer resections. Patients were stratified by operative approach: LAP, OPEN, or CONVERTED. Oncologic and clinical outcomes data was examined for each operative approach. RESULTS Overall, 294 patients were analyzed-116 LAP (39.5%), 153 OPEN (52.0%), and 25 (8.5%) CONVERTED. Groups were comparable in demographics. Mean distal margin, circumferential resection margin, and lymph nodes harvested were comparable. The median length of stay was 4 days (range 1-20) LAP, 6 days (range 3-13) CONVERTED, and 8 days (range 1-35) OPEN (p < 0.01). More OPEN had postoperative complications (p < 0.01)-complication rates were 43.8% OPEN, 32.0% CONVERTED, and 21.5 % LAP. Unplanned readmissions and reoperations were similar (21.6% OPEN, 16.0% CONVERTED, 12.1% LAP). Overall 3-year disease-free survival (DFS) was 98.3%, and local recurrence rate was 2.0%. By approach, DFS was 100% CONVERTED, 93.1% LAP, and 87.6% OPEN (p = 0.31). Overall survival (OS) was 100 % CONVERTED, 99.1% LAP, and 97.4%. OPEN. Local recurrence was 0% CONVERTED, 2% OPEN, and 2.6% LAP. 3-year DFS for LAP and CONVERTED was superior to OPEN (p = 0.05), with comparable local recurrence (p = 0.07) and OS rates (0.43). CONCLUSIONS LAP and converted procedures have comparable or superior clinical and oncologic outcomes. More procedures should be approached through a LAP approach. If the procedure cannot be completed laparoscopically, outcomes are not compromised for converted patients.
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Integration of open and laparoscopic approaches for rectal cancer resection: oncologic and short-term outcomes. Surg Endosc 2014; 28:2129-36. [PMID: 24488357 DOI: 10.1007/s00464-014-3444-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2013] [Accepted: 01/13/2014] [Indexed: 12/21/2022]
Abstract
BACKGROUND Laparoscopy is increasingly used for rectal cancer surgery. Laparoscopic surgery is not attempted for some suitable patients because of concerns for conversion or technical difficulty. This study aimed to evaluate oncologic and short-term outcomes for patients undergoing curative resection for rectal cancer via laparoscopic and open approaches. METHODS A prospective database was reviewed to identify rectal cancer resections from 2005 to 2011. Patients who had primary rectal cancer within 15 cm of the anal verge were included in the study. Those with recurrent or metastatic disease were excluded. Patients were assigned to laparoscopic or open approaches preoperatively based on clinical criteria and imaging. All patients underwent a standard total mesorectal excision and followed a standardized enhanced recovery pathway. The oncologic and clinical outcomes were evaluated by approach. RESULTS The analysis included 81 patients. The preoperative assignments consisted of 62 laparoscopic (77%) and 19 open (23%) procedures. Nine laparoscopic procedures (14.5%) were converted to open procedures. After a median follow-up period of 25 months, all oncologic outcomes were comparable. Three patients (two laparoscopic, one open) had a positive circumferential margin (≤1 mm). The laparoscopic and open groups were similar in terms of their 3-year disease-free periods (93.6 vs. 88.2%; P = 0.450) and overall survival periods (93.5 vs. 90.9%; P = 0.766). The local recurrence rate was 2.5%. CONCLUSIONS Laparoscopic resection for rectal cancer can be attempted for most patients. Conversion to open procedure does not compromise clinical or oncologic outcomes. In practice, combining laparoscopic and open surgery optimizes resource use and results in at least equivalent outcomes.
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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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Cai Y, Zhou Y, Li Z, Xiang J, Chen Z. Surgical outcome of laparoscopic colectomy for colorectal cancer in obese patients: A comparative study with open colectomy. Oncol Lett 2013; 6:1057-1062. [PMID: 24137464 PMCID: PMC3796378 DOI: 10.3892/ol.2013.1508] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2013] [Accepted: 07/25/2013] [Indexed: 12/29/2022] Open
Abstract
The aim of the present study was to assess the short-term outcome and survival time of 166 obese patients who received laparoscopic and open colectomy for colorectal cancer (CRC) between January 2007 and December 2012. All 166 patients included in the study had a BMI >28. Laparoscopic or open colectomy procedures were performed on 64 and 102 patients, respectively. The short-term outcome and post-operative survival rates were compared. The patient characteristics were similar between the two groups. Laparoscopic colectomy correlated with an increased duration of surgery compared with open colectomy (183 vs. 167 min, respectively; P<0.05) but intraoperative blood loss was decreased (168 vs. 188 ml, respectively; P<0.05). Hospitalization costs were slightly higher following the laparoscopic procedure compared with open surgery, but this was affordable for the majority of patients (¥56,484 vs. ¥56,161, respectively; P<0.05). The incidence of wound infection (17 vs. 31%; P<0.05) and abdominal abscess rates (6 vs. 18%; P<0.05) were reduced in the laparoscopic group compared with the open group. Pathological characteristics were identified to be similar and no significant differences were identified in overall (log-rank test; P=0.85) and disease-free (log-rank test; P=0.85) survival between the two types of surgery (log-rank test; P=0.76). The current retrospective study demonstrated an improved short-term outcome in laparoscopic colectomy for CRC patients with a BMI >28 compared with patients who underwent the open procedure. Laparoscopic colectomy is technically and oncologically safe and must be popularized in obese CRC patients.
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Affiliation(s)
- Yantao Cai
- Department of General Surgery, Huashan Hospital Affiliated to Fudan University, Shanghai 200040, P.R. China
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Twijnstra ARH, Blikkendaal MD, van Zwet EW, Jansen FW. Clinical relevance of conversion rate and its evaluation in laparoscopic hysterectomy. J Minim Invasive Gynecol 2013; 20:64-72. [PMID: 23312244 DOI: 10.1016/j.jmig.2012.09.006] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2012] [Revised: 09/18/2012] [Accepted: 09/22/2012] [Indexed: 10/27/2022]
Abstract
STUDY OBJECTIVES To estimate the current conversion rate in laparoscopic hysterectomy (LH); to estimate the influence of patient, procedure, and performer characteristics on conversion; and to hypothesize the extent to which conversion rate can act as a means of evaluation in LH. DESIGN Prospective cohort study (Canadian Task Force classification II-2). SETTING The study included 79 gynecologists representing 42 hospitals throughout the Netherlands. This reflects 75% of all gynecologists performing LH in the Netherlands, and 68% of all hospitals. PATIENTS Data from 1534 LH procedures were collected between 2008 and 2010. INTERVENTION All participants in the nationwide LapTop registration study recorded each consecutive LH they performed during 1 year. MEASUREMENTS AND MAIN RESULTS Conversion rate and odds ratios (OR) of risk factors for conversion were calculated. Conversions were described as reactive or strategic. The literature reported a conversion rate for LH of 0% to 19% (mean, 3.5%). In our cohort, 70 LH procedures (4.6%) were converted. Using a mixed-effects logistic regression model, we estimated independent risk factors for conversion. Body mass index (BMI) (p = .002), uterus weight (p < .001), type of LH (p = .004), and age (p = .02) had a significant influence on conversion. The risk of conversion was increased at BMI >35 (OR, 6.53; p < .001), age >65 years (OR, 6.97; p = .007), and uterus weight 200 to 500 g (OR, 4.05; p < .001) and especially >500 g (OR, 30.90; p < .001). A variation that was not explained by the covariates included in our model was identified and referred to as the "surgical skills factor" (average OR, 2.79; p = .001). CONCLUSION Use of estimated risk factors (BMI, age, uterus weight, and surgical skills) provides better insight into the risk of conversion. Conversion rate can be used as a means of evaluation to ensure better outcomes of LH in future patients.
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Blikkendaal MD, Twijnstra ARH, Stiggelbout AM, Beerlage HP, Bemelman WA, Jansen FW. Achieving consensus on the definition of conversion to laparotomy: a Delphi study among general surgeons, gynecologists, and urologists. Surg Endosc 2013; 27:4631-9. [PMID: 23846371 DOI: 10.1007/s00464-013-3086-1] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2013] [Accepted: 06/24/2013] [Indexed: 01/29/2023]
Abstract
BACKGROUND In laparoscopic surgery, conversion to laparotomy is associated with worse clinical outcomes, especially if the conversion is due to a complication. Although apparently important, no commonly used definition of conversion exists. The aim of this study was to achieve multidisciplinary consensus on a uniform definition of conversion. METHODS On the basis of definitions currently used in the literature, a web-based Delphi consensus study was conducted among members of all four Dutch endoscopic societies. The rate of agreement (RoA) was calculated; a RoA of >70% suggested consensus. RESULTS The survey was completed by 268 respondents in the first Delphi round (response rate, 45.6%); 43% were general surgeons, 49% gynecologists, and 8% urologists. Average ± standard deviation laparoscopic experience was 12.5 ± 7.2 years. On the basis of the results of round 1, a consensus definition was compiled. Conversion to laparotomy is an intraoperative switch from a laparoscopic to an open abdominal approach that meets the criteria of one of the two subtypes: strategic conversion, a standard laparotomy that is made directly after the assessment of the feasibility of completing the procedure laparoscopically and because of anticipated operative difficulty or logistic considerations; and reactive conversion, the need for a laparotomy because of a complication or (extension of an incision) because of (anticipated) operative difficulty after a considerable amount of dissection (i.e., >15 min in time). A laparotomy after a diagnostic laparoscopy (i.e., to assess the curability of the disease) should not be considered a conversion. In the second Delphi round, a RoA of 90% was achieved with this definition. CONCLUSIONS After two Delphi rounds, consensus on a uniform multidisciplinary definition of conversion was achieved within a representative group of general surgeons, gynecologists, and urologists. An unambiguous interpretation will result in a more reliable clinical registration of conversion and scientific evaluation of the feasibility of a laparoscopic procedure.
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Affiliation(s)
- Mathijs D Blikkendaal
- Department of Gynecology, Leiden University Medical Center, PO Box 9600, 2300 RC, Leiden, The Netherlands,
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Successful and safe introduction of laparoscopic colorectal cancer surgery in Dutch hospitals. Ann Surg 2013; 257:916-21. [PMID: 22735713 DOI: 10.1097/sla.0b013e31825d0f37] [Citation(s) in RCA: 67] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
OBJECTIVE To investigate the safety of laparoscopic colorectal cancer resections in a nationwide population-based study. BACKGROUND Although laparoscopic techniques are increasingly used in colorectal cancer surgery, little is known on results outside trials. With the fast introduction of laparoscopic resection (LR), questions were raised about safety. METHODS Of all patients who underwent an elective colorectal cancer resection in 2010 in the Netherlands, 93% were included in the Dutch Surgical Colorectal Audit. Short-term outcome after LR, open resection (OR), and converted LR were compared in a generalized linear mixed model. We further explored hospital differences in LR and conversion rates. RESULTS A total of 7350 patients, treated in 90 hospitals, were included. LR rate was 41% with a conversion rate of 15%. After adjustment for differences in case-mix, LR was associated with a lower risk of mortality (odds ratio 0.63, P < 0.01), major morbidity (odds ratio 0.72, P < 0.01), any complications (odds ratio 0.74, P < 0.01), hospital stay more than 14 days (odds ratio 0.71, P < 0.01), and irradical resections (odds ratio 0.68, P < 0.01), compared to OR. Outcome after conversion was similar to OR (P > 0.05). A large variation in LR and conversion rates among hospitals was found; however, the difference in outcome associated with operative techniques was not influenced by hospital of treatment. CONCLUSIONS Use of laparoscopic techniques in colorectal cancer surgery in the Netherlands is safe and results are better in short-term outcome than open surgery, irrespective of the hospital of treatment. Outcome after conversion was similar to OR.
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Laparoscopic sigmoidectomy in moderate and severe diverticulitis: analysis of short-term outcomes in a continuous series of 121 patients. Surg Endosc 2013; 27:1766-71. [PMID: 23436080 DOI: 10.1007/s00464-012-2676-7] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2012] [Accepted: 10/20/2012] [Indexed: 01/04/2023]
Abstract
BACKGROUND The role of laparoscopic surgery has been shown to be safe, feasible, and equivalent to open surgery for moderate diverticulitis, but its role in severe disease is still being elucidated. The aim of this study was to compare short-term outcomes in patients who underwent laparoscopic sigmoidectomy for moderate and severe diverticulitis. METHODS All patients who had elective laparoscopic sigmoidectomy for diverticulitis between April 2003 and September 2011 at the University Hospital of Luxembourg were selected from a retrospective database. The patients were divided in two groups: moderate acute diverticulitis (MAD) included patients with an episode of left-lower-quadrant pain, elevated inflammatory markers, and radiologic evidence of diverticulitis, and severe acute diverticulitis (SAD) included patients with diverticula associated with abscess, phlegmon, perforation, fistula, obstruction, bleeding, or stricture. RESULTS A total of 121 patients (81 MAD and 40 SAD) underwent elective laparoscopic sigmoidectomy with primary anastomosis. There were no significant differences between the two groups with respect to demographic characteristics, except for sex ratio. In this series the overall morbidity rate at 30 postoperative days (POD) was 12.4 %, with no significant differences between MAD and SAD (16.0 vs. 5 %, respectively; P = 0.083). No significant differences were found with respect to mean length of hospital stay (6.7 vs. 7.7 days; P = 0.399) as well. The overall conversion rate to open surgery was 2.5 % (3 patients), with no difference between the two groups. Conversion to laparotomy was associated with an increased morbidity rate (11.0 % for full laparoscopy vs. 66.6 % for conversion; P = 0.040) and a longer length of stay (6.8 vs. 16.7 days; P = 0.008). There were no deaths within 30 POD. CONCLUSIONS Elective laparoscopic sigmoidectomy is safe and feasible for patients with moderate and severe acute diverticulitis and the outcomes are equivalent.
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Kang CY, Chaudhry OO, Halabi WJ, Nguyen V, Carmichael JC, Stamos MJ, Mills S. Outcomes of laparoscopic colorectal surgery: data from the Nationwide Inpatient Sample 2009. Am J Surg 2012; 204:952-7. [PMID: 23122910 DOI: 10.1016/j.amjsurg.2012.07.031] [Citation(s) in RCA: 80] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2012] [Revised: 07/02/2012] [Accepted: 07/02/2012] [Indexed: 02/07/2023]
Abstract
BACKGROUND Specific International Classification of Diseases, Ninth Revision, codes for laparoscopic procedures introduced in 2008 allow a more accurate evaluation of laparoscopic colorectal surgery. METHODS Using the Nationwide Inpatient Sample 2009, a retrospective analysis of surgical colorectal cancer and diverticulitis patients was conducted. Logistic regression was used to estimate odds ratios comparing the outcomes of laparoscopic, open, and converted surgery. RESULTS A total of 121,910 patients underwent resection for cancer and diverticulitis, 35.41% of whom underwent laparoscopic surgery. Compared with open surgery, laparoscopic surgery had lower postoperative complication rates, lower mortality, shorter hospital stays, and lower costs. Compared to open surgery, laparoscopic surgery independently decreased mortality, postoperative anastomotic leak, urinary tract infection, ileus or obstruction, pneumonia, respiratory failure, and wound infection. Converted surgery was independently associated with anastomotic leak, wound infection, ileus or obstruction, and urinary tract infection. CONCLUSIONS Laparoscopic colorectal surgery has lower postoperative complications, lower mortality, lower costs, and shorter hospital stays. Conversion had higher complications compared with laparoscopy. The use of laparoscopy should increase with efforts to minimize conversion.
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Affiliation(s)
- Celeste Y Kang
- Department of Surgery, University of California, Irvine, School of Medicine, Irvine, CA, USA
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Abstract
Laparoscopic colorectal surgery may be comparable with open techniques when considering oncological and long-term follow-up outcomes; however, there are a few operative complications specific to laparoscopic colorectal surgery. This article reviews the array of complications and discusses them in detail.
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41
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Laparoscopic surgery for colon cancer in obese patients: a case-matched control study. Surg Today 2012; 43:763-8. [DOI: 10.1007/s00595-012-0352-0] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2012] [Accepted: 05/17/2012] [Indexed: 11/25/2022]
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42
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Aly OE, Quayyum Z. Has laparoscopic colorectal surgery become more cost-effective over time? Int J Colorectal Dis 2012; 27:855-60. [PMID: 22290571 DOI: 10.1007/s00384-012-1410-1] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/19/2012] [Indexed: 02/04/2023]
Abstract
BACKGROUND Several studies have confirmed that laparoscopic colorectal surgery (LCS) has superior short-term outcomes when compared to open colorectal surgery. However, the evidence for cost-effectiveness of LCS is less clear. AIM The aim of this study is to explore the cost-effectiveness of LCS over time since it was first developed in 1991. METHODS Systematic review of the literature was conducted. Electronic databases (PubMed, ScienceDirect and Google Scholar) were searched for studies from 1991 to 2010 using the keywords "laparoscopic, colorectal surgery cost, economic evaluation". RESULTS Fifteen economic evaluations met the inclusion criteria. The percentage cost difference between open and laparoscopic surgery varied widely between different studies. The general trend when observing all the included economic evaluations is that there is a moderate negative correlation between progression of time and the size of the cost gap between laparoscopic and open surgery (R-value=-0.44). This correlation is even stronger (R-value=-0.64, P=0.046) if the studies are subdivided by the country where the surgery was carried out in. Western healthcare systems, even though they had a heterogeneous set of results (SD=27%), showed a decline in costs of laparoscopic surgery with time. CONCLUSION From the current trends, it is projected that the results of future economic evaluations will unequivocally show that laparoscopic surgery is cheaper than open surgery. The initial higher costs of laparoscopic surgery training may be worth the savings made in the long term if it is practised in settings where postoperative care is expensive.
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Affiliation(s)
- O E Aly
- Medical Student - School of Medicine and Dentistry, University of Aberdeen, Aberdeen AB25 2ZD, Scotland, UK.
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43
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Stottmeier S, Harling H, Wille-Jørgensen P, Balleby L, Kehlet H. Postoperative morbidity after fast-track laparoscopic resection of rectal cancer. Colorectal Dis 2012; 14:769-75. [PMID: 21848895 DOI: 10.1111/j.1463-1318.2011.02767.x] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
AIM Analysis was carried out of the nature and chronological order of early complications after fast-track laparoscopic rectal surgery with a view to optimizing the short-time outcome of rectal cancer surgery. METHOD A total of 102 consecutive patients who underwent elective fast-track laparoscopic rectal cancer surgery were analysed prospectively from the Danish Colorectal Cancer Database supplemented by data from the medical records. We studied in detail the nature and chronological order of postoperative morbidity and reason for prolonged stay (> 5 days). RESULTS Twenty-five patients (25%) had one or more complications. Surgical complications occurred in 19 patients, while six patients had medical complications as the primary event. Fifteen patients underwent reoperation, three died, and eight were readmitted within 30 days. The median length of stay was 5 days (range 2-42). CONCLUSION Postoperative morbidity remains a significant problem in the fast-track era, even in experienced surgical hands. Our results suggest that besides improvement of surgical technique further improvement of outcome lies in early recognition and proper treatment of complications and the perioperative optimization of organ function.
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Affiliation(s)
- S Stottmeier
- Department of Surgery K, Bispebjerg Hospital, Copenhagen, Denmark
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Conversion risk factors in laparoscopic colorectal surgery. Wideochir Inne Tech Maloinwazyjne 2012; 7:240-5. [PMID: 23362422 PMCID: PMC3557741 DOI: 10.5114/wiitm.2011.28906] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2011] [Revised: 10/01/2011] [Accepted: 04/23/2012] [Indexed: 02/04/2023] Open
Abstract
Introduction This study is aimed at identifying important risk factors associated with conversion of laparoscopic colorectal surgery. Laparoscopic surgery is usually associated with less operative trauma, more favourable post-operative course and lower morbidity than open surgery. However, conversion is connected with some risks according to some authors. Aim To identify the risk factors associated with conversion and to create a model to predict possible conversion for a patient before surgery. Material and methods The source data file contained information about 649 patients who underwent laparoscopic colorectal surgery between 2001 and 2009 at the University Hospital Ostrava, Czech Republic. Conversion to open surgery was necessary in 54 cases. The variables gender, body mass index (BMI), American Society of Anesthesiologists (ASA) classification, stage of disease, number of previous operations and operation severity were included in the analysis as the potential risk factors of conversion. Discriminant analysis was used for the data evaluation; statistical software SPSS 17 and NCSS 2004 were used for the calculations. Results The created model had only low discriminating ability. The variable ASA classification was identified as the most important risk factor of conversion, followed by the variables operation severity, gender and BMI. Conclusions Discriminant analysis did not find the chosen input variables satisfactory enough to make a reasonable model for the prediction of conversion. The expected fact was confirmed that large bowel surgery and greater BMI mean greater risk of conversion, whereas there is no reason to refuse laparoscopy for a patient with higher ASA classification.
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Laparoscopic colorectal resection for cancer: effects of conversion on long-term oncologic outcomes. Surg Endosc 2012; 26:1971-6. [PMID: 22237758 DOI: 10.1007/s00464-011-2137-8] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2011] [Accepted: 12/07/2011] [Indexed: 12/13/2022]
Abstract
BACKGROUND The effects of conversion to open surgery during laparoscopic resection for colorectal cancer on long-term oncologic outcomes still are unclear. METHODS All 450 laparoscopic colorectal resections for cancer performed at a single center between 1994 and 2008 and included in a prospectively maintained database were considered. Patients who required conversion to open surgery (CONV) were matched 1:2 with laparoscopically completed cases (LAP) and 1:5 with open surgery cases (OPEN) for age, American Society of Anesthesiologists (ASA) score, year of surgery, tumor location, and tumor stage. Fisher's exact, chi-square, and Wilcoxon tests were used as appropriate. Kaplan-Meier curves were compared to analyze survival. RESULTS In this study, 31 CONV cases were independently compared with 62 LAP and 155 OPEN cases. Compared with the LAP and OPEN patients, the CONV patients were characterized by a numerically higher rate of preoperative comorbidity (61.3% vs LAP, 51.6; P = 0.4 and OPEN, 48.4%; P = 0.2), male gender (77.4% vs LAP, 59.7%; P = 0.09 and OPEN, 58.1%; P = 0.05), and a significantly higher mean body mass index (29.6 vs LAP, 26.8; P = 0.012 and OPEN, 28.8; P = 0.3). The pathologic tumor stage, location, and chemotherapy and radiotherapy rates were comparable among the groups. After a median follow-up period of 4.1, 4.2, and 4.6 years, the 5-year disease-free survival rate was significantly lower for the CONV patients (40.2%) than for the LAP (70.7%, P = 0.01) or the OPEN (63.3%, P = 0.04) patients. However, the 5-year cancer-specific survival rates were similar among the CONV (94.4%), LAP (86.1%, P = 0.36), and OPEN (84.9%, P = 0.14) patients. CONCLUSIONS Conversion to open surgery does not affect oncologic outcomes, although CONV patients have increased comorbidity rates affecting long-term mortality.
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Newman CM, Arnold SJ, Coull DB, Linn TY, Moran BJ, Gudgeon AM, Cecil TD. The majority of colorectal resections require an open approach, even in units with a special interest in laparoscopic surgery. Colorectal Dis 2012; 14:29-34; discussion 42-3. [PMID: 21070568 DOI: 10.1111/j.1463-1318.2010.02504.x] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
AIM Proponents suggest that laparoscopic colorectal resection might be achievable in up to 90% of cases, while keeping conversion rates below 10%. This unselected prospective case series reports on the proportion of patients having a completed laparoscopic colorectal resection in two units where laparoscopic colorectal practice is well established and readily available. METHOD All patients undergoing elective and emergency colorectal resection during a 6-month period were identified. The underlying pathology and the surgical approach (laparoscopic or open) were recorded. The contraindications to laparoscopic resection were also documented. The need and rationale for conversion to an open approach were recorded. RESULTS In total, 205 consecutive patients (160 elective and 45 emergency procedures) underwent colorectal resection for malignancy [117 (57%) patients] and benign pathology [88 (43%) patients]. Laparoscopic resection was attempted in 127/205 (62%) patients and 31/127 (24%) of these were converted to open surgery. The main reasons for not attempting laparoscopic resection were locally advanced disease and emergency surgery. The commonest reasons for conversion were advanced disease and to allow completion of rectal dissection and/or cross-stapling of the rectum. CONCLUSION Despite a special interest in laparoscopic colorectal surgery of the two colorectal units who provided the data for this study, fewer than half (96/205; 47%) of the patients in this consecutive unselected series who were undergoing major colorectal resection had the procedure completed laparoscopically.
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Affiliation(s)
- C M Newman
- Department of Colorectal Surgery, North Hampshire Hospital, Basingstoke, Hampshire, UK.
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Impact of conversion on outcome in laparoscopic colorectal cancer surgery. Wideochir Inne Tech Maloinwazyjne 2011; 7:74-81. [PMID: 23256006 PMCID: PMC3516970 DOI: 10.5114/wiitm.2011.25799] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2011] [Revised: 10/29/2011] [Accepted: 11/07/2011] [Indexed: 02/06/2023] Open
Abstract
INTRODUCTION Long-term results after laparoscopic surgery with conversion to open surgery for colorectal cancer are seldom published. AIM The study analysed the impact of conversion of laparoscopic surgery to open resection for colorectal cancer on short- and long-term results. MATERIAL AND METHODS The prospectively collected data of 469 patients with colorectal cancer in the period from 1 January 2001 to 31 December 2006 were analysed. Short- and long-term results were compared. RESULTS The relative frequency of conversion was 7%. The subgroups were statistically similar regarding age, gender, body mass index (BMI), localization of tumour, T stage, and TNM stage. We observed a lower frequency of previous surgery (p = 0.018) in the group of patients with conversions to open surgery as well as statistically significantly higher frequency of patients with American Society of Anesthesiologists (ASA) score II (p = 0.039). There was no statistical difference in morbidity, mortality, or the length of hospital stay between both the groups of patients. The operating time was significantly higher in the group of patients with conversion (p = 0.00001). There was a significantly higher blood loss in the patient groups with conversion to open surgery and in the group with primarily open surgery (p = 0.00023). There was no difference in the overall survival (p = 0.712), disease-free survival (p = 0.072) or in the local (p = 0.432) or distant (p = 0.957) recurrence. CONCLUSIONS No negative impact on short- or long-term results of conversion to open surgery was verified in patients with colorectal surgery.
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Scheidbach H, Garlipp B, Oberländer H, Adolf D, Köckerling F, Lippert H. Conversion in laparoscopic colorectal cancer surgery: impact on short- and long-term outcome. J Laparoendosc Adv Surg Tech A 2011; 21:923-7. [PMID: 22011276 DOI: 10.1089/lap.2011.0298] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
INTRODUCTION Despite the well-documented safety and effectiveness of laparoscopic colorectal surgery in curative intention, the role of conversion and its impact on short- and long-term outcome after resection of a carcinoma are unclear and continue to give rise to controversial discussion. METHODS Within the framework of a prospective, multicenter observational study (Laparoscopic Colorectal Surgery Study Group), into which a total of 5,863 patients from 69 hospitals were recruited over a period of 10 years, a subgroup of all patients who had undergone curative resection was analyzed with regard to the effects of conversion. RESULTS Of the 1409 patients who had undergone curative resection for colorectal carcinoma, conversion had to be performed in 80 (5.7%) cases for the most diverse reasons. The duration of surgery (median: 183 vs. 241 minutes; P<.001) was significantly longer in the conversion group. Perioperatively, significant disadvantages were noted in converted patients in terms of intraoperative blood loss (median: 243 vs. 573 mL, P<.001), need for perioperative blood transfusion (10.8% vs. 33.8%; P<.001), and resumption of bowel movement (median: after 3 vs. 4 days; P<.001). With regard to postoperative morbidity, significant disadvantages were observed in converted patients, in particular in terms of specific surgical complications, including a higher rate of anastomotic insufficiency (5.0% vs. 13.8%; P=.003) and a higher reoperation rate (4.9% vs. 15.0%; P=.001). In the long term, conversion was associated with lower overall survival, but not with poorer disease-free survival. CONCLUSION Significantly higher postoperative morbidity was observed in patients after conversion, in particular in terms of specific surgical complications. In addition, conversion is associated with overall lower survival but not with poorer disease-free survival.
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Affiliation(s)
- Hubert Scheidbach
- Department of General, Visceral, and Thoracic Surgery, Kreisklinik Bad Neustadt/Saale, Bad Neustadt/Saale, Germany.
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White I, Greenberg R, Itah R, Inbar R, Schneebaum S, Avital S. Impact of conversion on short and long-term outcome in laparoscopic resection of curable colorectal cancer. JSLS 2011; 15:182-7. [PMID: 21902972 PMCID: PMC3148868 DOI: 10.4293/108680811x13071180406439] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
These authors found that conversion in laparoscopic surgery for curable colorectal cancer is associated with a worse peri-operative outcome and worse disease-free survival. Introduction: Long-term outcome of patients following conversion during laparoscopic surgery for colorectal cancer is not often reported. Recent data suggest a negative impact of conversion on long-term survival. This study aimed to evaluate the impact of conversion on the perioperative outcome and on long-term survival in patients who underwent laparoscopic resection for curable colorectal cancer. Methods: Evaluation of our prospective in-hospital collected data of patients who underwent laparoscopic surgery for curable colorectal cancer over a 5-year period. Long-term data were collected from our outpatient's clinic data and personal contact when necessary. Results: During the study period, 175 patients were operated on laparoscopically for curable colon cancer (stage I-III). Mean follow-up was 33±18 months with a minimum follow-up of 12 months. For various reasons, 25 patients (14.4%) had to be converted to open surgery. Short-term outcome revealed a trend towards longer operations, a higher rate of surgical complications, and a longer hospital stay in the converted group. Five-year, Kaplan-Meier, disease-free analysis was worse for converted patients. Overall survival did not differ between the 2 groups. Cox proportional hazards regression analysis revealed that conversion and AJCC stage were independent risk factors for recurrence. Conclusions: Conversion in laparoscopic surgery for curable colorectal cancer is associated with a worse perioperative outcome and worse disease-free survival.
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Affiliation(s)
- Ian White
- Department of Surgery A, Tel-Aviv Sourasky Medical Center and the Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
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Lee JK, Stein SL. Laparoscopic Management of Diverticular Disease. SEMINARS IN COLON AND RECTAL SURGERY 2011. [DOI: 10.1053/j.scrs.2011.05.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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