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Alvarado J, Besser N, Mohan H, Heriot A, Warrier S, Larach JT. Complete mesocolic excision and central vascular ligation for transverse colon cancer: intraoperative quality landmarks following resection. ANZ J Surg 2024; 94:757-758. [PMID: 38149756 DOI: 10.1111/ans.18842] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2023] [Revised: 12/06/2023] [Accepted: 12/07/2023] [Indexed: 12/28/2023]
Affiliation(s)
- Juan Alvarado
- Department of Digestive Surgery, Pontificia Universidad Catolica de Chile, Santiago, Chile
| | - Nicolás Besser
- Department of Digestive Surgery, Pontificia Universidad Catolica de Chile, Santiago, Chile
| | - Helen Mohan
- Colorectal Surgery, Austin Health, Heidelberg, Victoria, Australia
| | - Alexander Heriot
- Division of Cancer Surgery, Peter MacCallum Cancer Centre, East Melbourne, Victoria, Australia
| | - Satish Warrier
- Division of Cancer Surgery, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
| | - José Tomás Larach
- Department of Digestive Surgery, Pontificia Universidad Catolica de Chile, Santiago, Chile
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2
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Alvarado J, Montero I, Besser N, Vela J, Bellolio F, Larach JT. Laparoscopic extended right colectomy with complete mesocolic excision for transverse colon cancer is feasible in the setting of vascular anatomical variations - A video vignette. Colorectal Dis 2024; 26:804-805. [PMID: 38348942 DOI: 10.1111/codi.16874] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2023] [Accepted: 12/30/2023] [Indexed: 05/02/2024]
Affiliation(s)
- Juan Alvarado
- Department of Digestive Surgery, Faculty of Medicine, Pontifical Catholic University of Chile, Santiago, Chile
| | - Isabella Montero
- Department of Digestive Surgery, Faculty of Medicine, Pontifical Catholic University of Chile, Santiago, Chile
| | - Nicolás Besser
- Department of Digestive Surgery, Faculty of Medicine, Pontifical Catholic University of Chile, Santiago, Chile
| | - Javier Vela
- Department of Digestive Surgery, Faculty of Medicine, Pontifical Catholic University of Chile, Santiago, Chile
| | - Felipe Bellolio
- Department of Digestive Surgery, Faculty of Medicine, Pontifical Catholic University of Chile, Santiago, Chile
| | - José Tomás Larach
- Department of Digestive Surgery, Faculty of Medicine, Pontifical Catholic University of Chile, Santiago, Chile
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Anania G, Campagnaro A, Chiozza M, Randolph J, Resta G, Marino S, Pedon S, Agrusa A, Cuccurullo D, Cirocchi R. A SICE (Società Italiana di Chirurgia Endoscopica e Nuove Tecnologie) observational prospective multicenter study on anatomical variants of the superior mesenteric artery: intraoperative analysis during laparoscopic right hemicolectomy-CoDIG 2 database (ColonDx Italian Group). Updates Surg 2024:10.1007/s13304-024-01787-6. [PMID: 38526696 DOI: 10.1007/s13304-024-01787-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2023] [Accepted: 02/12/2024] [Indexed: 03/27/2024]
Abstract
Colorectal cancer, the third most common cancer worldwide, affects 40-45% of patients on the right side. Surgery, especially minimally invasive methods such as laparoscopic and robotic procedures, is the preferred treatment. However, these techniques present technical complications. The anatomical complexity and variations in vessel branching patterns pose challenges, particularly for less experienced surgeons. The CoDIG 2 is a nationwide observational study involving 76 specialized Italian general surgery departments focused on colorectal surgery. The centres were directed to maintain their standard surgical and clinical practices. The aim of this study was to analyse the intraoperative vascular anatomy of Italian patients who underwent laparoscopic right colectomy and explore the ligature techniques used by Italian surgeons. Surgeons reported information about vascularization of the right colon for 616 patients and about surgical anatomy of RCA for 368 patients. Fifty-three patients (10.8%) showed no RCA intraoperatively. The right colic artery (RCA) was categorized according to the Yada classification (types 1-4) during evaluation, and intraoperative assessments revealed that Yada type 1 was the most common type (55.2%), while radiologic evaluations revealed a higher prevalence of type 2. Furthermore, compared with the superior mesenteric vein (SMV), the RCA is more often located anteriorly according to intraoperative and contrast-enhanced CT examination; 59.9% were found in the anterior position during intraoperative examination, while 40.1% were found in the same position on preoperative contrast-enhanced CT. Vascularization of the right colon, including missing branches, additional branches, shared trunks, and retro-superior courses of the mesenteric vein, exhibited notable variations. To understand vascular variations, a preoperative radiological study is necessary; although there was no concordance between the intraoperative and radiological evaluations, this is a limitation of preinterventional radiological evaluation (PII) because it is always needed for oncological staging. This approach is especially critical for inexperienced surgeons to avoid potential complications, such as problematic bleeding.
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Affiliation(s)
- G Anania
- Unit of General Surgery, S. Anna University Hospital of Ferrara, Via Aldo Moro 8, Cona, FE, Italy
- Department of Medical Science, University of Ferrara, Via Fossato di Mortara 64/B, 44121, Ferrara, FE, Italy
| | - A Campagnaro
- Unit of General Surgery, S. Anna University Hospital of Ferrara, Via Aldo Moro 8, Cona, FE, Italy.
- Department of Medical Science, University of Ferrara, Via Fossato di Mortara 64/B, 44121, Ferrara, FE, Italy.
| | - M Chiozza
- Unit of General Surgery, S. Anna University Hospital of Ferrara, Via Aldo Moro 8, Cona, FE, Italy
- Department of Medical Science, University of Ferrara, Via Fossato di Mortara 64/B, 44121, Ferrara, FE, Italy
| | - J Randolph
- Georgia Baptist College of Nursing, Mercer University, Atlanta, GA, 30341, USA
| | - G Resta
- Unit of General Surgery, S. Anna University Hospital of Ferrara, Via Aldo Moro 8, Cona, FE, Italy
| | - S Marino
- Unit of General Surgery, S. Anna University Hospital of Ferrara, Via Aldo Moro 8, Cona, FE, Italy
| | - S Pedon
- Unit of General Surgery, S. Anna University Hospital of Ferrara, Via Aldo Moro 8, Cona, FE, Italy
- Department of Medical Science, University of Ferrara, Via Fossato di Mortara 64/B, 44121, Ferrara, FE, Italy
| | - A Agrusa
- Department of Surgical, Oncological and Oral Sciences, University of Palermo, Palermo, PA, Italy
| | - D Cuccurullo
- Division of Laparoscopic and Robotic Surgery Unit, A.O.R.N. Colli Monaldi Hospital, Napoli, NA, Italy
| | - R Cirocchi
- Department of Medicine and Surgery, University of Perugia, Piazza Università 1, 06123, Perugia, PG, Italy
- Division of Digestive and Emergency Surgery, Santa Maria Hospital, Via Tristano di Joannuccio 05100, Terni, TR, Italy
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4
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Blackburn KW, Cooper LE, Bafford AC, Hu Y, Brown RF. Using risk-adjusted cumulative sum to evaluate surgeon, divisional, and institutional outcomes-a feasibility study. Surgery 2024:S0039-6060(24)00060-6. [PMID: 38523020 DOI: 10.1016/j.surg.2024.01.033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2023] [Revised: 12/07/2023] [Accepted: 01/24/2024] [Indexed: 03/26/2024]
Abstract
BACKGROUND Few objective, real-time measurements of surgeon performance exist. The risk-adjusted cumulative sum is a novel method that can track surgeon-level outcomes on a continuous basis. The objective of this study was to demonstrate the feasibility of using risk-adjusted cumulative sum to monitor outcomes after colorectal operations and identify clinically relevant performance variations. METHODS The National Surgical Quality Improvement Program was queried to obtain patient-level data for 1,603 colorectal operations at a high-volume center from 2011 to 2020. For each case, expected risks of morbidity, mortality, reoperation, readmission, and prolonged length of stay were estimated using the National Surgical Quality Improvement Program risk calculator. Risk-adjusted cumulative sum curves were generated to signal observed-to-expected odds ratios of 1.5 (poor performance) and 0.5 (exceptional performance). Control limits were set based on a false positive rate of 5% (α = 0.05). RESULTS The cohort included data on 7 surgeons (those with more than 20 cases in the study period). Institutional observed versus expected outcomes were the following: morbidity 12.5% (vs 15.0%), mortality 2.5% (vs 2.0%), prolonged length of stay 19.7% (vs 19.1%), reoperation 11.1% (vs 11.3%), and 30-day readmission 6.1% (vs 4.8%). Risk-adjusted cumulative sum accurately demonstrated within- and between-surgeon performance variations across these metrics and proved effective when considering division-level data. CONCLUSION Risk-adjusted cumulative sum adjusts for patient-level risk factors to provide real-time data on surgeon-specific outcomes. This approach enables prompt identification of performance outliers and can contribute to quality assurance, root-cause analysis, and incentivization not only at the surgeon level but at divisional and institutional levels as well.
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Affiliation(s)
- Kyle W Blackburn
- School of Medicine, Baylor College of Medicine, Waco, TX. https://twitter.com/KyleWBlackburn
| | - Laura E Cooper
- Department of Surgery, University of Maryland School of Medicine, Baltimore, MD
| | | | - Yinin Hu
- Department of Surgery, University of Maryland School of Medicine, Baltimore, MD
| | - Rebecca F Brown
- Department of Surgery, University of Maryland School of Medicine, Baltimore, MD.
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5
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Brown KGM, Ng KS, Solomon MJ, Chapuis PH, Koh CE, Ahmadi N, Austin KKS. Complete mesocolic excision for colon cancer: current status and controversies. ANZ J Surg 2024; 94:309-319. [PMID: 37850417 DOI: 10.1111/ans.18741] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2023] [Revised: 10/04/2023] [Accepted: 10/05/2023] [Indexed: 10/19/2023]
Abstract
According to Hohenberger's original description, complete mesocolic excision for colon cancer involves precise dissection of the avascular embryonic plane between the parietal retroperitoneum and visceral peritoneum of the mesocolon. This ensures mesocolic integrity, access to high ligation of the supplying vessels at their origin and an associated extended lymphadenectomy. Results from centres which have adopted this approach routinely have demonstrated that oncological outcomes can be improved by the rigorous implementation of established principles of cancer surgery. Meticulous anatomical dissection along embryonic planes is a well-established principle of precision cancer surgery used routinely by the specialist colorectal surgeon. Therefore, the real question concerns the need for true central vascular ligation and associated extended (D3) lymphadenectomy or otherwise, particularly along the superior mesenteric vessels when performing a right colectomy. Whether this approach results in improved overall or disease-free survival remains unclear and its role remains controversial particularly given the potential for significant morbidity associated with a more extensive central vascular dissection. Current literature is limited by considerable bias, as well as inconsistent and variable terminology, and the results of established randomized trials are awaited. As a result of the current state of equipoise, various national guidelines have disparate recommendations as to when complete mesocolic excision should be performed if at all. This article aims to review the rationale for and technical aspects of complete mesocolic excision, summarize available short and long term outcome data and address current controversies.
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Affiliation(s)
- Kilian G M Brown
- Department of Colorectal Surgery, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia
- Surgical Outcomes Research Centre (SOuRCe), Sydney, New South Wales, Australia
- The Institute of Academic Surgery at RPA, Sydney Local Health District, Sydney, New South Wales, Australia
- Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Kheng-Seong Ng
- Department of Colorectal Surgery, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia
- Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
- Department of Colorectal Surgery, Concord Repatriation General Hospital, Sydney, New South Wales, Australia
| | - Michael J Solomon
- Department of Colorectal Surgery, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia
- Surgical Outcomes Research Centre (SOuRCe), Sydney, New South Wales, Australia
- The Institute of Academic Surgery at RPA, Sydney Local Health District, Sydney, New South Wales, Australia
- Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Pierre H Chapuis
- Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
- Department of Colorectal Surgery, Concord Repatriation General Hospital, Sydney, New South Wales, Australia
| | - Cherry E Koh
- Department of Colorectal Surgery, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia
- Surgical Outcomes Research Centre (SOuRCe), Sydney, New South Wales, Australia
- The Institute of Academic Surgery at RPA, Sydney Local Health District, Sydney, New South Wales, Australia
- Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Nima Ahmadi
- Department of Colorectal Surgery, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia
- Surgical Outcomes Research Centre (SOuRCe), Sydney, New South Wales, Australia
| | - Kirk K S Austin
- Department of Colorectal Surgery, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia
- Surgical Outcomes Research Centre (SOuRCe), Sydney, New South Wales, Australia
- The Institute of Academic Surgery at RPA, Sydney Local Health District, Sydney, New South Wales, Australia
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6
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Gupta A, Garabetian C, Cologne K, Duldulao MP. Complete mesocolic excision and extended lymphadenectomy: Where should we stand? J Surg Oncol 2024; 129:338-348. [PMID: 37811555 DOI: 10.1002/jso.27475] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2023] [Revised: 09/10/2023] [Accepted: 09/23/2023] [Indexed: 10/10/2023]
Abstract
Debate regarding the risks and merits of complete mesocolic excision and extended lymphadenectomy is ongoing, particularly for right-sided colon cancers. In this article, we hope to provide a succinct yet encompassing review of the relevant literature. We posit that complete mesocolic excision with D3 dissection is indicated in select patients with colon cancers, particularly those distal to the cecum.
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Affiliation(s)
- Abhinav Gupta
- Department of Surgery, Keck School of Medicine, University of Southern California, Los Angeles, California, USA
| | - Christine Garabetian
- Department of Internal Medicine, Prime West Consortium, West Anaheim Medical Center, Anaheim, California, USA
| | - Kyle Cologne
- Department of Surgery, Keck School of Medicine, University of Southern California, Los Angeles, California, USA
| | - Marjun Philip Duldulao
- Department of Surgery, Keck School of Medicine, University of Southern California, Los Angeles, California, USA
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Yeganeh A, Johannssen A, Chukhrova N, Erfanian M, Azarpazhooh MR, Morovatdar N. A monitoring framework for health care processes using Generalized Additive Models and Auto-Encoders. Artif Intell Med 2023; 146:102689. [PMID: 38042610 DOI: 10.1016/j.artmed.2023.102689] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2023] [Revised: 10/11/2023] [Accepted: 10/13/2023] [Indexed: 12/04/2023]
Abstract
In recent years, there has been a considerable focus on developing effective methods for monitoring health care processes. Utilizing Statistical Process Monitoring (SPM) approaches, particularly risk-adjusted control charts, has emerged as a highly promising approach for achieving robust frameworks for this aim. Considering risk-adjusted control charts, longitudinal health care process data is typically monitored by establishing a regression relationship between various risk factors (explanatory variables) and patient outcomes (response variables). While the majority of prior research has primarily employed logistic models in risk-adjusted control charts, there are more intricate health care processes that necessitate the incorporation of both parametric and nonparametric risk factors. In such scenarios, the Generalized Additive Model (GAM) proves to be a suitable choice, albeit it often introduces higher computational complexity and associated challenges. Surprisingly, there are limited instances where researchers have proposed advancements in this direction. The primary objective of this paper is to introduce an SPM framework for monitoring health care processes using a GAM over time, coupled with a novel risk-adjusted control chart driven by machine learning techniques. This control chart is implemented on a data set encompassing two stroke types: ischemic and hemorrhagic. The key focus of this study is to monitor the stability of the relationship between stroke types and predefined explanatory variables over time within this data set. Extensive simulation results, based on real data from patients with acute stroke, demonstrate the remarkable flexibility of the proposed method in terms of its detection capabilities compared to conventional approaches.
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Affiliation(s)
- Ali Yeganeh
- University of Hamburg, 20146 Hamburg, Germany.
| | | | | | - Mahdiyeh Erfanian
- Department of Statistics, Ferdowsi University of Mashhad, Mashhad, Iran.
| | - Mahmoud Reza Azarpazhooh
- Department of Neurology, Ghaem Hospital, Mashhad University of Medical Sciences (MUMS), Mashhad, Iran; Department of Clinical Neurological Sciences, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada.
| | - Negar Morovatdar
- Clinical Research Development Unit, Imam Reza Hospital, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran.
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Lombardi PM, Mazzola M, Veronesi V, Granieri S, Cioffi SPB, Baia M, Del Prete L, Bernasconi DP, Danelli P, Ferrari G. Learning curve of laparoscopic cholecystectomy: a risk-adjusted cumulative summation (RA-CUSUM) analysis of six general surgery residents. Surg Endosc 2023; 37:8133-8143. [PMID: 37684403 DOI: 10.1007/s00464-023-10345-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2023] [Accepted: 07/30/2023] [Indexed: 09/10/2023]
Abstract
BACKGROUND Laparoscopic cholecystectomy (LapC) is one of the most frequently performed surgical procedures worldwide. Reaching technical competency in performing LapC is considered one essential task for young surgeons. Investigating the learning curve for LapC (LC-LapC) may provide important information regarding the learning process and guide the training pathway of residents, improving educational outcomes. The present study aimed to investigate LC-LapC among general surgery residents (GSRs). METHODS Operative surgical reports of consecutive patients undergoing LapC performed by GSRs attending the General Surgery Residency Program at the University of Milan were analysed. Data on patient- and surgery-related variables were obtained from the ICD-9-CM diagnosis codes and gathered. A multidimensional assessment of the LC was performed through Cumulative Sum (CUSUM) and Risk-Adjusted (RA)-CUSUM analysis. RESULTS 340 patients operated by 6 GSRs were collected. The CUSUM and RA-CUSUM graphs based on surgical failures allowed to distinguish two defined phases for all GSRs: an initial phase ending at the peak, so-called learning phase, followed by a phase in which there was a significant decrease in failure incidence, so-called proficiency phase. The learning phase was completed for all GSRs at most within 25 procedures, but the trend of the curves and the number of procedures needed to achieve technical competency varied among operators ranging between 7 and 25. CONCLUSIONS The present study suggested that at most 25 procedures might be sufficient to acquire technical competency in LapC. The variability in the number of procedures needed to complete the LC, ranging between 7 and 25, could be due to the heterogeneous scenarios in which LapC was performed, and deserves to be investigated through a prospective study involving a larger number of GSRs and institutions.
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Affiliation(s)
- Pietro Maria Lombardi
- Division of Minimally-Invasive Surgical Oncology, Niguarda Cancer Center, ASST Grande Ospedale Metropolitano Niguarda, Piazza Ospedale Maggiore 3, 20162, Milan, Italy.
| | - Michele Mazzola
- Division of Minimally-Invasive Surgical Oncology, Niguarda Cancer Center, ASST Grande Ospedale Metropolitano Niguarda, Piazza Ospedale Maggiore 3, 20162, Milan, Italy
| | - Valentina Veronesi
- Bicocca Bioinformatics Biostatistics and Bioimaging Center - B4, School of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy
| | - Stefano Granieri
- General Surgery Unit, ASST-Brianza, Vimercate Hospital, Via Santi Cosma e Damiano 10, 20871, Vimercate, Italy
| | - Stefano Piero Bernardo Cioffi
- General Surgery and Trauma Team, ASST Niguarda, Piazza Ospedale Maggiore 3, 20162, Milan, Italy
- Department of Surgical Sciences, Sapienza University, Rome, Italy
| | - Marco Baia
- Sarcoma Service, Department of Surgery, IRCCS Fondazione Istituto Nazionale dei Tumori di Milano, Milan, Italy
| | - Luca Del Prete
- IRCCS Fondazione Cà Granda Ospedale Maggiore Policlinico di Milan - General Surgery and Transplant Unit, Milan, Italy
- University of Milan - Translational Medicine PhD Program, Milan, Italy
| | - Davide Paolo Bernasconi
- Bicocca Bioinformatics Biostatistics and Bioimaging Center - B4, School of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy
- Functional Department for Higher Education, Research, and Development, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Piergiorgio Danelli
- Department of Biomedical and Clinical Sciences, "Luigi Sacco" Hospital, University of Milan, Via Giovanni Battista Grassi 74, 20157, Milan, Italy
| | - Giovanni Ferrari
- Division of Minimally-Invasive Surgical Oncology, Niguarda Cancer Center, ASST Grande Ospedale Metropolitano Niguarda, Piazza Ospedale Maggiore 3, 20162, Milan, Italy
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Mazzola M, Ripamonti L, Giani A, Carnevali P, Origi M, Alampi B, Giusti I, Achilli P, Bertoglio CL, Magistro C, Ferrari G. Should Laparoscopic Complete Mesocolic Excision Be Offered to Elderly Patients to Treat Right-Sided Colon Cancer? Curr Oncol 2023; 30:4979-4989. [PMID: 37232834 DOI: 10.3390/curroncol30050376] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2023] [Revised: 05/06/2023] [Accepted: 05/09/2023] [Indexed: 05/27/2023] Open
Abstract
BACKGROUND Despite its potential oncologic benefit, complete mesocolic excision (CME) has rarely been offered to elderly patients. The present study evaluated the effect of age on postoperative outcomes among patients undergoing laparoscopic right colectomies with CME for right-sided colon cancer (RCC). METHODS Data of patients undergoing laparoscopic right colectomies with CME for RCC between 2015 and 2018 were retrospectively analyzed. Selected patients were divided into two groups: the under-80 group and the over-80 group. Surgical, pathological, and oncological outcomes among the groups were compared. RESULTS A total of 130 patients were selected (95 in the under-80 group and 35 in the over-80 group). No difference was found between the groups in terms of postoperative outcomes, except for median length of stay and adjuvant chemotherapy received, which were in favor of the under-80 group (5 vs. 8 days, p < 0.001 and 26.3% vs. 2.9%, p = 0.003, respectively). No difference between the groups was found regarding overall survival and disease free survival. Using multivariate analysis, only the ASA score > 2 (p = 0.01) was an independent predictor of overall complications. CONCLUSIONS laparoscopic right colectomy with CME for RCC was safely performed in elderly patients ensuring similar oncological outcomes compared to younger patients.
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Affiliation(s)
- Michele Mazzola
- Division of Minimally-Invasive Surgical Oncology, ASST Grande Ospedale Metropolitano Niguarda, 20162 Milano, Italy
| | - Lorenzo Ripamonti
- Department of General Surgery, IRCCS san Gerardo dei Tintori, 20900 Monza, Italy
| | - Alessandro Giani
- Division of Minimally-Invasive Surgical Oncology, ASST Grande Ospedale Metropolitano Niguarda, 20162 Milano, Italy
| | - Pietro Carnevali
- Division of Minimally-Invasive Surgical Oncology, ASST Grande Ospedale Metropolitano Niguarda, 20162 Milano, Italy
| | - Matteo Origi
- Division of Minimally-Invasive Surgical Oncology, ASST Grande Ospedale Metropolitano Niguarda, 20162 Milano, Italy
| | - BrunocDomenico Alampi
- Division of Minimally-Invasive Surgical Oncology, ASST Grande Ospedale Metropolitano Niguarda, 20162 Milano, Italy
| | - Irene Giusti
- Division of Minimally-Invasive Surgical Oncology, ASST Grande Ospedale Metropolitano Niguarda, 20162 Milano, Italy
| | - Pietro Achilli
- Division of Minimally-Invasive Surgical Oncology, ASST Grande Ospedale Metropolitano Niguarda, 20162 Milano, Italy
| | | | - Carmelo Magistro
- Division of General Surgery, ASST Melegnano e Martesana, Hospital of Vizzolo Predabissi, 20070 Vizzolo Predabissi, Italy
| | - Giovanni Ferrari
- Division of Minimally-Invasive Surgical Oncology, ASST Grande Ospedale Metropolitano Niguarda, 20162 Milano, Italy
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10
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Yi X, Liao W, Zhu B, Feng X, Li H, Chen C, Ouyang M, Diao D. "Caudal to cranial" versus "medial to lateral" approach in laparoscopic right hemicolectomy with complete mesocolic excision for the treatment of stage II and III colon cancer: perioperative outcomes and 5-year prognosis. Updates Surg 2023:10.1007/s13304-023-01514-7. [PMID: 37178402 DOI: 10.1007/s13304-023-01514-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2023] [Accepted: 04/17/2023] [Indexed: 05/15/2023]
Abstract
The purpose of this study was to compare the "caudal to cranial" (CC) versus "medial to lateral" (ML) approach for laparoscopic right hemicolectomy. Pertinent data from all patients with stage II and III between January 2015 and August 2017 were entered into a retrospective database. A total of 175 patients underwent the ML (N = 109) or CC approach (N = 66). Patient characteristics were equivalent between groups. The CC group showed a shorter surgical time 170.00 (145.00, 210.00) vs. (206.50 (178.75, 226.25) min) than the ML group (p < 0.001). The time to oral intake was shorter in the CC group than in the ML group ((3.00 (1.00, 4.00) vs. 3.00 (2.00, 5.00) days; p = 0.007). For the total harvested lymph nodes, there was no statistical significance between the CC group 16.50 (14.00, 21.25) and the ML group 18.00 (15.00, 22.00) (p = 0.327), and no difference was found in the positive harvested lymph nodes (0 (0, 2.00) vs. 0 (0, 1.50); p = 0.753). Meanwhile, no differences were found in other perioperative or pathological outcomes, including blood loss and complications. For 5-year prognosis, overall survival rates were 75.76% in the CC group and 82.57% in the ML group (HR 0.654, 95% CI 0.336-1.273, p = 0.207); disease-free survival rates were 80.30% in the CC group and 85.32% in the ML group (HR 0.683, 95% CI 0.328-1.422, p = 0.305). Both approaches were safe and feasible and resulted in excellent survival. The CC approach was beneficial in terms of the surgical time and time to oral intake.
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Affiliation(s)
- Xiaojiang Yi
- The Second School of Clinical Medicine, Southern Medical University, Guangzhou, 510080, Guangdong Province, China
- Department of Gastrointestinal Surgery, Shunde Hospital, Southern Medical University (The First People's Hospital of Shunde Foshan), Shunde, Foshan, 528300, Guangdong Province, China
- Department of Colorectal (Tumor) Surgery, Guangdong Provincial Hospital of Chinese Medicine, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, 510120, China
| | - Weilin Liao
- Department of Colorectal (Tumor) Surgery, Guangdong Provincial Hospital of Chinese Medicine, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, 510120, China
| | - Bosen Zhu
- Department of Gastroenteroanal Surgery, The Second Affiliated Hospital of Guangdong Medical University, Zhanjiang, 524002, China
| | - Xiaochuang Feng
- Department of Colorectal (Tumor) Surgery, Guangdong Provincial Hospital of Chinese Medicine, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, 510120, China
| | - Hongming Li
- Department of Colorectal (Tumor) Surgery, Guangdong Provincial Hospital of Chinese Medicine, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, 510120, China
| | - Chuangqi Chen
- Department of Colorectal Surgery, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, 510000, China
| | - Manzhao Ouyang
- The Second School of Clinical Medicine, Southern Medical University, Guangzhou, 510080, Guangdong Province, China.
- Department of Gastrointestinal Surgery, Shunde Hospital, Southern Medical University (The First People's Hospital of Shunde Foshan), Shunde, Foshan, 528300, Guangdong Province, China.
| | - Dechang Diao
- Department of Colorectal (Tumor) Surgery, Guangdong Provincial Hospital of Chinese Medicine, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, 510120, China.
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Mazzola M, Giani A, Veronesi V, Bernasconi DP, Benedetti A, Magistro C, Bertoglio CL, De Martini P, Ferrari G. Multidimensional evaluation of the learning curve for totally laparoscopic pancreaticoduodenectomy: a risk-adjusted cumulative summation analysis. HPB (Oxford) 2023; 25:507-517. [PMID: 36872109 DOI: 10.1016/j.hpb.2023.02.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2022] [Revised: 02/03/2023] [Accepted: 02/10/2023] [Indexed: 03/07/2023]
Abstract
INTRODUCTION Laparoscopic pancreaticoduodenectomy (LPD) is a challenging procedure. We investigated the learning curve (LC) for LPD with a multidimensional analysis. METHODS Data of patients undergoing LPD between 2017 and 2021, operated by a single surgeon, were considered. A multidimensional assessment of the LC was performed through Cumulative Sum (CUSUM) and Risk-Adjusted (RA)-CUSUM analysis. RESULTS 113 patients were selected. Rates of conversion, overall postoperative complication, severe complication and mortality were 4%, 53%, 29% and 4%, respectively. RA-CUSUM analysis showed a LC with three phases: competency (procedures 1-51), proficiency (procedures 52-94), and mastery (after procedure 94). Operative time was lower in both phase two (588.17 vs 541.13 min, p = 0.001) and three (534.72 vs 541.13 min, p = 0.004) with respect to phase one. Severe complication rate was lower in mastery as compared to competency phase (42% vs 6%, p = 0.005). During mastery phase a greater number of lymph nodes was harvested in comparison to proficiency phase. CONCLUSIONS According to our LC analysis, 52 procedures were required to achieve technical competency in LPD. Mastery, which corresponded to a reduction in operative time and surgical failures, was acquired after 94 procedures.
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Affiliation(s)
- Michele Mazzola
- ASST Grande Ospedale Metropolitano Niguarda, Division of Minimally-invasive Surgical Oncology, Piazza Ospedale Maggiore, 3 20162, Milan, Italy.
| | - Alessandro Giani
- ASST Grande Ospedale Metropolitano Niguarda, Division of Minimally-invasive Surgical Oncology, Piazza Ospedale Maggiore, 3 20162, Milan, Italy
| | - Valentina Veronesi
- Bicocca Bioinformatics Biostatistics and Bioimaging Centre - B4, School of Medicine and Surgery, University of Milan - Bicocca, Monza, Italy
| | - Davide P Bernasconi
- Bicocca Bioinformatics Biostatistics and Bioimaging Centre - B4, School of Medicine and Surgery, University of Milan - Bicocca, Monza, Italy; ASST Grande Ospedale Metropolitano Niguarda, Department of Advanced Training Research and Development, Piazza Ospedale Maggiore, 3 20162, Milan, Italy
| | - Antonio Benedetti
- ASST Grande Ospedale Metropolitano Niguarda, Division of Minimally-invasive Surgical Oncology, Piazza Ospedale Maggiore, 3 20162, Milan, Italy
| | - Carmelo Magistro
- ASST Grande Ospedale Metropolitano Niguarda, Division of Minimally-invasive Surgical Oncology, Piazza Ospedale Maggiore, 3 20162, Milan, Italy
| | - Camillo L Bertoglio
- ASST Grande Ospedale Metropolitano Niguarda, Division of Minimally-invasive Surgical Oncology, Piazza Ospedale Maggiore, 3 20162, Milan, Italy
| | - Paolo De Martini
- ASST Grande Ospedale Metropolitano Niguarda, Division of Minimally-invasive Surgical Oncology, Piazza Ospedale Maggiore, 3 20162, Milan, Italy
| | - Giovanni Ferrari
- ASST Grande Ospedale Metropolitano Niguarda, Division of Minimally-invasive Surgical Oncology, Piazza Ospedale Maggiore, 3 20162, Milan, Italy
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KOÇ MA. Sağ kolon tümörlerinde laparoskopik komplet mezokolik eksizyon ve santral vasküler ligasyon öğrenme eğrisi için kümülatif toplam analizi. Cukurova Med J 2022. [DOI: 10.17826/cumj.1162953] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
Amaç: Her prosedürün, ne kadar zor olursa olsun, bir öğrenme eğrisi vardır. Ancak, hiç kimse basit işlemler için öğrenme eğrisinden bahsetmez. Bu kavram alışkanlıklara meydan okuyan zorlu bir cerrahi yöntem söz konusu olduğunda karşımıza çıkar. Bu çalışmanın amacı, sağ taraflı kolon kanseri için zorlayıcı bir yöntem olan laparoskopik komplet mezokolik eksizyon ve santral vasküler ligasyon tekniğinin kümülatif toplam analizi ile öğrenme eğrisinin belirlenmesidir.
Gereç ve Yöntem: Bu retrospektif çalışmada Ocak 2015-Haziran 2022 tarihleri arasında Ankara Üniversitesi Tıp Fakültesi Genel Cerrahi Anabilim Dalı'na başvuran 18 yaşından büyük sağ kolon kanserli hastalar dahil edilmiştir. Ameliyat süresi ve lenf nodu miktarına göre kümülatif toplam (CUSUM) analizi kullanılarak öğrenme eğrisi belirlenmiştir.
Bulgular: 53 hasta çalışmaya dahil edildi. Operasyon süresine göre yapılan CUSUM analizi, cerrahın 21 vakadan sonra öğrenme aşamasını geçtiğini ve yeterlik kazandığını göstermiştir. Lenf nodlarına göre yapılan CUSUM analizi ise cerrahın 25. vakada yeterlik kazandığını ortaya koymuştur. CUSUM analizlerine göre yeterlik öncesi ve sorası fazlardaki hastaların karşılaştırılmasında demografik, onkolojik ve operasyonel veriler açısından fark bulunamamıştır.
Sonuç: Cerrahlar sağ kolon kanseri için laparoskopik komplet mezokolik eksizyon prosedürünü yaklaşık 21 ile 25 vaka sonrasında rahatlıkla yapabilirler.
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