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World Journal of Gastroenterology Aug 2020Rectal cancer is one of the most common malignancies worldwide. Surgical resection for rectal cancer usually requires a proctectomy with respective lymphadenectomy... (Review)
Review
Rectal cancer is one of the most common malignancies worldwide. Surgical resection for rectal cancer usually requires a proctectomy with respective lymphadenectomy (total mesorectal excision). This has traditionally been performed transabdominally through an open incision. Over the last thirty years, minimally invasive surgery platforms have rapidly evolved with the goal to accomplish the same quality rectal resection through a less invasive approach. There are currently three resective modalities that complement the traditional open operation: (1) Laparoscopic surgery; (2) Robotic surgery; and (3) Transanal total mesorectal excision. In addition, there are several platforms to carry out transluminal local excisions (without lymphadenectomy). Evidence on the various modalities is of mixed to moderate quality. It is unreasonable to expect a randomized comparison of all options in a single trial. This review aims at reviewing in detail the various techniques in regard to intra-/perioperative benchmarks, recovery and complications, oncological and functional outcomes.
Topics: Digestive System Surgical Procedures; Humans; Laparoscopy; Minimally Invasive Surgical Procedures; Proctectomy; Rectal Neoplasms; Robotic Surgical Procedures; Transanal Endoscopic Surgery
PubMed: 32874053
DOI: 10.3748/wjg.v26.i30.4394 -
Colorectal Disease : the Official... Nov 2022This study evaluates the relationship of tumour and anatomical features with operative difficulty in robotic low anterior resection performed by four experienced...
AIM
This study evaluates the relationship of tumour and anatomical features with operative difficulty in robotic low anterior resection performed by four experienced surgeons in a high-volume colorectal cancer practice.
METHODS
Data from 382 patients who underwent robotic low anterior resection by four expert surgeons between January 2016 and June 2019 were included in the analysis. Operating time was used as a measure of operative difficulty. Univariate and multivariate mixed models were used to identify associations between baseline characteristics and operating time, with surgeon as a random effect, thereby controlling for variability in surgeon speed and proficiency. In an exploratory analysis, operative difficulty was defined as conversion to laparotomy, a positive margin or an incomplete mesorectum.
RESULTS
Median operating time was 4.28 h (range 1.95-11.33 h) but varied by surgeon from 3.45 h (1.95-6.10 h) to 5.93 h (3.33-11.33 h) (P < 0.001). Predictors of longer operating time in multivariate analysis were male sex, higher body mass index, neoadjuvant radiotherapy, low tumour height, greater sacral height and larger mesorectal area at the S5 vertebral level. Conversion occurred in two cases (0.5%), and incomplete mesorectum and positive margins were found in nine (2.4%) and 19 (5.0%) patients, respectively. Neoadjuvant radiotherapy and larger pelvic outlet were the only characteristics associated with the exploratory measure of difficulty.
CONCLUSION
Predicting operative difficulty based on easy to identify, preoperative radiological and clinical variables is feasible in robotic anterior resection.
Topics: Humans; Male; Female; Robotic Surgical Procedures; Laparoscopy; Rectal Neoplasms; Proctectomy; Robotics; Operative Time; Treatment Outcome; Retrospective Studies
PubMed: 35656853
DOI: 10.1111/codi.16212 -
World Journal of Surgical Oncology May 2020The incidence of synchronous RCC and colorectal cancer is heterogeneous ranging from 0.03 to 4.85%. Instead, only one case of huge colon carcinoma and renal... (Review)
Review
INTRODUCTION
The incidence of synchronous RCC and colorectal cancer is heterogeneous ranging from 0.03 to 4.85%. Instead, only one case of huge colon carcinoma and renal angiomyolipoma was reported. The treatment of synchronous kidney and colorectal neoplasm is, preferably, synchronous resection. Currently, laparoscopic approach has shown to be feasible and safe, and it has become the gold standard of synchronous resection due to advantages of minimally invasive surgery. We presented a case synchronous renal neoplasm and colorectal cancer undergone simultaneous totally robotic renal enucleation and rectal resection with primary intracorporeal anastomosis. As our knowledge, this is the first case in literature of simultaneous robotic surgery for renal and colorectal tumor.
CASE PRESENTATION
A 53-year-old woman was affected by recto-sigmoid junction cancer and a solid 5 cm left renal mass. We performed a simultaneous robotic low anterior rectal resection and renal enucleation. Total operative time was 260 min with robotic time of 220 min; estimated blood loss was 150 ml; time to flatus was 72 h, and oral diet was administered 4 days after surgery. The patient was discharged on the eighth post-operative day without peri- and post-operative complication. The definitive histological examination showed a neuroendocrine tumor pT2N1 G2, with negative circumferential and distal resection margins. Renal tumor was angiomyolipoma. At 23 months follow-up, the patient is recurrence free.
DISCUSSION AND CONCLUSION
As our knowledge, we described the first case in literature of simultaneous robotic anterior rectal resection and partial nephrectomy for treatment of colorectal tumor and renal mass. Robotic rectal resection with intracorporeal anastomosis surgery seems to be feasible and safe even when it is associated with simultaneous partial nephrectomy. Many features of robotic technology could be useful in combined surgery. This strategy is recommended only when patients' medical conditions allow for longer anesthesia exposure. The advantages are to avoid a delay treatment of second tumor, to reduce the time to start the post-operative adjuvant chemotherapy, to avoid a second anesthetic procedure, and to reduce the patient discomfort. However, further studies are needed to evaluate robotic approach as standard surgical strategy for simultaneous treatment of colorectal and renal neoplasm.
Topics: Anastomosis, Surgical; Carcinoma, Renal Cell; Colorectal Neoplasms; Female; Humans; Kidney; Kidney Neoplasms; Middle Aged; Neoplasms, Multiple Primary; Nephrectomy; Operative Time; Proctectomy; Rectum; Robotic Surgical Procedures; Time Factors; Treatment Outcome
PubMed: 32366262
DOI: 10.1186/s12957-020-01864-1 -
Techniques in Coloproctology Apr 2023
Topics: Humans; Proctocolectomy, Restorative; Ileum; Anastomosis, Surgical; Colonic Pouches; Colitis, Ulcerative; Treatment Outcome; Anal Canal
PubMed: 36115896
DOI: 10.1007/s10151-022-02700-2 -
Colorectal Disease : the Official... Nov 2022The aim of this systematic review was to analyse recurrence rates after different surgical techniques for perineal hernia repair. (Meta-Analysis)
Meta-Analysis
AIM
The aim of this systematic review was to analyse recurrence rates after different surgical techniques for perineal hernia repair.
METHOD
All original studies (n ≥ 2 patients) reporting recurrence rates after perineal hernia repair after abdominoperineal resection (APR) were included. The electronic database PubMed was last searched in December 2021. The primary outcome was recurrent perineal hernia. A weighted average of the logit proportions was determined by the use of the generic inverse variance method and random effects model.
RESULTS
A total of 19 studies involving 172 patients were included. The mean age of patients was 64 ± 5.6 years and the indication for APR was predominantly cancer (99%, 170/172). The pooled percentage of recurrent perineal hernia was 39% (95% CI: 27%-52%) after biological mesh closure, 29% (95% CI: 21%-39%) after synthetic mesh closure, 37% (95% CI: 14%-67%) after tissue flap reconstruction only and 9% (95% CI: 1%-45%) after tissue flap reconstruction combined with mesh.
CONCLUSION
Recurrence rates after mesh repair of perineal hernia are high, without a clear difference between biological and synthetic meshes. The addition of a tissue flap to mesh repair seemed to have a favourable outcome, which warrants further investigation.
Topics: Aged; Humans; Middle Aged; Hernia, Abdominal; Herniorrhaphy; Perineum; Proctectomy; Surgical Mesh; Free Tissue Flaps; Recurrence; Neoplasms
PubMed: 35712806
DOI: 10.1111/codi.16224 -
Inflammatory Bowel Diseases Mar 2023Many patients with Crohn's disease (CD) require fecal diversion. To understand the long-term outcomes, we performed a multicenter review of the experience with retained... (Review)
Review
BACKGROUND
Many patients with Crohn's disease (CD) require fecal diversion. To understand the long-term outcomes, we performed a multicenter review of the experience with retained excluded rectums.
METHODS
We reviewed the medical records of all CD patients between 1990 and 2014 who had undergone diversionary surgery with retention of the excluded rectum for at least 6 months and who had at least 2 years of postoperative follow-up.
RESULTS
From all the CD patients in the institutions' databases, there were 197 who met all our inclusion criteria. A total of 92 (46.7%) of 197 patients ultimately underwent subsequent proctectomy, while 105 (53.3%) still had retained rectums at time of last follow-up. Among these 105 patients with retained rectums, 50 (47.6%) underwent reanastomosis, while the other 55 (52.4%) retained excluded rectums. Of these 55 patients whose rectums remained excluded, 20 (36.4%) were symptom-free, but the other 35 (63.6%) were symptomatic. Among the 50 patients who had been reconnected, 28 (56%) were symptom-free, while 22(44%) were symptomatic. From our entire cohort of 197 cases, 149 (75.6%) either ultimately lost their rectums or remained symptomatic with retained rectums, while only 28 (14.2%) of 197, and only 4 (5.9%) of 66 with initial perianal disease, were able to achieve reanastomosis without further problems. Four patients developed anorectal dysplasia or cancer.
CONCLUSIONS
In this multicenter cohort of patients with CD who had fecal diversion, fewer than 15%, and only 6% with perianal disease, achieved reanastomosis without experiencing disease persistence.
Topics: Humans; Crohn Disease; Rectum; Feces; Proctectomy; Pelvis; Retrospective Studies; Treatment Outcome; Multicenter Studies as Topic
PubMed: 35522225
DOI: 10.1093/ibd/izac099 -
Colorectal Disease : the Official... Sep 2021The continent ileostomy allows evacuation of an ileal reservoir at a time convenient to the patient. It is a surgical option for patients with ulcerative colitis (UC)... (Review)
Review
AIM
The continent ileostomy allows evacuation of an ileal reservoir at a time convenient to the patient. It is a surgical option for patients with ulcerative colitis (UC) when a restorative option is not suitable or has not succeeded and the patient does not want a conventional end ileostomy. Continent ileostomy types include the Kock pouch, Barnett continent intestinal reservoir and T-pouch. All of the published evidence on the long-term outcome and quality of life after continent ileostomy for UC was systematically reviewed.
METHODS
A systematic review was performed in line with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Studies published between 1990 and 2020 were included. A descriptive synthesis was used due to the clinical heterogeneity.
RESULTS
The search returned 1655 abstracts and after screening of abstracts and full text review, 19 were included in the final review, involving 1602 patients. Operative mortality is low (0%-3.6%) after all types of continent ileostomy but reoperation rates are high (20.8%-65%) because of valve mechanism failures. Rates of fistulae (0%-25.5%) and stomal stenosis (0%-25%) can be relatively high postoperatively. Quality of life scores improve for most patients undergoing continent ileostomy, especially for patients converted from ileal pouch anal anastomosis. Overall, continent ileostomy retention is high in the long-term.
DISCUSSION
In the long-term, patients report high satisfaction and a good quality of life with continent ileostomy, despite high reoperation rates and complications. Newer technologies may reinvigorate interest in the continent ileostomy for this population.
Topics: Colitis, Ulcerative; Colonic Pouches; Humans; Ileostomy; Proctocolectomy, Restorative; Quality of Life
PubMed: 34166559
DOI: 10.1111/codi.15788 -
BJS Open Jun 2019This population-based cohort study aimed to evaluate occurrence of low anterior resection syndrome (LARS) and correlate this to health-related quality of life in... (Comparative Study)
Comparative Study
BACKGROUND
This population-based cohort study aimed to evaluate occurrence of low anterior resection syndrome (LARS) and correlate this to health-related quality of life in patients who had undergone segmental colonic resection for colonic cancer in the Stockholm-Gotland region. The hypothesis was that there is a difference in occurrence of LARS depending on whether a right- or a left-sided resection was performed.
METHODS
Patients who underwent segmental colonic resection for colonic cancer stages I-III in the Stockholm-Gotland region in 2013-2015 received EORTC QLQ-C30, QLQ-CR29 and LARS score questionnaires 1 year after surgery. Clinical patient and tumour data were collected from the Swedish ColoRectal Cancer Registry. Patient-reported outcome measures were analysed in relation to type of colonic resection.
RESULTS
Questionnaires were sent to 866 patients and complete responses were provided by 517 (59·7 per cent). After right-sided resection 20·6 per cent reported major LARS. After left-sided resection the proportion with major LARS was 15·6 per cent. The odds ratio (OR) for major LARS after right-sided resection was 1·45 (95 per cent c.i. 1·02 to 2·06; = 0·037) compared with left-sided resection. After adjustment for age and sex, an increase in the risk of major LARS after right- left-sided resection remained (OR 1·48, 1·03 to 2·13; = 0·035). Major LARS correlated with impaired quality of life.
CONCLUSION
Major LARS was more frequent after right-sided than following left-sided colonic resection. Major LARS reflected impaired quality of life.
Topics: Adult; Aged; Aged, 80 and over; Chemotherapy, Adjuvant; Cohort Studies; Colectomy; Colonic Neoplasms; Female; Humans; Length of Stay; Male; Middle Aged; Neoplasm Staging; Postoperative Complications; Proctectomy; Quality of Life; Rectum; Risk Assessment; Surveys and Questionnaires; Sweden; Syndrome
PubMed: 31183455
DOI: 10.1002/bjs5.50128 -
Journal of Gastrointestinal Surgery :... Jul 2018The Iowa Rectal Surgery Risk Calculator estimates risk for proctectomy procedures. The Iowa Calculator performed well on NSQIP 2010-2011 training and 2005-2009...
BACKGROUND
The Iowa Rectal Surgery Risk Calculator estimates risk for proctectomy procedures. The Iowa Calculator performed well on NSQIP 2010-2011 training and 2005-2009 validation datasets, but was not prospectively validated and did not include low anterior resections. This study sought to demonstrate validity on new independent data, to update the calculator to include low anterior resection, and to compare performance to other risk assessment tools.
METHODS
Non-emergent ACS-NSQIP proctectomy and low anterior resection data from 2010 to 2015 (n = 65,683) were included. The Iowa Calculator generated risk estimates for 30-day morbidity using 2012-2015 data. An Updated Calculator used 2010-2011 training data to include low anterior resection, with validation on 2012-2015 data. NSQIP data provided NSQIP Morbidity Model predictions and a custom web-script collected ACS-NSQIP Online Surgical Risk Calculator predictions for all patients.
RESULTS
Proctectomy morbidity (not including low anterior resection) decreased from 40.4% in 2010-2011 to 37.0% in 2012-2015. Low anterior resection had lower morbidity (22.4% in 2012-15). The Iowa Calculator demonstrated good discrimination and calibration using 2012-2015 data (C-statistic 0.676, deviance + 9.2%). After including low anterior resection, the Updated Iowa Calculator performed well during training (c-statistic 0.696, deviance 0%) and validation (C-statistic 0.706, deviance + 7.9%). The Updated Iowa Calculator had significantly better discrimination and calibration than morbidity predictions from the ACS Online Calculator (C-statistic 0.693, P < 0.001, deviance - 28.1%) and NSQIP General/Vascular Surgery Model (C-statistic 0.703, P < 0.05, deviance - 40.8%).
CONCLUSION
When applied to new independent data, the Iowa Calculator supplies accurate risk estimates. The Updated Iowa Calculator includes low anterior resection, and both are prospectively validated. Risk estimation by the Iowa Calculators was superior to ACS-provided risk tools.
Topics: Aged; Female; Follow-Up Studies; Humans; Iowa; Male; Middle Aged; Morbidity; Postoperative Complications; Proctectomy; Prospective Studies; Risk Assessment; Risk Factors
PubMed: 29687422
DOI: 10.1007/s11605-018-3770-5 -
World Journal of Gastroenterology Jun 2007Ulcerative colitis (UC) is a relapsing and remitting disease characterised by chronic mucosal and submucosal inflammation of the colon and rectum. Treatment may vary... (Review)
Review
Ulcerative colitis (UC) is a relapsing and remitting disease characterised by chronic mucosal and submucosal inflammation of the colon and rectum. Treatment may vary depending upon the extent and severity of inflammation. Broadly speaking medical treatments aim to induce and then maintain remission. Surgery is indicated for inflammatory disease that is refractory to medical treatment or in cases of neoplastic transformation. Approximately 25% of patients with UC ultimately require colectomy. Ileal pouch-anal anastomosis (IPAA) has become the standard of care for patients with ulcerative colitis who ultimately require colectomy. This review will examine indications for IPAA, patient selection, technical aspects of surgery, management of complications and long term outcome following this procedure.
Topics: Anastomosis, Surgical; Colitis, Ulcerative; Gastrointestinal Hemorrhage; Humans; Intestinal Obstruction; Laparoscopy; Postoperative Complications; Pouchitis; Proctocolectomy, Restorative; Sepsis
PubMed: 17659667
DOI: 10.3748/wjg.v13.i24.3288