• Laparoscopy
• Obesity
• Rectal neoplasms

• Humans
• Rectal Neoplasms/surgery
• Rectal Neoplasms/mortality
• Rectal Neoplasms/complications
• Rectal Neoplasms/pathology
• Laparoscopy/methods
• Obesity/complications
• Aged
• Retrospective Studies
• Middle Aged
• Treatment Outcome
• Male
• Female
• Age Factors
• Disease-Free Survival
• Time Factors
• Length of Stay/statistics & numerical data
• Digestive System Surgical Procedures/methods
• Cohort Studies
• Aged, 80 and over
• Blood Loss, Surgical/statistics & numerical data
• Neoplasm Staging
• Adult
• Body Mass Index

• endoscopic sinus surgery
• endoscopic skull base surgery
• ergonomics
• musculoskeletal pain
• neurosurgeons
• occupational diseases
• otolaryngologists
• posture

• Humans
• Endoscopy
• Occupational Diseases/epidemiology
• Skull Base/surgery
• Musculoskeletal Diseases/epidemiology
• Prevalence
• Ergonomics

• Colorectal cancer
• Elderly
• Frailty
• Modified 5-item frailty index
• Perioperative complications
• Sarcopenia

• Humans
• Aged
• Female
• Male
• Colorectal Neoplasms/surgery
• Colorectal Neoplasms/mortality
• Postoperative Complications/epidemiology
• Postoperative Complications/etiology
• Aged, 80 and over
• Risk Factors
• Sarcopenia/complications
• Sarcopenia/epidemiology
• Length of Stay/statistics & numerical data
• Retrospective Studies
• Serum Albumin/analysis
• Age Factors
• Patient Readmission/statistics & numerical data
• Frailty/complications
• Frailty/epidemiology
• Colectomy/adverse effects
• Colectomy/methods
• Morbidity
• Hypoalbuminemia/epidemiology
• Hypoalbuminemia/complications
• Perioperative Period

• Hebrew University of Jerusalem

• Colorectal surgery
• Laparoscopy
• Postoperative complications

• Humans
• Retrospective Studies
• Blood Loss, Surgical
• Prospective Studies
• Colorectal Surgery/adverse effects
• Laparoscopy/adverse effects
• Laparoscopy/methods
• Colectomy/adverse effects
• Colectomy/methods
• Postoperative Complications/epidemiology
• Postoperative Complications/etiology
• Length of Stay
• Treatment Outcome

• Elderly patients
• laparoscopic surgery
• open surgery
• rectal cancer
• surgical outcomes

• colon neoplasms
• complication
• elderly
• obese
• prognosis

• Colorectal surgery
• Complications
• Laparoscopic
• Older versus younger
• Robotic

• Humans
• Aged
• Aged, 80 and over
• Robotic Surgical Procedures/methods
• Retrospective Studies
• Treatment Outcome
• Laparoscopy/adverse effects
• Postoperative Complications/etiology
• Rectal Neoplasms/surgery
• Rectal Neoplasms/pathology

• 81972269 The National Natural Science Foundation of China

• frailty
• functional recovery
• geriatric assessment
• optimization
• prehabilitation

• colorectal cancer
• elderly
• laparoscopic surgery
• meta-analysis
• open surgery

• Colorectal cancer
• Laparoscopy
• Retrospective cohort
• Right hemicolectomy
• Transverse colon

• Colectomy/methods
• Colonic Neoplasms/surgery
• Humans
• Laparoscopy/methods
• Prospective Studies
• Retrospective Studies

• Cytoreductive surgery
• Length of stay
• Outcomes
• Overall survival
• Postoperative complications

• Antineoplastic Combined Chemotherapy Protocols/therapeutic use
• Combined Modality Therapy
• Cytoreduction Surgical Procedures
• Humans
• Hyperthermia, Induced
• Hyperthermic Intraperitoneal Chemotherapy
• Laparoscopy
• Peritoneal Neoplasms/drug therapy
• Retrospective Studies
• Survival Rate

• Geriatric surgery
• Perioperative management
• Pulmonary support

• R01 GM107625 NIGMS NIH HHS
• national institute of general medical sciences

• Frailty
• Frailty scales
• General surgery
• Long-term mortality
• Surgical emergencies

Surgical site infections (SSIs) are among the most common healthcare-associated infections. Evaluating risk factors for SSIs among patients undergoing laparoscopic and open colorectal resections can aid in selecting appropriate candidates for each modality.

A cohort of all consecutive patients undergoing elective colorectal resections during 2008–2017 in a single center was analyzed. SSIs were prospectively assessed by infection control personnel. Patient data were collected from electronic medical records. Risk factors for SSIs were compared between patients who underwent laparoscopic and open surgeries. A multivariate analysis was performed for significant variables.

During the study period, 865 patients underwent elective colorectal resection: 596 laparoscopic and 269 open surgeries. Mean age was 68.2 ± 15.1 years, weight 72.5 ± 18.3 kg and 441 (51%) were men. The most common indication for surgery was malignancy, in 767 patients (88.7%) with inflammatory bowel diseases and diverticulitis following (4.5% and 3.9%, respectively). Patients undergoing laparoscopic surgery were younger, had fewer comorbidities, shorter pre-operative hospitalizations, lower risk index scores, and lower rates of SSI, compared with open surgery. Independent risk factors for SSI following laparoscopic surgery were chronic obstructive pulmonary disease [odds ratio (OR) 2.655 95% CI (1.267, 5.565)], risk index ≥ 2 [OR 2.079, 95% CI (1.041,4.153)] and conversion of laparoscopic to open surgery [OR 2.056 95%CI (1.212, 3.486)]. Independent risk factors for SSI following open surgery were immunosuppression [OR 3.378 95% CI (1.071, 10.655)], chronic kidney disease [OR 2.643 95% CI (1.008, 6.933)], and need for a second dose of prophylactic antibiotics [OR 2.519 95%CI (1.074, 5.905)].

Risk factors for SSIs differ between laparoscopic and open colorectal resections. Knowledge of specific risk factors may inform patient selection for these modalities.

• Chronic obstructive pulmonary disease
• Colorectal surgery
• Laparoscopic
• Risk factors
• Surgical site infection

• Age Factors
• Aged
• Geriatric Assessment
• Humans
• Neoplasms/surgery
• Patient-Centered Care
• Precision Medicine
• Randomized Controlled Trials as Topic

• P30 CA008748 NCI NIH HHS

The benefits of laparoscopic approach for right colectomy have been well established. However, the technical difficulty to construct the intra-corporeal anastomosis is still cumbersome.

To analyze the results of 3D and 2D laparoscopic right colectomy and to compare it to the published series through a systematic review and meta-analysis.

A retrospective study with propensity score matching analysis of patients undergoing laparoscopic right colectomy at Umbria2 Hospitals from January 2014 to March 2020 was performed. A systematic review was accomplished comparing 2D and 3D right colectomy.

In the personal series 47 patients of the 2D group were matched to 47 patients of the 3D group. The 3D group showed a favorable trend in terms of mean operative time (170.7 ± 32.9 min vs 183.8 ± 35.4 min; P = 0.053) and a significant lower anastomotic time (16.9 ± 2.3 min vs 19.6 ± 2.9 min, P < 0.001). The complete mesocolic excision (CME) subgroups analysis showed a shorter anastomotic time (16.5 ± 1.8 min vs 19.9 ± 3.0 min; P < 0.001) and operative time (175.0 ± 38.5 min vs 193.7 ± 37.1 min; P = 0.063) in the 3D group. Six studies and our series were included in the meta-analysis with 551 patients (2D group: 291; 3D group: 260).The pooled analysis demonstrated a significant difference in favour of the 3D group regarding the operative time (P < 0.001) and the anastomotic time (P < 0.001) while no differences were identified between groups in terms of blood loss (P = 0.827), LNH yield (P = 0.243), time to first flatus (P = 0.333), postoperative complications (P = 0.718) and length of stay (P = 0.835).

The meta-analysis results showed that 3D laparoscopic right colectomy shortens operative and anastomotic time without affecting the standard lymphadenectomy. In our series, the advantage of the 3D system becomes evident when CME and/or more complex associated procedure are requested significantly reducing both the total operative and the anastomotic time.

• Colon cancer
• Right colectomy
• Laparoscopy
• Complete mesocolic excision
• Two-dimensional
• Three-dimensional

• colorectal cancer
• octogenarian
• outcome
• robotic surgery
• survival

This study aimed to analyse the perioperative results from a national dataset of rectal cancer resections in elderly patients.

The clinical records of patients undergoing rectal cancer surgery between 2012 and 2014 were retrieved from the Japanese National Clinical Database and analysed retrospectively. Patients were categorized according to age and those 80 years or older were defined as elderly. Subgroups were also defined according to the surgical approach (laparoscopy versus open surgery). The short-term outcomes, including mortality, anastomotic leak, surgical site infections and medical complications were compared between subgroups.

Of 56 175 patients undergoing rectal cancer surgery, some 6717 patients were elderly and laparoscopy was performed in 46.8 per cent of the sample. When comparing laparoscopy and open surgery in elderly patients, the operative mortality rate (1.5 versus 2.8 per cent; P < 0.001), the incidence of anastomotic leakage (5.2 versus 6.5 per cent; P = 0.026), surgical site infections (6.0 versus 8.0 per cent; P = 0.001), pneumonia (1.4 versus 2.5 per cent; P = 0.001), renal failure (0.7 versus 1.3 per cent; P = 0.016) and cardiac events (0.3 versus 0.8 per cent; P = 0.008) were lower for laparoscopy than for open surgery. The overall complication rate in elderly patients (19.5 per cent) was comparable to that in the younger group (P = 0.07). However, incidence of systemic complications was significantly higher in elderly than in younger patients (all P < 0.001).

Laparoscopy was safe and feasible in elderly patients compared with open surgery. However, the rates of systemic complications were significantly higher than in younger patients.

• Colorectal cancer
• Elderly
• Laparoscopic colorectal surgery
• Minimally invasive surgery
• Surgical outcomes
• Utilization

• Appendicitis
• appendectomy
• cohort studies
• epidemiology
• laparoscopy
• length of stay
• mortality

• Elderly patients
• Minimally invasive pancreatoduodenectomy
• Propensity score-matched analysis
• Short-term postoperative outcomes

Recently, colorectal cancer has increased in elderly patients worldwide, with laparoscopic colorectal surgery increasing in elderly patients with colorectal cancer. However, whether laparoscopic colorectal surgery is an optimal procedure for colorectal cancer in the elderly remains unclear. This study aimed to verify safety and curability of laparoscopic colorectal surgery in elderly patients ≥80 years old.

Patients undergoing curative colorectal surgery from 2006 to 2014 were enrolled and classified into the laparoscopic surgery in elderly patients aged ≥80 years (LAC-E) group, open surgery in elderly patients (OC-E) group, and laparoscopic surgery in non-elderly patients (LAC-NE) group. Short- and long-term outcomes were compared between these groups.

The LAC-E, OC-E, and LAC-NE groups comprised 85, 25, and 358 patients, respectively. Intraoperative blood loss and incidence of postoperative complications were significantly lower in the LAC-E versus OC-E group (97 vs. 440 mL, p < .01 and 14% vs. 32%, p < .05, respectively). Long-term outcomes were not different between these two groups. Operation time was significantly shorter in the LAC-E versus LAC-NE group (249 vs. 288 min, p < .01). Intraoperative blood loss and postoperative complications were similar between the groups. Although the 5-year overall survival rate in the LAC-E group was lower than that in the LAC-NE group (64% vs. 80%, p < .01), there was no difference in 5-year disease-specific survival between the groups.

Laparoscopic colorectal surgery is technically and oncologically safe for colorectal cancer in the elderly as well as the non-elderly and can be an optimal procedure for colorectal cancer in the elderly.

• Colorectal cancer
• Curability
• Elderly
• Laparoscopic surgery
• Safety

• Colorectal surgery
• Elderly
• Laparoscopic surgery
• Short-term outcomes

• Laparoscopy (LAP)
• colorectal
• elderly
• geriatric

• Colorectal cancer
• Geriatric
• Laparoscopy
• Minimally invasive surgery
• Senior

• Aged
• Colorectal Neoplasms/surgery
• Digestive System Surgical Procedures/methods
• Geriatric Assessment/methods
• Global Health
• Humans
• Minimally Invasive Surgical Procedures/methods
• Morbidity/trends
• Postoperative Complications/epidemiology
• Postoperative Complications/prevention & control

• Colon cancer
• Curative surgery
• Elderly
• Emergency surgery
• Rectal cancer
• Survival

• Aged
• Colonic Neoplasms/surgery
• Elective Surgical Procedures/methods
• Geriatric Assessment/methods
• Global Health
• Humans
• Morbidity/trends
• Postoperative Complications/epidemiology
• Risk Factors

• Colorectal surgery
• Frailty assessment
• Functional recovery
• Geriatric oncology
• Quality of life

• Colorectal surgery
• colorectal neoplasms
• endoscopy

• Colorectal cancer
• Functional status
• Geriatric oncology
• Quality of life

• Colorectal surgery
• Laparoscopic
• Minimally-invasive
• Older adults

• Aged
• Colorectal Neoplasms/mortality
• Colorectal Neoplasms/surgery
• Enhanced Recovery After Surgery
• Female
• Humans
• Laparoscopy
• Length of Stay
• Male
• Middle Aged
• Patient Compliance
• Postoperative Complications/prevention & control

There is little evidence on the safety and benefits of laparoscopic pancreaticoduodenectomy (LPD) in elderly patients; therefore, we evaluated the feasibility and efficacy of this procedure by comparing perioperative and oncological outcomes between LPD and open pancreaticoduodenectomy (OPD) in elderly patients. We retrospectively reviewed the data of 1,693 patients who underwent PD to manage periampullary tumours at a single institution between January 2014 and June 2017. Of these patients, 326 were elderly patients aged ≥70 years, with 56 patients allocated to the LPD group and 270 to the OPD group. One-to-one propensity score matching (56:56) was used to match the baseline characteristics of patients who underwent LPD and OPD. LPD was associated with significantly fewer clinically significant postoperative pancreatic fistulas (7.1% vs. 21.4%), fewer analgesic injections (10 vs. 15.6 times; p = 0.022), and longer operative time (321.8 vs. 268.5 minutes; p = 0.001) than OPD in elderly patients. There were no significant differences in 3-year overall and disease-free survival rates between the LPD and OPD groups. LPD had acceptable perioperative and oncological outcomes compared with OPD in elderly patients. LPD is a reliable treatment option for elderly patients with periampullary tumours.

• Elderly
• National in-patient sample(NIS)
• Proctectomy
• Robotic

• Clinicopathological outcomes
• Elderly patients
• Gastric GIST
• Prognosis

• Cancer surgery
• Colorectal cancer
• Elderly
• Oncology

• Aged
• Colorectal neoplasms
• Laparoscopy
• Meta-analysis
• Systematic review

Gastrectomy has been widely used for the treatment of gastric cancer, and the severity of physiological and microbial disorders has greatly harmed the health of patients. In the present study, a probiotic combination containing Bifidobacterium infantis, Lactobacillus acidophilus, Enterococcus faecalis and Bacillus cereus was used to reduce the physiological disorders induced by gastrectomy via monitoring the blood index and microbial diversity using high-throughput sequencing. Our results indicated that the probiotic combination had significantly reduced the inflammation indexes (leukocyte) (p<0.05), while it markedly enhanced the immunity indexes (lymphocyte) and nutrition indexes (albumin and total protein) (p<0.05). In addition, gastric cancer had a strong influence on the microbial diversity of the stomach via enhancing the number of pathogens of Streptococcus, Peptostreptococcus and Prevotella, and reducing the percentage of the probiotic Bifidobacterium. Although partial gastrectomy markedly changed intestinal microbial diversity, the taking of the probiotic combination greatly reduced the ratio of Firmicutes/Bacteroidetes compared with patients taking no probiotics at the phylum level. At the genus level, the probiotic combination significantly enhanced the numbers of the probiotic bacteria Bacteroides, Faecalibacterium and Akkermansia and lowered the richness of Streptococcus. Therefore, we concluded that the taking of the probiotic combination significantly enhances the immune response of patients and reduces the severity of inflammation through modification of gut microbiota.

• Akkermansia
• Gastric cancer
• gastrectomy
• high‑throughput sequencing
• probiotics

Colorectal cancer (CRC) is one of the most common malignant tumors in the world, and its morbidity and mortality both rank third among all malignant tumors in China. Rectal cancer accounts for 60%-70% of cases of CRC. With the in-depth study of the pathogenesis of CRC and the mechanism of tumor metastasis, and the improvement of surgical techniques and methods, anal sphincter surgery for middle and low rectal cancer is increasing gradually. Although the quality of life of the patients improves significantly after anal sphincter preservation for rectal cancer, anastomotic leakage is still one of the most common and serious complications. Studies show that the incidence of anastomotic leakage after surgery for low rectal cancer is 3%-21%, and the death rate is up to 3%. Therefore, a comprehensive assessment of patients and analysis of risk factors before operation is of great significant for reducing the potential risk of anastomotic leakage and choosing surgical approach and appropriate preventive measures to prevent and reduce the occurrence of anastomotic leakage. In this paper, we summarize the recent research on anastomotic leakage after rectal cancer surgery in order to help other clinicians reduce the incidence of anastomotic leakage in clinical practice.

• Low rectal cancer
• Surgical operation
• Anastomotic leakage
• Preventive ileostomy

Transanal total mesorectal excision (TaTME) is emerging as a novel alternative to laparoscopic total mesorectal excision (LaTME). The aim of this study was to compare clinical and pathological results from these two techniques in patients undergoing rectal resections because of low rectal cancer.

Thirty-five patients undergoing TaTME were matched with 35 patients operated on using LaTME. Composite primary endpoint (complete TME, negative circumferential resection margin [pCRM], and distal resection margin [pDRM]) was used to assess pathological quality specimens. Secondary outcomes included operative and postoperative parameters (operative time, total blood loss, postoperative morbidity, length of stay, 30-day mortality).

Composite primary endpoint was achieved by 85% of subjects in the TaTME group and 82% of subjects in the LaTME group (P=0.66). Mean pCRM was 1.1±1.29 vs 0.99±0.78 mm (P=0.25). Distal pDRM was 1.57±0.92 and 1.98±1.22 cm (P=0.15). In the TaTME and LaTME groups, respectively, complete mesorectal excision was achieved in 89% and 83% of subjects, while excision was nearly complete for the remaining 11% and 17% (P=0.23).

TaTME appears to be a noninferior alternative to laparoscopic surgery. TaTME allows for quality retrieval of surgical specimens with comparable clinical outcomes with LaTME.

• laparoscopic TME
• low rectal cancer
• minimally invasive surgery
• rectal cancer
• transanal TME

Thanks to laparoscopy and enhanced recovery protocols (ERAS) it is possible to shorten hospitalization. Therefore, it seems reasonable to search for new early markers of infectious complications in order to select patients who are prone to development of complications.

To assess the usefulness of serum levels of C-reactive protein, interleukin-6 and procalcitonin as early indicators of infectious complications in patients after laparoscopic colorectal surgery with ERAS.

The prospective analysis included consecutive patients who underwent laparoscopic colorectal cancer resection. The following parameters were included in the analysis: C-reactive protein (CRP), interleukin 6 (IL-6) and procalcitonin measured on postoperative days (PODs) 1, 2, 3. Patients were divided into two groups: uncomplicated (group 1) and complicated (group 2). The difference in levels of the markers and the dynamics of changes observed in both groups were analyzed.

Group 1 comprised 34 patients, and group 2 consisted of 17 patients. A significant increase of both absolute values and delta increments on all postoperative days was noted. ROC curve analysis showed that the best cut-off values indicating an infectious process were: CRP 129 mg/l on POD3 (92% sensitivity/80% specificity), IL-6 of 78 pg/ml on POD2 (91% sensitivity/97% specificity) and PCT 0.24 ng/ml on POD3 (93% sensitivity/68% specificity).

Our study showed that regular measurement of all analyzed markers in the early postoperative days may be beneficial in the detection of postoperative infectious complications. Further studies are needed to fully assess the role of routine biochemical measurements in the postoperative period after laparoscopic surgery with the ERAS protocol.

• colorectal surgery
• complications
• enhanced recovery after surgery protocol
• inflammatory markers
• laparoscopy
• procalcitonin

The advantages of laparoscopy are widely known. Nevertheless, its legitimacy in liver surgery is often questioned because of the uncertain value associated with minimally invasive methods. Our main goal was to compare the outcomes of pure laparoscopic (LLR) and open liver resection (OLR) in patients with hepatocellular carcinoma.

We searched EMBASE, MEDLINE, Web of Science, and The Cochrane Library databases to find eligible studies. The most recent search was performed on December 1, 2017. Studies were regarded as suitable if they reported morbidity in patients undergoing LLR versus OLR. Extracted data were pooled and subsequently used in a meta-analysis with a random-effects model. Clinical applicability of results was evaluated using predictive intervals. Review was reported following the PRISMA guidelines.

From 2085 articles, forty-three studies (N = 5100 patients) were included in the meta-analysis. Our findings showed that LLR had lower overall morbidity than OLR (15.59% vs. 29.88%, p < 0.001). Moreover, major morbidity was reduced in the LLR group (3.78% vs. 8.69%, p < 0.001). There were no differences between groups in terms of mortality (1.58% vs. 2.96%, p = 0.05) and both 3- and 5-year overall survival (68.97% vs. 68.12%, p = 0.41) and disease-free survival (46.57% vs. 44.84%, p = 0.46).

The meta-analysis showed that LLR is beneficial in terms of overall morbidity and non-procedure-specific complications. That being said, these results are based on non-randomized trials. For these reasons, we are calling for randomization in upcoming studies. Systematic review registration: PROSPERO registration number CRD42018084576.

The online version of this article (10.1007/s00464-018-6431-6) contains supplementary material, which is available to authorized users.

• Hepatocellular carcinoma
• Laparoscopic liver resection
• Meta-analysis
• Systematic review