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Vaghiri S, Prassas D, Krieg S, Knoefel WT, Krieg A. Intracorporeal Versus Extracorporeal Colo-colic Anastomosis in Minimally-invasive Left Colectomy: a Systematic Review and Meta-analysis. J Gastrointest Surg 2023; 27:3024-3037. [PMID: 37698813 PMCID: PMC10837220 DOI: 10.1007/s11605-023-05827-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Accepted: 08/26/2023] [Indexed: 09/13/2023]
Abstract
PURPOSE The primary aim was to investigate the operative outcomes of intracorporeal (IA) and extracorporeal (EA) anastomosis in left-sided minimally-invasive colectomy. METHODS A comprehensive literature search was conducted for studies comparing operative outcomes and follow-up data of IA versus EA in minimally-invasive left colectomy. Studies that investigated recto-sigmoid resections using transanal circular staplers were excluded. Data from eligible studies were extracted, qualitatively assessed, and included in a meta-analysis. Odds ratios (ORs) and mean differences with 95 per cent confidence intervals were calculated. RESULTS Eight studies with a total of 750 patients were included (IA n = 335 versus EA n = 415). IA was associated with significantly lower overall morbidity (OR 0.40, 95% CI 0.26-0.61, p < 0.0001) and less frequent surgical site infection (SSI) (OR 0.27, 95% CI 0.12-0.61, p = 0.002) as primary outcomes compared to EA. Of the secondary outcomes, length of incision (SMD -2.51, 95% CI -4.21 to -0.81, p = 0.004), time to first oral diet intake (SMD -0.49, 95% CI -0.76 to -0.22, p = 0. 0004) and time to first bowel movement (SMD -0.40, 95% CI -0.71 to -0.09, p = 0.01) were significantly in favor of IA, while operative time was significantly shorter in the EA group (SMD 0.36, 95% CI 0.14-0.59, p = 0.001). CONCLUSIONS IA proves to be a safe and feasible option as it demonstrates benefits in terms of lower overall morbidity, fewer rates of SSI, smaller incision length, and faster postoperative gastrointestinal recovery despite a longer operative time compared to EA.
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Affiliation(s)
- Sascha Vaghiri
- Department of Surgery (A), Heinrich-Heine-University and University Hospital Duesseldorf, Moorenstr. 5, Bldg. 12.46, 40225, Duesseldorf, Germany
| | - Dimitrios Prassas
- Department of Surgery (A), Heinrich-Heine-University and University Hospital Duesseldorf, Moorenstr. 5, Bldg. 12.46, 40225, Duesseldorf, Germany
| | - Sarah Krieg
- Clinic for Gastroenterology, Hepatology and Infectious Diseases, Heinrich-Heine-University and University Hospital Duesseldorf, Duesseldorf, Germany
| | - Wolfram Trudo Knoefel
- Department of Surgery (A), Heinrich-Heine-University and University Hospital Duesseldorf, Moorenstr. 5, Bldg. 12.46, 40225, Duesseldorf, Germany
| | - Andreas Krieg
- Department of Surgery (A), Heinrich-Heine-University and University Hospital Duesseldorf, Moorenstr. 5, Bldg. 12.46, 40225, Duesseldorf, Germany.
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Solis-Pazmino P, Oka K, La K, Termeie O, Ponce O, Figueroa L, Weston A, Machry M, Cohen J, Barnajian M, Nasseri Y. Robotic right versus left colectomy for colorectal neoplasia: a systemic review and meta-analysis. J Robot Surg 2023; 17:1907-1915. [PMID: 37310528 DOI: 10.1007/s11701-023-01649-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2023] [Accepted: 05/31/2023] [Indexed: 06/14/2023]
Abstract
Previous studies comparing right and left colectomies have shown variable short-term outcomes. Despite the rapid adoption of robotics in colorectal operations, few studies have addressed outcome differences between robotic right (RRC) and left (RLC) colectomies. Therefore, we sought to compare the short-term outcomes of RRC and RLC for neoplasia. This is a systematic review and meta-analysis of articles published from the time of inception of the datasets to May 1, 2022. The electronic databases included English publications in Ovid MEDLINE In-Process and Other Non-Indexed Citations, Ovid MEDLINE, Ovid EMBASE, and Scopus. A total of 13,514 patients with colon neoplasia enrolled in 9 comparative studies were included. The overall mean age was 64.1 years (standard deviation [SD] ± 9.8), and there was a minor female predominance (52% female vs. 48% male). 8656 (64.0%) underwent RRC and 4858 (36.0%) underwent RLC. The ASA score 1 of - 2 in the LRC group was 37% vs. 21% in the R. Whereas the ASA score 3-4 was 62% in the LRC vs. 76% in RRC. Moreover, the mean of the Charlson Comorbidity Score in the LRC was 4.3 (SD 1.9) vs. 3.1 (SD 2.3) in the RRC. Meta-analysis revealed a significantly higher rate of ileus in RRC (10%) compared to RLC (7%) (OR 1.46, 95% CI 1.27-1.67). Additionally, operative time was significantly shorter by 22.6 min in RRC versus LRC (95% CI - 37.4-7.8; p < 0.001). There were no statistically significant differences between RRC and RLC in conversion to open operation, estimated blood loss, wound infection, anastomotic leak, reoperation, readmission, and hospital length of stay. In this only meta-analysis comparing RRC and LRC for colon neoplasia, we found that RRC was independently associated with a shorter operative time but increased risk of ileus.
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Affiliation(s)
- Paola Solis-Pazmino
- Surgery Group Los Angeles, Los Angeles, CA, USA.
- Surgery Department, Santa Casa de Porto Alegre, Porto Alegre, RS, Brazil.
- Knowledge and Evaluation Research Unit, Mayo Clinic, Rochester, MN, 55905, USA.
- CaTaLiNA-Cancer de Tiroides en Latino America, Quito, Ecuador.
| | | | - Kristina La
- Surgery Group Los Angeles, Los Angeles, CA, USA
| | | | - Oscar Ponce
- Knowledge and Evaluation Research Unit, Mayo Clinic, Rochester, MN, 55905, USA
- CaTaLiNA-Cancer de Tiroides en Latino America, Quito, Ecuador
| | - Luis Figueroa
- CaTaLiNA-Cancer de Tiroides en Latino America, Quito, Ecuador
- Facultad de Ciencias Médicas, Universidad Central del Ecuador, Quito, Ecuador
| | - Antonio Weston
- Surgery Department, Santa Casa de Porto Alegre, Porto Alegre, RS, Brazil
| | - Mayara Machry
- Surgery Department, Santa Casa de Porto Alegre, Porto Alegre, RS, Brazil
| | - Jason Cohen
- Surgery Group Los Angeles, Los Angeles, CA, USA
| | | | - Yosef Nasseri
- Surgery Group Los Angeles, Los Angeles, CA, USA
- Cedars-Sinai Medical Center, Los Angeles, CA, USA
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Bianchi PP, Salaj A, Rocco B, Formisano G. First worldwide report on Hugo RAS™ surgical platform in right and left colectomy. Updates Surg 2023; 75:775-780. [PMID: 36897505 DOI: 10.1007/s13304-023-01489-5] [Citation(s) in RCA: 11] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2023] [Accepted: 02/24/2023] [Indexed: 03/11/2023]
Abstract
The diffusion of robotic surgery is rapidly and constantly growing in different surgical specialties. Recently, novel robotic platforms have entered into the market. To date, however, most of the reports on their clinical use have specifically focused on gynecological and urological surgery. In this study, we present the first three robotic-assisted colectomies performed with the new Hugo RAS system (Medtronic, Minneapolis, MN, USA). The surgical team had previous robotic experience and completed simulation training and an official 2-day cadaver laboratory session. Operating room setting and trocar layout were planned and two full cadaver procedures were carried out (right and left colectomy). Onsite dry-run sessions were performed before tackling clinical cases. Three patients underwent robotic-assisted colectomies: one left colectomy, two right colectomies with complete mesocolic excision (CME) and high vascular ligation (HVL) at our Institution. Preoperative diagnosis was colonic adenocarcinoma in all cases. A description of the operative room setup, robotic arm configuration and docking angles is provided. Mean docking time and console time were 8 and 259 min, respectively. All the surgical steps were completed without critical surgical errors or high-priority alarms. Neither intraoperative complications nor conversions to open surgery were recorded. Postoperative courses were uneventful with a mean length of stay of 5 days. Further clinical data and experience are required for procedural standardization and potential integration of the system into robotic general surgery and colorectal programs.
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Affiliation(s)
- Paolo Pietro Bianchi
- Department of Surgery, Asst Santi Paolo e Carlo, Dipartimento di Scienze della Salute, University of Milan, Milan, Italy.
| | - Adelona Salaj
- Department of Surgery, Asst Santi Paolo e Carlo, Dipartimento di Scienze della Salute, University of Milan, Milan, Italy
| | - Bernardo Rocco
- Urology Unit, ASST Santi Paolo e Carlo, Dipartimento di Scienze della Salute, University of Milan, Milan, Italy
| | - Giampaolo Formisano
- Department of Surgery, Asst Santi Paolo e Carlo, Dipartimento di Scienze della Salute, University of Milan, Milan, Italy
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Ozgur I, Liska D, Valente MA, Smith N, Jia X, Catalano B, Steele SR, Gorgun E. Best surgical approach for splenic flexure colon cancers: Extended versus segmental resection? Am J Surg 2023; 225:454-9. [PMID: 36404169 DOI: 10.1016/j.amjsurg.2022.11.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2022] [Revised: 10/30/2022] [Accepted: 11/10/2022] [Indexed: 11/17/2022]
Abstract
BACKGROUND The optimal surgical treatment approach for splenic flexure colon cancers remains controversial regarding the type of resection. METHODS We hypothesized that both extended and segmental resections have similar surgical and oncologic outcomes. A retrospective review of prospectively collected database was performed on all patients who had colectomy for splenic flexure colon cancer between 1996 and 2018. RESULTS Of 142 patients, 119 underwent extended resection; therefore, this group was compared with the group which underwent segmental resection (n = 23). The groups were similar in age, sex, ASA scores, operative times, estimated blood loss, hospital length of stay, and postoperative complication rates (p > 0.05). Median follow-up was 9.58 years (IQR:5.46-16.48). Multivariable regression models demonstrated no significant association between resection approach and disease-free survival (HR 1.63 [95%CI:0.91-2.92]), as well as overall survival (HR 1.80 [95%CI:0.97; 3.36]). CONCLUSION In the treatment of splenic flexure colon cancer, segmental colon resections have similar oncologic outcomes when compared to extended colectomies.
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Andersen BT, Stimec BV, Kazaryan AM, Rancinger P, Edwin B, Ignjatovic D. Re-interpreting mesenteric vascular anatomy on 3D virtual and/or physical models, part II: anatomy of relevance to surgeons operating splenic flexure cancer. Surg Endosc 2022; 36:9136-9145. [PMID: 35773607 PMCID: PMC9652173 DOI: 10.1007/s00464-022-09394-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2022] [Accepted: 06/06/2022] [Indexed: 01/06/2023]
Abstract
BACKGROUND The splenic flexure is irrigated from two vascular areas, both from the middle colic and the left colic artery. The challenge for the surgeon is to connect these two vascular areas in an oncological safe procedure. MATERIALS AND METHODS The vascular anatomy, manually 3D reconstructed from 32 preoperative high-resolution CT datasets using Osirix MD, Mimics Medical and 3-matic Medical Datasets, were exported as STL-files, video clips, stills and supplemented with 3D printed models. RESULTS Our first major finding was the difference in level between the middle colic and the inferior mesenteric artery origins. We have named this relationship a mesenteric inter-arterial stair. The middle colic artery origin could be found cranial (median 3.38 cm) or caudal (median 0.58 cm) to the inferior mesenteric artery. The lateral distance between the two origins was 2.63 cm (median), and the straight distance 4.23 cm (median). The second finding was the different trajectories and confluence pattern of the inferior mesenteric vein. This vein ended in the superior mesenteric/jejunal vein (21 patients) or in the splenic vein (11 patients). The inferior mesenteric vein confluence could be infrapancreatic (17 patients), infrapancreatic with retropancreatic arch (7 patients) or retropancreatic (8 patients). Lastly, the accessory middle colic artery was present in ten patients presenting another pathway for lymphatic dissemination. CONCLUSION The IMV trajectory when accessible, is the solution to the mesenteric inter-arterial stair. The surgeon could safely follow the IMV to its confluence. When the IMV trajectory is not accessible, the surgeon could follow the caudal border of the pancreas.
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Affiliation(s)
- Bjarte Tidemann Andersen
- Department of Gastrointestinal Surgery, Østfold Hospital Trust, Grålum, Norway
- Institute for Clinical Medicine, University of Oslo, Oslo, Norway
| | - Bojan V Stimec
- Anatomy Sector, Teaching Unit, Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | - Airazat M Kazaryan
- Department of Gastrointestinal Surgery, Østfold Hospital Trust, Grålum, Norway.
- Institute for Clinical Medicine, University of Oslo, Oslo, Norway.
- Interventional Centre, Oslo University Hospital - Rikshospitalet, Oslo, Norway.
- Department of Surgery, Fonna Hospital Trust, Odda, Norway.
- Department of Faculty Surgery, I.M. Sechenov First, Moscow State Medical University, Moscow, Russia.
- Department of Surgery N 2, Yerevan State Medical University after M. Heratsi, Yerevan, Armenia.
| | - Peter Rancinger
- Department of Gastrointestinal Surgery, Østfold Hospital Trust, Grålum, Norway
| | - Bjørn Edwin
- Institute for Clinical Medicine, University of Oslo, Oslo, Norway
- Interventional Centre, Oslo University Hospital - Rikshospitalet, Oslo, Norway
- Department of Gastrointestinal and Pediatric Surgery, Oslo University Hospital-Rikshospitalet, Oslo, Norway
| | - Dejan Ignjatovic
- Institute for Clinical Medicine, University of Oslo, Oslo, Norway
- Department of Digestive Surgery, Akershus University Hospital, Lørenskog, Norway
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Huang Z, Li T, Zhang G, Zhou Z, Shi H, Tang C, Yang L, Lei X. Comparison of open, laparoscopic, and robotic left colectomy for radical treatment of colon cancer: a retrospective analysis in a consecutive series of 211 patients. World J Surg Oncol 2022; 20:345. [PMID: 36253768 PMCID: PMC9578184 DOI: 10.1186/s12957-022-02796-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2022] [Accepted: 09/14/2022] [Indexed: 11/13/2022] Open
Abstract
Background Robotic surgery has been widely used in the radical treatment of colonic cancer. However, it is unclear what advantages the robotic approach offers over other approaches in left colectomy. This study aims to explore the advantage of robotic surgery in left colectomy by comparing open, laparoscopic, and robotic surgery. Methods A retrospective analysis was performed on the clinical data of patients with radical left colectomy for colon cancer who were admitted to the Department of General Surgery, The First Affiliated Hospital of Nanchang University, from November 2012 to November 2017. Two hundred eleven patients included were divided into the open surgery group (OS, n=49), laparoscopic surgery group (LS, n=92), and robotic surgery group (RS, n=70) according to surgical techniques. The clinicopathologic data were collected for clinical outcome assessment. Finally, the clinical value of RS in radical left colectomy was further evaluated by propensity score matching (PSM) analysis. Results Three groups were similar in demographics and clinical characteristics. Compared with OS, LS and RS groups had better intraoperative and perioperative clinical outcomes. Moreover, the RS group exhibited the minimum operative times, length of stay (LOS), and evaluated blood loss. LS and RS also exhibited less perioperative and postoperative long-term complications. Three groups showed similar postoperative pathological outcomes. The overall survival and disease-free survival were also similar among the three groups (all P > 0.05). Cox regression analysis showed surgical approach was not a prognostic factor for overall survival (P = 0.671) and disease-free survival (P = 0.776). PSM analysis of RS and LS by clinical characteristics showed RS showed shorter operation time (P < 0.001) and LOS for patients without complications (P = 0.005). However, no significant differences were found in perioperative and long-term postoperative complications, pathological outcomes, overall survival, and disease-free survival. Conclusions Among three techniques for radical left colectomy, LS and RS had significant advantages over OS in short-term clinical outcomes, and no significant differences were found in overall, disease-free survival, local recurrence, and distant metastasis incidence. Moreover, RS shows better perioperative clinical outcomes but without compromising survival compared with LS. Supplementary Information The online version contains supplementary material available at 10.1186/s12957-022-02796-8.
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Affiliation(s)
- Zhixiang Huang
- Gastrointernal Surgical Institute, Nanchang University, Nanchang, 330006, Jiangxi, China.,China-Japan Union Hospital Of Jilin University, 130000, Chang Chun, China
| | - Taiyuan Li
- Gastrointernal Surgical Institute, Nanchang University, Nanchang, 330006, Jiangxi, China.,Department of General Surgery, The First Affiliated Hospital of Nanchang University, Nanchang, 330006, Jiangxi, China
| | - Genghua Zhang
- Department of General Surgery, The First Affiliated Hospital of Nanchang University, Nanchang, 330006, Jiangxi, China
| | - Zhen Zhou
- Department of General Surgery, The First Affiliated Hospital of Nanchang University, Nanchang, 330006, Jiangxi, China
| | - Haoran Shi
- Department of General Surgery, The First Affiliated Hospital of Nanchang University, Nanchang, 330006, Jiangxi, China
| | - Cheng Tang
- Department of General Surgery, The First Affiliated Hospital of Nanchang University, Nanchang, 330006, Jiangxi, China
| | - Lingling Yang
- Department of Gastroenterology, The Second Affiliated Hospital of Nanchang University, Nanchang, 330006, Jiangxi, China
| | - Xiong Lei
- Gastrointernal Surgical Institute, Nanchang University, Nanchang, 330006, Jiangxi, China. .,Department of General Surgery, The First Affiliated Hospital of Nanchang University, Nanchang, 330006, Jiangxi, China.
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7
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Solaini L, Bocchino A, Avanzolini A, Annunziata D, Cavaliere D, Ercolani G. Robotic versus laparoscopic left colectomy: a systematic review and meta-analysis. Int J Colorectal Dis 2022; 37:1497-1507. [PMID: 35650261 PMCID: PMC9262793 DOI: 10.1007/s00384-022-04194-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/25/2022] [Indexed: 02/04/2023]
Abstract
BACKGROUND This study aimed to review the new evidence to understand whether the robotic approach could find some clear indication also in left colectomy. METHODS A systematic review of studies published from 2004 to 2022 in the Web of Science, PubMed, and Scopus databases and comparing laparoscopic (LLC) and robotic left colectomy (RLC) was performed. All comparative studies evaluating robotic left colectomy (RLC) versus laparoscopic (LLC) left colectomy with at least 20 patients in the robotic arm were included. Abstract, editorials, and reviews were excluded. The Newcastle-Ottawa Scale for cohort studies was used to assess the methodological quality. The random-effect model was used to calculate pooled effect estimates. RESULTS Among the 139 articles identified, 11 were eligible, with a total of 52,589 patients (RLC, n = 13,506 versus LLC, n = 39,083). The rate of conversion to open surgery was lower for robotic procedures (RR 0.5, 0.5-0.6; p < 0.001). Operative time was longer for the robotic procedures in the pooled analysis (WMD 39.1, 17.3-60.9, p = 0.002). Overall complications (RR 0.9, 0.8-0.9, p < 0.001), anastomotic leaks (RR 0.7, 0.7-0.8; p < 0.001), and superficial wound infection (RR 3.1, 2.8-3.4; p < 0.001) were less common after RLC. There were no significant differences in mortality (RR 1.1; 0.8-1.6, p = 0.124). There were no differences between RLC and LLC with regards to postoperative variables in the subgroup analysis on malignancies. CONCLUSIONS Robotic left colectomy requires less conversion to open surgery than the standard laparoscopic approach. Postoperative morbidity rates seemed to be lower during RLC, but this was not confirmed in the procedures performed for malignancies.
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Affiliation(s)
- Leonardo Solaini
- grid.6292.f0000 0004 1757 1758Department of Medical and Surgical Sciences (DIMEC), University of Bologna, Bologna, Italy ,grid.415079.e0000 0004 1759 989XGeneral and Oncologic Surgery, Morgagni-Pierantoni Hospital, Ausl Romagna, Forlì, Italy
| | - Antonio Bocchino
- grid.6292.f0000 0004 1757 1758Department of Medical and Surgical Sciences (DIMEC), University of Bologna, Bologna, Italy
| | - Andrea Avanzolini
- grid.415079.e0000 0004 1759 989XGeneral and Oncologic Surgery, Morgagni-Pierantoni Hospital, Ausl Romagna, Forlì, Italy
| | - Domenico Annunziata
- grid.415079.e0000 0004 1759 989XGeneral and Oncologic Surgery, Morgagni-Pierantoni Hospital, Ausl Romagna, Forlì, Italy
| | - Davide Cavaliere
- grid.415079.e0000 0004 1759 989XGeneral and Oncologic Surgery, Morgagni-Pierantoni Hospital, Ausl Romagna, Forlì, Italy
| | - Giorgio Ercolani
- grid.6292.f0000 0004 1757 1758Department of Medical and Surgical Sciences (DIMEC), University of Bologna, Bologna, Italy ,grid.415079.e0000 0004 1759 989XGeneral and Oncologic Surgery, Morgagni-Pierantoni Hospital, Ausl Romagna, Forlì, Italy
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Nasseri Y, Kasheri E, Oka K, Cox B, Cohen J, Ellenhorn J, Barnajian M. Minimally invasive right versus left colectomy for cancer: does robotic surgery mitigate differences in short-term outcomes? J Robot Surg 2021; 16:875-881. [PMID: 34581955 DOI: 10.1007/s11701-021-01310-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2021] [Accepted: 09/19/2021] [Indexed: 01/11/2023]
Abstract
Studies comparing right (RC) and left colectomies (LC) show higher rates of ileus in RC and higher wound infection and anastomotic leak rates in LC. However, prior studies did not include robotic procedures. We compared short-term outcomes of laparoscopic and robotic RC and LC for cancer, with sub-analysis of robotic procedures. In a retrospective review of a prospective database, preoperative factors, intraoperative events, and 30-day postoperative outcomes were compared. Student's t tests and Chi-square tests were used for continuous and categorical variables, respectively. A logistic binomial regression was performed to assess whether type of surgery was associated with postoperative complications. Between January 2014 and August 2020, 115 patients underwent minimally invasive RC or LC for cancer. Sixty-eight RC [30 (44.1%) laparoscopic, 38 (55.9%) robotic] and 47 LC [13 (27.6%) laparoscopic, 34 (72.4%) robotic] cases were included. On univariate analysis, RC patients had significantly higher overall postoperative complications but no differences in rates of ileus/small bowel obstruction, wound infection, time to first flatus/bowel movement, length of hospital stay, and 30-day readmissions. On multivariate analysis, there was no significant difference in overall complications and laparoscopic surgery had a 2.5 times higher likelihood of complications than robotic surgery. In sub-analysis of robotic cases, there was no significant difference among all outcome variables. Previously reported outcome differences between laparoscopic RC and LC for cancer may be mitigated by robotic surgery.
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Affiliation(s)
- Yosef Nasseri
- Surgery Group of Los Angeles, 8635 West 3rd Street, Suite 880W, Los Angeles, CA, 90048, USA. .,Department of Colorectal Surgery, Cedars-Sinai Medical Center, Los Angeles, CA, USA.
| | - Eli Kasheri
- Surgery Group of Los Angeles, 8635 West 3rd Street, Suite 880W, Los Angeles, CA, 90048, USA
| | - Kimberly Oka
- Surgery Group of Los Angeles, 8635 West 3rd Street, Suite 880W, Los Angeles, CA, 90048, USA
| | - Brian Cox
- Department of Pathology, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Jason Cohen
- Surgery Group of Los Angeles, 8635 West 3rd Street, Suite 880W, Los Angeles, CA, 90048, USA.,Department of General Surgery, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Joshua Ellenhorn
- Surgery Group of Los Angeles, 8635 West 3rd Street, Suite 880W, Los Angeles, CA, 90048, USA.,Department of Surgical Oncology, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Moshe Barnajian
- Surgery Group of Los Angeles, 8635 West 3rd Street, Suite 880W, Los Angeles, CA, 90048, USA.,Department of Colorectal Surgery, Cedars-Sinai Medical Center, Los Angeles, CA, USA
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9
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Lochman P, Páral J. Primary Gastric Lymphoma Invading Spleen, Pancreas, and Transverse Colon. Case Rep Oncol 2021; 14:928-930. [PMID: 34248560 PMCID: PMC8255734 DOI: 10.1159/000516759] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2021] [Accepted: 04/12/2021] [Indexed: 11/29/2022] Open
Abstract
Primary gastric lymphoma is a relatively rare tumour which is not primarily indicated on for surgical treatment. We present a case of locally advanced primary gastric lymphoma with penetration to the surrounding organs that had to be managed surgically. The proximal gastrectomy with splenectomy, distal pancreatectomy, and left colectomy was performed. We reached R0 resection, and patient was recovered well.
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Affiliation(s)
- Petr Lochman
- Department of Field Surgery, Faculty of Military Health Sciences, University of Defence, Hradec Králové, Czechia.,Department of Surgery, Charles University Faculty of Medicine and University Hospital, Hradec Králové, Czechia
| | - Jiří Páral
- Department of Field Surgery, Faculty of Military Health Sciences, University of Defence, Hradec Králové, Czechia.,Department of Surgery, Charles University Faculty of Medicine and University Hospital, Hradec Králové, Czechia
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Bardol T, Souche R, Genet D, Ferrandis C, Guillon F, Pirlet I, Fabre JM. Outcomes of elective left colectomy in renal-transplanted patients: a single-center case-control study (LECoRT study). Int J Colorectal Dis 2021; 36:1209-1219. [PMID: 33511479 DOI: 10.1007/s00384-021-03860-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/21/2021] [Indexed: 02/04/2023]
Abstract
PURPOSE Renal-transplanted patients are reported to have a high anastomotic leakage (AL) rate after colorectal surgery. We aimed to define AL-related morbidity and mortality rates after elective left colectomy in renal-transplanted patients. METHODS Data were prospectively collected between 2010 and 2015 from patients who underwent elective left colectomy with supra-peritoneal anastomosis in a single French referral hospital. We compared AL rate, and morbidity and mortality rates between renal-transplanted patients and controls. RESULTS We identified 120 patients who underwent elective left colectomy during the study period. We retrospectively divided this cohort into 20 (17%) kidney-transplanted recipients (KTR-group) and the remaining 100 patients comprised the control group (C-group). There were no significant differences in sex, age, ASA score, body mass index, history of abdominal surgery and benign/malignant disease ratio between the KTR-group and the C-group. The AL rate was approximately four times higher in the KTR-group versus the C-group (25% vs 7%, p = 0.028). Intra-abdominal septic complications (p = 0.0005) and reoperation rates (p = 0.025) were also higher in the KTR-group. The laparoscopic approach was performed less in the KTR-group (35% versus 93%, p < 0.0001). CONCLUSION Renal transplantation was identified as a risk factor of AL following elective left colectomy, as well as increased intra-abdominal septic morbidity and higher reoperation rate. Further multicentric studies are required to identify potential independent risk factors of AL after colorectal surgery in these frail populations. TRIAL REGISTRATION The present study was declared on ClinicalTrials.gov (ID: NCT04495023).
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Affiliation(s)
- Thomas Bardol
- Digestive and Mini-invasive Surgery Unit, Department of Digestive Surgery and Transplantation, Montpellier University Hospital, University of Montpellier-Nimes, 641 Avenue du Doyen Gaston Giraud, 34090, Montpellier, France.
| | - Regis Souche
- Digestive and Mini-invasive Surgery Unit, Department of Digestive Surgery and Transplantation, Montpellier University Hospital, University of Montpellier-Nimes, 641 Avenue du Doyen Gaston Giraud, 34090, Montpellier, France
| | - Diane Genet
- Digestive and Mini-invasive Surgery Unit, Department of Digestive Surgery and Transplantation, Montpellier University Hospital, University of Montpellier-Nimes, 641 Avenue du Doyen Gaston Giraud, 34090, Montpellier, France
| | - Charlotte Ferrandis
- Digestive and Mini-invasive Surgery Unit, Department of Digestive Surgery and Transplantation, Montpellier University Hospital, University of Montpellier-Nimes, 641 Avenue du Doyen Gaston Giraud, 34090, Montpellier, France
| | - Françoise Guillon
- Digestive and Mini-invasive Surgery Unit, Department of Digestive Surgery and Transplantation, Montpellier University Hospital, University of Montpellier-Nimes, 641 Avenue du Doyen Gaston Giraud, 34090, Montpellier, France
| | - Isabelle Pirlet
- Digestive and Mini-invasive Surgery Unit, Department of Digestive Surgery and Transplantation, Montpellier University Hospital, University of Montpellier-Nimes, 641 Avenue du Doyen Gaston Giraud, 34090, Montpellier, France
- Department of Visceral and Digestive Surgery, Hospital Center of Dunkerque, Avenue Louis Herbeaux, 59240, Dunkerque, France
| | - Jean-Michel Fabre
- Digestive and Mini-invasive Surgery Unit, Department of Digestive Surgery and Transplantation, Montpellier University Hospital, University of Montpellier-Nimes, 641 Avenue du Doyen Gaston Giraud, 34090, Montpellier, France
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11
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Andersen BT, Stimec BV, Edwin B, Kazaryan AM, Maziarz PJ, Ignjatovic D. Re-interpreting mesenteric vascular anatomy on 3D virtual and/or physical models: positioning the middle colic artery bifurcation and its relevance to surgeons operating colon cancer. Surg Endosc 2021; 36:100-108. [PMID: 33492511 PMCID: PMC8741724 DOI: 10.1007/s00464-020-08242-8] [Citation(s) in RCA: 4] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2020] [Accepted: 12/16/2020] [Indexed: 12/14/2022]
Abstract
Background The impact of the position of the middle colic artery (MCA) bifurcation
and the trajectory of the accessory MCA (aMCA) on adequate lymphadenectomy when
operating colon cancer have as of yet not been described and/or analysed in the
literature. The aim of this study was to determine the MCA bifurcation position to
anatomical landmarks and to assess the trajectory of aMCA. Methods The colonic vascular anatomy was manually reconstructed in 3D from
high-resolution CT datasets using Osirix MD and 3-matic Medical and analysed. CT
datasets were exported as STL files and supplemented with 3D printed models when
required. Results Thirty-two datasets were analysed. The MCA bifurcation was left to the
superior mesenteric vein (SMV) in 4 (12.1%), in front of SMV in 17 (53.1%) and right
to SMV in 11 (34.4%) models. Median distances from the MCA origin to bifurcation were
3.21 (1.18–15.60) cm. A longer MCA bifurcated over or right to SMV, while a shorter
bifurcated left to SMV (r = 0.457, p = 0.009). The main MCA direction was towards right in
19 (59.4%) models. When initial directions included left, the bifurcation occurred
left to or anterior to SMV in all models. When the initial directions included right,
the bifurcation occurred anterior or right to SMV in all models. The aMCA was found
in 10 (31.3%) models, following the inferior mesenteric vein (IMV) in 5 near the
lower pancreatic border. The IMV confluence was into SMV in 18 (56.3%), splenic vein
in 11 (34.4%) and jejunal vein in 3 (9.4%) models. Conclusion Awareness of the wide range of MCA bifurcation positions reported is
crucial for the quality of lymphadenectomy performed. The aMCA occurs in 31.3% models
and its trajectory is in proximity to the lower pancreatic border in one half of
models, indicating that it needs to be considered when operating splenic flexure
cancer. Supplementary information The online version of this article (10.1007/s00464-020-08242-8) contains supplementary material, which is available to authorized
users.
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Affiliation(s)
- Bjarte T Andersen
- Department of Gastrointestinal Surgery, Østfold Hospital Trust, PO Box 300, 1714, Grålum, Norway.,Institute for Clinical Medicine, Medical Faculty, University of Oslo, Oslo, Norway
| | - Bojan V Stimec
- Anatomy Sector, Teaching Unit, Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | - Bjørn Edwin
- Intervention Centre and Department of Hepatopancreatobiliary Surgery, Oslo University Hospital - Rikshospitalet, Oslo, Norway.,Institute for Clinical Medicine, Medical Faculty, University of Oslo, Oslo, Norway
| | - Airazat M Kazaryan
- Department of Gastrointestinal Surgery, Østfold Hospital Trust, PO Box 300, 1714, Grålum, Norway. .,Intervention Centre and Department of Hepatopancreatobiliary Surgery, Oslo University Hospital - Rikshospitalet, Oslo, Norway. .,Institute for Clinical Medicine, Medical Faculty, University of Oslo, Oslo, Norway. .,Department of Faculty Surgery, I.M. Sechenov First Moscow State Medical University, Moscow, Russia. .,Department of Surgery N 2, Yerevan State Medical University After M.Heratsi, Yerevan, Armenia.
| | - Przemyslaw J Maziarz
- Department of Digestive Surgery, Akershus University Hospital, Lørenskog, Norway.,Lancet Kirurgisk Praksis, Rolvsøy, Norway
| | - Dejan Ignjatovic
- Institute for Clinical Medicine, Medical Faculty, University of Oslo, Oslo, Norway.,Department of Digestive Surgery, Akershus University Hospital, Lørenskog, Norway
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12
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Salem JF, Agarwal S, Schoonyoung H, Martin C, Marks JH. Initial clinical experience with Single-Port robotic (SP r) left colectomy using the SP surgical system: description of the technique. Surg Endosc 2020; 35:4022-4027. [PMID: 33211162 DOI: 10.1007/s00464-020-08159-2] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [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: 06/06/2020] [Accepted: 11/11/2020] [Indexed: 12/29/2022]
Abstract
BACKGROUND The daVinci Single-Port (SP) robot is a new robotic platform designed to overcome the challenges of Single-Incision Laparoscopic Surgery. The objective of this study is to demonstrate the feasibility and technical aspects of SP robotic (SP r) left colectomy using the SP platform. METHODS Under Institutional Review Board approval and registration on ClinicalTrials.gov, we performed SP rLeft colectomy using the daVinci SP surgical system on four patients. The primary end-point of this study was to report and describe the technical feasibility to perform SP rLeft colectomy. The secondary end-points included perioperative metrics and outcomes. RESULTS Four patients underwent successful SP rLeft colectomy for diverticulitis through a single incision (average size: 4.4 cm) without intraoperative complications or conversions. The robot was docked 2.7 times on average (range 2-4). The average docking time was 8.4 min (range: 3-33 min). The mean estimated blood loss was 91 mL (range: 20-250 mL). There were no morbidities or mortalities. Patients were discharged on POD 2 and 3. CONCLUSION We demonstrated in this initial clinical series the SP rLeft colectomy to be feasible and safe to perform in select patients. The SP robot's single-arm design and flexible instruments have shown to provide excellent visualization and retraction with minimal collisions. We predict that the SP robot will be widely utilized in the field of colorectal surgery as it becomes available to colorectal surgeons. Further experience and larger studies are needed to define the advantages and identify the problems with the SP rLeft colectomy.
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Affiliation(s)
- Jean F Salem
- The Colorectal Center at Lankenau Medical Center, Division of Colorectal Surgery, Medical Science Building, Suite 375, 100 East Lancaster Avenue, Wynnewood, PA, 19096, USA
| | - Samir Agarwal
- The Colorectal Center at Lankenau Medical Center, Division of Colorectal Surgery, Medical Science Building, Suite 375, 100 East Lancaster Avenue, Wynnewood, PA, 19096, USA
| | - Henry Schoonyoung
- The Colorectal Center at Lankenau Medical Center, Division of Colorectal Surgery, Medical Science Building, Suite 375, 100 East Lancaster Avenue, Wynnewood, PA, 19096, USA
| | - Charlie Martin
- The Colorectal Center at Lankenau Medical Center, Division of Colorectal Surgery, Medical Science Building, Suite 375, 100 East Lancaster Avenue, Wynnewood, PA, 19096, USA
| | - John H Marks
- The Colorectal Center at Lankenau Medical Center, Division of Colorectal Surgery, Medical Science Building, Suite 375, 100 East Lancaster Avenue, Wynnewood, PA, 19096, USA.
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13
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de'Angelis N, Martínez-Pérez A, Winter DC, Landi F, Vitali GC, Le Roy B, Coccolini F, Brunetti F, Celentano V, Di Saverio S, Ris F, Fuks D, Espin E; SFC Study Group. Extended right colectomy, left colectomy, or segmental left colectomy for splenic flexure carcinomas: a European multicenter propensity score matching analysis. Surg Endosc 2021; 35:661-72. [PMID: 32072288 DOI: 10.1007/s00464-020-07431-9] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2019] [Accepted: 02/10/2020] [Indexed: 12/13/2022]
Abstract
BACKGROUND The surgical resection of the splenic flexure carcinoma (SFC) is challenging and the optimal surgical procedure for SFCs remains a matter of debate. The present study aimed to compare in a multicenter European sample of patients the short- and long-term outcomes of extended right (ERC) vs. left (LC) vs. segmental left colectomy (SLC) for SFCs. METHODS This retrospective multicenter study analyzed the surgical and oncological outcomes of SFC patients undergoing elective curative intent surgery between 2000 and 2018. Descriptive and exploratory analyses were first conducted on the whole sample. Outcomes of the different procedures (ERC vs. LC vs. SLC) were then compared using propensity score matching for multilevel treatment. Overall (OS) and disease-free survival (DFS) were evaluated by Kaplan-Meier method. RESULTS From a total of 399 SFC patients, 143 (35.8%) underwent ERC, 131 (32.8%) underwent LC, and 125 (31.4%) underwent SLC. Overall, 297 (74.4%) were laparoscopic procedures. An increase in operative time, time to flatus, time to regular diet, and hospital stay was observed with the progressive extension of SFC resection. ERC was associated with significantly increased risk of postoperative ileus compared to both LC and SLC. A significantly greater number of lymph nodes were retrieved by ERC, but the objective of at least 12 retrieved lymph nodes was achieved in 85% of patients, without procedure-related differences. No differences were observed in OS or DFS between ERC, LC, and SLC. CONCLUSION The present study supports the resection of SFCs by colon-sparing surgical techniques, such as SLC.
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14
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Taira T, Murono K, Nozawa H, Hojo D, Kawai K, Hata K, Tanaka T, Ishihara S. A cross sectional study to investigate internal hernia post left-sided colectomy preserving superior rectal artery. Ann Med Surg (Lond) 2019; 48:124-128. [PMID: 31763040 PMCID: PMC6864359 DOI: 10.1016/j.amsu.2019.10.026] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [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: 07/02/2019] [Revised: 10/26/2019] [Accepted: 10/28/2019] [Indexed: 01/18/2023] Open
Abstract
Background and Purpose: Intestinal obstruction caused by an internal hernia projecting through a mesenteric defect is a rare sequela of laparoscopic colectomy, as surgeons usually leave such defects open. In this study, we investigated cases of internal hernia after laparoscopic left-sided colectomy. Methods Data of 308 patients who underwent laparoscopic left hemicolectomy or sigmoidectomy at our institute between 2013 and 2018 were retrospectively reviewed. Patient characteristics and surgical variables were analyzed. The distance between the superior rectal artery (SRA) and abdominal aorta at the level of aortic bifurcation was measured using postoperative computed tomography in patients who underwent SRA-preserving colectomy. Results In all, 3 patients (0.97%), all of whom had undergone colostomy without anastomosis and with SRA preservation, developed internal hernia passing between the SRA and the aorta. The distance between the SRA and abdominal aorta in patients who underwent ostomy was significantly more than that in patients who underwent non-ostomy (10.6 mm vs. 4.7 mm, respectively, p < 0.001). Conclusions SRA preservation and stoma construction are potential risk factors for internal hernia after laparoscopic left-sided colectomy. Lifting of the SRA due to stoma construction possibly enlarges the space between the SRA and aorta. When colostomy is created, it is important to evaluate the space behind the SRA.
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Affiliation(s)
- Tetsuro Taira
- Department of Surgical Oncology, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan
| | - Koji Murono
- Department of Surgical Oncology, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan
| | - Hiroaki Nozawa
- Department of Surgical Oncology, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan
| | - Daisuke Hojo
- Department of Surgical Oncology, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan
| | - Kazushige Kawai
- Department of Surgical Oncology, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan
| | - Keisuke Hata
- Department of Surgical Oncology, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan
| | - Toshiaki Tanaka
- Department of Surgical Oncology, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan
| | - Soichiro Ishihara
- Department of Surgical Oncology, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan
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15
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Ogura A, Kobayashi R, Kawai S, Takagi K, Kawai K, Maeda T, Aritake T, Nagano N, Kamiya S. Cranial-first approach of laparoscopic left colectomy for T4 descending colon cancer invading the Gerota's fascia. Surg Case Rep 2019; 5:159. [PMID: 31659502 PMCID: PMC6816766 DOI: 10.1186/s40792-019-0720-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2019] [Accepted: 09/27/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The safety and feasibility of laparoscopic colectomy for T4 colorectal cancer remain controversial. We believe that setting a "Goal" that will guide the surgeons in returning from the deep layer could be the key to safe en bloc resection of neighboring organs. For descending colon cancer, the cranial-first approach makes it possible to clearly visualize the pancreas and origin of the transverse mesocolon, leading to safe splenic flexure mobilization and complete mesocolic excision, which is the strongest advantage of this approach. CASE PRESENTATION A 75-year-old woman was diagnosed with T4 descending colon cancer invading the Gerota's fascia. We performed laparoscopic left colectomy using the cranial-first approach to set a "Goal" at the inferior border of the pancreas for safe resection of the Gerota's fascia. The total operative time was 233 min, and the estimated blood loss was 98 ml. She was discharged after surgery without postoperative complications. Pathological findings revealed the invasion into the Gerota's fascia, and the resection margin was negative for cancer. CONCLUSIONS The cranial-first approach of laparoscopic left colectomy appears to be safe and feasible and could be a promising method for selected patients with T4 descending colon cancer invading the Gerota's fascia.
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Affiliation(s)
- Atsushi Ogura
- Department of Surgery, Tsushima City Hospital, 3-73, Tachibana Town, Tsushima City, Aichi, 496-8537, Japan.
| | - Ryutaro Kobayashi
- Department of Surgery, Tsushima City Hospital, 3-73, Tachibana Town, Tsushima City, Aichi, 496-8537, Japan
| | - Satoru Kawai
- Department of Surgery, Tsushima City Hospital, 3-73, Tachibana Town, Tsushima City, Aichi, 496-8537, Japan
| | - Kenji Takagi
- Department of Surgery, Tsushima City Hospital, 3-73, Tachibana Town, Tsushima City, Aichi, 496-8537, Japan
| | - Kiyotaka Kawai
- Department of Surgery, Tsushima City Hospital, 3-73, Tachibana Town, Tsushima City, Aichi, 496-8537, Japan
| | - Takashi Maeda
- Department of Surgery, Tsushima City Hospital, 3-73, Tachibana Town, Tsushima City, Aichi, 496-8537, Japan
| | - Tsukasa Aritake
- Department of Surgery, Tsushima City Hospital, 3-73, Tachibana Town, Tsushima City, Aichi, 496-8537, Japan
| | - Natsuki Nagano
- Department of Surgery, Tsushima City Hospital, 3-73, Tachibana Town, Tsushima City, Aichi, 496-8537, Japan
| | - Satoaki Kamiya
- Department of Surgery, Tsushima City Hospital, 3-73, Tachibana Town, Tsushima City, Aichi, 496-8537, Japan
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16
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Blank JJ, Gibson EK, Peterson CY, Ridolfi TJ, Ludwig KA. Retroileal anastomosis in hand-assisted laparoscopic left colectomy: experience at a single institution. Surg Endosc 2020; 34:3408-13. [PMID: 31506794 DOI: 10.1007/s00464-019-07116-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2019] [Accepted: 08/29/2019] [Indexed: 12/14/2022]
Abstract
BACKGROUND Left hemicolectomy and complicated sigmoid colectomy require an anastomosis between the transverse colon and rectum. Generous mobilization will typically allow the colon to reach to the rectum. However, despite full mobilization of the splenic flexure and extensive work on the mesentery, there are cases in which reach to the pelvis is still an issue. Retroileal routing of the colon is one technique for overcoming such a reach problem and achieving a tension-free anastomosis. Performing retroileal routing using laparoscopic techniques has been reported rarely, and to date, there are no data on this technique when performed in a hand-assisted laparoscopic fashion. This study aimed to describe the feasibility of doing a retroileal routing using a hand-assisted laparoscopic technique. METHODS This was a retrospective chart review of patients who underwent a colon or rectal resection, either open or laparoscopic, with a pelvic anastomosis, by a single colorectal surgeon at an academic institution between 2008 and 2015 with a focus on the immediate and long-term postoperative complications, estimated blood loss, and operating room time for patients having an operation that included retroileal routing for construction of a colorectal anastomosis. RESULTS A total of 340 patients fit inclusion criteria and of these, 13 underwent hand-assisted laparoscopic procedures with retroileal routing of the proximal colon to the colorectal anastomosis. Postoperative morbidity included intubation for CO2 retention in one patient and a RLL effusion in another patient; there were no anastomotic leaks. Long-term morbidities included two ventral hernias at 2 years postoperatively. Mean operating room time was 208 min. There were no 30- or 90-day mortalities. CONCLUSIONS Hand-assisted laparoscopic retroileal routing is a feasible and safe technique in accomplishing a tension-free colorectal anastomosis when proximal colon length makes standard routing of the colon to the rectum an issue.
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17
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Faucheron JL, Abba J, Trilling B. If you must operate on a patient presenting with purulent peritonitis secondary to sigmoid diverticular perforation…do not throw the baby out with the bathwater, not yet…. J Visc Surg 2018; 156:81-83. [PMID: 30241908 DOI: 10.1016/j.jviscsurg.2018.08.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- J-L Faucheron
- Department of Surgery, Colorectal Unit, Michallon University Hospital, 38000 Grenoble, France; University Grenoble Alps, UMR 5525, CNRS, TIMC-IMAG, 38000 Grenoble, France.
| | - J Abba
- Department of Surgery, Emergency Unit, Michallon University Hospital, 38000 Grenoble, France
| | - B Trilling
- Department of Surgery, Colorectal Unit, Michallon University Hospital, 38000 Grenoble, France; University Grenoble Alps, UMR 5525, CNRS, TIMC-IMAG, 38000 Grenoble, France
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18
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Martín Arévalo J, Moro-Valdezate D, García-Botello SA, Pla-Martí V, Garcés-Albir M, Pérez Santiago L, Vargas-Durán A, Espí-Macías A. Propensity score analysis of postoperative and oncological outcomes after surgical treatment for splenic flexure colon cancer. Int J Colorectal Dis 2018; 33:1201-13. [PMID: 29845387 DOI: 10.1007/s00384-018-3063-1] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/24/2018] [Indexed: 02/04/2023]
Abstract
PURPOSE The surgical treatment of splenic flexure colon cancer (SFCC) is somehow not yet well standardized. Postoperative and oncological results of the three surgical techniques most commonly used to treat SFCC: extended right colectomy (ERC), egmental left colectomy (SLC), and left colectomy (LC) were evaluated. METHODS The study included all patients with stage I-III SFCC treated by ERC, SLC, or LC between 2005 and 2016. Postoperative and long-term outcomes after the different surgical techniques were analyzed: Propensity score matching (PSM) was performed to compare the outcomes between these surgical techniques and survival analyses were performed using the Kaplan-Meier method and log-rank tests. RESULTS A total of 170 SFCC patients were operated; ERC was performed in 71 (41.76%), SLC in 36 (21.18%), and LC in 63 (37.06%). There were no significant differences in the short and long-term postoperative outcomes. Three comparison groups were developed so that PSM could be performed between the surgical technique cases: ERC (n = 59) vs. LC (n = 50); ERC (n = 50) vs. SLC (n = 33); and SLC (n = 32) vs. LC (n = 44). No differences in the short or long-term outcomes of these techniques were observed. CONCLUSION The short and long-term outcomes between ERC, SLC, and LC are similar. SLC should be considered oncologically as appropiate as the other more extensive resections.
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19
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Ghinea R, Avital S, Katz E, Shpitz B, White I. A surgical solution to regain bowel continuity following an extended left colectomy-reviving and extending the indication for a "Flip-Flop" procedure. Int J Colorectal Dis 2018; 33:95-97. [PMID: 29080993 DOI: 10.1007/s00384-017-2922-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [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] [Accepted: 10/15/2017] [Indexed: 02/04/2023]
Abstract
BACKGROUND AND AIMS Extended left hemicolectomy might be necessary for several indications. Once the resection is completed, it would be difficult or impossible to anastomose the transverse colon to the rectum due to the difficulty in mobilizing the transverse colon to reach for a tension-free rectal anastomosis. The aim of this report is to present the "Flip-Flop" technique to overcome this challenging situation. The procedure is based on a surgical technique published in the early 1960s to avoid permanent stoma after proctectomy and consists of changing the location of the right colon to reach the rectum. METHODS Clinical parameters, surgical aspects, and postoperative outcome of patients that underwent the flip-flop procedure following an extended left colectomy in our medical service was reviewed. RESULTS Three patients underwent a flip-flop procedure after an extended left colectomy performed for various reasons. The surgical technique is detailed in a step by step manner. Patients had uneventful postoperative recovery with an adequate functional outcome. CONCLUSIONS We believe that this approach should be revived and be considered also in cases when the full length of the rectum is preserved to avoid ileo-rectal anastomosis or a high-tension colocolonic anastomosis. Popularization of this surgical solution among surgeons is highly important.
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Affiliation(s)
- Ronen Ghinea
- Department of Surgery B, Meir Medical Center, Kfar Saba, Israel.,The Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Shmuel Avital
- Department of Surgery B, Meir Medical Center, Kfar Saba, Israel. .,The Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
| | - Ephraim Katz
- Department of Surgery B, Meir Medical Center, Kfar Saba, Israel.,The Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Baruch Shpitz
- Department of Surgery B, Meir Medical Center, Kfar Saba, Israel.,The Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Ian White
- Department of Surgery B, Meir Medical Center, Kfar Saba, Israel.,The Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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20
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Faucheron JL, Paquette B, Trilling B, Heyd B, Koch S, Mantion G. Emergency surgery for obstructing colonic cancer: a comparison between right-sided and left-sided lesions. Eur J Trauma Emerg Surg 2017; 44:71-77. [PMID: 28271148 DOI: 10.1007/s00068-017-0766-x] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2016] [Accepted: 01/20/2017] [Indexed: 12/16/2022]
Abstract
PURPOSE Few studies compare management and outcomes of obstructive colonic cancer, depending on the tumor site. We aim to evaluate the differences in patient characteristics, tumor characteristics, and outcomes of emergency surgery for obstructive right-sided versus left-sided colonic cancers. METHODS Between 2000 and 2009, 71 consecutive patients had an emergency colectomy following strict and clear definition of obstruction in a single institution. We retrospectively analyzed pre, per, and postoperative data that were prospectively collected. RESULTS There were 31 and 40 patients in the right and left group, respectively. Patients aged over 80 were more frequent in the right group (p = 0.03). At operation, ileocecal valve was less often competent in the right group (p = 0.03). The one-stage strategy was more frequent in the right group (p = 0.008). Patients in the right group had a higher rate of nodes invasion (p = 0.04). One- and two-year mortality rate in the right group had a tendency to be higher. CONCLUSIONS Patients presenting with a right obstructive colonic cancer are older, have a more advanced locoregional disease, and are more often treated in a one-stage strategy than patients with a left obstructive tumor.
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Affiliation(s)
- J-L Faucheron
- Colorectal Unit, Department of Surgery, Grenoble Alps University Hospital, 38000, Grenoble, France.
- University Grenoble Alps, UMR 5525, CNRS, TIMC-IMAG, 38000, Grenoble, France.
| | - B Paquette
- Department of Surgery, University Hospital, 25030, Besançon Cedex, France
| | - B Trilling
- Colorectal Unit, Department of Surgery, Grenoble Alps University Hospital, 38000, Grenoble, France
- University Grenoble Alps, UMR 5525, CNRS, TIMC-IMAG, 38000, Grenoble, France
| | - B Heyd
- Department of Surgery, University Hospital, 25030, Besançon Cedex, France
| | - S Koch
- Department of Gastroenterology, University Hospital, 25030, Besançon Cedex, France
| | - G Mantion
- Department of Surgery, University Hospital, 25030, Besançon Cedex, France
- Department of Gastroenterology, University Hospital, 25030, Besançon Cedex, France
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Sciuto A, Grifasi C, Pirozzi F, Leon P, Pirozzi REM, Corcione F. Laparoscopic Deloyers procedure for tension-free anastomosis after extended left colectomy: technique and results. Tech Coloproctol 2016; 20:865-869. [PMID: 27928685 DOI: 10.1007/s10151-016-1562-z] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [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: 10/17/2016] [Accepted: 10/19/2016] [Indexed: 11/30/2022]
Abstract
BACKGROUND The Deloyers procedure, which includes inversion of the right colon around the axis of the ileocolic vessels, can be used to achieve a well vascularized, tension-free colorectal anastomosis after extended left colectomy. The aim of this study is to report our technique and outcome in a series of ten consecutive patients who underwent right colonic transposition by laparoscopic approach. METHODS Charts were retrospectively reviewed to analyze postoperative outcome and bowel function. A video was recorded to demonstrate the procedure. RESULTS Conversion was required in one (10%) patient due to extensive adhesions. No intraoperative complications were recorded. Anastomotic leakage occurred in one (10%) case and was managed with peritoneal lavage and ileostomy. Six months after surgery, all patients reported a median number of 2.5 (range 2-3) bowel movements per day with solid stool consistency. Neither anastomotic stricture nor bowel ischemia was found at 1-year endoscopic follow-up. CONCLUSION Our experience shows that laparoscopic right colonic transposition is a safe and feasible procedure and provides good functional outcomes.
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Affiliation(s)
- A Sciuto
- Department of General, Laparoscopic and Robotic Surgery, Azienda Ospedaliera Specialistica dei Colli - Monaldi Hospital, Via Leonardo Bianchi, 80131, Naples, NA, Italy
| | - C Grifasi
- Department of General, Laparoscopic and Robotic Surgery, Azienda Ospedaliera Specialistica dei Colli - Monaldi Hospital, Via Leonardo Bianchi, 80131, Naples, NA, Italy
| | - F Pirozzi
- Department of Abdominal Surgery, Casa Sollievo della Sofferenza Research Hospital, San Giovanni Rotondo, FG, Italy
| | - P Leon
- Department of General, Laparoscopic and Robotic Surgery, Azienda Ospedaliera Specialistica dei Colli - Monaldi Hospital, Via Leonardo Bianchi, 80131, Naples, NA, Italy
| | - R E M Pirozzi
- School of Medicine and Surgery, University of Naples Federico II, Naples, Italy
| | - F Corcione
- Department of General, Laparoscopic and Robotic Surgery, Azienda Ospedaliera Specialistica dei Colli - Monaldi Hospital, Via Leonardo Bianchi, 80131, Naples, NA, Italy.
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Abstract
BACKGROUND We have designed a modified caudal-to-cranial approach to perform laparoscopic left colectomy preserving the inferior mesenteric artery for benign colorectal diseases. METHODS IRB approval and informed consent have been obtained. A dissection is conducted to separate the descending mesocolon of the Gerota's plan from the medial aspect to the peritoneal lining to the left parietal gutter. The peritoneal layer is incised parallel to the vessel and close to the colonic wall. The dissection is continued anteriorly up to reach the resected parietal gutter. A passage into the mesentery of the upper rectum is created for the allocation of the stapler and the dissection of the rectum. These maneuvers permit to straighten the mesentery simplifying the identification and cutting of the sigmoid arteries. A caudal-to-cranial dissection of the mesentery is performed from the sectioned rectum to the proximal descending colon by a sealed envelope device. It can be very useful to mobilize the colon in any direction: laterally, medially, or upward. The dissection is performed along the course of the vessel up to the proximal colon, with progressive sectioning of the sigmoid arterial branches. The specimen is extracted by a pfannenstiel incision. The anastomosis is performed transanally with a circular stapler according to Knight-Griffin technique. RESULTS We performed a laparoscopic segmental colectomy using this approach for 21 patients with benign sigmoid lesions: 13 diverticulitis, 3 flat polypoid lesions (no lift-up sign), and 5 bowel endometriosis. The mean operative time and blood loss were 161.4 ± 15.7 min and 50 ± 40 ml, respectively. There were not a single conversion to open surgery and no any leakage or stricture. Only 2 cases of intraluminal bleeding and 1 case of wound infection (treated conservatively) were observed. CONCLUSION We consider this approach to be safe and useful for segmental colectomy to be performed sectioning the sigmoid artery close to the colonic wall.
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Antona AD, Reggio S, Pirozzi F, Corcione F. Laparoscopic 3D high-definition Deloyers procedure: when, how, why? Updates Surg 2016; 68:111-3. [PMID: 27062142 DOI: 10.1007/s13304-016-0355-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2016] [Accepted: 02/22/2016] [Indexed: 01/16/2023]
Abstract
After extensive mobilization and resection of the left colon, colorectal anastomosis may result impossible due to the distance between the remaining colon and the rectal stump. The Deloyers procedure represents an interesting alternative to total colectomy with ileorectal anastomosis. In this manuscript, we describe when and how to perform this technique with a mini-invasive approach. We also report the case of a patient who underwent Deloyers procedure, due to early ischemia of the descending colon after left colectomy.
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Affiliation(s)
- Angelo Danilo Antona
- Department of Laparoscopic and Robotic Surgery, "Azienda Ospedaliera dei Colli", Monaldi Hospital, Via Leonardo Bianchi, 80131, Naples, NA, Italy
| | - Stefano Reggio
- Department of Laparoscopic and Robotic Surgery, "Azienda Ospedaliera dei Colli", Monaldi Hospital, Via Leonardo Bianchi, 80131, Naples, NA, Italy
| | - Felice Pirozzi
- Department of Laparoscopic and Robotic Surgery, "Azienda Ospedaliera dei Colli", Monaldi Hospital, Via Leonardo Bianchi, 80131, Naples, NA, Italy.
| | - Francesco Corcione
- Department of Laparoscopic and Robotic Surgery, "Azienda Ospedaliera dei Colli", Monaldi Hospital, Via Leonardo Bianchi, 80131, Naples, NA, Italy
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de'Angelis N, Hain E, Disabato M, Cordun C, Carra MC, Azoulay D, Brunetti F. Laparoscopic extended right colectomy versus laparoscopic left colectomy for carcinoma of the splenic flexure: a matched case-control study. Int J Colorectal Dis 2016; 31:623-30. [PMID: 26689401 DOI: 10.1007/s00384-015-2469-2] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [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] [Accepted: 12/14/2015] [Indexed: 02/04/2023]
Abstract
PURPOSE The aim of the study was to compare the short- and long-term outcomes of laparoscopic extended right colectomy (ER) versus laparoscopic left colectomy (LC) for splenic flexure carcinomas. METHODS Patients with stage 0-III adenocarcinoma of the splenic flexure who underwent laparoscopy between 2000 and 2013 were identified from a prospectively maintained database. Twenty-seven patients who underwent ER were matched by age, gender, BMI, ASA score, and tumor stage with 27 patients who underwent LC. RESULTS The ER procedures were significantly longer than LC (235 ± 49.2 min vs. 192 ± 43.4 min, p = 0.001, respectively). Post-operatively, time to flatus and return to regular diet were observed to average 2.4 ± 0.8 days (1-4 days) and 4.6 ± 1.05 days (3-8 days), respectively, without differences between the groups. Overall, 14 complications were observed in 12 patients and 90-day mortality was nil. The length of hospitality stay was not different between ER and LC, with an overall mean of 8.3 ± 2.7 days. All procedures were classified as R0 resections, but ER was associated with a higher number of lymph nodes retrieved (21.4 ± 4.9) compared with LC (16.6 ± 5.5, p = 0.001). The 1-, 3-, and 5-year cumulative survival rates were 92.6, 85.8, and 72.8% for the ER group and 96.3, 91.9, and 75.1% for the LC group (p = 0.851). The 1-, 3-, and 5-year disease-free survival rates were 85.2, 76.7, and 67.1% for the ER group and 96.2, 75.5, and 66.7% for the LC group (p = 0.636). CONCLUSIONS Laparoscopic ER and LC procedures performed for splenic flexure carcinomas appear to have similar short- and long-term oncologic outcomes.
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Affiliation(s)
- Nicola de'Angelis
- Unit of Digestive, Hepato-Pancreato-Biliary Surgery and Liver Transplantation, Henri Mondor Hospital, AP-HP, Université Paris Est-UPEC, 51, Avenue du Maréchal de Lattre de Tassigny, 94010, Créteil, France. .,Inserm, Unité 4394-MACBEth, Créteil, France.
| | - Elisabeth Hain
- Unit of Digestive, Hepato-Pancreato-Biliary Surgery and Liver Transplantation, Henri Mondor Hospital, AP-HP, Université Paris Est-UPEC, 51, Avenue du Maréchal de Lattre de Tassigny, 94010, Créteil, France
| | - Mara Disabato
- Unit of Digestive, Hepato-Pancreato-Biliary Surgery and Liver Transplantation, Henri Mondor Hospital, AP-HP, Université Paris Est-UPEC, 51, Avenue du Maréchal de Lattre de Tassigny, 94010, Créteil, France
| | - Cristiana Cordun
- Unit of Digestive, Hepato-Pancreato-Biliary Surgery and Liver Transplantation, Henri Mondor Hospital, AP-HP, Université Paris Est-UPEC, 51, Avenue du Maréchal de Lattre de Tassigny, 94010, Créteil, France
| | | | - Daniel Azoulay
- Unit of Digestive, Hepato-Pancreato-Biliary Surgery and Liver Transplantation, Henri Mondor Hospital, AP-HP, Université Paris Est-UPEC, 51, Avenue du Maréchal de Lattre de Tassigny, 94010, Créteil, France.,Inserm, Unité 955-IMRB, Créteil, France
| | - Francesco Brunetti
- Unit of Digestive, Hepato-Pancreato-Biliary Surgery and Liver Transplantation, Henri Mondor Hospital, AP-HP, Université Paris Est-UPEC, 51, Avenue du Maréchal de Lattre de Tassigny, 94010, Créteil, France.,Inserm, Unité 4394-MACBEth, Créteil, France
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Baucom RB, Poulose BK, Herline AJ, Muldoon RL, Cone MM, Geiger TM. Smoking as dominant risk factor for anastomotic leak after left colon resection. Am J Surg 2015; 210:1-5. [PMID: 25910885 DOI: 10.1016/j.amjsurg.2014.10.033] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [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: 09/11/2014] [Revised: 09/30/2014] [Accepted: 10/03/2014] [Indexed: 01/25/2023]
Abstract
BACKGROUND Some risk factors for anastomotic leak have been identified, but the effect of smoking is unknown. METHODS This study aimed to evaluate the effect of smoking on clinical leak after left-sided anastomoses. Adult patients who underwent elective left colectomy between January 1, 2008 and December 31, 2012 were included. Those with stomas and inflammatory bowel diseases were excluded. Primary outcome was anastomotic leak requiring percutaneous drainage or operative intervention within 30 days. RESULTS There were 246 patients included; 56% were female. Most had a diagnosis of diverticular disease (53%) or cancer (37%). Anastomotic leak rate was 6.5% (n = 16). The rate in smokers was 17% versus 5% in nonsmokers (P = .01). Smokers had over 4 times greater chance of leak (odds ratio 4.2, 95% confidence interval 1.3 to 13.5, P = .02). CONCLUSION Smoking is a risk factor for leak after left colectomy. Consideration should be given to delaying elective left colectomy until smoking cessation is achieved.
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Affiliation(s)
- Rebeccah B Baucom
- Division of General Surgery, Vanderbilt University Medical Center, D-5203 Medical Center North, 1161 Medical Center Drive, Nashville, TN 37232, USA.
| | - Benjamin K Poulose
- Division of General Surgery, Vanderbilt University Medical Center, D-5203 Medical Center North, 1161 Medical Center Drive, Nashville, TN 37232, USA
| | - Alan J Herline
- Division of General Surgery, Vanderbilt University Medical Center, D-5203 Medical Center North, 1161 Medical Center Drive, Nashville, TN 37232, USA
| | - Roberta L Muldoon
- Division of General Surgery, Vanderbilt University Medical Center, D-5203 Medical Center North, 1161 Medical Center Drive, Nashville, TN 37232, USA
| | - Molly M Cone
- Division of General Surgery, Vanderbilt University Medical Center, D-5203 Medical Center North, 1161 Medical Center Drive, Nashville, TN 37232, USA
| | - Timothy M Geiger
- Division of General Surgery, Vanderbilt University Medical Center, D-5203 Medical Center North, 1161 Medical Center Drive, Nashville, TN 37232, USA
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Daskalaki A, Kaimasidis G, Xenaki S, Athanasakis E, Chalkiadakis G. Internal-mesocolic hernia after laparoscopic left colectomy report of case with late manifestation. Int J Surg Case Rep 2014; 6C:88-91. [PMID: 25528033 PMCID: PMC4334638 DOI: 10.1016/j.ijscr.2014.11.067] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [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: 06/26/2014] [Revised: 11/23/2014] [Accepted: 11/23/2014] [Indexed: 12/18/2022] Open
Abstract
Introduction In contrast to right colectomy, closure of the mesocolic gap after laparoscopic left colectomy is not practiced, and reports of small gut herniation through this gap are scarce. Presentation of case A 73 year old male was admitted as an emergency with symptoms and clinical signs, suggesting obstruction of the small bowel. Abdominal imaging, including computed tomography confirmed the diagnosis. The patient had undergone laparoscopic left colectomy for cancer, three years ago. At laparotomy small bowel loops were found to herniate through the mesocolic defect at the level of the colonic anastomosis. The small bowel loops were reduced and their viability was ascertained. Because of an iatrogenic perforation of the colon at the anastomosis during small bowel loops mobilization, the colon was temporarily exteriorized in the form of a double barrel colostomy. The postoperative course was uneventful. Discussion Very few cases have been reported in the liteature indicating the need of sutuing the mesenterium. Despite the limited numbe of the reported cases, there is clearly a risk of intenal hernia after laparoscopic left colectomy. Conclusion Although rare internal hernia after laparoscopic left colectomy may occur, and this brings forward the question of mesocolic gap closure.
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Affiliation(s)
- Anna Daskalaki
- Department of General Surgery, Heraklion University Hospital, 71110 Heraklion, Crete, Greece
| | - George Kaimasidis
- Department of General Surgery, Heraklion University Hospital, 71110 Heraklion, Crete, Greece
| | - Sofia Xenaki
- Department of General Surgery, Heraklion University Hospital, 71110 Heraklion, Crete, Greece.
| | - Elias Athanasakis
- Department of General Surgery, Heraklion University Hospital, 71110 Heraklion, Crete, Greece
| | - George Chalkiadakis
- Department of General Surgery, Heraklion University Hospital, 71110 Heraklion, Crete, Greece
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Vignali A, Nardi PD, Ghirardelli L, Palo SD, Staudacher C. Short and long-term outcomes of laparoscopic colectomy in obese patients. World J Gastroenterol 2013; 19:7405-7411. [PMID: 24259971 PMCID: PMC3831222 DOI: 10.3748/wjg.v19.i42.7405] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2013] [Revised: 10/03/2013] [Accepted: 10/14/2013] [Indexed: 02/06/2023] Open
Abstract
AIM: To investigate the impact of laparoscopic colectomy on short and long-term outcomes in obese patients with colorectal diseases.
METHODS: A total of 98 obese (body mass index > 30 kg/m2) patients who underwent laparoscopic (LPS) right or left colectomy over a 10 year period were identified from a prospective institutionally approved database and manually matched to obese patients who underwent open colectomy. Controls were selected to match for body mass index, site of primary disease, American Society of Anesthesiologists score, and year of surgery (± 3 year). The parameters analyzed included age, gender, comorbid conditions, American Society of Anaesthesiologists class, diagnosis, procedure, and duration of operation, operative blood loss, and amount of homologous blood transfused. Conversion rate, intra and postoperative complications as were as reoperation rate, 30 d and long-term morbidity rate were also analyzed. For continuous variables, the Student’s t test was used for normally distributed data the Mann-Whitney U test for non-normally distributed data. The Pearson’s χ2 tests, or the Fisher exact test as appropriate, were used for proportions.
RESULTS: Conversion to open surgery was necessary in 13 of 98 patients (13.3%). In the LPS group, operative time was 29 min longer and blood loss was 78 mL lower when compared to open colectomy (P = 0.03, P = 0.0001, respectively). Overall morbidity, anastomotic leak and readmission rate did not significantly differ between the two groups. A trend toward a reduction of wound complications was observed in the LPS when compared to open group (P = 0.09). In the LPS group, an earlier recovery of bowel function (P = 0.001) and a shorter length of stay (P = 0.03) were observed. After a median follow-up of 62 (range 12-132) mo 23 patients in the LPS group and 38 in the open group experienced long-term complications (LPS vs open, P = 0.03). Incisional hernia resulted to be the most frequent long-term complication with a significantly higher occurrence in the open group when compared to the laparoscopic one (P = 0.03).
CONCLUSION: Laparoscopic colectomy in obese patients is safe, does not jeopardize postoperative complications and resulted in lower incidence of long-term complications when compared with open cases.
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