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1.
A. Zarzavadjian Le Bian C. Denet N. Tabchouri H. Levard R. Besson T. Perniceni R. Costi P. Wind D. Fuks B. Gayet 《Techniques in coloproctology》2018,22(3):215-221
Background
Among the criteria used to diagnose metabolic syndrome (MS), obesity and diabetes mellitus (DM) are associated with poor postoperative outcomes following colectomy. MS is also associated with colorectal cancer (CRC) and diverticulosis, both of which may be treated with colectomy. However, the effect of MS on postoperative outcomes following laparoscopic colectomy has yet to be clarified.Methods
In an academic tertiary hospital, data from all consecutive patients undergoing laparoscopic colectomy from 2005 to 2014 were prospectively recorded and analysed. Patients presenting with MS [defined by the presence of three or more of the following criteria: elevated blood pressure, body mass index?>?28 kg/m2, dyslipidemia (decreased serum HDL cholesterol, increased serum triglycerides) and increased fasting glucose/DM] were compared with patients without MS regarding peri-operative outcome [mainly anastomotic leaks, severe postoperative complications (Clavien–Dindo III and IV)] and mortality.Results
Overall, 1236 patients were included: 508 (41.1%) right colectomies and 728 (58.9%) left colectomies. Seven hundred seventy-two (62.4%) of these procedures were performed for CRC. MS was diagnosed in 85 (6.9%) patients, who were significantly older than the others (70 vs. 64.2 years, p?<?0.001), and presented with more cardiac comorbidities (p?<?0.001). MS was associated with increased blood loss (122.5 vs. 79.9 mL p?=?0.001) and blood transfusion requirement (5.9 vs. 1.7%, p?=?0.021). The anastomotic leak rate was 6.6% (with 2.2% of anastomotic leaks requiring surgical treatment), and the overall reoperation rate was 6.9%. The incidence of severe postoperative complications was 11.5%, and the overall mortality rate 0.6%. No differences were found between the groups in overall postoperative morbidity and mortality. Median length of stay was similar in both groups (7 days).Conclusions
MS does not jeopardize postoperative outcomes following laparoscopic colectomy.2.
J. W. Shin A. H. Y. Amar S. H. Kim J. M. Kwak S. J. Baek J. S. Cho J. Kim 《Techniques in coloproctology》2014,18(9):795-803
Background
There is emerging evidence that complete mesocolic excision (CME) for colon cancer produces favorable oncologic outcomes. The applicability of CME technique in laparoscopic colectomy has not been fully explored. The aim of our retrospective study was to evaluate the feasibility of the CME technique with D3 lymphadenectomy in laparoscopic colectomy and its short- and long-term outcomes.Methods
Between September 2006 and December 2009, 168 laparoscopic colectomies were performed for stages II and III colon cancer. Prospectively, collected data on demographics, tumor characteristics, complications, and outcomes were analyzed retrospectively.Results
Eighty-seven patients (51.8 %) had stage II colon cancer, and 81 patients had stage III cancer. The mean operative time was 196.0 ± 61.2 min. The overall morbidity rate was 17.8 %, which included anastomotic leak in 10 patients (5.9 %). There was no operative mortality. The number of lymph nodes harvested was 27.8 ± 13.6. With a median follow-up of 57.3 months, locoregional recurrence and systemic metastasis developed in 6 (3.6 %) and 14 patients (8.3 %), respectively. Seven patients died of causes related to cancer, and all had stage III cancer. Disease-free survival at 5-years was 95.2 % for patients with stage II and 80.9 % for patients with stage III.Conclusions
Standardization of laparoscopic CME and D3 lymphadenectomy is expedient. The technique is associated with acceptable morbidity and provides excellent oncologic outcomes for stage II and stage III colon cancer. A longer follow-up is needed to validate the enhancement of oncological outcome related to this surgical concept. 相似文献3.
S. Woo Lim H. Jin Kim C. Hyun Kim J. Wook Huh Y. Jin Kim H. Rok Kim 《Techniques in coloproctology》2013,17(2):193-199
Background
Recently, laparoscopic colorectal surgery using a single incision usually made at the umbilical area has emerged as a tool to minimize the numbers of scars and provide better cosmetic results. But experience in laparoscopic skills is needed to maintain the oncologic principles of colorectal cancer surgery with the restricted operating field during the procedure. Adding an additional port to single-incision laparoscopic colorectal surgery (SILS) may be a bridge between conventional multiport laparoscopic surgery and SILS. The present study was undertaken to investigate whether umbilical incision laparoscopic colorectal cancer surgery with one additional port (ULAP) could be performed in a similar manner to conventional multiport surgery.Methods
One hundred and sixty-three patients with colorectal adenocarcinoma underwent laparoscopic colectomy between February 2011 and August 2011. Forty of these patients underwent ULAP and were compared with the other 123 patients who had conventional laparoscopic surgery. Demographic, intraoperative, and postoperative data were analyzed.Results
Both groups were similar in age (p = 0.438), gender (p = 0.818), body mass index (p = 0.149), American Society of Anesthesiologists (ASA) scores (p = 0.417), history of previous abdominal operation (p = 0.503), and tumor location (p = 0.051). Operation time was longer in the ULAP group (255.5 min) than in the conventional laparoscopic surgery group (144.6 min) (p < 0.001). No significant differences were evident between groups for estimated blood loss (p = 0.263), transfusion requirements (p = 0.841), conversion to open procedures (p = 0.40), length of umbilical incisions (4.6 vs. 4.4 cm, p = 0.628), postoperative hospital stay (p = 0.862), tumor size (p = 0.455), number of harvested lymph nodes (p = 0.203), proximal margins (p = 0.189), and distal resection margins (p = 0.151). Postoperative morbidity (p = 0.736) was similar in both groups. There was no mortality postoperatively.Conclusions
Umbilical incision laparoscopic colorectal cancer surgery with an additional port is a feasible and safe approach, although it is more time consuming than conventional laparoscopic colectomy. 相似文献4.
Carlos Pastor Javier A. Cienfuegos Jorge Baixauli Jorge Arredondo Jesus J. Sola Carmen Beorlegui Jose Luis Hernandez-Lizoain 《International journal of colorectal disease》2013,28(5):671-677
Introduction
The present work is a comparative study to investigate the independent effect of tutored senior residents on rectal cancer surgery in an academic university hospital. The variable “surgeon” is held to be a major determinant of outcome following total mesorectal excision (TME) for rectal cancer.Objective
We hypothesized that TME can be tutored to senior surgical residents without compromising surgical and oncological outcomes.Methods
Demographics, preoperative characteristics, and surgical data from consecutive patients undergoing elective TME in an academic center over the last decade were retrospectively reviewed from a prospectively collected database. Outcomes were compared in the two cohorts by a principal surgeon (senior resident or staff) and supervised in all cases by a senior colorectal consultant. Association of outcome variables with the type of surgeon was determined by univariate and multivariate analyses and results were corrected by tumor’s height.Results
A total of 230 patients were treated over the study period; 136 (59 %) surgeries were performed by staff surgeons (group S) and 94 (41 %) by residents (group R). Both groups were comparable except for distance to anal verge; staff surgeons operated on lower tumors and performed a high percentage of coloanal anastomosis. There were no statistical differences between groups in terms of surgical and oncological outcomes when tumors were located over 7 cm from the anal verge.Conclusions
Rectal surgery can be performed by senior residents with equal results to staff surgeons when there is direct supervision by a senior consultant and when the tumor is located in the mid–upper rectum (>7 cm from the anal verge). For lower tumors, a careful selection must be made as the operation may require a higher level of training. 相似文献5.
M. R. Freund Y. Edden P. Reissman A. Dagan 《International journal of colorectal disease》2016,31(9):1649-1651
Purpose
The purpose of this review is to highlight the perils and pitfalls associated with high vascular ligation during right colectomies for adenocarcinoma and to identify the various mechanisms of injury to the superior mesenteric vein (SMV) and its tributaries.Methods
This is a retrospective chart review of 304 right colectomies (159 open and 145 laparoscopic) performed over a period of 10 years (1 June 2006–31 May 2016) for right-sided colonic adenocarcinoma in an academic medical center.Results
During a 10-year study period, we encountered five cases in which significant damage to the SMV and its tributaries occurred. This accounts for a total of 1.6 % of all right colectomies performed for colonic adenocarcinoma.Conclusions
Iatrogenic superior mesenteric vein injury is a rare, severe, and underreported complication of both open and laparoscopic right colectomy for colonic adenocarcinoma. We identified several mechanisms of injury such as anatomic misperception, excessive traction and pulling on the venous system, extensive tumor involvement of the mesentery, and uncontrolled suturing attempts at hemostasis. We believe that increased awareness of this complication with profound understanding of vascular anatomy and the different mechanisms of injury will allow surgeons to avoid this often devastating complication.6.
Objective
This study aimed to compare single-incision laparoscopic colectomy (SILC) to conventional multiport laparoscopic colectomy (MLC).Background
Single-incision laparoscopic surgery (SILS) is a minimally invasive technique being recently applied to colorectal surgery. A number of studies comparing SILC to conventional MLC have recently been published.Methods
A literature search of PubMed and MEDLINE databases for studies comparing SILC to conventional MLC was conducted. The primary outcome measures for meta-analysis were postoperative complications, length of stay, and operative time. Secondary outcome measures were incision length, estimated blood loss, and number of lymph nodes harvested.Results
Fifteen studies comparing 467 patients undergoing SILC to 539 patients undergoing conventional MLC were reviewed and the data pooled for analysis. Patients undergoing SILC had a shorter length of stay (pooled weighted mean difference (WMD)?=??0.68; 95 % CI?=??1.20 to ?0.16; p?=?0.0099), shorter incision length (pooled WMD?=??1.37; 95 % CI?=??2.74 to 0.000199; p?=?0.05), less estimated blood loss (pooled WMD?=??20.25; 95 % CI?=??39.25 to ?1.24; p?=?0.037), and more lymph nodes harvested (pooled WMD?=?1.75; 95 % CI?=?0.12 to 3.38; p?=?0.035), while there was no significant difference in the number of postoperative complications (pooled odds ratio?=?0.83; 95 % CI?=?0.57 to 1.20; p?=?0.33) or operative time (pooled WMD?=?5.06; 95 % CI?=??2.91 to 13.03; p?=?0.21).Conclusion
SILC appears to have comparable results to conventional MLC in the hands of experienced surgeons. Prospective randomized trials are necessary to define the relative benefits of one procedure over the other. 相似文献7.
M. G. Pramateftakis D. Raptis I. Mantzoros D. Kanellos S. Angelopoulos S. Psomas Th. Tsachalis 《Techniques in coloproctology》2011,15(1):29-31
Aim
The aim of this study is to present our experience with the laparoscopic treatment approach for colonic carcinoma.Patients and methods
Between 2005 and 2010, laparoscopic colectomy was performed in 13 patients; 9 patients underwent laparoscopic right hemicolectomy, 3 sigmoidectomy and 1 patient underwent laparoscopic caecectomy.Results
With regards to the right hemicolectomies, the average operative time was 168 min and the average hospital stay 5.3 days. In patients who underwent laparoscopic sigmoidectomy, the average operative time was 176 min, while the average hospital stay was 10.2 days. Finally, the laparoscopic caecectomy was performed in 85 min. There was one conversion (7.7%) to an open procedure, as well as one case (7.7%) of anastomotic leakage, which was treated with re-laparotomy and a Hartmann’s procedure. Up to today, all patients remain healthy with no signs of tumor recurrence.Conclusion
Laparoscopic colectomy for cancer, in the hands of an experienced laparoscopic surgeon, is a safe and efficient procedure.8.
The technical approach to laparoscopic colectomy in patients who have undergone prior abdominoplasty
S. Atallah M. Albert O. Felix S. Izfar T. deBeche-Adams S. Larach 《Techniques in coloproctology》2013,17(1):111-116
Background
For those patients undergoing laparoscopic colorectal surgery who have had prior abdominoplasty, cosmetic outcome is important and the technical considerations for laparoscopy in post-abdominoplasty patients have not been previously addressed. The aim of the present study was to define the technical approach to the post-abdominoplasty patient undergoing laparoscopic colorectal surgery after abdominoplasty.Methods
Utilizing the technical approach described, eleven patients underwent laparoscopy after prior abdominoplasty over a 7-year period.Results
The majority of patients (10/11) felt their laparoscopic colorectal resection had no adverse effect on the aesthetics of their prior abdominoplasty. From a surgeon’s standpoint, the only significant challenge was due to the loss of abdominal wall compliance.Conclusions
The surgical approach to laparoscopic colectomy in the post-abdominoplasty patient requires careful planning. Cosmetic outcome is a particularly important consideration for this subset of patients, and this should be appreciated by the operating surgeon. 相似文献9.
Dimitrios Tzanis Nairuthya Shivathirthan Alexis Laurent Mohammad Abu Hilal Olivier Soubrane Airazat M. Kazaryan Giuseppe Maria Ettore Ronald M. Van Dam Panagiotis Lainas Hadrien Tranchart Bjorn Edwin Giulio Belli Ricardo Robles Campos Neil Pearce Brice Gayet Ibrahim Dagher 《Journal of hepato-biliary-pancreatic sciences》2013,20(2):120-124
Background/purpose
Laparoscopic hepatectomies have seen a worldwide proliferation. Major anatomic resections, which were initially considered unsuitable for laparoscopy, are currently confined to a few centers of expertise. The aim of this study was to discuss the current trends and techniques in laparoscopic major hepatectomy in Europe.Methods
The prospective databases of ten European centers were combined to provide answers to a questionnaire that had been addressed to all European teams known to perform laparoscopic liver surgery.Results
Between 1996 and 2011 a total of 2245 laparoscopic liver resections have been carried out, of which 495 (22 %) were major resections. The proportion of laparoscopic right and left hepatectomies varied between 4 and 40 % of all major hepatectomies of the same type. Benign, primary malignant and metastatic lesions were, respectively, 22.4, 19.6 and 58 % of all indications. The different techniques and approaches, as regards hand assistance, hepatic inflow and outflow control, liver mobilization and concomitant colectomies, are discussed.Conclusions
To date, an important level of experience of laparoscopic liver resection has been accumulated in Europe, and experience of major hepatectomies is constantly increasing. However, they remain technically very demanding procedures which should be confined to expert surgeons who have already acquired considerable experience with simpler laparoscopic liver resections. 相似文献10.
Background
Anastomotic leak following colorectal surgery is associated with significant morbidity and mortality. With the widespread adoption of laparoscopy, data from initial clinical trials evaluating the efficacy of laparoscopic when compared to open surgery may not currently be generalizable. We assess the risk of anastomotic leak after laparoscopic versus open colorectal resection using a nationwide database with standardized definitions.Methods
The 2012–2013 ACS-NSQIP targeted colectomy data were queried for all elective colorectal resections. Characteristics were compared for those patients undergoing laparoscopic versus open operations. Univariable and multivariable analyses, followed by a propensity score-matched analysis, were performed to assess the impact of laparoscopy on the development of an anastomotic leak.Results
Of 23,568 patients, 3.4% developed an anastomotic leak. Laparoscopic surgery was associated with a leak rate of 2.8% (n = 425) and open surgery, 4.5% (n = 378, p <0.0001). Patients who developed a leak were more likely to die within 30 days of surgery (5.7 vs 0.6%, p <0.0001). Patients who underwent laparoscopic surgery compared to open were younger (61 vs 63 years, p = 0, p = 0.045) and with fewer comorbidities. On univariable analysis laparoscopic surgery was associated with reduced odds of developing an anastomotic leak (OR 0.60, p <0.0001), and this remained after adjusting for all significant preoperative and disease-related confounders (OR 0.69, 95% CI 0.58–0.82). A propensity score-matched analysis confirmed benefit of laparoscopic surgery over open surgery for anastomotic leak.Conclusion
Laparoscopic colectomy is safe and associated with reduced odds of developing an anastomotic leak following colectomy when controlling for patient-, disease and procedure-related factors.11.
L. Koskenvuo L. Renkonen-Sinisalo H. J. Järvinen A. Lepistö 《International journal of colorectal disease》2014,29(2):225-230
Purpose
The aim of our retrospective study was to review the outcome of patients undergoing colectomy with ileorectal anastomosis (IRA) due to familial adenomatous polyposis (FAP) in Finland during the last 50 years.Methods
The cumulative risk of rectal cancer and the rate of anus preservation were analyzed. A total of 140 FAP patients with previous colectomy combined with ileorectal anastomosis were included. Kaplan–Meier analysis was performed to evaluate cumulative risks.Results
Secondary proctectomy was performed for 39 (28 %) of 140 patients. The cumulative risk of secondary proctectomy was 53 % at 30 years after colectomy with IRA. A total of 17 (44 %) secondary proctectomies were performed due to cancer or suspicion of cancer, and another 17 (44 %) secondary proctectomies were performed due to uncontrollable rectal polyposis. During our study, the anus preservation rate in secondary proctectomies was 49 %. The cumulative risk of rectal cancer was 24 % at 30 years after colectomy with IRA. Therefore, the cumulative rectal cancer mortality 30 years after colectomy with IRA was 9 %.Conclusions
Proctocolectomy and ileal pouch-anal anastomosis (IPAA) should be favored as a primary operation for patients not having technical or medical contraindications for it because colectomy with IRA carried a rectal cancer risk of 13 % with a mortality of 7 % during our study, and because IPAA is likely to succeed better at earlier phase of the disease. Patients with attenuated FAP had no rectal cancer in our study, and they may form a group where IRA should still be the first choice as an exception. 相似文献12.
Hitoshi Inagaki Tsuyoshi Kurokawa Tadashi Yokoyama Nobuhiro Ito Yasuhisa Yokoyama Toshiaki Nonami 《Journal of hepato-biliary-pancreatic sciences》2009,16(1):64-68
Background
Although an increasing number of reports and publications have dealt with the laparoscopic approach to liver resection, this procedure remains uncommon, and its feasibility, safety and effectiveness are still not established. There are few reports of the advantages of this approach on postoperative recovery.Methods
From December 1997 to March 2007, laparoscopic hepatic resection were performed in 68 patients.Results
There were 52 malignant tumors (36 hepatocellular carcinomas, three intrahepatic cholangiocarcinomas, one cystadenocarcinoma, liver metastases from ten colorectal carcinomas and two other organs) and 16 benign lesions among our 68 patients. Fifteen patients with hepatocellular carcinoma had cirrhosis. The mean tumor size was 3.1 ± 1.8 cm (range 1.0–14.0 cm), and the tumors were located in every liver segment except segment I. Liver resection was anatomical in 17 patients and consisted of a lobectomy in four patients and a lateral segmentectomy in 13 patients. Non-anatomical resections were performed in 51 patients. The operative time was 214 ± 93 min. Mean blood loss was 393 ± 564 g. A hand-assisted laparoscopic method or mini-laparotomy method was required in 35 patients (51.4%). Operative complications occurred mainly in our early cases and included three patients (4.4%) with operative bleeding, 2 of whom (2.9%) requiring a conversion to open surgery. Postoperative complications occurred in seven patients (10.0%), and two of then eventually required a re-operation. The mean hospital stay was 17 days. There were no complications in the more recent cases.Conclusions
The laparoscopic approach for liver tumors is feasible, if the indication is carefully selected. The safety of this procedure depends on the surgical experience of the surgeon and team and the availability of the necessary technology. 相似文献13.
Dr. E. Schlöricke M. Zimmermann M. Hoffmann F.G. Bader U. Roblick H. Esnaashari T. Laubert M. Rehbein H.-P. Bruch P. Hildebrand 《coloproctology》2010,32(5):279-283
Background
Iatrogenic colon perforation is a rare but life-threatening complication of colonoscopy. Although conservative therapy is possible in selected cases, if it fails it often leads to the necessity of more extensive operations with increased morbidity in contrast to immediate and definitive surgery. Laparoscopic colorectal surgery offers the possibility of minimizing the invasiveness and associated complications.Patients and methods
The data of all patients who underwent laparoscopic surgery for iatrogenic colon perforation within a 10-year time period (1997–2009) were recorded prospectively and analyzed retrospectively with regard to age, sex, localization of the perforation, diagnoses and clinical symptoms, type of procedure, intra- and postoperative complications as well as postoperative course.Results
In the observation period 24 patients with iatrogenic colon perforation were treated laparoscopically. In 17 cases the perforation was associated with therapeutic colonoscopy and in 7 cases with diagnostic colonoscopy. In 19 patients the affected part of the colon was resected and in 5 patients a simple closure by suture was performed. Four cases required conversion. The median operating time was 165 min (range: 90–420 min) and the median hospital stay 11 days (range: 7–25 days). There were no surgical complications in the postoperative course. One patient (91 years) developed cardiac decompensation leading to death.Conclusion
Laparoscopic treatment of iatrogenic colon perforations offers a minimally invasive and definitive solution to this life-threatening complication. In the hands of an experienced surgeon a laparoscopic approach is a safe and efficient enrichment to the therapeutic options in iatrogenic colon perforation. 相似文献14.
Mario Schietroma Beatrice Pessia Francesco Carlei Emanuela Marina Cecilia Gianfranco Amicucci 《International journal of colorectal disease》2013,28(12):1651-1660
Purpose
In this prospective randomized study, we investigated the effect of surgery on intestinal permeability (IP), endotoxemia, and bacterial translocation (BT) in patients undergoing elective colectomy for colon cancer by comparing the laparoscopic with the open approach.Methods
Seventy-two consecutive patients underwent colectomy for colon cancer: 35 cases open resection and 37 cases laparoscopic resection. IP was measured preoperatively and at days 1 and 3 after surgery. Serial venous blood sample were taken at 0, 30, 60, 90, 120, and 180 min and at 12, 24, and 48 h after surgery for endotoxin measurement. Tissue sample were taken from the liver, spleen, and mesenteric lymph nodes and were weighed under sterile conditions.Results
IP was significantly increased in the open and closed group at day 1 compared with the preoperative level (p?<?0.05), but no difference was found between laparoscopic and open surgery group. The concentration endotoxin systemic increased significantly in the both group during the course of surgery but returned to baseline levels at the second day 2. No difference was found between laparoscopic and open surgery. A significant correlation was observed between the maximum systemic endotoxin concentration and IP measured at D1 in the open group and in the laparoscopic group. The incidence of BT increased in laparoscopic and open group after bowel mobilization, compared with the before mobilization (p?<?0.05). There was not a statistically significant difference in BT value between the two groups.Conclusion
An increase in IP, systemic endotoxemia, and BT were observed during the open and laparoscopic resection for colon cancer, without significant statistically difference between the two groups. 相似文献15.
Aim
Enhanced recovery after surgery (ERAS) programmes and laparoscopic techniques both provide short-term benefits to patients undergoing colorectal cancer surgery. ERAS protocol compliance may improve long-term survival in those undergoing open colorectal resection but as laparoscopic data has not been reported. Therefore, we aimed to investigate the impact of the combination of laparoscopy and ERAS management on 5-year overall survival.Methods
A dedicated prospectively populated colorectal cancer surgery database was reviewed. Patient inclusion criteria were biopsy-proven colorectal adenocarcinoma, undergoing elective surgery undertaken with curative intent. All patients were managed within an established ERAS programme and routinely followed up for 5 years. Overall survival was measured using the log-rank Kaplan-Meier method at 5 years.Results
Eight hundred fifty-four patients met the inclusion criteria. Four hundred eighty-one (56%) cases were laparoscopic with 98 patients (20%) requiring conversion. There were no differences in patient or tumour demographics between the surgical groups. Median ERAS protocol compliance was 93% (range 53–100%). Five-year overall survival was superior in laparoscopic cases compared with that of converted and open surgery (78 vs 68 vs 70%, respectively, p < 0.007). An open approach (HR 1.55, 95%CI 1.16–2.06, p = 0.002) and delayed hospital discharge (> 7 days, HR 1.5, 95%CI 1.13–1.9, p = 0.003) were the only modifiable risk factors associated with poor survival.Conclusions
The use of a laparoscopic approach with enhanced recovery after surgery management appears to have long-term survival benefits following colorectal cancer resection.16.
M. E. Hamaker A. H. Schiphorst N. M. Verweij A. Pronk 《International journal of colorectal disease》2014,29(10):1231-1236
Introduction
Older colorectal cancer patients have a higher risk of postoperative complications, and the impact of adverse events on survival is also significantly higher. Innovations like laparoscopic surgery which improve short-term outcome for older patients can also benefit their overall prognosis. We set out to analyse the impact of an increased utilisation of laparoscopic surgery for colorectal cancer in the Netherlands on overall survival.Methods
All patients diagnosed with stages I–III colorectal cancer in the Netherlands between 2008 and 2011 were selected from the Netherlands Cancer Registry. Changes in perioperative mortality, 3-month mortality and 1-year mortality rates were analysed using year of diagnosis as an instrumental variable.Results
Over 33,000 patients were included in the analyses. Data on surgical approach were not precisely known for 2008 and 2009; in 2010, 36.6 % of definitive surgical procedures were performed laparoscopically and 45.9 % in 2011. A laparoscopic approach was used less frequently in the patients aged ≥75 years (in 2011, 40.3 versus 49.2 % of younger patients; p?0.001). Between 2008 and 2011, perioperative mortality decreased from 2.0 to 1.5 % (p?=?0.02), 3-month mortality from 4.8 to 3.9 % (p?=?0.01) and 1-year mortality from 9.6 to 8.3 % (p?0.001). The absolute risk reduction was greatest for patients aged ≥75 years, reaching 2.1 % for 1-year mortality.Conclusion
Between 2008 and 2011, the utilisation of a laparoscopic approach increases significantly, resulting in reduced mortality rates, particularly for the elderly. Therefore, a laparoscopic approach should be used whenever possible, which may allow for further improvement of outcomes. 相似文献17.
Tetsuo Ikeda Yohei Mano Kazutoyo Morita Naotaka Hashimoto Hirohito Kayashima Atsuro Masuda Toru Ikegami Tomoharu Yoshizumi Ken Shirabe Yoshihiko Maehara 《Journal of hepato-biliary-pancreatic sciences》2013,20(2):145-150
Background
Pure laparoscopic liver resection is technically difficult for tumors located in the dorsal anterior and posterior sectors. We have developed a maneuver to perform pure laparoscopic hepatectomy in the semiprone position which was developed for resecting tumors located in these areas.Methods
The medical records have been reviewed retrospectively in 30 patients who underwent laparoscopic liver resection in the semiprone position for carcinoma in the dorsal anterior or posterior sectors of the right liver between 2008 and 2011.Results
Seventeen liver tumors were primary liver tumors and 13 were colorectal metastases. Of the 30 patients, 11 (36.6 %) underwent major hepatectomy [right hemihepatectomy in 7 (23.3 %) and posterior sectionectomy in 4 (13.3 %)]. Anatomical minor resection, such as S6 or S7 segmentectomy, was performed in five patients (16.6 %). Five patients with liver metastasis underwent a simultaneous laparoscopic resection. There was no mortality, reoperation, or conversion to open procedures. There were no hepatectomy-related complications such as postoperative bleeding, bile leakage, or liver failure.Conclusions
Pure laparoscopic hepatectomy in the semiprone position for tumors present in the dorsal anterior and posterior sectors is feasible and safe. This method expands the indications for laparoscopic liver resection for tumors. 相似文献18.
R. Ghinea R. Greenberg I. White E. Sacham-Shmueli H. Mahagna S. Avital 《Techniques in coloproctology》2013,17(5):549-554
Background
Perioperative blood transfusion has been associated with a poor prognosis in patients undergoing surgery for colorectal cancer. The aim of this study was to evaluate risk factors for blood transfusion and its impact on long-term outcome exclusively in patients undergoing laparoscopic surgery for curable colorectal cancer.Methods
Data were retrieved from a prospectively collected database of patients who underwent laparoscopic surgery for curable colorectal cancer over a 6-year period. Long-term data were collected from our outpatient clinic and personal contact when necessary.Results
Two hundred and one patients underwent laparoscopic surgery for curable colorectal cancer (stage I–III). Sixty-eight (33.8 %) received blood transfusions during or after surgery. These patients were typically older, had lower preoperative hemoglobin levels, had a more advanced cancer, had a higher Charlson score, had a higher rate of complications and had a higher conversion rate. Kaplan–Meier overall survival analysis was significantly worse in patients who received blood transfusions (P = 0.004). Decreased disease-free survival was also observed in transfused patients; however, this did not reach statistical significance (P = 0.21). A multivariate analysis revealed that transfusion was not an independent risk factor for decreased overall and disease-free survival. The Charlson score was the only independent risk factor for overall survival (OR = 2.1, P = 0.002). Independent factors affecting disease-free survival were stage of disease, Charlson score and, to a lesser degree, age and body mass index.Conclusions
Perioperative blood transfusion is associated with decreased long-term survival in patients undergoing laparoscopic resection for colorectal cancer. However, this association apparently reflects the poorer medical condition of patients requiring surgery and not a causative relationship. 相似文献19.
Ajit Sood Vandana Midha Suresh Sharma Neena Sood Manu Bansal Amandeep Thara Pankaj Khanna 《Indian journal of gastroenterology》2014,33(1):31-34
Introduction
The role of infliximab in the treatment of acute severe ulcerative colitis is established. However, all the data available in the literature are from western countries. This is the first report on the use of infliximab in patients with severe steroid-refractory ulcerative colitis from India.Methods
Retrospective analysis of 28 patients who had received infliximab therapy for induction of remission, with three doses of 5 mg/kg at 0, 2, and 6 weeks, was performed.Results
Twenty-four (85.6 %) patients had shown a clinical response by week 8 and, hence, avoided urgent colectomy. In 2 years of follow up, 9/16 (56 %) patients had not required colectomy.Conclusion
Infliximab averted colectomy in a proportion of patients with severe steroid-refractory ulcerative colitis. 相似文献20.
S. Nir R. Greenberg E. Shacham-Shmueli I. White S. Schneebaum S. Avital 《Techniques in coloproctology》2010,14(2):147-152