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Ono T, Hirata Y, Kato K, Nagata M, Higa S, Fujiwara H. Novel reconstruction using pedicled ileocolic interposition after laparoscopic total gastrectomy: A report of two cases. Int J Surg Case Rep 2024; 125:110501. [PMID: 39522411 PMCID: PMC11747605 DOI: 10.1016/j.ijscr.2024.110501] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2024] [Revised: 10/17/2024] [Accepted: 10/21/2024] [Indexed: 11/16/2024] Open
Abstract
INTRODUCTION Although Roux-en-Y reconstruction using the jejunum is generally performed after laparoscopic total gastrectomy, the postoperative function is inadequate. We designed a novel reconstruction technique using pedicled ileocolic interposition with laparoscopic anastomosis of the esophagus and ileum, and further anastomosis of the colon and duodenum. Two patients were treated with this technique. CASE PRESENTATION Case 1 involved a 74-year-old man with multiple gastric cancer. Case 2 involved a 77-year-old man with extensive scirrhous esophagogastric junction cancer and esophageal invasion of 2 cm. These 2 patients underwent laparoscopic total gastrectomy and pedicled ileocolic interposition anastomosis. The patients were discharged without major complications. DISCUSSION We anticipate that the implementation of this reconstruction method will enhance the quality of life of patients after total gastrectomy, particularly in terms of minimizing esophageal reflux and facilitating oral ingestion. To our knowledge, this is the first report of laparoscopic reconstruction with a pedicled ileocolic interposition after total gastrectomy. CONCLUSION Pedicled ileocolic interposition is characterized by the expectation of good postoperative function owing to the anti-reflux mechanism of the ileocecal valve and adequate reservoir function of the cecum and colon.
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Affiliation(s)
- Takeshi Ono
- Department of Surgery, Okinawa Kyodo Hospital, Okinawa, Japan.
| | - Yuichiro Hirata
- Department of Surgery, Okinawa Kyodo Hospital, Okinawa, Japan
| | - Koji Kato
- Department of Surgery, Okinawa Kyodo Hospital, Okinawa, Japan
| | - Masashi Nagata
- Department of Surgery, Okinawa Kyodo Hospital, Okinawa, Japan
| | - Satoru Higa
- Department of Surgery, Okinawa Kyodo Hospital, Okinawa, Japan
| | - Hisashi Fujiwara
- Department of Gastrointestinal Surgery, Tokyo Medical and Dental University, Tokyo, Japan
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Kanaka S, Yamada T, Matsuda A, Uehara K, Shinji S, Yokoyama Y, Takahashi G, Iwai T, Takeda K, Kuriyama S, Miyasaka T, Yoshida H. Short-term and three-year long-term outcomes of laparoscopic surgery versus open surgery for obstructive colorectal cancer following self-expandable metallic stent placement: a meta-analysis. Surg Endosc 2024; 38:5514-5527. [PMID: 39210057 PMCID: PMC11458689 DOI: 10.1007/s00464-024-11187-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2023] [Accepted: 08/17/2024] [Indexed: 09/04/2024]
Abstract
BACKGROUND A bridge to surgery (BTS) after self-expandable metallic stent (SEMS) placement is a widely recognized treatment strategy for obstructive colorectal cancer. However, there is still a lack of evidence for the efficacy and safety of laparoscopic surgery following SEMS placement. The aim of this systematic review and meta-analysis was to compare the short-term and long-term outcomes of laparoscopic surgery with those of open surgery following SEMS placement in patients with obstructive colorectal cancer. METHODS An electronic literature search through to December 2022 was performed to identify studies comparing short-term and long-term outcomes between laparoscopic and open surgery following SEMS placement for obstructive colorectal cancer. The main outcome measures were postoperative complication rates and mortality. Secondary outcome measures were the 3-year recurrence-free survival (RFS) and 3-year overall survival (OS) rates. The meta-analysis was performed using fixed-effect or random-effects methods to calculate odds ratios (ORs) with 95% confidence intervals (95% CIs). RESULTS The meta-analysis included 15 studies and 883 patients, of whom 467 (52.9%) underwent laparoscopic surgery and 416 (47.1%) underwent open surgery following SEMS placement. The postoperative complication rate was significantly lower in the laparoscopic surgery group than in the open surgery group (OR 0.47, 95% CI 0.32-0.67, P < 0.001). There was no significant difference in the 3-year RFS rate or 3-year OS rate between the laparoscopic and open surgery groups (3-year RFS, OR 0.78, 95% CI 0.50-1.24, P = 0.30; 3-year OS, OR 0.68, 95% CI 0.41-1.12, P = 0.13). CONCLUSION This meta-analysis found that the short-term outcome was better in patients who underwent laparoscopic surgery following SEMS placement than in those who underwent open surgery. Furthermore, there was no significant difference in long-term outcomes between the two groups. Laparoscopic surgery following SEMS placement may be a safe and effective treatment option for obstructive colorectal cancer.
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Affiliation(s)
- Shintaro Kanaka
- Department of Gastrointestinal and Hepato-Biliary-Pancreatic Surgery, Nippon Medical School, 1-1-5 Sendagi, Bunkyo-Ku, Tokyo, 113-8603, Japan.
| | - Takeshi Yamada
- Department of Gastrointestinal and Hepato-Biliary-Pancreatic Surgery, Nippon Medical School, 1-1-5 Sendagi, Bunkyo-Ku, Tokyo, 113-8603, Japan
| | - Akihisa Matsuda
- Department of Gastrointestinal and Hepato-Biliary-Pancreatic Surgery, Nippon Medical School, 1-1-5 Sendagi, Bunkyo-Ku, Tokyo, 113-8603, Japan
| | - Kay Uehara
- Department of Gastrointestinal and Hepato-Biliary-Pancreatic Surgery, Nippon Medical School, 1-1-5 Sendagi, Bunkyo-Ku, Tokyo, 113-8603, Japan
| | - Seiichi Shinji
- Department of Gastrointestinal and Hepato-Biliary-Pancreatic Surgery, Nippon Medical School, 1-1-5 Sendagi, Bunkyo-Ku, Tokyo, 113-8603, Japan
| | - Yasuyuki Yokoyama
- Department of Gastrointestinal and Hepato-Biliary-Pancreatic Surgery, Nippon Medical School, 1-1-5 Sendagi, Bunkyo-Ku, Tokyo, 113-8603, Japan
| | - Goro Takahashi
- Department of Gastrointestinal and Hepato-Biliary-Pancreatic Surgery, Nippon Medical School, 1-1-5 Sendagi, Bunkyo-Ku, Tokyo, 113-8603, Japan
| | - Takuma Iwai
- Department of Gastrointestinal and Hepato-Biliary-Pancreatic Surgery, Nippon Medical School, 1-1-5 Sendagi, Bunkyo-Ku, Tokyo, 113-8603, Japan
| | - Kohki Takeda
- Department of Gastrointestinal and Hepato-Biliary-Pancreatic Surgery, Nippon Medical School, 1-1-5 Sendagi, Bunkyo-Ku, Tokyo, 113-8603, Japan
| | - Sho Kuriyama
- Department of Gastrointestinal and Hepato-Biliary-Pancreatic Surgery, Nippon Medical School, 1-1-5 Sendagi, Bunkyo-Ku, Tokyo, 113-8603, Japan
| | - Toshimitsu Miyasaka
- Department of Gastrointestinal and Hepato-Biliary-Pancreatic Surgery, Nippon Medical School, 1-1-5 Sendagi, Bunkyo-Ku, Tokyo, 113-8603, Japan
| | - Hiroshi Yoshida
- Department of Gastrointestinal and Hepato-Biliary-Pancreatic Surgery, Nippon Medical School, 1-1-5 Sendagi, Bunkyo-Ku, Tokyo, 113-8603, Japan
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Shigaki T, Hasegawa H, Teramura K, Takeshita N, Ikeda K, Tsukada Y, Nishizawa Y, Sasaki T, Ito M. Development of a laparoscopic sigmoidectomy simulator: Sigmaster. Surg Today 2024; 54:1272-1276. [PMID: 38740574 DOI: 10.1007/s00595-024-02855-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2023] [Accepted: 03/17/2024] [Indexed: 05/16/2024]
Abstract
The sigmoid colon simulator was designed to accurately reproduce the anatomical layer structure and the arrangement of characteristic organs in each layer, and to have conductivity so that energy devices can be used. Dry polyester fibers were used to reproduce the layered structures, which included characteristic blood vessels, nerve sheaths, and intestinal tracts. The adhesive strength of the layers was controlled to allow realistic peeling techniques. The features of the Sigmaster are illustrated through a comparison of simulated sigmoidectomy using Sigmaster and actual surgery. We developed a laparoscopic sigmoidectomy simulator called Sigmaster. Sigmaster is a training device that closely reproduces the membrane structures of the human body and allows surgeons to experience the entire laparoscopic sigmoidectomy process.
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Affiliation(s)
- Takahiro Shigaki
- Department of Colorectal Surgery, National Cancer Center Hospital East, 6-5-1 Kashiwanoha, Kashiwa, Chiba, 277-8577, Japan
| | - Hiro Hasegawa
- Department of Colorectal Surgery, National Cancer Center Hospital East, 6-5-1 Kashiwanoha, Kashiwa, Chiba, 277-8577, Japan
- Surgical Device Innovation Office, NEXT Medical Device Innovation Center, National Cancer Center Hospital East, Kashiwa, Japan
| | - Koichi Teramura
- Department of Colorectal Surgery, National Cancer Center Hospital East, 6-5-1 Kashiwanoha, Kashiwa, Chiba, 277-8577, Japan
| | - Nobuyoshi Takeshita
- Department of Colorectal Surgery, National Cancer Center Hospital East, 6-5-1 Kashiwanoha, Kashiwa, Chiba, 277-8577, Japan
- Surgical Device Innovation Office, NEXT Medical Device Innovation Center, National Cancer Center Hospital East, Kashiwa, Japan
| | - Koji Ikeda
- Department of Colorectal Surgery, National Cancer Center Hospital East, 6-5-1 Kashiwanoha, Kashiwa, Chiba, 277-8577, Japan
| | - Yuichiro Tsukada
- Department of Colorectal Surgery, National Cancer Center Hospital East, 6-5-1 Kashiwanoha, Kashiwa, Chiba, 277-8577, Japan
| | - Yuji Nishizawa
- Department of Colorectal Surgery, National Cancer Center Hospital East, 6-5-1 Kashiwanoha, Kashiwa, Chiba, 277-8577, Japan
| | - Takeshi Sasaki
- Department of Colorectal Surgery, National Cancer Center Hospital East, 6-5-1 Kashiwanoha, Kashiwa, Chiba, 277-8577, Japan
| | - Masaaki Ito
- Department of Colorectal Surgery, National Cancer Center Hospital East, 6-5-1 Kashiwanoha, Kashiwa, Chiba, 277-8577, Japan.
- Surgical Device Innovation Office, NEXT Medical Device Innovation Center, National Cancer Center Hospital East, Kashiwa, Japan.
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Kanaka S, Matsuda A, Yamada T, Miyamoto Y, Yokoyama Y, Matsumoto S, Sonoda H, Ohta R, Shinji S, Sekiguchi K, Baba H, Yoshida H. Segmental or right hemi-colectomy? The optimal surgical procedure for transverse colon cancer: a propensity score-matched, multicenter, retrospective study. Int J Colorectal Dis 2023; 38:58. [PMID: 36864355 DOI: 10.1007/s00384-023-04360-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/23/2023] [Indexed: 03/04/2023]
Abstract
PURPOSE Extended colectomy is sometimes chosen for treatment of transverse colon cancer (TCC) because of concerns about short- and long-term outcomes. However, there is still a lack of evidence regarding the optimal surgical procedure. METHODS We retrospectively collected and analyzed data of patients who underwent surgical treatment of pathological stage II/III TCC at four hospitals from January 2011 to June 2019. We excluded the patients with TCC located at distal transverse colon, and just evaluated and analyzed proximal and middle third TCC. Inverse probability treatment-weighted propensity score analyses was used to compare short- and long-term outcomes between patients who underwent segmental transverse colectomy (STC) and those who underwent right hemicolectomy (RHC). RESULTS In total, 106 patients were enrolled in this study (STC group, n = 45; RHC group, n = 61). The patients' backgrounds were well balanced after matching. The incidence of major postoperative complications (Clavien-Dindo grade ≥ III) was not significantly different between the STC and RHC groups (4.5% vs. 5.6%, respectively; P = 0.53). The 3-year recurrence-free survival and overall survival rates were not significantly different between the STC and RHC groups (88.2% vs. 81.8%, P = 0.86 and 90.3% vs. 91.9%, P = 0.79, respectively). CONCLUSION RHC has no significant benefits over STC with respect to either short- or long-term outcomes. STC with necessary lymphadenectomy could be an optimal procedure for proximal and middle TCC.
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Affiliation(s)
- Shintaro Kanaka
- Department of Gastrointestinal and Hepato-Biliary-Pancreatic Surgery, Nippon Medical School, 1-1-5 Sendagi, Bunkyo-ku, Tokyo, 113-8603, Japan
| | - Akihisa Matsuda
- Department of Gastrointestinal and Hepato-Biliary-Pancreatic Surgery, Nippon Medical School, 1-1-5 Sendagi, Bunkyo-ku, Tokyo, 113-8603, Japan.
| | - Takeshi Yamada
- Department of Gastrointestinal and Hepato-Biliary-Pancreatic Surgery, Nippon Medical School, 1-1-5 Sendagi, Bunkyo-ku, Tokyo, 113-8603, Japan
| | - Yuji Miyamoto
- Department of Gastroenterological Surgery, Graduate School of Medical Sciences, Kumamoto University, 1-1-1 Honjo, Chuou-Ku, Kumamoto, 860-8556, Japan
| | - Yasuyuki Yokoyama
- Department of Digestive Surgery, Nippon Medical School Musashikosugi Hospital, 1-383 Kosugi-Cho, Nakahara-Ku, Kawasaki, Kanagawa, 211-8533, Japan
| | - Satoshi Matsumoto
- Department of Surgery, Nippon Medical School Chiba Hokusoh Hospital, 1715 Kamagari, Inzai, Chiba, 270-1694, Japan
| | - Hiromichi Sonoda
- Department of Gastrointestinal and Hepato-Biliary-Pancreatic Surgery, Nippon Medical School, 1-1-5 Sendagi, Bunkyo-ku, Tokyo, 113-8603, Japan
| | - Ryo Ohta
- Department of Digestive Surgery, Nippon Medical School Musashikosugi Hospital, 1-383 Kosugi-Cho, Nakahara-Ku, Kawasaki, Kanagawa, 211-8533, Japan
| | - Seiichi Shinji
- Department of Gastrointestinal and Hepato-Biliary-Pancreatic Surgery, Nippon Medical School, 1-1-5 Sendagi, Bunkyo-ku, Tokyo, 113-8603, Japan
| | - Kumiko Sekiguchi
- Department of Surgery, Nippon Medical School Chiba Hokusoh Hospital, 1715 Kamagari, Inzai, Chiba, 270-1694, Japan
| | - Hideo Baba
- Department of Gastroenterological Surgery, Graduate School of Medical Sciences, Kumamoto University, 1-1-1 Honjo, Chuou-Ku, Kumamoto, 860-8556, Japan
| | - Hiroshi Yoshida
- Department of Gastrointestinal and Hepato-Biliary-Pancreatic Surgery, Nippon Medical School, 1-1-5 Sendagi, Bunkyo-ku, Tokyo, 113-8603, Japan
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Lymph Node Mapping in Transverse Colon Cancer Treated Using Laparoscopic Colectomy With D3 Lymph Node Dissection. Dis Colon Rectum 2022; 65:340-352. [PMID: 35138285 DOI: 10.1097/dcr.0000000000002108] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
BACKGROUND Laparoscopic surgery for transverse colon cancer has been excluded from 7 randomized trials for various reasons. The optimal procedure for transverse colon cancer remains controversial. OBJECTIVE This study aimed to analyze the patterns of lymph node metastasis in transverse colon cancer and to report short- and long-term outcomes of the treatment procedures. DESIGN This was a single-center retrospective study. SETTINGS This study was conducted at Cancer Institute Hospital, Tokyo, Japan. PATIENTS We enrolled 252 patients who underwent laparoscopic surgery for transverse colon cancer. INTERVENTIONS The transverse colon was divided into 3 segments, and the procedures for transverse colon cancer were based on these segments, as follows: right hemicolectomy, transverse colectomy, and left hemicolectomy. MAIN OUTCOME MEASURES Postoperatively, the surgeons identified and mapped the lymph nodes from specimens and performed formalin fixation separately to compare the results of the pathological findings. RESULTS For right-sided, middle-segment, and left-sided transverse colon cancers, the frequency of lymph node metastases was 28.2%, 19.2%, and 19.2%. Skipped lymph node metastasis occurred in right-sided and left-sided transverse colon cancers but not in middle-segment transverse colon cancers. The pathological vascular invasion rate was significantly higher in right and left hemicolectomy than in transverse colectomy. For right hemicolectomy, transverse colectomy, and left hemicolectomy, 5-year overall survival rates were 96.3%, 92.7%, and 93.7%, and relapse-free survival rates were 92.4%, 88.3%, and 95.5%. In multivariate analysis, the independent risk factor for relapse-free survival was lymph node metastasis. LIMITATIONS Selection bias and different backgrounds may have influenced surgical and long-term outcomes. CONCLUSION Laparoscopic surgery for transverse colon cancer may be a feasible technique. Harvested lymph node mapping after laparoscopic resection based on D3 lymphadenectomy may help guide the field of dissection when managing patients who have transverse colon cancer. The only independent prognostic factor for relapse-free survival was node-positive cancer. See Video Abstract at http://links.lww.com/DCR/B706.MAPEO DE GANGLIOS LINFÁTICOS EN CÁNCER DE COLON TRANSVERSO TRATADO MEDIANTE COLECTOMÍA LAPAROSCÓPICA CON LINFADENECTOMÍA D3ANTECEDENTES:La cirugía laparoscópica en casos de cáncer de colon transverso fué excluida de siete estudios randomizados mayores por diversas razones. El procedimiento más idóneo en casos de cáncer de colon transverso, sigue siendo controvertido.OBJETIVO:Analizar los patrones de las metástasis en los ganglios linfáticos en casos de cáncer de colon transverso y reportar los resultados a corto y largo plazo de los diferentes procedimientos para su tratamiento.DISEÑO:Estudio retrospectivo en un solo centro de referencia.AJUSTE:Estudio llevado a cabo en el Hospital del Instituto del Cancer, Tokio, Japón.PACIENTES:Fueron incluidos 252 pacientes, sometidos a cirugía laparoscópica por cáncer de colon transverso.INTERVENCIONES:El colon transverso fué dividido en tres segmentos y los procedimientos en casos de cáncer se basaron sobre estos segmentos del tranverso, de la siguiente manera: hemicolectomía derecha, colectomía transversa y hemicolectomía izquierda.PRINCIPALES MEDIDAS DE RESULTADO:En el postoperatorio, los cirujanos identificaron y mapearon los ganglios linfáticos de las piezas quirúrgicas y las fijaron con formaldehido por separado para así poder comparar los resultados con los hallazgos histopatológicos.RESULTADOS:En los cánceres de colon transverso del segmento derecho, del segmento medio y del segmento izquierdo, la frecuencia de metástasis en los ganglios linfáticos fue del 28,2%, 19,2% y 19,2%, respectivamente. Las metástasis en los ganglios linfáticos omitidos se produjo en los cánceres de colon transverso del lado derecho y del lado izquierdo, pero no en los cánceres de colon transverso del segmento medio. La tasa de invasión vascular patológica fue significativamente mayor en la hemicolectomía derecha e izquierda que en la colectomía transversa. Para la hemicolectomía derecha, colectomía transversa y hemicolectomía izquierda, las tasas de supervivencia general a cinco años fueron del 96,3%, 92,7% y 93,7%, y las tasas de supervivencia sin recaída fueron del 92,4%, 88,3% y 95,5%, respectivamente. En el análisis multivariado, el factor de riesgo independiente para la sobrevida sin recidiva fue la metástasis en los ganglios linfáticos.LIMITACIONES:El sesgo de selección y los diferentes antecedentes pueden haber influido en los resultados quirúrgicos a largo plazo.CONCLUSIONES:La cirugía laparoscópica en casos de cáncer de colon transverso puede ser una técnica factible. El mapeo de los ganglios linfáticos recolectados después de la resección laparoscópica basada en la linfadenectomía D3 puede ayudar a guiar el campo de la disección en el manejo de pacientes con cáncer de colon transverso. El único factor pronóstico independiente para el SLR fue el cáncer con ganglios positivos. Consulte Video Resumen en http://links.lww.com/DCR/B706. (Traducción-Dr. Xavier Delgadillo).
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Saito S, Akagi T, Katayama H, Wakabayashi M, Inomata M, Yamamoto S, Ito M, Kinugasa Y, Egi H, Munakata Y, Kokuba Y, Bando H, Yasui M, Ikeda M, Nakajima K, Shida D, Kanemitsu Y, Kitano S. Identification of patient subgroups with unfavorable long-term outcomes associated with laparoscopic surgery in a randomized controlled trial comparing open and laparoscopic surgery for colon cancer (Japan Clinical Oncology Group Study JCOG0404). Ann Gastroenterol Surg 2021; 5:804-812. [PMID: 34755012 PMCID: PMC8560616 DOI: 10.1002/ags3.12475] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2021] [Revised: 05/01/2021] [Accepted: 05/17/2021] [Indexed: 01/17/2023] Open
Abstract
BACKGROUND Previously, we conducted a randomized controlled trial (JCOG0404) for stage II/III colon cancer patients and reported that the long-term survival after open surgery (OP) and laparoscopic surgery (LAP) were almost identical; however, JCOG0404 suggested that survival of patients after LAP with tumors located in the rectosigmoid colon, cT4 or cN2 tumors, and high body mass index (BMI) might be unfavorable. AIM To identify the patient subgroups associated with poor long-term survival in the LAP arm compared with the OP arm. METHODS Patients aged 20-75, clinical T3 or deeper lesion without involvement of other organs, clinical N0-2 and M0 were included. The patients with pathological stage IV and R2 resection were excluded from the current analysis. In each subgroup, the hazard ratio for LAP (vs. OP) in overall survival (OS) from surgery was estimated using a multivariable Cox regression model adjusted for the clinical and pathological factors. RESULTS In total, 1025 patients (OP, 511 and LAP, 514) were included in the current analysis. Adjusted hazards ratios for OS of patients with high BMI (>25 kg/m2), pT4, and pN2 in LAP were 3.37 (95% confidence interval [CI], 1.24-9.19), 1.33 (0.73-2.41), and 1.74 (0.76-3.97), respectively. In contrast, that of rectosigmoid colon tumors was 0.98 (0.46-2.09). CONCLUSIONS Although LAP is an acceptable optional treatment for stage II/III colon cancer, the present subgroup analysis suggests that high BMI (>25 kg/m2), pT4, and pN2 except for RS were factors associated with unfavorable long-term outcomes of LAP in patients with colon cancer who underwent curative resection. (JCOG 0404: NCT00147134/UMIN-CTR: C000000105.).
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Affiliation(s)
- Shuji Saito
- Division of SurgeryGastrointestinal CenterYokohama Shin‐Midori General HospitalYokohamaJapan
| | - Tomonori Akagi
- Department of Gastroenterological and Pediatric SurgeryOita University Faculty of MedicineOitaJapan
| | - Hiroshi Katayama
- Japan Clinical Oncology Group Data Center/Operations OfficeNational Cancer Center HospitalTokyoJapan
| | - Masashi Wakabayashi
- Japan Clinical Oncology Group Data Center/Operations OfficeNational Cancer Center HospitalTokyoJapan
| | - Masafumi Inomata
- Department of Gastroenterological and Pediatric SurgeryOita University Faculty of MedicineOitaJapan
| | | | - Masaaki Ito
- Department of Colorectal SurgeryNational Cancer Center Hospital EastChibaJapan
| | - Yusuke Kinugasa
- Department of Gastrointestinal SurgeryTokyo Medical and Dental UniversityTokyoJapan
| | - Hiroyuki Egi
- Department of Gastrointestinal Surgery and Surgical OncologyEhime University Graduate School of MedicineEhimeJapan
| | | | - Yukihito Kokuba
- Department of Gastroenterological SurgerySt. Marianna University Yokohama Seibu HospitalYokohamaJapan
| | - Hiroyuki Bando
- Department of Gastroenterological SurgeryIshikawa Prefectural Central HospitalKanazawaJapan
| | - Masayoshi Yasui
- Department of Gastroenterological SurgeryOsaka International Cancer InstituteOsakaJapan
| | - Masataka Ikeda
- Division of Lower Gastrointestinal Surgery, Department of Gastroenterological SurgeryHyogo College of MedicineNishinomiyaJapan
| | | | - Dai Shida
- Division of Frontier SurgeryThe Institute of Medical ScienceThe University of TokyoTokyoJapan
| | - Yukihide Kanemitsu
- Department of Colorectal SurgeryNational Cancer Center HospitalTokyoJapan
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Katayama H, Inomata M, Mizusawa J, Nakamura K, Watanabe M, Akagi T, Yamamoto S, Ito M, Kinugasa Y, Okajima M, Takemasa I, Okuda J, Shida D, Kanemitsu Y, Kitano S. Institutional variation in survival and morbidity in laparoscopic surgery for colon cancer: From the data of a randomized controlled trial comparing open and laparoscopic surgery (JCOG0404). Ann Gastroenterol Surg 2021; 5:823-831. [PMID: 34755014 PMCID: PMC8560602 DOI: 10.1002/ags3.12484] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2021] [Revised: 06/14/2021] [Accepted: 06/21/2021] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND Institutional variation in outcomes is a key factor to ascertain the generalizability of results and reliability of the clinical trial. This study evaluated institutional variation in survival and postoperative complications using data from JCOG0404 comparing laparoscopic colectomy (LAP) with open colectomy (OP). METHODS Institutions with fewer than 10 registered patients were excluded from this analysis. Institutional variation was evaluated in terms of early postoperative complications, overall survival, and relapse-free survival and estimated using a mixed-effect model with institution as a random effect after adjusting for background factors. RESULTS This analysis included 1028 patients in the safety analysis and 1040 patients in the efficacy analysis from 26 institutions. In the safety analysis, there was no variation in grades 3-4 early postoperative complications (in OP, median 6.3% [range 6.3%-6.3%]; in LAP, median 2.6% [range 2.6%-2.6%]), but some variation in grades 1-4 early postoperative complications was observed (in OP, median 20.8% [range 13.2%-31.8%]; in LAP, median 11.9% [range 7.2%-28.7%]), and that in grades 2-4 was observed only in LAP (median 8.8% [range 4.7%-24.0%]; in OP, median 12.7% [range 12.7%-12.7%]). Two specific institutions showed especially high incidences of postoperative complications in LAP. In the efficacy analysis, there was no institutional variation in OP, although a certain variation was observed in LAP. CONCLUSIONS Some institutional variations in safety and efficacy were observed, although only in LAP. We conclude that a qualification system, including training and education, is needed when new surgical techniques such as laparoscopic surgery are introduced in clinical practice.
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Affiliation(s)
- Hiroshi Katayama
- Japan Clinical Oncology Group Data Center/Operations OfficeNational Cancer Center HospitalTokyoJapan
| | - Masafumi Inomata
- Department of Gastroenterological and Pediatric SurgeryOita University Faculty of MedicineOitaJapan
| | - Junki Mizusawa
- Japan Clinical Oncology Group Data Center/Operations OfficeNational Cancer Center HospitalTokyoJapan
| | - Kenichi Nakamura
- Japan Clinical Oncology Group Data Center/Operations OfficeNational Cancer Center HospitalTokyoJapan
| | - Masahiko Watanabe
- Department of SurgeryKitasato University Kitasato Institute HospitalTokyoJapan
| | - Tomonori Akagi
- Department of Gastroenterological and Pediatric SurgeryOita University Faculty of MedicineOitaJapan
| | - Seiichiro Yamamoto
- Department of Gastroenterological SurgeryTokai University School of MedicineKanagawaJapan
| | - Masaaki Ito
- Department of Colorectal SurgeryNational Cancer Center Hospital EastChibaJapan
| | - Yusuke Kinugasa
- Department of Gastrointestinal SurgeryTokyo Medical and Dental UniversityTokyoJapan
| | - Masazumi Okajima
- Department of SurgeryHiroshima City Hiroshima Citizens HospitalHiroshimaJapan
| | - Ichiro Takemasa
- Department of SurgerySurgical Oncology and ScienceSapporo Medical UniversityHokkaidoJapan
| | - Junji Okuda
- General and Gastroenterological SurgeryOsaka Medical CollegeOsakaJapan
| | - Dai Shida
- Department of Colorectal SurgeryNational Cancer Center HospitalTokyoJapan
| | - Yukihide Kanemitsu
- Department of Colorectal SurgeryNational Cancer Center HospitalTokyoJapan
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Ueda K, Daito K, Ushijima H, Yane Y, Yoshioka Y, Tokoro T, Iwamoto M, Wada T, Makutani Y, Kawamura J. Laparoscopic complete mesocolic excision with central vascular ligation for splenic flexure colon cancer: short- and long-term outcomes. Surg Endosc 2021; 36:2661-2670. [PMID: 34031741 PMCID: PMC8921072 DOI: 10.1007/s00464-021-08559-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2020] [Accepted: 05/11/2021] [Indexed: 12/01/2022]
Abstract
Background Complete mesocolic excision (CME) with central vascular ligation (CVL) for colon cancer is an essential procedure for improved oncologic outcomes after surgery. Laparoscopic surgery for splenic flexure colon cancer was recently adopted due to a greater understanding of surgical anatomy and improvements in surgical techniques and innovative surgical devices. Methods We retrospectively analyzed the data of patients with splenic flexure colon cancer who underwent laparoscopic CME with CVL at our institution between January 2005 and December 2017. Results Forty-five patients (4.8%) were enrolled in this study. Laparoscopic CME with CVL was successfully performed in all patients. The median operative time was 178 min, and the median estimated blood loss was 20 g. Perioperative complications developed in 6 patients (13.3%). The median postoperative hospital stay was 9 days. According to the pathological report, the median number of harvested lymph nodes was 15, and lymph node metastasis developed in 14 patients (31.1%). No metastasis was observed at the root of the middle colic artery or the inferior mesenteric artery. The median follow-up period was 49 months. The cumulative 5-year overall survival and disease-free survival rates were 85.9% and 84.7%, respectively. The cancer-specific survival rate in stage I-III patients was 92.7%. Recurrence was observed in 5 patients (11.1%), including three patients with peritoneal dissemination and two patients with distant metastasis. Conclusions Laparoscopic CME with CVL for splenic flexure colon cancer appears to be oncologically safe and feasible based on the short- and long-term outcomes in our study. However, it is careful to introduce this procedure to necessitate the anatomical understandings and surgeon’s skill. The appropriate indications must be established with more case registries because our experience is limited.
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Affiliation(s)
- Kazuki Ueda
- Department of Surgery, Kindai University Faculty of Medicine, 377-2, Ohnohigashi, Osaka Sayama, Osaka, 589-8511, Japan.
| | - Koji Daito
- Department of Surgery, Kindai University Faculty of Medicine, 377-2, Ohnohigashi, Osaka Sayama, Osaka, 589-8511, Japan
| | - Hokuto Ushijima
- Department of Surgery, Kindai University Faculty of Medicine, 377-2, Ohnohigashi, Osaka Sayama, Osaka, 589-8511, Japan
| | - Yoshinori Yane
- Department of Surgery, Kindai University Faculty of Medicine, 377-2, Ohnohigashi, Osaka Sayama, Osaka, 589-8511, Japan
| | - Yasumasa Yoshioka
- Department of Surgery, Kindai University Faculty of Medicine, 377-2, Ohnohigashi, Osaka Sayama, Osaka, 589-8511, Japan
| | - Tadao Tokoro
- Department of Surgery, Kindai University Faculty of Medicine, 377-2, Ohnohigashi, Osaka Sayama, Osaka, 589-8511, Japan
| | - Masayoshi Iwamoto
- Department of Surgery, Kindai University Faculty of Medicine, 377-2, Ohnohigashi, Osaka Sayama, Osaka, 589-8511, Japan
| | - Toshiaki Wada
- Department of Surgery, Kindai University Faculty of Medicine, 377-2, Ohnohigashi, Osaka Sayama, Osaka, 589-8511, Japan
| | - Yusuke Makutani
- Department of Surgery, Kindai University Faculty of Medicine, 377-2, Ohnohigashi, Osaka Sayama, Osaka, 589-8511, Japan
| | - Junichiro Kawamura
- Department of Surgery, Kindai University Faculty of Medicine, 377-2, Ohnohigashi, Osaka Sayama, Osaka, 589-8511, Japan
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9
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Zhang Q, Liang J, Chen J, Mei S, Wang Z. Outcomes of Laparoscopic Versus Open Surgery in Elderly Patients with Rectal Cancer. Asian Pac J Cancer Prev 2021; 22:1325-1329. [PMID: 33906329 PMCID: PMC8325135 DOI: 10.31557/apjcp.2021.22.4.1325] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2021] [Indexed: 12/14/2022] Open
Abstract
Background: Laparoscopic colorectal resection has been gaining popularity over the past two decades-and the number of elderly patients with colorectal cancer treated with a surgical modality has gradually increased. However, studies about laparoscopic rectal surgery in elderly patients with long-term oncologic outcomes are limited. In this study, we evaluated the safety and effectiveness of laparoscopic resection in patients with rectal cancer aged ≥80 y. Methods: From 2007-2015, a total of 84 consecutive patients with rectal cancer from a single institution were included, 45 patients undergoing laparoscopic rectal resection were compared with 39 patients undergoing open rectal resection. Results: The two groups were well balanced in terms of age, gender, body mass index, American society of anesthesiologists scores, previous abdominal surgery, neoadjuvant therapy, tumor stage, distance of tumor from the anal verge, and comorbidities. One (2.2%) patient in the laparoscopic group required conversion to open surgery. Laparoscopic surgery was associated with significantly longer operating time (160.1±28.2 versus 148.2±41.3 min; P=0.031), less intraoperative blood loss (80.5±20.9 versus 160.3±42.4 mL; P=0.002), less need of blood transfusion (6.7% versus 20.5%; P=0.003), a shorter time to diet recovery (2.5±1.5 versus 4.9±1.1; P=0.015) and postoperative hospital stay (7.5±4.5 versus 10.8±4.2; P=0.035), lower overall postoperative complication rate (8.9% versus 20.5%; P=0.017), and wound-related complication rate (4.4% versus 10.2%; P=0.013) when compared with open surgery. Specimen length, no. of retrieced lymph nodes, positive distal and circumferential margin rate, mortality rate, and reoperation rate were not significantly different between two groups. The disease-free and overall 5-year survival rates were similar between two groups. Conclusions: Laparoscopic rectal surgery is safe and feasible in patients aged≥80 y and is associated with similar long-term oncologic outcomes when compared with open surgery.
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Affiliation(s)
- Qi Zhang
- Department of Colorectal Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, China
| | - Jianwei Liang
- Department of Colorectal Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, China
| | - Jianan Chen
- Department of Colorectal Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, China
| | - Shiwen Mei
- Department of Colorectal Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, China
| | - Zheng Wang
- Department of Colorectal Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, China
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10
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Ramachandra C, Sugoor P, Karjol U, Arjunan R, Altaf S, Srinivas C, Prakash BV, Patil V. Robotic Total Mesorectal Excision for Rectal Cancer: Short-Term Oncological Outcomes of Initial 178 Cases. Indian J Surg Oncol 2020; 11:653-661. [PMID: 33281405 PMCID: PMC7714805 DOI: 10.1007/s13193-020-01212-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2020] [Accepted: 09/03/2020] [Indexed: 11/06/2022] Open
Abstract
Emerging techniques in minimally invasive rectal resection include robotic total mesorectal excision (R-TME). The Da Vinci Surgical System offers precise dissection in narrow and deep confined spaces and is gaining increasing acceptance during recent times. The aim of this study is to analyse our initial experience of R-TME with Da Vinci Xi platform in terms of perioperative and oncological outcomes in the context of data from recently published randomised ROLARR trial amongst minimally invasive novice surgeons. Patients who underwent R-TME or tumour specific mesorectal excision for rectal cancer between May 2016 and November 2019 were identified from a prospectively maintained single institution colorectal database. Demographic, clinical-pathological and short-term oncological outcomes were analysed. Of the 178 patients, 117 (65.7%) and 31 (17.4%) patients had lower and mid third rectal cancer. Most of the tumours were locally advanced, cT3-T4: 138 (77.5%). One hundred/178 (56.2%) underwent sphincter preserving TME. Eighty-seven (48.8%) were grade II adenocarcinoma. Nonmucinous adenocarcinoma was the predominant histology, 138 (78.4%). One hundred one cases (56.7%) were pT3. The mean number of lymph node yield was 13 ± 5. Distal resection margin and circumferential resection margin were positive in 2 (1.12%), 12 cases (6.74%) respectively. Eleven cases (6.7%) had to be converted to open TME. Mean blood loss and duration of surgery was 170 ± 60 ml and 286 ± 45 min respectively. Five percent cases had an anastomotic leak. Grade IIIa-IIIb Clavien Dindo (CD) morbidity score was reported to be in 12 (6.75%) and 10 (5.61%) cases. Median length of hospitalisation was 7 days (range 4-14 days). Perioperative and pathologic outcomes following robotic rectal resection is associated with good short-term oncological outcomes and is safe, effective, and reproducible by a minimally invasive novice surgeon.
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Affiliation(s)
- C. Ramachandra
- Department of Surgical Oncology, Kidwai Memorial Institute of Oncology, Bengaluru, Karnataka India
| | - Pavan Sugoor
- Department of Surgical Oncology, Kidwai Memorial Institute of Oncology, Bengaluru, Karnataka India
| | - Uday Karjol
- Department of Surgical Oncology, Kidwai Memorial Institute of Oncology, Bengaluru, Karnataka India
| | - Ravi Arjunan
- Department of Surgical Oncology, Kidwai Memorial Institute of Oncology, Bengaluru, Karnataka India
| | - Syed Altaf
- Department of Surgical Oncology, Kidwai Memorial Institute of Oncology, Bengaluru, Karnataka India
| | - C. Srinivas
- Department of Surgical Oncology, Kidwai Memorial Institute of Oncology, Bengaluru, Karnataka India
| | - B. V. Prakash
- Department of Surgical Oncology, Kidwai Memorial Institute of Oncology, Bengaluru, Karnataka India
| | - Vijay Patil
- Department of Surgical Oncology, Kidwai Memorial Institute of Oncology, Bengaluru, Karnataka India
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11
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Ouchi A, Shida D, Hamaguchi T, Takashima A, Ito Y, Ueno H, Ishiguro M, Takii Y, Ikeda S, Ohue M, Fujita S, Shiozawa M, Kataoka K, Ito M, Tsukada Y, Akagi T, Inomata M, Shimada Y, Kanemitsu Y. Challenges of improving treatment outcomes for colorectal and anal cancers in Japan: the Colorectal Cancer Study Group (CCSG) of the Japan Clinical Oncology Group (JCOG). Jpn J Clin Oncol 2020; 50:368-378. [PMID: 32115643 DOI: 10.1093/jjco/hyaa014] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2019] [Revised: 01/15/2020] [Accepted: 01/23/2020] [Indexed: 12/20/2022] Open
Abstract
Colorectal cancer is a major public health concern in Japan. While early-stage colorectal adenocarcinoma treatment entails radical resection of the primary tumor, the importance of perioperative treatment is growing as physicians seek to further improve treatment outcomes. For anal squamous cell carcinoma, definitive chemoradiotherapy is superior to radical surgery in terms of improved patient quality of life. The Colorectal Cancer Study Group of the Japanese Clinical Oncology Group was established in 2001 and has worked to provide answers to common clinical questions and improve treatment outcomes for colorectal and anal cancers through 15 large-scale prospective clinical trials. Here, we discuss the current state of perioperative treatment for early-stage colon, rectal and anal cancers in Japan and approaches taken by the Colorectal Cancer Study Group/the Japanese Clinical Oncology Group to improve treatment outcomes for these cancers.
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Affiliation(s)
- Akira Ouchi
- Department of Gastroenterological Surgery, Aichi Cancer Center Hospital, Aichi
| | - Dai Shida
- Department of Colorectal Surgery, National Cancer Center Hospital, Tokyo
| | - Tetsuya Hamaguchi
- Department of Gastroenterological Oncology, Saitama Medical University International Medical Center, Saitama
| | - Atsuo Takashima
- Department of Gastrointestinal Medical Oncology, National Cancer Center Hospital, Tokyo
| | - Yoshinori Ito
- Department of Radiation Oncology, Showa University Graduate School of Medicine, Tokyo
| | - Hideki Ueno
- Department of Surgery, National Defense Medical College, Saitama
| | - Megumi Ishiguro
- Department of Chemotherapy and Oncosurgery, Tokyo Medical and Dental University Medical Hospital, Tokyo
| | - Yasumasa Takii
- Department of Surgery, Niigata Cancer Center Hospital, Niigata
| | - Satoshi Ikeda
- Department of Gastroenterological Surgery, Hiroshima Prefectural Hospital, Hiroshima
| | - Masayuki Ohue
- Department of Surgery, Osaka International Cancer Institute, Osaka
| | - Shin Fujita
- Department of Surgery, Tochigi Cancer Center, Tochigi
| | - Manabu Shiozawa
- Department of Gastrointestinal Surgery, Kanagawa Cancer Center, Yokohama
| | - Kozo Kataoka
- Division of Lower GI, Department of Surgery, Hyogo College of Medicine, Hyogo
| | - Masaaki Ito
- Department of Colorectal Surgery, National Cancer Center Hospital East, Chiba
| | - Yuichiro Tsukada
- Department of Colorectal Surgery, National Cancer Center Hospital East, Chiba
| | - Tomonori Akagi
- Department of Gastroenterological and Pediatric Surgery, Oita University Hospital, Oita
| | - Masafumi Inomata
- Department of Gastroenterological and Pediatric Surgery, Oita University Hospital, Oita
| | - Yasuhiro Shimada
- Division of Clinical Oncology, Kochi Health Sciences Center, Kochi, Japan
| | - Yukihide Kanemitsu
- Department of Colorectal Surgery, National Cancer Center Hospital, Tokyo
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12
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Akagi T, Inomata M, Hara T, Mizusawa J, Katayama H, Shida D, Ohue M, Ito M, Kinugasa Y, Saida Y, Masaki T, Yamamoto S, Hanai T, Yamaguchi S, Watanabe M, Sugihara K, Fukuda H, Kanemitsu Y, Kitano S. Clinical impact of D3 lymph node dissection with left colic artery (LCA) preservation compared to D3 without LCA preservation: Exploratory subgroup analysis of data from JCOG0404. Ann Gastroenterol Surg 2020; 4:163-169. [PMID: 32258982 PMCID: PMC7105844 DOI: 10.1002/ags3.12318] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2019] [Revised: 01/20/2020] [Accepted: 01/23/2020] [Indexed: 12/21/2022] Open
Abstract
AIM We investigated the clinical impact of D3 lymph node dissection preserving left colic artery (LCA) compared to D3 without LCA preservation using data from JCOG0404. LCA preservation is expected to maintain adequate blood supply, which is effective in preventing anastomotic leakage, intestinal paralysis, and bowel obstruction. Whether D3 with LCA preservation (Group A) improves clinical outcomes following resection of sigmoid colon cancer compared to D3 without LCA preservation (Group B) is unclear. METHODS Procedure type was identified from photographs of the surgical field collected for central surgical review in JCOG0404. Clinical outcomes were compared between each procedure. RESULTS Among the 1057 randomized patients in JCOG0404, 631 patients receiving sigmoid colectomy or anterior resection were included in the subgroup analysis. Group A comprised of 135 patients and Group B of 496 patients. Patient backgrounds did not differ between groups. Median operative time, blood loss, anastomotic leakage, and intestinal paralysis were not remarkably different (Group A vs Group B: 185 vs 186 minutes, 60 vs 50 mL, 3.0% vs 5.0%, and 2.2% vs 3.8%). More overall postoperative complications occurred in Group B than Group A (21.6% vs 9.6%, P = .022). Five-year relapse-free survival (RFS) and overall survival (OS) tended to be better in Group A than Group B (RFS: 83.7% and 80.5%, HR 0.80 [95% CI 0.51-1.26], OS: 96.3% and 91.1%, HR 0.41 [95% CI 0.19-0.89]). CONCLUSIONS Short- and long-term outcomes tend to be better in Group A than Group B, indicating that preservation of LCA could be an alternative treatment.
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Affiliation(s)
- Tomonori Akagi
- Gastroenterological and Pediatric SurgeryOita University of Faculty of MedicineYufuJapan
| | - Masafumi Inomata
- Gastroenterological and Pediatric SurgeryOita University of Faculty of MedicineYufuJapan
| | - Takao Hara
- Gastroenterological and Pediatric SurgeryOita University of Faculty of MedicineYufuJapan
| | - Junki Mizusawa
- Japan Clinical Oncology Group Data Center/Operations OfficeNational Cancer Center HospitalTokyoJapan
| | - Hiroshi Katayama
- Japan Clinical Oncology Group Data Center/Operations OfficeNational Cancer Center HospitalTokyoJapan
| | - Dai Shida
- Department of Colorectal SurgeryNational Cancer CenterTokyoJapan
| | - Masayuki Ohue
- Department of SurgeryOsaka International Cancer InstituteOsakaJapan
| | - Masaaki Ito
- Department of Colorectal SurgeryNational Cancer Center Hospital EastKashiwaJapan
| | - Yusuke Kinugasa
- Department of Gastrointestinal SurgeryTokyo Medical and Dental UniversityTokyoJapan
| | | | | | | | | | - Shigeki Yamaguchi
- Department of Gastroenterological SurgerySaitama Medical University International Medical CenterSaitamaJapan
| | - Masahiko Watanabe
- Department of SurgeryKitasato University School of MedicineSagamiharaJapan
| | - Kenichi Sugihara
- Department of SurgeryTokyo Medical and Dental UniversityTokyoJapan
| | - Haruhiko Fukuda
- Japan Clinical Oncology Group Data Center/Operations OfficeNational Cancer Center HospitalTokyoJapan
| | | | - Seigo Kitano
- Gastroenterological and Pediatric SurgeryOita University of Faculty of MedicineYufuJapan
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13
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Nagasaki T, Akiyoshi T, Fukunaga Y, Tominaga T, Yamaguchi T, Konishi T, Fujimoto Y, Nagayama S, Ueno M. The Short- and Long-Term Feasibility of Laparoscopic Surgery in Colon Cancer Patients with Bulky Tumors. J Gastrointest Surg 2019; 23:1893-1899. [PMID: 30706379 DOI: 10.1007/s11605-019-04114-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2018] [Accepted: 01/08/2019] [Indexed: 01/31/2023]
Abstract
BACKGROUND Compared to open surgery for colon cancer, randomized controlled trials have shown that laparoscopic approaches have equivalent short- and long-term outcomes. However, the feasibility of laparoscopy for removal of bulky tumors has not been evaluated. The aim of our study was to determine the short- and long-term feasibility of laparoscopic surgery for bulky (> 8 cm) colon cancer. METHODS A total of 80 patients with bulky tumors (defined as greater than 8 cm in diameter) underwent curative resection from July 2004 to July 2014. Short- and long-term outcomes were compared between patients undergoing laparoscopic (n = 48) and open (n = 32) resection. RESULTS Compared to open, the operative time was significantly longer (213 vs. 148 min, p < 0.001), return of bowel function quicker (time to oral intake; 2 vs. 5 days, p < 0.001), and length of stay shorter (10 vs. 13 days, p < 0.001) in the laparoscopic group. Five-year cancer-specific and relapse-free survival was similar with no patients developing local recurrence in either group. CONCLUSIONS Laparoscopic resection of colon cancers greater than 8 cm in diameter is feasible and oncologically safe with better short-term and equivalent long-term outcomes compared to open surgery.
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Affiliation(s)
- Toshiya Nagasaki
- Gastroenterological Center, Department of Gastroenterological Surgery, Cancer Institute Hospital, Japanese Foundation for Cancer Research, 3-8-31 Ariake, Koto-ku, Tokyo, 135-8550, Japan.
| | - Takashi Akiyoshi
- Gastroenterological Center, Department of Gastroenterological Surgery, Cancer Institute Hospital, Japanese Foundation for Cancer Research, 3-8-31 Ariake, Koto-ku, Tokyo, 135-8550, Japan
| | - Yosuke Fukunaga
- Gastroenterological Center, Department of Gastroenterological Surgery, Cancer Institute Hospital, Japanese Foundation for Cancer Research, 3-8-31 Ariake, Koto-ku, Tokyo, 135-8550, Japan
| | - Tetsuro Tominaga
- Gastroenterological Center, Department of Gastroenterological Surgery, Cancer Institute Hospital, Japanese Foundation for Cancer Research, 3-8-31 Ariake, Koto-ku, Tokyo, 135-8550, Japan
| | - Tomohiro Yamaguchi
- Gastroenterological Center, Department of Gastroenterological Surgery, Cancer Institute Hospital, Japanese Foundation for Cancer Research, 3-8-31 Ariake, Koto-ku, Tokyo, 135-8550, Japan
| | - Tsuyoshi Konishi
- Gastroenterological Center, Department of Gastroenterological Surgery, Cancer Institute Hospital, Japanese Foundation for Cancer Research, 3-8-31 Ariake, Koto-ku, Tokyo, 135-8550, Japan
| | - Yoshiya Fujimoto
- Gastroenterological Center, Department of Gastroenterological Surgery, Cancer Institute Hospital, Japanese Foundation for Cancer Research, 3-8-31 Ariake, Koto-ku, Tokyo, 135-8550, Japan
| | - Satoshi Nagayama
- Gastroenterological Center, Department of Gastroenterological Surgery, Cancer Institute Hospital, Japanese Foundation for Cancer Research, 3-8-31 Ariake, Koto-ku, Tokyo, 135-8550, Japan
| | - Masashi Ueno
- Gastroenterological Center, Department of Gastroenterological Surgery, Cancer Institute Hospital, Japanese Foundation for Cancer Research, 3-8-31 Ariake, Koto-ku, Tokyo, 135-8550, Japan
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14
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Nishizawa Y, Akagi T, Inomata M, Katayama H, Mizusawa J, Yamamoto S, Ito M, Masaki T, Watanabe M, Shimada Y, Kitano S. Risk factors for early postoperative complications after D3 dissection for stage II or III colon cancer: Supplementary analysis of a multicenter randomized controlled trial in Japan (JCOG0404). Ann Gastroenterol Surg 2019; 3:310-317. [PMID: 31131360 PMCID: PMC6524116 DOI: 10.1002/ags3.12246] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/25/2018] [Revised: 02/25/2019] [Accepted: 03/04/2019] [Indexed: 01/24/2023] Open
Abstract
OBJECTIVE To determine risk factors for early postoperative complications after D3 dissection for stage II/III colon cancer. BACKGROUND Identification of risk factors for postoperative complications is essential in patients surgically treated for colon cancer. The Japan Clinical Oncology Group (JCOG) conducted a randomized controlled trial, JCOG0404, to confirm the non-inferiority of laparoscopic surgery (LAP) to open surgery (OP) with D3 dissection for stage II/III colon cancer. This supplementary analysis was made to assess risk factors for surgery requiring D3 dissection using data from JCOG0404. METHODS Proportion of postoperative complications of any grade (CTCAE ver. 3.0) until first discharge and risk factors for the most frequent complications were analyzed by univariable and multivariable analysis. RESULTS Among 1057 randomized patients treated between October 2004 and March 2009, 520 patients with OP and 525 patients with LAP were analyzed. Overall postoperative complications of all grades occurred in 190 patients (18.2%). Multivariable analysis showed that the risk factors for overall early postoperative complications were OP itself (odds ratio [OR] 2.01, 95% confidence interval [CI]: 1.38-2.91, P = 0.0003) and operation time of >240 minutes (OR 1.94, 95% CI: 1.24-3.02, P = 0.0036). The most frequent adverse event was wound complication (50/1045, 4.8%). In the univariable analysis, reconstruction, greater blood loss, OP, and higher body mass index were significantly associated with wound complication. CONCLUSION Open surgery and longer operation time of >240 minutes were significant risk factors for postoperative complications. LAP surgery and shorter operation time could contribute to fewer postoperative complications in patients undergoing colectomy with D3 dissection. (Japan Clinical Oncology Group study JCOG 0404: NCT00147134/UMIN-CTR: C000000105.).
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Affiliation(s)
- Yusuke Nishizawa
- Division of Gastroenterological SurgerySaitama Cancer CenterKitaadachi‐gunSaitamaJapan
| | - Tomonori Akagi
- Faculty of Medicine, Gastroenterological and Pediatric SurgeryOita UniversityYufuOitaJapan
| | - Masafumi Inomata
- Faculty of Medicine, Gastroenterological and Pediatric SurgeryOita UniversityYufuOitaJapan
| | | | - Junki Mizusawa
- JCOG Data CenterNational Cancer Center HospitalTokyoJapan
| | | | - Masaaki Ito
- Department of Colorectal SurgeryNational Cancer Center Hospital EastKashiwaChibaJapan
| | | | - Masahiko Watanabe
- Department of SurgeryKitasato University School of MedicineSagamiharaKanagawaJapan
| | - Yasuhiro Shimada
- Department of Medical OncologyKochi Health Sciences CenterKochiJapan
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15
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Fujii S, Akagi T, Inomata M, Katayama H, Mizusawa J, Ota M, Saito S, Kinugasa Y, Yamaguchi S, Sato T, Kitano S. Transitional impact of short- and long-term outcomes of a randomized controlled trial to evaluate laparoscopic versus open surgery for colorectal cancer from Japan Clinical Oncology Group Study JCOG0404. Ann Gastroenterol Surg 2019; 3:301-309. [PMID: 31131359 PMCID: PMC6524094 DOI: 10.1002/ags3.12245] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2018] [Revised: 02/04/2019] [Accepted: 02/17/2019] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND The JCOG0404 randomized controlled trial conducted to compare laparoscopic surgery (LAP) with open surgery (OP) for stage II/III colon cancer showed better short-term outcomes and equal long-term outcomes of LAP versus OP. Technical instrumentation of surgery and anticancer agents given during the registration period might have affected the outcomes. AIM To evaluate outcomes according to the registration periods. METHODS The overall registration period was divided into three periods (first: 2004-2005, second: 2006-2007 and third: 2008-2009). Short-term and long-term outcomes were compared between registration periods. RESULTS In total, 1057 patients were registered. Numbers of patients undergoing each approach for each of the three periods (1st/2nd/3rd) were 528 for OP (106/244/178) and 529 for LAP (106/246/177). Operation time (minutes) did not change between the periods for OP (160/156/161) or LAP (205/211/219). Blood loss (mL) gradually decreased in the latter two periods: (119/80/75) for OP and (35/28/25) for LAP. Incidence of complications (%) decreased in the latter periods for OP (27.6/20.3/21.3), whereas that for LAP remained consistently low (14.3/14.8/13.6). There was no particular trend in 5-year overall survival and recurrence-free survival depending on the period regardless of treatment. D3 dissection rates were 95% or more for all periods in both groups. CONCLUSIONS Operation time and survival rates did not change over time, whereas blood loss in OP improved in the latter periods. Quality control applied in this trial might have been effective in producing such safe endpoints. (ClinicalTrials.gov, number NCT00147134, UMIN Clinical Trials Registry, number C000000105.).
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Affiliation(s)
- Shoichi Fujii
- Department of Gastroenterological SurgeryYokohama City University Medical CenterYokohamaJapan
| | - Tomonori Akagi
- Department of Gastroenterological and Pediatric SurgeryOita UniversityOitaJapan
| | - Masafumi Inomata
- Department of Gastroenterological and Pediatric SurgeryOita UniversityOitaJapan
| | - Hiroshi Katayama
- Japan Clinical Oncology Group Data Center/Operations OfficeNational Cancer CenterTokyoJapan
| | - Junki Mizusawa
- Japan Clinical Oncology Group Data Center/Operations OfficeNational Cancer CenterTokyoJapan
| | - Mitsuyoshi Ota
- Department of Gastroenterological SurgeryYokohama City University Medical CenterYokohamaJapan
| | - Shuji Saito
- Division of Colon and Rectal SurgeryShizuoka Cancer CenterShizuokaJapan
| | - Yusuke Kinugasa
- Division of Colon and Rectal SurgeryShizuoka Cancer CenterShizuokaJapan
| | - Shigeki Yamaguchi
- Division of Colon and Rectal SurgeryShizuoka Cancer CenterShizuokaJapan
| | - Takeo Sato
- Department of SurgeryKitasato University HospitalSagamiharaJapan
| | - Seigo Kitano
- Department of Gastroenterological and Pediatric SurgeryOita UniversityOitaJapan
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16
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Martel G, Boushey RP, Marcello PW. Reprint of: Results of the laparoscopic colon cancer randomized trials: An evidence-based review. SEMINARS IN COLON AND RECTAL SURGERY 2018. [DOI: 10.1053/j.scrs.2018.11.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Midterm follow-up of a randomized trial of open surgery versus laparoscopic surgery in elderly patients with colorectal cancer. Surg Endosc 2017; 31:3890-3897. [DOI: 10.1007/s00464-017-5418-z] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2016] [Accepted: 01/20/2017] [Indexed: 12/30/2022]
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Survival outcomes following laparoscopic versus open D3 dissection for stage II or III colon cancer (JCOG0404): a phase 3, randomised controlled trial. Lancet Gastroenterol Hepatol 2017; 2:261-268. [PMID: 28404155 DOI: 10.1016/s2468-1253(16)30207-2] [Citation(s) in RCA: 172] [Impact Index Per Article: 21.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2016] [Revised: 11/30/2016] [Accepted: 11/30/2016] [Indexed: 01/13/2023]
Abstract
BACKGROUND Although benefits of laparoscopic surgery compared with open surgery have been suggested, the long-term survival of patients undergoing laparoscopic surgery for colon cancer requiring Japanese D3 dissection remains unclear. We did a randomised controlled trial to establish non-inferiority of laparoscopic surgery to open surgery. METHODS We did an open-label, multi-institutional, randomised, two-arm phase 3 trial in 30 hospitals in Japan. Patients aged 20-75 years who had histologically proven colon cancer; tumours located in the caecum or ascending, sigmoid, or rectosigmoid colon; T3 or deeper lesions without involvement of other organs, node stages N0-2, and metastasis stage M0; and tumour size of 8 cm or smaller were included. Only accredited surgeons did surgery as an operator or instructor. Patients were randomly assigned (1:1) preoperatively to undergo D3 resection either by an open route or a laparoscopic route, via phone call or fax to the Japan Clinical Oncology Group (JCOG) Data Center. Randomisation used a minimisation method with a biased-coin assignment according to tumour location (caecum, ascending vs sigmoid, rectosigmoid) and institution. The primary endpoint was overall survival and was analysed by intention to treat. The non-inferiority margin for the hazard ratio (HR) was set at 1·366. This study is registered with UMIN Clinical Trials Registry, number C000000105, and ClinicalTrials.gov, number NCT00147134. FINDINGS Between Oct 1, 2004, and March 27, 2009, 1057 patients were randomly assigned to either open surgery (n=528) or laparoscopic surgery (n=529). 5-year overall survival was 90·4% (95% CI 87·5-92·6) for open surgery and 91·8% (89·1-93·8) for laparoscopic surgery. Laparoscopic D3 surgery was not non-inferior to open surgery for overall survival (HR 1·06, 90% CI 0·79-1·41; pnon-inferiority=0·073). 65 (13%) patients in the open surgery group and 53 (10%) patients in the laparoscopic surgery group had grade 2-4 adverse events. Grade 2-4 adverse events included diarrhoea (15 [3%] in the open surgery group vs 14 [3%] in the laparoscopic surgery group), paralytic ileus (six [1%] vs nine [2%]), and small intestine bowel obstruction (16 [3%] vs 11 [2%]). Two treatment-related deaths occurred in the open surgery group: one patient died 7 days after surgery (probably due to myocardial infarction), and one patient died from febrile neutropenia, pneumonia, diarrhoea, and gastrointestinal haemorrhage during postoperative chemotherapy. INTERPRETATION Laparoscopic D3 surgery was not non-inferior to open D3 surgery in terms of overall survival for patients with stage II or III colon cancer. However, because overall survival in both groups was similar and better than expected, laparoscopic D3 surgery could be an acceptable treatment option for patients with stage II or III colon cancer. FUNDING National Cancer Center Research and Development Fund, Grant-in-Aid for Cancer Research, and Health and Labour Sciences Research Grant for Clinical Cancer Research from the Ministry of Health, Labour and Welfare of Japan.
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SUGIMOTO KIICHI, SAKAMOTO KAZUHIRO, ICHIKAWA RYOSUKE, KURE KAZUMASA, HONJO KUMPEI, RO HISASHI, TAKAHASHI RINA, KAWANO SHINGO, NIWA KOICHIRO, ISHIYAMA SHUN, KAMIYAMA HIROHIKO, KOMIYAMA HIROMITSU, TAKAHASHI MAKOTO, KOJIMA YUTAKA, GOTO MICHITOSHI, OKUZAWA ATSUSHI, ISHIBIKI YOSHIRO, TOMIKI YUICHI. Propensity Score Analysis in the Comparison of Long-Term Outcomes for Locally Advanced Colon Cancer Between Laparoscopic Colectomy and Open Colectomy. JUNTENDO MEDICAL JOURNAL 2017. [DOI: 10.14789/jmj.63.264] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Affiliation(s)
- KIICHI SUGIMOTO
- Department of Coloproctological Surgery, Juntendo University Faculty of Medicine
| | - KAZUHIRO SAKAMOTO
- Department of Coloproctological Surgery, Juntendo University Faculty of Medicine
| | - RYOSUKE ICHIKAWA
- Department of Coloproctological Surgery, Juntendo University Faculty of Medicine
| | - KAZUMASA KURE
- Department of Coloproctological Surgery, Juntendo University Faculty of Medicine
| | - KUMPEI HONJO
- Department of Coloproctological Surgery, Juntendo University Faculty of Medicine
| | - HISASHI RO
- Department of Coloproctological Surgery, Juntendo University Faculty of Medicine
| | - RINA TAKAHASHI
- Department of Coloproctological Surgery, Juntendo University Faculty of Medicine
| | - SHINGO KAWANO
- Department of Coloproctological Surgery, Juntendo University Faculty of Medicine
| | - KOICHIRO NIWA
- Department of Coloproctological Surgery, Juntendo University Faculty of Medicine
| | - SHUN ISHIYAMA
- Department of Coloproctological Surgery, Juntendo University Faculty of Medicine
| | - HIROHIKO KAMIYAMA
- Department of Coloproctological Surgery, Juntendo University Faculty of Medicine
| | - HIROMITSU KOMIYAMA
- Department of Coloproctological Surgery, Juntendo University Faculty of Medicine
| | - MAKOTO TAKAHASHI
- Department of Coloproctological Surgery, Juntendo University Faculty of Medicine
| | - YUTAKA KOJIMA
- Department of Coloproctological Surgery, Juntendo University Faculty of Medicine
| | - MICHITOSHI GOTO
- Department of Coloproctological Surgery, Juntendo University Faculty of Medicine
| | - ATSUSHI OKUZAWA
- Department of Coloproctological Surgery, Juntendo University Faculty of Medicine
| | - YOSHIRO ISHIBIKI
- Department of Coloproctological Surgery, Juntendo University Faculty of Medicine
| | - YUICHI TOMIKI
- Department of Coloproctological Surgery, Juntendo University Faculty of Medicine
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Huang J, Zhang Z, Wang S. Efficacy of the Da Vinci surgical system in colorectal surgery comparing with traditional laparoscopic surgery or open surgery. INT J ADV ROBOT SYST 2016; 13. [DOI: 10.1177/1729881416664849] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2025] Open
Abstract
In order to compare the curative effect of the Da Vinci surgical system (DVSS) with laparoscopic surgery (LS) or open surgery for colorectal resection, literature search was conducted in PubMed, Excerpt Medica Database (Embase), and Cochrane library up to January 15, 2016. Odds ratio (OR) and weighted mean difference with their corresponding 95% confidence intervals were used as effect size for evaluation of different outcomes. In total, 10 studies consisting of 2767 patients were included for the meta-analysis. As a result, there were no significant differences between DVSS and LS/open surgery in the long-term oncologic outcomes ( p > 0.05). However, DVSS achieved a significantly lower length of hospital stay and estimated blood loss (EBL), but a longer operation time. Moreover, DVSS showed a significantly reduced conversion to open surgery than LS (OR = 0.19, 95% confidence interval: 0.08–0.48). Subgroup analysis indicated that DVSS had different results in rectal adenocarcinoma and colon cancer subgroups on outcomes of conversion to open surgery and operation time. DVSS is superior to LS/open surgery in length of hospital stay and EBL, but needs longer operation time. Long-term outcomes of DVSS are comparable with the other approaches. From long-term perspective, DVSS has an equivalent effect to the other two techniques.
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Affiliation(s)
- Jintang Huang
- Guizhou Provincial People’s Hospital, Guiyang, China
| | | | - Shaoyong Wang
- Guizhou Provincial People’s Hospital, Guiyang, China
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21
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Trakarnsanga A, Weiser MR. Minimally invasive surgery of rectal cancer: current evidence and options. Am Soc Clin Oncol Educ Book 2016:214-8. [PMID: 24451737 DOI: 10.14694/edbook_am.2012.32.41] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Minimally invasive surgery (MIS) of colorectal cancer has become more popular in the past two decades. Laparoscopic colectomy has been accepted as an alternative standard approach in colon cancer, with comparable oncologic outcomes and several better short-term outcomes compared to open surgery. Unlike the treatment for colon cancer, however, the minimally invasive approach in rectal cancer has not been established. In this article, we summarize the current status of MIS for rectal cancer and explore the various technical options.
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Affiliation(s)
- Atthaphorn Trakarnsanga
- From the Department of Surgery, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand; Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, NY
| | - Martin R Weiser
- From the Department of Surgery, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand; Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, NY
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Kim CN, Bae SU, Lee SG, Yang SH, Hyun IG, Jang JH, Cho BS, Park JS. Clinical and oncologic outcomes of totally robotic total mesorectal excision for rectal cancer: initial results in a center for minimally invasive surgery. Int J Colorectal Dis 2016; 31:843-52. [PMID: 26956581 DOI: 10.1007/s00384-016-2544-3] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/24/2016] [Indexed: 02/04/2023]
Abstract
PURPOSE A robotic system was mainly designed to allow precise dissection in deep and narrow spaces. We report the clinical and oncologic outcomes of totally robotic total mesorectal excision for rectal cancer. METHODS Between July 2009 and January 2012, 60 consecutive patients undergoing robotic surgery for rectal cancer at the Eulji University Hospital were included. RESULTS The mean total operation time, docking time, and surgeon console time were 466.8 ± 115.6, 7.5 ± 6.7, and 261 ± 87.5 min, respectively. Oral intake of diet was started at 3.3 ± 0.9 days and the mean hospital stay was 8.6 ± 2.4 days. All 60 procedures were technically successful without the need for conversion to open or laparoscopic surgery. Complications included anastomotic leakage, anastomotic stricture, postoperative bleeding, ileus, and perineal wound infection in 3 (5 %), 1 (1.7 %), 2 (3.3 %), 2 (3.3 %), and 1 (1.7 %) patient, respectively. The mean distal resection margin and total number of lymph nodes harvested was 3.1 ± 1.7 cm and 20.1 ± 11.5, respectively. During the mean follow-up period of 48.5 months (range, 7-75), the 4-year overall and disease-free survival rates were 87.7 and 72.8 %, respectively. CONCLUSIONS A totally robotic approach for rectal cancer operations was a time-consuming procedure, although we already had a lot experience in laparoscopic colorectal surgery. However, the dexterity of the robotic surgery could enable the surgeon to expand the choice of surgical methods according to the condition of the rectal cancer without the need for conversion.
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Affiliation(s)
- Chang-Nam Kim
- Department of Surgery, Eulji University Hospital, School of Medicine, Eulji University, 95 Dunsanseo-ro, Seo-gu, Daejeon, 302-799, South Korea.
| | - Sung Uk Bae
- Department of Surgery, Dongsan Medical Center, School of Medicine, Keimyung University, Daegu, South Korea
| | - Seul-Gi Lee
- Department of Surgery, Eulji University Hospital, School of Medicine, Eulji University, 95 Dunsanseo-ro, Seo-gu, Daejeon, 302-799, South Korea
| | - Seung Hyun Yang
- Department of Surgery, Eulji University Hospital, School of Medicine, Eulji University, 95 Dunsanseo-ro, Seo-gu, Daejeon, 302-799, South Korea
| | - In Gun Hyun
- Department of Surgery, Eulji University Hospital, School of Medicine, Eulji University, 95 Dunsanseo-ro, Seo-gu, Daejeon, 302-799, South Korea
| | - Je Ho Jang
- Department of Surgery, Eulji University Hospital, School of Medicine, Eulji University, 95 Dunsanseo-ro, Seo-gu, Daejeon, 302-799, South Korea
| | - Byung Sun Cho
- Department of Surgery, Eulji University Hospital, School of Medicine, Eulji University, 95 Dunsanseo-ro, Seo-gu, Daejeon, 302-799, South Korea
| | - Joo Seung Park
- Department of Surgery, Eulji University Hospital, School of Medicine, Eulji University, 95 Dunsanseo-ro, Seo-gu, Daejeon, 302-799, South Korea
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Etoh T, Inomata M, Watanabe M, Konishi F, Kawamura Y, Ueda Y, Toujigamori M, Shiroshita H, Katayama H, Kitano S. Success rate of informed consent acquisition and factors influencing participation in a multicenter randomized controlled trial of laparoscopic versus open surgery for stage II/III colon cancer in Japan (JCOG0404). Asian J Endosc Surg 2015; 8:419-23. [PMID: 26176956 DOI: 10.1111/ases.12204] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2015] [Accepted: 06/06/2015] [Indexed: 12/22/2022]
Abstract
INTRODUCTION Successful completion of randomized controlled trials (RCT) is dependent on informed consent (IC) acquisition from patients. The aim of this study was to prospectively calculate the proportion of participation in a surgical RCT and to identify the reasons for failed IC acquisition. METHODS A 30-institute RCT was conducted to evaluate oncological outcomes of open and laparoscopic surgery for stage II/III colon cancer (JCOG0404: UMIN-CTR C000000105). The success rate of obtaining IC, which was supported by a DVD that helped patients understand this trial, was evaluated in eight periods between October 2004 and March 2009. In addition, reasons for failed IC acquisition were identified from questionnaires. RESULTS A total of 1767 patients were informed of their eligibility for the trial, and 1057 (60%) were randomly assigned to either the laparoscopic surgery (n = 529) or open surgery (n = 528) group. The success rate of IC acquisition ranged from 50% to 62% in eight periods. The most common reasons for failed IC acquisition were anxiety/unhappiness about the randomization, patients' preference for one form of surgery, and strong recommendations from referring doctors or relatives. CONCLUSIONS With the assistance of a DVD, high success rates of IC acquisition were obtained for an RCT of laparoscopic versus open surgery for stage II/III colon cancers. To obtain such a rate, investigators should make efforts to inform patients, their relatives, and referring doctors about the medical contributions a surgical RCT can make.
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Affiliation(s)
- Tsuyoshi Etoh
- Department of Gastroenterological and Pediatric Surgery, Oita University Faculty of Medicine, Yufu, Japan
| | - Masafumi Inomata
- Department of Gastroenterological and Pediatric Surgery, Oita University Faculty of Medicine, Yufu, Japan
| | - Masahiko Watanabe
- Department of Surgery, Kitasato University School of Medicine, Sagamihara, Japan
| | - Fumio Konishi
- Department of Surgery, Jichi Medical University Saitama Medical Center, Saitama, Japan
| | - Yutaka Kawamura
- Department of Surgery, Jichi Medical University Saitama Medical Center, Saitama, Japan
| | - Yoshitake Ueda
- Department of Gastroenterological and Pediatric Surgery, Oita University Faculty of Medicine, Yufu, Japan
| | - Manabu Toujigamori
- Department of Gastroenterological and Pediatric Surgery, Oita University Faculty of Medicine, Yufu, Japan
| | - Hidefumi Shiroshita
- Department of Gastroenterological and Pediatric Surgery, Oita University Faculty of Medicine, Yufu, Japan
| | - Hiroshi Katayama
- JCOG Data Center, Multi-institutional Clinical Trial Support Center, National Cancer Center, Tokyo, Japan
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Zhang FW, Zhou ZY, Wang HL, Zhang JX, Di BS, Huang WH, Yang KH. Laparoscopic versus open surgery for rectal cancer: a systematic review and meta-analysis of randomized controlled trials. Asian Pac J Cancer Prev 2015; 15:9985-96. [PMID: 25520140 DOI: 10.7314/apjcp.2014.15.22.9985] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
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 with laparoscopic 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 potential randomized controlled trials from their inception to March 31, 2014 without language restriction. Additional articles were identified from searching bibliographies of retrieved articles. Two reviewers independently assessed the full-text articles according to the pre-specified inclusion and exclusion criteria as well as the methodological quality of included trials. The meta-analysis was performed using RevMan 5.2. RESULTS A total of 16 randomized controlled trials involving 3,045 participants (laparoscopic group, 1,804 cases; open group, 1,241 cases) were reviewed. Laparoscopic surgery was associated with significantly lower intraoperative blood loss, earlier return of bowel movement and reduced length of hospital stay as compared to open surgery, although with increased operative time. It also showed an obvious advantage for minimizing late complications of adhesion-related bowel obstruction. Importantly, there were no significant differences in other postoperative complications, oncological clearance, 3-year and 5-year or 10 year recurrence and survival rates between two procedures. CONCLUSIONS On the basis of this meta-analysis we conclude that laparoscopic surgery has advantages of earlier postoperative recovery, less blood loss and lower rates of adhesion-related bowel obstruction. In addition, oncological outcome is comparable after laparoscopic and open resection for rectal cancer.
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Affiliation(s)
- Feng-Wa Zhang
- The First Clinical Medical School, Lanzhou University, Lanzhou, Gansu, China E-mail :
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Mohamed ZK, Law WL. Outcome of tumor-specific mesorectal excision for rectal cancer: the impact of laparoscopic resection. World J Surg 2015; 38:2168-74. [PMID: 24671302 DOI: 10.1007/s00268-014-2533-z] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
OBJECTIVE The study aimed to compare the outcomes of laparoscopic and open resection for rectal cancer in 1,063 consecutive cases in a single center. METHODS We performed an analysis of 11 years of experience in rectal cancer surgery and compared the outcome of laparoscopic and open surgery. Multivariate and subgroup analysis was performed to look at the effect of the level of tumor and stage of disease on short-term outcomes like conversion rate, anastomotic leak rate, length of stay, complication rate, 30-day mortality, and long-term outcomes like local recurrence and survival. RESULTS A total of 1,063 patients underwent rectal resection with 470 (44.2%) patients undergoing the laparoscopic approach. Groups were comparable in terms of age, sex, or co-morbidities, and the operating time was longer in the laparoscopic group (210 vs. 150 min; p value < 0.001). A conversion rate of 6.8% was noted, with an anastomotic leak rate of 3.87% in the open group and 2.97% in the laparoscopic group. The laparoscopic group had a lower blood loss (100 vs. 350 ml; p < 0.001), lower complication rates, and shorter length of stay (6 vs. 9 days). The local recurrence rate was comparable, and the laparoscopic approach had better overall and cancer-specific survival, even after adjusting for stages. The laparoscopic approach was an independent factor associated with better overall and cancer-specific survival on multivariate analysis. CONCLUSION We confirmed the oncological safety of laparoscopic rectal cancer surgery. Laparoscopic surgery also showed superiority in the short-term and long-term outcomes of rectal cancer.
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Affiliation(s)
- Zakir K Mohamed
- Division of Colorectal Surgery, Department of Surgery, The University of Hong Kong, Queen Mary Hospital, 102 Pokfulam Road, Hong Kong, China
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Fujii S, Ishibe A, Ota M, Yamagishi S, Watanabe K, Watanabe J, Kanazawa A, Ichikawa Y, Oba M, Morita S, Hashiguchi Y, Kunisaki C, Endo I. Short-term results of a randomized study between laparoscopic and open surgery in elderly colorectal cancer patients. Surg Endosc 2015; 28:466-76. [PMID: 24122242 DOI: 10.1007/s00464-013-3223-x] [Citation(s) in RCA: 61] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2013] [Accepted: 09/12/2013] [Indexed: 12/12/2022]
Abstract
BACKGROUND In surgical treatment of elderly patients, securing the safety of surgery and radical cure must be balanced. Our purpose was to verify the safety and validity of laparoscopic surgery for the treatment of colorectal cancer in elderly patients. METHODS Patients with cTis–T4a colorectal cancer who were 75 years or older were randomized to receive open or laparoscopic surgery. Exclusion criteria were patients who had a bulky tumor, rectal cancer that required pelvic side wall lymphadenectomy, and history of colon resection. Patients were divided according to tumor location (right colon, left colon, and rectum). The short-term outcomes were compared between the two groups. RESULTS One hundred patients (right 43, left 28, and rectum 29) were registered in each group from August 2008 to August 2012. There were no differences in patient characteristics between the two groups. Three patients were converted from laparoscopic to open, because of bleeding, excision of peritoneum metastasis, and patient’s desire, respectively. In the short-term results (open:laparoscopic), there were significant differences in the rates of complications (36:23 %) and ileus (12:4 %), amount of blood loss (157:63 mL), and duration of surgery (150:172 min). There were no significant differences in the pathological margins, and the number of dissected lymph nodes. In the subgroup analysis according to the tumor location, there were significant differences in the rate of complications (39.4:22.5 %), amount of blood loss (135:42 mL), duration of surgery (139:160 min), and length of postoperative stay (13.0:10.0 days) in the colon cancer. There were no significant differences in short-term results in the rectal cancer. CONCLUSIONS Laparoscopic surgery in elderly colorectal cancer patients did not result in a difference in radical cure compared with open surgery, and the short-term results except the duration of surgery were excellent. It is an effective procedure for elderly patients with colorectal cancer, especially colon cancer.
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The Role of the Laparoscopy on Circumferential Resection Margin Positivity in Patients With Rectal Cancer. Surg Laparosc Endosc Percutan Tech 2015; 25:129-37. [DOI: 10.1097/sle.0000000000000060] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
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Abstract
Advances in the surgical management of rectal cancer have placed the quality of total mesorectal excision (TME) as the major predictor in overall survival. A standardized TME technique along with quality increases the percentage of patients undergoing a complete TME. Quality measurements of TME will place increasing demands on surgeons maintaining competence with present and future techniques. These efforts will improve the outcome of the rectal cancer patients.
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Affiliation(s)
- Warren E Lichliter
- Division of Colon and Rectal Surgery, Baylor University Medical Center, Dallas, Texas
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29
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Rectal Cancer. Surg Oncol 2015. [DOI: 10.1007/978-1-4939-1423-4_18] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Inomata M, Akagi T, Katayama H, Kimura A, Mizusawa J, Etoh T, Yamaguchi S, Ito M, Kinugasa Y, Saida Y, Hasegawa H, Ota M, Kanemitsu Y, Shimada Y, Kitano S. A randomized controlled trial comparing laparoscopic surgery with open surgery in palliative resection of primary tumor in incurable Stage IV colorectal cancer: Japan Clinical Oncology Group Study JCOG 1107 (ENCORE trial). Jpn J Clin Oncol 2014; 44:1123-6. [PMID: 25156683 DOI: 10.1093/jjco/hyu115] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
A randomized controlled trial was started in Japan to evaluate the non-inferiority of overall survival of laparoscopic surgery to open surgery for palliative resection of primary tumor in incurable Stage IV colorectal cancer. Symptomatic, Stage IV colorectal cancer patients with non-curable metastasis are pre-operatively randomized to either open or laparoscopic colorectal resection. Surgeons in 56 specialized institutions will recruit 450 patients. The primary endpoint is overall survival. Secondary endpoints are progression-free survival, the proportion of conversion from laparoscopic surgery to open surgery, the proportion of patients who fulfill the criteria of starting chemotherapy by 6 weeks after operation, intraoperative and post-operative complications, adverse events during chemotherapy and serious adverse events.
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Affiliation(s)
- Masafumi Inomata
- Department of Gastroenterological and Pediatric Surgery, Oita University Faculty of Medicine, Oita
| | - Tomonori Akagi
- Department of Gastroenterological and Pediatric Surgery, Oita University Faculty of Medicine, Oita
| | - Hiroshi Katayama
- JCOG Data Center/Operations Office, Center for Research Administration and Support, National Cancer Center, Tokyo
| | - Aya Kimura
- JCOG Data Center/Operations Office, Center for Research Administration and Support, National Cancer Center, Tokyo
| | - Junki Mizusawa
- JCOG Data Center/Operations Office, Center for Research Administration and Support, National Cancer Center, Tokyo
| | - Tsuyoshi Etoh
- Department of Gastroenterological and Pediatric Surgery, Oita University Faculty of Medicine, Oita
| | - Shigeki Yamaguchi
- Department of Gastroenterological Surgery, Comprehensive Cancer Center, Saitama International Medical Center, Saitama Medical University, Saitama
| | | | | | | | | | - Mitsuyoshi Ota
- Department of Surgery, Gastroenterological Center, Yokohama City University, Kanagawa
| | - Yukihide Kanemitsu
- Department of Colorectal Surgery Division, National Cancer Center Hospital, Tokyo
| | - Yasuhiro Shimada
- Department of Gastrointestinal Medical Oncology, National Cancer Center Hospital, Tokyo, Japan
| | - Seigo Kitano
- Department of Gastroenterological and Pediatric Surgery, Oita University Faculty of Medicine, Oita
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Qu H, Du YF, Li MZ, Zhang YD, Shen J. Laparoscopy-assisted posterior low anterior resection of rectal cancer. BMC Gastroenterol 2014; 14:158. [PMID: 25216936 PMCID: PMC4168196 DOI: 10.1186/1471-230x-14-158] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2014] [Accepted: 09/08/2014] [Indexed: 12/14/2022] Open
Abstract
Background Laparoscopy-assisted low anterior resection (LAR) of colorectal cancer, using a posterior surgical approach, is a difficult and controversial procedure to perform. We report successful operations on 13 patients with clear surgical margins and no serious complications. Methods Thirteen patients [10 males and three females, age range: 48 to 69 years (median: 61 years)] with low adenocarcinoma confirmed by preoperative colonoscopic biopsy (four stage T1; nine stage T2) were resected. The distance from inferior edge of tumor to dentate line was 2 ~ 5 cm (average: 3.4 cm). Intraperitoneal laparoscopy was performed to isolate rectosigmoid and mesocolon moving toward distal end of the tumor. Perineal operation was performed in the prone clasp-knife position. Results The circumferential resection margin (CRM) was negative in all cases. No serious postoperative complications occurred. There were four cases of perineal wound infection, two cases with superficial perineal wound dehiscence, and two cases with persistent postoperative sacral pain. All 13 patients passed the Wexner continence test and had satisfactory anal function during a mean 18-month postoperative follow-up period. Conclusion Laparoscopic posterior LAR of colorectal cancer is a safe and reliable treatment for patients with low colorectal cancer, increasing the chance of anal functional recovery. Trial registration Chinese Clinical Trial Register ChiCTR-ONC-14005145. Registered 19 August 2014.
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Affiliation(s)
| | - Yan-Fu Du
- Department of General Surgery, Beijing Chaoyang Hospital, Capital Medical University, Beijing 100020, China.
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Outcome of laparoscopic versus open resection for rectal cancer in elderly patients. J Surg Res 2014; 193:613-8. [PMID: 25214259 DOI: 10.1016/j.jss.2014.08.012] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2014] [Revised: 07/15/2014] [Accepted: 08/08/2014] [Indexed: 02/07/2023]
Abstract
BACKGROUND Laparoscopic colorectal resection has been gaining popularity over the past two decades. However, studies about laparoscopic rectal surgery in elderly patients with long-term oncologic outcomes are limited. In this study, we evaluated the short-term and long-term outcomes of laparoscopic and open resection in patients with rectal cancer aged ≥ 70 y. METHODS From 2007-2012, a total of 294 consecutive patients with rectal cancer from a single institution were included, 112 patients undergoing laparoscopic rectal resection were compared with 182 patients undergoing open rectal resection. RESULTS Seven (6.3%) patients in the laparoscopic group required conversion to open surgery. The two groups were well balanced in terms of age, gender, body mass index, American society of anesthesiologists scores, site, and stage of the tumors. Laparoscopic surgery was associated with significantly longer median operating time (220 versus 200 min; P = 0.005), less estimated blood loss (100 versus 150 mL; P < 0.001), a shorter postoperative hospital stay (8 versus 11 d), lower overall postoperative complication rate (15.2% versus 26.4%; P = 0.025), wound-related complication rate (7.14% versus 17.03%; P = 0.015), less need of blood transfusion (8.04% versus 16.5%; P = 0.038), and surgical intensive care unit after surgery (12.5% versus 22.0%; P = 0.042) when compared with open surgery. Mortality, quality of surgical specimen, lymph nodes harvested, positive distal, and circumferential margin rate were not significantly different between two groups. The estimated 3-y survival rates were similar between two groups. CONCLUSIONS Laparoscopic rectal surgery is safe and feasible in patients >70 y and is associated with better short-term outcomes when compared with open surgery.
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Short-term surgical outcomes from a randomized controlled trial to evaluate laparoscopic and open D3 dissection for stage II/III colon cancer: Japan Clinical Oncology Group Study JCOG 0404. Ann Surg 2014; 260:23-30. [PMID: 24509190 DOI: 10.1097/sla.0000000000000499] [Citation(s) in RCA: 252] [Impact Index Per Article: 22.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
OBJECTIVE A randomized controlled trial to confirm the non-inferiority of laparoscopic surgery to open surgery in terms of overall survival was conducted, and short-term surgical outcomes are demonstrated. BACKGROUND The efficacy and safety outcome of laparoscopic surgery for clinical stages II/III colon cancer undergoing Japanese D3 dissection are still unclear. METHODS Eligibility criteria included colon cancer; tumor located in the cecum, ascending, sigmoid, or rectosigmoid colon; T3 or T4 without involvement of other organs; N0-2; and M0. Patients were randomized preoperatively and underwent tumor resection with D3 dissection. Safety analyses were conducted by per-protocol set. RESULTS A total of 1057 patients were randomized between October 2004 and March 2009. By per-protocol set, 524 patients who underwent open surgery and 533 patients who underwent laparoscopic surgery were analyzed. D3 dissection was performed in 521 (99.4%) patients in the open surgery arm and 529 (99.2%) patients in the laparoscopic surgery arm. Conversion to open surgery was needed for 29 (5.4%) patients. Patients assigned to laparoscopic surgery had less blood loss (P < 0.001), although laparoscopic surgery lasted 52 minutes longer (P < 0.001). Laparoscopic surgery was associated with a shorter time to pass first flatus, decreased use of analgesics after 5 postoperative days, and a shorter hospital stay. Morbidity [14.3% (76/533) vs 22.3% (117/524), P < 0.001] was lower in the laparoscopic surgery arm. CONCLUSIONS Short-term surgical safety and clinical benefits of laparoscopic D3 dissection were demonstrated. The primary endpoint will be reported after the primary analysis, planned for 2014.
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Nakajima K, Inomata M, Akagi T, Etoh T, Sugihara K, Watanabe M, Yamamoto S, Katayama H, Moriya Y, Kitano S. Quality control by photo documentation for evaluation of laparoscopic and open colectomy with D3 resection for stage II/III colorectal cancer: Japan Clinical Oncology Group Study JCOG 0404. Jpn J Clin Oncol 2014; 44:799-806. [PMID: 25084776 DOI: 10.1093/jjco/hyu083] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
Abstract
OBJECTIVE The quality of surgery with D3 resection in randomized controlled clinical trial [Japan Clinical Oncology Group study (JCOG0404)] was assessed by evaluation of the photo documentation of both open and laparoscopic surgeries. METHODS A multi-institutional randomized-controlled trial (JCOG0404) was conducted to evaluate open and laparoscopic D3 resection (complete mesocolic excision + ligation and dissection at the root of the main vessels) for Stage II/III colon cancer (UMIN-CTR number C000000105). A total of 1057 (open, 528; laparoscopic, 529) eligible patients were enrolled. For quality control, it was ensured that the surgeries were performed by accredited surgeons, and a central committee reviewed each surgery on the basis of the submitted photographs of the resected field, specimen and skin incision. RESULTS For right-sided tumors, the rate of D3 resection was 98.5% (131/133) in the open arm and 100% (136/136) in the laparoscopic arm, and for left-sided tumors, they were 97.9% (322/329) and 98.2% (320/326), respectively. Sufficient length of the resected longitudinal margin was ensured in all cases. The skin incisions made in all the cases were <8 cm as defined in the protocol in laparoscopic arm. CONCLUSIONS Completion of high quality surgery with D3 resection was confirmed in JCOG0404 by central peer review of photographs of the surgical procedures in addition to operator regulations. This study suggests that the central review of the photo documentation is one of the important tools to assure a quality control of surgical technique in the Phase III randomized-controlled study.
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Affiliation(s)
- Kentaro Nakajima
- Department of Gastroenterological and Pediatric Surgery, Oita University Faculty of Medicine, Oita
| | - Masafumi Inomata
- Department of Gastroenterological and Pediatric Surgery, Oita University Faculty of Medicine, Oita
| | - Tomonori Akagi
- Department of Gastroenterological and Pediatric Surgery, Oita University Faculty of Medicine, Oita
| | - Tsuyoshi Etoh
- Department of Gastroenterological and Pediatric Surgery, Oita University Faculty of Medicine, Oita
| | - Kenichi Sugihara
- Department of Surgical Oncology, Tokyo Medical and Dental University, Tokyo
| | | | | | - Hiroshi Katayama
- JCOG Data Center, Multi-institutional Clinical Trial Support Center, National Cancer Center, Tokyo
| | - Yoshihiro Moriya
- Division of Colorectal Surgery, National Cancer Center Hospital, Tokyo
| | - Seigo Kitano
- Oita University Faculty of Medicine, Oita, Japan
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Inada R, Yamamoto S, Takawa M, Fujita S, Akasu T. Laparoscopic resection of synchronous colorectal cancers in separate specimens. Asian J Endosc Surg 2014; 7:227-31. [PMID: 24815206 DOI: 10.1111/ases.12110] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2014] [Revised: 03/21/2014] [Accepted: 04/06/2014] [Indexed: 01/19/2023]
Abstract
INTRODUCTION Laparoscopic approaches are increasingly being used in patients with colorectal cancer, but the feasibility of laparoscopic resection of synchronous colorectal cancers in separate specimens remains unknown. In such cases, it is necessary to consider the site of port placement, sequence of dissection, choice of specimen extraction sites, specimen handling, and extracorporeal anastomosis sites. Moreover, the need for complete mesenteric dissection in two areas, removal of two separate specimens containing malignancies, and two anastomoses elicit unique questions related to technical considerations. The aim of this study was to determine the feasibility of laparoscopic resection of two separate specimens containing malignancies for multiple synchronous colorectal cancers. METHODS Between June 2001 and January 2013, 1341 patients with colorectal cancer underwent laparoscopic surgery at our institution. Of them, 11 patients underwent laparoscopy-assisted combined resection of two separate colorectal specimens for multiple synchronous primary colorectal cancers. We retrospectively reviewed their surgical outcomes. RESULTS All procedures were completed laparoscopically without perioperative mortality. Patients underwent right-sided colon resection for right-sided cancer and left-sided or rectal resection for left-sided colon or rectal cancer. The median duration of surgery was 296 min, and the median blood loss was 65 mL. Median time to first postoperative liquid and solid intake was 1 day and 3 days, respectively. Most patients were discharged on postoperative day 8. With regard to postoperative complications, two patients had a surgical-site infection. CONCLUSION Laparoscopic resection of two separate colorectal specimens for multiple synchronous primary colorectal cancers is a feasible and safe procedure.
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Affiliation(s)
- Ryo Inada
- Colorectal Surgery Division, National Cancer Center Hospital, Tokyo, Japan; Department of Gastroenterological Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
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Ogiso S, Yamaguchi T, Sakai Y, Okuchi Y, Murakami T, Hata H, Fukuda M, Ikai I. Short- and mid-term outcomes after early surgical training in laparoscopic colorectal cancer surgery: trainees' performance has no negative impact. J Laparoendosc Adv Surg Tech A 2014; 24:475-83. [PMID: 24919163 DOI: 10.1089/lap.2014.0018] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Abstract
BACKGROUND This study aimed to evaluate the safety and quality of laparoscopic colorectal cancer surgery undertaken by trainees. PATIENTS AND METHODS From a prospectively maintained database, we identified 456 consecutive patients who underwent laparoscopic resection for colorectal cancer between 2006 and 2010. Short-term operative outcomes, relapse-free survival (RFS), and overall survival (OS) were compared between operations undertaken by the experts (E group) and trainees (T group). Multivariate analyses were performed for RFS and OS in stage II/III disease. RESULTS Trainees performed 313 surgeries (68.6%) and completed the procedure by themselves in 297 cases (94.9%). Short-term outcomes, including operative time, blood loss, conversion, complication, mortality, and retrieval of less than 12 lymph nodes, were comparable between the E group and the T group. After a median follow-up period of 35 months, RFS and OS were similar between the two groups, with the exception of OS for stage II (3-year OS for E group versus T group, 96.9% versus 87.0%; P=.029); however, this difference disappeared after multivariate analyses. Multivariate analyses showed that positive resection margin and higher log carcinoembryonic antigen (CEA) levels were associated with lower RFS. Furthermore, increasing age, positive resection margin, higher log CEA levels, intraoperative surgeon exchange, rectal cancer, postoperative complications, absence of postoperative chemotherapy, and shorter operative time were associated with poor OS. CONCLUSIONS Laparoscopic operations undertaken by trainees did not negatively affect short-term outcomes and were not associated with impaired mid-term oncologic outcomes. Our findings support early initiation of training in laparoscopic surgery for colorectal cancer treatment.
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Affiliation(s)
- Satoshi Ogiso
- 1 Department of Surgery, Kyoto Medical Center , Kyoto, Japan
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Mizrahi I, Mazeh H. Role of laparoscopy in rectal cancer: A review. World J Gastroenterol 2014; 20:4900-4907. [PMID: 24803801 PMCID: PMC4009521 DOI: 10.3748/wjg.v20.i17.4900] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2013] [Revised: 12/07/2013] [Accepted: 01/15/2014] [Indexed: 02/06/2023] Open
Abstract
Despite established evidence on the advantages of laparoscopy in colon cancer resection, the use of laparoscopy for rectal cancer resection is still controversial. The initial concern was mainly regarding the feasibility of laparoscopy to achieve an adequate total mesorectal excision specimen. These concerns have been raised following early studies demonstrating higher rates of circumferential margins positivity following laparoscopic resection, as compared to open surgery. Similar to colon resection, patients undergoing laparoscopic rectal cancer resection are expected to benefit from a shorter length of hospital stay, less analgesic requirements, and a faster recovery of bowel function. In the past decade there have been an increasing number of large scale clinical trials investigating the oncological and perioperative outcomes of laparoscopic rectal cancer resection. In this review we summarize the current literature available on laparoscopic rectal cancer surgery.
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Bianchi PP, Petz W, Luca F, Biffi R, Spinoglio G, Montorsi M. Laparoscopic and robotic total mesorectal excision in the treatment of rectal cancer. Brief review and personal remarks. Front Oncol 2014; 4:98. [PMID: 24834429 PMCID: PMC4018567 DOI: 10.3389/fonc.2014.00098] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2014] [Accepted: 04/20/2014] [Indexed: 12/11/2022] Open
Abstract
The current standard treatment for rectal cancer is based on a multimodality approach with preoperative radiochemotherapy in advanced cases and complete surgical removal through total mesorectal excision (TME). The most frequent surgical approach is traditional open surgery, as laparoscopic TME requires high technical skill, a long learning curve, and is not widespread, still being confined to centers with great experience in minimally invasive techniques. Nevertheless, in several studies, the laparoscopic approach, when compared to open surgery, has shown some better short-term clinical outcomes and at least comparable oncologic results. Robotic surgery for the treatment of rectal cancer is an emerging technique, which could overcome some of the technical difficulties posed by standard laparoscopy, but evidence from the literature regarding its oncologic safety and clinical outcomes is still lacking. This brief review analyses the current status of minimally invasive surgery for rectal cancer therapy, focusing on oncologic safety and the new robotic approach.
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Affiliation(s)
- Paolo Pietro Bianchi
- Unit of Minimally Invasive Surgery, European Institute of Oncology , Milan , Italy
| | - Wanda Petz
- Unit of Minimally Invasive Surgery, European Institute of Oncology , Milan , Italy
| | - Fabrizio Luca
- Unit of Abdominal Integrated Surgery, European Institute of Oncology , Milan , Italy
| | - Roberto Biffi
- Division of Abdomino-Pelvic Surgery, European Institute of Oncology , Milan , Italy
| | - Giuseppe Spinoglio
- Department of General and Oncologic Surgery, Azienda Ospedaliera SS Antonio e Biagio , Alessandria , Italy
| | - Marco Montorsi
- Division of General Surgery, Istituto Clinico Humanitas, School of Medicine, University of Milan , Rozzano , Italy
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Vennix S, Pelzers L, Bouvy N, Beets GL, Pierie J, Wiggers T, Breukink S. Laparoscopic versus open total mesorectal excision for rectal cancer. Cochrane Database Syst Rev 2014; 2014:CD005200. [PMID: 24737031 PMCID: PMC10875406 DOI: 10.1002/14651858.cd005200.pub3] [Citation(s) in RCA: 98] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
BACKGROUND Colorectal cancer including rectal cancer is the third most common cause of cancer deaths in the western world. For colon carcinoma, laparoscopic surgery is proven to result in faster postoperative recovery, fewer complications and better cosmetic results with equal oncologic results. These short-term benefits are expected to be similar for laparoscopic rectal cancer surgery. However, the oncological safety of laparoscopic surgery for rectal cancer remained controversial due to the lack of definitive long-term results. Thus, the expected short-term benefits can only be of interest when oncological results are at least equal. OBJECTIVES To evaluate the differences in short- and long-term results after elective laparoscopic total mesorectal excision (LTME) for the resection of rectal cancer compared with open total mesorectal excision (OTME). SEARCH METHODS We searched the Cochrane Central Register of Controlled Trials (CENTRAL, The Cochrane Library 2013, Issue 2), MEDLINE (January 1990 to February 2013), EMBASE (January 1990 to February 2013), ClinicalTrials.gov (February 2013) and Current Controlled Trials (February 2013). We handsearched the reference lists of the included articles for missed studies. SELECTION CRITERIA Only randomised controlled trials (RCTs) comparing LTME and OTME, reporting at least one of our outcome measures, was considered for inclusion. DATA COLLECTION AND ANALYSIS Two authors independently assessed study quality according to the CONSORT statement, and resolved disagreements by discussion. We rated the quality of the evidence using GRADE methods. MAIN RESULTS We identified 45 references out of 953 search results, of which 14 studies met the inclusion criteria involving 3528 rectal cancer patients. We did not consider the risk of bias of the included studies to have impacted on the quality of the evidence. Data were analysed according to an intention-to-treat principle with a mean conversion rate of 14.5% (range 0% to 35%) in the laparoscopic group.There was moderate quality evidence that laparoscopic and open TME had similar effects on five-year disease-free survival (OR 1.02; 95% CI 0.76 to1.38, 4 studies, N = 943). The estimated effects of laparoscopic and open TME on local recurrence and overall survival were similar, although confidence intervals were wide, both with moderate quality evidence (local recurrence: OR 0.89; 95% CI 0.57 to1.39 and overall survival rate: OR 1.15; 95% CI 0.87 to1.52). There was moderate to high quality evidence that the number of resected lymph nodes and surgical margins were similar between the two groups.For the short-term results, length of hospital stay was reduced by two days (95% CI -3.22 to -1.10), moderate quality evidence), and the time to first defecation was shorter in the LTME group (-0.86 days; 95% CI -1.17 to -0.54). There was moderate quality evidence that 30 days morbidity were similar in both groups (OR 0.94; 95% CI 0.8 to 1.1). There were fewer wound infections (OR 0.68; 95% CI 0.50 to 0.93) and fewer bleeding complications (OR 0.30; 95% CI 0.10 to 0.93) in the LTME group.There was no clear evidence of any differences in quality of life after LTME or OTME regarding functional recovery, bladder and sexual function. The costs were higher for LTME with differences up to GBP 2000 for direct costs only. AUTHORS' CONCLUSIONS We have found moderate quality evidence that laparoscopic total mesorectal excision (TME) has similar effects to open TME on long term survival outcomes for the treatment of rectal cancer. The quality of the evidence was downgraded due to imprecision and further research could impact on our confidence in this result. There is moderate quality evidence that it leads to better short-term post-surgical outcomes in terms of recovery for non-locally advanced rectal cancer. Currently results are consistent in showing a similar disease-free survival and overall survival, and for recurrences after at least three years and up to 10 years, although due to imprecision we cannot rule out superiority of either approach. We await long-term data from a number of ongoing and recently completed studies to contribute to a more robust analysis of long-term disease free, overall survival and local recurrence.
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Affiliation(s)
- Sandra Vennix
- Academic Medical CenterDepartment of SurgeryMeibergdreef 9AmsterdamNetherlands1105 AZ
| | - Loeki Pelzers
- Maastricht University Medical CentreDepartment of SurgeryPO Box 5800MaastrichtNetherlands6202 AZ
| | - Nicole Bouvy
- Maastricht University Medical CentreDepartment of SurgeryPO Box 5800MaastrichtNetherlands6202 AZ
| | - Geerard L. Beets
- Maastricht University Medical CentreDepartment of SurgeryPO Box 5800MaastrichtNetherlands6202 AZ
| | - Jean‐Pierre Pierie
- Medical Centre LeeuwardenDepartment of SurgeryH. Dunantweg 2LeeuwardenNetherlands8934 AD
| | - Theo Wiggers
- University Medical Centre GroningenDepartment of Surgical OncologyPostbox 30.001RG GroningenNetherlands9700
| | - Stephanie Breukink
- Maastricht University Medical CentreDepartment of SurgeryPO Box 5800MaastrichtNetherlands6202 AZ
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Kusano T, Inomata M, Hiratsuka T, Akagi T, Ueda Y, Tojigamori M, Shiroshita H, Etoh T, Shiraishi N, Kitano S. A comparison of laparoscopic and open surgery following pre-operative chemoradiation therapy for locally advanced lower rectal cancer. Jpn J Clin Oncol 2014; 44:305-10. [PMID: 24596335 DOI: 10.1093/jjco/hyu013] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
OBJECTIVE Although pre-operative chemoradiation therapy for advanced lower rectal cancer is a controversial treatment modality, it is increasingly used in combination with surgery. Few studies have considered the combination of chemoradiation therapy followed by laparoscopic surgery for locally advanced lower rectal cancer; therefore, this study aimed to assess the usefulness of this therapeutic combination. METHODS We retrospectively reviewed the medical records of patients with locally advanced lower rectal cancer treated by pre-operative chemoradiation therapy and surgery from February 2002 to November 2012 at Oita University. We divided patients into an open surgery group and a laparoscopic surgery group and evaluated various parameters by univariate and multivariate analyses. RESULTS In total, 33 patients were enrolled (open surgery group, n = 14; laparoscopic surgery group, n = 19). Univariate analysis revealed that compared with the open surgery group, operative time was significantly longer, whereas intra--operative blood loss and intra-operative blood transfusion requirements were significantly less in the laparoscopic surgery group. There were no significant differences in post-operative complication and recurrence rates between the two groups. According to multivariate analysis, operative time and intra-operative blood loss were significant predictors of outcome in the laparoscopic surgery group. CONCLUSIONS This study suggests that laparoscopic surgery after chemoradiation therapy for locally advanced lower rectal cancer is a safe procedure. Further prospective investigation of the long-term oncological outcomes of laparoscopic surgery after chemoradiation therapy for locally advanced lower rectal cancer is required to confirm the advantages of laparoscopic surgery over open surgery.
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Affiliation(s)
- Toru Kusano
- *Oita University Faculty of Medicine, 1-1 Hasama-machi, Yufu, Oita 879-5593, Japan.
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Abstract
Minimally invasive or minimal access surgery (MAS) for colon and rectal cancer was introduced in the early 1990s. Although laparoscopic colon surgery is now practiced worldwide, technical barriers, including a steep learning curve, preclude the widespread adoption of MAS techniques for rectal cancer. In addition, although randomized controlled trials have demonstrated that MAS techniques for colon cancer are oncologically equivalent to open surgery, similar confirmatory studies for rectal cancer have yet to be reported. In this Review, current evidence in support of laparoscopic and robotic total mesorectal excision for rectal cancer resection is presented. Other MAS approaches, such as transanal endoscopic microsurgery and natural orifice transluminal endoscopic surgery, are also discussed.
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Affiliation(s)
- Vanessa W Hui
- Department of Surgery, Colorectal Service, Memorial Sloan-Kettering Cancer Center, 1275 York Avenue, New York, NY 10065, USA
| | - José G Guillem
- Department of Surgery, Colorectal Service, Memorial Sloan-Kettering Cancer Center, 1275 York Avenue, New York, NY 10065, USA
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Abstract
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.
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Affiliation(s)
- Wei-Gen Zeng
- Department of Gastrointestinal Surgery, Cancer Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing 100021, P. R. China.
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Brown CJ, Raval MJ. Advances in minimally invasive surgery in the treatment of colorectal cancer. Expert Rev Anticancer Ther 2014; 8:111-23. [DOI: 10.1586/14737140.8.1.111] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
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Grimm L, Fleshman JW. Modern rectal cancer surgery—Total mesorectal excision—The standard of care. SEMINARS IN COLON AND RECTAL SURGERY 2013. [DOI: 10.1053/j.scrs.2013.03.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Matsuda T, Fujita H, Kunimoto Y, Kimura T, Hayashi T, Maeda T, Yamakawa J, Mizumoto T, Ogino K. Clinical outcomes of laparoscopic surgery for transverse and descending colon cancers in a community setting. Asian J Endosc Surg 2013; 6:186-91. [PMID: 23323722 DOI: 10.1111/ases.12017] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2012] [Revised: 11/01/2012] [Accepted: 12/09/2012] [Indexed: 12/29/2022]
Abstract
INTRODUCTION The feasibility, safety and oncological outcomes of laparoscopic surgery for transverse and descending colon cancers in a community hospital setting were evaluated. METHODS Twenty-six patients with transverse or descending colon cancers who underwent laparoscopic surgery at our hospital were included in this retrospective analysis (group A). Their outcomes were compared with those of 71 patients who underwent laparoscopic surgery for colon cancer at other tumor sites (group B). RESULTS There were no significant differences between the two groups in terms of operative time, estimated blood loss, postoperative hospital stay and morbidity rate. Extended lymphadenectomy was performed more frequently and the number of harvested lymph nodes was significantly higher in group B than in group A. However, no recurrence developed in group A, while recurrence occurred in four patients from group B. The 3-year disease-free survival rates were 100% for group A and 93.5% for group B. The 3-year overall survival rates were 100% for group A and 91.6% for group B. CONCLUSIONS Laparoscopic surgery for transverse and descending colon cancers can be performed safely with oncological validity in a community hospital setting, provided there is careful selection of the patients and adequate lymphadenectomy considering the clinical stage of their disease.
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Affiliation(s)
- Takeru Matsuda
- Department of Surgery, Seirei Mikatahara General Hospital, Hamamatsu, Japan.
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Itabashi T, Sasaki A, Otsuka K, Kimura T, Nitta H, Wakabayashi G. Potential value of sonazoid-enhanced intraoperative laparoscopic ultrasonography for liver assessment during laparoscopy-assisted colectomy. Surg Today 2013; 44:696-701. [PMID: 23670037 PMCID: PMC3950561 DOI: 10.1007/s00595-013-0607-4] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2012] [Accepted: 03/04/2013] [Indexed: 12/23/2022]
Abstract
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.
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Affiliation(s)
- Tetsuya Itabashi
- Department of Surgery, Iwate Medical University School of Medicine, 19-1 Uchimaru, Morioka, 020-8505, Japan,
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Inada R, Yamamoto S, Oshiro T, Takawa M, Fujita S, Akasu T. A case-matched comparison of the short-term outcomes between laparoscopic and open abdominoperineal resection for rectal cancer. Surg Today 2013; 44:640-5. [DOI: 10.1007/s00595-013-0611-8] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2012] [Accepted: 01/23/2013] [Indexed: 12/21/2022]
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Peterson CY, Weiser MR. Minimally invasive surgery for locally advanced rectal cancer: recent advances and future developments. COLORECTAL CANCER 2013. [DOI: 10.2217/crc.13.5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
SUMMARY Laparoscopic rectal surgery is technically challenging, difficult to perform and has a steep learning curve. Initial studies comparing laparoscopic and open total mesorectal excision indicate that laparoscopy is associated with decreased hospital stays, reduced postoperative pain and equivalent oncologic outcomes, although definitive randomized controlled trial results evaluating laparoscopy for rectal cancer are still pending. Robotic proctectomy is thought to provide additional benefits to the patient (i.e., reduced sexual and bladder dysfunction postoperatively). It can be performed either as a hybrid technique accompanied with laparoscopic splenic flexure mobilization, or as an entirely robotic procedure. Future investigations into robotic surgery and other new technologies that have potential use in rectal cancer surgery will be critically important as we seek to optimize patient outcomes.
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Affiliation(s)
- Carrie Y Peterson
- Department of Surgery, Division of Colorectal Surgery, Memorial Sloan-Kettering Cancer Center, 1275 York Avenue, NY 10065, USA
| | - Martin R Weiser
- Department of Surgery, Division of Colorectal Surgery, Memorial Sloan-Kettering Cancer Center, 1275 York Avenue, NY 10065, USA.
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Van Koughnett JAM, Kalaskar SN, Wexner SD. Pitfalls of laparoscopic colorectal surgery and how to avoid them. COLORECTAL CANCER 2013. [DOI: 10.2217/crc.13.10] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
SUMMARY Laparoscopic surgery is commonly used for colorectal diseases. Recently, laparoscopy for colorectal carcinoma has increased in use, especially by colorectal surgeons. Laparoscopy is associated with potential pitfalls that pose challenges to the surgeon and team. The identification and management of these pitfalls may not directly parallel those during an open approach. As such, it is essential for the surgeon to have a good working knowledge of how to avoid potential problems and how to best manage them when they do occur. This review highlights common pitfalls of laparoscopic colorectal surgery, as well as offering practical approaches to their management. Technical, patient and surgeon factors are all discussed.
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Affiliation(s)
- Julie Ann M Van Koughnett
- Department of Colorectal Surgery, Cleveland Clinic FL, 2950 Cleveland Clinic Boulevard, Weston, FL 33331, USA
| | - Sudhir N Kalaskar
- Department of Colorectal Surgery, Cleveland Clinic FL, 2950 Cleveland Clinic Boulevard, Weston, FL 33331, USA
| | - Steven D Wexner
- Department of Colorectal Surgery, Cleveland Clinic FL, 2950 Cleveland Clinic Boulevard, Weston, FL 33331, USA.
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