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Grönroos-Korhonen MT, Kössi JAO. LapEmerge trial: study protocol for a laparoscopic approach for emergency colon resection-a multicenter, open label, randomized controlled trial. Trials 2024; 25:268. [PMID: 38632602 PMCID: PMC11022348 DOI: 10.1186/s13063-024-08058-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2023] [Accepted: 03/14/2024] [Indexed: 04/19/2024] Open
Abstract
BACKGROUND Due to faster recovery and lower morbidity rates, laparoscopy has become the gold standard in elective colorectal surgery for both the benign and malignant forms of the disease. A substantial proportion of colorectal operations are, however, carried out in emergency settings, and most of the emergency resections are still performed open. The aim of this study is to compare the laparoscopic versus open approach for emergency colorectal surgery. METHOD/DESIGN This is a multicenter prospective randomized controlled trial including adult patients presenting with a condition requiring emergency colorectal resection. DISCUSSION Previous studies cautiously recommend wider use of laparoscopy in emergency colorectal resections, but all earlier reports are retrospective, are mostly single-center studies, and have limited numbers of patients. Laparoscopy may involve some unpredictable risks that have not yet been reported because of the infrequent use of the techniqueded to assess the safety of laparoscopy as well as the advantages and disadvantages of open compared with laparoscopic emergency surgery. TRIAL REGISTRATION Trial registration number: ClinicalTrials.gov NCT05005117 . Registered on August 12, 2021.
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Affiliation(s)
- Marie T Grönroos-Korhonen
- Gastroenterological Surgery, Päijät-Häme Central Hospital, Keskussairaalankatu 7, 15850, Lahti, Finland.
- Helsinki University, Helsinki, Finland.
| | - Jyrki A O Kössi
- Gastroenterological Surgery, Päijät-Häme Central Hospital, Keskussairaalankatu 7, 15850, Lahti, Finland
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Hussain MI, Piozzi GN, Sakib N, Duhoky R, Carannante F, Khan JS. Laparoscopic versus Open Emergency Surgery for Right Colon Cancers. Diagnostics (Basel) 2024; 14:407. [PMID: 38396446 PMCID: PMC10888455 DOI: 10.3390/diagnostics14040407] [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: 01/02/2024] [Revised: 02/01/2024] [Accepted: 02/10/2024] [Indexed: 02/25/2024] Open
Abstract
BACKGROUND A laparoscopic approach to right colectomies for emergency right colon cancers is under investigation. This study compares perioperative and oncological long-term outcomes of right colon cancers undergoing laparoscopic or open emergency resections and identifies risk factors for survival. METHODS Patients were identified from a prospectively maintained institutional database between 2009 and 2019. Demographics, clinicopathological features, recurrence, and survival were investigated. Cox regression analysis was performed for risk factor analysis. RESULTS A total of 202 right colectomies (114 open and 88 laparoscopic) were included. ASA III-IV was higher in the open group. The conversion rate was 14.8%. Laparoscopic surgery was significantly longer (156 vs. 203 min, p < 0.001); pTNM staging did not differ. Laparoscopy was associated with higher lymph node yield, and showed better resection clearance (R0, 78.9 vs. 87.5%, p = 0.049) and shorter postoperative stay (12.5 vs. 8.0 days, p < 0.001). Complication rates and grade were similar. The median length of follow-up was significantly higher in the laparoscopic group (20.5 vs. 33.5 months, p < 0.001). Recurrences were similar (34.2 vs. 36.4%). Open surgery had lower five-year overall survival (OS, 27.1 vs. 51.7%, p = 0.001). Five-year disease-free survival was similar (DFS, 55.8 vs. 56.5%). Surgical approach, pN, pM, retrieved LNs, R stage, and complication severity were risk factors for OS upon multivariate analysis. Pathological N stage and R stage were risk factors for DFS upon multivariate analysis. CONCLUSIONS A laparoscopic approach to right colon cancers in an emergency setting is safe in terms of perioperative and long-term oncological outcomes. Randomized control trials are required to further investigate these results.
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Affiliation(s)
- Mohammad Iqbal Hussain
- Department of Colorectal Surgery, Portsmouth Hospitals University NHS Trust, Portsmouth PO6 3LY, UK; (M.I.H.); (G.N.P.)
| | - Guglielmo Niccolò Piozzi
- Department of Colorectal Surgery, Portsmouth Hospitals University NHS Trust, Portsmouth PO6 3LY, UK; (M.I.H.); (G.N.P.)
| | - Najmu Sakib
- Department of Colorectal Surgery, Portsmouth Hospitals University NHS Trust, Portsmouth PO6 3LY, UK; (M.I.H.); (G.N.P.)
| | - Rauand Duhoky
- Department of Colorectal Surgery, Portsmouth Hospitals University NHS Trust, Portsmouth PO6 3LY, UK; (M.I.H.); (G.N.P.)
- University of Portsmouth, Portsmouth PO1 2UP, UK
| | - Filippo Carannante
- Colorectal Surgery Unit, Fondazione Policlinico Universitario Campus Bio-Medico, 00128 Rome, Italy
| | - Jim S. Khan
- Department of Colorectal Surgery, Portsmouth Hospitals University NHS Trust, Portsmouth PO6 3LY, UK; (M.I.H.); (G.N.P.)
- University of Portsmouth, Portsmouth PO1 2UP, UK
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Singh SS, Shinde RK. Minimally Invasive Gastrointestinal Surgery: A Review. Cureus 2023; 15:e48864. [PMID: 38106769 PMCID: PMC10724411 DOI: 10.7759/cureus.48864] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2023] [Accepted: 11/15/2023] [Indexed: 12/19/2023] Open
Abstract
Minimally invasive surgery uses several procedures with fewer side effects (bleeding, infections, etc.), a shorter hospital stay, and less discomfort following minimally invasive surgery. Laparoscopy was one of the first forms of minimally invasive surgery. It involves doing surgery while using tiny cameras through one or more small incisions, surgical tools along with tubes. Robotic surgery is another kind of minimally invasive procedure. Along with supporting accurate, flexible, and regulated surgical procedures, it provides the physician with a three-dimensional, enlarged view of the operative site. Minimally invasive surgery continues to advance, making it an advantage for patients with a variety of illnesses. Nowadays, many surgeons prefer it to traditional surgery, which frequently necessitates a longer hospital stay and requires larger incisions. Since then, numerous surgical specialties have greatly increased their use of minimally invasive surgery. A minimally invasive procedure is preferred for the majority of patients who require gastrointestinal surgery. Minimally invasive gastrointestinal procedures are just as successful as open procedures and, in some situations, may result in more effective outcomes. While recovery from open surgeries frequently takes five to ten days in the hospital, minimally invasive surgeries are less painful for patients and hasten recovery. It is safe from the perspective of the patient and has a lower postoperative mortality rate. This procedure involves a learning curve among surgeons.
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Affiliation(s)
- Sejal S Singh
- Surgery, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Raju K Shinde
- General Surgery, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
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Sobocki J, Pędziwiatr M, Bigda J, Hołówko W, Major P, Mitura K, Myśliwiec P, Nowosad M, Obcowska-Hamerska A, Orłowski M, Proczko-Stepaniak M, Szeliga J, Wallner G, Zawadzki M. The Association of Polish Surgeons (APS) clinical guidelines for the use of laparoscopy in the management of abdominal emergencies. Part II. Wideochir Inne Tech Maloinwazyjne 2023; 18:379-400. [PMID: 37868279 PMCID: PMC10585467 DOI: 10.5114/wiitm.2023.127884] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2023] [Accepted: 04/27/2023] [Indexed: 10/24/2023] Open
Abstract
Introduction Over the past three decades, almost every type of abdominal surgery has been performed and refined using the laparoscopic technique. Surgeons are applying it for more procedures, which not so long ago were performed only in the classical way. The position of laparoscopic surgery is therefore well established, and in many operations it is currently the recommended and dominant method. Aim The aim of the preparation of these guidelines was to concisely summarize the current knowledge on laparoscopy in acute abdominal diseases for the purposes of the continuous training of surgeons and to create a reference for opinions. Material and methods The development of these recommendations is based on a review of the available literature from the PubMed, Medline, EMBASE and Cochrane Library databases from 1985 to 2022, with particular emphasis on systematic reviews and clinical recommendations of recognized scientific societies. The recommendations were formulated in a directive form and evaluated by a group of experts using the Delphi method. Results and conclusions There are 63 recommendations divided into 12 sections: diagnostic laparoscopy, perforated ulcer, acute pancreatitis, incarcerated hernia, acute cholecystitis, acute appendicitis, acute mesenteric ischemia, abdominal trauma, bowel obstruction, diverticulitis, laparoscopy in pregnancy, and postoperative complications requiring emergency surgery. Each recommendation was supported by scientific evidence and supplemented with expert comments. The guidelines were created on the initiative of the Videosurgery Chapter of the Association of Polish Surgeons and are recommended by the national consultant in the field of general surgery. The second part of the guidelines covers sections 6 to12 and the following challenges for surgical practice: acute appendicitis, acute mesenteric ischemia, abdominal injuries, bowel obstruction, diverticulitis, laparoscopy in pregnancy and postoperative complications requiring a reoperation.
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Affiliation(s)
- Jacek Sobocki
- Chair and Department of General Surgery and Clinical Nutrition, Medical Center of Postgraduate Education Warsaw, Warsaw, Poland
| | - Michał Pędziwiatr
- 2 Department of General Surgery, Jagiellonian University, Collegium Medicum, Krakow, Poland
| | - Justyna Bigda
- Department of General, Endocrine and Transplant Surgery, University Medical Center, Medical University of Gdansk, Gdansk, Poland
| | - Wacław Hołówko
- Department of General, Transplant and Liver Surgery, Medical University of Warsaw, Warsaw, Poland
| | - Piotr Major
- 2 Department of General Surgery, Jagiellonian University, Collegium Medicum, Krakow, Poland
| | - Kryspin Mitura
- Faculty of Medical and Health Sciences, Siedlce University of Natural Sciences and Humanities, Siedlce, Poland
| | - Piotr Myśliwiec
- 1 Department of General and Endocrine Surgery, Medical University of Bialystok, Bialystok, Poland
| | - Małgorzata Nowosad
- Department of General, Transplant and Liver Surgery, Medical University of Warsaw, Warsaw, Poland
| | - Aneta Obcowska-Hamerska
- Department of General, Vascular and Oncological Surgery, Medical University of Warsaw, Warsaw, Poland
| | - Michał Orłowski
- Department of General and Oncological Surgery, Florian Ceynowa Specialist Hospital, Wejherowo, Poland
| | - Monika Proczko-Stepaniak
- Department of General, Endocrine and Transplant Surgery, University Medical Center, Medical University of Gdansk, Gdansk, Poland
| | - Jacek Szeliga
- Department of General, Gastroenterological and Oncological Surgery, Collegium Medicum of the Nicolaus Copernicus University, Torun, Poland
| | - Grzegorz Wallner
- 2 Department and Clinic of General, Gastroenterological and Cancer of the Digestive System Surgery, Medical University of Lublin, Lublin, Poland
| | - Marek Zawadzki
- Department of Oncological Surgery, Provincial Specialist Hospital, Wroclaw, Poland
| | - the Expert Group: Prof. Tomasz Banasiewicz, Prof. Andrzej Budzyński, Prof. Adam Dziki, Prof. Michał Grąt, Prof. Marek Jackowski, Prof. Wojciech Kielan, Prof. Andrzej Matyja, Prof. Krzysztof Paśnik, Prof. Piotr Richter, Prof. Antoni Szczepanik, Prof. Mirosław Szura, Prof. Wiesław Tarnowski, Prof. Krzysztof Zieniewicz
- Chair and Department of General Surgery and Clinical Nutrition, Medical Center of Postgraduate Education Warsaw, Warsaw, Poland
- 2 Department of General Surgery, Jagiellonian University, Collegium Medicum, Krakow, Poland
- Department of General, Endocrine and Transplant Surgery, University Medical Center, Medical University of Gdansk, Gdansk, Poland
- Department of General, Transplant and Liver Surgery, Medical University of Warsaw, Warsaw, Poland
- Faculty of Medical and Health Sciences, Siedlce University of Natural Sciences and Humanities, Siedlce, Poland
- 1 Department of General and Endocrine Surgery, Medical University of Bialystok, Bialystok, Poland
- Department of General, Vascular and Oncological Surgery, Medical University of Warsaw, Warsaw, Poland
- Department of General and Oncological Surgery, Florian Ceynowa Specialist Hospital, Wejherowo, Poland
- Department of General, Gastroenterological and Oncological Surgery, Collegium Medicum of the Nicolaus Copernicus University, Torun, Poland
- 2 Department and Clinic of General, Gastroenterological and Cancer of the Digestive System Surgery, Medical University of Lublin, Lublin, Poland
- Department of Oncological Surgery, Provincial Specialist Hospital, Wroclaw, Poland
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Smyth R, Darbyshire A, Mercer S, Khan J, Richardson J. Trends in emergency colorectal surgery: a 7-year retrospective single-centre cohort study. Surg Endosc 2023; 37:3911-3920. [PMID: 36729232 DOI: 10.1007/s00464-023-09876-0] [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: 10/15/2022] [Accepted: 01/06/2023] [Indexed: 02/03/2023]
Abstract
BACKGROUND Emergency colorectal resections carry a higher morbidity and mortality than elective surgery. The use of minimally invasive surgery has now become widespread in elective colorectal surgery, with improved patient outcomes. Laparoscopy is being increasingly used for emergency colorectal resections, but its role is still being defined. Our aim was to observe the uptake of laparoscopy for emergency colorectal surgery in our centre. METHOD A retrospective single-centre cohort study was performed using local National Emergency Laparotomy Audit data from January 2014-December 2020. All patients who had a colorectal resection were included. Trends in the number and type of resections were recorded. Primary outcome was the proportion of cases started and completed laparoscopically. Secondary outcomes included rate of conversion to open, length of stay and 30-day mortality. RESULTS A total 523 colorectal resections were performed. The number of cases attempted and completed laparoscopically steadily increased over the study period (28.3% to 63.3% and 16.3% to 35.4%, respectively). The mean rate of conversion to open was 43.8%. The greatest expansion in laparoscopy was for cases of intestinal obstruction, perforation and peritonitis, and for those undergoing Hartmann's procedure and right hemicolectomy. 30‑day mortality for cases completed laparoscopically was much lower than those converted or started with open surgery (2.1% vs 11.7% and 17.5%, respectively). Laparoscopic approach was independently associated with reduced length of stay. CONCLUSION Laparoscopy has been successfully adopted for emergency colorectal resections in our centre, with half of cases felt to be suitable for minimally invasive surgery.
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Affiliation(s)
- Rachel Smyth
- MRCS Colorectal Surgery, Portsmouth University Hospitals NHS Trust, Portsmouth, UK.
| | - Alexander Darbyshire
- MRCS Upper GI Surgery, Portsmouth University Hospitals NHS Trust, Portsmouth, UK
| | - Stuart Mercer
- FRCS Upper GI Surgery, Portsmouth University Hospitals NHS Trust, Portsmouth, UK
| | - Jim Khan
- FRCS Colorectal Surgery, Portsmouth University Hospitals NHS Trust, Portsmouth, UK
| | - John Richardson
- FRCS Colorectal Surgery, Portsmouth University Hospitals NHS Trust, Portsmouth, UK
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Alselaim NA, Altoub HA, Alhassan MK, Alhussain RM, Alsubaie AA, Almomen FA, Almutairi AM, Bin Gheshayan SF. The role of laparoscopy in emergency colorectal surgery. Saudi Med J 2022; 43:1333-1340. [PMID: 36517055 PMCID: PMC9994520 DOI: 10.15537/smj.2022.43.12.20220658] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2022] [Accepted: 11/15/2022] [Indexed: 12/17/2023] Open
Abstract
OBJECTIVES To assess the outcomes of the laparoscopic approach compared to those of the open approach in emergency colorectal surgery. METHODS This retrospective cohort study included all patients aged >15 years who underwent emergency colorectal surgery from 2016-2021 at King Abdulaziz Medical City, Riyadh, Saudi Arabia. Patients were divided based on the surgical approach into laparoscopic and open groups. RESULTS A total of 241 patients (182 open resections, 59 laparoscopic approaches) were included in this study. The length of stay in the intensive care unit was shorter in the laparoscopic than in the open group (1±3 days vs. 7±16 days). After multivariable logistic regression, patients undergoing laparoscopic resection had a 70% lower risk of surgical site infection than those undergoing open surgery (adjusted odds ratio=0.33, 95% confidence interval: [0.06-1.67]), a difference that was not significant (p=0.18). Lastly, patients who underwent open surgery had a high proportion of 30-day mortality (n=26; 14.3%), compared to those who underwent laparoscopic resection (n=2; 3.4%, p=0.023). CONCLUSION Laparoscopy in emergency colorectal surgery is safe and feasible, with a trend toward better outcomes. Colorectal surgery specialization is an independent predictor of an increased likelihood of undergoing laparoscopy in emergency colorectal surgery.
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Affiliation(s)
- Nahar A. Alselaim
- From College of Medicine (Alselaim, Altoub, Bin Gheshayan), King Saud bin Abdulaziz University for Health Sciences; from the Research Unit (Almutairi), College of Applied Medical Science, King Saud bin Abdulaziz University for Health Sciences; from the College of Medicine (Alhassan), King Saud University Medical City; from the Department of Surgery (Alselaim, Almutairi, Bin Gheshayan), King Abdullah International Medical Research Center; from the Department of General Surgery (Alselaim, Bin Gheshayan), Ministry of National Guard- Health Affairs; from College of Medicine (Almomen), Imam Mohammad Ibn Saud Islamic University, Riyadh; and from College of Medicine, King Khalid University, Abha, Kingdom of Saudi Arabia (Alhussain, Alsubaie).
| | - Haifa A. Altoub
- From College of Medicine (Alselaim, Altoub, Bin Gheshayan), King Saud bin Abdulaziz University for Health Sciences; from the Research Unit (Almutairi), College of Applied Medical Science, King Saud bin Abdulaziz University for Health Sciences; from the College of Medicine (Alhassan), King Saud University Medical City; from the Department of Surgery (Alselaim, Almutairi, Bin Gheshayan), King Abdullah International Medical Research Center; from the Department of General Surgery (Alselaim, Bin Gheshayan), Ministry of National Guard- Health Affairs; from College of Medicine (Almomen), Imam Mohammad Ibn Saud Islamic University, Riyadh; and from College of Medicine, King Khalid University, Abha, Kingdom of Saudi Arabia (Alhussain, Alsubaie).
| | - Mohammed K. Alhassan
- From College of Medicine (Alselaim, Altoub, Bin Gheshayan), King Saud bin Abdulaziz University for Health Sciences; from the Research Unit (Almutairi), College of Applied Medical Science, King Saud bin Abdulaziz University for Health Sciences; from the College of Medicine (Alhassan), King Saud University Medical City; from the Department of Surgery (Alselaim, Almutairi, Bin Gheshayan), King Abdullah International Medical Research Center; from the Department of General Surgery (Alselaim, Bin Gheshayan), Ministry of National Guard- Health Affairs; from College of Medicine (Almomen), Imam Mohammad Ibn Saud Islamic University, Riyadh; and from College of Medicine, King Khalid University, Abha, Kingdom of Saudi Arabia (Alhussain, Alsubaie).
| | - Raghad M. Alhussain
- From College of Medicine (Alselaim, Altoub, Bin Gheshayan), King Saud bin Abdulaziz University for Health Sciences; from the Research Unit (Almutairi), College of Applied Medical Science, King Saud bin Abdulaziz University for Health Sciences; from the College of Medicine (Alhassan), King Saud University Medical City; from the Department of Surgery (Alselaim, Almutairi, Bin Gheshayan), King Abdullah International Medical Research Center; from the Department of General Surgery (Alselaim, Bin Gheshayan), Ministry of National Guard- Health Affairs; from College of Medicine (Almomen), Imam Mohammad Ibn Saud Islamic University, Riyadh; and from College of Medicine, King Khalid University, Abha, Kingdom of Saudi Arabia (Alhussain, Alsubaie).
| | - Abdullah A. Alsubaie
- From College of Medicine (Alselaim, Altoub, Bin Gheshayan), King Saud bin Abdulaziz University for Health Sciences; from the Research Unit (Almutairi), College of Applied Medical Science, King Saud bin Abdulaziz University for Health Sciences; from the College of Medicine (Alhassan), King Saud University Medical City; from the Department of Surgery (Alselaim, Almutairi, Bin Gheshayan), King Abdullah International Medical Research Center; from the Department of General Surgery (Alselaim, Bin Gheshayan), Ministry of National Guard- Health Affairs; from College of Medicine (Almomen), Imam Mohammad Ibn Saud Islamic University, Riyadh; and from College of Medicine, King Khalid University, Abha, Kingdom of Saudi Arabia (Alhussain, Alsubaie).
| | - Farah A. Almomen
- From College of Medicine (Alselaim, Altoub, Bin Gheshayan), King Saud bin Abdulaziz University for Health Sciences; from the Research Unit (Almutairi), College of Applied Medical Science, King Saud bin Abdulaziz University for Health Sciences; from the College of Medicine (Alhassan), King Saud University Medical City; from the Department of Surgery (Alselaim, Almutairi, Bin Gheshayan), King Abdullah International Medical Research Center; from the Department of General Surgery (Alselaim, Bin Gheshayan), Ministry of National Guard- Health Affairs; from College of Medicine (Almomen), Imam Mohammad Ibn Saud Islamic University, Riyadh; and from College of Medicine, King Khalid University, Abha, Kingdom of Saudi Arabia (Alhussain, Alsubaie).
| | - Abrar M. Almutairi
- From College of Medicine (Alselaim, Altoub, Bin Gheshayan), King Saud bin Abdulaziz University for Health Sciences; from the Research Unit (Almutairi), College of Applied Medical Science, King Saud bin Abdulaziz University for Health Sciences; from the College of Medicine (Alhassan), King Saud University Medical City; from the Department of Surgery (Alselaim, Almutairi, Bin Gheshayan), King Abdullah International Medical Research Center; from the Department of General Surgery (Alselaim, Bin Gheshayan), Ministry of National Guard- Health Affairs; from College of Medicine (Almomen), Imam Mohammad Ibn Saud Islamic University, Riyadh; and from College of Medicine, King Khalid University, Abha, Kingdom of Saudi Arabia (Alhussain, Alsubaie).
| | - Sultanah F. Bin Gheshayan
- From College of Medicine (Alselaim, Altoub, Bin Gheshayan), King Saud bin Abdulaziz University for Health Sciences; from the Research Unit (Almutairi), College of Applied Medical Science, King Saud bin Abdulaziz University for Health Sciences; from the College of Medicine (Alhassan), King Saud University Medical City; from the Department of Surgery (Alselaim, Almutairi, Bin Gheshayan), King Abdullah International Medical Research Center; from the Department of General Surgery (Alselaim, Bin Gheshayan), Ministry of National Guard- Health Affairs; from College of Medicine (Almomen), Imam Mohammad Ibn Saud Islamic University, Riyadh; and from College of Medicine, King Khalid University, Abha, Kingdom of Saudi Arabia (Alhussain, Alsubaie).
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Chen YC, Tsai YY, Chang SC, Chen HC, Ke TW, Fingerhut A, Chen WTL. Laparoscopic versus open emergent colectomy for ischemic colitis: a propensity score-matched comparison. World J Emerg Surg 2022; 17:53. [PMID: 36229844 PMCID: PMC9563494 DOI: 10.1186/s13017-022-00458-4] [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: 06/09/2022] [Accepted: 10/06/2022] [Indexed: 11/29/2022] Open
Abstract
Introduction Laparoscopic colectomy is rarely performed for ischemic colitis. The aim of this propensity score-matched study was to compare preoperative characteristics, intraoperative details and short-term outcomes for emergent laparoscopic colectomy versus the traditional open approach for patients with ischemic colitis.
Methods Retrospective review of 96 patients who underwent emergent colectomy for ischemic colitis between January 2011 and December 2020 (39 via laparoscopy, 57 via laparotomy) was performed. We compared short-term outcomes after using a one-to-one ratio and nearest-neighbor propensity score matching to obtain similar preoperative and intraoperative parameters in each group. Results Patients in the open group experienced more surgical site complications (52.6% vs. 23.0%, p = 0.004), more intra-abdominal abscesses (47.3% vs. 17.9%, p = 0.003), longer need for ventilator support (20 days vs. 0 days, p < 0.001), more major complications (77.2% vs. 43.5%, p = 0.001), higher mortality (49.1% vs. 20.5%, p = 0.004), and longer hospital stay (32 days vs. 19 days, p = 0.001). After propensity score matching (31 patients in each group), patients undergoing open (vs. laparoscopy) had more surgical site complications (45.1% vs. 19.4%, p = 0.030) and required longer ventilator support (14 vs. 3 days, p = 0.039). After multivariate analysis, Charlson Comorbidity Index (p = 0.024), APACHE II score (p = 0.001), and Favier’s classification (p = 0.023) were independent predictors of mortality. Conclusions Laparoscopic emergent colectomy for ischemic colitis is feasible and is associated with fewer surgical site complications and better respiratory function, compared to the open approach.
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Affiliation(s)
- Yi-Chang Chen
- Institute of Medicine, Chung Shan Medical University, Taichung, Taiwan, ROC.,Department of Colorectal Surgery, China Medical University Hospital, Taichung, Taiwan, ROC
| | - Yuan-Yao Tsai
- Department of Colorectal Surgery, China Medical University Hospital, Taichung, Taiwan, ROC
| | - Sheng-Chi Chang
- Department of Colorectal Surgery, China Medical University Hospital, Taichung, Taiwan, ROC
| | - Hung-Chang Chen
- Department of Colorectal Surgery, China Medical University Hospital, Taichung, Taiwan, ROC
| | - Tao-Wei Ke
- Department of Colorectal Surgery, China Medical University Hospital, Taichung, Taiwan, ROC
| | - Abe Fingerhut
- Department of General Surgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.,Section for Surgical Research, Department of Surgery, Medical University of Graz, Graz, Austria
| | - William Tzu-Liang Chen
- Department of Colorectal Surgery, China Medical University Hsinchu Hospital, No. 199, Sec.1, Xinglong RD, Zhubei City, 30272, Hsinchu County, Taiwan, ROC.
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Schwartzberg DM, Valente MA. Surgical Dilemmas Associated with Malignant Large Bowel Obstructions. Clin Colon Rectal Surg 2022; 35:197-203. [PMID: 35966387 PMCID: PMC9374526 DOI: 10.1055/s-0042-1742589] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/27/2023]
Abstract
Despite an increase in screening colonoscopy, with the objective to decrease the incidence of colorectal cancer, a third of patients will present with an obstructing cancer. Malignant large bowel obstructions (MLBO) pose a challenging workup and treatment paradigm where an oncologic primary tumor resection must be balanced with relieving the obstruction, functional outcomes, palliation, and consideration for adjuvant therapy. A thorough work up with cross-sectional imaging and medical optimization should be attempted; however, patients may present in extremis and require emergent intervention. The onset of MLBO can be insidious, but result in electrolyte derangements, perforation, small bowel obstruction, hemorrhage, and ischemia. Self-expandable metallic stents have been used as palliation or as a bridge to surgery and have allowed for minimally invasive surgical options as well as a decrease in stoma rates. Patients with signs of colon ischemia or perforation require emergent surgery, which is associated with an increase in stoma formation, morbidity, mortality, and a decrease in overall survival.
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Affiliation(s)
- David M. Schwartzberg
- Mather Colorectal Surgery, Mather Hospital-Northwell Health, Port Jefferson, New York
| | - Michael A. Valente
- Department of Colorectal Surgery, Cleveland Clinic Foundation, Cleveland, Ohio,Address for correspondence Michael A. Valente, DO, FACS, FASCRS Department of Colorectal Surgery, Digestive Disease Institute9500 Euclid Avenue, A30, Cleveland, OH 44195
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9
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Warps ALK, Zwanenburg ES, Dekker JWT, Tollenaar RAEM, Bemelman WA, Hompes R, Tanis PJ, de Groof EJ. Laparoscopic Versus Open Colorectal Surgery in the Emergency Setting: A Systematic Review and Meta-analysis. ANNALS OF SURGERY OPEN 2021; 2:e097. [PMID: 37635817 PMCID: PMC10455067 DOI: 10.1097/as9.0000000000000097] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2021] [Accepted: 08/19/2021] [Indexed: 11/26/2022] Open
Abstract
Objective This systematic review and meta-analysis aimed to compare published outcomes of patients undergoing laparoscopic versus open emergency colorectal surgery, with mortality as primary outcome. Background In contrast to the elective setting, the value of laparoscopic emergency colorectal surgery remains unclear. Methods PubMed, Embase, the Cochrane Library, and CINAHL were searched until January 6, 2021. Only comparative studies were included. Meta-analyses were performed using a random-effect model. The Cochrane Risk of Bias Tool and the Newcastle-Ottawa Scale were used for quality assessment. Results Overall, 28 observational studies and 1 randomized controlled trial were included, comprising 7865 laparoscopy patients and 55,862 open surgery patients. Quality assessment revealed 'good quality' in 16 of 28 observational studies, and low to intermediate risk of bias for the randomized trial. Laparoscopy was associated with significantly lower postoperative mortality compared to open surgery (odds ratio [OR] 0.44; 95% confidence interval [CI], 0.35-0.54). Laparoscopy resulted in significantly less postoperative overall morbidity (OR, 0.53; 95% CI, 0.43-0.65), wound infection (OR, 0.63; 95% CI, 0.45-0.88), wound dehiscence (OR, 0.37; 95% CI, 0.18-0.77), ileus (OR, 0.68; 95% CI 0.51-0.91), pulmonary (OR, 0.43; 95% CI, 0.24-0.78) and cardiac complications (OR, 0.56; 95% CI, 0.35-0.90), and shorter length of stay. No meta-analyses were performed for long-term outcomes due to scarcity of data. Conclusions The systematic review and meta-analysis suggest a benefit of laparoscopy for emergency colorectal surgery, with a lower risk of postoperative mortality and morbidity. However, the almost exclusive use of retrospective observational study designs with inherent biases should be taken into account.
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Affiliation(s)
- Anne-Loes K Warps
- From the Department of Surgery, Amsterdam University Medical Centers, University of Amsterdam, Cancer Center Amsterdam, Meibergdreef, Amsterdam, The Netherlands
- Department of Surgery, Leiden University Medical Center, Albinusdreef, Leiden, The Netherlands
- Dutch ColoRectal Audit (DCRA), Dutch Institute for Clinical Auditing, Rijnsburgerweg, Leiden, The Netherlands
| | - Emma S Zwanenburg
- From the Department of Surgery, Amsterdam University Medical Centers, University of Amsterdam, Cancer Center Amsterdam, Meibergdreef, Amsterdam, The Netherlands
| | - Jan Willem T Dekker
- Department of Surgery, Reinier de Graaf Groep, Reinier de Graafweg, Delft, The Netherlands
| | - Rob A E M Tollenaar
- Department of Surgery, Leiden University Medical Center, Albinusdreef, Leiden, The Netherlands
- Dutch ColoRectal Audit (DCRA), Dutch Institute for Clinical Auditing, Rijnsburgerweg, Leiden, The Netherlands
| | - Willem A Bemelman
- From the Department of Surgery, Amsterdam University Medical Centers, University of Amsterdam, Cancer Center Amsterdam, Meibergdreef, Amsterdam, The Netherlands
| | - Roel Hompes
- From the Department of Surgery, Amsterdam University Medical Centers, University of Amsterdam, Cancer Center Amsterdam, Meibergdreef, Amsterdam, The Netherlands
| | - Pieter J Tanis
- Department of Surgery, Amsterdam University Medical Centers, University of Amsterdam, Cancer Center Amsterdam, de Boelelaan, Amsterdam, The Netherlands
| | - Elisabeth J de Groof
- From the Department of Surgery, Amsterdam University Medical Centers, University of Amsterdam, Cancer Center Amsterdam, Meibergdreef, Amsterdam, The Netherlands
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10
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Nguyen HV, Nguyen DT, Nguyen AT, Phan NT. Laparoscopic two-stage operation for obstructive left-sided colorectal cancer: A case report. INTERNATIONAL JOURNAL OF SURGERY OPEN 2021. [DOI: 10.1016/j.ijso.2021.100387] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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11
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Linderman GC, Lin W, Sanghvi MR, Becher RD, Maung AA, Bhattacharya B, Davis KA, Schuster KM. Improved outcomes using laparoscopy for emergency colectomy after mitigating bias by negative control exposure analysis. Surgery 2021; 171:305-311. [PMID: 34332782 DOI: 10.1016/j.surg.2021.06.048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2021] [Revised: 06/11/2021] [Accepted: 06/29/2021] [Indexed: 02/07/2023]
Abstract
BACKGROUND Laparoscopy is superior to open surgery for elective colectomy, but its role in emergency colectomy remains unclear. Previous studies were small and limited by confounding because surgeons may have selected lower-risk patients for laparoscopy. We therefore studied the effect of attempting laparoscopy for emergency colectomies while adjusting for confounding using multiple techniques in a large, nationwide registry. METHODS Using National Surgical Quality Improvement Program data, we identified emergency colectomy cases from 2014 to 2018. We first compared outcomes between patients who underwent laparoscopic versus open surgery, while adjusting for baseline variables using both propensity scores and regression. Next, we performed a negative control exposure analysis. By assuming that the group that converted to open did not benefit from the attempt at laparoscopy, we used the observed benefit to bound the effect of unmeasured confounding. RESULTS Of 21,453 patients meeting criteria, 3,867 underwent laparoscopy, of which 1,375 converted to open. In both inverse probability of treatment weighting and regression analyses, attempting laparoscopy was associated with improved 30-day mortality, overall morbidity, anastomotic leak, surgical site infection, postoperative septic shock, and length of hospital stay compared with open surgery. These effects were consistent with the lower bounds computed from the converted group. CONCLUSION Laparoscopic surgery for colorectal emergencies appears to improve outcomes compared with open surgery. The benefit is observed even after adjusting for both measured and unmeasured confounding using multiple statistical approaches, thus suggesting a benefit not attributable to patient selection.
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Affiliation(s)
- George C Linderman
- Department of Surgery, Yale School of Medicine, New Haven, CT; Applied Mathematics Program, Department of Mathematics, Yale University, New Haven, CT. https://twitter.com/GCLinderman
| | - Winston Lin
- Department of Statistics and Data Science, Yale University, New Haven, CT
| | - Mansi R Sanghvi
- Department of Surgery, Yale School of Medicine, New Haven, CT
| | - Robert D Becher
- Department of Surgery, Yale School of Medicine, New Haven, CT
| | - Adrian A Maung
- Department of Surgery, Yale School of Medicine, New Haven, CT
| | | | - Kimberly A Davis
- Department of Surgery, Yale School of Medicine, New Haven, CT. https://twitter.com/kadtraumamd
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12
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Reinke CE, Lim RB. Minimally invasive acute care surgery. Curr Probl Surg 2021; 59:101031. [PMID: 35227422 DOI: 10.1016/j.cpsurg.2021.101031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2021] [Accepted: 05/16/2021] [Indexed: 12/07/2022]
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13
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Reinke CE, Lim RB. Minimally Invasive Acute Care Surgery. Curr Probl Surg 2021. [DOI: 10.1016/j.cpsurg.2021.101033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/07/2022]
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14
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Harji DP, Marshall H, Gordon K, Twiddy M, Pullan A, Meads D, Croft J, Burke D, Griffiths B, Verjee A, Sagar P, Stocken D, Brown J. Laparoscopic versus open colorectal surgery in the acute setting (LaCeS trial): a multicentre randomized feasibility trial. Br J Surg 2020; 107:1595-1604. [PMID: 32573782 DOI: 10.1002/bjs.11703] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2020] [Revised: 03/11/2020] [Accepted: 04/22/2020] [Indexed: 12/12/2022]
Abstract
BACKGROUND Approximately 30 000 people undergo major emergency abdominal gastrointestinal surgery annually, and 36 per cent of these procedures (around 10 800) are carried out for emergency colorectal pathology. Some 14 per cent of all patients requiring emergency surgery have a laparoscopic procedure. The aims of the LaCeS (laparoscopic versus open colorectal surgery in the acute setting) feasibility trial were to assess the feasibility, safety and acceptability of performing a large-scale definitive phase III RCT, with a comparison of emergency laparoscopic versus open surgery for acute colorectal pathology. METHODS LaCeS was designed as a prospective, multicentre, single-blind, parallel-group, pragmatic feasibility RCT with an integrated qualitative study. Randomization was undertaken centrally, with patients randomized on a 1 : 1 basis between laparoscopic or open surgery. RESULTS A total of 64 patients were recruited across five centres. The overall mean steady-state recruitment rate was 1·2 patients per month per site. Baseline compliance for clinical and health-related quality-of-life data was 99·8 and 93·8 per cent respectively. The conversion rate from laparoscopic to open surgery was 39 (95 per cent c.i. 23 to 58) per cent. The 30-day postoperative complication rate was 27 (13 to 46) per cent in the laparoscopic arm and 42 (25 to 61) per cent in the open arm. CONCLUSION Laparoscopic emergency colorectal surgery may have an acceptable safety profile. Registration number: ISRCTN15681041 ( http://www.controlled-trials.com).
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Affiliation(s)
- D P Harji
- Department of Colorectal Surgery, Royal Victoria Infirmary, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | - H Marshall
- Clinical Trials Research Unit, Leeds, UK
| | - K Gordon
- Clinical Trials Research Unit, Leeds, UK
| | - M Twiddy
- Institute of Clinical and Applied Health Research, University of Hull, Hull, UK
| | - A Pullan
- Clinical Trials Research Unit, Leeds, UK
| | - D Meads
- Leeds Institute of Health Sciences, University of Leeds, Leeds, UK
| | - J Croft
- Clinical Trials Research Unit, Leeds, UK
| | - D Burke
- Department of Colorectal Surgery, St James's University Hospital, Leeds, UK
| | - B Griffiths
- Department of Colorectal Surgery, Royal Victoria Infirmary, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | - A Verjee
- Patient and Public Involvement Representative for LaCeS Trial, UK
| | - P Sagar
- Department of Colorectal Surgery, St James's University Hospital, Leeds, UK
| | - D Stocken
- Clinical Trials Research Unit, Leeds, UK
| | - J Brown
- Clinical Trials Research Unit, Leeds, UK
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15
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Role and Outcome of Laparoscopic/Minimally Invasive Surgery for Variety of Colorectal Emergencies. Surg Laparosc Endosc Percutan Tech 2020; 30:451-453. [PMID: 32496346 DOI: 10.1097/sle.0000000000000812] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Recently, the laparoscopic or minimally invasive approach has become common practice for planned colorectal malignancies. Its use in the emergency setting is limited by various factors, including resource availability and surgical expertise. However, more recent evidence suggests a laparoscopic approach to colorectal emergencies, which is comparable with laparoscopic routine work, and often promising. In this study, authors have investigated the outcome of the laparoscopic approach in both benign and malignant colorectal emergencies. METHOD Retrospective analysis of prospectively collected data (theater records, histology database, and discharge records) over the course of 9 years. The standard surgical approach included conventional laparoscopic and single-port technique (single-incision laparoscopic surgery). The outcome variables included in the final analysis were: success of the minimally invasive approach, conversion rate, postoperative complications, return to theater, and mortality. RESULTS A total of 202 (males, 110 and females, 92) emergency patients with a median age of 59 years underwent surgery between December 2009 and 2019. The mean operating time was 169 minutes and median American Society of Anesthesiology grade III. Single-incision laparoscopic surgery was used in 19 patients (9.4%). The conversion to open surgery was 12.3% (n=25). The majority of them had primary anastomosis (n= 132, 65.3%).The complications from most to least frequent were: CONCLUSION:: The favorable results obtained in this study underline the theme that with the availability of resources and expertise, it is possible to offer minimal invasive approach to emergency colonic pathology.
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16
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Tebala GD, Mingoli A, Natili A, Khan AQ, Brachini G. Surgical Risk and Pathological Results of Emergency Resection in the Treatment of Acutely Obstructing Colorectal Cancers: A Retrospective Cohort Study. Ann Coloproctol 2020; 37:21-28. [PMID: 32178504 PMCID: PMC7989555 DOI: 10.3393/ac.2019.03.10.1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/02/2019] [Accepted: 03/10/2019] [Indexed: 12/13/2022] Open
Abstract
Purpose The treatment of acutely obstructing colorectal cancers is still a matter of debate. The prevailing opinion is that an immediate resection should be performed whenever possible. This study sought to determine whether immediate resection is safe and oncologically valid. Methods We completed a retrospective 2-center cohort study using the medical records of patients admitted for acutely obstructing colorectal cancer under the care of the Colorectal Team, Noble’s Hospital, Isle of Man, and the Emergency Surgery Unit, Umberto I University Hospital, Rome, from March 2013 to May 2017. The primary endpoints were 90-day mortality and morbidity, reoperation rate, and length of stay. The secondary endpoints were status of margins, number of lymph nodes retrieved, and the rate of adequate nodal harvest. Results Sixty-three patients were retrospectively enrolled in the study. Mortality was associated with age > 80 years and Dukes B tumors. The length of hospital stay was shorter in patients who had their resection less than 24 hours from their admission, in those who had laparoscopic resection and in those with distal tumors. The number of lymph nodes retrieved and rate of R0 resections were similar to those reported in elective colorectal surgery and were greater in laparoscopic resections and in patients operated on within 24 hours, respectively. Conclusion Immediate resection is a safe and reliable option in patients with acutely obstructing colorectal cancer.
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Affiliation(s)
- Giovanni Domenico Tebala
- Colorectal Team, Noble's Hospital, Isle of Man, British Isles.,Surgical Emergency Unit, John Radcliffe Hospital, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Andrea Mingoli
- Emergency Surgery Unit, "P. Valdoni" Department of Surgery, Umberto I University Hospital, Rome, Italy
| | - Andrea Natili
- Colorectal Team, Noble's Hospital, Isle of Man, British Isles.,Emergency Surgery Unit, "P. Valdoni" Department of Surgery, Umberto I University Hospital, Rome, Italy.,General and Transplantation Surgery Unit, S. Salvatore Regional Hospital, L'Aquila, Italy
| | | | - Gioia Brachini
- Emergency Surgery Unit, "P. Valdoni" Department of Surgery, Umberto I University Hospital, Rome, Italy
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17
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Abstract
BACKGROUND Acute diverticulitis is a common disease with public health significance. Many studies with a high level of evidence have been published recently on the surgical management of acute diverticulitis. OBJECTIVE The aim of this systematic review was to define the accurate surgical management of acute diverticulitis. DATA SOURCES Medline, Embase, and the Cochrane Library were sources used. STUDY SELECTION One reviewer conducted a systematic study with combinations of key words for the disease and the surgical procedure. Additional studies were searched in the reference lists of all included articles. The results of the systematic review were submitted to a working group composed of 13 practitioners. All of the conclusions were obtained by full consensus and validated by an external committee. INTERVENTIONS The interventions assessed were laparoscopic peritoneal lavage, primary resection with anastomosis with or without ileostomy, and the Hartmann procedure, with either a laparoscopic or an open approach. MAIN OUTCOME MEASURES Morbidity, mortality, long-term stoma rates, and quality of life were measured. RESULTS Seventy-one articles were included. Five guidelines were retrieved, along with 4 meta-analyses, 14 systematic reviews, and 5 randomized controlled trials that generated 8 publications, all with a low risk of bias, except for blinding. Laparoscopic peritoneal lavage showed concerning results of deep abscesses and unplanned reoperations. Studies on Hinchey III/IV diverticulitis showed similar morbidity and mortality. A reduced length of stay with Hartmann procedure compared with primary resection with anastomosis was reported in the short term, and in the long term, more definite stoma along with poorer quality of life was reported with Hartmann procedure. No high-quality data were found to support the laparoscopic approach. LIMITATIONS Trials specifically assessing Hinchey IV diverticulitis have not yet been completed. CONCLUSIONS High-quality studies showed that laparoscopic peritoneal lavage was associated with an increased morbidity and that Hartmann procedure was associated with poorer long-term outcomes than primary resection with anastomosis with ileostomy, but Hartmann procedure is still acceptable, especially in high-risk patients.
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18
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Role of Emergency Laparoscopic Colectomy for Colorectal Cancer: A Population-based Study in England. Ann Surg 2020; 270:172-179. [PMID: 29621034 DOI: 10.1097/sla.0000000000002752] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
OBJECTIVE To evaluate factors associated with the use of laparoscopic surgery and the associated postoperative outcomes for urgent or emergency resection of colorectal cancer in the English National Health Service. SUMMARY OF BACKGROUND DATA Laparoscopy is increasingly used for elective colorectal cancer surgery, but uptake has been limited in the emergency setting. METHODS Patients recorded in the National Bowel Cancer Audit who underwent urgent or emergency colorectal cancer resection between April 2010 and March 2016 were included. A multivariable multilevel logistic regression model was used to estimate odds ratios (ORs) of undergoing laparoscopic resection and postoperative outcome according to approach. RESULTS There were 15,516 patients included. Laparoscopy use doubled from 15.1% in 2010 to 30.2% in 2016. Laparoscopy was less common in patients with poorer physical status [American Society of Anaesthesiologists (ASA) 4/5 vs 1, OR 0.29 (95% confidence interval, 95% CI 0.23-0.37), P < 0.001] and more advanced T-stage [T4 vs T0-T2, OR 0.28 (0.23-0.34), P < 0.001] and M-stage [M1 vs M0, OR 0.85 (0.75-0.96), P < 0.001]. Age, socioeconomic deprivation, nodal stage, hospital volume, and a dedicated colorectal emergency service were not associated with laparoscopy. Laparoscopic patients had a shorter length of stay [median 8 days (interquartile range (IQR) 5 to 15) vs 12 (IQR 8 to 21), adjusted mean difference -3.67 (-4.60 to 2.74), P < 0.001], and lower 90-day mortality [8.1% vs 13.0%; adjusted OR 0.78 (0.66-0.91), P = 0.004] than patients undergoing open resection. There was no significant difference in rates of readmission or reoperation by approach. CONCLUSION The use of laparoscopic approach in the emergency resection of colorectal cancer is linked to a shorter length of hospital stay and reduced postoperative mortality.
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19
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Dreifuss NH, Schlottmann F, Piatti JM, Bun ME, Rotholtz NA. Safety and feasibility of laparoscopic sigmoid resection without diversion in perforated diverticulitis. Surg Endosc 2019; 34:1336-1342. [PMID: 31209604 DOI: 10.1007/s00464-019-06910-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2019] [Accepted: 06/11/2019] [Indexed: 12/15/2022]
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20
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Pisano M, Zorcolo L, Merli C, Cimbanassi S, Poiasina E, Ceresoli M, Agresta F, Allievi N, Bellanova G, Coccolini F, Coy C, Fugazzola P, Martinez CA, Montori G, Paolillo C, Penachim TJ, Pereira B, Reis T, Restivo A, Rezende-Neto J, Sartelli M, Valentino M, Abu-Zidan FM, Ashkenazi I, Bala M, Chiara O, De' Angelis N, Deidda S, De Simone B, Di Saverio S, Finotti E, Kenji I, Moore E, Wexner S, Biffl W, Coimbra R, Guttadauro A, Leppäniemi A, Maier R, Magnone S, Mefire AC, Peitzmann A, Sakakushev B, Sugrue M, Viale P, Weber D, Kashuk J, Fraga GP, Kluger I, Catena F, Ansaloni L. 2017 WSES guidelines on colon and rectal cancer emergencies: obstruction and perforation. World J Emerg Surg 2018; 13:36. [PMID: 30123315 PMCID: PMC6090779 DOI: 10.1186/s13017-018-0192-3] [Citation(s) in RCA: 175] [Impact Index Per Article: 25.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2018] [Accepted: 06/28/2018] [Indexed: 02/07/2023] Open
Abstract
ᅟ Obstruction and perforation due to colorectal cancer represent challenging matters in terms of diagnosis, life-saving strategies, obstruction resolution and oncologic challenge. The aims of the current paper are to update the previous WSES guidelines for the management of large bowel perforation and obstructive left colon carcinoma (OLCC) and to develop new guidelines on obstructive right colon carcinoma (ORCC). Methods The literature was extensively queried for focused publication until December 2017. Precise analysis and grading of the literature has been performed by a working group formed by a pool of experts: the statements and literature review were presented, discussed and voted at the Consensus Conference of the 4th Congress of the World Society of Emergency Surgery (WSES) held in Campinas in May 2017. Results CT scan is the best imaging technique to evaluate large bowel obstruction and perforation. For OLCC, self-expandable metallic stent (SEMS), when available, offers interesting advantages as compared to emergency surgery; however, the positioning of SEMS for surgically treatable causes carries some long-term oncologic disadvantages, which are still under analysis. In the context of emergency surgery, resection and primary anastomosis (RPA) is preferable to Hartmann’s procedure, whenever the characteristics of the patient and the surgeon are permissive. Right-sided loop colostomy is preferable in rectal cancer, when preoperative therapies are predicted. With regards to the treatment of ORCC, right colectomy represents the procedure of choice; alternatives, such as internal bypass and loop ileostomy, are of limited value. Clinical scenarios in the case of perforation might be dramatic, especially in case of free faecal peritonitis. The importance of an appropriate balance between life-saving surgical procedures and respect of oncologic caveats must be stressed. In selected cases, a damage control approach may be required. Medical treatments including appropriate fluid resuscitation, early antibiotic treatment and management of co-existing medical conditions according to international guidelines must be delivered to all patients at presentation. Conclusions The current guidelines offer an extensive overview of available evidence and a qualitative consensus regarding management of large bowel obstruction and perforation due to colorectal cancer.
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Affiliation(s)
- Michele Pisano
- General Surgery Papa Giovanni XXII Hospital Bergamo, Bergamo, Italy
| | - Luigi Zorcolo
- 2Colorectal Unit, Department of Surgery, University of Cagliari, Cagliari, Italy
| | - Cecilia Merli
- Unit of Emergency Medicine Ospedale Bufalini Cesena, AUSL Romagna, Romagna, Italy
| | | | - Elia Poiasina
- General Surgery Papa Giovanni XXII Hospital Bergamo, Bergamo, Italy
| | - Marco Ceresoli
- 5Department of General Surgery, School of Medicine, University of Milano, Milan, Italy
| | | | - Niccolò Allievi
- General Surgery Papa Giovanni XXII Hospital Bergamo, Bergamo, Italy
| | | | - Federico Coccolini
- Unit of General and Emergency Surgery, Ospedale Bufalini Cesena, AUSL Romagna, Romagna, Italy
| | - Claudio Coy
- 9Colorectal Unit, Campinas State University, Campinas, SP Brazil
| | - Paola Fugazzola
- General Surgery Papa Giovanni XXII Hospital Bergamo, Bergamo, Italy
| | | | | | - Ciro Paolillo
- Emergency Department Udine Healthcare and University Integrated Trust, Udine, Italy
| | | | - Bruno Pereira
- 14Department of Surgery, University of Campinas, Campinas, Brazil
| | - Tarcisio Reis
- Oncology Surgery and Intensive Care, Oswaldo Cruz Hospital, Recife, Brazil
| | - Angelo Restivo
- 2Colorectal Unit, Department of Surgery, University of Cagliari, Cagliari, Italy
| | - Joao Rezende-Neto
- 16Department of Surgery Division of General Surgery, University of Toronto, Toronto, Canada
| | | | - Massimo Valentino
- 18Radiology Unit Emergency Department, S. Antonio Abate Hospital, Tolmezzo, UD Italy
| | - Fikri M Abu-Zidan
- 19Department of Surgery, College of Medicine and Health Sciences, UAE University, Al-Ain, United Arab Emirates
| | | | - Miklosh Bala
- 21Trauma and Acute Care Surgery Unit Hadassah, Hebrew University Medical Center, Jerusalem, Israel
| | | | - Nicola De' Angelis
- 22Unit of Digestive Surgery, HPB Surgery and Liver Transplant Henri Mondor Hospital, Créteil, France
| | - Simona Deidda
- 2Colorectal Unit, Department of Surgery, University of Cagliari, Cagliari, Italy
| | - Belinda De Simone
- Department of General and Emergency Surgery Cannes' Hospital Cannes, Cedex, Cannes, France
| | | | - Elena Finotti
- Department of General Surgery ULSS5 del Veneto, Adria, (RO) Italy
| | - Inaba Kenji
- 25Division of Trauma & Critical Care University of Southern California, Los Angeles, USA
| | - Ernest Moore
- 26Department of Surgery, Denver Health Medical Center, University of Colorado, Denver, CO USA
| | - Steven Wexner
- Digestive Disease Center, Department of Colorectal Surgery Cleveland Clinic Florida, Tallahassee, USA
| | - Walter Biffl
- 28Acute Care Surgery The Queen's Medical Center, Honolulu, HI USA
| | - Raul Coimbra
- 29Division of Trauma, Surgical Critical Care, Burns, and Acute Care Surgery, University of California San Diego Health Sciences, San Diego, USA
| | - Angelo Guttadauro
- 5Department of General Surgery, School of Medicine, University of Milano, Milan, Italy
| | - Ari Leppäniemi
- Second Department of Surgery, Meilahti Hospital, Helsinki, Finland
| | - Ron Maier
- Department of Surgery, Harborview Medical Centre, Seattle, USA
| | - Stefano Magnone
- General Surgery Papa Giovanni XXII Hospital Bergamo, Bergamo, Italy
| | - Alain Chicom Mefire
- 32Department of Surgery and Obs/Gyn, Faculty of Health Sciences, University of Buea, Buea, Cameroon
| | - Andrew Peitzmann
- 33Department of Surgery, Trauma and Surgical Services, University of Pittsburgh School of Medicine, Pittsburgh, USA
| | - Boris Sakakushev
- 34General Surgery Department, Medical University, University Hospital St George, Plovdiv, Bulgaria
| | - Michael Sugrue
- General Surgery Department, Letterkenny Hospital, Letterkenny, Ireland
| | - Pierluigi Viale
- Infectious Diseases Unit, Department of Medical and Surgical Sciences, Sant'Orsola Hospital, University of Bologna, Bologna, Italy
| | - Dieter Weber
- 37Trauma and General Surgeon, Royal Perth Hospital, Perth, Australia
| | - Jeffry Kashuk
- 38Surgery and Critical Care Assuta Medical Centers, Tel Aviv, Israel
| | - Gustavo P Fraga
- 39Division of Trauma Surgery, Department of Surgery, School of Medical Sciences, University of Campinas (Unicamp), Campinas, SP Brazil
| | - Ioran Kluger
- 40Department of General Surgery, Division of Surgery, Rambam Health Care Campus, Haifa, Israel
| | - Fausto Catena
- Department of Emergency Surgery, Parma Maggiore Hospital, Parma, Italy
| | - Luca Ansaloni
- Unit of General and Emergency Surgery, Ospedale Bufalini Cesena, AUSL Romagna, Romagna, Italy
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21
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Keller DS, Boulton R, Rodriguez-Justo M, Cohen R, Chand M. A Novel Application of Indocyanine Green Immunofluorescence in Emergent Colorectal Surgery. J Fluoresc 2018; 28:487-490. [PMID: 29700776 DOI: 10.1007/s10895-018-2230-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2018] [Accepted: 04/11/2018] [Indexed: 01/06/2023]
Abstract
Here, we report on the feasibility of ICG fluorescence imaging to localize lesions in emergent minimally invasive surgery. A 49-year old female presented to the emergency department with a previously unknown malignant bowel obstruction. She was taken emergently to the operating room for a laparoscopic extended right hemicolectomy, based on tumor location from imaging. With intraoperative difficulty localizing the lesion, an on-table colonoscopy was performed. When the tumor was encountered, peritumoral ICG injections were performed, and the fluorescence lymphoscintigraphy was performed intraoperatively in an attempt to visualize the primary tumor laparoscopically. Intraoperative ICG Immunofluorescence allowed precise, real-time localization of the mass in the descending colon. This information changed the course of the operation, as a laparoscopic left hemicolectomy was then performed instead of the planned extended right hemicolectomy. The patient underwent an end-to-end anastomosis without the need for a defunctioning ileostomy. From this case, we demonstrate the use of ICG fluorescence imaging for tumor localization in the emergent setting is safe, feasible, and effective. This information gained from this technology enables real-time decision making, and can even change the operative plan in the emergent setting for the best patient outcomes. What does this paper add to the existing literature? This paper offers a novel application of an emerging technology- ICG fluorescence- that in this capacity allowed precise, real-time localization of a previously unknown mass in the emergent setting, and changed the course of the operation.
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Affiliation(s)
- Deborah S Keller
- Department of Surgery and Interventional Sciences, University College London Hospitals, 235 Euston Rd, London, NW1 2BU, UK. .,NHS Trusts, GENIE Centre, University College London, 235 Euston Rd, London, NW1 2BU, UK.
| | - Richard Boulton
- Department of Surgery and Interventional Sciences, University College London Hospitals, 235 Euston Rd, London, NW1 2BU, UK
| | | | - Richard Cohen
- Department of Surgery and Interventional Sciences, University College London Hospitals, 235 Euston Rd, London, NW1 2BU, UK
| | - Manish Chand
- Department of Surgery and Interventional Sciences, University College London Hospitals, 235 Euston Rd, London, NW1 2BU, UK.,NHS Trusts, GENIE Centre, University College London, 235 Euston Rd, London, NW1 2BU, UK
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22
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Tebala GD, Natili A, Gallucci A, Brachini G, Khan AQ, Tebala D, Mingoli A. Emergency treatment of complicated colorectal cancer. Cancer Manag Res 2018; 10:827-838. [PMID: 29719419 PMCID: PMC5916257 DOI: 10.2147/cmar.s158335] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
Abstract
Aim To find evidence to suggest the best approach in patients admitted as an emergency for complicated colorectal cancer. Methods The medical records of 131 patients admitted as an emergency with an obstructing, perforated, or bleeding colorectal cancer to Noble’s Hospital, Isle of Man, and the Umberto I University Hospital, Rome, were retrospectively evaluated. Patients were divided in 3 groups on the basis of the emergency treatment they received, namely 1) immediate resection, 2) damage control procedure and elective or semielective resection, and 3) no radical treatment. Demographic variables, clinical data, and treatment data were considered, and formed the basis for the comparison of groups. Primary endpoints were 90-day mortality and morbidity. Secondary endpoints were length of stay, number of lymph nodes analyzed, rate of radical R0 resections, and the number of patients who had chemoradiotherapy. Results Forty-two patients did not have any radical treatment because the cancer was too advanced or they were too ill to tolerate an operation, 78 patients had immediate resection and 11 had damage control followed by elective resection. There was no statistically significant difference between immediate resections and 2-stage treatment in 90-day mortality and morbidity (mortality: 15.4% vs 0%; morbidity: 26.9% vs 27.3%), number of nodes retrieved (16.6±9.4 vs 14.9±5.7), and rate of R0 resections (84.6% vs 90.9%), but mortality was slightly higher in patients who underwent immediate resection. The patients who underwent staged treatment had a higher possibility of receiving a laparoscopic resection (11.5% vs 36.4%). Conclusion The present study failed to demonstrate a clear superiority of one treatment with respect to the other, even if there is an interesting trend favoring staged resection.
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Affiliation(s)
| | - Andrea Natili
- Colorectal Team, Noble's Hospital, Strang, Douglas, Isle of Man, UK.,Emergency Surgery Unit, "P. Valdoni" Department of Surgery, "Umberto I" University Hospital, Rome, Italy
| | - Antonio Gallucci
- Colorectal Team, Noble's Hospital, Strang, Douglas, Isle of Man, UK
| | - Gioia Brachini
- Emergency Surgery Unit, "P. Valdoni" Department of Surgery, "Umberto I" University Hospital, Rome, Italy
| | | | | | - Andrea Mingoli
- Emergency Surgery Unit, "P. Valdoni" Department of Surgery, "Umberto I" University Hospital, Rome, Italy
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23
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Mentored Trainees have Similar Short-Term Outcomes to a Consultant Trainer Following Laparoscopic Colorectal Resection. World J Surg 2018; 41:1896-1902. [PMID: 28255631 DOI: 10.1007/s00268-017-3925-7] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
BACKGROUND Laparoscopic colorectal surgery has a long learning curve. Using a modular-based training programme may shorten this. Concerns with laparoscopic surgery have been oncological compromise and poor surgical outcomes when training more junior surgeons. This study aimed to compare operative and oncological outcomes between trainees undergoing a mentored training programme and a consultant trainer. METHODS A prospective study of all elective laparoscopic colorectal resections was undertaken in a single institution. Operative and oncological outcomes were recorded. All trainees were mentored by a National Laparoscopic Trainer (Lapco), and results between trainer and trainees compared. RESULTS Three hundred cases were included, with 198 (66%) performed for cancer. The trainer undertook 199 (66%) of operations, whilst trainees performed 101 (34%). Anterior resection was the commonest operation (n = 124, 41%). There were no differences between trainer and trainees for the majority of surgical outcomes, including blood loss (p = 0.598), conversion to open (p = 0.113), anastomotic leak (p = 0.263), readmission (p = 1.000) and death rates (p = 0.549). Only length of stay (p = 0.034), stoma formation (p < 0.01) and operative duration (p = 0.007) were higher in the trainer cohort, reflecting the more complex cases undertaken. Overall, there were no significant differences in both short- and longer-term oncology outcomes according to the grade of operating surgeon, including lymph nodes in specimen, circumferential resection margin and 1- and 2-year radiological recurrence. CONCLUSION When a modular-based training system was combined with case selection, both clinical and histopathological outcomes following resectional laparoscopic colorectal surgery were similar between trainees and trainer. This should encourage the use of more training opportunities in laparoscopic colorectal surgery.
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24
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Verzaro R, Mattia S, Rago T, Casella F, Ferroni A, Gianfreda V, Cofini V, Necozione S. Selection Bias in Colorectal Surgery in a Non-Tertiary Hospital: Laparoscopic Versus Open Surgery. J Laparoendosc Adv Surg Tech A 2017; 28:263-268. [PMID: 29206557 DOI: 10.1089/lap.2017.0174] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
Abstract
INTRODUCTION Laparoscopy is used increasingly to treat malignant and benign colorectal surgical diseases. However, this practice is still not offered to all patients. Many barriers halt the widespread use of laparoscopic colorectal surgery. Both surgeon's and patient's factors contribute to limit a wider use of laparoscopy in colorectal surgery. MATERIALS AND METHODS We retrospectively analyzed 408 consecutive colorectal resections in a 4-year period, to find out if a selection bias exists in using laparotomy or laparoscopy for colorectal surgical diseases, and which factors are associated with a poor use of laparoscopy or to a preferred laparotomy. RESULTS In our practice, advanced disease, American Society of Anesthesiologist class III and IV, and emergency status are all patient-related factors associated with laparotomy. Surgeon's age more than 52 years and lack of laparoscopic training are surgeon-related factors that negatively affect the chance of being operated on with the laparoscopic technique. CONCLUSIONS An extensive laparoscopic colorectal training and a supporting environment, especially during the night shift, are needed to facilitate the use of laparoscopy in colorectal surgery avoiding a bias in selecting surgical candidates to one technique or another.
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Affiliation(s)
- Roberto Verzaro
- 1 Department of General Surgery, Vannini Hospital in Rome, Rome, Italy
| | - Simona Mattia
- 1 Department of General Surgery, Vannini Hospital in Rome, Rome, Italy
| | - Teresa Rago
- 1 Department of General Surgery, Vannini Hospital in Rome, Rome, Italy
| | - Francesco Casella
- 1 Department of General Surgery, Vannini Hospital in Rome, Rome, Italy
| | - Andrea Ferroni
- 1 Department of General Surgery, Vannini Hospital in Rome, Rome, Italy
| | - Valeria Gianfreda
- 1 Department of General Surgery, Vannini Hospital in Rome, Rome, Italy
| | - Vincenza Cofini
- 2 Department of Life, Health and Environmental Science University of L'Aquila , L'Aquila, Italy
| | - Stefano Necozione
- 2 Department of Life, Health and Environmental Science University of L'Aquila , L'Aquila, Italy
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25
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Sujatha-bhaskar S, Alizadeh RF, Koh C, Inaba C, Jafari MD, Carmichael JC, Stamos MJ, Pigazzi A. The Growing Utilization of Laparoscopy in Emergent Colonic Disease. Am Surg 2017. [DOI: 10.1177/000313481708301011] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Emergent colonic disease has traditionally been managed with open procedures. Evaluation of recent trends suggests a shift toward minimally invasive techniques in this disease setting. The American College of Surgeons National Surgical Quality Improvement Program (NSQIP) targeted colectomy database from 2012 to 2014 was used to examine clinical data from patients who emergently underwent open colectomy (OC) and laparoscopic colectomy (LC). Multivariate regression was utilized to analyze preoperative characteristics and determine risk-adjusted outcomes with intent-to-treat and as-treated approach. Of 10,018 patients with emergent colonic operation, 90 per cent (9023) underwent OC whereas 10 per cent (995) underwent LC. Laparoscopic utilization increased annually, with LC composing 10.9 per cent of emergent colonic operations in 2014 compared with 9.3 per cent in 2012. Compared with LC, patients treated with OC had higher rates of overall morbidity (odds ratio 2.01, 95% confidence interval 1.74–2.34, P < 0.01) and 30-day mortality (odds ratio 1.79, 95% confidence interval 1.30–2.46, P < 0.01). Subset analysis of emergent patients without preoperative septic shock revealed consistent benefits with laparoscopy in overall morbidity, 30-day mortality, ileus, and surgical site infection. In select patients with hemodynamic stability, emergent LC appears to be a safe and beneficial operation. This study reflects the growing preference and utilization of minimally invasive techniques in emergent colonic operations.
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Affiliation(s)
- Sarath Sujatha-bhaskar
- Department of Surgery, University of California, Irvine School of Medicine, Irvine, California
| | - Reza F. Alizadeh
- Department of Surgery, University of California, Irvine School of Medicine, Irvine, California
| | - Christina Koh
- Department of Surgery, University of California, Irvine School of Medicine, Irvine, California
| | - Colette Inaba
- Department of Surgery, University of California, Irvine School of Medicine, Irvine, California
| | - Mehraneh D. Jafari
- Department of Surgery, University of California, Irvine School of Medicine, Irvine, California
| | - Joseph C. Carmichael
- Department of Surgery, University of California, Irvine School of Medicine, Irvine, California
| | - Michael J. Stamos
- Department of Surgery, University of California, Irvine School of Medicine, Irvine, California
| | - Alessio Pigazzi
- Department of Surgery, University of California, Irvine School of Medicine, Irvine, California
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26
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Birindelli A, Segalini E, Kwan S, Biscardi A, Tonini V, Di Saverio S. Challenging emergency laparoscopic right colectomy for completely obstructing caecal carcinoma - a video vignette. Colorectal Dis 2017; 19:504-506. [PMID: 28258638 DOI: 10.1111/codi.13645] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/31/2016] [Accepted: 01/04/2017] [Indexed: 02/05/2023]
Affiliation(s)
- A Birindelli
- Emergency and Trauma Surgery Unit, Maggiore Hospital Regional Emergency Surgery and Trauma Center - Bologna Local Health District, Bologna, Italy
| | - E Segalini
- Emergency and Trauma Surgery Unit, Maggiore Hospital Regional Emergency Surgery and Trauma Center - Bologna Local Health District, Bologna, Italy
| | - S Kwan
- University of Western Australia, Perth, Western Australia, Australia
| | - A Biscardi
- Emergency and Trauma Surgery Unit, Maggiore Hospital Regional Emergency Surgery and Trauma Center - Bologna Local Health District, Bologna, Italy
| | - V Tonini
- S. Orsola Malpighi University Hospital, University of Bologna, Bologna, Italy
| | - S Di Saverio
- Emergency and Trauma Surgery Unit, Maggiore Hospital Regional Emergency Surgery and Trauma Center - Bologna Local Health District, Bologna, Italy
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27
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Laparoscopic Approach in Colonic Diverticulitis: Dispelling Myths and Misperceptions. Surg Laparosc Endosc Percutan Tech 2017; 27:73-82. [PMID: 28212260 DOI: 10.1097/sle.0000000000000386] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
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28
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Xu Z, Becerra AZ, Aquina CT, Hensley BJ, Justiniano CF, Boodry C, Swanger AA, Arsalanizadeh R, Noyes K, Monson JR, Fleming FJ. Emergent Colectomy Is Independently Associated with Decreased Long-Term Overall Survival in Colon Cancer Patients. J Gastrointest Surg 2017; 21:543-553. [PMID: 28083841 DOI: 10.1007/s11605-017-3355-8] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2016] [Accepted: 01/01/2017] [Indexed: 01/31/2023]
Abstract
BACKGROUND The purpose of this study was to examine the long-term overall survival (OS) of colon cancer patients who underwent emergent resection versus patients who were resected electively. METHODS The 2006-2012 National Cancer Data Base was queried for colon cancer patients who underwent surgical resection. Emergent resection was defined as resection within 24 h of diagnosis. A mixed-effects logistic regression was used to estimate the effect of emergent resection on 30- and 90-day mortality. A propensity score-matched mixed-effects Cox proportional-hazards model was used to estimate the effect of emergent resection on 5-year OS. RESULTS Two hundred fourteen thousand one hundred seventy-four patients met inclusion criteria, 30% of the cohort had an emergent resection. After controlling for patient and hospital factors, pathological stage, lymph node yield, margin status, and adjuvant chemotherapy, emergent resection was associated with increased odds of 30-day mortality (OR = 1.69, 95% CI = 1.60, 1.78) and hazard of death at 5 years (HR = 1.13, 95% CI = 1.09, 1.15) compared to elective resections. CONCLUSION Emergent resection for colon cancer is independently associated with poor short-term outcomes and decreased 5-year OS compared to elective resection. With 30% of cases in this study emergent, these findings underlie the importance of adherence to colon cancer screening guidelines to limit the need for emergent resections.
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Affiliation(s)
- Zhaomin Xu
- Department of Surgery, University of Rochester Medical Center, 601 Elmwood Avenue Box SURG, Rochester, NY, 14642, USA.
| | - Adan Z Becerra
- Department of Public Health Sciences, Division of Epidemiology, University of Rochester Medical Center, Rochester, NY, USA
| | - Christopher T Aquina
- Department of Surgery, University of Rochester Medical Center, 601 Elmwood Avenue Box SURG, Rochester, NY, 14642, USA
| | - Bradley J Hensley
- Department of Surgery, University of Rochester Medical Center, 601 Elmwood Avenue Box SURG, Rochester, NY, 14642, USA
| | - Carla F Justiniano
- Department of Surgery, University of Rochester Medical Center, 601 Elmwood Avenue Box SURG, Rochester, NY, 14642, USA
| | - Courtney Boodry
- Department of Surgery, University of Rochester Medical Center, 601 Elmwood Avenue Box SURG, Rochester, NY, 14642, USA
| | - Alex A Swanger
- Department of Surgery, University of Rochester Medical Center, 601 Elmwood Avenue Box SURG, Rochester, NY, 14642, USA
| | - Reza Arsalanizadeh
- Department of Surgery, University of Rochester Medical Center, 601 Elmwood Avenue Box SURG, Rochester, NY, 14642, USA
| | - Katia Noyes
- Department of Epidemiology and Environmental Health, Division of Health Services Policy and Practice, State University of New York at Buffalo, School of Public Health and Health Professions, Buffalo, NY, USA
| | - John R Monson
- Center for Colon and Rectal Surgery, Florida Hospital Medical Group, University of Central Florida, College of Medicine, Orlando, FL, USA
| | - Fergal J Fleming
- Department of Surgery, University of Rochester Medical Center, 601 Elmwood Avenue Box SURG, Rochester, NY, 14642, USA
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29
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Shrestha B. Minimally invasive surgery for inflammatory bowel disease: Current perspectives. World J Gastrointest Pharmacol Ther 2016; 7:214-216. [PMID: 27158536 PMCID: PMC4848243 DOI: 10.4292/wjgpt.v7.i2.214] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/29/2015] [Revised: 02/09/2016] [Accepted: 03/25/2016] [Indexed: 02/06/2023] Open
Abstract
The surgical management of complicated and recurrent inflammatory bowel disease (IBD), has remained a challenge. Minimally invasive surgery (MIS), in the form of laparoscopic resections, single port approach and robotic-assisted dissections in the management of IBD, have been examined in several prospective studies. All of them have shown advantages over open surgery in terms of reduction of physical trauma of surgery, recovery time, better cosmetic outcomes and shorter hospitalization. However, it is important to appreciate that not all patients with IBD are suitable for MIS, so a combination of both open and MIS should be adopted to achieve optimum outcomes. A review on this subject performed by Neumann et al in this issue of World Journal of Gastrointestinal Pharmacology and Therapeutics have provided evidence in support of the contemporary practice of MIS in the management of IBD and the accompanying commentary further critically evaluates their application in clinical practice.
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30
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Current status of laparoscopic colorectal surgery in the emergency setting. Updates Surg 2016; 68:47-52. [DOI: 10.1007/s13304-016-0356-1] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2015] [Accepted: 02/28/2016] [Indexed: 12/15/2022]
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31
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Jimenez Rodriguez RM, Segura-Sampedro JJ, Flores-Cortés M, López-Bernal F, Martín C, Diaz VP, Ciuro FP, Ruiz JP. Laparoscopic approach in gastrointestinal emergencies. World J Gastroenterol 2016; 22:2701-2710. [PMID: 26973409 PMCID: PMC4777993 DOI: 10.3748/wjg.v22.i9.2701] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2015] [Revised: 12/24/2015] [Accepted: 01/11/2016] [Indexed: 02/06/2023] Open
Abstract
This review focuses on the laparoscopic approach to gastrointestinal emergencies and its more recent indications. Laparoscopic surgery has a specific place in elective procedures, but that does not apply in emergency situations. In specific emergencies, there is a huge range of indications and different techniques to apply, and not all of them are equally settle. We consider that the most controversial points in minimally invasive procedures are indications in emergency situations due to technical difficulties. Some pathologies, such as oesophageal emergencies, obstruction due to colon cancer, abdominal hernias or incarcerated postsurgical hernias, are nearly always resolved by conventional surgery, that is, an open approach due to limited intraabdominal cavity space or due to the vulnerability of the bowel. These technical problems have been solved in many diseases, such as for perforated peptic ulcer or acute appendectomy for which a laparoscopic approach has become a well-known and globally supported procedure. On the other hand, endoscopic procedures have acquired further indications, relegating surgical solutions to a second place; this happens in cholangitis or pancreatic abscess drainage. This endoluminal approach avoids the need for laparoscopic development in these diseases. Nevertheless, new instruments and new technologies could extend the laparoscopic approach to a broader array of potentials procedures. There remains, however, a long way to go.
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32
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Daher R, Barouki E, Chouillard E. Laparoscopic treatment of complicated colonic diverticular disease: A review. World J Gastrointest Surg 2016; 8:134-142. [PMID: 26981187 PMCID: PMC4770167 DOI: 10.4240/wjgs.v8.i2.134] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2015] [Revised: 10/11/2015] [Accepted: 12/08/2015] [Indexed: 02/06/2023] Open
Abstract
Up to 10% of acute colonic diverticulitis may necessitate a surgical intervention. Although associated with high morbidity and mortality rates, Hartmann’s procedure (HP) has been considered for many years to be the gold standard for the treatment of generalized peritonitis. To reduce the burden of surgery in these situations and as driven by the accumulated experience in colorectal and minimally-invasive surgery, laparoscopy has been increasingly adopted in the management of abdominal emergencies. Multiple case series and retrospective comparative studies confirmed that with experienced hands, the laparoscopic approach provided better outcomes than the open surgery. This technique applies to all interventions related to complicated diverticular disease, such as HP, sigmoid resection with primary anastomosis (RPA) and reversal of HP. The laparoscopic approach also provided new therapeutic possibilities with the emergence of the laparoscopic lavage drainage (LLD), particularly interesting in the context of purulent peritonitis of diverticular origin. At this stage, however, most of our knowledge in these fields relies on studies of low-level evidence. More than ever, well-built large randomized controlled trials are necessary to answer present interrogations such as the exact place of LLD or the most appropriate sigmoid resection procedure (laparoscopic HP or RPA), as well as to confirm the advantages of laparoscopy in chronic complications of diverticulitis or HP reversal.
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33
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The current status of emergent laparoscopic colectomy: a population-based study of clinical and financial outcomes. Surg Endosc 2015; 30:3321-6. [PMID: 26490770 DOI: 10.1007/s00464-015-4605-z] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2015] [Accepted: 09/28/2015] [Indexed: 12/22/2022]
Abstract
BACKGROUND Population-based studies evaluating laparoscopic colectomy and outcomes compared with open surgery have concentrated on elective resections. As such, data assessing non-elective laparoscopic colectomies are limited. Our goal was to evaluate the current usage and outcomes of laparoscopic in the urgent and emergent setting in the USA. METHODS A national inpatient database was reviewed from 2008 to 2011 for right, left, and sigmoid colectomies in the non-elective setting. Cases were stratified by approach into open or laparoscopic groups. Demographics, perioperative clinical variables, and financial outcomes were compared across each group. RESULTS A total of 22,719 non-elective colectomies were analyzed. The vast majority (95.8 %) was open. Most cases were performed in an urban setting at non-teaching hospitals by general surgeons. Colorectal surgeons were significantly more likely to perform a case laparoscopic than general surgeons (p < 0.001). Demographics were similar between open and laparoscopic groups; however, the disease distribution by approach varied, with significantly more severe cases in the open colectomy arm (p < 0.001). Cases performed laparoscopically had significantly better mortality and complication rates. Laparoscopic cases also had significantly improved outcomes, including shorter length of stay and hospital costs (all p < 0.001). CONCLUSIONS Our analysis revealed less than 5 % of urgent and emergent colectomies in the USA are performed laparoscopically. Colorectal surgeons were more likely to approach a case laparoscopically than general surgeons. Outcomes following laparoscopic colectomy in this setting resulted in reduced length of stay, lower complication rates, and lower costs. Increased adoption of laparoscopy in the non-elective setting should be considered.
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