Laparoscopic colectomy for cancer: an oncologic feasible option

The conventional and accepted treatment for curative resection of colon cancer is laparotomy with hemicolectomy for right or left sided lesions. The technique of colon resection through an open laparotomy incision is well known. Over the past several years, laparoscopically assisted colectomy has been developed and studied, following the explosion of laparoscopic technology from the cholecystectomy experience and with acquisition of advanced general laparoscopic techniques. The right, left or sigmoid colon can be mobilized and regional lymphadenectomy performed using laparoscopic instruments and video-imaging equipment. The advantage of laparoscopic colectomy is the use of small abdominal port site and wound incisions which translate to reduced postoperative pain and analgesic requirement, earlier return of bowel function and normal physical activities, and shorter hospital stay without increasing health care costs. Laparoscopic colectomy compares favorably with open colectomy in terms of surgical morbidity and mortality. The laparoscopic approach has been shown to be technically and oncologically feasible with equivalent lymph node harvest from mesenteric lymphadenectomy and achieves adequate proximal and distal margins of colonic resection. Despite initial early anecdotal reports of port site cancer recurrence in laparoscopically assisted colectomy, port site recurrence is rare and its incidence is similar to incisional recurrences in conventional open colectomy. Recent prospective comparative studies have demonstrated equivalent patient survival and equivalent local or distant colon cancer recurrences for open versus laparoscopic curative resection of colon cancer.     

Colon cancer: trials, results, techniques (LAP and HALS), future

Laparoscopic resection of colon cancer became mired in controversy when it appeared that the technique might be associated with an increased risk of tumor recurrence within the surgical incisions. This was not a uniform finding among all surgeons, however, and other evidence suggested that this did not occur in experienced hands. Thus were born several randomized controlled trials of laparoscopic versus open colectomy for cancer in the early and mid-1990s. These trials came to maturity between 2002 and 2006 and form the basis of this review.     

Laparoscopic Versus Open Surgery for Rectal Cancer: A Systematic Review and Meta-analysis of Randomized Controlled Trials

Background and Aim: Laparoscopic and open rectum surgery for rectal cancer remains controversial.This systematic review compared the short-term and long-term efficiency and complications associated withlaparoscopic and open resection for rectal cancer. Materials and Methods: We searched PubMed, Embase,Cochrane Library, ISI Web of Knowledge and the China Biology Medicine Database to identify potentialrandomized controlled trials from their inception to March 31, 2014 without language restriction. Additionalarticles were identified from searching bibliographies of retrieved articles. Two reviewers independently assessedthe full-text articles according to the pre-specified inclusion and exclusion criteria as well as the methodologicalquality of included trials. The meta-analysis was performed using RevMan 5.2. Results: A total of 16 randomizedcontrolled trials involving 3,045 participants (laparoscopic group, 1,804 cases; open group, 1,241 cases) werereviewed. Laparoscopic surgery was associated with significantly lower intraoperative blood loss, earlier returnof bowel movement and reduced length of hospital stay as compared to open surgery, although with increasedoperative time. It also showed an obvious advantage for minimizing late complications of adhesion-related bowelobstruction. Importantly, there were no significant differences in other postoperative complications, oncologicalclearance, 3-year and 5-year or 10 year recurrence and survival rates between two procedures. Conclusions: Onthe basis of this meta-analysis we conclude that laparoscopic surgery has advantages of earlier postoperativerecovery, less blood loss and lower rates of adhesion-related bowel obstruction. In addition, oncological outcomeis comparable after laparoscopic and open resection for rectal cancer.     

Laparoscopic surgery for colorectal cancer.

Despite the widespread use of laparoscopic techniques in many fields, in the realm of malignant diseases, a great concern has been raised regarding safety, efficacy, and long-term results. The authors report their experience of 163 patients operated on for colorectal malignancies by minimally invasive access. The conversion rate (20.4%), morbidity (15.1%), and null mortality compare well with other studies published worldwide. The postoperative outcome was characterized by a prompt return to activity (1.3 days) and of bowel movements (2.9 days), while length of stay and an adequate oral resumption were comparable to those of open surgery. Peritoneal lavage did not show tumor cells disseminated during the operative maneuvers. The distance of tumor from resection margins and the number of lymph nodes harvested with the operative specimen did not vary from those obtained in open surgery. Two patients (1.2%) recurred at the mini-laparotomy and port sites, but, in both cases, the traumatic manipulation of the cancer specimen was probably responsible for the event. After a mean follow-up of over 3 years, 34 patients died of neoplastic recurrence, and 17 are alive with disease relapse. The laparoscopic approach to colectomy has not yet gained an unquestioned place in the experience of the colorectal surgeon. However, if sound surgical method and judgement are used to minimize local recurrences, and if a better preservation of postoperative immune function proves to be of clinical significance in the long term, laparoscopic colectomy may prove to be a safe and less stressful approach to colon resection.     

Laparoscopy for colon cancer: state of the art

As a result of several years of trials and investigations, laparoscopic colectomy for colon cancer is now considered an acceptable and safe alternative to traditional open techniques. Four large randomized trials (Barcelona, COST, COLOR, CLASSIC) have shown the noninferiority of laparoscopic colectomy in overall survival, disease-free survival, and overall and local recurrences. Laparoscopic surgery is associated with better short-term outcomes, such as shorter hospital stay, shorter duration of ileus, less narcotic usefulness and postoperative pain, and a faster postoperative recovery. The procedures are also safe and feasible in elderly patients. Hand-assisted laparoscopic colectomy is a recent hybrid technique that could reduce learning time, and its role has been established in more challenging procedures. Future prospects include robotic and natural-orifice surgery.     

Laparoscopy for colon cancer.

Laparoscopic resection of the colon is certainly feasible. There are conflicting reports regarding decreased postoperative pain, resumption of gastrointestinal function, and earlier return to work. There is no change in either mortality or morbidity when compared with open resection. For benign disease laparoscopic colonic resection is ideal if performed by a surgeon who performs the operation frequently. For malignant disease, [table: see text] at this stage, laparoscopic colonic resection should only be performed in the setting of a randomized controlled trial. The future of laparoscopic surgery for colon cancer will be decided by oncologic parameters. There is good evidence that a laparoscopic resection can be technically equivalent to its open counterpart. The data on recurrence, both local and distant, and long-term survival will become clearer when results of randomized controlled trials currently underway become available. The issue of port-site recurrence is a major concern in laparoscopic colorectal cancer surgery. The reported incidence is low; however, its cause remains unexplained and its presence in patients with early stage tumors cannot be ignored.     

Laparoscopic management of colorectal cancer

Laparoscopic treatment of colorectal cancer has emerged as a result of the technical advances that have been made since the introduction of laparoscopic cholecystectomy. The minimal-access approach to treatment of benign disease results in smaller incisions, reduced length of hospital stay, and a faster return to productive life. Laparoscopic approaches to colon cancer must take into consideration the potential effects of the technique on tumor dissemination at the time of the surgical procedure, as well as rates of recurrence and overall survival. Several technical approaches to laparascopic colon resection have now become possible, utilizing either total intra-abdominal maneuvers or laparoscopic-assisted techniques. Margins of resection and lymph node removal with the minimal-access techniques compare favorably with those of open colectomy. Several series now show that early results utilizing laparoscopic resection for colorectal cancer are favorable but that routine implementation of this procedure should await confirmatory outcomes generated by well-done prospective clinical trials.     

腹腔镜结直肠癌手术的现状

腹腔镜手术具有切口小、疼痛轻、住院时间短等优点,应用于结直肠手术在技术上被证明是可行的,但是用于结直肠恶性肿瘤切除尚存在争议,主要是人们对手术的安全性和肿瘤的根治效果尚不明确。本文对近几年腹腔镜结直肠癌手术的文献进行综述,了解其手术疗效的初步结果。结论:腹腔镜用于结直肠癌根治经历了“学习曲线”阶段后,手术并发症和病死率与开腹手术相当,现有的回顾性随访资料显示,复发率和生存率与开腹手术相比也无较大差异,但缺少更有说服力的前瞻性临床随机对照研究资料。     

腹腔镜与开腹手术治疗晚期结肠癌的临床疗效分析

目的 比较分析腹腔镜与开腹手术治疗晚期结肠癌的疗效.方法 78例结直肠癌患者,采用传统开腹25例,腹腔镜手术者53例,比较两组患者术中出血量、手术持续时间、切除淋巴结数目及切缘阳性率;术后在院天数、疼痛持续时间、开始进食时间及1、3、5年生存率情况.结果 在术中方面,腹腔镜手术在术中出血量及手术时间两方面优于传统开腹手术;在术后恢复方面,腹腔镜对患者带来低创伤对与患者的术后恢复显著快于开腹组;在术后预后方面,开腹切除结肠癌相比于腹腔镜切除较好.结论 手术本身所带来的创伤方面,腹腔镜切除结肠癌肿瘤相比于开腹手术具有明显的优势;但远期预后,腹腔镜切除却低于开腹手术.     

肝癌腹腔镜及开腹治疗的临床疗效比较

目的:比较腹腔镜及开腹肝癌切除术的治疗效果.方法:选取2012年4月至2014年12月的22例腹腔镜肝癌切除术(腔镜组)与57例开腹肝癌切除术(开腹组)患者,对比两者的相关临床资料.结果:两组均顺利完成肝癌切除术.腔镜组术中出血量、拔管时间、术后引流量、术后住院时间均明显少于开腹组(P＜0.05),而手术时间两组无明显差异(P＞0.05),治疗后腔镜组并发症发生率、复发率、生存率依次为4.5％、0％、100％,开腹组依次为10.5％、5.3％、94.7％,两组并发症发生率差别无意义(P＞0.05),腔镜组较开腹组生存率高、复发率低(P＜0.05).术后腹腔镜组AST、ALT、ALB以及TBIL水平均明显优于开腹组(P＜0.05).结论:腹腔镜肝癌切除术安全可靠,与开腹手术比较,具有手术创伤小,术后恢复快,住院时间短的优点.     

保留回盲部的完全腹腔镜右侧横结肠癌根治术的可行性及安全性分析北大核心

目的:探讨保留回盲部的完全腹腔镜右侧横结肠癌根治术的可行性、安全性及近期疗效。方法:回顾性分析中国医学科学院北京协和医学院肿瘤医院2018年01月至2020年12月行保留回盲部的完全腹腔镜右侧横结肠癌根治术患者27例的临床资料,统计并分析患者的临床病理特征、手术情况、术后恢复及围手术期并发症等资料。结果:27例患者均成功完成保留回盲部的完全腹腔镜右侧横结肠癌根治术,中位手术时间为120.0 min,中位术中出血量为20.0 mL。标本中位近端切缘长度为12.0 cm,中位远端切缘长度为11.0 cm,中位淋巴结检出数目为27.0枚。患者中位术后下地时间、进食时间、排气时间和住院时间分别为18.0 h、13.0 h、32.0 h和6.0 d,中位住院费用为71618.5元。随访过程中,仅1例患者术后出现切口感染,1例患者术后出现淋巴漏,保守治疗后均痊愈。患者术后1月、3月、6月及1年腹泻发生率分别为22.2%、7.4%、3.7%及3.7%。所有患者均未出现吻合口狭窄、吻合口漏、吻合口出血、肠梗阻等严重并发症。随访期间无患者出现肿瘤复发或者转移。结论:保留回盲部的完全腹腔镜右侧横结肠癌根治术切实可行,近期疗效较为满意,可能有助于降低结肠癌术后腹泻的发生率。     

Is laparoscopic surgery acceptable for advanced colon cancer?

Laparoscopic surgery is widespread in the treatment of colorectal cancer. In Japan, a nationwide survey has shown that the rate of advanced colorectal cancer has increased gradually to 65% of total laparoscopic surgeries in 2007. Many randomized controlled trials have demonstrated that in the short term, laparoscopic surgery is feasible, safe, and has many benefits, including reduction of peri-operative mortality. In terms of long-term outcomes, four randomized controlled trials suggest that there are no differences in laparosupic and open surgery for colon cancer. However, important issues, including long-term oncological outcome, cost effectiveness, and the impact on the quality of life of patients, should be addressed in well-designed large-scale trials. In Japan, a retrospective multicenter study has demonstrated that the short-term outcomes of laparoscopic surgery are beneficial, and the long-term outcomes are the same as for open surgery. In 2004, a prospective large-scale randomized controlled trial (JCOG0404) to compare laparoscopic surgery with open surgery was started to evaluate oncological outcomes for advanced colon cancer. This trial is supported in part by a Grant-in-Aid for Cancer Research from the Japanese Ministry of Health, Labour, and Welfare. In the present study, laparoscopic surgery is found to be acceptable for stage I disease of colon cancer, whereas it is controversial for stage II/III disease because of inadequate clinical evidence. Whether laparoscopic surgery is acceptable for advanced colon cancer or not should be confirmed by the Japanese large-scale prospective randomized controlled trial (JCOG0404) in the near future. ( Cancer Sci 2009; 100: 567–571)     

Laparoscopic colectomy for cancer

Since the first minimally invasive colon resection 15 years ago, laparoscopic colectomy has been implemented as techniques have evolved. Like the laparoscopic approach for other operations, minimally invasive colectomy has potential benefits of improved short-term outcomes. Questions have been raised, however, regarding its use for colorectal cancer resection. Until recently, it was unclear whether minimally invasive surgery for colonic malignancies would achieve adequate oncologic resection. This review provides an overview of laparoscopic colectomy and techniques and examines recent data from randomized, controlled trials that report the short- and long-term outcomes after laparoscopic colectomy for cancer.     

腹腔镜手术治疗结直肠癌：外科的方向

 腹腔镜下结直肠癌手术是否能达到与开腹手术相同的肿瘤根治疗效曾存在争议。近年来，国际上主要的前瞻性大规模随机对照研究及大规模回顾性研究均揭示，腹腔镜下结直肠癌手术不仅具有损伤小、术后疼痛轻、肠道功能恢复快、住院时间短、不增加围手术期并发症等短期疗效，而且在肿瘤局部复发、远处转移、切口复发及长期生存率等方面，均可获得至少与开腹手术相同的远期疗效。相信随着循证医学研究的深入，腹腔镜手术在结直肠癌治疗中的地位将更加明确。     

Mini-invasive surgery for colorectal cancer

Laparoscopic techniques have been extensively used for the surgical management of colorectal cancer during the last two decades. Accumulating data have demonstrated that laparoscopic colectomy is associated with better short-term outcomes and equivalent oncologic outcomes when compared with open surgery. However, some controversies regarding the oncologic quality of mini-invasive surgery for rectal cancer exist. Meanwhile, some progresses in colorectal surgery, such as robotic technology, single-incision laparoscopic surgery, natural orifice specimen extraction, and natural orifice transluminal endoscopic surgery, have been made in recent years. In this article, we review the published data and mainly focus on the current status and latest advances of mini-invasive surgery for colorectal cancer.     

Functional outcomes of surgery for colon cancer: A systematic review and meta-analysis

IntroductionAs survival rates of colon cancer increase, knowledge about functional outcomes is becoming ever more important. The primary aim of this systematic review and meta-analysis was to quantify functional outcomes after surgery for colon cancer. Secondly, we aimed to determine the effect of time to follow-up and type of colectomy on postoperative functional outcomes.Materials and methodsA systematic literature search was performed to identify studies reporting bowel function following surgery for colon cancer. Outcome parameters were bowel function scores and/or prevalence of bowel symptoms. Additionally, the effect of time to follow-up and type of resection was analyzed.ResultsIn total 26 studies were included, describing bowel function between 3 to 178 months following right hemicolectomy (n = 4207), left hemicolectomy/sigmoid colon resection (n = 4211), and subtotal/total colectomy (n = 161). In 16 studies (61.5%) a bowel function score was used. Pooled prevalence for liquid and solid stool incontinence was 24.1% and 6.9%, respectively. The most prevalent constipation-associated symptoms were incomplete evacuation and obstructive, difficult emptying (33.3% and 31.4%, respectively). Major Low Anterior Resection Syndrome was present in 21.1%. No differences between time to follow-up or type of colectomy were found.ConclusionBowel function problems following surgery for colon cancer are common, show no improvement over time and do not depend on the type of colectomy. Apart from fecal incontinence, constipation-associated symptoms are also highly prevalent. Therefore, more attention should be paid to all possible aspects of bowel dysfunction following surgery for colon cancer and targeted treatment should commence promptly.     

Systematic review of laparoscopic vs open surgery for colorectal cancer in elderly patients

AIM: To verify the safety and validity of laparoscopic surgery for the treatment of colorectal cancer in elderly patients. METHODS: A meta-analysis was performed of a systematic search of studies on an electronic database. Studies that compared laparoscopic colectomy (LAC) in elderly colorectal cancer patients with open colectomy (OC) were retrieved, and their short and long-term outcomes compared. Elderly people were defined as 65 years old or more. Inclusion criteria were set at: Resection of colorectal cancer, comparison between laparoscopic and OC and no significant difference in backgrounds between groups. RESULTS: Fifteen studies were identified for analysis. LAC was performed on 1436 patients, and OC performed on 1810 patients. In analyses of short-term outcomes, operation time for LAC was longer than for OC (mean difference = 34.4162, 95%CI: 17.8473-50.9851, P < 0.0001). The following clinical parameters were lower in LAC than in OC: Amount of estimated blood loss (mean difference = -93.3738, 95%CI: -132.3437 to -54.4039, P < 0.0001), overall morbidity (OR = 0.5427, 95%CI: 0.4425-0.6655, P < 0.0001), incisional surgical site infection (OR = 0.6262, 95%CI: 0.4310-0.9097, P = 0.0140), bowel obstruction and ileus (OR = 0.6248, 95%CI: 0.4519-0.8638, P = 0.0044) and cardiovascular complications (OR = 0.4767, 95%CI: 0.2805-0.8101, P = 0.0062). In analyses of long-term outcomes (median follow-up period: 36.4 mo in LAC, 34.3 mo in OC), there was no significant difference in overall survival (mean difference = 0.8321, 95%CI: 0.5331-1.2990, P = 0.4187) and disease specific survival (mean difference = 1.0254, 95%CI: 0.6707-1.5675, P = 0.9209). There was also no significant difference in the number of dissected lymph nodes (mean difference = -0.1360, 95%CI: -4.0553-3.7833, P = 0.9458). CONCLUSION: LAC in elderly colorectal cancer patients had benefits in short-term outcomes compared with OC except operation time. The long-term outcomes and oncological clearance of LAC were similar to that of OC. These results support the assertion that LAC is an effective procedure for elderly patients with colorectal cancer.     

What is the best surgical procedure of transverse colon cancer? An evidence map and minireview

Colorectal cancers comprise a large percentage of tumors worldwide, and transverse colon cancer (TCC) is defined as tumors located between hepatic and splenic flexures. Due to the anatomy and embryology complexity, and lack of large randomized controlled trials, it is a challenge to standardize TCC surgery. In this study, the current situation of transverse/extended colectomy, robotic/ laparoscopic/open surgery and complete mesocolic excision (CME) concept in TCC operations is discussed and a heatmap is conducted to show the evidence level and gap. In summary, transverse colectomy challenges the dogma of traditional extended colectomy, with similar oncological and prognostic outcomes. Compared with conventional open resection, laparoscopic and robotic surgery plays a more important role in both transverse colectomy and extended colectomy. The CME concept may contribute to the radical resection of TCC and adequate harvested lymph nodes. According to published studies, laparoscopic or robotic transverse colectomy based on the CME concept was the appropriate surgical procedure for TCC patients.     

Advantages of Laparoscopic Abdominoperineal Resection for Anastomotic Recurrence of Rectal Cancer

Background: Surgery offers the only potential for cure and long-term survival of recurrence of rectal cancer.Few studies about laparoscopic recurrent lesion resection have been reported. This study was designed to evaluatethe safety and feasibility of laparoscopic abdomino-perineal resection for anastomotic recurrence of rectal cancer.Materials and Methods: Data for 42 patients with recurrence of rectal cancer were collected retrospectively. Of the42 patients, 22 underwent laparoscopic surgery (LR group) and 20 received open surgery (OR group). Outcomesbetween the two groups were compared. Results: Operation time in LR group was shorter compared with theOR group (164.6±27.7min vs 203.0±45.3min); intra-operative blood loss was 119.7±44.4ml and 185.0±94.0ml inLR group and OR group, respectively (p<0.001); time to first flatus in LR group was shorter than in OR group,and the difference was statistically significant (2.6±0.8 days vs 3.1±0.8 days, p=0.013); hospital stay in the LRand OR groups was 8.6±1.3 days and 9.8±2.2 days; 3-year survival rates in the LR and OR groups were 44.4%and 42.8% (p=0.915) and the 3-year disease-free survival rates were 36.4% and 30.0%, respectively (p=0.737).Conclusions: Laparoscopic abdomino-perineal resection is safe and feasible for anastomotic recurrence of rectalcancer.     

Salvage laparoscopic surgery in advanced prostate cancer: is it possible or beneficial?

Purpose: The surgical management of recurrent urological cancer continues to evolve. This review focuses on the role laparoscopic surgical techniques have within recurrent prostate treatments. Methods: A literature search from 1990 to 2007 was conducted using the PubMed database to determine the role of laparoscopic salvage surgery for prostate cancers. In all articles studied, we evaluated: estimated blood loss; transfusion rates; hemoglobin level; serum and drain fluid creatinine levels; bowel injury; hospital stay and complication rates. Results: Laparoscopic surgery is used regularly for the treatment of urological cancers; however, its role in treating radiorecurrent or chemoradiorecurrent cancer is unknown. Adjuvant chemo-radiotherapy, other experimental localized therapies (cryotherapy) or hormonal therapy are known to affect the operative field, causing greater morbidity in open surgery. Relative survival rates were lowest among patients who received no treatment and highest among patients who underwent surgical procedures. Conclusions: Although associated with significant morbidity, salvage prostatectomy remains a viable form of therapy. Laparoscopic salvage radical prostatectomy for recurrent cancer is feasible with no more morbidity than an open procedure, with promising short-term oncologic and functional outcomes. Long-term data will ultimately confirm the viability of the laparoscopic approach most probably in a multicenter setting.