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Journal of Visceral Surgery Feb 2010
Topics: Colectomy; Colon, Ascending; Colonic Neoplasms; Humans; Laparoscopy; Treatment Outcome
PubMed: 20587377
DOI: 10.1016/j.jviscsurg.2010.01.002 -
World Journal of Surgical Oncology Oct 2022Robotic 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...
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.
Topics: Colectomy; Colonic Neoplasms; Humans; Laparoscopy; Length of Stay; Postoperative Complications; Retrospective Studies; Robotic Surgical Procedures; Treatment Outcome
PubMed: 36253768
DOI: 10.1186/s12957-022-02796-8 -
World Journal of Emergency Surgery :... Oct 2022Laparoscopic colectomy is rarely performed for ischemic colitis. The aim of this propensity score-matched study was to compare preoperative characteristics,...
INTRODUCTION
Laparoscopic colectomy is rarely performed for ischemic colitis. The aim of this propensity score-matched study was to compare preoperative characteristics, intraoperative details and short-term outcomes for emergent laparoscopic colectomy versus the traditional open approach for patients with ischemic colitis.
METHODS
Retrospective review of 96 patients who underwent emergent colectomy for ischemic colitis between January 2011 and December 2020 (39 via laparoscopy, 57 via laparotomy) was performed. We compared short-term outcomes after using a one-to-one ratio and nearest-neighbor propensity score matching to obtain similar preoperative and intraoperative parameters in each group.
RESULTS
Patients in the open group experienced more surgical site complications (52.6% vs. 23.0%, p = 0.004), more intra-abdominal abscesses (47.3% vs. 17.9%, p = 0.003), longer need for ventilator support (20 days vs. 0 days, p < 0.001), more major complications (77.2% vs. 43.5%, p = 0.001), higher mortality (49.1% vs. 20.5%, p = 0.004), and longer hospital stay (32 days vs. 19 days, p = 0.001). After propensity score matching (31 patients in each group), patients undergoing open (vs. laparoscopy) had more surgical site complications (45.1% vs. 19.4%, p = 0.030) and required longer ventilator support (14 vs. 3 days, p = 0.039). After multivariate analysis, Charlson Comorbidity Index (p = 0.024), APACHE II score (p = 0.001), and Favier's classification (p = 0.023) were independent predictors of mortality.
CONCLUSIONS
Laparoscopic emergent colectomy for ischemic colitis is feasible and is associated with fewer surgical site complications and better respiratory function, compared to the open approach.
Topics: Colectomy; Colitis, Ischemic; Humans; Laparoscopy; Propensity Score; Treatment Outcome
PubMed: 36229844
DOI: 10.1186/s13017-022-00458-4 -
World Journal of Surgical Oncology Mar 2022There were differences in the recovery of bowel function and prolonged postoperative ileus (PPOI) between laparoscopic right colectomy (RC) and left colectomy (LC) under... (Review)
Review
BACKGROUND
There were differences in the recovery of bowel function and prolonged postoperative ileus (PPOI) between laparoscopic right colectomy (RC) and left colectomy (LC) under the guidance of enhanced recovery after surgery.
METHODS
We selected 870 patients who underwent elective laparoscopic colectomy from June 2016 to December 2021, including 272 patients who had RC and 598 who had LC. According to 1:1 proportion for propensity score matching and correlation analysis, 247 patients who had RC and 247 who had LC were finally enrolled.
RESULTS
The incidence of PPOI in all patients was 13.1%. Age, sex, smoking habit, preoperative serum albumin level, operation type, and operation time were the important independent risk factors based on multivariate logistic regression and correlation analysis for PPOI (p<0.05). Age, sex, body mass index, preoperative serum albumin level, operation time, and degree of differentiation between the two groups were significantly different before case matching (p<0.05). There were no statistically significant differences in baseline characteristics and preoperative biochemical parameters between the two groups after case matching (p>0.05). The incidence of PPOI in patients who had RC was 21.9%, while that in patients who had LC was 13.0%. The first flatus, first semi-liquid, and length of stay in LC patients were lower than those in RC patients (p<0.05).
CONCLUSION
The return of bowel function in LC was faster than that in RC, and the incidence of PPOI was relatively lower. Therefore, caution should be taken during the early feeding of patients who had laparoscopic RC.
Topics: Colectomy; Enhanced Recovery After Surgery; Humans; Ileus; Laparoscopy; Postoperative Complications; Propensity Score
PubMed: 35246150
DOI: 10.1186/s12957-022-02504-6 -
Cirugia Y Cirujanos 2020Laparoscopic colectomy (LC) presents similar short-term results and oncological outcomes to conventional colectomy (CC) in colon cancer.
BACKGROUND
Laparoscopic colectomy (LC) presents similar short-term results and oncological outcomes to conventional colectomy (CC) in colon cancer.
OBJECTIVES
Compare short-term and oncological outcomes at 3-year follow up between LC and CC.
MATERIALS AND METHODS
Patients who underwent LC and CC for colon cancer between January 2010 and December 2017 were retrospectively analyzed. Short-term results and oncological outcomes were studied.
RESULTS
Two hundred sixty-nine patients were included in the study. CC was performed in 37.5% and LC in 62.5%. LC presented shorter operative time (157 vs. 175 min, p = 0.01), shorter length of stay (8.4 vs. 10.5 days, p = 0.02), lees readmission (6% vs. 15%, p = 0.02), and lower morbidity (40% vs. 56%, p = 0.01). No differences were found for overall survival (OAS) (LC = 87.1% vs. CC = 82.8%, p = 0.28) and disease-free survival (DFS) (LC = 78.2% vs. CC = 75.3%, p = 0.47). Recurrence was observed in 37 patients (LC = 16.1% vs. CC = 18.3%, p = 0.53). No differences were found for local recurrence (LC = 6.5% vs. CC = 8.6%, p = 0.49) and distant recurrence (LC = 12.1% vs. CC = 16.1%, p = 0.3). Stage analysis showed no difference for recurrence, OAS, and DFS.
CONCLUSIONS
LC is a safe procedure with short-term outcomes, OAS, DFS, and recurrence similar to CC. LC should be the initial indication in non-metastatic colon cancer in our population.
Topics: Adenocarcinoma; Adult; Aged; Aged, 80 and over; Colectomy; Colonic Neoplasms; Disease-Free Survival; Female; Follow-Up Studies; Humans; Kaplan-Meier Estimate; Laparoscopy; Length of Stay; Lymph Node Excision; Lymphatic Metastasis; Male; Middle Aged; Neoplasm Staging; Operative Time; Patient Readmission; Postoperative Complications; Recurrence; Retrospective Studies; Treatment Outcome
PubMed: 32539009
DOI: 10.24875/CIRU.19001353 -
Arquivos Brasileiros de Cirurgia... 2024The laparoscopic approach considerably reduced the morbidity of colorectal surgery when compared to the open approach. Among its benefits, we can highlight less...
BACKGROUND
The laparoscopic approach considerably reduced the morbidity of colorectal surgery when compared to the open approach. Among its benefits, we can highlight less intraoperative bleeding, early oral intake, lower rates of surgical site infection, incisional hernia, and postoperative pain, and earlier hospital discharge.
AIMS
To compare the perioperative morbidity of right versus left colectomy for cancer and the quality of laparoscopic oncologic resection.
METHODS
Retrospective analysis of patients submitted to laparoscopic right and left colctomy between 2006 and 2016. Postoperative complications were classified using the Clavien-Dindo scale, 30 days after surgery.
RESULTS
A total of 293 patients were analyzed, 97 right colectomies (33.1%) and 196 left colectomies (66.9%). The averageage was 62.8 years. The groups were comparable in terms of age, comorbidities, body mass index, and the American Society of Anesthesiology (ASA) classification. Preoperative transfusion was higher in the right colectomy group (5.1% versus 0.4%, p=0.004, p<0.05). Overall, 233 patients (79.5%) had no complications. Complications found were grade I and II in 62 patients (21.1%) and grade III to V in 37 (12.6%). Twenty-three patients (7.8%) underwent reoperation. The comparison between left and right colectomy was not statistically different for operative time, conversion, reoperation, severe postoperative complications, and length of stay. The anastomotic leak rate was comparable in both groups(5.6% versus 2.1%, p=0.232, p>0.05). The oncological results were similar in both surgeries. In multiple logistic regression, ASA statistically influenced the worst results (≥ III; p=0.029, p<0.05).
CONCLUSIONS
The surgical and oncological results of laparoscopic right and left colectomies are similar, making this the preferred approach for both procedures.
Topics: Humans; Retrospective Studies; Surgical Wound Infection; Neoplasms; Laparoscopy; Colectomy; Postoperative Complications; Treatment Outcome; Length of Stay
PubMed: 38324853
DOI: 10.1590/0102-672020230074e1792 -
Langenbeck's Archives of Surgery Apr 2023To analyze the safety and feasibility of intracorporeal resection and anastomosis in upper rectum, sigmoid, and left colon surgery, via both laparoscopic and robotic... (Observational Study)
Observational Study
Laparoscopic and robotic intracorporeal resection and end-to-end anastomosis in left colectomy: a prospective cohort study - stage 2a IDEAL framework for evaluating surgical innovation.
PURPOSE
To analyze the safety and feasibility of intracorporeal resection and anastomosis in upper rectum, sigmoid, and left colon surgery, via both laparoscopic and robotic approaches. The secondary aim was to assess possible short-term differences between laparoscopic versus robotic surgery.
METHODS
A prospective observational cohort study according to IDEAL framework exploration and assessment stage (Development, stage 2a), evaluating and comparing the laparoscopic approach and the robotic approach in left colon, sigmoid, and upper rectum surgery with intracorporeal resection and end-to-end anastomosis. Demographic, preoperative, surgical, and postoperative variables of patients undergoing laparoscopic and robotic surgery are described and compared according to the surgical technique used.
RESULTS
Between May 2020 and March 2022, seventy-nine patients were consecutively included in the study, 41 operated via laparoscopy (laparoscopic left colectomy: LLC) and 38 by robotic surgery (robotic left colectomy: RLC). There were no statistically significant differences between the two groups in terms of demographic variables. In surgical variables, the median surgical times differed significantly: 198 min (SD 48 min) for LLC vs. 246 min (SD 72 min) for RLC (p = 0.01, 95% CI: - 75.2 to - 20.5)). The only significant difference regarding postoperative complications was a higher degree of relevant morbidity in the LLC (Clavien-Dindo > II (14.6% vs. 0%, p = 0.03) and Comprehensive Complication Index (IQR 22 vs. IQR 0, p = 0.03). The pathological results were similar in both approaches.
CONCLUSION
Laparoscopic and robotic intracorporeal resection and anastomosis are feasible and safe, and obtain similar surgical, postoperative, and pathological results than described in literature. However, morbidity seems to be higher in LLC group with fewer relevant postoperative complications. The results of this study enable us to proceed to stage 2b of the IDEAL framework.
CLINICAL TRIAL REGISTRATIONS
The study is registered in Clinical trials with the registration code NCT0445693.
Topics: Humans; Robotic Surgical Procedures; Prospective Studies; Colectomy; Anastomosis, Surgical; Laparoscopy; Postoperative Complications; Treatment Outcome; Colonic Neoplasms; Retrospective Studies
PubMed: 37002506
DOI: 10.1007/s00423-023-02844-1 -
BMC Anesthesiology Jul 2022Few studies have investigated the depth of intraoperative analgesia with non-opioid anesthesia. This study evaluated whether opioid-free anesthesia can provide an... (Randomized Controlled Trial)
Randomized Controlled Trial
BACKGROUND
Few studies have investigated the depth of intraoperative analgesia with non-opioid anesthesia. This study evaluated whether opioid-free anesthesia can provide an effective analgesia-antinociception balance monitored by the / pain threshold index in laparoscopic radical colectomy.
METHODS
We enrolled 102 patients undergoing laparoscopic radical colectomy with general anesthesia. Participants were randomly allocated into two groups to receive opioid-free anesthesia (group OFA) with dexmedetomidine (loading dose with 0.6 μg·kg for 10 min and then 0.5 μg·kg·h continuous infusion) and sevoflurane plus bilateral paravertebral blockade (0.2 μg·kg dexmedetomidine and 0.5% ropivacaine 15 ml per side) or opioid-based anesthesia (group OA) with remifentanil, sevoflurane, and bilateral paravertebral blockade (0.5% ropivacaine 15 ml per side). The primary outcome variable was pain intensity during the operation, as assessed by the pain threshold index with the multifunction combination monitor HXD- I. Results were analyzed using repeated measures analysis of variance and Student's t-test. The secondary outcomes were wavelet index, lactic levels, and blood glucose concentration during the operation. The visual analog scale (VAS), rescue analgesic consumption, and side-effects of opioids after surgery were further assessed.
RESULTS
One hundred and one patients were included in the analysis. Analysis revealed that the intraoperative pain threshold index readings were not significantly different between the groups from incision to the end of the operation (P = 0.06). Furthermore, similar changes in the brain wavelet index readings were observed in the OFA and OA groups. There was no statistical difference in VAS scores between the groups (P > 0.05); however, non-opioid anesthesia did reduce the rescue analgesic consumption after operation (P < 0.05). In the OFA group, the blood glucose levels increased by 20% compared to baseline and were significantly higher than those in the OA group (P < 0.001). The incidences of postoperative nausea and vomiting, urine retention, intestinal paralysis and pruritus were not significantly different from those in the OA group (P > 0.05).
CONCLUSIONS
This study suggests that compared to the opioid anesthesia regimen, our opioid-free anesthesia regimen achieved an equally effective intraoperative pain threshold index in laparoscopic radical colectomy. The incidence of opioid-related adverse reactions was not different between regimens, and intraoperative blood glucose levels were higher with opioid-free anesthesia.
TRIAL REGISTRATION
ChiCTR1900021223, 02/02/2019, Title: " Opioid-free anesthesia in laparoscopic surgery: a randomized controlled trial ". Website: hppts:// www.chictr.ogr.cn.
Topics: Analgesia, Patient-Controlled; Analgesics; Analgesics, Opioid; Anesthesia; Blood Glucose; Colectomy; Dexmedetomidine; Humans; Laparoscopy; Pain Threshold; Pain, Postoperative; Ropivacaine; Sevoflurane
PubMed: 35906554
DOI: 10.1186/s12871-022-01747-w -
International Journal of Surgery... Dec 2017Several different operative approaches have been applied nowadays in laparoscopic right hemi-colectomy. This study aims to evaluate the potential benefits of different... (Meta-Analysis)
Meta-Analysis Review
AIM
Several different operative approaches have been applied nowadays in laparoscopic right hemi-colectomy. This study aims to evaluate the potential benefits of different approaches by conducting a network meta-analysis (NMA).
METHOD
A comprehensive literature research of the PubMed, Embase, Medline, the Cochrane Central Library, Wan Fang and China National Knowledge Infrastructure (CNKI) databases was performed. Original articles comparing two of three different approaches including medial to lateral (MtL) approach, lateral to medial (LtM) approach and cranial to caudal (CtC) approach of laparoscopic right colon resection for patients with both neoplastic and benign diseases were included.
RESULTS
3 RCTs and 3 NRCTs with a total of 571 patients were included in this NMA. The result revealed that LtM approach needs shorter postoperative flatus recovery time than both MtL approach with a WMD of 1.40 (95% CI: 0.13 to 2.67, P < 0.05) and CtC approach (WMD = -1.25, 95% CI: -1.90 to -0.61, P < 0.05). The length of hospital stay of LtM approach is shorter than that of MtL approach (WMD = 0.29, 95% CI: 0.08 to 0.50, P < 0.05). CtC approach can achieve less postoperative complications (OR = 3.37, 95% CI: 1.06 to 10.70, P < 0.05) compared with MtL approach.
CONCLUSION
All three approaches are safe and acceptable in laparoscopic right hemi-colectomy since the pooled evidence revealed that most aspects of different approaches are comparable in general. The postoperative flatus recovery time and hospitalization time of LtM approach is shorter compared with MtL approach. And CtC approach may have slight superiority in postoperative complications compared with MtL approach.
Topics: Aged; Colectomy; Female; Humans; Laparoscopy; Length of Stay; Male; Middle Aged; Network Meta-Analysis; Postoperative Complications; Treatment Outcome
PubMed: 29032159
DOI: 10.1016/j.ijsu.2017.10.029 -
International Journal of Surgery... Apr 2023In laparoscopic right hemicolectomy for right colon cancer, complete mesocolic excision is a standard procedure that involves extended lymphadenectomy and blood vessel... (Randomized Controlled Trial)
Randomized Controlled Trial
BACKGROUND
In laparoscopic right hemicolectomy for right colon cancer, complete mesocolic excision is a standard procedure that involves extended lymphadenectomy and blood vessel ligation. This study aimed to establish a nomogram to facilitate evaluation of the surgical difficulty of laparoscopic right hemicolectomy based on preoperative parameters.
MATERIALS AND METHODS
The preoperative clinical and computed tomography-related parameters, operative details, and postoperative outcomes were analyzed. The difficulty of laparoscopic colectomy was defined using the scoring grade reported by Escal et al . with modifications. Multivariable logistic analysis was performed to identify parameters that increased the surgical difficulty. A preoperative nomogram to predict the surgical difficulty was established and validated.
RESULTS
A total of 418 consecutive patients with right colon cancer who underwent laparoscopic radical resection at a single tertiary medical center between January 2016 and May 2022 were retrospectively enrolled. The patients were randomly assigned to a training data set ( n =300, 71.8%) and an internal validation data set ( n =118, 28.2%). Meanwhile, an external validation data set with 150 consecutive eligible patients from another tertiary medical center was collected. In the training data set, 222 patients (74.0%) comprised the non-difficulty group and 78 (26.0%) comprised the difficulty group. Multivariable analysis demonstrated that adipose thickness at the ileocolic vessel drainage area, adipose area at the ileocolic vessel drainage area, adipose density at the ileocolic vessel drainage area, presence of the right colonic artery, presence of type III Henle's trunk, intra-abdominal adipose area, plasma triglyceride concentration, and tumor diameter at least 5 cm were independent risk factors for surgical difficulty; these factors were included in the nomogram. The nomogram incorporating seven independent predictors showed a high C-index of 0.922 and considerable reliability, accuracy, and net clinical benefit.
CONCLUSIONS
The study established and validated a reliable nomogram for predicting the surgical difficulty of laparoscopic colectomy for right colon cancer. The nomogram may assist surgeons in preoperatively evaluating risk and selecting appropriate patients.
Topics: Humans; Retrospective Studies; Nomograms; Reproducibility of Results; Colonic Neoplasms; Colectomy; Lymph Node Excision; Mesocolon; Laparoscopy
PubMed: 36999773
DOI: 10.1097/JS9.0000000000000352