scholarly journals Pulmonary Complications after Surgery for Rectal Cancer in Elderly Patients: Evaluation of Laparoscopic versus Open Approach from a Multicenter Study on 477 Consecutive Cases

2017 ◽  
Vol 2017 ◽  
pp. 1-7 ◽  
Author(s):  
Marco Milone ◽  
Ugo Elmore ◽  
Andrea Vignali ◽  
Alfredo Mellano ◽  
Nicola Gennarelli ◽  
...  
Keyword(s):  
Rectal Cancer ◽  
Laparoscopic Surgery ◽  
Elderly Patients ◽  
Rectal Surgery ◽  
Laparoscopic Group ◽  
Pulmonary Complications ◽  
Open Approach ◽  
Postoperative Pulmonary Complications ◽  
Old Patients ◽  
The Impact

Aim. To evaluate the impact of open or laparoscopic rectal surgery on pulmonary complications in elderly (>75 years old) patients. Methods. Data from consecutive patients who underwent elective laparoscopic or open rectal surgery for cancer were collected prospectively from 3 institutions. Pulmonary complications were defined according to the ACS/NSQUIP definition. Results. A total of 477 patients (laparoscopic group: 242, open group: 235) were included in the analysis. Postoperative pulmonary complications were significantly more common after open surgery (8 out of 242 patients (3.3%) versus 23 out of 235 patients (9.8%); p=0.005). In addition, PPC occurrence was associated with the increasing of postoperative pain (5.04 ± 1.62 versus 5.03 ± 1.58; p=0.001) and the increasing of operative time (270.06 ± 51.49 versus 237.37 ± 65.97; p=0.001). Conclusion. Our results are encouraging to consider laparoscopic surgery a safety and effective way to treat rectal cancer in elderly patients, highlighting that laparoscopic surgery reduces the occurrence of postoperative pulmonary complications.

scholarly journals Short-Physical Performance Battery (SPPB) score is associated with postoperative pulmonary complications in elderly patients undergoing lung resection surgery: A prospective multicenter cohort study

2020 ◽  
Vol 17 ◽  
pp. 147997312096184
Author(s):  
Masatoshi Hanada ◽  
Kota Yamauchi ◽  
Shinjiro Miyazaki ◽  
Yohei Oyama ◽  
Yorihide Yanagita ◽  
...  
Keyword(s):  
Cohort Study ◽  
Elderly Patients ◽  
Physical Performance ◽  
Lung Resection ◽  
Pulmonary Complications ◽  
Short Physical Performance Battery ◽  
Postoperative Pulmonary Complications ◽  
Multicenter Cohort Study ◽  
Multicenter Cohort ◽  
The Impact

Elderly patients awaiting lung resection surgery often have poor physical function, which puts them at a high risk of postoperative pulmonary complications. The aim of this study was to investigate the impact of preoperative physical performance on postoperative pulmonary complications in patients awaiting lung resection surgery. In this prospective multicenter cohort study, the characteristics of patients and postoperative pulmonary complications were compared between subjects with low (<10) and high (≥10) Short Physical Performance Battery (SPPB) scores. Postoperative pulmonary complications were defined as over grade II in Clavien-Dindo classification system. We estimated the effects of physical performance on postoperative pulmonary complications using multivariable hierarchical logistic regression. The postoperative pulmonary complications were compared between 331 patients in the high and 33 patients in the low SPPB group. Patients in the low SPPB score group had a significantly higher rate of postoperative pulmonary complications (p < 0.001). Low SPPB score was associated with a higher risk of postoperative pulmonary complications (odds ratio, 8.80; p < 0.001). The SPPB is a clinically useful evaluation tool to assess surgical patients’ physical performance. The low physical performance indicated by the SPPB may be predictive of postoperative pulmonary complications after lung resection surgery. Trial registration: Clinical Trials. University hospital Medical Information Network Center (UMIN-CTR) UMIN000021875.

Assessment of Circumferential Resection Margins (CRM) clearance in Conventional open Versus Laparoscopic Cancer Rectum Resection

QJM ◽  
2021 ◽  
Vol 114 (Supplement_1) ◽  
Author(s):  
Ibrahim H Bayan ◽  
Ahmed Abdelaziz ◽  
Tarek Youssef Ahmed ◽  
Mohamed Magdy
Keyword(s):  
Rectal Cancer ◽  
Laparoscopic Surgery ◽  
Abdominal Surgery ◽  
Open Surgery ◽  
Laparoscopic Group ◽  
Resection Margins ◽  
Laparoscopy Group ◽  
Surgery Group ◽  
Colon And Rectal Cancer ◽  
Significant Difference

Abstract Background Colon and rectal cancer represent the fourth commonest malignancy worldwide. Globally, colon and rectal cancer make up 9.4% and 10.1% in men and women of all cancers, respectively. Colon and rectal tumors are the third most common malignancy after breast and lung cancer, respectively. The main management of rectal cancer involves a multi-disciplinary team approach and an individually tailored treatment routine. Operative surgery remains the primary and definitive treatment for locally confined rectal adenocarcinoma and is the only historical and current treatment which allows for cure. Resection of the colon and rectal cancer can be done either by open surgical excision or laparoscopically. Aim of the work The objective is to compare the radicality of total mesorectal excision for rectal cancer in both open and laparoscopic surgery through the pathology report. Methods In this multicentric, prospective, comparative study, we included the pathologically established rectal cancer patients from 2 hospitals in Cairo, Egypt, Ain Shams University Hospitals and Maadi Military Hospital, Egypt between 2013 and 2016. The sample size was 40 patients divided into two groups; 20 patients for laparoscopic arm and 20 patients for the open trans-abdominal surgery. Inclusion criteria: histopathology confirmed rectal cancer, patients fit for operative resection, and with T1- T3 grades according to the preoperative evaluation. The exclusion criteria: Patients with T4 stage tumor, patients present as emergency cases and patients present with recurrence of the tumor and synchronous colonic tumors. Results The circumferential resection margins (CRM) of the mesorectum when examined pathologically after resection showed no difference between the two arms of the study with laparoscopic group specimens 3.18±1.16 mm mean, (SD) compared to 3.50±0.45 mm mean, (SD) in the open surgery group with no statistically significant difference. The longitudinal resection margins (LRM) was (5.50±1.98 mean, SD) in the laparoscopic group compared to (5.20±2.28 mean, SD) in the open conventional surgery group with no significant difference found between the two groups. Total operative time was significantly shorter in the trans-abdominal surgery group, while the hospital stay period was significantly shorter in the laparoscopy group. Laparoscopy group also showed significantly time before flatus passage, and the patients in the laparoscopy group started oral intake faster than open surgery group. Conclusion In our study, the radicality of the rectal cancer excision in both laparoscopic and traditional open surgery, showed non inferiority of the laparoscopic technique over open surgery Long-term clinical outcomes of overall survival and recurrence is the foremost parameters which should be taken in consideration for decision for laparoscopic surgery for rectal cancer. Additional follow-up results from the current trial are presently being developed, beside with records on other secondary end points, like cost effectiveness and quality of life.

scholarly journals Lung ultrasound score to determine the effect of fraction inspired oxygen during alveolar recruitment on absorption atelectasis in laparoscopic surgery: A randomized controlled trial

2020 ◽  
Author(s):  
Bo Rim Kim ◽  
Seohee Lee ◽  
Hansu Bae ◽  
Minkyoo Lee ◽  
Jae-Hyon Bahk ◽  
...  
Keyword(s):  
Laparoscopic Surgery ◽  
Lung Ultrasound ◽  
Controlled Trial ◽  
Pulmonary Complications ◽  
Alveolar Recruitment ◽  
Postoperative Pulmonary Complications ◽  
Trendelenburg Position ◽  
Alveolar Recruitment Maneuver ◽  
Ultrasound Score ◽  
Inspired Oxygen

Abstract Background The intraoperative alveolar recruitment maneuver (ARM) efficiently treats atelectasis, but the effect of Fio 2 during ARM on atelectasis is uncertain. Here, we investigated this effect. Methods Patients undergoing elective laparoscopic surgery in the Trendelenburg position were randomized to low- (Fio 2 0.4; n=44) and high-Fio 2 (Fio 2 1.0, n=46) groups. ARMs were performed 1-min post tracheal intubation and post changes between supine and Trendelenburg positions during surgery. Intraoperative Fio 2 was set at 0.4 for both groups. Modified lung ultrasound (LUS) scores were calculated to assess lung aeration after inducing anesthesia and at surgery completion. The primary outcome was modified LUS score at the end of the surgery, and secondary outcomes were the intra- and postoperative Pao 2 to Fio 2 ratio and postoperative pulmonary complications. Results Both groups presented similar modified LUS scores before capnoperitoneum and ARM ( P =0.747). However, the postoperative modified LUS score was significantly lower in the low- than in the high-Fio 2 group (7.0±4.1 vs 11.7±4.2, mean difference 4.7, 95% CI 2.96–6.44, P <0.001). Significant atelectasis postoperatively was more common in the high-Fio 2 group (relative risk 1.77, 95% CI 1.27‒2.47, P <0.001). Intra- and postoperative Pao 2 to Fio 2 were similar and no postoperative pulmonary complications occurred. Atelectasis occurred more frequently when ARM was performed with high than with low Fio 2 . High-Fio 2 did not benefit oxygenation. Conclusions In patients undergoing laparoscopic surgery in the Trendelenburg position, absorption atelectasis occurred more frequently when the ARM was performed with high rather than low Fio 2 . No oxygenation benefit was observed in the high-Fio 2 group.

scholarly journals Surgical resection for rectal cancer. Is laparoscopic surgery as successful as open approach? A systematic review with meta-analysis

PLoS ONE ◽  
2018 ◽  
Vol 13 (10) ◽  
pp. e0204887 ◽  
Author(s):  
Marco Milone ◽  
Michele Manigrasso ◽  
Morena Burati ◽  
Nunzio Velotti ◽  
Francesco Milone ◽  
...  
Keyword(s):  
Systematic Review ◽  
Rectal Cancer ◽  
Laparoscopic Surgery ◽  
Surgical Resection ◽  
Meta Analysis ◽  
Open Approach

Short-Term Outcomes of Laparoscopic Rectal Surgery for Primary Rectal Cancer in Elderly Patients: Is it Safe and Beneficial?

2009 ◽  
Vol 13 (9) ◽  
pp. 1614-1618 ◽  
Author(s):  
Takashi Akiyoshi ◽  
Hiroya Kuroyanagi ◽  
Masatoshi Oya ◽  
Tsuyoshi Konishi ◽  
Meiki Fukuda ◽  
...  
Keyword(s):  
Rectal Cancer ◽  
Elderly Patients ◽  
Rectal Surgery ◽  
Short Term ◽  
Primary Rectal Cancer ◽  
Laparoscopic Rectal Surgery

scholarly journals Single-Access Laparoscopic Rectal Surgery Is Technically Feasible

2013 ◽  
Vol 2013 ◽  
pp. 1-6 ◽  
Author(s):  
Siripong Sirikurnpiboon ◽  
Paiboon Jivapaisarnpong
Keyword(s):  
Rectal Cancer ◽  
Laparoscopic Surgery ◽  
Total Mesorectal Excision ◽  
Perioperative Complications ◽  
Rectal Surgery ◽  
Anal Canal Cancer ◽  
Mesorectal Excision ◽  
Single Access ◽  
Laparoscopic Rectal Surgery ◽  
The Mean

Introduction. Single-access laparoscopic surgery (SALS) has been successfully introduced for colectomy surgery; however, for mid to low rectum procedures such as total mesorectal excision, it can be technically complicated. In this study, we introduced a single-access technique for rectum cancer operations without the use of other instruments.Aims. To show the short-term results of single-access laparoscopic rectal surgery in terms of pathologic results and immediate complications.Settings and Design. Prospective study.Materials and Methods. We selected middle rectum to anal canal cancer patients to undergo single-access laparoscopic rectal resection for rectal cancer. All patients had total mesorectal excisions. An umbilical incision was made for the insertion of a single multichannel port, and a mesocolic window was created to identify the inferior mesenteric artery and vein. Total mesorectal excision was performed. There were no perioperative complications. The mean operative time was 269 minutes; the median hospital stay was 7 days; the mean wound size was 5.5 cm; the median number of harvested lymph nodes was 15; and all patients had intact mesorectal capsules.Statistical Analysis Used. Mean, minimum–maximum.Conclusion. Single-access laparoscopic surgery for rectal cancer is feasible while oncologic principles and patient safety are maintained.

Safety of Biologic Agents in Elderly Patients with Rheumatoid Arthritis

2016 ◽  
Vol 43 (11) ◽  
pp. 1984-1988 ◽  
Author(s):  
Atsuko Murota ◽  
Yuko Kaneko ◽  
Kunihiro Yamaoka ◽  
Tsutomu Takeuchi
Keyword(s):  
Rheumatoid Arthritis ◽  
Risk Factors ◽  
Adverse Events ◽  
Elderly Patients ◽  
Young Patients ◽  
Pulmonary Complications ◽  
Biologic Agents ◽  
Treatment Withdrawal ◽  
Old Patients ◽  
Independent Risk Factors

Objective.To clarify the safety of biologics in elderly patients with rheumatoid arthritis.Methods.Biologics were analyzed for safety in relation to age in 309 patients.Results.Young (< 65 yrs old, n = 174), elderly (65–74 yrs old, n = 86), and older elderly patients (≥ 75 yrs old, n = 49) were enrolled. Although the incidence of adverse events causing treatment withdrawal was significantly higher in elderly and old elderly compared with young patients, no difference was found between elderly and older elderly patients. Pulmonary complications were independent risk factors.Conclusion.Old patients require special attention, although the safety of biologics in those ≥ 75 years old and 65–74 was comparable.

scholarly journals The effect of the fraction of inspired oxygen during alveolar recruitment on absorption atelectasis in laparoscopic surgery: A randomized, controlled trial

2020 ◽  
Author(s):  
Bo Rim Kim ◽  
Seohee Lee ◽  
Hansu Bae ◽  
Minkyoo Lee ◽  
Jae-Hyon Bahk ◽  
...  
Keyword(s):  
Laparoscopic Surgery ◽  
Controlled Trial ◽  
Pulmonary Complications ◽  
Alveolar Recruitment ◽  
Postoperative Pulmonary Complications ◽  
Trendelenburg Position ◽  
Alveolar Recruitment Maneuver ◽  
Fraction Of Inspired Oxygen ◽  
Inspired Oxygen ◽  
Group Trial

Abstract Background The intraoperative alveolar recruitment maneuver (ARM) efficiently treats atelectasis, but the effect of Fio2 during ARM on atelectasis is uncertain. Here, we investigated this effect. Methods Patients undergoing elective laparoscopic surgery in the Trendelenburg position were randomized to low- (Fio2 0.4; n = 44) and high-Fio2 (Fio2 1.0, n = 46) groups. ARMs were performed 1-min post tracheal intubation and post changes between supine and Trendelenburg positions during surgery. Intraoperative Fio2 was set at 0.4 for both groups. Modified lung ultrasound (LUS) scores were calculated to assess lung aeration after inducing anesthesia and at surgery completion. The primary outcome was modified LUS score at the end of the surgery, and secondary outcomes were the intra- and postoperative Pao2 to Fio2 ratio and postoperative pulmonary complications. Results Both groups presented similar modified LUS scores before capnoperitoneum and ARM (P = 0.747). However, the postoperative modified LUS score was significantly lower in the low- than in the high-Fio2 group (7.0 ± 4.1 vs 11.7 ± 4.2, mean difference 4.7, 95% CI 2.96–6.44, P < 0.001). Significant atelectasis postoperatively was more common in the high-Fio2 group (relative risk 1.77, 95% CI 1.27‒2.47, P < 0.001). Intra- and postoperative Pao2 to Fio2 were similar and no postoperative pulmonary complications occurred. Atelectasis occurred more frequently when ARM was performed with high than with low Fio2. High-Fio2 did not benefit oxygenation. Conclusions In patients undergoing laparoscopic surgery in the Trendelenburg position, absorption atelectasis occurred more frequently when the ARM was performed with high rather than low Fio2. No oxygenation benefit was observed in the high-Fio2 group. Trial registration: ClinicalTrials.gov, NCT03943433. Registered 7 May 2019, https://clinicaltrials.gov/ct2/show/NCT03943433

scholarly journals Impact of Procedure Time of Preceding Endoscopic Submucosal Dissection on the Difficulty of Laparoscopic Rectal Surgery

2020 ◽  
Author(s):  
Hiroaki Nozawa ◽  
Kazushige Kawai ◽  
Kazuhito Sasaki ◽  
Shigenobu Emoto ◽  
Koji Murono ◽  
...  
Keyword(s):  
Rectal Cancer ◽  
Laparoscopic Surgery ◽  
Blood Loss ◽  
Operative Time ◽  
Anal Verge ◽  
Rectal Surgery ◽  
Tumor Location ◽  
Intraoperative Blood Loss ◽  
Procedure Time ◽  
Laparoscopic Rectal Surgery

Abstract Background Endoscopic treatment for gastrointestinal cancer can cause inflammation, edema, and fibrosis formation in the surrounding tissue. Recently, we reported that preceding endoscopic treatment increased the volume of intraoperative blood loss and slightly prolonged the operative time of laparoscopic surgery for rectal cancer. In this study, we addressed which factors, including endoscopic submucosal dissection (ESD)- related parameters, affect the difficulty of laparoscopic rectal surgery. Methods We retrospectively reviewed 24 consecutive patients who underwent ESD followed by laparoscopic surgery for rectal cancer in our hospital. Short-term surgical outcomes were evaluated by intraoperative blood loss and operative time for laparoscopic surgery. The correlations between the surgical outcomes and preoperative parameter were analyzed by scatter diagrams and multiple linear regression analyses. Results The patient cohort comprised 12 men and 12 women. The median distance between primary cancer and anal verge was 7 cm. The median procedure time of ESD was 120 minutes (21 available cases). The scatter diagram graph revealed a positive correlation between the ESD procedure time and estimated blood loss during rectal surgery (rs = 0.26). There was no association between the ESD procedure time and operative time for rectal surgery. Based on multiple linear regression analyses, the ESD procedure time (p = 0.007) and tumor location from the anal verge (p = 0.046) were independently predictive of intraoperative blood loss. On the other hand, only tumor location was found an independent predictor of surgical time (p = 0.014). Conclusions A long session of ESD for rectal cancer may make subsequent laparoscopic surgery difficult based on intraoperative blood loss.

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