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International Journal of Surgery... Aug 2023To compare the short-term outcomes of patients undergoing intracorporeal anastomosis (IA) during laparoscopic colectomy to those undergoing extracorporeal anastomosis...
BACKGROUND
To compare the short-term outcomes of patients undergoing intracorporeal anastomosis (IA) during laparoscopic colectomy to those undergoing extracorporeal anastomosis (EA).
METHODS AND MATERIALS
The study was a single-centre retrospective propensity score-matched analysis conducted. Consecutive patients who underwent elective laparoscopic colectomy without the double stapling technique between January 2018 and June 2021 were investigated. The main outcome was overall postoperative complications within 30 days after the procedure. The authors also performed a sub-analysis of the postoperative results of ileocolic anastomosis and colocolic anastomosis, respectively.
RESULTS
A total of 283 patients were initially extracted; after propensity score matching, there were 113 patients in each of the IA and EA groups. There were no differences in patient characteristics between the two groups. The IA group had a significantly longer operative time than the EA group (208 vs. 183 min, P =0.001). The rate of overall postoperative complications was significantly lower in the IA group ( n =18, 15.9%) than in the EA group ( n =34, 30.1%; P =0.02), especially in colocolic anastomosis after left-sided colectomy (IA: 23.8% vs. EA: 59.1%; P =0.03). Postoperative inflammatory marker levels were significantly higher in the IA group on postoperative day 1 but not on postoperative day 7. There was no difference in the postoperative lengths of hospital stay between the two groups, and no deaths occurred.
CONCLUSION
The data suggest that performing IA during laparoscopic colectomy can potentially reduce the risk of postoperative complications, especially in colocolic anastomosis after left-sided colectomy.
Topics: Humans; Retrospective Studies; Propensity Score; Treatment Outcome; Colectomy; Postoperative Complications; Anastomosis, Surgical; Laparoscopy; Colonic Neoplasms
PubMed: 37222668
DOI: 10.1097/JS9.0000000000000485 -
Medicine Mar 2021One-stage resections of primary colorectal cancer and liver metastases have been reported to be feasible and safe. Minimally invasive approaches have become more common... (Observational Study)
Observational Study
One-stage resections of primary colorectal cancer and liver metastases have been reported to be feasible and safe. Minimally invasive approaches have become more common for both colorectal and hepatic surgeries. This study aimed to investigate outcomes of these combined surgical procedures among different approaches.We retrospectively analyzed patients diagnosed as having primary colorectal cancer with synchronous liver metastases and who underwent 1-stage primary resection and hepatectomy with curative intent in our hospital. According to the surgical approach for the primary tumor and hepatic lesions, namely open laparotomy (Op) or laparoscopic approach (Lap), patients were classified into Op-Op, Lap-Op (laparoscopic colorectal resection plus open hepatectomy), and Lap-Lap groups, respectively. Clinicopathological factors were reviewed, and short- and long-term outcomes were compared among the groups.The Op-Op, Lap-Op, and Lap-Lap groups comprised 36, 18, and 17 patients, respectively. The superior/posterior hepatic segments were more frequently resected via an open approach. There was no laparoscopic major hepatectomy. The median volume of intraoperative blood loss was smaller in the Lap-Lap and Lap-Op groups (290 and 270 mL) than in the Op-Op group (575 mL, P = .008). The hospital stay after surgery was shorter in the Lap-Lap and Lap-Op groups (median: 17 days and 15 days, vs 19 days for the Op-Op group, P = .033). The postoperative complication rates and survivals were similar among the groups.Application of laparoscopy to 1-stage resections of primary colorectal cancer and liver metastases may offer advantages of enhanced recovery from surgical treatment, given appropriate patient selection.
Topics: Adult; Aged; Aged, 80 and over; Blood Loss, Surgical; Colectomy; Colorectal Neoplasms; Combined Modality Therapy; Feasibility Studies; Female; Hepatectomy; Humans; Laparoscopy; Laparotomy; Liver Neoplasms; Male; Middle Aged; Neoplasms, Multiple Primary; Operative Time; Proctectomy; Retrospective Studies; Treatment Outcome
PubMed: 33726015
DOI: 10.1097/MD.0000000000025205 -
International Journal of Surgery... Mar 2016To evaluate the pathologic, short-term and oncologic outcomes of laparoscopic and open complete mesocolic excision (CME) and central ligation for right-sided colon... (Observational Study)
Observational Study
PURPOSE
To evaluate the pathologic, short-term and oncologic outcomes of laparoscopic and open complete mesocolic excision (CME) and central ligation for right-sided colon cancer.
METHODS
All patients (n = 215) underwent elective CME either by open surgery (n = 99) or laparoscopy (n = 116).
RESULTS
Mean number of retrieved lymph nodes (31 vs. 27, p = 0.012) was greater in the open CME group. Between the open and laparoscopic CME groups, there were no differences of length of the specimen (44.3 cm and 43.2 cm), ileum (14 cm and 13.3 cm), or colon (30.3 cm and 29.8 cm), respectively. Proximal and distal margins were similar. Mean operative time was similar between the open and laparoscopic CME groups (175 min vs. 178 min). The rate of 30-day postoperative complications (36.4% vs. 23.3%, p = 0.036) was higher in the open CME group. There were no differences in 3-year overall survival rates (86.9% vs. 95.5% in stage II disease and 70.2% vs. 90.7% in stage III disease) or recurrence-free survival rates (84.5% vs. 84.8% in stage II disease and 64.2% vs. 68.9% in stage III disease) between the open and laparoscopic CME groups.
CONCLUSIONS
Pathologic (specimen lengths, resection margin lengths, number of lymph nodes, and R0 resection) and oncologic outcomes of the laparoscopic CME group were comparable. Moreover, laparoscopic CME conferred short-term benefits in terms of lower rates of postoperative complications, reduced time to soft diet, and reduced length of hospital stay. Based on these results, laparoscopic CME can be considered as a routine elective approach for right-sided colon cancer.
Topics: Adult; Aged; Cohort Studies; Colectomy; Colonic Neoplasms; Female; Humans; Laparoscopy; Length of Stay; Ligation; Lymph Nodes; Male; Mesocolon; Middle Aged; Neoplasm Staging; Operative Time; Survival Rate; Time Factors; Treatment Outcome
PubMed: 26850326
DOI: 10.1016/j.ijsu.2016.02.001 -
International Journal of Surgery... Dec 2023The conventional laparoscopic approach for the surgical management of deep endometriosis (DE) infiltrating the rectum appears to ensure improved digestive functional... (Randomized Controlled Trial)
Randomized Controlled Trial
Laparoscopic natural orifice specimen extraction colectomy versus conventional laparoscopic colorectal resection in patients with rectal endometriosis: a randomized, controlled trial.
BACKGROUND
The conventional laparoscopic approach for the surgical management of deep endometriosis (DE) infiltrating the rectum appears to ensure improved digestive functional outcomes. The natural orifice specimen extraction (NOSE) technique for the treatment of colorectal DE can significantly accelerate postoperative recovery; however, data on gastrointestinal function following conventional laparoscopic segmental bowel resection (CLR) compared with NOSE colectomy (NC) for DE are sparse.
MATERIALS AND METHODS
Between 30 September 2019 and 31 December 2020, a randomized, open-label, two-arm, parallel-group controlled trial with women aged 18-45 years was conducted at University Hospital.Ninety-nine patients were randomized to CLR or NC, with DE infiltrating at least the muscular layer, at least 50% of the circumference of the bowel, up to 15 cm from the anal verge, exhibiting pain and bowel symptoms and/or infertility. The primary endpoint was bowel function, represented by low anterior resection syndrome (LARS). Secondary parameters included the Endometriosis Health Profile 30 (EHP30), Gastrointestinal Quality of Life Index (GIQLI), Visual Analog Scale (VAS) scores preoperatively and at set times (1 and 6 months, 1 year) following surgery.
RESULTS
No significant differences were observed in the postoperative LARS scores, VAS, EHP30, and GIQLI between the NC and CLR groups. LARS scores did not reveal significant differences 12 months postoperatively compared to the preoperative values in both groups (CLR group P =0.93 versus NC group, P =0.87). GIQLI scores were significantly improved 12 months after the operation compared with baseline values in the CLR group ( P =0.002) and NC group ( P =0.001). Pain symptoms and quality of life scores significantly improved 12 months postoperatively in both groups.
CONCLUSIONS
NC is a feasible surgical approach for treating patients with rectal DE. Our study did not show a statistically significant difference between CLR and NC techniques in mid-term digestive and pain outcomes.
Topics: Humans; Female; Postoperative Complications; Endometriosis; Quality of Life; Rectal Neoplasms; Treatment Outcome; Syndrome; Rectal Diseases; Laparoscopy; Colectomy; Pain
PubMed: 37720929
DOI: 10.1097/JS9.0000000000000728 -
Journal of the American College of... Jul 2013The Clinical Outcomes in Surgical Therapy trial demonstrated that laparoscopic colectomy (LC) was equivalent to open colectomy (OC) for 30-day mortality, time to... (Randomized Controlled Trial)
Randomized Controlled Trial
BACKGROUND
The Clinical Outcomes in Surgical Therapy trial demonstrated that laparoscopic colectomy (LC) was equivalent to open colectomy (OC) for 30-day mortality, time to recurrence, and overall survival in colon cancer (CC) patients. Current use of LC for CC is not well known.
STUDY DESIGN
Surgical data were reviewed for all patients randomized into a national phase III clinical trial for adjuvant therapy in stage III CC (North Central Cancer Treatment Group trial N0147). Colon resections were grouped as open (traditional laparotomy) or laparoscopic, including laparoscopic; laparoscopic assisted; hand assisted; and laparoscopic converted to OC. Statistical methods included nonparametric methods, categorical analysis, and logistic regression modeling.
RESULTS
A total of 3,393 evaluable patients were accrued between 2004 and 2009; 53% were male, median age was 58 years, 86% were white, and 70% had a body mass index >25 kg/m(2). Two thousand one hundred thirteen (62%) underwent OC. One thousand two hundred eighty (38%) were initiated as laparoscopic procedures, 25% (n = 322) were laparoscopic, 32% (n = 410) were laparoscopic assisted, 26% (n = 339) were hand assisted, and 16% (n = 209) were LC converted to OC. Significant predictors of LC (vs OC) in multivariate models were T stage (T1 or T2 vs T3 or T4; p = 0.0286), and absence of perforation, bowel obstruction, or adherence to surrounding organs (p < 0.01 each). Increasing rates of LC were observed over time, with LC eclipsing OC in 2009 (p < 0.0001). Surgical efficacy, measured by lymph node retrieval, was similar, with the mean number of lymph nodes retrieved higher in the LC group (20.6 vs 19.5 nodes; p = 0.0006).
CONCLUSIONS
This study demonstrated a steadily increasing use of LC for the surgical treatment of CC between 2004 and 2009, with LC preferred by study completion. Surgical efficacy was similar in stage III CC patients.
Topics: Adult; Aged; Aged, 80 and over; Antineoplastic Agents; Antineoplastic Combined Chemotherapy Protocols; Chemotherapy, Adjuvant; Colectomy; Colonic Neoplasms; Female; Humans; Laparoscopy; Logistic Models; Lymph Node Excision; Male; Middle Aged; Multivariate Analysis; Neoplasm Staging; Treatment Outcome; United States
PubMed: 23623224
DOI: 10.1016/j.jamcollsurg.2013.02.023 -
Journal of Robotic Surgery May 2024Colorectal surgery has progressed greatly via minimally invasive techniques, laparoscopic and robotic. With the advent of ERAS protocols, patient recovery times have... (Review)
Review
Colorectal surgery has progressed greatly via minimally invasive techniques, laparoscopic and robotic. With the advent of ERAS protocols, patient recovery times have greatly shortened, allowing for same day discharges (SDD). Although SDD have been explored through laparoscopic colectomy reviews, no reviews surrounding robotic ambulatory colorectal resections (RACrR) exist to date. A systematic search was carried out across three databases and internet searches. Data were selected and extracted by two independent reviewers. Inclusion criteria included robotic colorectal resections with a length of hospital stay of less than one day or 24 h. 4 studies comprising 136 patients were retrieved. 56% of patients were female and were aged between 21 and 89 years. Main surgery indications were colorectal cancer and recurrent sigmoid diverticulitis (43% each). Most patients had low anterior resections (48%). Overall, there was a 4% complication rate postoperatively, with only 1 patient requiring readmission due to postoperative urinary retention (< 1%). Patient selection criteria involved ASA score cut-offs, nutritional status, and specific health conditions. Protocols employed shared similarities including ERAS education, transabdominal plane blocks, early removal of urinary catheters, an opioid-sparing regime, and encouraged early oral intake and ambulation prior to discharge. All 4 studies had various follow-up methods involving telemedicine, face-to-face consultations, and virtual ward teams. RACrRs is safe and feasible in a highly specific patient population; however, further high-quality studies with larger sample sizes are needed to draw more significant conclusions. Several limitations included small sample size and the potential of recall bias due to retrospective nature of 2 studies.
Topics: Humans; Robotic Surgical Procedures; Ambulatory Surgical Procedures; Length of Stay; Female; Aged; Colorectal Neoplasms; Aged, 80 and over; Middle Aged; Colectomy; Adult; Male; Postoperative Complications; Young Adult; Laparoscopy
PubMed: 38713324
DOI: 10.1007/s11701-024-01961-3 -
BMC Surgery Sep 2022This retrospective study aimed to compare long-term oncological outcomes between laparoscopic-assisted colectomy (LAC) with extracorporeal anastomosis (EA) and totally...
Medium-term oncological outcomes of totally laparoscopic colectomy with intracorporeal anastomosis for right-sided and left-sided colon cancer: propensity score matching analysis.
BACKGROUND
This retrospective study aimed to compare long-term oncological outcomes between laparoscopic-assisted colectomy (LAC) with extracorporeal anastomosis (EA) and totally laparoscopic colectomy (TLC) with intracorporeal anastomosis (IA) for colon cancers, including right- and left-sided colon cancers.
METHODS
Patients with stage I-III colon cancers who underwent elective laparoscopic colectomy between January 2013 and December 2017 were analyzed retrospectively. Patients converted from laparoscopic to open surgery and R1/R2 resection were excluded. Propensity score matching (PSM) analysis (1:1) was performed to overcome patient selection bias.
RESULTS
A total of 388 patients were reviewed. After PSM, 83 patients in the EA group and 83 patients in the IA group were compared. Median follow-up was 56.5 months in the EA group and 55.5 months in the IA group. Estimated 3-year overall survival (OS) did not differ significantly between the EA group (86.6%; 95% confidence interval (CI), 77.4-92.4%) and IA group (84.8%; 95%CI, 75.0-91.1%; P = 0.68). Estimated 3-year disease-free survival (DFS) likewise did not differ significantly between the EA group (76.4%; 95%CI, 65.9-84.4%) and IA group (81.0%; 95%CI, 70.1-88.2%; P = 0.12).
CONCLUSION
TLC with IA was comparable to LAC with EA in terms of 3-year OS and DFS. TLC with IA thus appears to offer an oncologically feasible procedure.
Topics: Anastomosis, Surgical; Colectomy; Colonic Neoplasms; Humans; Laparoscopy; Propensity Score; Retrospective Studies; Treatment Outcome
PubMed: 36123673
DOI: 10.1186/s12893-022-01798-3 -
World Journal of Gastroenterology Nov 2013To investigate the impact of laparoscopic colectomy on short and long-term outcomes in obese patients with colorectal diseases.
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/m(2)) 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 χ(2) 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.
Topics: Aged; Body Mass Index; Case-Control Studies; Chi-Square Distribution; Colectomy; Female; Humans; Laparoscopy; Male; Middle Aged; Obesity; Postoperative Complications; Risk Factors; Time Factors; Treatment Outcome
PubMed: 24259971
DOI: 10.3748/wjg.v19.i42.7405 -
Medicine May 2023Surgical intervention is the recommended line for the management of colon cancer. The aim of this study was to evaluate the impact of different surgical techniques... (Meta-Analysis)
Meta-Analysis
BACKGROUND
Surgical intervention is the recommended line for the management of colon cancer. The aim of this study was to evaluate the impact of different surgical techniques (laparoscopic, open, extended right, and left colectomy) on clinical outcomes such as mortality, postoperative complications, operation and hospitalization time, and oncological factors.
METHODS
A total of 15 studies have been included in the current study. The outcomes of these studies were analyzed using a random-effect model and it was used to calculate the mean difference with 95% confidence intervals to quantify the impact of open, laparoscopic, extended right, and left colectomy. Inclusion criteria included studies in which subjects undergo splenic flexure colon cancer surgery with 2 comparable different surgical techniques.
RESULTS
Laparoscopic splenic flexure colon cancer surgery showed a significant beneficial impact on the length of hospital stay (P < .001), the volume of blood loss during surgery (P < .001), postoperative complications (P < .001), and time to an oral diet (P < .001). On the other hand, there was no significance regarding anastomotic leakage, infection of the surgical site, and operation time. Regarding the comparison between extended right colectomy (ERC) and lift colectomy (LC), analysis findings showed a significant (P = .001) higher efficacy of ERC in harvested number of lymph nodes compared with LC. On the other hand, there was no significant difference for the rest of the parameters. The neoadjuvant therapy as an influencing factor on postoperative outcome showed a beneficial impact regarding the overall survival rate.
CONCLUSION
Laparoscopic splenic flexure colon cancer surgery showed a significant beneficial impact compared with open surgery as proved by clinical outcomes. On the other hand, ERC and LC resulted in similar findings except for harvested lymph nodes, results were in favor of ERC.
Topics: Humans; Colon, Transverse; Treatment Outcome; Colonic Neoplasms; Laparoscopy; Postoperative Complications; Colectomy; Retrospective Studies
PubMed: 37171307
DOI: 10.1097/MD.0000000000033742 -
Asian Journal of Surgery Jan 2020Laparoscopic complete mesocolic excision is gradually becoming the standard surgical approach in colon cancer therapy, the core element of which is central vascular... (Review)
Review
Laparoscopic complete mesocolic excision is gradually becoming the standard surgical approach in colon cancer therapy, the core element of which is central vascular ligation. However, this increases the difficulty for surgeons, particularly in the context of right colectomy, which encounters complex vascular anatomy. This study aimed to examine vascular variations that occur during laparoscopic right hemicolectomy through a review of the medical literature. We demonstrated that the ICA and MCA are evident in the majority of patients. The RCA was inconsistently present ranging from 12% to 45%. The ICA passed the SMV anteriorly or posteriorly at average rates. However, the RCA passed anterior to the SMV in most patients. Regarding intravenous, the ICV was consistently present, whereas the RCV was absent in up to 80% of patients. The GTH was present in nearly 80% of patients. We classified the vascular variations by the location of the branches instead of using numerical classification. The GCT and GPCT were common types whilst the GPT was relatively rare. In summary, detailed information on the vascular anatomical variations occurring on the right-side of the colon is vital. Failure to identify variations during surgical procedures can result in unwanted bleeding. Thus, we advocate for the use of the ICV as an anatomic marker during surgery.
Topics: Anatomic Variation; Blood Vessels; Colectomy; Colon; Colonic Neoplasms; Humans; Laparoscopy
PubMed: 30979567
DOI: 10.1016/j.asjsur.2019.03.013