1
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Pena R, Borja de Lacy F, Balibrea JM, Lacy AM. Locoregional recurrence after transanal total mesorectal excision: an emotional rollercoaster. Br J Surg 2021; 108:e138-e139. [PMID: 33793725 DOI: 10.1093/bjs/znaa174] [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: 12/11/2020] [Accepted: 12/13/2020] [Indexed: 11/12/2022]
Abstract
Transanal total mesorectal excision is a complex technique that should be performed in expert centers.
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Affiliation(s)
- R Pena
- Department of Gastrointestinal Surgery, Hospital Clinic of Barcelona, Barcelona, Spain
| | - F Borja de Lacy
- Department of Gastrointestinal Surgery, Hospital Clinic of Barcelona, Barcelona, Spain
| | - J M Balibrea
- Department of Gastrointestinal Surgery, Hospital Clinic of Barcelona, Barcelona, Spain
| | - A M Lacy
- Department of Gastrointestinal Surgery, Hospital Clinic of Barcelona, Barcelona, Spain
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2
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Otero-Piñeiro A, Bravo R, Besa A, Pena R, De Lacy FB, Lacy AM. Robotic right hemicolectomy with D3 lymphadenectomy, complete mesocolon excision and intracorporeal anastomosis - a video vignette. Colorectal Dis 2020; 22:1809-1810. [PMID: 32639682 DOI: 10.1111/codi.15256] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2020] [Accepted: 06/25/2020] [Indexed: 02/08/2023]
Affiliation(s)
| | - R Bravo
- Hospital Clinic, Barcelona, Spain
| | - A Besa
- Hospital Clinic, Barcelona, Spain
| | - R Pena
- Hospital Clinic, Barcelona, Spain
| | | | - A M Lacy
- Hospital Clinic, Barcelona, Spain
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3
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González-Abós C, de Lacy FB, Lacy AM. Fluorescent-guided surgery with quantitative indocyanine green assessment - a video vignette. Colorectal Dis 2020; 22:1466. [PMID: 32348604 DOI: 10.1111/codi.15097] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2020] [Accepted: 04/11/2020] [Indexed: 02/08/2023]
Affiliation(s)
- C González-Abós
- Department of Gastrointestinal Surgery, Institute of Digestive and Metabolic Diseases, Centro de Investigación Biomédica en Red en Enfermedades Hepáticas y Digestivas (CIBERehd), Centro Esther Koplowitz, Cellex Biomedical Research Centre, IDIBAPS, Advances in Surgery (AIS) Channel, Hospital Clinic, University of Barcelona, Barcelona, Spain
| | - F B de Lacy
- Department of Gastrointestinal Surgery, Institute of Digestive and Metabolic Diseases, Centro de Investigación Biomédica en Red en Enfermedades Hepáticas y Digestivas (CIBERehd), Centro Esther Koplowitz, Cellex Biomedical Research Centre, IDIBAPS, Advances in Surgery (AIS) Channel, Hospital Clinic, University of Barcelona, Barcelona, Spain
| | - A M Lacy
- Department of Gastrointestinal Surgery, Institute of Digestive and Metabolic Diseases, Centro de Investigación Biomédica en Red en Enfermedades Hepáticas y Digestivas (CIBERehd), Centro Esther Koplowitz, Cellex Biomedical Research Centre, IDIBAPS, Advances in Surgery (AIS) Channel, Hospital Clinic, University of Barcelona, Barcelona, Spain
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4
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de Lacy FB, Roodbeen SX, Ríos J, van Laarhoven J, Otero-Piñeiro A, Bravo R, Visser T, van Poppel R, Valverde S, Hompes R, Sietses C, Castells A, Bemelman WA, Tanis PJ, Lacy AM. Three-year outcome after transanal versus laparoscopic total mesorectal excision in locally advanced rectal cancer: a multicenter comparative analysis. BMC Cancer 2020; 20:677. [PMID: 32689968 PMCID: PMC7372845 DOI: 10.1186/s12885-020-07171-y] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2020] [Accepted: 07/12/2020] [Indexed: 12/16/2022] Open
Abstract
Background For patients with mid and distal rectal cancer, robust evidence on long-term outcome and causal treatment effects of transanal total mesorectal excision (TaTME) is lacking. This multicentre retrospective cohort study aimed to assess whether TaTME reduces locoregional recurrence rate compared to laparoscopic total mesorectal excision (LapTME). Methods Consecutive patients with rectal cancer within 12 cm from the anal verge and clinical stage II-III were selected from three institutional databases. Outcome after TaTME (Nov 2011 - Feb 2018) was compared to a historical cohort of patients treated with LapTME (Jan 2000 - Feb 2018) using the inverse probability of treatment weights method. The primary endpoint was three-year locoregional recurrence. Results A total of 710 patients were analysed, 344 in the TaTME group and 366 in the LapTME group. At 3 years, cumulative locoregional recurrence rates were 3.6% (95% CI, 1.1–6.1) in the TaTME group and 9.6% (95% CI, 6.5–12.7) in the LapTME group (HR = 0.4; 95% CI, 0.23–0.69; p = 0.001). Three-year cumulative disease-free survival rates were 74.3% (95% CI, 68.8–79.8) and 68.6% (95% CI, 63.7–73.5) (HR = 0.82; 95% CI, 0.65–1.02; p = 0.078) and three-year overall survival 87.2% (95% CI, 82.7–91.7) and 82.2% (95% CI, 78.0–86.2) (HR = 0.74; 95% CI, 0.53–1.03; p = 0.077), respectively. In patients who underwent sphincter preservation procedures, TaTME was associated with a significantly better disease-free survival (HR = 0.78; 95% CI, 0.62–0.98; p = 0.033). Conclusions These findings suggest that TaTME may improve locoregional recurrence and disease-free survival rates among patients with mid and distal locally advanced rectal cancer.
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Affiliation(s)
- F B de Lacy
- Department of Gastrointestinal Surgery, Institute of Digestive and Metabolic Diseases, Hospital Clinic, IDIBAPS, Centro de Investigación Biomédica en Red en Enfermedades Hepáticas y Digestivas (CIBERehd), University of Barcelona, Centro Esther Koplowitz, and Cellex Biomedical Research Center, Barcelona, Catalonia, Spain.
| | - S X Roodbeen
- Department of Surgery, Amsterdam University Medical Centers, University of Amsterdam, Cancer Center Amsterdam, Meibergdreef 9, Amsterdam, The Netherlands
| | - J Ríos
- Medical Statistics Core Facility, August Pi and Sunyer Biomedical Research Institute (IDIBAPS); Biostatistics Unit, Faculty of Medicine, Universitat Autònoma de Barcelona, Villarroel 170, 08036, Barcelona, Catalonia, Spain
| | - J van Laarhoven
- Department of General Surgery, Jeroen Bosch Ziekenhuis, 's Hertogenbosch, The Netherlands
| | - A Otero-Piñeiro
- Department of Gastrointestinal Surgery, Institute of Digestive and Metabolic Diseases, Hospital Clinic, IDIBAPS, Centro de Investigación Biomédica en Red en Enfermedades Hepáticas y Digestivas (CIBERehd), University of Barcelona, Centro Esther Koplowitz, and Cellex Biomedical Research Center, Barcelona, Catalonia, Spain
| | - R Bravo
- Department of Gastrointestinal Surgery, Institute of Digestive and Metabolic Diseases, Hospital Clinic, IDIBAPS, Centro de Investigación Biomédica en Red en Enfermedades Hepáticas y Digestivas (CIBERehd), University of Barcelona, Centro Esther Koplowitz, and Cellex Biomedical Research Center, Barcelona, Catalonia, Spain
| | - T Visser
- Department of Surgery, Gelderse Vallei Hospital, Ede, The Netherlands
| | - R van Poppel
- Department of Surgery, Gelderse Vallei Hospital, Ede, The Netherlands
| | - S Valverde
- Department of Gastrointestinal Surgery, Institute of Digestive and Metabolic Diseases, Hospital Clinic, IDIBAPS, Centro de Investigación Biomédica en Red en Enfermedades Hepáticas y Digestivas (CIBERehd), University of Barcelona, Centro Esther Koplowitz, and Cellex Biomedical Research Center, Barcelona, Catalonia, Spain
| | - R Hompes
- Department of Surgery, Amsterdam University Medical Centers, University of Amsterdam, Cancer Center Amsterdam, Meibergdreef 9, Amsterdam, The Netherlands
| | - C Sietses
- Department of Surgery, Gelderse Vallei Hospital, Ede, The Netherlands
| | - A Castells
- Department of Gastroenterology, Institute of Digestive and Metabolic Diseases, Hospital Clinic, IDIBAPS, Centro de Investigación Biomédica en Red en Enfermedades Hepáticas y Digestivas (CIBERehd), University of Barcelona, Barcelona, Catalonia, Spain
| | - W A Bemelman
- Department of Surgery, Amsterdam University Medical Centers, University of Amsterdam, Cancer Center Amsterdam, Meibergdreef 9, Amsterdam, The Netherlands
| | - P J Tanis
- Department of Surgery, Amsterdam University Medical Centers, University of Amsterdam, Cancer Center Amsterdam, Meibergdreef 9, Amsterdam, The Netherlands
| | - A M Lacy
- Department of Gastrointestinal Surgery, Institute of Digestive and Metabolic Diseases, Hospital Clinic, IDIBAPS, Centro de Investigación Biomédica en Red en Enfermedades Hepáticas y Digestivas (CIBERehd), University of Barcelona, Centro Esther Koplowitz, and Cellex Biomedical Research Center, Barcelona, Catalonia, Spain
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5
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Lacy AM, De Lacy FB, Balibrea JM. Considerations for transanal total mesorectal excision (TaTME) use during the COVID-19 pandemic. Br J Surg 2020; 107:e203. [PMID: 32383490 PMCID: PMC7267642 DOI: 10.1002/bjs.11685] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2020] [Accepted: 04/17/2020] [Indexed: 01/27/2023]
Affiliation(s)
- A M Lacy
- Department of Gastrointestinal Surgery, Hospital Clínic de Barcelona, Barcelona, Spain
| | - F B De Lacy
- Department of Gastrointestinal Surgery, Hospital Clínic de Barcelona, Barcelona, Spain
| | - J M Balibrea
- Department of Gastrointestinal Surgery, Hospital Clínic de Barcelona, Barcelona, Spain
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6
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Otero-Piñeiro AM, de Lacy FB, Van Laarhoven JJ, Martín-Perez B, Valverde S, Bravo R, Lacy AM. The impact of fluorescence angiography on anastomotic leak rate following transanal total mesorectal excision for rectal cancer: a comparative study. Surg Endosc 2020; 35:754-762. [DOI: 10.1007/s00464-020-07442-6] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2019] [Accepted: 02/10/2020] [Indexed: 02/07/2023]
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7
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Lacy AM, Nogueira ST, Lacy FB. Comment on: Norwegian moratorium on transanal total mesorectal excision. Br J Surg 2019; 106:1855. [DOI: 10.1002/bjs.11375] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2019] [Accepted: 08/29/2019] [Indexed: 11/09/2022]
Affiliation(s)
- A M Lacy
- Department of Gastrointestinal Surgery, Hospital Clínic Barcelona, Barcelona, Spain
| | - S T Nogueira
- Department of Gastrointestinal Surgery, Hospital Clínic Barcelona, Barcelona, Spain
| | - F Borja Lacy
- Department of Gastrointestinal Surgery, Hospital Clínic Barcelona, Barcelona, Spain
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8
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Lacy AM, Bravo R, Otero-Piñeiro AM, Pena R, De Lacy FB, Menchaca R, Balibrea JM. 5G-assisted telementored surgery. Br J Surg 2019; 106:1576-1579. [PMID: 31483054 DOI: 10.1002/bjs.11364] [Citation(s) in RCA: 66] [Impact Index Per Article: 13.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2019] [Revised: 08/19/2019] [Accepted: 08/21/2019] [Indexed: 01/10/2023]
Abstract
Safe and effective implementation of remote surgery and telementoring can have significant limitations. Fifth-generation (5G) wireless networks could be useful in overcoming these drawbacks. As a proof of concept, the authors present technical and clinical details of two procedures assisted by telementoring using 5G that were also broadcast live. Secure remote access advice.
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Affiliation(s)
- A M Lacy
- Department of Gastrointestinal Surgery, Hospital Clínic de Barcelona, Barcelona, Spain.,AIS Channel, Barcelona, Spain
| | - R Bravo
- Department of Gastrointestinal Surgery, Hospital Clínic de Barcelona, Barcelona, Spain
| | - A M Otero-Piñeiro
- Department of Gastrointestinal Surgery, Hospital Clínic de Barcelona, Barcelona, Spain.,AIS Channel, Barcelona, Spain
| | - R Pena
- Department of Gastrointestinal Surgery, Hospital Clínic de Barcelona, Barcelona, Spain.,AIS Channel, Barcelona, Spain
| | - F B De Lacy
- Department of Gastrointestinal Surgery, Hospital Clínic de Barcelona, Barcelona, Spain.,AIS Channel, Barcelona, Spain
| | | | - J M Balibrea
- Department of Gastrointestinal Surgery, Hospital Clínic de Barcelona, Barcelona, Spain.,AIS Channel, Barcelona, Spain
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9
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Otero-Piñeiro A, Valverde S, de Lacy FB, Bravo R, Lacy AM. Combined robotic and transanal total mesorectal excision with hysterectomy for rectal cancer. Tech Coloproctol 2019; 23:277-278. [PMID: 30788727 DOI: 10.1007/s10151-019-01939-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2018] [Accepted: 01/30/2019] [Indexed: 11/28/2022]
Affiliation(s)
- A Otero-Piñeiro
- Department of Gastrointestinal Surgery, Hospital Clinic, Villarroel, 170, 08036, Barcelona, Spain.
| | - S Valverde
- Department of Gastrointestinal Surgery, Hospital Clinic, Villarroel, 170, 08036, Barcelona, Spain
| | - F B de Lacy
- Department of Gastrointestinal Surgery, Hospital Clinic, Villarroel, 170, 08036, Barcelona, Spain
| | - R Bravo
- Department of Gastrointestinal Surgery, Hospital Clinic, Villarroel, 170, 08036, Barcelona, Spain
| | - A M Lacy
- Department of Gastrointestinal Surgery, Hospital Clinic, Villarroel, 170, 08036, Barcelona, Spain
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10
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Mizrahi I, de Lacy FB, Abu-Gazala M, Fernandez LM, Otero A, Sands DR, Lacy AM, Wexner SD. Transanal total mesorectal excision for rectal cancer with indocyanine green fluorescence angiography. Tech Coloproctol 2018; 22:785-791. [PMID: 30430309 DOI: 10.1007/s10151-018-1869-z] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2018] [Accepted: 10/15/2018] [Indexed: 12/18/2022]
Abstract
BACKGROUND The aim of this study was to evaluate the impact of fluorescence angiography (FA) on any change in proximal resection margin and/or anastomotic leak (AL) following transanal total mesorectal excision (TaTME) for rectal cancer (RC). METHODS This retrospective cohort study was conducted at two centers by three senior surgeons. Both institutions' prospectively maintained Institutional Review Board-approved databases were retrospectively queried for all consecutive patients between July 2015 and May 2017 who had laparoscopic hybrid trans-abdominal total mesorectal excision (TME) and TaTME for RC with colorectal or coloanal anastomosis < 10 cm from the anal verge. All patients had intraoperative FA to assess colonic perfusion of the planned proximal resection margin before bowel transection and after construction of the anastomosis. Primary outcomes measured any changes in proximal resection margins and AL rates. RESULTS Fifty-four patients (31 males; mean age 63 ± 12 years) were included; 30 (55%) of whom received neoadjuvant chemoradiation. The average anastomotic height was 3.6 cm from the anal verge and 8 (14.5%) patients required intersphincteric dissection. Forty-six patients (85%) had loop ileostomy. FA led to a change in the proximal resection margin in 10 patients (18.5%), one of whom had AL on postoperative day 3 requiring diagnostic laparoscopy and loop ileostomy. A second patient, without a change in the proximal resection margin, also had an AL. The overall AL rate was 3.7%. CONCLUSIONS FA changed the planned proximal resection margin in 18.5% of patients, possibly accounting for the relatively low AL rate. FA is imperfect, and subjective but does have the potential to improve outcomes.
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Affiliation(s)
- I Mizrahi
- Department of Colorectal Surgery, Cleveland Clinic Florida, 2950 Cleveland Clinic Blvd, Weston, FL, 33331, USA
| | - F B de Lacy
- Department of Gastrointestinal Surgery, Institute of Digestive and Metabolic Diseases, Hospital Clinic, IDIBAPS, Barcelona, Spain
| | - M Abu-Gazala
- Department of Colorectal Surgery, Cleveland Clinic Florida, 2950 Cleveland Clinic Blvd, Weston, FL, 33331, USA
| | - L M Fernandez
- Department of Colorectal Surgery, Cleveland Clinic Florida, 2950 Cleveland Clinic Blvd, Weston, FL, 33331, USA
| | - A Otero
- Department of Gastrointestinal Surgery, Institute of Digestive and Metabolic Diseases, Hospital Clinic, IDIBAPS, Barcelona, Spain
| | - D R Sands
- Department of Colorectal Surgery, Cleveland Clinic Florida, 2950 Cleveland Clinic Blvd, Weston, FL, 33331, USA
| | - A M Lacy
- Department of Gastrointestinal Surgery, Institute of Digestive and Metabolic Diseases, Hospital Clinic, IDIBAPS, Barcelona, Spain
| | - S D Wexner
- Department of Colorectal Surgery, Cleveland Clinic Florida, 2950 Cleveland Clinic Blvd, Weston, FL, 33331, USA.
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11
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Otero-Piñeiro AM, De Lacy FB, Martín-Pérez B, Lacy AM. Indications for a transanal approach in complicated inflammatory bowel disease. Tech Coloproctol 2018; 22:469-470. [PMID: 29882178 DOI: 10.1007/s10151-018-1809-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2018] [Accepted: 06/01/2018] [Indexed: 10/14/2022]
Affiliation(s)
- A M Otero-Piñeiro
- Department of Gastrointestinal Surgery, Hospital Clinic Barcelona, Villarroel, 170, 08036, Barcelona, Spain.
| | - F B De Lacy
- Department of Gastrointestinal Surgery, Hospital Clinic Barcelona, Villarroel, 170, 08036, Barcelona, Spain
| | - B Martín-Pérez
- Department of Gastrointestinal Surgery, Hospital Clinic Barcelona, Villarroel, 170, 08036, Barcelona, Spain
| | - A M Lacy
- Department of Gastrointestinal Surgery, Hospital Clinic Barcelona, Villarroel, 170, 08036, Barcelona, Spain
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12
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Martin-Perez B, Bennis H, Lacy AM. Virtual reality simulation for surgery: from video games to transanal total mesorectal excision. Tech Coloproctol 2017; 22:5-6. [PMID: 29256138 DOI: 10.1007/s10151-017-1738-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2017] [Accepted: 12/03/2017] [Indexed: 12/29/2022]
Affiliation(s)
- B Martin-Perez
- Department of General Surgery, Hospital Clinic of Barcelona, ICMDiM, Carrer de Villarroel, 170, 08036, Barcelona, Spain.
| | - H Bennis
- Department of General Surgery, Hospital Clinic of Barcelona, ICMDiM, Carrer de Villarroel, 170, 08036, Barcelona, Spain
| | - A M Lacy
- Department of General Surgery, Hospital Clinic of Barcelona, ICMDiM, Carrer de Villarroel, 170, 08036, Barcelona, Spain
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13
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Brady RRW, Chapman SJ, Atallah S, Chand M, Mayol J, Lacy AM, Wexner SD. #colorectalsurgery. Br J Surg 2017; 104:1470-1476. [PMID: 28881004 DOI: 10.1002/bjs.10615] [Citation(s) in RCA: 55] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2017] [Revised: 04/21/2017] [Accepted: 05/15/2017] [Indexed: 12/20/2022]
Abstract
BACKGROUND The use of social media platforms among healthcare professionals is increasing. A Twitter social media campaign promoting the hashtag #colorectalsurgery was launched with the aim of providing a specialty-specific forum to collate discussions and science relevant to an engaged, global community of coloproctologists. This article reviews initial experiences of the early adoption, engagement and utilization of this pilot initiative. METHODS The hashtag #colorectalsurgery was promoted via the online microblogging service Twitter across a 180-day interval. Data on all tweets containing the #colorectalsurgery hashtag were analysed using online analytical tools. Data included total number of tweets, number of views, and user engagement since registration and launch of the campaign. Content of tweet and user demographic analysis was undertaken. RESULTS The number of tweets using #colorectalsurgery grew rapidly following the launch on 24 April 2016; #colorectalsurgery was used in 15 708 tweets, which resulted in 65 398 696 impressions and involved 1863 individual Twitter accounts. Increased volumes of #colorectalsurgery tweets were noted in association with the timing of three major international colorectal surgical conferences, and geographical trends were noted. Some 88·4 per cent of all posts were by male users. The top 25 users by volume of #colorectalsurgery tweets had considerable influence and posted 8023 tweets (51·1 per cent). CONCLUSION Online global communities formed via healthcare-related hashtags, such as #colorectalsurgery, unify social media posts, scientists, surgeons and authors who have an interest in coloproctology. Furthermore, they facilitate greater connectivity among geographically separate users.
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Affiliation(s)
- R R W Brady
- Department of Colorectal Surgery, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | - S J Chapman
- The John Goligher Colorectal Unit, St James's University Hospital, Leeds, UK
| | - S Atallah
- Department of Colon and Rectal Surgery, Florida Hospital, Orlando, Florida, USA
| | - M Chand
- Department of Colorectal Surgery, University College London, London, UK
| | - J Mayol
- Department of Surgery, Hospital Clinico, Instituto de Investigación Sanitaria San Carlos, Universidad Compluntense de Madrid, Madrid, Spain
| | - A M Lacy
- Department of Gastrointestinal Surgery, Hospital Clinic of Barcelona, University of Barcelona, Barcelona, Spain
| | - S D Wexner
- Digestive Disease Center, Department of Colorectal Surgery, Cleveland Clinic Florida, Weston, Florida, USA
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14
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Bravo R, Trépanier JS, Arroyave MC, Fernández-Hevia M, Pigazzi A, Lacy AM. Combined transanal total mesorectal excision (taTME) with laparoscopic instruments and abdominal robotic surgery in rectal cancer. Tech Coloproctol 2017; 21:233-235. [PMID: 28265766 DOI: 10.1007/s10151-017-1597-9] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2016] [Accepted: 01/21/2017] [Indexed: 12/27/2022]
Abstract
Laparoscopic surgery for rectal cancer can be technically challenging. We describe a hybrid technique combining abdominal robotic dissection and transanal total mesorectal excision. This procedure was performed in a 50-year-old man with rectal adenocarcinoma at 5 cm from the dentate lane. Preoperative staging was T2N0M0. Surgery went well without complications, and estimated blood loss was less than 50 mL. Robotic surgical time was 90 min, and total operative time was 160 min. The patient was discharged on postoperative day 3. Pathology analysis revealed an intact mesorectum (TME grade 3) and a T2N0 tumor with negative margins. Hybrid surgery with pelvic robotic dissection and transanal total mesorectal excision was feasible, quick and safe in this patient and may be a method that can be developed further.
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Affiliation(s)
- R Bravo
- Hospital Clínic de Barcelona, Villarroel 170, 08036, Barcelona, Spain.
| | - J-S Trépanier
- Hospital Clínic de Barcelona, Villarroel 170, 08036, Barcelona, Spain.,Hôpital Maisonneuve-Rosemont, Montreal, QC, Canada
| | - M C Arroyave
- Hospital Clínic de Barcelona, Villarroel 170, 08036, Barcelona, Spain.,Clínica Somer, Rionegro, Antioquia, Colombia
| | - M Fernández-Hevia
- Hospital Clínic de Barcelona, Villarroel 170, 08036, Barcelona, Spain
| | - A Pigazzi
- Irvine Medical Center, University of California, Orange, CA, USA
| | - A M Lacy
- Hospital Clínic de Barcelona, Villarroel 170, 08036, Barcelona, Spain
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15
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Lacy AM, Martin-Perez B, Diaz-DelGobbo G, DeLacy H, Cahill R, Wexner SD. The present and future of surgical education - a video vignette. Colorectal Dis 2017; 19:303-304. [PMID: 28160396 DOI: 10.1111/codi.13617] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2016] [Accepted: 01/05/2017] [Indexed: 02/08/2023]
Affiliation(s)
- A M Lacy
- Instituto Clínic de Enfermedades Digestivas y Metabólicas (ICMDiM), Hospital Clinic, Barcelona, Spain
| | - B Martin-Perez
- Instituto Clínic de Enfermedades Digestivas y Metabólicas (ICMDiM), Hospital Clinic, Barcelona, Spain
| | - G Diaz-DelGobbo
- Instituto Clínic de Enfermedades Digestivas y Metabólicas (ICMDiM), Hospital Clinic, Barcelona, Spain
| | - H DeLacy
- Instituto Clínic de Enfermedades Digestivas y Metabólicas (ICMDiM), Hospital Clinic, Barcelona, Spain
| | - R Cahill
- Mater Misericordiae University Hospital, Dublin, Ireland
| | - S D Wexner
- Cleveland Clinic Florida, Weston, Florida, USA
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16
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Martin-Perez B, Diaz-DelGobbo G, Otero-Piñeiro A, Almenara R, Lacy AM. Hartmann's reversal using a transanal and transabdominal approach. Tech Coloproctol 2016; 20:879-880. [PMID: 27915386 DOI: 10.1007/s10151-016-1558-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2016] [Accepted: 10/03/2016] [Indexed: 11/24/2022]
Affiliation(s)
- B Martin-Perez
- Department of Surgery, Hospital Clinic de Barcelona, Barcelona, Barcelona, Spain.
| | - G Diaz-DelGobbo
- Department of Surgery, Hospital Clinic de Barcelona, Barcelona, Barcelona, Spain
| | - A Otero-Piñeiro
- Department of Surgery, Hospital Clinic de Barcelona, Barcelona, Barcelona, Spain
| | - R Almenara
- Department of Surgery, Hospital Clinic de Barcelona, Barcelona, Barcelona, Spain
| | - A M Lacy
- Department of Surgery, Hospital Clinic de Barcelona, Barcelona, Barcelona, Spain
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Arroyave MC, DeLacy FB, Lacy AM. Transanal total mesorectal excision (TaTME) for rectal cancer: Step by step description of the surgical technique for a two-teams approach. Eur J Surg Oncol 2016; 43:502-505. [PMID: 27914773 DOI: 10.1016/j.ejso.2016.10.024] [Citation(s) in RCA: 53] [Impact Index Per Article: 6.6] [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: 10/10/2016] [Accepted: 10/13/2016] [Indexed: 12/11/2022] Open
Abstract
Interest in transanal total mesorectal excision (TaTME) is growing worldwide due to the application of minimally invasive techniques to rectal cancer surgery while maintaining adequate oncologic outcomes. This article presents the standardised and refined technique after performing more than 300 operations at Hospital Clinic of Barcelona.
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Affiliation(s)
- M C Arroyave
- Gastrointestinal Surgery Department, Hospital Clinic de Barcelona, Carrer de Villaroel 170, 08036, Barcelona, Catalonia, Spain(c); Oncologic Surgery Department, Clinica Somer, Calle 38 #54A-35, Rionegro, Antioquia, Colombia.
| | - F B DeLacy
- Gastrointestinal Surgery Department, Hospital Clinic de Barcelona, Carrer de Villaroel 170, 08036, Barcelona, Catalonia, Spain(c)
| | - A M Lacy
- Gastrointestinal Surgery Department, Hospital Clinic de Barcelona, Carrer de Villaroel 170, 08036, Barcelona, Catalonia, Spain(c)
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Cárdenas G, Bravo R, Delgado S, Jiménez M, Martínez A, Díaz del Gobbo G, de Lacy B, Lacy AM. Recurrent volvular herniation of the ileal pouch: a case report and literature review. Int J Colorectal Dis 2016; 31:749-50. [PMID: 25982467 DOI: 10.1007/s00384-015-2242-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [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] [Accepted: 05/08/2015] [Indexed: 02/04/2023]
Affiliation(s)
- Gabriel Cárdenas
- General Surgery Department, Hospital Clinic of Barcelona, Carrer Villarroel 170, Barcelona, 08036, Spain
| | - Raquel Bravo
- General Surgery Department, Hospital Clinic of Barcelona, Carrer Villarroel 170, Barcelona, 08036, Spain.
| | - Salvadora Delgado
- General Surgery Department, Hospital Clinic of Barcelona, Carrer Villarroel 170, Barcelona, 08036, Spain
| | - Marta Jiménez
- General Surgery Department, Hospital Clinic of Barcelona, Carrer Villarroel 170, Barcelona, 08036, Spain
| | - Alberto Martínez
- General Surgery Department, Hospital Clinic of Barcelona, Carrer Villarroel 170, Barcelona, 08036, Spain
| | - Gabriel Díaz del Gobbo
- General Surgery Department, Hospital Clinic of Barcelona, Carrer Villarroel 170, Barcelona, 08036, Spain
| | - Borja de Lacy
- General Surgery Department, Hospital Clinic of Barcelona, Carrer Villarroel 170, Barcelona, 08036, Spain
| | - A M Lacy
- General Surgery Department, Hospital Clinic of Barcelona, Carrer Villarroel 170, Barcelona, 08036, Spain
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Abstract
Surgical treatment has been in constant evolution in the search for minimizing incisions regardless of the complexity of the operation. Natural Orifice Translumenal Endoscopic Surgery (NOTES) represents this progression of surgery to less invasive procedures. Transanal endoscopic microsurgery (TEM) is an ideal NOTES platform to access the peritoneal cavity endoscopically through the anus and specifically to allow colorectal resections be performed through smaller, or indeed without, abdominal incisions. Transanal rectosigmoidectomy with total mesorectal excision (TME) using TEM is a feasible and oncologically safe option. Such use of currently available combined hybrid laparoendoscopic systems provides a safe platform to define future clinical applications and advantages of NOTES. Furthermore, it stimulates the active development of technologies that will support and enable it.
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Affiliation(s)
- A M Lacy
- Department of Gastrointestinal Surgery, Institute of Digestive and Metabolic Diseases, Hospital Clínic, IDIBAPS, Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas, Centro Esther Koplowitz, University of Barcelona, Barcelona, Spain.
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Fernández-Esparrach G, San José Estépar R, Guarner-Argente C, Martínez-Pallí G, Navarro R, Rodríguez de Miguel C, Córdova H, Thompson CC, Lacy AM, Donoso L, Ayuso-Colella JR, Ginès A, Pellisé M, Llach J, Vosburgh KG. The role of a computed tomography-based image registered navigation system for natural orifice transluminal endoscopic surgery: a comparative study in a porcine model. Endoscopy 2010; 42:1096-103. [PMID: 20960391 PMCID: PMC3061238 DOI: 10.1055/s-0030-1255824] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [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] [Indexed: 12/21/2022]
Abstract
BACKGROUND AND STUDY AIMS Most natural orifice transluminal endoscopic surgery (NOTES) procedures have been performed in animal models through the anterior stomach wall, but this approach does not provide efficient access to all anatomic areas of interest. Moreover, injury of the adjacent structures has been reported when using a blind access. The aim of the current study was to assess the utility of a CT-based (CT: computed tomography) image registered navigation system in identifying safe gastrointestinal access sites for NOTES and identifying intraperitoneal structures. METHODS A total of 30 access procedures were performed in 30 pigs: anterior gastric wall (n = 10), posterior gastric wall (n = 10), and anterior rectal wall (n = 10). Of these, 15 procedures used image registered guidance (IR-NOTES) and 15 procedures used a blind access (NOTES only). Timed abdominal exploration was performed with identification of 11 organs. The location of the endoscopic tip was tracked using an electromagnetic tracking system and was recorded for each case. Necropsy was performed immediately after the procedure. The primary outcome was the rate of complications; secondary outcome variables were number of organs identified and kinematic measurements. RESULTS A total of 30 animals weighting a mean (± SD) of 30.2 ± 6.8 kg were included in the study. The incision point was correctly placed in 11 out of 15 animals in each group (73.3 %). The mean peritoneoscopy time and the number of properly identified organs were equivalent in the two groups. There were eight minor complications (26.7 %), two (13.3 %) in the IR-NOTES group and six (40.0 %) in the NOTES only group ( P = n. s.). Characteristics of the endoscope tip path showed a statistically significant improvement in trajectory smoothness of motion for all organs in the IR-NOTES group. CONCLUSION The image registered system appears to be feasible in NOTES procedures and results from this study suggest that image registered guidance might be useful for supporting navigation with an increased smoothness of motion.
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Affiliation(s)
- G. Fernández-Esparrach
- Endoscopy Unit, Department of Gastroenterology, Hospital Clinic, University of Barcelona, IDIBAPS, CIBERehd, Barcelona, Spain
| | | | - C. Guarner-Argente
- Endoscopy Unit, Department of Gastroenterology, Hospital Clinic, University of Barcelona, IDIBAPS, CIBERehd, Barcelona, Spain
| | - G. Martínez-Pallí
- Anesthesiology Department, Hospital Clinic, University of Barcelona, Barcelona, Spain
| | - R. Navarro
- Anesthesiology Department, Hospital Clinic, University of Barcelona, Barcelona, Spain
| | - C. Rodríguez de Miguel
- Endoscopy Unit, Department of Gastroenterology, Hospital Clinic, University of Barcelona, IDIBAPS, CIBERehd, Barcelona, Spain
| | - H. Córdova
- Endoscopy Unit, Department of Gastroenterology, Hospital Clinic, University of Barcelona, IDIBAPS, CIBERehd, Barcelona, Spain
| | - C. C. Thompson
- Division of Gastroenterology, Brigham and Women’s Hospital, Boston, Massachusetts, USA
| | - A. M. Lacy
- Department of Surgery, Hospital Clinic, University of Barcelona, IDIBAPS, CIBERehd, Barcelona, Spain
| | - L. Donoso
- Department of Radiology, Hospital Clinic, University of Barcelona, Barcelona, Spain
| | - J. R. Ayuso-Colella
- Department of Radiology, Hospital Clinic, University of Barcelona, Barcelona, Spain
| | - A. Ginès
- Endoscopy Unit, Department of Gastroenterology, Hospital Clinic, University of Barcelona, IDIBAPS, CIBERehd, Barcelona, Spain
| | - M. Pellisé
- Endoscopy Unit, Department of Gastroenterology, Hospital Clinic, University of Barcelona, IDIBAPS, CIBERehd, Barcelona, Spain
| | - J. Llach
- Endoscopy Unit, Department of Gastroenterology, Hospital Clinic, University of Barcelona, IDIBAPS, CIBERehd, Barcelona, Spain
| | - K. G. Vosburgh
- Department of Radiology, Brigham and Women’s Hospital, Boston, USA,Center for Integration of Medicine and Innovative Technology, USA
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Buunen M, Bonjer HJ, Hop WCJ, Haglind E, Kurlberg G, Rosenberg J, Lacy AM, Cuesta MA, D'Hoore A, Fürst A, Lange JF, Jess P, Bulut O, Poornoroozy P, Jensen KJ, Christensen MM, Lundhus E, Ovesen H, Birch D, Iesalnieks I, Jäger C, Kreis M, van riet Y, van der Harst E, Gerhards MF, Bemelman WA, Hansson BME, Neijenhuis PA, Prins HA, Balague C, Targarona E, Luján Mompeán JA, Franco Osorio JD, Garcia Molina FJ, Skullman S, Läckberg Z, Kressner U, Matthiessen P, Kim SH, Poza AA. COLOR II. A randomized clinical trial comparing laparoscopic and open surgery for rectal cancer. Dan Med Bull 2009; 56:89-91. [PMID: 19486621] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
INTRODUCTION Laparoscopic resection of rectal cancer has been proven efficacious but morbidity and oncological outcome need to be investigated in a randomized clinical trial. TRIAL DESIGN Non-inferiority randomized clinical trial. METHODS The COLOR II trial is an ongoing international randomized clinical trial. Currently 27 hospitals from Europe, South Korea and Canada are including patients. The primary endpoint is loco-regional recurrence rate three years post-operatively. Secondary endpoints cover quality of life, overall and disease free survival, post-operative morbidity and health economy analysis. RESULTS By July 2008, 27 hospitals from the Netherlands, Belgium, Germany, Sweden, Spain, Denmark, South Korea and Canada had included 739 patients. The intra-operative conversion rate in the laparoscopic group was 17%. Distribution of age, location of the tumor and radiotherapy were equal in both treatment groups. Most tumors are located in the mid-rectum (41%). CONCLUSION Laparoscopic surgery in the treatment of rectal cancer is feasible. The results and safety of laparoscopic surgery in the treatment of rectal cancer remain unknown, but are subject of interim analysis within the COLOR II trial. Completion of inclusion is expected by the end of 2009. TRIAL REGISTRATION Clinicaltrials.gov, identifier: NCT00297791 (www.clinicaltrials.gov).
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Merino I, Borrat X, Balust J, Delgado S, Lacy AM, Vidal J, Martinez-Palli G. Rhabdomyolysis after bariatric surgery: a potentially fatal complication. Br J Anaesth 2009; 102:283-4. [PMID: 19151057 DOI: 10.1093/bja/aen374] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Ugidos L, Conill C, Delgado S, Gines A, Gallego R, Ayuso JR, Miquel R, Lacy AM, Castells A, Maurel J. Phase I trial of neoadjuvant chemoradiotherapy with capecitabine and weekly irinotecan followed by laparoscopic mesorectal excision. J Clin Oncol 2007. [DOI: 10.1200/jco.2007.25.18_suppl.14556] [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: 11/20/2022] Open
Abstract
14556 Background: To establish the feasibility and efficacy of capecitabine with weekly irinotecan (CAPIRI) and concurrent radiotherapy (RT) in patients with locally advanced and resectable metastatic rectal cancer, followed by LAME. Methods: Eligible criteria included adenocarcinoma of the rectum staged by endoscopic ultrasonography (us), spiral abdominal and pelvic CT and chest X-ray. Patients received weekly irinotecan 50 mg/m2 (days 1,8,15,22,29) and two doses of capecitabine (days 1 through 5 for 5 weeks); dose level; (DL) I 250 mg/m2 bid; DL II 375 mg/m2 bid; DL III 500 mg/m2 bid, according to phase I methodology. Conformal radiotherapy was administered up to a total dose of 45 Gy/1.8 Gy per fraction. LAME was planned 5–7 weeks after CRT. Results: From January 2003 to March 2006, 22 patients (three with potentially resectable metastatic disease) were included. Median age was 62 (range 48 to 78). 6 pts were usT3N0 and 16 pts usT3–4N1. Seven patients were treated at DL I, six at DL II and nine at DL III. Grade 3 or 4 adverse events were observed in all levels; DL I asthenia (1p); DL II diarrhea (2p) and DL III asthenia and neutropenia (1p), diarrhea (1p) and hyperbilirrubinaemia (1p). All patients except one who refused treatment after 1 week therapy (DL I), completed CRT and underwent surgical resection (R0 81%, R2 19%). Abdominoperineal resection was done in two cases (9%). Conversion rate to open surgery was 5%. Median hospital stay was 7.9 days. The overall postoperative morbidity was 4.7%. Median excised nodes were 11 (range 4–21). Pathological complete response was observed in two patients (9%), both of them in DL III. With a median follow-up of 25 months (range 9–46), disease free survival and overall survival was 67% and 95% respectively. Conclusions: Preoperative CRT with CAPIRI is feasible, but severe adverse events were found in all levels despite the use of lower dose of capecitabine than previously published. LAME after CAPIRI had short oncologic outcomes comparable with open mesorectal excision. No significant financial relationships to disclose.
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Affiliation(s)
| | | | | | - A. Gines
- Hospital Clinic, Barcelona, Spain
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Delgado S, Momblán D, Salvador L, Bravo R, Castells A, Ibarzabal A, Piqué JM, Lacy AM. Laparoscopic-assisted approach in rectal cancer patients: lessons learned from >200 patients. Surg Endosc 2004; 18:1457-62. [PMID: 15791369 DOI: 10.1007/s00464-003-8831-4] [Citation(s) in RCA: 55] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2003] [Accepted: 03/30/2004] [Indexed: 01/04/2023]
Abstract
BACKGROUND The applicability of laparoscopic surgery in the treatment of colorectal diseases is still controversial. Early reports on laparoscopic-assisted colectomy in patients with colon cancer suggested that it minimizes surgical trauma, decreases perioperative complications, and leads to a more rapid recovery. To our knowledge, no previous studies have compared the laparoscopic vs the open approach in rectal cancer. The aim of this paper was to assess the results of laparoscopic techniques in patients with rectal cancer. METHODS From March 1998 to February 2003, all patients admitted to our unit with adenocarcinoma of the rectum were evaluated for surgery by the laparoscopic approach. RESULTS A total of 220 patients with a mean age of 67.3 years were included in the study. One hundred thirty patients (59%) were treated with neoadjuvant chemoradiotherapy. In >75% of the patients, a surgical procedure with sphincter preservation was performed. The rate of conversion to the open approach was 20%. Ten patients had intraoperative complications. Fifty-eight patients (26.3%) developed postoperative complications. The length of hospital stay was 6.8 days. The distribution of tumor stages was as follows: stage I, 16.81%; stage II, 33.6%; stage III, 26.36%; stage IV, 19.09%. The mean number of lymph nodes was 13.8. The incidence of local relapse was 5.3%, with a follow-up of 18 months. CONCLUSION Laparoscopic surgery can be safely performed in patients with adenocarcinoma of the rectum with good short-term results. Randomized controlled trials are needed to confirm these results.
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Affiliation(s)
- S Delgado
- Department of Gastrointestinal Surgery, Institute of Digestive Diseases, Hospital Clinic, University of Barcelona, Villarroel 170, 08036, Barcelona, Spain
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Veldkamp R, Gholghesaei M, Bonjer HJ, Meijer DW, Buunen M, Jeekel J, Anderberg B, Cuesta MA, Cuschierl A, Fingerhut A, Fleshman JW, Guillou PJ, Haglind E, Himpens J, Jacobi CA, Jakimowicz JJ, Koeckerling F, Lacy AM, Lezoche E, Monson JR, Morino M, Neugebauer E, Wexner SD, Whelan RL. Laparoscopic resection of colon Cancer: Consensus of the European Association of Endoscopic Surgery (EAES). Surg Endosc 2004; 18:1163-85. [PMID: 15457376 DOI: 10.1007/s00464-003-8253-3] [Citation(s) in RCA: 178] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2003] [Accepted: 09/17/2003] [Indexed: 12/11/2022]
Abstract
BACKGROUND The European Association of Endoscopic Surgery (EAES) initiated a consensus development conference on the laparoscopic resection of colon cancer during the annual congress in Lisbon, Portugal, in June 2002. METHODS A systematic review of the current literature was combined with the opinions, of experts in the field of colon cancer surgery to formulate evidence-based statements and recommendations on the laparoscopic resection of colon cancer. RESULTS Advanced age, obesity, and previous abdominal operations are not considered absolute contraindications for laparoscopic colon cancer surgery. The most common cause for conversion is the presence of bulky or invasive tumors. Laparoscopic operation takes longer to perform than the open counterpart, but the outcome is similar in terms of specimen size and pathological examination. Immediate postoperative morbidity and mortality are comparable for laparoscopic and open colonic cancer surgery. The laparoscopically operated patients had less postoperative pain, better-preserved pulmonary function, earlier restoration of gastrointestinal function, and an earlier discharge from the hospital. The postoperative stress response is lower after laparoscopic colectomy. The incidence of port site metastases is <1%. Survival after laparoscopic resection of colon cancer appears to be at least equal to survival after open resection. The costs of laparoscopic surgery for colon cancer are higher than those for open surgery. CONCLUSION Laparoscopic resection of colon cancer is a safe and feasible procedure that improves short-term outcome. Results regarding the long-term survival of patients enrolled in large multicenter trials will determine its role in general surgery.
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Affiliation(s)
- R Veldkamp
- Department of General Surgery, Erasmus MC, P. O. Box 2040, 3000, Rotterdam, CA, The Netherlands
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Martínez JL, Rivas H, Delgado S, Castells A, Pique JM, Lacy AM. Laparoscopic-assited colectomy in patients with liver cirrhosis. Surg Endosc 2004; 18:1071-4. [PMID: 15156381 DOI: 10.1007/s00464-003-9222-6] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2003] [Accepted: 01/15/2004] [Indexed: 10/26/2022]
Abstract
BACKGROUND Nonhepatic abdominal surgery, and especially colorectal surgery, is associated with high rates of morbidity and mortality among cirrhotic patients. With proper patient selection and preoperative optimization of the patient's condition, laparoscopic-assisted colectomy could become effective and safe for patients with compensated liver cirrhosis. The aim of this study was to evaluate the safety and feasibility of minimal-access surgery in these patients. METHODS Between September 1993 and March 2003, 820 patients underwent laparoscopic-assisted colectomy at our hospital. We studied all patients with liver cirrhosis who underwent this operation. RESULTS Seventeen patients with cirrhosis were included in the study. Twelve were Child's A and five were Child's B. The mean operative time was 150 min (ranges 75-280), mean estimated blood loss was 245 ml (ranges 100-250). The conversion rate to open surgery was 29% (five patients). Median length of hospital stay was 5 days. The morbidity rate was 29% (five patients). There were no anastomotic leaks or operative-related deaths. The median follow-up was 21 months. CONCLUSIONS Laparoscopic-assisted colorectal surgery can be performed in compensated cirrhotic patients with low morbidity and mortality. Adequate patient selection and expertise in advanced minimal-access surgery are essential to obtain such good results.
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Affiliation(s)
- J-L Martínez
- Department of Gastrointestinal Surgery, Institute of Digestive Diseases, Colorectal Cancer Unit, Hospital Clinic, University of Barcelona, Corporació Sanitària Clínic, Villarroel 170, 08036, Barcelona, Spain
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Soriano A, Castells A, Lacy AM, Ayuso C, Ayuso JR, Conill C, Delgado S, Fuster J, García-Valdecasas JC, Ginès A, Martín M, Maurel J, Miquel R, Mollà M, Vilana R, Castellví-Bel S, Elizalde JI, Piñol V, Pellisé M, Biete A, Gascón P, Piqué JM. [Evaluation of the efficacy and efficiency of a multidisciplinary unit for the treatment of patients with colorectal cancer]. Gastroenterol Hepatol 2002; 25:579-84. [PMID: 12459118 DOI: 10.1016/s0210-5705(02)70319-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
INTRODUCTION Because of the increased complexity of the diagnostic-therapeutic approach to colorectal cancer (CRC), these patients should be managed in specialized multidisciplinary units. The aim of this study was to evaluate the efficacy and efficiency of a CRC unit (CRCU) in the diagnostic-therapeutic management of these patients. PATIENTS AND METHODS Two groups of 50 patients with colon cancer treated in our center before and after the implementation of the CRCU were selected. Fulfillment with the protocol in terms of tumoral staging, surgical and adjuvant treatment, follow-up, interval until treatment, hospital stay, morbidity and early mortality, and the overall duration of the diagnostic-therapeutic process was analyzed. In addition, clinical workload was evaluated and a cost-minimization analysis was performed. RESULTS The CRCU reduced the interval until surgery (20.3 12.0 vs 28.0 20.4 days; p = 0.05), hospital stay (9.8 7.7 vs 14.5 9.3 days: p = 0.01), the time to the start of adjuvant treatment (29.4 10.2 vs 39.7 19.8 days; p = 0.03) and the overall duration of the process (60.4 23,8 vs 82.1 46.1 days; p = 0.05), representing a saving of 978.85 E per patient. This improvement took place despite an increase in clinical workload (24% in 5 years in relation to the number of admissions) and had no effect on morbidity (26 vs 24%; NS) or immediate mortality (6 vs 4%; NS). CONCLUSION Specialized multidisciplinary units increase the efficacy and efficiency of the management of patients with CRC.
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Affiliation(s)
- A Soriano
- Servicios de Gastroenterología. Institut de Malalties Digestives. Hospital Clinic. IDIBAPS. Universitat de Barcelona. Spain
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Pérez J, Taurá P, Rueda J, Balust J, Anglada T, Beltran J, Lacy AM, Garcia-Valdecasas JC. Role of dopamine in renal dysfunction during laparoscopic surgery. Surg Endosc 2002; 16:1297-301. [PMID: 12000983 DOI: 10.1007/s00464-001-9201-8] [Citation(s) in RCA: 41] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2002] [Accepted: 01/24/2002] [Indexed: 01/12/2023]
Abstract
BACKGROUND Sympathetic vascular insult and hemodynamic changes represent the most reliable explanation of renal impairment resulting from acute intraabdominal pressure. We evaluated the effects of low-dose dopamine administration during a long-lasting surgical laparoscopic procedure. METHODS For this study 40, patients submitted to a colorectal laparoscopic procedure with 15 mmHg of intraabdominal pressure were randomly allocated to two groups: 20 receiving 2 mg/kg/min of dopamine and 20 receiving the same perfusion of saline. Hemodynamic parameters, renal function, urinary output, and creatinine clearance, were studied. RESULTS The hemodynamic parameters were similar in both groups. The urinary output decreased during the intraoperative period only the saline group (p = 0.4). Then 2 h postoperatively, it increased in both groups, and no statistically significant differences were found between the groups. The creatinine clearance decreased in both groups during the intraoperative time, but it was worse in the saline group (-28 +/- 120 vs -194 +/- 106; p = 0.022). During the postoperative period, both groups showed improvement, but in control group the values remained lower than at baseline (p = 0.04), and significantly lower than in the dopamine group (230 +/- 337 vs 100 +/- 192; p = 0.012). CONCLUSIONS An intrabdominal pressure of 15 mmHg induces a time-limited renal dysfunction, and low doses of dopamine could prevent this undesirable effect.
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Affiliation(s)
- J Pérez
- Anesthesiology Department, Hospital Clinic of Barcelona, University of Barcelona, Villaroel 170, Barcelona, 08036, Spain.
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Pera M, Delgado S, García-Valdecasas JC, Pera M, Castells A, Piqué JM, Bombuy E, Lacy AM. The management of leaking rectal anastomoses by minimally invasive techniques. Surg Endosc 2002; 16:603-6. [PMID: 11972197 DOI: 10.1007/s00464-001-9097-3] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2001] [Accepted: 09/06/2001] [Indexed: 12/22/2022]
Abstract
BACKGROUND The salvage of a leaking rectal anastomosis has been reported in selected cases. Herein we present our experience in the management of rectal anastomotic dehiscence by minimally invasive techniques. METHODS A total of 94 patients underwent anterior rectal resection for rectal cancer in an 18-month period. The operation was laparoscopic-assisted in 76 cases (81%). RESULTS Clinical anastomotic dehiscences occurred in 10 cases (10.6%). Conservative therapy, including the percutaneous drainage of pelvic abscesses, was successful in three cases. Among the seven patients who required reoperation, the anastomosis was taken down in only one case. In four of these cases, the reoperation was performed laparoscopically, including peritoneal lavage and the creation of a diverting stoma. There were no complications resulting from the use of laparoscopy in the early postoperative period. Closure of the stoma was possible in eight patients. CONCLUSIONS The salvage of a leaking rectal anastomosis is feasible in the vast majority of these cases (80%). The combination of laparoscopy and interventional radiology is a good alternative to laparotomy in patients who have had previous laparoscopic rectal excision.
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Affiliation(s)
- M Pera
- Department of Gastrointestinal Surgery, Institute of Digestive Diseases, Hospital Clinic of Barcelona, Villarroel 170, Barcelona 08036, Spain.
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Targarona EM, Balague C, Cerdán G, Espert JJ, Lacy AM, Visa J, Trias M. Hand-assisted laparoscopic splenectomy (HALS) in cases of splenomegaly: a comparison analysis with conventional laparoscopic splenectomy. Surg Endosc 2002; 16:426-30. [PMID: 11928021 DOI: 10.1007/s00464-001-8104-z] [Citation(s) in RCA: 67] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2001] [Accepted: 09/20/2001] [Indexed: 12/12/2022]
Abstract
BACKGROUND Laparoscopic splenectomy (LS) is considerably more difficult to perform when the spleen is enlarged. The new technique of hand-assisted designed technique aimed to assist laparoscopic surgery allows the surgeon to insert his or her hand into the abdomen while maintaining the pneumoperitoneum, thus recovering the tactile sensation lost in conventional laparoscopic surgery. OBJECT In this study, we compared the immediate results of conventional LS and hand-assisted LS (HALS) in cases of splenomegaly. METHODS Between February 1993 and August 2001, 200 LS were attempted at two university hospitals. In 56 cases, splenomegaly (final spleen weight >700 g) was observed clinically or detected on radiological examination. We compared the first 36 patients operated on by conventional LS (group I) with the last consecutive 20 patients, who underwent HALS (group II). The study parameters were operative time, conversion rate, transfusion rate, morbidity and length of hospital stay. RESULTS The groups were comparable in terms of age (58 +/- 13 [ranges, l9-82] vs 58 +/- 16 years [range, 44-84] (ns), diagnosis, and spleen weight (1425 +/- 884 [range, 700-3400]) vs 1753 +/- 1124 g [range, 720-4500] (ns). HALS was associated with less morbidity (36% vs 10%) (ns), a shorter operative time (177 +/- 52 [range, 95-300]) vs 135 +/- 53 min [range, 85-270] (p <0.009), and a shorter hospital stay (6.3 +/- 3.3 [range, 3-14]) vs 4 +/- 1.2 [range, 2-7] days (p <0.05). CONCLUSION In cases of splenomegaly, HALS assisted laparoscopic surgery significantly facilitates the surgical maneuvers during LS while maintaining the advantages of a purely laparoscopic approach.
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Affiliation(s)
- E M Targarona
- Department of General and Digestive Surgery, Hospital of Sant Pau, Autonomous University of Barcelona, C/Padre Claret 167, 08025, Barcelona, Spain.
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Rull R, Garcia Valdecasas JC, Grande L, Fuster J, Lacy AM, González FX, Rimola A, Navasa M, Iglesias C, Visa J. Intrahepatic biliary lesions after orthotopic liver transplantation. Transpl Int 2002. [PMID: 11499901 DOI: 10.1111/j.1432-2277.2001.tb00031.x] [Citation(s) in RCA: 48] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
Intrahepatic biliary lesions (IBL) are rare (2-9%) after orthotopic liver transplantation (OLT). The aim was to evaluate the incidence, etiology and outcome. In nine years, a total 532 OLTs were performed in 481 patients. Twenty-four patients developed IBL. Eight were due to HAT, seven to ABOI, three to CDR and six to PI. The time until diagnosis of HAT is longest in patients (14+/-6) with IBL. ABOI is another cause of IBL. CDR is a rare cause of IBL, however when it takes place, patients must undergo Rtx. Finally, PI is a relevant cause of IBL. In order to suppress the incidence of IBL we should consider 1) the systematic use of Doppler-Ultrasound; 2) emergency reoperation of patients with HAT, 3) avoid ABOI in OLT; 4) Rtx in cases of CDR, and 5) OLT should still be performed as an emergency procedure.
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Affiliation(s)
- R Rull
- Liver Transplant Unit, Hospital Clinic, University of Barcelona, Spain
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32
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Rull R, Garcia Valdecasas JC, Grande L, Fuster J, Lacy AM, González FX, Rimola A, Navasa M, Iglesias C, Visa J. Intrahepatic biliary lesions after orthotopic liver transplantation. Transpl Int 2001; 14:129-34. [PMID: 11499901 DOI: 10.1007/s001470100320] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Intrahepatic biliary lesions (IBL) are rare (2-9%) after orthotopic liver transplantation (OLT). The aim was to evaluate the incidence, etiology and outcome. In nine years, a total 532 OLTs were performed in 481 patients. Twenty-four patients developed IBL. Eight were due to HAT, seven to ABOI, three to CDR and six to PI. The time until diagnosis of HAT is longest in patients (14+/-6) with IBL. ABOI is another cause of IBL. CDR is a rare cause of IBL, however when it takes place, patients must undergo Rtx. Finally, PI is a relevant cause of IBL. In order to suppress the incidence of IBL we should consider 1) the systematic use of Doppler-Ultrasound; 2) emergency reoperation of patients with HAT, 3) avoid ABOI in OLT; 4) Rtx in cases of CDR, and 5) OLT should still be performed as an emergency procedure.
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Affiliation(s)
- R Rull
- Liver Transplant Unit, Hospital Clinic, University of Barcelona, Spain
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33
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Delgado S, Lacy AM, Filella X, Castells A, García-Valdecasas JC, Pique JM, Momblán D, Visa J. Acute phase response in laparoscopic and open colectomy in colon cancer: randomized study. Dis Colon Rectum 2001; 44:638-46. [PMID: 11357021 DOI: 10.1007/bf02234558] [Citation(s) in RCA: 128] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
PURPOSE All types of trauma to the organism produce a systemic response that is proportional to the severity of the lesion caused. The more rapid clinical recovery during the postoperative period of patients undergoing laparoscopic-assisted colectomy vs. patients receiving conventional surgery suggests that laparoscopic surgery produces less surgical trauma. The aim of this randomized, prospective study was to compare acute phase postoperative response in patients diagnosed with colon neoplasm undergoing open segmentary colectomy vs. laparoscopic-assisted colectomy. METHODS From June 1994 to July 1997 the results of 97 patients (58 submitted to open colectomy and 39 undergoing laparoscopic-assisted colectomy) were analyzed. Blood determinations of cortisol, prolactin, C-reactive protein and interleukin-6 were performed before surgery and at 4, 12, 24, and 72 hours after surgery. RESULTS The plasma levels of cortisol and prolactin were higher in the postoperative period with both surgical techniques with no significant differences being observed. The levels of interleukin-6 achieved a maximum peak at 4 hours after surgery, later showing a decrease and practically achieving basal levels at 72 hours in both groups. The levels of interleukin-6 were higher with significant differences at 4, 12, and 24 hours in the patients undergoing open colectomy. The plasma levels of C-reactive protein were significantly lower at 72 hours in patients receiving laparoscopic-assisted colectomy. CONCLUSIONS The results obtained in this randomized, prospective study suggest that acute phase systemic response is attenuated in patients undergoing laparoscopic-assisted colectomy in comparison with patients receiving open colectomy.
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Affiliation(s)
- S Delgado
- Department of General and Digestive Surgery, Institute of Digestive Diseases ("IMD"), Hospital Clinic, University of Barcelona, Spain
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Bessa X, Elizalde JI, Boix L, Piñol V, Lacy AM, Saló J, Piqué JM, Castells A. Lack of prognostic influence of circulating tumor cells in peripheral blood of patients with colorectal cancer. Gastroenterology 2001; 120:1084-92. [PMID: 11266372 DOI: 10.1053/gast.2001.23245] [Citation(s) in RCA: 63] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
BACKGROUND AND AIMS Circulating tumor cells in peripheral blood may be detected using high-sensitivity molecular techniques in several types of solid neoplasms, but their significance in colorectal cancer is controversial. The aim of this study was to assess the prognostic value of carcinoembryonic antigen (CEA) messenger RNA (mRNA) detection in peripheral blood samples from patients with colorectal cancer. METHODS Peripheral vein blood samples from 95 consecutive patients with histologically confirmed colorectal carcinoma were obtained immediately before surgery to determine the presence of circulating tumor cells by use of a reverse-transcription polymerase chain reaction targeting CEA mRNA. Endpoints of the study were disease-free and overall survival. Results are referred to the whole series and, more importantly, to the 68 patients who underwent surgery for cure. RESULTS After a median follow-up of 42 months, 19 of 68 patients (28%) operated on for cure had tumor relapse. In addition, 50 of 68 patients (73%) were alive. The probability of disease-free and overall survival was dependent on lymph node metastases and degree of differentiation, but not on the presence of circulating tumor cells (disease-free survival: relative risk, 1.00; 95% confidence interval [CI], 0.39-2.22, P = 0.99; overall survival: relative risk, 0.91, 95% CI, 0.34-2.43; P = 0.84). Similar results were obtained when all 95 patients with colorectal cancer were analyzed (disease-free survival: relative risk, 1.11; 95% CI, 0.63-1.95; P = 0.71; overall survival: relative risk, 1.21; 95% CI, 0.63-2.30, P = 0.55). CONCLUSIONS Preoperative detection of blood circulating tumor cells by means of reverse-transcription polymerase chain reaction of CEA does not have prognostic significance in patients with colorectal cancer.
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Affiliation(s)
- X Bessa
- Department of Gastroenterology, Institut de Malalties Digestives, Hospital Clínic, Institut d'Investigacions Biomèdiques August Pi i Sunyer, University of Barcelona, Barcelona, Catalonia, Spain
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35
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Bessa X, Castells A, Lacy AM, Elizalde JI, Delgado S, Boix L, Piñol V, Pellisé M, García-Valdecasas JC, Piqué JM. Laparoscopic-assisted vs. open colectomy for colorectal cancer: influence on neoplastic cell mobilization. J Gastrointest Surg 2001; 5:66-73. [PMID: 11309650 DOI: 10.1016/s1091-255x(01)80015-9] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
Laparoscopic surgery for treatment of colorectal cancer has been suggested to enhance tumor dissemination. Recently, molecular techniques have been developed to detect micrometastatic disease in patients with solid tumors, with a higher accuracy than cytologic or immunohistochemical approaches. This study was undertaken to investigate the potential harmful effects of laparoscopic-assisted colectomy on neoplastic cell mobilization in patients with resectable colorectal cancer. Fifty patients with nonmetastatic colorectal cancer were randomly assigned to laparoscopic-assisted (LAC, n = 26) or open (OC, n = 24) colectomy. Peripheral venous blood samples were obtained preoperatively, immediately after tumor removal, and 24 hours later. In 10 patients from each treatment group, portal blood and peritoneal fluid samples were also obtained before and after resection. Neoplastic cells were detected by means of reverse transcriptase-polymerase chain reaction targeted to carcinoembryonic antigen (CEA) transcription. CEA mRNA was detected in peripheral venous blood samples from 35 of 50 colorectal cancer patients preoperatively. Among those 15 baseline-negative patients, four experienced conversion 24 hours after tumor resection (2 [33%] of 6 in the LAC group vs. 2 [22%] of 9 in the OC group; NS). At that time point, clearance of CEA mRNA expression was observed in 14 of the 35 baseline-positive patients (9 [45%] of 20 in the LAC group vs. 5 [33%] of 15 in the OC group; NS). In addition, only one patient in the LAC group with baseline-negative CEA mRNA expression experienced portal blood conversion after tumor removal, although his peripheral blood level remained negative. Finally, baseline peritoneal fluid CEA mRNA expression was never detected, but one patient in each group became positive postoperatively. These results confirm that preoperative and perioperative mobilization of neoplastic cells is a frequent occurrence in patients with colorectal cancer, but the surgical approach (LAC vs. OC) does not seem to be a determining factor.
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Affiliation(s)
- X Bessa
- Department of Gastroenterology, Institut de Malalties Digestives, Hospital Clínic, Institut d'Investigacious Biomèdiques August Pi y Sunyer, University of Barcelona, Villaroel 170, 08036 Barcelona, Catalonia, Spain
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Delgado S, Lacy AM, García Valdecasas JC, Balagué C, Pera M, Salvador L, Momblan D, Visa J. Could age be an indication for laparoscopic colectomy in colorectal cancer? Surg Endosc 2000; 14:22-6. [PMID: 10653230 DOI: 10.1007/s004649900004] [Citation(s) in RCA: 96] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
BACKGROUND The incidence of colorectal carcinoma increases in the elderly. Regardless of age as an isolated factor, postoperative complications represent the main factor in increasing hospital mortality. METHODS The aim of this study was to compare the short-term results (first 30 postoperative days) after laparoscopically assisted colectomy (LAC) and open segmental colectomy (OC) in colorectal carcinoma between two groups of patients, older than 70 and younger than 70 years of age. In the study from November 1993 to June 1998, 255 patients were evaluated to participate. RESULTS Peristalsis, oral intake, and discharge from the hospital occurred earlier in LAC than in OC treated patients, in the two age groups. The mean operative time was significantly longer in the LAC than in the OC patients in the two age groups. No differences were observed in morbidity between LAC and OC in the group younger than 70 years of age. However, the overall morbidity was significantly lower in the LAC group in patients older than 70 years. One patient in the LAC group older than 70 years died. CONCLUSION These results suggest that laparoscopically assisted colectomy may be particularly indicated in elderly patients.
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Affiliation(s)
- S Delgado
- Department of Gastrointestinal Surgery, Institute of Digestive Diseases, Hospital Clinic, University of Barcelona, Spain
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37
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Targarona EM, Espert JJ, Piulachs J, Lacy AM, Bosch F, Trias M. Laparoscopic removal of accessory spleens after splenectomy for relapsing autoimmune thrombocytopenic purpura. Eur J Surg 1999; 165:1199-200. [PMID: 10636559 DOI: 10.1080/110241599750007784] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/16/2022]
Affiliation(s)
- E M Targarona
- General and Digestive Surgery Service, Hospital Clinic, University of Barcelona, Spain
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39
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Sala-Blanch X, Fontanals J, Martínez-Palli G, Taurá P, Delgado S, Bosch J, Lacy AM, Visa J. Effects of carbon dioxide vs helium pneumoperitoneum on hepatic blood flow. Surg Endosc 1998; 12:1121-5. [PMID: 9716764 DOI: 10.1007/s004649900797] [Citation(s) in RCA: 35] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
BACKGROUND Elevated intraabdominal pressure due to gas insufflation for laparoscopic surgery may result in regional blood flow changes. Impairments of hepatic, splanchnic, and renal blood flow during peritoneal insufflation have been reported. Therefore we set out to investigate the effects of peritoneal insufflation with helium (He) and carbon dioxide (CO2) on hepatic blood flow in a porcine model. METHODS Twelve pigs were anesthetized and mechanically ventilated with a fixed tidal volume after the stabilization period. Peritoneal cavity was insufflated with CO2 (n = 6) or He (n = 6) to a maximum intraabdominal pressure of 15 mmHg. Hemodynamic parameters, gas exchange, and oxygen content were studied at baseline, 90 mm and 150 min after pneumoperitoneum, and 30 min after desufflation. Determination of hepatic blood flow with indocyanine green was made at all measured points by a one-compartment method using hepatic vein catheterization. RESULTS A similar decrease in cardiac output was observed during insufflation with both gases. Hepatic vein oxygen content decreased with respect to the baseline during He pneumoperitoneum (p < 0.05), but it did not change during CO2 insufflation. Hepatic blood flow was significantly reduced in both the He and CO2 pneumoperitoneums at 90 min following insufflation (63% and 24% decrease with respect to the baseline; p < 0.001 and p < 0.05, respectively) being this decrease marker in the He group (p = 0.02). CONCLUSIONS These findings suggest that helium intraperitoneal insufflation results in a greater impairment on hepatic blood flow than CO2 insufflation.
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Affiliation(s)
- X Sala-Blanch
- Department of Anesthesiology, Hospital Clinic, University of Barcelona, Villarroel 170, 08036 Barcelona, Spain
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40
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Lacy AM, Delgado S, García-Valdecasas JC, Castells A, Piqué JM, Grande L, Fuster J, Targarona EM, Pera M, Visa J. Port site metastases and recurrence after laparoscopic colectomy. A randomized trial. Surg Endosc 1998; 12:1039-42. [PMID: 9685538 DOI: 10.1007/s004649900776] [Citation(s) in RCA: 150] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND This study was performed to prospectively assess the impact of the laparoscopic approach to the patterns of port site metastases (PSM) and recurrence rate (RR) of resected colon carcinomas as compared with conventional colectomies. METHODS All patients were included in a prospective randomized trial comparing laparoscopic-assisted colectomy (LAC) versus open colectomy (OC) for colon cancer. The randomization was stratified for localization of the lesion. Patients with metastasic disease at time of the surgery were excluded. Follow-up in the outpatient clinic was done every 3 months for a minimum of 12 months. Endpoints for the study were metastasis at port site and laparotomy incision as well as recurrence rate. RESULTS Of 91 segmental colectomies performed from November 1993 to January 1996, there were 44 LAC and 47 OC. Patient data were similar in both groups (age, sex, Dukes stage, type of operation). Mean follow-up was 21.4 months, with a range of 13 to 41 months. There were no wounds or PSM in those series. RR was similar for both groups. For LAC, it was five of 31 (16.1%); for OC, it was six of 40 (15%). CONCLUSIONS The laparoscopic approach has a recurrence rate similar to that for open procedures for colon cancer. However, additional follow-up of these patients is needed before we can determine whether or not the laparoscopic approach influences overall survival.
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Affiliation(s)
- A M Lacy
- Department of Surgery, Hospital Clinic, University of Barcelona, Spain
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41
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Castells A, Bessa X, Daniels M, Ascaso C, Lacy AM, García-Valdecasas JC, Gargallo L, Novell F, Astudillo E, Filella X, Piqué JM. Value of postoperative surveillance after radical surgery for colorectal cancer: results of a cohort study. Dis Colon Rectum 1998; 41:714-23; discussion 723-4. [PMID: 9645739 DOI: 10.1007/bf02236257] [Citation(s) in RCA: 80] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
PURPOSE Early detection of recurrence after curative resection for primary colorectal cancer should improve patients' prognosis. However, the usefulness of postoperative surveillance programs has not been clarified yet. The present cohort study was aimed at assessing the effectiveness of systematic follow-up in patients with colorectal cancer who were operated on for cure, regarding both rate of tumor recurrence amenable to curative-intent surgery and rate of survival. METHODS One hundred ninety-nine colorectal cancer patients who underwent radical primary surgery were followed according a well-defined postoperative surveillance program, which consisted of laboratory studies (including serum carcinoembryonic antigen assay) every three months, physical examination and abdominal ultrasound or computed tomography every six months, and chest radiograph and total colonoscopy once per year. Cohorts were defined according to patients' compliance with the proposed follow-up program. A multivariate regression model was constructed to predict survival. RESULTS One hundred forty patients were considered to be compliant with the surveillance program, whereas the remaining 59 patients occasionally attended follow-up investigations or did not comply at all. Although there were no differences in the overall recurrence rate (38 vs. 41 percent; P = 0.52), curative-intent reoperation was possible in 18 patients (34 percent) of those with tumor recurrence in the compliant cohort but in only 3 patients (12 percent) in the noncompliant cohort (P = 0.05). Similarly, the probability of survival was higher in the compliant cohort, both regarding overall (63 vs. 37 percent at 5 years; P < 0.001) and cancer-related (69 vs. 49 percent at 5 years; P < 0.02) rates. Cox regression analysis disclosed that only a more advanced TNM stage (odds ratio, 8.17; 95 percent confidence interval, 1.13-59.29) and noncompliance with the postoperative surveillance program (odds ratio, 2.32; 95 percent confidence interval, 1.50-3.60) had an independent negative impact on survival. CONCLUSION Systematic postoperative surveillance in patients with colorectal cancer who were operated on for cure increases both the rate of tumor recurrence amenable to curative-intent surgery and rate of survival.
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Affiliation(s)
- A Castells
- Department of Gastroenterology, Hospital Clínic i Provincial, University of Barcelona, Catalonia, Spain
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Lacy AM, García-Valdecasas JC, Delgado S, Sabater L, Grande L, Fuster J, Visa J. Unusual intraoperative complication in laparoscopic sigmoidectomy. Surg Endosc 1998; 12:448-9. [PMID: 9569368 DOI: 10.1007/s004649900701] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
The authors report a case of complete rotation of the left colon after laparoscopic sigmoidectomy. Such an uncommon complication in open colectomies has not been previously described with the laparoscopic approach. During the performance of laparoscopic-assisted colectomies the proximal segment of the colon can be rotated when removing the specimen through a small incision. Therefore we recommend inspecting the position of the colon before the stapler is fired.
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Affiliation(s)
- A M Lacy
- Department of Surgery, Hospital Clínic, University of Barcelona, Villarroel 170, 08036 Barcelona, Spain
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Lacy AM. Application of composite resin for single-appointment anterior and posterior diastema closure. Pract Periodontics Aesthet Dent 1998; 10:279-288. [PMID: 9655061] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/22/2023]
Abstract
Due to aesthetic and periodontal factors, patients often seek treatment to close diastemata. This condition may be eliminated by either direct or indirect techniques. Indirect techniques generally require multiple visits to facilitate the placement of laminate, crown, or bridge restorations, and involve significant financial expense. Direct techniques can be economical and successful, although they present unique challenges in the achievement of satisfactory proximal contacts and contours. This article describes three clinical techniques that may be employed to treat anterior and posterior diastemata in a single appointment.
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Affiliation(s)
- A M Lacy
- Department of Restorative Dentistry, University of California, San Francisco 94143-0758, USA.
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44
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González FX, García-Valdecasas JC, Grande L, Pacheco JL, Cugat E, Fuster J, Lacy AM, Taurá P, López-Boado MA, Rimola A, Visa J. Vena cava vascular reconstruction during orthotopic liver transplantation: a comparative study. Liver Transpl Surg 1998; 4:133-40. [PMID: 9516565 DOI: 10.1002/lt.500040206] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
The aim of this study was to evaluate the influence of preserving the recipient's inferior vena cava during orthotopic liver transplantation (OLT) on hemodynamic alterations, blood component requirements, postoperative liver and renal function, as well as vascular-related complications. A total of 122 OLTs was studied. In 35 OLTs, venovenous bypass (BP) was used; in 35 OLTs, bypass was not used (NBP); and in 52 OLTs, the recipient's inferior vena cava was preserved (PC). Preservation of the inferior vena cava means that venous return is not compromised at any time during transplantation. The time of hepatectomy was not different among the three groups (208 +/- 11, 188 +/- 13, and 194 +/- 6 minutes for BP, NBP, and PC, respectively); however, the total operating time was significantly lower in PC patients (492 +/- 24, 459 +/- 18, and 419 +/- 10 minutes for BP, NBP, and PC, respectively; P = .004, ANOVA). Blood component requirements were significantly lower in patients with PC. For red blood cells, these were 15.2 +/- 2.6, 16 +/- 3.4, and 7.1 +/- 1.5 units for BP, NBP, and PC, respectively (P = .009, ANOVA), and for fresh-frozen plasma, these were 5.4 +/- .7, 5.8 +/- .9, and 3 +/- .4 L for BP, NBP, and PC, respectively (P = .005, ANOVA). Postoperative liver and renal function did not differ among the three groups. The incidence of surgical complications (bleeding and vascular) was similar. Preservation of the inferior vena cava of the recipient significantly reduces the magnitude of OLT.
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Affiliation(s)
- F X González
- Department of Surgery, Hospital Clínic i Provincial of Barcelona, University of Barcelona, Spain
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45
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Taura P, Lopez A, Lacy AM, Anglada T, Beltran J, Fernandez-Cruz L, Targarona E, Garcia-Valdecasas JC, Marin JL. Prolonged pneumoperitoneum at 15 mmHg causes lactic acidosis. Surg Endosc 1998; 12:198-201. [PMID: 9502694 DOI: 10.1007/s004649900633] [Citation(s) in RCA: 49] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
BACKGROUND Acute increases in intraabdominal pressure (IAP) induce systemic and regional circulatory changes. Besides, mechanical compression on the capillary beds may decrease oxygen availability to the tissues. The purpose of this clinical study was to analyze the effects of increased IAP on acid-base disturbances and plasma lactate levels during prolonged carbon dioxide pneumoperitoneum. METHODS Twenty-eight patients undergoing laparoscopic sigmoidectomy were included in this study. Fourteen of them (group A) had IAP of 15 +/- 1 mmHg while the remaining 14 (group B) had IAP of 10 +/- 1 mmHg. The control group included six patients undergoing conventional sigmoidectomy. RESULTS A progressive significant increase in PaCO2 was observed in the laparoscopic groups (p < 0.01). Plasma lactate levels in group A significantly increased 90 min after insufflation (p < 0.05) and reached the highest value 1 h after deflation (9.9 +/- 1 vs 31.9 +/- 2.5 mg/dl, p < 0.005). Simultaneously, arterial pH decreased in all groups; however, at 1 h after surgery, it was significantly lower (p = 0.02) in group A. There was a significant correlation between acid concentration due to lactate and lactate concentration (GA: R2 = 0.717, p = 0.03; GB: R2 = 0.879, p = 0.006 and GC: R2 = 0.853, p = 0.008). CONCLUSION High IAP causes lactic acidic accumulation in patients undergoing prolonged laparoscopic procedures.
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Affiliation(s)
- P Taura
- Department of Anesthesiology, Hospital Clinic, University of Barcelona, Villarroel 170, E-08036 Barcelona, Spain
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Grande L, Rull A, Rimola A, Manyalic M, Cabrer C, Garcia-Valdecasas JC, Navasa M, Fuster J, Lacy AM, González FX, López-Boado MA, Visa J. Impact of donor gender on graft survival after liver transplantation. Transplant Proc 1997; 29:3373-4. [PMID: 9414753 DOI: 10.1016/s0041-1345(97)00945-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Affiliation(s)
- L Grande
- Liver Transplant Unit, Hospital Clinic, University of Barcelona, Spain
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Grande L, Rull A, Rimola A, Garcia-Valdecasas JC, Manyalic M, Cabrer C, Fuster J, Lacy AM, González FX, López-Boado MA, Visa J. Outcome of patients undergoing orthotopic liver transplantation with elderly donors (over 60 years). Transplant Proc 1997; 29:3289-90. [PMID: 9414718 DOI: 10.1016/s0041-1345(97)00914-7] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Affiliation(s)
- L Grande
- Liver Transplant Unit, University of Barcelona, Spain
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Figueras J, Garcia-Valdecasas JC, Rafecas A, Grande L, Virgili J, Fuster JM, Fabregat J, Lacy AM, Casanovas T, Rimola A, Xiol X, Bruix J, Jaurrieta E, Visa J. Prognosis of hepatocarcinoma in liver transplantation in cirrhotic patients. Transplant Proc 1997; 29:495. [PMID: 9123099 DOI: 10.1016/s0041-1345(96)00222-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Affiliation(s)
- J Figueras
- Liver Transplant Units, Hospital Clinic, CSU Bellvitge, University of Barcelona, Spain
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Rull R, García-Valdecasas JC, Grande L, Tabet J, Fuster J, Lacy AM, Rimola A, Gonzalez FX, Ramos C, Visa J. Outcome after liver transplantation. Differences between two time periods: 1988-1991 and 1992-1995. Transplant Proc 1997; 29:471-2. [PMID: 9123087 DOI: 10.1016/s0041-1345(96)00209-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Affiliation(s)
- R Rull
- Department of Surgery, Hospital Clinic of Barcelona, Spain
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Lacy AM, García-Valdecasas JC, Delgado S, Grande L, Fuster J, Tabet J, Ramos C, Piqué JM, Cifuentes A, Visa J. Postoperative complications of laparoscopic-assisted colectomy. Surg Endosc 1997; 11:119-22. [PMID: 9069140 DOI: 10.1007/s004649900311] [Citation(s) in RCA: 89] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
BACKGROUND This study was performed to prospectively assess the complications of 118 consecutive patients who underwent laparoscopic assisted colorectal resections. METHODS The variables included were: indication for surgery, type of resection, duration of operation, duration of postoperative ileus, length of hospital stay, port-site recurrence, and complications in relation to the laparoscopic technique. RESULTS 118 Laparoscopic-assisted procedures were performed between July 1992 and October 1995. Surgical indications were: 106 patients for colonic malignancy, six for diverticulitis, two for Crohn's disease, two for benign polyps, one for endometriosis, and one for ischemic colitis. Fifteen patients required conversion to open techniques for completion of the operations (12.7%). The mean operating time was 168.8 min. The amount of operative blood loss was 98 ml. The mean time for passing flatus was 36 +/- 16 h. Mean postoperative stay was 5.4 (range 3-13) days. Eight patients (6.8%) sustained complications: four unrelated to laparoscopy (three wound infection, one anastomotic leak); and four complications related to the laparoscopic approach: one small-bowel obstruction, one trocar injury, one rotation of the anastomosis, and one misdiagnosed synchronous adenocarcinoma. CONCLUSIONS We suggest that with the development of improved technical devices and more experience, the indications for laparoscopic colectomy should continue to expand. The low incidence of infectious complications suggests an important role for the laparoscopic approach to colorectal surgery.
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Affiliation(s)
- A M Lacy
- Department of Surgery, Hospital Clínic, University of Barcelona, Villarroel 170, 08036 Barcelona, Spain
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