Preoperative anatomical road mapping reduces variability of operating time, estimated blood loss, and lymph node yield in right colectomy with extended D3 mesenterectomy for cancer

Abstract Purpose The assistance of robotic systems raises the concern of whether there is an improved learning in robotic-assisted radical prostatectomy (RARP) compared to open retropubic radical prostatectomy (ORP). Methods We retrospectively analyzed data from 1438 patients who underwent ORP (n = 735) or RARP (n = 703). For each procedure, the level of experience of three different surgeons was summarized. Perioperative and pathological parameters reflecting surgical performance were compared between both learning curves. RARP data were influenced by new introduction of the robotic system. Results The median patient age at surgery was 66 years (IQR 42–80). Patients in the RARP group were younger (p < 0.001) and had a lower oncological risk (p < 0.001). Inexperienced RARP surgeons had a higher pT2-PSM rate and lower lymph node yield (13.8 ± 4.7 vs. 14.7 ± 4.8; p = 0.03) than inexperienced ORP surgeons. After 100 procedures, RARP and ORP surgeons had the same pT2-PSM rate (8% vs. 8%; p = 0.8) and lymph node yield (15.4 ± 5.4 vs. 15.4 ± 5.1; p = 1.0). In multivariate analysis for ORP, surgical inexperience (≤ 100 cases) was an independent predictor of a longer operating time (OR 9.0; p < 0.001) and higher amount of blood loss (OR 2.9; p < 0.001). For RARP, surgical inexperience (≤ 100 cases) was a predictor of a longer operating time (OR 3.9; p < 0.001), higher amount of blood loss (OR 1.9; p = 0.004), higher pT2-PSM rate (OR 1.6; p = 0.03), and lower lymph node yield (OR 0.6; p = 0.001). Conclusions Surgical experience has a relevant impact on perioperative and pathological parameters RARP has a higher initial pT2-PSM rate and lower lymph node yield than ORP. This is relevant for patient selection for novice teaching in RARP.

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Lymph node yield in right colectomy for cancer: a comparison of open, laparoscopic and robotic approaches

Colorectal Disease ◽

10.1111/codi.13786 ◽

2017 ◽

Vol 19 (10) ◽

pp. 888-894 ◽

Cited By ~ 13

Author(s):

M. Widmar ◽

M. Keskin ◽

P. Strombom ◽

P. Beltran ◽

O. S. Chow ◽

...

Keyword(s):

Lymph Node ◽

Right Colectomy ◽

Lymph Node Yield ◽

Node Yield

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A comprehensive assessment of postoperative complications in female patients undergoing robot versus open radical cystectomy.

Journal of Clinical Oncology ◽

10.1200/jco.2019.37.7_suppl.490 ◽

2019 ◽

Vol 37 (7_suppl) ◽

pp. 490-490

Author(s):

Vikram M Narayan ◽

Mohamed Seif ◽

Amy Lim ◽

Roger Li ◽

Wei Qiao ◽

...

Keyword(s):

Lymph Node ◽

Blood Loss ◽

Radical Cystectomy ◽

Smoking History ◽

Cancer Center ◽

Wound Complications ◽

Robotic Approach ◽

Lymph Node Yield ◽

Female Patients ◽

Node Yield

490 Background: Radical cystectomy (RC) is the standard of care for non-metastatic, muscle invasive bladder cancer. Studies comparing robotic to open RC have found that the robotic approach confers non-inferior oncologic outcomes while potentially decreasing morbidity, but to date there have been no comparisons performed exclusively within female patients, who have unique anatomic considerations. Women undergoing RC may be at higher risk for urethral margin positivity, wound complications, and bleeding. Methods: Female patients who underwent either open or robot-assisted RC at the MD Anderson Cancer Center from 1/2014-6/2018 were identified. We assessed co-morbidities, pathologic data, and outcomes including complications. Descriptive statistics, along with uni- and multivariable logistic regression, were performed. Results: 122 female patients underwent either open (n=76) or robotic (n=46) RC. There were no statistically significant differences in age, BMI, smoking history, exposure to neoadjuvant chemotherapy, Charlson comorbidity index, or cTNM stages between the groups. In both uni- and multivariable models, open RC in females was associated with greater blood loss (median EBL 775 mL, IQR 600 mL) compared with robotic RC (median EBL 300 mL, IQR 350 mL), p<0.001. Female open RC was also associated with greater risk of transfusion compared to robotic RC (OR 6.2, 95% CI 2.7-14.3, p<0.001). Robotic RC conferred a higher median lymph node yield (27 nodes (range 7,57) vs 20 nodes (0,57), p, <0.001). Operative times were longer in the robotic cohort (median 507 min vs 388 min, p<0.001). There were no differences between robotic vs open groups in margin positivity (5.3% vs 4.4%, p≥0.99), length of stay (6.3 vs 6.9 days, p=0.32), or readmission rates at 30 (26.1% vs 22.7%, p=0.67) and 90 days (32.6% vs 28%, p=0.68). Conclusions: In this cohort of women undergoing RC, the robotic approach was associated with a lower risk of transfusion and EBL, and a higher median lymph node yield and operative time. Unique anatomic considerations in female patients and the improved visualization conferred by the robotic approach may be responsible for these findings, particularly with respect to blood loss.

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Artery first versus traditional approach in pancreatoduodenectomy for pancreatic head cancer

International Surgery Journal ◽

10.18203/2349-2902.isj20205420 ◽

2020 ◽

Vol 8 (1) ◽

pp. 1

Author(s):

Ali Zedan Tohamy ◽

Hanan A. Eltyb ◽

Marwa T. Hussien ◽

Haisam Atta

Keyword(s):

Lymph Node ◽

Length Of Stay ◽

Blood Loss ◽

Operative Time ◽

R0 Resection ◽

Complication Rates ◽

Term Survival ◽

Lymph Node Yield ◽

Artery First ◽

Node Yield

Background: Artery first approach pancreatoduodenectomy (AFAPD) technique is one of the many modifications of the standard whipple procedure (sPD) thus enabling a complete dissection of the right side of this artery and of the portal vein, as well as a complete excision of the retroportal pancreatic lamina. Objective was to evaluate the clinical, perioperative and oncological outcomes of “artery first” approach compared with those of the traditional approach.Methods: Between 2010 and 2019, The present study includes two groups of patients. A first group of 28 patients with PD by “artery first” and a second group including 28 matched patients with PD by TAPD. Demographic characteristics (sex, age), intraoperative data (approach type, operative time, blood loss, intraoperative complications, need for vascular resections), histological diagnosis and pathology data (tumor location, TNM staging, tumor grading, tumor vascular invasion) and patient outcomes (postoperative length of stay, in-hospital postoperative mortality and morbidity, survival time) were collected.Results: There were no significant differences between the two groups regarding: total operative time (422 vs. 460.min, p=0.19), estimated blood loss (p=0.67), median length of stay (14 days in both groups) (p=0. 0.39), complication rates (32.1% and 35.7%) (p=0. 1.00), lymph node yield (22 and 21) and R0 resection rate (75% and 67.9%). Conclusions: We concluded that artery first” offers similar operative time, intraoperative blood loss, R0 resection rates, lymph node yield and long-term survival as TAPD.

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Right hemicolectomy with complete mesocolic excision is safe, leads to an increased lymph node yield and to increased survival: results of a systematic review and meta-analysis

Techniques in Coloproctology ◽

10.1007/s10151-021-02471-2 ◽

2021 ◽

Author(s):

G. Anania ◽

R. J. Davies ◽

F. Bagolini ◽

N. Vettoretto ◽

J. Randolph ◽

...

Keyword(s):

Lymph Node ◽

Postoperative Complications ◽

Meta Analysis ◽

Operating Time ◽

Disease Free Survival ◽

Complete Mesocolic Excision ◽

Right Hemicolectomy ◽

Oncologic Outcomes ◽

Lymph Node Yield ◽

Node Yield

Abstract Background The introduction of complete mesocolic excision (CME) for right colon cancer has raised an important discussion in relation to the extent of colic and mesenteric resection, and the impact this may have on lymph node yield. As uncertainty remains regarding the usefulness of and indications for right hemicolectomy with CME and the benefits of CME compared with a traditional approach, the purpose of this meta-analysis is to compare the two procedures in terms of safety, lymph node yield and oncological outcome. Methods We performed a systematic review of the literature from 2009 up to March 15th, 2020 according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Two hundred eighty-one publications were evaluated, and 17 met the inclusion criteria and were included. Primary endpoints analysed were anastomotic leak rate, blood loss, number of harvested lymph nodes, 3- and 5-year oncologic outcomes. Secondary outcomes were operating time, conversion, intraoperative complications, reoperation rate, overall and Clavien–Dindo grade 3–4 postoperative complications. Results In terms of safety, right hemicolectomy with CME is not inferior to the standard procedure when comparing rates of anastomotic leak (RR 0.82, 95% CI 0.38–1.79), blood loss (MD −32.48, 95% CI −98.54 to −33.58), overall postoperative complications (RR 0.82, 95% CI 0.67–1.00), Clavien–Dindo grade III–IV postoperative complications (RR 1.36, 95% CI 0.82–2.28) and reoperation rate (RR 0.65, 95% CI 0.26–1.75). Traditional surgery is associated with a shorter operating time (MD 16.43, 95% CI 4.27–28.60) and lower conversion from laparoscopic to open approach (RR 1.72, 95% CI 1.00–2.96). In terms of oncologic outcomes, right hemicolectomy with CME leads to a higher lymph node yield than traditional surgery (MD 7.05, 95% CI 4.06–10.04). Results of statistical analysis comparing 3-year overall survival and 5-year disease-free survival were better in the CME group, RR 0.42, 95% CI 0.27–0.66 and RR 0.36, 95% CI 0.17–0.56, respectively. Conclusions Right hemicolectomy with CME is not inferior to traditional surgery in terms of safety and has a greater lymph node yield when compared with traditional surgery. Moreover, right-sided CME is associated with better overall and disease-free survival.

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Comparison of short-term outcomes following open and laparoscopic resections for colorectal malignancies

International Journal of Research in Medical Sciences ◽

10.18203/2320-6012.ijrms20173525 ◽

2017 ◽

Vol 5 (8) ◽

pp. 3372

Author(s):

Keerthi B. R. ◽

Amritha Prabha Shankar ◽

Ganesh M. S. ◽

Hemanth G. N.

Keyword(s):

Lymph Node ◽

Operating Time ◽

Resection Margins ◽

Lymph Node Yield ◽

Open Procedure ◽

Postoperative Stay ◽

Duration Of Surgery ◽

Operative Complications ◽

Node Yield ◽

Post Operative Complications

Background: The laparoscopic approach for colorectal cancers are still a matter of controversy. In the present study, we tried to compare the laparoscopy with open methods of colorectal resections.Methods: Retrospective study where patients diagnosed with colorectal cancer in our hospital from year 2014 January to December 2016 were taken. Total number of cases were 69 of which, the total number of right colon cases were 26. Out of twenty-six, 12 underwent open procedure and 14 underwent laparoscopic resections. Total number of left colon cancers were 09. Of these, 2 underwent open and 7 underwent laparoscopic procedure. Thirty-four (34) rectal cancers were included in the study. Of these, 12 underwent open rectal procedures and 22 underwent laparoscopic resections. Multiple parameters like duration of surgery, post-operative complications, postoperative stay, pathological T staging, lymph node yield, positive nodes, distal resection margins, circumferential radial margins were compared.Results: Operating time was significantly shorter in open procedure than laparoscopic surgery in both rectal resection and right hemicolectomies. The postoperative stay was significantly shorter in laparoscopic right hemicolectomy compared to open procedure. All other parameters like post-operative complications, T stage, lymph node yield, positive nodes, distal resection margins and CRMs were comparable in both groups. The lymph node yield was similar in upfront and post neoadjuvant carcinoma rectum cases.Conclusions: Laparoscopic colorectal resections have similar rates of complication, with shorter hospital stays with no compromise on oncological clearance with respect to lymph node yield, CRMs, distal resection margins compared to open procedures.

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Lymph node yield in treatment naïve cases of head and neck squamous cell carcinoma: en bloc lymphadenectomy versus level-by-level dissection

The Journal of Laryngology & Otology ◽

10.1017/s0022215121000621 ◽

2021 ◽

pp. 1-8

Author(s):

K Devaraja ◽

K Pujary ◽

B Ramaswamy ◽

D R Nayak ◽

N Kumar ◽

...

Keyword(s):

Squamous Cell Carcinoma ◽

Lymph Node ◽

Cell Carcinoma ◽

Head And Neck ◽

Neck Dissection ◽

Squamous Cell ◽

Neck Squamous Cell Carcinoma ◽

En Bloc ◽

Lymph Node Yield ◽

Node Yield

Abstract Background Lymph node yield is an important prognostic factor in head and neck squamous cell carcinoma. Variability in neck dissection sampling techniques has not been studied as a determinant of lymph node yield. Methods This retrospective study used lymph node yield and average nodes per level to compare level-by-level and en bloc neck dissection sampling methods, in primary head and neck squamous cell carcinoma cases operated between March 2017 and February 2020. Results From 123 patients, 182 neck dissections were analysed, of which 133 were selective and the rest were comprehensive: 55 had level-by-level sampling and 127 had undergone en bloc dissection. The level-by-level method yielded more nodes in all neck dissections combined (20 vs 17; p = 0.097), but the difference was significant only for the subcohort of selective neck dissection (18.5 vs 15; p = 0.011). However, the gain in average nodes per level achieved by level-by-level sampling was significant in both groups (4.2 vs 3.33 and 4.4 vs 3, respectively; both p < 0.001). Conclusion Sampling of cervical lymph nodes level-by-level yields more nodes than the en bloc technique. Further studies could verify whether neck dissection sampling technique has any impact on survival rates.

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