Long-Term Outcomes of Laparoscopic Surgery for Advanced Transverse Colon Cancer

Background

The role of laparoscopic surgery for advanced transverse colon cancer (TCC) remains controversial, especially in terms of long-term oncologic outcomes.

Methods

This retrospective cohort study enrolled 157 consecutive patients who underwent curable resections for advanced TCC between January 2002 and June 2011 (laparoscopic-assisted colectomy (LAC), n?=?74; open colectomy (OC), n?=?83). Short-term outcomes and oncologic long-term outcomes were compared between the two groups.

Results

Compared to the OC group, patients in the LAC group had less blood loss (LAC vs. OC, 79.6?±?70.3 vs. 158.4?±?89.3 ml, p?<?0.001), faster return of bowel function (2.6?±?0.7 vs. 3.8?±?0.8 days, p?<?0.001), and shorter postoperative hospital stay (10.3?±?3.7 vs. 12.6?±?6.0 days, p?=?0.007). Conversions were required in four (5.4 %) patients. Rates of short-term complication, mortality, and long-term complication were comparable between the two groups. The median follow-up time was 54 (26–106) months in the LAC group and 58 (29–113) months in the OC group (p?=?0.407). There were no statistical differences in the rates of 5-year overall survival (73.6 vs. 71.1 %, p?=?0.397) and 5-year disease-free survival (70.5 vs. 66.7 %, p?=?0.501) between the two groups.

Conclusions

Laparoscopic surgery for advanced TCC yield short-term benefits while achieving equivalent long-term oncologic outcomes.     

Laparoscopic surgery for colon cancer in obese patients: a case-matched control study

Purpose

This study compared the results of laparoscopic surgery for colon cancer in obese patients with a body-mass index (BMI) of 25 kg/m² or higher with those in nonobese patients (BMI <25 kg/m²) who were matched for clinicohistopathological factors.

Methods

The oncologic outcomes were compared between 140 patients with a BMI of 25 kg/m² or higher (obese group) and 140 patients with a BMI of <25 kg/m² (nonobese group) that were matched for sex, tumor location, date of operation, and pTNM stage.

Results

The proportion of patients with postoperative complications was significantly higher in the obese group (15 %) than in the nonobese group (6 %). The disease-free survival rate and overall survival rate in patients with stage I or II disease were similar in the obese group (98.6 and 98.8 %, respectively) and the nonobese group (97.8 and 97.8 %, respectively). The disease-free survival rate and overall survival rate in patients with stage III disease also did not differ significantly between the obese group (77.2 and 79.4 %, respectively) and the nonobese group (83.4 and 84.9 %, respectively).

Conclusions

Postoperative complications and long-term oncologic outcomes were similar in obese and nonobese patients who underwent laparoscopic colectomy for colon cancer in this hospital.     

Short- and long-term results of laparoscopic surgery for transverse colon cancer

Purposes

We investigated the feasibility of laparoscopic surgery for transverse colon cancer (TCC) by examining the results of this procedure, and comparing the short- and long-term outcomes with those for right-sided and sigmoid colon cancer (OSCC).

Methods

The subjects consisted of 117 patients with TCC. Their complications, forms of recurrence and disease-free and 5-year survival rates were compared to those of 564 patients with OSCC.

Results

There were no significant between-group differences in the patient background. The average length of the operation in the TCC group was 215 min and that in the OSCC group was 184 min (p < 0.05). There were also no significant between-group differences in the average blood loss, which was 83.9 and 70.5 g, respectively. No significant difference was observed between groups by stage in terms of the disease-free survival rates, which were 94.4 and 79.1 % for stage II and III in the TCC group, and 92.4 and 78.8 % for stage II and III in the OSCC group. The incidence of intraoperative and postoperative complications was low, and the five-year survival rate was favorable. As favorable results of laparoscopic colectomy (LAC) for TCC were also obtained at other sites in a multicenter randomized controlled trial, LAC is expected to become a standard therapy for TCC.     

Feasibility of single-site laparoscopic colectomy with complete mesocolic excision for colon cancer: a prospective case–control comparison

Background

Single-site laparoscopic colectomy (SLC) is an emerging concept that, compared with conventional multiport laparoscopic colectomy (MLC), yields reduced postoperative pain and improved cosmesis. Complete mesocolic excision (CME) is a novel concept for colon cancer surgery that provides improved oncologic outcomes; however, there are no reports of SLC with CME. We conducted a prospective case–control study to evaluate the feasibility and safety of SLC with CME for colon cancer.

Methods

Prospectively collected data of patients with stage I-III colon cancer who underwent SLC (n = 150) or MLC (n = 150) between June 2008 and March 2012 were analyzed. Patients who underwent SLC were, in terms of clinical characteristics and tumor location, matched as closely as possible with those undergoing MLC. Within each group, patients were classified as having right-sided (n = 69 in each group) or left-sided (n = 81 in each group) colon cancer, and short-term outcomes were compared between the two procedures overall and per side.

Results

Overall perioperative outcomes, including operation time, blood loss, number of lymph nodes harvested, length of the resected specimen, and complications, were similar between the two procedures, whereas postoperative pain was significantly lower with SLC. Operation time for right-sided SLC was significantly shortened. SLC with CME was completed successfully in 94 % (65/69) of right-sided cases and in 88 % (71/81) of left-sided cases. Conversion rates were 1.4 % (1/69) and 1.1 % (1/81), respectively. The umbilical scars were nearly invisible 3 months after the procedure, and most patients reported being quite satisfied with the cosmetic outcomes.

Conclusions

SLC with CME for colon cancer is feasible when performed by experienced surgeons in selected patients. Excellent cosmesis and reduced postoperative pain as well as oncologic clearance can be expected. A large-scale, prospective, randomized, controlled trial should be conducted to confirm the superiority of this procedure over MLC with CME.     

Laparoscopic Colectomy for Crohn’s Colitis. A Large Prospective Comparative Study

Introduction

The purpose of this study was to compare short-term outcomes of laparoscopic (LC) vs open colectomy (OC) in patients with Crohn’s colitis.

Materials and Methods

We collected data on all patients undergoing colectomy for primary or recurrent Crohn’s disease confined to the colon from July 2002 to August 2008. Patient and disease-specific characteristics and perioperative and short-term postoperative outcomes were prospectively collected and analyzed.

Results

A total of 125 patients underwent colectomy during the study period, 55 (44%) LC. There were six conversions (10.9%). Median operative time was shorter in the LC group (212 min, interquartile range (IQR) 180–315 LC vs 286 min, IQR 231–387 OC, p?=?0.032). Estimated blood loss was less for the LC group (100 ml, IQR 90–250 LC vs 250 ml, IQR 100–400 OC, p?=?0.002). Earlier return of bowel function was noted in the LC group (3 days vs 4 days, OC). Length of post-op stay was shorter in the LC group (6 days, IQR 5–8 vs 8 days, IQR 6–10 OC, p?=?0.001). There was one death in the OC group. Postoperative complications occurred in eight (14.5%) LC patients vs 16 (22.9%) OC. Disease recurrence rate was 16%, 10.9% LC and 20% OC, respectively.

Conclusions

Laparoscopic colectomy is a safe and effective technique in the hands of experienced surgeons. Benefits of laparoscopic colectomy in Crohn’s disease include reduced operative blood loss, quicker return of bowel function, and shorter hospital length of stay.     

Totally laparoscopic versus laparoscopic-assisted right colectomy for colon cancer: is there any advantage in short-term outcomes? A prospective comparative assessment in our center

Background

Several techniques are described in the literature about laparoscopic treatment of the right colon. Among them, laparoscopic-assisted colectomy (LAC) with creation of an extracorporeal ileocolonic anastomosis remains the favourite approach in most centers. So far, total laparoscopic colectomy (TLC) with intracorporeal anastomosis is not widely performed, because it requires adequate skills and competence in the use of mechanical linear staplers and laparoscopic manual sutures. The purpose of this study was to determine prospectively if TLC offers some advantages in short-term outcomes over LAC.

Methods

A prospective comparative study was designed for 80 consecutive patients who were alternatively treated with TLC and LAC for right colon neoplasms. The following data were collected: operative time, intra- and postoperative complication rate, time to bowel movement, hospitalization time, length of minilaparotomy, number of harvested lymph nodes, and specimen length.

Results

Operative time in TLC resulted significantly longer than in LAC (230 vs. 203 min), complication rate was similar in both groups, with no case of anastomotic dehiscence, two anastomotic bleedings in TLC vs. three in LAC and one case of postoperative ileus for each group. One case of death occurred in LAC patient developing a postoperative severe cardiopulmonary syndrome. Time to first flatus was in favour of TLC (2.2 vs. 2.6 days), whereas hospitalization was comparable. As regards to the oncological parameters of radicality, the specimen length was superior in TLC group, but the number of lymph nodes excised was equivalent. The length of the minilaparotomy was clearly shorter in TLC group (5.5 vs. 7.2 cm).

Conclusions

No evidence of relevant differences in terms of functional and safety outcomes between the two laparoscopic procedures. TLC determines less abdominal manipulation and shorter incision length, but clear advantages must be still demonstrated. Larger series are necessary to test the superiority of totally laparoscopic procedures for right colectomy.     

Robotic versus laparoscopic anterior resection of sigmoid colon cancer: comparative study of long-term oncologic outcomes

Background

Robotically assisted colon resection is a new type of surgery for colon cancer. However, the evidence is inadequate for the general adaptation of robotic colon surgery. This study aimed to show the oncologic and perioperative clinical results of robotically assisted anterior resection (R-AR) compared with those of laparoscopically assisted anterior resection (L-AR) for sigmoid colon cancer.

Methods

A total of 180 patients (sigmoid colon cancer stages 1–3) were assigned to receive either R-AR (n = 34) or L-AR (n = 146) between April 2006 and September 2008. Patient characteristics, perioperative clinical results, and long-term oncologic outcomes were compared between the two groups.

Results

The patient characteristics did not differ significantly between the two groups. The mean operation time was 217.6 ± 70.7 min for L-AR versus 252.5 ± 94.9 min for R-AR (p = 0.016). The total postoperative complication rate was 10.3 % for R-AR versus 5.9 % for L-AR (p = 0.281). The 3-year overall survival rate for all the patients was 93.4 % for L-AR versus 92.1 % for R-AR (p = 0.723). The 3-year overall survival rate was 100 % for both L-AR and R-AR in stage 1, 95.5 % for L-AR versus 100 % for R-AR (p = 0.386) in stage 2, and 88.4 % for L-AR versus 72.9 % (p = 0.881) for R-AR in stage 3.

Conclusion

In this study, R-AR showed safety and feasibility in terms of perioperative clinical and long-term oncologic outcomes. However, the advanced technologies of R-AR did not translate into better long-term oncologic outcomes compared with L-AR.     

Long-term oncologic outcomes of 714 consecutive laparoscopic gastrectomies for gastric cancer: results from the 7-year experience of a single institute

Background

Although many reports have indicated the feasibility of laparoscopic gastrectomy (LG) regarding short-term surgical outcomes, the role of LG remains controversial because studies of long-term outcomes of LG are insufficient. The purpose of this study was to evaluate the long-term oncologic outcomes of patients who have undergone LG.

Methods

Between May 2003 and December 2009, 714 consecutive patients underwent LG for gastric cancer. After excluding operative mortality (n?=?4) and a case of Krukenberg tumor that was not identified at the time of surgery (n?=?1), a total of 709 patients were analyzed for long-term oncologic outcomes. Gastric cancer cases were analyzed according to the American Joint Committee on Cancer classification (seventh edition). Overall survival and relapse-free survival were estimated by using the Kaplan-Meier method.

Results

Median follow-up was 46.2?months. Postoperative recurrence was observed in 26 patients (3.7%). The instances of recurrence were as follows: seven peritoneal, six locoregional, five hematogenous, four distant lymph nodes, and four mixed recurrence. There were neither port-site nor wound site metastases. The 5-year relapse-free survival rates were: 95.8% in stage I, 83.4% in stage II, and 46.4% in stage III. Five-year overall survival rates were: 96.4% in stage I, 83.1% in stage II, and 50.2% in stage III. The independent risk factors for recurrence were T stage and N stage. For survival, age, T stage, and N stage were statistically independent prognostic factors

Conclusions

Our single-center study of a large patient series revealed that LG for gastric cancer had acceptable long-term oncologic outcomes comparable to those of conventional open surgery.     

Laparoscopic-Assisted Versus Open Complete Mesocolic Excision and Central Vascular Ligation for Right-Sided Colon Cancer

Background

A concept of complete mesocolic excision (CME) and central vascular ligation for colonic cancer has been recently introduced. The aim of this study was to evaluate and compare perioperative and oncologic outcomes after laparoscopic-assisted CME (LCME) and open CME (OCME) for right-sided colon cancers.

Methods

The study group included 128 patients who underwent an LCME and 137 patients who underwent an OCME for right-sided colon cancer between June 2006 and December 2008. The propensity scoring matching for sex, body mass index, tumor location, and pathologic T and TNM stage produced 85 matched pairs.

Results

The median time to soft diet (LCME 6 days vs. OCME 7 days, p < 0.001) and the possible length of stay (7 vs. 13 days, p < 0.001) were significantly shorter in the laparoscopic group. The median operation time (179 vs. 194 minutes, p = 0.862) and number of harvested lymph nodes (27 vs. 28, p = 0.337) were comparable between groups. The morbidity within 30 days after surgery was comparable between the groups (12.9 vs. 24.7 %, p = 0.050). The 5-year overall survival rates of the OCME and LCME groups were 77.8 and 90.3 % (p = 0.028), and the 5-year disease-free survival rates were 71.8 and 83.3 % (p = 0.578), respectively.

Conclusions

Herein, we demonstrated the feasibility and safety of LCME for right-sided colon cancer, and in terms of better short-term outcomes, LCME was more advantageous than OCME. Although LCME for right-sided colon cancer was associated with better 5-year overall survival, compared with an open approach, the long-term oncologic outcomes between the groups were comparable.     

A comparison of the feasibility of laparoscopic resection of the primary tumor in patients with stage IV colon cancer with early and advanced disease: the short- and long-term outcomes at a single institution

Purpose

The role of resection of the primary tumor in patients with stage IV colorectal cancer (CRC) remains controversial. Laparoscopic resection has become an accepted therapeutic option for treating early stage I–III CRC; however, it has not been evaluated for use in patients with advanced stage disease.

Methods

We conducted a retrospective observational study to evaluate the feasibility of laparoscopic resection of the primary tumor exclusively in patients with stage IV colon cancer compared to open resection in patients with stage IV colon cancer and laparoscopic resection in patients with stage I–III colon cancer in terms of operative results and short- and long-term outcomes.

Results

Laparoscopic resection was performed in 35 stage IV patients and open resection was performed in 40 stage IV patients. One hundred and eighteen stage I–III patients who underwent laparoscopic resection were evaluated. In the comparison between the laparoscopic group and the open group among patients with stage IV colon cancer, postoperative recovery appeared to be better in the laparoscopic group than in the open group, as reflected by shorter times to resumption of a regular diet (p = 0.049), shorter lengths of hospitalization (p = 0.083), increased feasibility of postoperative chemotherapy (p < 0.001), shorter time intervals from surgery to chemotherapy (p = 0.031) and longer median survival (p = 0.078) at the expense of longer operative times (p = 0.025). In the comparison between the laparoscopic resection in stage IV and stage I–III disease groups, no significant differences were observed in operative results and short- and long-term outcomes, except for the rate of ostomy creation (48.5 vs. 8.5 %, p = 0.02).

Conclusion

Laparoscopic resection of the primary tumor in patients with stage IV colon cancer achieves equivalent results to that performed in patients with stage I–III disease and that performed in patients with stage IV disease using open resection. The use of a minimally invasive approach in the laparoscopic procedure is beneficial because it results in shorter times to resumption of a normal diet, shorter lengths of hospitalization, increased feasibility of postoperative chemotherapy and shorter time intervals from surgery to chemotherapy at the expense of longer operative times. We believe that patients undergoing laparoscopic resection can receive targeted chemotherapy earlier and more aggressively, which might provide a survival benefit.     

Laparoscopic colorectal resection for cancer: effects of conversion on long-term oncologic outcomes

Background

The effects of conversion to open surgery during laparoscopic resection for colorectal cancer on long-term oncologic outcomes still are unclear.

Methods

All 450 laparoscopic colorectal resections for cancer performed at a single center between 1994 and 2008 and included in a prospectively maintained database were considered. Patients who required conversion to open surgery (CONV) were matched 1:2 with laparoscopically completed cases (LAP) and 1:5 with open surgery cases (OPEN) for age, American Society of Anesthesiologists (ASA) score, year of surgery, tumor location, and tumor stage. Fisher’s exact, chi-square, and Wilcoxon tests were used as appropriate. Kaplan–Meier curves were compared to analyze survival.

Results

In this study, 31 CONV cases were independently compared with 62 LAP and 155 OPEN cases. Compared with the LAP and OPEN patients, the CONV patients were characterized by a numerically higher rate of preoperative comorbidity (61.3% vs LAP, 51.6; P?=?0.4 and OPEN, 48.4%; P?=?0.2), male gender (77.4% vs LAP, 59.7%; P?=?0.09 and OPEN, 58.1%; P?=?0.05), and a significantly higher mean body mass index (29.6 vs LAP, 26.8; P?=?0.012 and OPEN, 28.8; P?=?0.3). The pathologic tumor stage, location, and chemotherapy and radiotherapy rates were comparable among the groups. After a median follow-up period of 4.1, 4.2, and 4.6?years, the 5-year disease-free survival rate was significantly lower for the CONV patients (40.2%) than for the LAP (70.7%, P?=?0.01) or the OPEN (63.3%, P?=?0.04) patients. However, the 5-year cancer-specific survival rates were similar among the CONV (94.4%), LAP (86.1%, P?=?0.36), and OPEN (84.9%, P?=?0.14) patients.

Conclusions

Conversion to open surgery does not affect oncologic outcomes, although CONV patients have increased comorbidity rates affecting long-term mortality.     

Integration of open and laparoscopic approaches for rectal cancer resection: oncologic and short-term outcomes

Background

Laparoscopy is increasingly used for rectal cancer surgery. Laparoscopic surgery is not attempted for some suitable patients because of concerns for conversion or technical difficulty. This study aimed to evaluate oncologic and short-term outcomes for patients undergoing curative resection for rectal cancer via laparoscopic and open approaches.

Methods

A prospective database was reviewed to identify rectal cancer resections from 2005 to 2011. Patients who had primary rectal cancer within 15 cm of the anal verge were included in the study. Those with recurrent or metastatic disease were excluded. Patients were assigned to laparoscopic or open approaches preoperatively based on clinical criteria and imaging. All patients underwent a standard total mesorectal excision and followed a standardized enhanced recovery pathway. The oncologic and clinical outcomes were evaluated by approach.

Results

The analysis included 81 patients. The preoperative assignments consisted of 62 laparoscopic (77 %) and 19 open (23 %) procedures. Nine laparoscopic procedures (14.5 %) were converted to open procedures. After a median follow-up period of 25 months, all oncologic outcomes were comparable. Three patients (two laparoscopic, one open) had a positive circumferential margin (≤1 mm). The laparoscopic and open groups were similar in terms of their 3-year disease-free periods (93.6 vs. 88.2 %; P = 0.450) and overall survival periods (93.5 vs. 90.9 %; P = 0.766). The local recurrence rate was 2.5 %.

Conclusions

Laparoscopic resection for rectal cancer can be attempted for most patients. Conversion to open procedure does not compromise clinical or oncologic outcomes. In practice, combining laparoscopic and open surgery optimizes resource use and results in at least equivalent outcomes.     

Comparison of One-Stage Managements of Obstructing Left-Sided Colon and Rectal Cancer: Stent-Laparoscopic Approach vs. Intraoperative Colonic Lavage

Purpose

We evaluated the operative outcomes of laparoscopic surgery following self-expandable metallic stent compared to one-stage emergency surgical treatment.

Methods

From April 1996 to October 2007, 95 consecutive patients with left-sided malignant colorectal obstruction were enrolled. Twenty-five patients were assigned to the preoperative stenting and elective laparoscopic surgical treatment group (SLAP) and 70 to the emergency open surgery with intraoperative colon lavage group (OLAV).

Results

Among the 25 patients in the SLAP group, a primary anastomosis was possible in all patients and a diverting stoma was needed in one patient. The operative time was shorter in the SLAP group (198.53 vs. 262.17 min, P?=?0.002). Tumor size, number of retrieved lymph nodes, and pathological stage were similar in both groups. The rate of anastomotic failure was similar and postoperative complications occurred less in the SLAP group (5.9% vs. 31.4%, P?=?0.034). The passage of flatus and oral intake were resumed earlier in the SLAP group (2.88 vs. 3.68 days, P?=?0.046 and 5.18 vs. 6.65 days, P?<?0.001, respectively). The postoperative hospital stay was shorter in the SLAP group (10 vs. 15.4 days, P?=?0.013).

Conclusions

In patients with left-sided malignant colon and rectal obstruction, laparoscopic surgery after SEMS could be safely performed with successful early postoperative outcomes.     

Short- and Long-term Outcomes After Laparoscopic Versus Open Emergency Resection for Colon Cancer: An Observational Propensity Score-matched Study

Background

Case series suggest the feasibility and safety of emergency resection of colon cancer by laparoscopy. The present study compares short- and long-term outcomes of laparoscopic and open resection for colon cancers treated as emergencies.

Methods

The study was a propensity score-matched design based on a prospective database. From October 2006 to December 2011, emergency laparoscopic colon cancer resections were 1:2 propensity score-matched to open cases. Covariates for match-estimation were age, gender, American Society of Anesthesiologists grade, procedure type, tumor site, and reason for emergency surgery. Short-term outcomes included oncological quality surrogates (lymph node harvest and R stage), need for a stoma, length of hospital stay, and postoperative complications. For long-term outcomes, overall and recurrence-free survival rates were analyzed with Kaplan–Meier curves.

Results

During the study period, a total of 217 colon cancers were resected (181 open and 36 laparoscopic) as emergencies. The laparoscopic cases were matched to 72 open cases. Median follow-up was 3.6 [95 % confidence interval (CI) 2.3–4.3] years. The overall 3-year survival rate was 51 % (95 % CI 35–76) in the laparoscopic group versus 43 % (95 % CI 32–58) in the open group (p = 0.24). The 3-year recurrence-free survival rate in the laparoscopic group was 35 % (95 % CI 20–60) versus 37 % (95 % CI 27–50) in the open group (p = 0.53). Median lymph node harvest (17 vs. 13 nodes; p = 0.041) and median length of hospital stay (7.5 vs. 11.0 days; p = 0.019) favored laparoscopy.

Conclusions

Our data suggest that selective emergency laparoscopy for colon cancer is not inferior to open surgery with regard to short- and long-term outcomes. Laparoscopy resulted in a shorter length of hospital stay.     

Laparoscopic versus open D2 gastrectomy for advanced gastric cancer: a retrospective cohort study

Background

The oncologic safety and feasibility of laparoscopic D2 gastrectomy for advanced gastric cancer are still uncertain. The aim of this study is to compare our results for laparoscopic D2 gastrectomy with those for open D2 gastrectomy.

Methods

Between 1998 and 2008, a total of 336 patients with clinical T2, T3, or T4 tumors underwent laparoscopic (n = 186) or open (n = 150) gastrectomy involving D2 lymph node dissection with curative intent. To produce this study population, 123 patients in the open group who matched those of the laparoscopic group with regard to age, sex, body mass index (BMI), American Society of Anesthesiologists (ASA) score, tumor location, and clinical tumor stage were retrospectively selected. The short- and long-term outcomes of these patients were examined.

Results

Laparoscopic D2 gastrectomy was associated with significantly less operative blood loss and shorter hospital stay, but longer operative time, compared with open D2 gastrectomy. The mortality and morbidity rates of the laparoscopic group were comparable to those of the open group (1.1 % vs. 0, P = 0.519, and 24.2 % vs. 28.5 %, P = 0.402). The 5-year disease-free and overall survival rates were 65.8 and 68.1 % in the laparoscopic group and 62.0 and 63.7 % in the open group (P = 0.737 and P = 0.968). There were no differences in the patterns of recurrence between the two groups.

Conclusions

This study suggests that laparoscopic D2 gastrectomy provides reasonable oncologic outcomes with acceptable morbidity and low mortality rates. Although operation time is currently long, this approach is associated with several advantages of laparoscopic surgery, including quick recovery of bowel function and short hospital stay. Laparoscopic D2 gastrectomy may offer a favorable alternative to open D2 gastrectomy for patients with advanced gastric cancer.     

Robotic versus Laparoscopic Proctectomy for Rectal Cancer: A Meta-analysis

Background

Robot-assisted laparoscopic surgery is being performed more frequently for the minimally invasive management of rectal cancer. The objective of this meta-analysis was to compare the clinical and oncologic safety and efficacy of robot-assisted versus conventional laparoscopic surgery.

Methods

A search of the Medline and Embase databases was performed for studies that compared clinical or oncologic outcomes of conventional laparoscopic proctectomy with robot-assisted laparoscopic proctectomy for rectal cancer. The methodological quality of the selected studies was critically assessed to identify studies suitable for inclusion. Meta-analysis was performed by a random effects model and analyzed by Review Manager. Clinical outcomes evaluated were conversion rates, operation times, length of hospital stay, and complications. Oncologic outcomes evaluated were circumferential margin status, number of lymph nodes collected, and distal resection margin lengths.

Results

Eight comparative studies were assessed for quality, and seven studies were included in the meta-analysis. Two studies were matched case-control studies, and five were unmatched. A total of 353 robot-assisted laparoscopic surgery proctectomy cases and 401 conventional laparoscopic surgery proctectomy cases were analyzed. Robotic surgery was associated with a significantly lower conversion rate (P?=?0.03; 95% confidence interval 1?C12). There was no difference in complications, circumferential margin involvement, distal resection margin, lymph node yield, or hospital stay (P?=?NS).

Conclusions

Robot-assisted surgery decreased the conversion rate compared to conventional laparoscopic surgery. Other clinical outcomes and oncologic outcomes were equivalent. The benefits of robotic rectal cancer surgery may differ between population groups.     

T4N0 Colon Cancer Has Oncologic Outcomes Comparable to Stage III in a Specialized Center

Background

National data indicate that patients with T4N0 colon carcinoma have worse oncologic outcomes than other stage II cases. Our hypothesis was that optimized surgical resection and lymph node staging in a specialized center could eliminate discrepancies in oncologic outcomes within stage II colon carcinomas.

Methods

Patient characteristics and outcomes after oncologically radical colectomy for pT4N0 were compared to control groups of T1?C2N1, T3N1, and T3N0 cases. Group comparisons were adjusted for age, American Society of Anesthesiologists score, tumor location, year of surgery, and duration of follow-up. Cases with at least 12 collected lymph nodes and uninvolved resection margins (R0) were analyzed separately. In addition, the T4a subgroup was compared to both T4b cases with involvement of bowel loops and with infiltration of other organs or structures.

Results

T4N0 patients had worse oncologic outcomes than T1?C2N1 patients and were comparable to T3N1 patients, regardless of margins status or lymph node collection. When a T4b tumor infiltrated bowel, survival and recurrence rates were similar to T4a cases, while T4b tumors involving other organs were associated with increased recurrence rate and reduced survival.

Conclusions

T4N0 colon carcinoma remains associated with poor oncologic outcomes, regardless of treatment in a specialized center. The biologic aggressiveness of T4N0 colon cancers and the different oncologic outcomes according to specific organ infiltration should be taken into consideration in the choice of adjuvant therapies.     

Effects of laparoscopic surgery on the patterns of death in elderly colorectal cancer patients: competing risk analysis compared with open surgery

Purpose

The effects of laparoscopic colorectal surgery (LAC) on the long-term outcomes of elderly patients remain unclear. This study aimed to assess the short- and long-term outcomes of LAC in elderly colorectal cancer patients and to quantify the effects of LAC on the patient death patterns.

Methods

The clinicopathological data of elderly colorectal cancer patients aged ≥80 years old who were treated between 2006 and 2014 were extracted. The relationships between the clinicopathological factors and overall survival (OS) were assessed using the Cox proportional hazards model and Kaplan–Meier analyses. The risk factors for the types of death were estimated using a competing risk analysis.

Results

A total of 107 patients were included. Fifty-two patients underwent LAC, whereas 55 underwent open surgery (OC). There were no significant differences in the American Society of Anesthesiologists grade or comorbidity rate between the groups. The postoperative complication rate was significantly lower with LAC than OC (p < 0.001). After adjustment for covariates, laparoscopic surgery was not a significant risk factor for any of the types of death.

Conclusions

LAC is an effective and safe technique for elderly patients with colorectal cancer. Furthermore, there was no significant association between the surgical procedure and the pattern of death.

     

Laparoscopic approach for treatment of multiple hepatocellular carcinomas

Background

The aim of this study is to evaluate clinical and oncologic outcomes after laparoscopic surgery for patients with multiple hepatocellular carcinoma (HCC).

Methods

Among the 260 patients who underwent laparoscopic procedures, including laparoscopic liver resection and laparoscopic radiofrequency ablation (LRFA), between September 2003 and December 2009, 107 patients with HCC were included in this retrospective study. According to tumor multiplicity, patients were divided into multiple lesion (n?=?23) and single lesion (n?=?84) groups. We compared the operative outcomes after the laparoscopic procedures between the single and multiple tumor groups.

Results

There was no difference in the clinicopathologic characteristics between the two groups, except the multiple group had more frequent previous history of preoperative transarterial chemoembolization. LRFA was more frequently used in the multiple group as compared with the single group. There was no postoperative mortality in either group. Application of laparoscopic surgery in the multiple group did not increase the operative time, rate of intraoperative transfusion, length of postoperative hospital stay, or postoperative complications, as compared with the single group. After median follow-up of 33.7?months, there was no statistically significant difference of the survival rates between the two groups, although there was a better disease-free survival rate in the single group.

Conclusions

This study shows that laparoscopic surgery, including LH and LRFA, can be safely applied to patients with multiple HCCs, and the survival outcomes are acceptable.     

Potential value of sonazoid-enhanced intraoperative laparoscopic ultrasonography for liver assessment during laparoscopy-assisted colectomy

Purpose

Laparoscopy-assisted colectomy (LAC) has gained acceptance for the treatment of colorectal cancer. However, conventional palpation of the liver and adequate observation of the abdominal cavity are not achievable during LAC. The aim of this study was to assess the clinical value of using Sonazoid (contrast enhanced)-intraoperative laparoscopic ultrasonography (S-IOLUS) in patients with primary colorectal cancer.

Methods

From May 2005 to August 2008, 454 patients underwent 339 LACs and 115 open colectomies for colorectal cancer. One hundred forty-eight patients with clinical stage II or III colorectal cancer, as determined by preoperative imaging, who were undergoing LACs were prospectively enrolled.

Results

Although IOLUS did not detect any lesions, small hypoechoic lesions were detected by the S-IOLUS (n = 71) in the Kupffer-phase view of two patients (2.8 %). None of the 71 patients who underwent S-IOLUS showed liver metastases within 6 months after LAC. In the conventional IOLUS group (n = 77), metastatic lesions were identified in two patients (2.6 %). The new liver metastases in these two patients were detected within 6 months after LAC.

Conclusions

S-IOLUS of the liver during colorectal cancer surgery is useful for staging and as a diagnostic modality. It can identify lesions that are undetectable by preoperative imaging, and may be considered for routine use during LAC.