Training in Laparoscopic Appendectomy

Background The role of laparoscopic appendectomy (LA) in surgical training is unclear. Although LA as a therapeutic modality is potentially superior to open surgery, it has failed to become established as standard in training hospitals. The aim of the present study was to evaluate the outcome of LA performed by inexperienced surgeons in a training environment. Materials and Methods A retrospective analysis of all attempted LA performed over a 12-month period was undertaken. Data collected included operator grade (experienced and inexperienced), conversion rate and duration of surgery, complications, and postoperative stay. Results During the study period, 169 appendectomies were performed. The conversion rate to open surgery declined significantly from 28% in the first quarter to 9% in the last quarter, with no difference in the conversion rate between experienced and inexperienced surgeons. Operative time shortened significantly in the inexperienced group. Postoperative complications occurred in 8% of patients, independent of operative grade. Conclusions Our findings demonstrate that LA may be safely introduced as a teaching procedure. Time-to-train should not preclude institutions from adopting the laparoscopic approach in the treatment of acute appendicitis.     

Multivisceral Resection in Colorectal Cancer: A Systematic Review

Background

The objective of this study was to critically evaluate current literature on outcomes following multivisceral resection (MVR) in colorectal cancer (CRC). Adequate surgical resection with clear margins is imperative in achieving long-term survival in colorectal cancer. Where there is adherence to or invasion of adjacent organs, (MVR) may be needed to achieve complete disease clearance.

Methods

A systematic review of MVR in CRC was performed. Pubmed/Medline and Cochrane databases were searched for English language articles from 1995 to 2012 using a predefined strategy. Retrieved abstracts were independently screened for relevance and data extracted from selected studies by 2 researchers. Results are reported as weighted means.

Results

Included were 22 studies comprising 1575 patients (87.0 % primary colorectal cancer; 13.0 % recurrent, 63.8 % rectal; 36.2 % colon). The most common organs resected were the bladder and reproductive organs. The perioperative mortality was 4.2 % with morbidity of 41.5 % (95 % CI, 40.8–42.2 %). The overall 5-year survival rate was 50.3 % (95 % CI, 49.9–50.8 %). Surgery for recurrence was associated with worse outcomes than primary tumors with 5-year survival 19.5 % (95 % CI, 17.8–21.1 %) for recurrent rectal cancer and primary rectal tumors 5-year overall survival 52.8 % (95 % CI, 52.0–53.8 %). R0 resection was the strongest factor associated with long-term survival.

Conclusions

Multivisceral resection provides the best possibility of long-term survival in locally advanced primary colorectal cancer in which a clear margin has been achieved.