Port site metastases and recurrence after laparoscopic colectomy

Background: This study was performed to prospectively assess the impact of the laparoscopic approach to the patterns of port site metastases (PSM) and recurrence rate (RR) of resected colon carcinomas as compared with conventional colectomies. Methods: All patients were included in a prospective randomized trial comparing laparoscopic-assisted colectomy (LAC) versus open colectomy (OC) for colon cancer. The randomization was stratified for localization of the lesion. Patients with metastasic disease at the time of the surgery were excluded. Follow-up in the outpatient clinic was done every 3 months for a minimum of 12 months. Endpoints for the study were metastasis at port site and laparotomy incision as well as recurrence rate. Results: Of 91 segmental colectomies performed from November 1993 to January 1996, there were 44 LAC and 47 OC. Patient data were similar in both groups (age, sex, Dukes stage, type of operation). Mean follow-up was 21.4 months, with a range of 13 to 41 months. There were no wounds or PSM in those series. RR was similar for both groups. For LAC, it was five of 31 (16.1%); for OC, it was six of 40 (15%). Conclusions: The laparoscopic approach has a recurrence rate similar to that for open procedures for colon cancer. However, additional follow-up of these patients is needed before we can determine whether or not the laparoscopic approach influences overall survival.     

Laparoscopic-assisted vs. open colectomy for colon cancer: a prospective randomized trial

PURPOSE: Although laparoscopic-assisted colectomy (LAC) has evolved as a technical option in the treatment of benign colonic diseases, its role in the treatment of malignancies remains controversial. The purpose of this prospective randomized trial was to compare perioperative parameters and outcomes between LAC vs. open colectomy (OC) in patients with stage I-III colon cancer. PATIENTS AND METHODS: Eligible patients with colon cancer who were scheduled for an elective colon resection from January 1995 to February 2001 were randomized to either the LAC or the OC treatment group. The two groups were compared with regard to operative time, blood loss, complications, pathologic findings and lymph node yield, length of postoperative hospital stay, gastrointestinal function, use of analgesic drugs, recurrence, and survival rates. The median follow-up was 35 months (range, 3-69 months). RESULTS: A total of 49 patients were enrolled in the study: 20 were randomized to OC and 29 to LAC, one of whom was lost to follow-up. Thirteen patients in the LAC group had to be converted to OC (COC), and were analyzed in a separate group. The three patient groups were comparable with regard to age, gender distribution, tumor site, lymph node harvest, operative procedure, anastomotic type, perioperative complication, recurrence, and survival rates. Tumor margins were clear in all patients. No incidence of port-site recurrence in the LAC group, or wound recurrence in the OC and COC groups, was found. Three patients died of cancer-related causes, one in each patient group. The LAC patients had significantly shorter hospital stay, faster recovery of gastrointestinal function, and less use of intravenous analgesia. CONCLUSION: Short-term outcomes revealed that LAC could be performed safely and has therapeutic results similar to OC for colon cancer. Conversion of LAC to an open procedure was frequent but was not associated with a negative outcome.     

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-assisted vs. Open Colectomy for Cancer: Comparison of Short-term Outcomes from 121 Hospitals

Background  Overall postoperative morbidity and mortality after laparoscopic-assisted colectomy (LAC) and open colectomy (OC) have been shown to be generally comparable; however, differences in the occurrence of specific complications are unknown. The objective of this study was to determine whether certain complications occurred more frequently after LAC vs. OC for colon cancer. Methods  Using the American College of Surgeons-National Surgical Quality Improvement Project’s (ACS-NSQIP) participant-use file, patients were identified who underwent colectomy for cancer at 121 participating hospitals in 2005–2006. Multiple logistic regression models including propensity scores were developed to assess the risk-adjusted association between surgical approach (LAC vs. OC) and 30-day outcomes. Patients were excluded if they underwent emergent procedures, were ASA class 5, or had metastatic disease. Results  Of the 3,059 patients who underwent elective colectomy for cancer, 837 (27.4%) underwent LAC and 2,222 (72.6%) underwent OC. There were no significant differences in age, comorbidities, ASA class, or body mass index (BMI) between patients undergoing LAC vs. OC. Patients undergoing LAC had a lower likelihood of developing any adverse event compared to OC (14.6% vs. 21.7%; OR 0.64, 95% CI 0.51–0.81, P < 0.0001), specifically surgical site infections, urinary tract infections, and pneumonias. Mean length of stay was significantly shorter after LAC vs. OC (6.2 vs. 8.7 days, P < 0.0001). There were no differences between LAC and OC in the reoperation rate (5.5% vs. 5.8%, P = 0.79) or 30-day mortality (1.4% vs. 1.8%, P = 0.53). Conclusions  Laparoscopic-assisted colectomy was associated with lower morbidity compared to OC in select patients, specifically for infectious complications. This study was presented in part at the 2008 Annual Meeting of the Society for Surgery of the Alimentary Tract in San Diego, CA on May 21, 2008.     

The short- and long-term outcomes for patients with splenic flexure tumours treated by left versus extended right colectomy are comparable: a retrospective analysis

Purpose

To compare the outcomes of colonic splenic flexure tumours treated by extended right colectomy versus left colectomy.

Methods

Stage I–III splenic flexure tumours, treated either by extended right colectomy or left colectomy between 1996 and 2011, were identified in a prospective database, and the short- and long-term outcomes compared. The survival analyses were performed using the Kaplan–Meier method and adjusted using a Cox-proportional hazard model.

Results

A total of 30 (44 %) splenic flexure tumours were resected by left colectomy and 38 (56 %) by right colectomy. Emergency operations were more common (74 versus 20 %, p < 0.001) in the right colectomy group. In the univariate analysis, the 5-year overall survival (55 % for right colectomy versus 60 % for left colectomy, p = 0.197) and 5-year recurrence-free survival (41 versus 54 %, p = 0.180, respectively) showed a trend towards a non-significant survival benefit for left colectomy. However, when adjusted for age, gender, ASA classification, tumour stage, urgency and year of surgery, this trend disappeared.

Conclusion

Patients undergoing extended right or left colectomy for splenic flexure tumours seemed to have comparable short- and long-term outcomes.     

What is the Effect of Laparoscopic Colectomy on Pattern of Colon Cancer Recurrence? A Propensity Score and Competing Risk Analysis Compared with Open Colectomy

Background

Variability in colon cancer recurrence after laparoscopic colectomy (LAC) remains poorly understood. The aim of our study was to quantify the influence of LAC on colon cancer recurrence patterns.

Methods

We included 986 patients undergoing curative colectomy at our institution between 1992 and 2008. Kaplan–Meier, multivariable Cox regression, propensity score adjustment, and competing risks modeling were used to evaluate the influence of laparoscopic surgery on the site of colon cancer recurrence, including the following: liver metastasis, lung metastasis, local recurrence, peritoneal dissemination, other, and multiple sites. We estimated the risk factors for each recurrence site.

Results

Laparoscopic surgery was used in 419 (42.5 %) of 986 patients, with an overall median follow-up time of 5.0 years (interquartile range 3.5). The overall 5-year disease-free survival rate was 86.1 % (open surgery 81.8 % vs. laparoscopic surgery 92.0 %; p < 0.001). However, after covariates and propensity score adjustment, laparoscopic surgery was not a significant risk factor for each type of recurrence: liver hazard ratio (HR) 0.93 (95 % CI 0.45–1.89), p = 0.84; lung HR 0.67 (95 % CI 0.26–1.70), p = 0.39; local HR 0.56 (95 % CI 0.12–2.63), p = 0.46; peritoneal HR 2.49 (95 % CI 0.75–8.27), p = 0.14; others HR 0.47 (95 % CI 0.04–5.13), p = 0.53; multiple HR 0.88 (95 % CI 0.25–3.14), p = 0.84. The risk factors for each type of recurrence were variable and characterized by specific clinicopathological features.

Conclusion

Our study reveals that LAC and open colectomy demonstrate comparable overall colon cancer recurrence rates and recurrence sites. Specific clinicopathological characteristics may have a stronger influence on colon cancer recurrence site compared with the surgical technique.     

Clinical outcomes of laparoscopic surgery for advanced transverse and descending colon cancer: a single-center experience

Background

The role of laparoscopic surgery in management of transverse and descending colon cancer remains controversial. The aim of the present study is to investigate the short-term and oncologic long-term outcomes associated with laparoscopic surgery for transverse and descending colon cancer.

Methods

This cohort study analyzed 245 patients (stage II disease, n?=?70; stage III disease, n?=?63) who underwent resection of transverse and descending colon cancers, including 200 laparoscopic surgeries (LAC) and 45 conventional open surgeries (OC) from December 1996 to December 2010. Short-term and oncologic long-term outcomes were recorded.

Results

The operative time was longer in the LAC group than in the OC group. However, intraoperative blood loss was significantly lower and postoperative recovery time was significantly shorter in the LAC group than in the OC group. The 5-year overall and disease-free survival rates for patients with stage II were 84.9% and 84.9% in the OC group and 93.7% and 90.0% in the LAC group, respectively. The 5-year overall and disease-free survival rates for patients with stage III disease were 63.4% and 54.6% in the OC group and 66.7% and 56.9% in the LAC group, respectively.

Conclusion

Use of laparoscopic surgery resulted in acceptable short-term and oncologic outcomes in patients with advanced transverse and descending colon cancer.     

Comparison of return of bowel function and length of stay in patients undergoing laparoscopic versus open colectomy.

BACKGROUND: Over the last decade, many advances have been made in laparoscopic techniques in various surgical specialties. The technique of laparoscopic-assisted colectomy (LAC) has been reported since 1992 and has been slowly gaining popularity in the surgical community. Several studies have compared laparoscopic versus open colectomy, assessing its applicability to patients with colon cancer, Crohn's disease, and diverticular disease. Studies to date have assessed length of stay, operative time, and clinical outcome. This study focuses on return of bowel function and length of hospital stay in patients undergoing LAC compared with those undergoing open colectomy. METHODS: We performed a retrospective review of patients undergoing either open colon resection or LAC between January 2000 and December 2005. All disease processes and both emergent and elective cases were included. Return of bowel function was determined by passage of flatus or first passage of stool and compared between the 2 groups. The data were statistically analyzed using the Student t test for interval data, and nominal data were analyzed using the chi-square analysis (95% confidence interval; CI). RESULTS: The study included 247 patients; 179 (72.5%) underwent open colectomy and 68 (27.5%) underwent LAC. Passage of flatus took 3.6 days (95% CI .18 or 3.4 to 3.8) for open colectomy, and 2.9 days (95% CI .19 or 2.7 to 3.1) for LAC. First bowel movement took 4.4 days (95% CI .19 or 4.2 to 4.6) for open colectomy and 3.7 days (95% CI .22 or 3.5 to 3.9) for LAC. When compared between the groups, mean length of hospital stay was 8.01 days (95% CI .93 or 7.1 to 8.9) for open colectomy and 4.38 days (95% CI .38 or 4.0 to 4.8) for LAC. CONCLUSION: Both return of bowel function and length of stay were statistically significantly shorter in LAC compared with those in open colectomy, which may indicate faster recovery after bowel surgery in patients undergoing the laparoscopic approach.     

Short-term outcome analysis of a randomized study comparing laparoscopic vs open colectomy for colon cancer

The authors examined the impact of the laparoscopic approach on the early outcome of resected colon carcinomas. The role of laparoscopic techniques in the treatment of colon carcinomas is questionable. Previous studies have suggested technical feasibility of surgical resections of these cancers by laparoscopic means and have implied a benefit to laparoscopic technique for patients undergoing colorectal resections. A prospective, randomized study was conducted comparing laparoscopic assisted colectomy (LAC) open colectomy (OC) for colon cancer. We present the preliminary results in relation to the short-term outcome and judge the feasibility of the laparoscopic procedure to as a way of performing accurate oncologic resection and staging. Benefit has been demonstrated with LAC in this setting. Passing flatus, oral intake, and discharge from hospital occurred earlier in LAC- than OC-treated patients The mean operative time was significantly longer in the LAC group than in the OC group. The overall morbidity was significantly lower in the LAC group. No significant differences were observed between both groups in the number of lymph nodes removed or the pathological stage following the Astler-Coller modification of the Dukes classification. The laparoscopic approach improves the short-term outcome of segmental colectomies for colon cancer. However, the further follow-up of these patients will allow us to answer in the near future whether or not the LAC may influence the long-term outcome.Presented at the annual meeting of the Society of American Gastrointestinal Surgeons (SAGES), Orlando, FL, USA, 11–14 March 1995     

Laparoscopic assisted colectomy

Background: The role and feasibility of laparoscopic assisted colectomy (LAC) in both benign and malignant disease of the colon are not clear. We have reviewed our series in an effort to further delineate whether or not LAC is appropriate in the treatment of colonic disease. Methods: This is a retrospective view of a personal series focusing on feasibility, cure of malignant disease, and length of stay (LOS). Results: One hundred and two LACs were completed out of 104 attempts (98%). There were no wound or trocar implants in the Dukes A, B and C patients. Lymph node retrieval was similar in the laparoscopic and open historical controls. The LOS was 5.9 days in the LAC group as compared with 11 days in the open group. There was a 4.8% major morbidity rate and a 1% mortality rate in this series. Conclusions: LAC is technically feasible in a high percentage of patients. While a definite statement regarding its use in malignant disease can not be ascertained from this review, the preliminary results are encouraging. A randomized trial comparing open and LAC is warranted. Received: 11 May 1995/Accepted: 26 March 1996     

Laparoscopic versus open colectomy for TNM stage III colon cancer: results of a prospective multicenter study in Italy

Background and Purpose

There is still debate about the practicality of performing laparoscopic colectomy instead of open colectomy for patients with curable cancer, although laparoscopic surgery is now being performed even for patients with advanced colon cancer. We compared the long-term results of laparoscopic versus open colectomy for TNM stage III carcinoma of the colon in a large series of patients followed up for at least 3?years.

Methods

The subjects of this prospective non-randomized multicentric study were 290 consecutive patients, who underwent open surgery (OS group; n?=?164) or laparoscopic surgery (LS group; n?=?126) between 1994 and 2005, at one of the four surgical centers. The same surgical techniques were used for the laparoscopic and open approaches to right and left colectomy. The distribution of TNM substages (III A, III B, IIIC) as well as the grading of carcinomas (G1, G2, G3) were similar in each arm of the study. The median follow-up periods were 76.9 and 58.0?months after OS and LS, respectively.

Results

There were 10 (6.1?%) versus 9 (7.1?%) deaths unrelated to cancer, 15 (9.1?%) versus 5 (4?%) cases of local recurrence, 7 (4.2?%) versus 5 (4?%) cases of peritoneal carcinosis, and 37 (22.5?%) versus 14 (11.1?%) cases of metastases in the OS and LS groups, respectively. There was also one case of port-site recurrence after LS (0.8?%). The OS group had a significantly higher probability of local recurrence and metastases (p?<?0.001) with a significant higher probability of cancer-related death (p?=?0.001) than the LS group.

Conclusions

These findings support that LS is safe and effective for advanced carcinoma of the colon. Although the LS group in this study had a significantly better long-term outcome than the OS group, further investigations are needed to draw a definitive conclusion.     

Canadian Association of General Surgeons and American College of Surgeons Evidence Based Reviews in Surgery. 21.: The risk of surgical site infection is reduced with perioperative oxygen

Objective: Does supplemental perioperative oxygen reduce the risk of surgical wound infection after colorectal surgery? Design: Randomized controlled trial. Setting: Multicentre trial that included 14 hospitals in Spain. Patients: 300 patients aged 18–80 years who underwent elective colorectal resection. Patients who had surgery performed laparoscopically or who had minor colon surgery were excluded. Intervention: Patients were randomly allocated to either 30% or 80% fraction of inspired oxygen (FiO₂) intraoperatively and for 6 hours postoperatively. Anesthetic treatment and antibiotic administration were standardized. Main Outcome Measure: Surgical site infection (SSI) as defined by the Center for Disease Control. Results: SSI occurred in 35 of 143 patients (24.4%) who were administered 30% FiO₂ and in 22 of 148 patients (14.9%) who were administered 80% FiO₂ (p = 0.04). The risk of SSI was 39% lower in the 80% group (relative risk [RR], 0.61; 95% confidence interval [CI], 0.38–0.98) versus the 30% FiO₂ group. Conclusions: Patients receiving supplemental oxygen have a significant reduction in risk of surgical site infection.     

Initial experience with 150 cases of laparoscopic assisted colectomy.

BACKGROUND: Despite multiple reports of large series in the literature over the past decade, laparoscopic assisted colectomy (LAC) has not received widespread acceptance by the surgical community. Critics of LAC note concerns regarding unproved benefits and increased complexity of the procedures. The authors report their initial experience with 150 procedures. METHODS: A retrospective review of 150 consecutive LACs was performed by the authors. RESULTS: Mean operative time for completed LAC, converted procedures, right, and sigmoid resections were 164 minutes, 203 minutes, 121 minutes, and 177 minutes, respectively. Twenty-two patients had additional concurrent laparoscopic procedures. Thirty-nine patients had undergone previous abdominal surgery. The conversion rate was 12%. Mean length of stay for all patients was 4.5 days. There were 8 major and 16 minor complications. There were no port site metastases. Major complications and conversion rate decreased from the first 50 cases to the last 50 cases. CONCLUSIONS: LAC can be safely performed with superior quality of life outcomes in comparison with open colectomy. The authors believe that LAC will eventually become the gold standard for colon resection. The learning curve is discussed as an ongoing process, rather than a set number of procedures.     

Single-incision laparoscopic right colectomy compared with conventional laparoscopy for malignancy: assessment of perioperative and short-term oncologic outcomes

Background

Laparoscopic colectomy for malignancy currently is the standard operative technique together with open colectomy. Single-incision laparoscopic surgery (SIL) is a recent advance in minimally invasive surgical techniques. This study aimed to compare SIL right colectomy with conventional laparoscopy (CL) used to treat patients with colon cancer.

Methods

This study was a retrospective analysis of data from the authors’ prospectively collected colorectal surgery database. Between August 2009 and November 2010, 159 patients who underwent primary laparoscopic right colectomy at the Samsung Medical Center were recruited to participate in this study. Of these, 66 patients underwent SIL colectomy.

Results

The SIL and CL right colectomy groups did not differ significantly in terms of general characteristics including age, sex, body mass index (BMI), American society of anesthesiology (ASA) score, previous abdominal operation, and diagnosis. The two groups also did not differ significantly in terms of perioperative complications (9.1 vs. 15.1 %, p = 0.335). Oncologic resection was similar in the two groups. The mean number of harvested lymph nodes was 24 for SIL and 27 for CL right colectomy (p = 0.068). Tumor size, disease stage, adjuvant chemotherapy, and proximal and distal resection margins did not differ significantly between the two groups. The mean follow-up period was 24.5 for the SIL group and 26.4 months for the CL group (p = 0.098), with six recurrences in the SIL group (9.1 %) and three recurrences in the CL group (3.2 %) (p = 0.120). One death occurred in the CL group. Disease-free survival at 24 months did not differ significantly between the two groups (89.7 vs. 96.3 %, p = 0.120).

Conclusion

The findings show that SIL right colectomy for colon cancer is safe and can provide resection and oncologic outcomes equal to those of conventional laparoscopic right colectomy.     

Hand-assisted laparoscopic colectomy vs open colectomy: a prospective randomized study

Background: We compared the perioperative parameters and outcomes achieved with hand-assisted laparoscopic colectomy (HALC) vs open colectomy (OC) for the management of benign and malignant colorectal disease, including cancer patients treated with curative intent. Methods: Sixty eligible patients were randomized to either HALC (n = 30) or OC (n = 30) treatment groups. We used Pearsons chi-square and two-sample t-tests to compare the differences in demographics and perioperative parameters. Results: There were no significant differences in age, gender distribution, disease pattern, operative procedure, comorbidity, or history of abdominal surgery. The HALC patients had significantly shorter hospital stays and incision lengths, faster recovery of gastrointestinal function, less analgesic use and blood loss, and lower pain scores on postoperative days 1, 3, and 14. There were no significant differences in operative time, complications, or time to return to normal activity. Conclusion: Hand-assisted laparoscopic colectomy (HALC) is safe and produces better therapeutic results in terms of perioperative parameters than OC.     

Laparoscopic Colectomy Versus Open Colectomy for Colorectal Carcinoma: A Retrospective Analysis of Patients Followed Up for at Least 4 Years

Purpose To compare the long-term outcome of laparoscopic-assisted colectomy (LAC) with that of open colectomy (OC) for carcinoma in patients followed up for a minimum of 4 years.Methods We reviewed the medical records of 118 patients who underwent LAC between January 1993 and September 1999, and compared the results with those of 163 selected patients who underwent OC during the same period.Results Curative surgery was performed in 114 of the LAC patients. Because recurrence did not develop in any of the patients with stage I cancer, we analyzed the patterns of recurrence only in those with stage II or III disease; 58 patients were analyzed in the laparoscopic group and 130 in the open colectomy group. In the LAC group, 7 (12.1%) patients had recurrence after a median follow-up of 58 months and in the OC group, 19 (14.6%) patients had recurrence after a median follow-up of 56.5 months. The 5-year disease-free rate was similar in the LAC (87.8%) and OC (85.5%) groups (P = 0.75 by the log-rank test).Conclusions Laparoscopic-assisted colectomy is effective and safe for the treatment of colorectal carcinomas under the criteria used in this study. However, further validation of these results is recommended.     

Laparoscopically assisted vs open colectomy for colon cancer: a meta-analysis

OBJECTIVE: To perform a meta-analysis of trials randomizing patients with colon cancer to laparoscopically assisted or open colectomy to enhance the power in determining whether laparoscopic colectomy for cancer is oncologically safe. DATA SOURCES: The databases of the Barcelona, Clinical Outcomes of Surgical Therapy (COST), Colon Cancer Laparoscopic or Open Resection (COLOR), and Conventional vs Laparoscopic-Assisted Surgery in Patients With Colorectal Cancer (CLASICC) trials were the data sources for the study. STUDY SELECTION: Patients who had at least 3 years of complete follow-up data were selected. DATA EXTRACTION: Patients who had undergone curative surgery before March 1, 2000, were studied. Three-year disease-free survival and overall survival were the primary outcomes of this analysis. DATA SYNTHESIS: Of 1765 patients, 229 were excluded, leaving 796 patients in the laparoscopically assisted arm and 740 patients in the open arm for analysis. Three-year disease-free survival rates in the laparoscopically assisted and open arms were 75.8% and 75.3%, respectively (95% confidence interval [CI] of the difference, -5% to 4%). The associated common hazard ratio (laparoscopically assisted vs open surgery with adjustment for sex, age, and stage) was 0.99 (95% CI, 0.80-1.22; P = .92). The 3-year overall survival rate after laparoscopic surgery was 82.2% and after open surgery was 83.5% (95% CI of the difference, -3% to 5%). The associated hazard ratio was 1.07 (95% CI, 0.83-1.37; P = .61). Disease-free and overall survival rates for stages I, II, and III evaluated separately did not differ between the 2 treatments. CONCLUSION: Laparoscopically assisted colectomy for cancer is oncologically safe.     

Hand-assisted laparoscopic versus open right colectomy: a randomized controlled trial

OBJECTIVE: Laparoscopic colectomy has been proved to be both technically and oncologically feasible. However, the approach has been criticized for its procedural complexity and long operative time as a result of the loss of tactile feedback and absence of depth perception. The advent of hand-access devices offered a potential solution to these problems. This randomized controlled trial aims to compare hand-assisted laparoscopic colectomy (HALC) with open colectomy (OC) in the management of right-sided colonic cancer. METHODS: Adult patients with nonmetastatic carcinoma of cancer or ascending colon were recruited. Patients were excluded if they presented with surgical emergencies, had synchronous tumors on work-up, or when the tumor was larger than 6.5 cm in any dimension or preoperative imaging. Recruited patients were randomized to undergo either HALC or OC by the same surgical team. Outcome measures included operative time, blood loss, postoperative pain score and analgesic requirement, length of hospital stay, postoperative complications, as well as disease recurrence and patient survival. RESULTS: Eighty-one patients (HALC = 41, OC = 40) were successfully recruited. The 2 groups were matched for age, gender distribution, body mass index, and comorbidities. No significant difference was observed between the 2 groups in the distribution of tumors and the final histopathological staging. HALC took significantly longer than OC (110 min vs. 97.5 minutes, P = 0.003) but resulted in significantly less blood loss (35 mL vs. 50 mL, P = 0.005). Patients after HALC experienced significantly less pain, required significantly less parenteral and enteral analgesia, recovered faster, and was associated with a shorter length of stay (7 days vs. 9 days, P = 0.004). With median follow-up of 28 to 30 months, no difference was observed in terms of disease recurrence, and the 5-year survival rates remained similar (83% vs. 74%, P = 0.90). CONCLUSION: HALC retained the same short-term benefits of the pure laparoscopic approach. The technique is associated with a slightly increased but acceptable operative time. Aside as a useful adjunct in complex laparoscopic procedures, the hand-assisted laparoscopic technique is also a useful, if not more effective, alternative for patients with right-sided colonic cancer.     

Influence of delays to nonemergent colon cancer surgery on operative mortality,disease-specific survival and overall survival

Background

There has been minimal research on the influence of delays for cancer treatments on patient outcomes. We measured the influence of delays to nonemergent colon cancer surgery on operative mortality, disease-specific survival and overall survival.

Methods

We used the linked Surveillance, Epidemiology and End Results (SEER)-Medicare databases (1993–1996) to identify patients who underwent nonemergent colon cancer surgery. We assessed 2 time intervals: surgeon consult to hospital admission for surgery and first diagnostic test for colon cancer to hospital admission. Follow-up data were available to the end of 2003. We selected the time intervals to create patient groups with clinical relevance and they did not extend past 120 days.

Results

We identified 7989 patients who underwent nonemergent colon cancer surgery. Median delays from surgeon consult to admission and from first diagnostic test to admission were 7 and 17 days, respectively. The odds of operative mortality were similar if the consult-to-admission interval was 22 days or more versus 1–7 days (odds ratio [OR] 1.0, 95% confidence interval [CI] 0.6–1.8, p = 0.91) or if the test-to-admission interval was 43 days or more versus 1–14 days (OR 0.8, 95% CI 0.4–1.5, p = 0.51), respectively. For these same respective interval comparisons, disease-specific survival was not influenced by the consult-to-admission wait (hazard ratio [HR] 1.0, 95% CI 0.9–1.2, p = 0.91) or the test-to-admission wait (HR 1.0, 95% CI 0.8–1.1, p = 0.63). The risk of death was slightly greater if the consult-to-admission interval was 22 or more days versus 1–7 days (HR 1.1, 95% CI 1.0–1.2, p = 0.013) and if the test-to-admission interval was 43 days or more versus 1–14 days (HR 1.2, 95% CI 1.1–1.3, p = 0.003).

Conclusion

It is unlikely that delays to nonemergent colon cancer surgery longer than 3 weeks from initial surgical consult or longer than 6 weeks from first diagnostic test negatively impact operative mortality, disease-specific survival or overall survival.