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Bahall V, De Barry L, Singh K. Optimizing Total Laparoscopic Hysterectomy for the Geriatric Population: A Practical Case Study and Comprehensive Literature Review. Cureus 2023; 15:e46265. [PMID: 37908921 PMCID: PMC10615228 DOI: 10.7759/cureus.46265] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/30/2023] [Indexed: 11/02/2023] Open
Abstract
Elderly patients represent a large cohort of patients requiring gynaecological surgery for benign and malignant indications. In recent years, several conventional gynaecological procedures have shifted towards minimally invasive alternatives such as laparoscopy, hysteroscopy, and robotic surgery. A recent Surveillance, Epidemiology, and End Results (SEER) analysis compared the outcomes of 25,000 women undergoing laparotomy versus laparoscopic approach to hysterectomy and found that laparoscopy is associated with a shorter duration of hospitalization (three days versus five days), less postoperative complications (76%), less requirement for blood transfusion, reduced operational costs, faster recovery, and an overall safer surgical experience. Although geriatric patients are affected by age-related comorbidities, physiologic changes, and altered pharmacodynamics and pharmacokinetics of administered drugs, these patients benefit most from minimally invasive surgery. In this paper, we present a comprehensive account of the interdisciplinary perioperative approaches employed to accomplish a total laparoscopic hysterectomy, bilateral salpingo-oophorectomy, and pelvic lymph node dissection in an 82-year-old patient who was diagnosed with grade I endometrial adenocarcinoma and multiple age-related medical comorbidities.
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Affiliation(s)
- Vishal Bahall
- Department of Obstetrics and Gynaecology, The University of the West Indies, St. Augustine, TTO
- Department of Obstetrics and Gynaecology, San Fernando General Hospital, San Fernando, TTO
| | - Lance De Barry
- Department of Obstetrics and Gynaecology, San Fernando General Hospital, San Fernando, TTO
| | - Keevan Singh
- Anaesthesia and Intensive Care Unit, Department of Clinical and Surgical Sciences, The University of the West Indies, San Fernando, TTO
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2
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Thompson HM, Williams H, Omer DM, Yuval JB, Verheij FS, Fiasconaro M, Widmar M, Wei IH, Pappou EP, Smith JJ, Nash GM, Weiser MR, Paty PB, Shahrokni A, Garcia-Aguilar J. Comparison of short-term outcomes and survival between minimally invasive colectomy and open colectomy in patients 80 years of age and older. J Robot Surg 2023; 17:1857-1865. [PMID: 37022559 PMCID: PMC10527224 DOI: 10.1007/s11701-023-01575-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2023] [Accepted: 03/12/2023] [Indexed: 04/07/2023]
Abstract
We investigated the short- and long-term outcomes of patients 80 years of age and older with colon cancer who underwent robotic colectomy versus laparoscopic colectomy. Data for patients treated at a comprehensive cancer center between January 2006 and November 2018 were collected retrospectively. Outcomes from minimally invasive laparoscopic or robotic colectomy were compared. Survival was analyzed by the Kaplan-Meier method with significance evaluated by the log-rank test. The laparoscopic (n = 104) and the robotic (n = 75) colectomy groups did not differ across baseline characteristics. Patients who underwent a robotic colectomy had a shorter median length of hospital stay (5 versus 6 days; p < 0.001) and underwent fewer conversions to open surgery (3% versus 17%; p = 0.002) compared to the laparoscopic cohort. The groups did not differ in postoperative complication rates, overall survival or disease-free survival. Elderly patients undergoing robotic colectomy for colon cancer have a shorter hospital stay and lower rates of conversion without compromise to oncologic outcomes.
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Affiliation(s)
- Hannah M Thompson
- Colorectal Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Hannah Williams
- Colorectal Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Dana M Omer
- Colorectal Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Jonathan B Yuval
- Colorectal Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Floris S Verheij
- Colorectal Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Megan Fiasconaro
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Maria Widmar
- Colorectal Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Iris H Wei
- Colorectal Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Emmanouil P Pappou
- Colorectal Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - J Joshua Smith
- Colorectal Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Garrett M Nash
- Colorectal Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Martin R Weiser
- Colorectal Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Philip B Paty
- Colorectal Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Armin Shahrokni
- Department of Medicine, Geriatrics Service, Jersey Shore Medical Center, Neptune Township, NJ, USA
| | - Julio Garcia-Aguilar
- Colorectal Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA.
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Sijberden JP, Cipriani F, Lanari J, Russolillo N, Benedetti Cacciaguerra A, Osei-Bordom D, Conci S, Görgec B, Primrose JN, Edwin B, López-Ben S, D'Hondt M, Rotellar F, Besselink MG, Dagher I, Giuliante F, Fuks D, Rozzini R, Ruzzenente A, Sutcliffe RP, Vivarelli M, Ferrero A, Cillo U, Aldrighetti LA, Abu Hilal M. Minimally invasive ver-sus open liver resection for hepatocellular carcinoma in the elderly: international multicentre propensity score-matched study. Br J Surg 2023; 110:927-930. [PMID: 36512475 DOI: 10.1093/bjs/znac423] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2022] [Revised: 06/09/2022] [Accepted: 10/24/2022] [Indexed: 07/20/2023]
Affiliation(s)
- Jasper P Sijberden
- Department of Surgery, Poliambulanza Foundation Hospital, Brescia, Italy
- Department of Surgery, Amsterdam UMC location, University of Amsterdam, Amsterdam, the Netherlands
- Cancer Centre Amsterdam, Cancer Treatment and Quality of Life, Amsterdam, the Netherlands
| | - Federica Cipriani
- Hepatobiliary Surgery Division, IRCCS San Raffaele Hospital, Milan, Italy
| | - Jacopo Lanari
- Department of Surgery, Oncology and Gastroenterology, Hepatobiliary Surgery and Liver Transplantation Unit, Padua University Hospital, Padua, Italy
| | - Nadia Russolillo
- Department of General and Oncological Surgery, Umberto I Mauriziano Hospital, Turin, Italy
| | - Andrea Benedetti Cacciaguerra
- Hepatobiliary and Abdominal Transplantation Surgery, Department of Experimental and Clinical Medicine, Riuniti Hospital, Polytechnic University of Marche, Ancona, Italy
| | | | - Simone Conci
- Department of Surgery, University of Verona, Verona, Italy
| | - Burak Görgec
- Department of Surgery, Amsterdam UMC location, University of Amsterdam, Amsterdam, the Netherlands
- Cancer Centre Amsterdam, Cancer Treatment and Quality of Life, Amsterdam, the Netherlands
| | - John N Primrose
- Department of Surgery, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Bjørn Edwin
- Intervention Centre and Department of Hepatopancreatobiliary Surgery, Oslo University Hospital and Institute of Medicine, University of Oslo, Oslo, Norway
| | - Santi López-Ben
- Servei de Cirurgia General i Digestiva, Hospital Doctor Josep Trueta de Girona, Girona, Catalonia, Spain
| | - Mathieu D'Hondt
- Department of Digestive and Hepatobiliary/Pancreatic Surgery, Groeninge Hospital, Kortrijk, Belgium
| | - Fernando Rotellar
- Department of General and Digestive Surgery, Clinica Universidad de Navarra, Pamplona, Spain
| | - Marc G Besselink
- Department of Surgery, Amsterdam UMC location, University of Amsterdam, Amsterdam, the Netherlands
- Cancer Centre Amsterdam, Cancer Treatment and Quality of Life, Amsterdam, the Netherlands
| | - Ibrahim Dagher
- Department of Digestive Minimally Invasive Surgery, Antoine Béclère Hospital, Paris, France
| | - Felice Giuliante
- Chirurgia Epatobiliare, Università Cattolica del Sacro Cuore-IRCCS, Rome, Italy
| | - David Fuks
- Department of Digestive, Oncologic and Metabolic Surgery, Institut Mutualiste Montsouris, Université Paris Descartes, Paris, France
| | - Renzo Rozzini
- Department of Geriatrics, Poliambulanza Foundation Hospital, Brescia, Italy
| | | | | | - Marco Vivarelli
- Hepatobiliary and Abdominal Transplantation Surgery, Department of Experimental and Clinical Medicine, Riuniti Hospital, Polytechnic University of Marche, Ancona, Italy
| | - Alessandro Ferrero
- Department of General and Oncological Surgery, Umberto I Mauriziano Hospital, Turin, Italy
| | - Umberto Cillo
- Department of Surgery, Oncology and Gastroenterology, Hepatobiliary Surgery and Liver Transplantation Unit, Padua University Hospital, Padua, Italy
| | - Luca A Aldrighetti
- Hepatobiliary Surgery Division, IRCCS San Raffaele Hospital, Milan, Italy
| | - Mohammad Abu Hilal
- Department of Surgery, Poliambulanza Foundation Hospital, Brescia, Italy
- Department of Surgery, University Hospital Southampton NHS Foundation Trust, Southampton, UK
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Ali M, Wang Y, Yu W, Baral S, Jun R, Wang D. Benefits of minimally invasive surgery for rectal cancer in older adults compared with younger adults: a retrospective study. J Robot Surg 2023:10.1007/s11701-023-01602-1. [PMID: 37085678 DOI: 10.1007/s11701-023-01602-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2023] [Accepted: 04/09/2023] [Indexed: 04/23/2023]
Abstract
Randomized research demonstrated that robotic surgery was oncologically safe and beneficial in the short term. We investigated whether older adults benefit from robotics more than younger adults do in terms of short-term outcomes. We identified all older (≥ 70 years old) and younger (≤ 70) adults with rectal cancer treated with resection between 2019 and 2022 from an institutional database. We assessed the short-term post-operative 90-day outcomes, which included the first bowel movement, length of hospital duration, sepsis, and harvested lymph node on an age-based differentiation. The key outcomes were complications and grades III-IV on the Clavien-Dindo scale. We identified 298 individuals treated with oncologic resection of rectal cancer: 108 (36.6%) were older adults, while 190 (63.4%) were younger adults. Older adults treated with robotic surgery include 45 (41.6%), whereas 63 (58.3%) older adults were treated with laparoscopic surgery, and 85 (44.7%) younger adults were treated with robotic surgery, while 105 (55.2%) younger adults were treated with laparoscopic surgery. The Clavien-Dindo grading system exposes a substantial P < 0.05 in younger group, whereas grade III-IV patients are seen more frequently in laparoscopic surgery than robotic surgery. Younger and older persons both benefited differently from robotic surgery when compared to laparoscopic surgery in terms of major post-operative complications.
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Affiliation(s)
- Muhammad Ali
- Northern Jiangsu People's Hospital Affiliated to Yangzhou University, Yangzhou, China
- Department of General Surgery, General Surgery Institute of Yangzhou, Yangzhou University, Northern Jiangsu People's Hospital, 98 Nantong West Road, Yangzhou, 225001, Jiangsu, China
- Medical College of Yangzhou University, Yangzhou, China
- Yangzhou Key Laboratory of Basic and Clinical Transformation of Digestive and Metabolic Diseases, Yangzhou, 225001, Jiangsu, China
| | - Yang Wang
- Northern Jiangsu People's Hospital Affiliated to Yangzhou University, Yangzhou, China
- Department of General Surgery, General Surgery Institute of Yangzhou, Yangzhou University, Northern Jiangsu People's Hospital, 98 Nantong West Road, Yangzhou, 225001, Jiangsu, China
- Medical College of Yangzhou University, Yangzhou, China
- Yangzhou Key Laboratory of Basic and Clinical Transformation of Digestive and Metabolic Diseases, Yangzhou, 225001, Jiangsu, China
| | - Wenhao Yu
- Northern Jiangsu People's Hospital Affiliated to Yangzhou University, Yangzhou, China
- Department of General Surgery, General Surgery Institute of Yangzhou, Yangzhou University, Northern Jiangsu People's Hospital, 98 Nantong West Road, Yangzhou, 225001, Jiangsu, China
- Medical College of Yangzhou University, Yangzhou, China
| | - Shantanu Baral
- Northern Jiangsu People's Hospital Affiliated to Yangzhou University, Yangzhou, China
- Department of General Surgery, General Surgery Institute of Yangzhou, Yangzhou University, Northern Jiangsu People's Hospital, 98 Nantong West Road, Yangzhou, 225001, Jiangsu, China
- Medical College of Yangzhou University, Yangzhou, China
- Yangzhou Key Laboratory of Basic and Clinical Transformation of Digestive and Metabolic Diseases, Yangzhou, 225001, Jiangsu, China
| | - Ren Jun
- Northern Jiangsu People's Hospital Affiliated to Yangzhou University, Yangzhou, China
- Department of General Surgery, General Surgery Institute of Yangzhou, Yangzhou University, Northern Jiangsu People's Hospital, 98 Nantong West Road, Yangzhou, 225001, Jiangsu, China
- Medical College of Yangzhou University, Yangzhou, China
| | - Daorong Wang
- Northern Jiangsu People's Hospital Affiliated to Yangzhou University, Yangzhou, China.
- Department of General Surgery, General Surgery Institute of Yangzhou, Yangzhou University, Northern Jiangsu People's Hospital, 98 Nantong West Road, Yangzhou, 225001, Jiangsu, China.
- Medical College of Yangzhou University, Yangzhou, China.
- Yangzhou Key Laboratory of Basic and Clinical Transformation of Digestive and Metabolic Diseases, Yangzhou, 225001, Jiangsu, China.
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Drews G, Bohnsteen B, Knolle J, Gradhand E, Würl P. Laparoscopic surgery for colorectal cancer in an elderly population with high comorbidity: a single centre experience. Int J Colorectal Dis 2022; 37:1963-1973. [PMID: 35931782 DOI: 10.1007/s00384-022-04229-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/29/2022] [Indexed: 02/04/2023]
Abstract
PURPOSE The use of laparoscopic surgery for colorectal cancer in elderly patients with high comorbidity is a controversial subject. This retrospective analysis aims to compare two different age groups with respect to short and long term clinical and oncological outcomes. METHODS All laparoscopic colorectal resections for cancer performed between February 2011 and October 2017 with curative or palliative intention were evaluated. RESULTS Among 128 completed resections, the rate of major complications, length of hospital stays, 30-day mortality, 2-year recurrence rate, and the survival after palliative surgery were comparable between group A (< 75 years; n = 76) and B (≥ 75 years; n = 52). Patients in group B showed an extraordinarily high proportion of ASA III stage (73.1% vs. A: 35.5%; p < 0.01) and, in this context, an increased rate of minor postoperative complications (17.3% vs. A: 6.6%; p < 0.05) and lower overall 2 and 5-year survival rates. Within the first 2 years, they died sooner in the event of recurrence (57.1% vs. A: 18.2%; p < 0.05), and their survival after rectal resection, especially for low rectal carcinoma, was significantly reduced (58.8% vs. A: 96.7%; p < 0.001). CONCLUSION Laparoscopic surgery for colorectal cancer can be strongly advocated for elderly patients even in the face of high comorbidity. Whether very old patients with low rectal carcinoma also benefit from minimally invasive surgery or should undergo alternative therapies would need to be clarified primarily by examining the quality of life.
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Affiliation(s)
- Gerald Drews
- Department of General, Visceral and Thoracic Surgery, Municipal Hospital Dessau, Städtisches Klinikum Dessau, and Brandenburg Medical School Theodor Fontane, Auenweg 38, 06847, Dessau, Germany.
| | - Beatrix Bohnsteen
- Oncological Outpatient Department, Kastanienhof 1, 06847, Dessau, Germany
| | - Jürgen Knolle
- Institute of Pathology, Martha-Maria Hospital Halle-Dölau, Röntgenstraße 1, 06120, Halle (Saale), Germany
| | - Elise Gradhand
- Institute of Pathology, University Hospital, Theodor-Stern-Kai 7, 60590, Frankfurt/Main, Germany
| | - Peter Würl
- Department of General, Visceral and Thoracic Surgery, Municipal Hospital Dessau, Städtisches Klinikum Dessau, and Brandenburg Medical School Theodor Fontane, Auenweg 38, 06847, Dessau, Germany
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What Should We Recommend for Colorectal Cancer Screening in Adults Aged 75 and Older? ACTA ACUST UNITED AC 2021; 28:2540-2547. [PMID: 34287279 PMCID: PMC8293045 DOI: 10.3390/curroncol28040231] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2021] [Revised: 06/30/2021] [Accepted: 07/06/2021] [Indexed: 12/14/2022]
Abstract
The current recommendation to stop colorectal cancer screening for older adults is based on a lack of evidence due to systematic exclusion of this population from trials. Older adults are a heterogenous population with many available strategies for patient-centered assessment and decision-making. Evolutions in management strategies for colorectal cancer have made safe and effective options available to older adults, and the rationale to screen for treatable disease more reasonably, especially given the aging Canadian population. In this commentary, we review the current screening guidelines and the evidence upon which they were built, the unique considerations for screening older adults, new treatment options, the risks and benefits of increased screening and potential considerations for the new guidelines.
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Lord AC, Hicks G, Pearce B, Tanno L, Pucher P. Safety and outcomes of laparoscopic cholecystectomy in the extremely elderly: a systematic review and meta-analysis. Acta Chir Belg 2019; 119:349-356. [PMID: 31437407 DOI: 10.1080/00015458.2019.1658356] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Background: Gallstones are a common cause of morbidity in the elderly. Operative treatment is often avoided due to concerns about poor outcomes but the evidence for this is unclear. We aim to consolidate available evidence assessing laparoscopic cholecystectomy outcomes in the extreme elderly (>80s) compared to younger patients. Methods: Studies comparing laparoscopic cholecystectomy in >80s with younger patients were considered. Total complications, mortality, conversion, bile duct injury, and length of stay were compared between the two groups. Results: Twelve studies including 366,522 patients were included. They were of moderate overall quality. The elderly group had more complicated gallbladder disease and also had more co-morbidities and a higher ASA grade. The risk of morbidity was lower in the younger group (RR 0.58 (95% CI 0.58-0.59)) with a slightly lower risk of conversion (RR 0.96 (0.94-0.98)) Length of stay was significantly longer for the elderly patients. Differences in mortality and bile duct injury were non-significant in all but one study. Conclusion: Laparoscopic cholecystectomy is safe and effective in the extreme elderly. Higher complication rates are predominantly related to increased co-morbidities and more complex gallbladder disease. Patients should be carefully selected, and cholecystectomy performed at an earlier stage to minimize these problems.
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Affiliation(s)
- Amy C. Lord
- Department of General Surgery, Croydon University Hospital, London, UK
| | - Georgina Hicks
- Department of General Surgery, Croydon University Hospital, London, UK
| | - Belinda Pearce
- Department of General Surgery, Royal Hampshire Hospital, Winchester, UK
| | - Lulu Tanno
- Department of General Surgery, University Hospital Southampton, Southampton, UK
| | - P.H. Pucher
- Department of Surgery, Portsmouth Hospitals NHS Trust, Portsmouth, UK
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Chesney TR, Quereshy HA, Draginov A, Chadi SA, Quereshy FA. Benefits of minimally-invasive surgery for sigmoid and rectal cancer in older adults compared with younger adults: Do older adults have the most to gain? J Geriatr Oncol 2019; 11:860-865. [PMID: 31706830 DOI: 10.1016/j.jgo.2019.09.018] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2019] [Revised: 08/29/2019] [Accepted: 09/25/2019] [Indexed: 02/07/2023]
Abstract
INTRODUCTION Randomized trials demonstrated oncologic safety and short-term benefits of laparoscopy. We investigated if the benefit of laparoscopy on short-term outcomes is greater for older adults compared with younger adults. METHODS We identified all older (≥70 years old) and younger (<70) adults with primary sigmoid and rectal cancer treated with resection between 2002 and 2018 from an institutional database. We compared 30-day postoperative outcomes using multivariable logistic regression with an interaction term between age group and surgical approach. Primary outcomes were death, major (Clavien-Dindo III-IV) and minor (Clavien-Dindo I-II) complications, and wound complications. RESULTS We included 792 patients, 293 (37%) older and 499 (63%) younger. Use of laparoscopy was similar between age groups: 120/293 (41%) older, 204/499 (41%) younger (p = .98). All patients had 30-day follow-up. Compared with open resection, minimally-invasive resection was associated with a greater reduction in deaths in older adults than in younger adults (absolute difference in older adults 7.0% less versus 2.1% less in younger adults; adjusted odds ratio [aOR] older 3.01, 95% confidence interval [CI] 1.31-7.33; aOR younger 0.31, 95% CI 0.05-1.24; interaction p = .01). Similarly, minimally-invasive resection was associated with a greater reduction in major complications in older adults than in younger adults (absolute difference in older adults 6.4% less versus 2.4% less in younger adults; aOR older 1.91, 95% CI 1.07-3.41; aOR younger 0.70, 95% CI 0.34-1.38; interaction p = .03). CONCLUSIONS Minimally-invasive compared with open surgery demonstrated a differential benefit on postoperative death and major complications between younger and older adults.
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Affiliation(s)
- Tyler R Chesney
- Department of Surgery, University of Toronto, Toronto, Ontario, Canada; Division of General Surgery, University Health Network, Toronto, Ontario, Canada.
| | - Humzah A Quereshy
- Case Western Reserve University School of Medicine, Cleveland, OH, USA
| | - Arman Draginov
- Department of Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Sami A Chadi
- Department of Surgery, University of Toronto, Toronto, Ontario, Canada; Division of General Surgery, University Health Network, Toronto, Ontario, Canada
| | - Fayez A Quereshy
- Department of Surgery, University of Toronto, Toronto, Ontario, Canada; Division of General Surgery, University Health Network, Toronto, Ontario, Canada
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Shin H, Song KB, Kim YI, Lee YJ, Hwang DW, Lee JH, Shin SH, Kwon J, Alshammary S, Park G, Park Y, Lee SJ, Kim SC. Propensity score-matching analysis comparing laparoscopic and open pancreaticoduodenectomy in elderly patients. Sci Rep 2019; 9:12961. [PMID: 31506513 PMCID: PMC6737197 DOI: 10.1038/s41598-019-49455-9] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2018] [Accepted: 08/16/2019] [Indexed: 12/22/2022] Open
Abstract
There is little evidence on the safety and benefits of laparoscopic pancreaticoduodenectomy (LPD) in elderly patients; therefore, we evaluated the feasibility and efficacy of this procedure by comparing perioperative and oncological outcomes between LPD and open pancreaticoduodenectomy (OPD) in elderly patients. We retrospectively reviewed the data of 1,693 patients who underwent PD to manage periampullary tumours at a single institution between January 2014 and June 2017. Of these patients, 326 were elderly patients aged ≥70 years, with 56 patients allocated to the LPD group and 270 to the OPD group. One-to-one propensity score matching (56:56) was used to match the baseline characteristics of patients who underwent LPD and OPD. LPD was associated with significantly fewer clinically significant postoperative pancreatic fistulas (7.1% vs. 21.4%), fewer analgesic injections (10 vs. 15.6 times; p = 0.022), and longer operative time (321.8 vs. 268.5 minutes; p = 0.001) than OPD in elderly patients. There were no significant differences in 3-year overall and disease-free survival rates between the LPD and OPD groups. LPD had acceptable perioperative and oncological outcomes compared with OPD in elderly patients. LPD is a reliable treatment option for elderly patients with periampullary tumours.
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Affiliation(s)
- Heeji Shin
- Division of Hepatobiliary and Pancreatic Surgery, Department of Surgery, University of Ulsan College of Medicine and Asan Medical Center, Seoul, South Korea
| | - Ki Byung Song
- Division of Hepatobiliary and Pancreatic Surgery, Department of Surgery, University of Ulsan College of Medicine and Asan Medical Center, Seoul, South Korea.
| | - Young Il Kim
- Division of Hepatobiliary and Pancreatic Surgery, Department of Surgery, University of Ulsan College of Medicine and Asan Medical Center, Seoul, South Korea
| | - Young-Joo Lee
- Division of Hepatobiliary and Pancreatic Surgery, Department of Surgery, University of Ulsan College of Medicine and Asan Medical Center, Seoul, South Korea
| | - Dae Wook Hwang
- Division of Hepatobiliary and Pancreatic Surgery, Department of Surgery, University of Ulsan College of Medicine and Asan Medical Center, Seoul, South Korea
| | - Jae Hoon Lee
- Division of Hepatobiliary and Pancreatic Surgery, Department of Surgery, University of Ulsan College of Medicine and Asan Medical Center, Seoul, South Korea
| | - Sang Hyun Shin
- Division of Hepatobiliary and Pancreatic Surgery, Department of Surgery, University of Ulsan College of Medicine and Asan Medical Center, Seoul, South Korea
| | - Jaewoo Kwon
- Division of Hepatobiliary and Pancreatic Surgery, Department of Surgery, University of Ulsan College of Medicine and Asan Medical Center, Seoul, South Korea
| | - Shadi Alshammary
- Division of Hepatobiliary and Pancreatic Surgery, Department of Surgery, University of Ulsan College of Medicine and Asan Medical Center, Seoul, South Korea
| | - Guisuk Park
- Division of Hepatobiliary and Pancreatic Surgery, Department of Surgery, University of Ulsan College of Medicine and Asan Medical Center, Seoul, South Korea
| | - Yejong Park
- Division of Hepatobiliary and Pancreatic Surgery, Department of Surgery, University of Ulsan College of Medicine and Asan Medical Center, Seoul, South Korea
| | - Seung Jae Lee
- Division of Hepatobiliary and Pancreatic Surgery, Department of Surgery, University of Ulsan College of Medicine and Asan Medical Center, Seoul, South Korea
| | - Song Cheol Kim
- Division of Hepatobiliary and Pancreatic Surgery, Department of Surgery, University of Ulsan College of Medicine and Asan Medical Center, Seoul, South Korea
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10
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de'Angelis N, Abdalla S, Bianchi G, Memeo R, Charpy C, Petrucciani N, Sobhani I, Brunetti F. Robotic Versus Laparoscopic Colorectal Cancer Surgery in Elderly Patients: A Propensity Score Match Analysis. J Laparoendosc Adv Surg Tech A 2018; 28:1334-1345. [DOI: 10.1089/lap.2018.0115] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Affiliation(s)
- Nicola de'Angelis
- Department of Digestive, Hepato-Pancreato-Biliary Surgery, and Liver Transplantation, Henri Mondor Hospital, AP-HP, Créteil, France
- University of Paris Est, UPEC, Créteil, France
| | - Solafah Abdalla
- Department of Digestive, Hepato-Pancreato-Biliary Surgery, and Liver Transplantation, Henri Mondor Hospital, AP-HP, Créteil, France
- University of Paris Est, UPEC, Créteil, France
| | - Giorgio Bianchi
- Department of Digestive, Hepato-Pancreato-Biliary Surgery, and Liver Transplantation, Henri Mondor Hospital, AP-HP, Créteil, France
- University of Paris Est, UPEC, Créteil, France
| | - Riccardo Memeo
- Chirurgia Generale e Trapianto di Fegato M Rubino, Policlinico di Bari, Bari, Italy
| | - Cecile Charpy
- University of Paris Est, UPEC, Créteil, France
- Department of Pathology, Henri Mondor Hospital, AP-HP, Créteil, France
| | - Niccolo Petrucciani
- Department of Digestive, Hepato-Pancreato-Biliary Surgery, and Liver Transplantation, Henri Mondor Hospital, AP-HP, Créteil, France
- University of Paris Est, UPEC, Créteil, France
| | - Iradj Sobhani
- University of Paris Est, UPEC, Créteil, France
- Department of Gastroenterology, Henri Mondor Hospital, AP-HP, Créteil, France
- EA7375 (EC2M3 Research Team), Université Paris-Est Creteil (UPEC)-Val de Marne, Creteil, France
| | - Francesco Brunetti
- Department of Digestive, Hepato-Pancreato-Biliary Surgery, and Liver Transplantation, Henri Mondor Hospital, AP-HP, Créteil, France
- University of Paris Est, UPEC, Créteil, France
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Grigorian A, Pigazzi A, Nguyen NT, Schubl SD, Joe V, Dolich M, Lekawa M, Nahmias J. Use of laparoscopic colectomy increasing in trauma: comparison of laparoscopic vs. open colectomy. Updates Surg 2018; 71:105-111. [PMID: 30143986 DOI: 10.1007/s13304-018-0588-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2018] [Accepted: 08/21/2018] [Indexed: 12/26/2022]
Abstract
Laparoscopy accounts for > 70% of general surgical cases. Given the increased use of laparoscopy in emergent colorectal disease, we hypothesized that there would be an increased use of laparoscopic colectomy (LC) in trauma patients. In addition, we hypothesized increased length of stay (LOS) and mortality in trauma patients undergoing open colectomy (OC) vs. LC. This was a retrospective analysis using the National Trauma Data Bank (2008-2015). We included adult patients undergoing LC or OC. A multivariable logistic regression model was used for determining risk of LOS and mortality. We identified 19,788 (96.8%) patients undergoing OC and 644 (3.2%) who underwent LC. There was a 21-fold increased number of patients that underwent LC over the study period (p < 0.05), with approximately 119 per 10,000 trauma patients undergoing LC. The most common operation was a laparoscopic right hemicolectomy (27.5%). LC patients had a lower median injury severity score (ISS) (16 vs. 17, p < 0.001). There was no difference in LOS (p = 0.14) or mortality (p = 0.44) between the two groups. This remained true in patients with isolated colorectal injury. The use of LC has increased 21-fold from 2008 to 2015, with laparoscopic right hemicolectomy being the most common procedure performed. There was no difference in LOS, in-hospital complications, or mortality between the two groups. We suggest that LC should be considered in stable adult trauma patients undergoing colectomy. However, future prospective research is needed to help determine which trauma patients may benefit from LC.
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Affiliation(s)
- Areg Grigorian
- Division of Trauma, Burns and Surgical Critical Care, Department of Surgery, Irvine Medical Center, University of California, Irvine, 333 The City Blvd West, Suite 1600, Orange, CA, 92868-3298, USA.
| | - Alessio Pigazzi
- Division of Trauma, Burns and Surgical Critical Care, Department of Surgery, Irvine Medical Center, University of California, Irvine, 333 The City Blvd West, Suite 1600, Orange, CA, 92868-3298, USA
| | - Ninh T Nguyen
- Division of Trauma, Burns and Surgical Critical Care, Department of Surgery, Irvine Medical Center, University of California, Irvine, 333 The City Blvd West, Suite 1600, Orange, CA, 92868-3298, USA
| | - Sebastian D Schubl
- Division of Trauma, Burns and Surgical Critical Care, Department of Surgery, Irvine Medical Center, University of California, Irvine, 333 The City Blvd West, Suite 1600, Orange, CA, 92868-3298, USA
| | - Victor Joe
- Division of Trauma, Burns and Surgical Critical Care, Department of Surgery, Irvine Medical Center, University of California, Irvine, 333 The City Blvd West, Suite 1600, Orange, CA, 92868-3298, USA
| | - Matthew Dolich
- Division of Trauma, Burns and Surgical Critical Care, Department of Surgery, Irvine Medical Center, University of California, Irvine, 333 The City Blvd West, Suite 1600, Orange, CA, 92868-3298, USA
| | - Michael Lekawa
- Division of Trauma, Burns and Surgical Critical Care, Department of Surgery, Irvine Medical Center, University of California, Irvine, 333 The City Blvd West, Suite 1600, Orange, CA, 92868-3298, USA
| | - Jeffry Nahmias
- Division of Trauma, Burns and Surgical Critical Care, Department of Surgery, Irvine Medical Center, University of California, Irvine, 333 The City Blvd West, Suite 1600, Orange, CA, 92868-3298, USA
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12
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Fan CJ, Chien HL, Weiss MJ, He J, Wolfgang CL, Cameron JL, Pawlik TM, Makary MA. Minimally invasive versus open surgery in the Medicare population: a comparison of post-operative and economic outcomes. Surg Endosc 2018; 32:3874-3880. [PMID: 29484556 DOI: 10.1007/s00464-018-6126-z] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2017] [Accepted: 02/23/2018] [Indexed: 12/13/2022]
Abstract
BACKGROUND Despite strong evidence demonstrating the clinical and economic benefits of minimally invasive surgery (MIS), utilization of MIS in the Medicare population is highly variable and tends to be lower than in the general population. We sought to compare the post-operative and economic outcomes of MIS versus open surgery for seven common surgical procedures in the Medicare population. METHODS Using the 2014 Medicare Provider Analysis and Review Inpatient Limited Data Set, patients undergoing bariatric, cholecystectomy, colectomy, hysterectomy, inguinal hernia, thoracic, and ventral hernia procedures were identified using DRG and ICD-9 codes. Adjusting for patient demographics and comorbidities, the odds of complication and all-cause 30-day re-admission were compared among patients undergoing MIS versus open surgery stratified by operation type. A generalized linear model was used to calculate the estimated difference in length of stay (LOS), Medicare claim cost, and Medicare reimbursement. RESULTS Among 233,984 patients, 102,729 patients underwent an open procedure versus 131,255 who underwent an MIS procedure. The incidence of complication after MIS was lower for 5 out of the 7 procedures examined (OR 0.36-0.69). Re-admission was lower for MIS for 6 out of 7 procedures (OR 0.43-0.87). MIS was associated with shorter LOS for 6 procedures (point estimate range 0.35-2.47 days shorter). Medicare claim costs for MIS were lower for 4 (range $3010.23-$4832.74 less per procedure) and Medicare reimbursements were lower for 3 (range $841.10-$939.69 less per procedure). CONCLUSIONS MIS benefited Medicare patients undergoing a range of surgical procedures. MIS was associated with fewer complications and re-admissions as well as shorter LOS and lower Medicare costs and reimbursements versus open surgery. MIS may represent a better quality and cost proposition in the Medicare population.
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Affiliation(s)
- Caleb J Fan
- Department of Otolaryngology, Head and Neck Surgery, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
| | - Hung-Lun Chien
- Minimally Invasive Therapies Group, Medtronic Inc., Mansfield, MA, USA
| | - Matthew J Weiss
- Department of Surgery, The Johns Hopkins University, Baltimore, MD, USA
| | - Jin He
- Department of Surgery, The Johns Hopkins University, Baltimore, MD, USA
| | | | - John L Cameron
- Department of Surgery, The Johns Hopkins University, Baltimore, MD, USA
| | - Timothy M Pawlik
- Department of Surgery, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Martin A Makary
- Department of Surgery, The Johns Hopkins University, Baltimore, MD, USA
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13
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Qi X, Hu Y, Liu H, Yu J, Li G. Reply to L. Zong et al. J Clin Oncol 2016; 34:3706-3707. [PMID: 27507881 DOI: 10.1200/jco.2016.68.9315] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- Xiaolong Qi
- Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Yanfeng Hu
- Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Hao Liu
- Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Jiang Yu
- Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Guoxin Li
- Nanfang Hospital, Southern Medical University, Guangzhou, China
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14
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Serban D, Branescu C, Savlovschi C, Purcărea AP, El-Khatib A, Balasescu SA, Nica A, Dascalu AM, Vancea G, Oprescu SM, Tudor C. Laparoscopic cholecystectomy in patients aged 60 years and over - our experience. J Med Life 2016; 9:358-362. [PMID: 27928438 PMCID: PMC5141394] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Aim. To analyze the efficiency of laparoscopic cholecystectomy for the population aged 60 years and over admitted with acute cholecystitis, the clinical features and associated pathology presented by these patients and the impact of these factors on the choice of surgical technique. Materials and method. A retrospective study was carried out between February 2010 and February 2015, on patients aged 60 years and over, operated in emergency for acute cholecystitis in our clinic. All data were extracted from the registered medical documents and operatory protocols. Results. A total of 497 surgeries were performed for acute cholecystitis, of which 149 were patients aged 60 years and over (30%). Open surgery is much better represented in the population aged over 60 years (61.75% vs. 29.98%). One major cause is the associated pathology that increases the anesthetic risk and hampers a laparoscopic procedure. The conversion rate in the study group presented a higher percentage, but not more exaggerated than in the general population (6.71% vs. 4.63 %).Patients who underwent laparoscopic surgery had a faster recovery and required lower doses and shorter term pain medication, in contrast to conventional surgery (1,8 days vs. 5.7 days). Bile leak has been of reduced quantity, short-term and stopped spontaneously. Only one case needed reintervention, in which aberrant bile ducts that were clipped were found in the gallbladder bed, was operated by laparoscopy. Wound infections and swelling were also encountered more frequently in patients that underwent classic surgery (3.24%). Conclusions. Performing laparoscopic cholecystectomy, when possible, has produced very good results, reducing the average length of stay of patients and even decreasing the number of postoperative complications, thus allowing a faster reintegration of patients into society. The main concern was related to the associated pathology that increased the anesthetic risk.
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Affiliation(s)
- D Serban
- Carol Davila” University of Medicine and Pharmacy, Bucharest, Romania
| | - C Branescu
- Upper Digestive Surgery Clinic, Emergency University Hospital, Bucharest, Romania
| | - C Savlovschi
- Carol Davila” University of Medicine and Pharmacy, Bucharest, Romania
| | - AP Purcărea
- Carol Davila” University of Medicine and Pharmacy, Bucharest, Romania
| | - A El-Khatib
- Upper Digestive Surgery Clinic, Emergency University Hospital, Bucharest, Romania
| | - SA Balasescu
- Upper Digestive Surgery Clinic, Emergency University Hospital, Bucharest, Romania
| | - A Nica
- Carol Davila” University of Medicine and Pharmacy, Bucharest, Romania
| | - AM Dascalu
- Carol Davila” University of Medicine and Pharmacy, Bucharest, Romania
| | - G Vancea
- Carol Davila” University of Medicine and Pharmacy, Bucharest, Romania
| | - SM Oprescu
- Carol Davila” University of Medicine and Pharmacy, Bucharest, Romania
| | - C Tudor
- Upper Digestive Surgery Clinic, Emergency University Hospital, Bucharest, Romania
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