scholarly journals 1367 Five Years of Robotic Surgery in Colorectal Service: James Cook University Hospital Experience

2021 ◽  
Vol 108 (Supplement_6) ◽  
Author(s):  
K France ◽  
M Aradaib ◽  
M Jha
Keyword(s):  
Robotic Surgery ◽  
Anterior Resection ◽  
Intraoperative Complications ◽  
Length Of Hospital Stay ◽  
Right Colectomy ◽  
University Hospital ◽  
R0 Resection ◽  
Oncological Outcomes ◽  
Robotic Colorectal Surgery ◽  
Institutional Experience

Abstract Aim This paper gives an account of our institutional experience with safe adoption of robotic surgery in colorectal service. Method Analysis of our prospectively maintained database of all patients who underwent robotic colorectal surgery in our institute between February 2015 and February 2020. Overall surgical and oncological outcomes were interrogated. Results A total of 255 patients underwent robotic surgery between 2015 and 2020. 148 were males, and 107 were females. Median age was 68 years (range: 35–89). 198 patients had bowel cancer and 57 had benign conditions. Operative procedures performed were anterior resection (n = 125), right colectomy (n = 77), abdominoperineal resection (n = 40), subtotal colectomy (n = 5), completion proctocolectomy (n = 2) and reversal of Hartmann’s procedure (n = 6). Mean operative time was 164 (SD ± 47.5) for right colectomy and 267 (SD ± 77.8) for anterior resection. Median length of hospital stay was 6 days (IQR: 4 – 9). There was no 30 days mortality or intraoperative complications. Conversion to open or laparoscopy surgery rate was 5.1% (n = 13). Anastomotic leakage occurred in 3 patients (1.2%). Median lymph nodes harvested were 21 (range 4 – 79) and the R0 resection rate was 96.5%. Conclusions Our results demonstrate that colorectal robotic surgery is feasible and can be adopted safely for both benign and neoplastic conditions without undermining clinical or oncological outcomes.

scholarly journals The art of robotic colonic resection: a review of progress in the past 5 years

2021 ◽  
Author(s):  
Hongyi Liu ◽  
Maolin Xu ◽  
Rong Liu ◽  
Baoqing Jia ◽  
Zhiming Zhao
Keyword(s):  
Robotic Surgery ◽  
Hospital Stay ◽  
Intraoperative Complications ◽  
Intestinal Anastomosis ◽  
Length Of Hospital Stay ◽  
Colonic Resection ◽  
Surgical Performance ◽  
Conversion To Open Surgery ◽  
Minimal Invasiveness ◽  
The Past

AbstractSurgery is developing in the direction of minimal invasiveness, and robotic surgery is becoming increasingly adopted in colonic resection procedures. The ergonomic improvements of robot promote surgical performance, reduce workload for surgeons and benefit patients. Compared with laparoscopy-assisted colon surgery, the robotic approach has the advantages of shorter length of hospital stay, lower rate of conversion to open surgery, and lower rate of intraoperative complications for short-term outcomes. Synchronous robotic liver resection with colon cancer is feasible. The introduction of the da Vinci Xi System (Intuitive Surgical, Inc., Sunnyvale, CA, USA) has introduced more flexibility to colonic operations. Optimization of the suprapubic surgical approach may shorten the length of hospital stay for patients who undergo robotic colonic resection. Single-port robotic colectomy reduces the number of robotic ports for better looking and faster recovery. Intestinal anastomosis methods using totally robotic surgery result in shorter time to bowel function recovery and tolerance to a solid diet, although the operative time is longer. Indocyanine green is used as a tracer to assess blood supplementation in the anastomosis and marks lymph nodes during operation. The introduction of new surgical robots from multiple manufacturers is bound to change the landscape of robotic surgery and yield high-quality surgical outcomes. The present article reviews recent advances in robotic colonic resection over the past five years.

scholarly journals Surgical Outcomes of Robotic Resection for Sigmoid and Rectal Cancer: Analysis of 109 Patients From a Single Center in China

2021 ◽  
Vol 8 ◽  
Author(s):  
Jianhong Peng ◽  
Weihao Li ◽  
Jinghua Tang ◽  
Yuan Li ◽  
Xueying Li ◽  
...  
Keyword(s):  
Rectal Cancer ◽  
Robotic Surgery ◽  
Clinical Data ◽  
Anterior Resection ◽  
Neoadjuvant Treatment ◽  
Neoadjuvant Chemoradiotherapy ◽  
Postoperative Mortality ◽  
Autonomic Nerve ◽  
Pelvic Hemorrhage ◽  
Robotic Colorectal Surgery

Background: Robotic colorectal surgery has been increasingly performed in recent years. The safety and feasibility of its application has also been demonstrated worldwide.However, limited studies have presented clinical data for patients with colorectal cancer (CRC) receiving robotic surgery in China. The aim of this study is to present short-term clinical outcomes of robotic surgery and further confirm its safety and feasibility in Chinese CRC patients.Methods: The clinical data of 109 consecutive CRC patients who received robotic surgery at Sun Yat-sen University Cancer Center between June 2016 and May 2019 were retrospectively reviewed. Patient characteristics,tumor traits, treatment details, complications, pathological details, and survival status were evaluated.Results: Among the 109 patients, 35 (32.1%) had sigmoid cancer, and 74 (67.9%) had rectal cancer. Thirty-seven (33.9%) patients underwent neoadjuvant chemoradiotherapy. Ten (9.2%) patients underwent sigmoidectomy, 38 (34.9%) underwent high anterior resection (HAR), 45 (41.3%) underwent low anterior resection (LAR), and 16 (14.7%) underwent abdominoperineal resection (APR). The median surgical procedure time was 270 min (range 120–465 min). Pathologically complete resection was achieved in all patients. There was no postoperative mortality. Complications occurred in 11 (10.1%) patients, including 3 (2.8%) anastomotic leakage, 1 (0.9%) anastomotic bleeding, 1 (0.9%) pelvic hemorrhage, 4 (3.7%) intestinal obstruction, 2 (1.8%) chylous leakage, and 1 (0.9%) delayed wound union. At a median follow-up of 17 months (range 1–37 months), 1 (0.9%) patient developed local recurrence and 5 (4.6%) developed distant metastasis, with one death due to disease progression.Conclusions: Our results suggest that robotic surgery is technically feasible and safe for Chinese CRC patients, especially for rectal cancer patients who received neoadjuvant treatment. A robotic laparoscope with large magnification showed a clear surgical space for pelvic autonomic nerve preservation in cases of mesorectal edema.

scholarly journals Applicability of minimally invasive surgery for clinically T4 colorectal cancer

2020 ◽  
Vol 10 (1) ◽  
Author(s):  
Yu-Tso Liao ◽  
Jin-Tung Liang
Keyword(s):  
Colorectal Cancer ◽  
Minimally Invasive Surgery ◽  
Minimally Invasive ◽  
Invasive Surgery ◽  
Disease Free Survival ◽  
Stage Iv ◽  
University Hospital ◽  
R0 Resection ◽  
Resection Rate ◽  
Oncological Outcomes

AbstractThe role of minimally invasive surgery (MIS) to treat clinically T4 (cT4) colorectal cancer (CRC) remains uncertain and deserves further investigation. A retrospective cohort study was conducted between September 2006 and March 2019 recruiting patients diagnosed as cT4 CRC and undergoing MIS at a university hospital and its branch. Patients’ demography, clinicopathology, surgical and oncological outcomes, and radicality were analyzed. A total of 128 patients were recruited with an average follow-up period of 33.8 months. The median time to soft diet was 6 days, and the median postoperative hospitalization periods was 11 days. The conversion and complication (Clavien–Dindo classification ≥ II) rates were 7.8% and 27.3%, respectively. The 30-day mortality was 0.78%. R0 resection rate was 92.2% for cT4M0 and 88.6% for pT4M0 patients. For cT4 CRC patients, the disease-free survival and 3-year overall survival were 86.1% and 86.8% for stage II, 54.1% and 57.9% for stage III, and 10.8% and 17.8% for stage IV. With acceptable conversion, complication and mortality rate, MIS may achieve satisfactory R0 resection rate and thus lead to good oncological outcomes for selected patients with cT4 CRC.

scholarly journals Surgical and Oncological Outcomes of Robotic Resection for Sigmoid and Rectal Cancer: Analysis of 109 Patients from A Single Center in China

2021 ◽  
Author(s):  
Jianhong Peng ◽  
Weihao Li ◽  
Jinghua Tang ◽  
Yuan Li ◽  
Xueying Li ◽  
...  
Keyword(s):  
Rectal Cancer ◽  
Robotic Surgery ◽  
Clinical Data ◽  
Anterior Resection ◽  
Neoadjuvant Treatment ◽  
Neoadjuvant Chemoradiotherapy ◽  
Postoperative Mortality ◽  
Autonomic Nerve ◽  
Pelvic Hemorrhage ◽  
Robotic Colorectal Surgery

Abstract Background: Robotic colorectal surgery has been increasingly performed in recent years. The safety and feasibility of its application has also been demonstrated worldwide. However, limited studies have presented clinical data for patients with colorectal cancer (CRC) receiving robotic surgery in China. The aim of this study is to present short-term clinical outcomes of robotic surgery and further confirm its safety and feasibility in Chinese CRC patients.Methods: The clinical data of 109 consecutive CRC patients whoreceived robotic surgery at Sun Yat-sen University Cancer Center between June 2016 and May 2019 were retrospectively reviewed. Patient characteristics,tumor traits, treatment details, complications, pathological details, and survival status were evaluated.Results: Among the 109 patients, 35 (32.1%) had sigmoid cancer, and 74 (67.9%) had rectal cancer. Thirty-seven (33.9%) patients underwent neoadjuvant chemoradiotherapy. Ten (9.2%) patients underwent sigmoidectomy, 38 (34.9%) underwent high anterior resection (HAR), 45 (41.3%) underwent low anterior resection (LAR), and 16 (14.7%) underwent abdominoperineal resection (APR). The median surgical procedure time was 270 min (range 120 - 465 min). Pathologically complete resection was achieved in all patients. There was no postoperative mortality. Complications occurred in 11 (10.1%) patients, including 3 (2.8%) anastomotic leakage, 1 (0.9%) anastomotic bleeding, 1 (0.9%) pelvic hemorrhage, 4 (3.7%) intestinal obstruction, 2 (1.8%) chylous leakage, and 1 (0.9%) delayed wound union. At a median follow-up of 17 months (range 1–37 months), 1 (0.9%) patient developed local recurrence and 5 (4.6%) developed distant metastasis, with one death due to disease progression.Conclusions: Our results suggest that robotic surgery is technically feasible and safe for Chinese CRC patients, especially for rectal cancer patients who received neoadjuvant treatment. A robotic laparoscope with large magnification showed a clear surgical space for pelvic autonomic nerve preservation in cases of mesorectal edema.

scholarly journals Laparoscopic versus open distal pancreatectomy: a single centre propensity score matching analysis

2021 ◽  
Author(s):  
Riccardo Casadei ◽  
Carlo Ingaldi ◽  
Claudio Ricci ◽  
Laura Alberici ◽  
Emilio De Raffele ◽  
...  
Keyword(s):  
Propensity Score ◽  
Hospital Stay ◽  
Distal Pancreatectomy ◽  
Pancreatic Neoplasms ◽  
Postoperative Morbidity ◽  
Laparoscopic Approach ◽  
Length Of Hospital Stay ◽  
Single Centre ◽  
Oncological Outcomes ◽  
Open Distal Pancreatectomy

AbstractThe laparoscopic approach is considered as standard practice in patients with body-tail pancreatic neoplasms. However, only a few randomized controlled trials (RCTs) and propensity score matching (PSM) studies have been performed. Thus, additional studies are needed to obtain more robust evidence. This is a single-centre propensity score-matched study including patients who underwent laparoscopic (LDP) and open distal pancreatectomy (ODP) with splenectomy for pancreatic neoplasms. Demographic, intra, postoperative and oncological data were collected. The primary endpoint was the length of hospital stay. The secondary endpoints included the assessment of the operative findings, postoperative outcomes, oncological outcomes (only in the subset of patients with pancreatic ductal adenocarcinoma-PDAC) and total costs. In total, 205 patients were analysed: 105 (51.2%) undergoing an open approach and 100 (48.8%) a laparoscopic approach. After PSM, two well-balanced groups of 75 patients were analysed and showed a shorter length of hospital stay (P = 0.001), a lower blood loss (P = 0.032), a reduced rate of postoperative morbidity (P < 0.001) and decreased total costs (P = 0.050) after LDP with respect to ODP. Regarding the subset of patients with PDAC, 22 patients were analysed: they showed a significant shorter length of hospital stay (P = 0.050) and a reduction in postoperative morbidity (P < 0.001) after LDP with respect to ODP. Oncological outcomes were similar. LDP showed lower hospital stay and postoperative morbidity rate than ODP both in the entire population and in patients affected by PDAC. Total costs were reduced only in the entire population. Oncological outcomes were comparable in PDAC patients.

scholarly journals Two dominant patterns of low anterior resection syndrome and their effects on patients’ quality of life

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Min Jung Kim ◽  
Ji Won Park ◽  
Mi Ae Lee ◽  
Han-Ki Lim ◽  
Yoon-Hye Kwon ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Risk Factors ◽  
Anterior Resection ◽  
Low Anterior Resection ◽  
University Hospital ◽  
Postoperative Treatment ◽  
Low Anterior Resection Syndrome ◽  
Cross Sectional ◽  
Anterior Resection Syndrome

AbstractTo identify low anterior resection syndrome (LARS) patterns and their associations with risk factors and quality of life (QOL). This cross-sectional study analyzed patients who underwent restorative anterior resection for left-sided colorectal cancer at Seoul National University Hospital, Seoul, Republic of Korea. We administered LARS questionnaires to assess bowel dysfunction and quality of life between April 2017 and November 2019. LARS patterns were classified based on factor analyses. Variable effects on LARS patterns were estimated using logistic regression analysis. The risk factors and quality of life associated with dominant LARS patterns were analyzed. Data of 283 patients with a median follow-up duration of 24 months were analyzed. Major LARS was observed in 123 (43.3%) patients. Radiotherapy (odds ratio [OR]: 2.851, 95% confidence interval [95% CI]: 2.504–43.958, p = 0.002), low anastomosis (OR: 10.492, 95% CI: 2.504–43.958, p = 0.001), and complications (OR: 2.163, 95% CI: 1.100–4.255, p = 0.025) were independently associated with major LARS. LARS was classified into incontinence- or frequency-dominant types. Risk factors for incontinence-dominant LARS were radiotherapy and complications, whereas those for frequency-dominant LARS included low tumor location. Patients with incontinence-dominant patterns showed lower emotional function, whereas those with frequency-dominant patterns showed lower global health QOL, lower emotional, cognitive, and social functions, and higher incidence of pain and diarrhea. Frequency-dominant LARS had a greater negative effect on QOL than incontinence-dominant LARS. These patterns could be used for preoperative prediction and postoperative treatment of LARS.

474 Multiple combinational strategies of immunotherapy for esophageal squamous cell carcinoma: one institutional experience in Taiwan since 2016

2020 ◽  
Vol 8 (Suppl 3) ◽  
pp. A505-A505
Author(s):  
Jo-Pai Chen ◽  
Wei-Chen Lu ◽  
Ruey-Long Hong
Keyword(s):  
Squamous Cell Carcinoma ◽  
Esophageal Squamous Cell Carcinoma ◽  
Cell Carcinoma ◽  
Squamous Cell ◽  
Clinical Benefit ◽  
Response Rate ◽  
University Hospital ◽  
List Type ◽  
Duration Of Response ◽  
Institutional Experience

BackgroundEsophageal squamous cell carcinoma is still a health burden in Taiwan. In R/M setting, the prognosis becomes worse. ESCC is still an immunogenic cancer. In randomized 2nd line ATTRACTION-3 study(nivolumab vs taxane after PF failure), median OS improved from 8.4 months in chemotherapy to 10.9 months in nivolumab(HR, 0.77; 95% CI, 0.62–0.96; p =0.019). The median duration of response was 3.9 months and 6.9 months. Nivolumab is a new 2nd line option for ESCC.MethodsFrom early 2016 to early 2020, 15 advanced ESCC patients had ever received immunotherapy-containing regimens in Yun-lin Branch of National Taiwan University Hospital and were analyzed.ResultsThe overall response to immunotherapy-containing regimens was 60%(9/15) and clinical benefit was 80%(12/15). 2nd line nivolumab was given in 3 cases; response rate was33% and clinical benefit was 67%. 2nd line afatinib combined with anti-PD1 was given in 9 case; response rate was 67% and clinical benefit was 78%. The response rate of 2nd line afatinib & pembrolizumab was 75%(3/4); however, Gr. III pneumonitis & Gr. II hepatitis were noted in the patient with progression. The response rate of 2nd line afatinib & nivolumab was 60%(3/5) and clinical benefit was 80%(4/5); skin rash and diarrhea were often found. 1st line afatinib combined with anti-PD1 was given in 3 patients; response rate was 67% and clinical benefit was 100%. The response rate of 1st line afatinib & nivolumab was 100%(2/2).ConclusionsEGFR TKIs have multiple immuno-modulatory effects and may increase immunotherapy benefits in ESCC. Anti-PD1 and anti-CTLA4, another possible rationale, could bring more benefits maybe in 1st line CheckMate649 study.AcknowledgementsNilTrial RegistrationN/AEthics ApprovalN/AConsentWritten informed consent was obtained from the patient for publication of this abstract and any accompanying images. A copy of the written consent is available for review by the Editor of this journal.ReferencesNil

scholarly journals Securing the surgical field for mobilization of right-sided colon cancer using the duodenum-first multidirectional approach in laparoscopic surgery

2021 ◽  
Author(s):  
K. Nagayoshi ◽  
S. Nagai ◽  
K. P. Zaguirre ◽  
K. Hisano ◽  
M. Sada ◽  
...  
Keyword(s):  
Colon Cancer ◽  
Laparoscopic Surgery ◽  
Postoperative Complications ◽  
Blood Loss ◽  
Operative Time ◽  
Right Colectomy ◽  
R0 Resection ◽  
Medial Approach ◽  
Total Operative Time ◽  
Advanced Tumors

Abstract Background The aim of this study was to compare the short-term outcomes of the duodenum-first multidirectional approach (DMA) in laparoscopic right colectomy with those of the conventional medial approach to assess its safety and feasibility. Methods This retrospective study enrolled 120 patients who had laparoscopic surgery for right-sided colon cancer in our institution between April 2013 and December 2019. Fifty-four patients underwent colectomy using the multidirectional approach; among these, 20 underwent the DMA and 34 underwent the caudal-first multidirectional approach (CMA). Sixty-six patients underwent the conventional medial approach. Complications within 30 days of surgery were compared between the groups. Results There were 54 patients in the multidirectional group [29 females, median age 72 years (range 36–91 years)] and 66 in the medial group [42 females, median age 72 years (range 41–91 years)]. Total operative time was significantly shorter in multidirectional approach patients than conventional medial approach patients (208 min vs. 271 min; p = 0.01) and significantly shorter in patients who underwent the DMA compared to the CMA (201 min vs. 269 min; p < 0.001). Operative time for the mobilization procedure was also significantly shorter in patients who underwent the DMA (131 min vs. 181 min; p < 0.001). Blood loss and incidence of postoperative complications did not differ. In 77 patients with advanced T3/T4 tumors, the DMA, CMA, and conventional medial approach were performed in 13, 21, and 43 patients, respectively. Total operative time and operative time of the mobilization procedure were significantly shorter in patients undergoing DMA. Blood loss and incidence of postoperative complications did not differ. R0 resection was achieved in all patients with advanced tumors. Conclusions The DMA in laparoscopic right colectomy is safe and feasible and can achieve R0 resection with a shorter operative time than the conventional medial approach, even in patients with advanced tumors.

scholarly journals Robotic rectosigmoidectomy: pioneer case report in Brazil. Current scene in colorectal robotic surgery

2010 ◽  
Vol 47 (1) ◽  
pp. 116-118 ◽  
Author(s):  
Marcelo Averbach ◽  
Pedro Popoutchi ◽  
Oswaldo Wiliam Marques Jr ◽  
Ricardo Z Abdalla ◽  
Sérgio Podgaec ◽  
...  
Keyword(s):  
Robotic Surgery ◽  
Colorectal Surgery ◽  
Colorectal Resection ◽  
Deep Infiltrating Endometriosis ◽  
Brazil Current ◽  
Current Series ◽  
Robotic Colorectal Surgery ◽  
Rectal Involvement ◽  
Surgical Device ◽  
Standard Laparoscopic Surgery

Laparoscopic colorectal surgery is believed to be technically and oncologically feasible. Robotic surgery is an attractive mode in performing minimally-invasive surgery once it has several advantages if compared to standard laparoscopic surgery. The aim of this paper is to report the first known case of colorectal resection surgery using the robotic assisted surgical device in Brazil. A 35-year-old woman with deep infiltrating endometriosis with rectal involvement was referred for colorectal resection using da Vinci® surgical system. The authors also reviewed the most current series and discussed not only the safety and feasibility but also the real benefits of robotic colorectal surgery

Prevalence and Recognition of Depressive Disorders in General Medical Inpatients

1988 ◽  
Vol 17 (4) ◽  
pp. 341-349 ◽  
Author(s):  
Michiel W. Hengeveld ◽  
Frans A. J. M. Ancion ◽  
Harry G. M. Rooijmans
Keyword(s):  
Depressive Disorder ◽  
Depressive Disorders ◽  
Length Of Hospital Stay ◽  
University Hospital ◽  
Psychiatric Consultation ◽  
Consultant Psychiatrist ◽  
Symptoms Of Depression ◽  
Medical Inpatients ◽  
Medical Wards ◽  
Depressive Patients

The Beck Depression Inventory (BDI) was administered to 220 of 340 patients consecutively admitted to three general medical wards of a University Hospital, whose length of hospital stay was more than five days. At least mild symptoms of depression (BDI ≥ 13) were reported by 70/220 (32%) of the patients. Alternate BDI depressive patients underwent psychiatric consultation. The psychiatric consultant established a DSM-III depressive disorder in 10/33 (30%) of these patients. Only 3/10 (30%) of the DSM-III depressive patients had been referred to the consultant psychiatrist by their physician.

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