Comparison Between Minimally Invasive and Open Gastrectomy for Gastric Cancer in Europe: A Systematic Review and Meta-analysis

Aims: We compared laparoscopic and robotic gastrectomies with open gastrectomies and with each other that were held for gastric cancer in Europe. Methods: We searched for studies conducted in Europe and published up to 20 February 2015 in the PubMed database that compared laparoscopic or robotic with open gastrectomies for gastric cancer and with each other. Results: We found 18 original studies (laparoscopic vs open: 13; robotic vs open: 3; laparoscopic vs robotic: 2). Of these, 17 were non-randomized trials and only 1 was a randomized controlled trial. Only four studies had more than 50 patients in each arm. No significant differences were detected between minimally invasive and open approaches regarding the number of retrieved lymph nodes, anastomotic leakage, duodenal stump leakage, anastomotic stenosis, postoperative bleeding, reoperation rates, and intraoperative/postoperative mortality. Nevertheless, laparoscopic procedures provided higher overall morbidity rates when compared with open ones, but robotic approaches did not differ from open ones. On the contrary, blood loss was less and hospital stay was shorter in minimally invasive than in open approaches. However, the results were controversial concerning the duration of operations when comparing minimally invasive with open gastrectomies. Additionally, laparoscopic and robotic procedures provided equivalent results regarding resection margins, duodenal stump leakage, postoperative bleeding, intraoperative/postoperative mortality, and length of hospital stay. On the contrary, robotic operations had less blood loss, but lasted longer than laparoscopic ones. Finally, there were relatively low conversion rates in laparoscopic (0%–6.7%) and robotic gastrectomies (0%–5.6%) in most studies. Conclusion: Laparoscopic and robotic gastrectomies may be considered alternative approaches to open gastrectomies for treating gastric cancer. Minimally invasive operations are characterized by less blood loss and shorter hospital stay than open ones. In addition, robotic procedures have less blood loss, but last longer than laparoscopic ones.

Download Full-text

Retroperitoneoscopic nephrectomy for a nonfunctioning kidney

Vojnosanitetski pregled ◽

10.2298/vsp170215112s ◽

2019 ◽

Vol 76 (6) ◽

pp. 577-581

Author(s):

Vuk Sekulic ◽

Jovo Bogdanovic ◽

Ranko Herin ◽

Senjin Djozic ◽

Mladen Popov

Keyword(s):

Blood Loss ◽

Minimally Invasive ◽

Hospital Stay ◽

Demographic Data ◽

Postoperative Mortality ◽

Ct Urography ◽

Average Hospital ◽

Average Blood Loss ◽

Duration Of Surgery ◽

Functioning Kidney

Background/Aim. The minimally invasive laparoscopic nephrectomy was first performed in 1991. The objective of this paper was to present the surgical technique of retroperitoneoscopic nephrectomy and to our experience with this procedure in removal of non-functioning kidneys. Methods. This retrospective study enrolled 55 patients who underwent retroperitoneoscopic nephrectomy at our institution during the period from January 2011 to November 2016. All patients had a unilateral non-functioning kidney confirmed by intravenous or computed tomography (CT)- urography and renal scintigram. Their medical records were analyzed for demographic data, duration of surgery, average blood loss, duration of hospital stay as well as time to return to normal life activities. Results. The mean age of patients was 43 years (range 23?78). Perioperative or early postoperative mortality was not recorded. Mean operative time was 82 minutes (range 45?210). The average blood loss was 90 mL (40?450). The average hospital stay was 4 days (3?7). Return to life activity was in average after 12 days (9?15). Conclusions. Retroperitoneoscopic nephrectomy for a non-functioning kidney is a feasible, safe, and effective minimally invasive method. The length of hospital stay and convalescence was shorter than after open nephrectomy.

Download Full-text

Our experience with laparoscopic total gastrectomy for gastric cancer: A case series

Journal of Gastric Surgery ◽

10.36159/jgs.v2i3.52 ◽

2020 ◽

Vol 2 (3) ◽

Author(s):

Manash Ranjan Sahoo ◽

Satyajit Samal ◽

Jyotirmay Nayak

Keyword(s):

Gastric Cancer ◽

Blood Loss ◽

Hospital Stay ◽

Total Gastrectomy ◽

Median Time ◽

Operative Time ◽

Laparoscopic Total Gastrectomy ◽

Oral Feeding ◽

Care Hospital ◽

Intraoperative Blood Loss

Background: Though laparoscopic distal gastrectomy has become a standard procedure for treatment of gastric cancer, laparoscopic total gastrectomy has not been widely accepted as it requires more dexterity and lack of evidence about its feasibility and safety. Methods: Here retrospectively we review a series of 12 cases of gastric cancer undergone laparoscopic total gastrectomy with D1 or D2 lymphadenectomy over a period of 7 years at a tertiary care hospital. The patient demographic characteristics were reviewed and the outcomes after surgery was analyzed in terms of extent of lymphadenectomy, mean operative time, mean intraoperative blood loss median number of lymph nodes harvested, median time for postoperative ambulation, median time for postoperative oral feeding, median time of postoperative hospital stay, postoperative complications and mortality. Results: All patients had total gastrectomy entirely through laparoscopic method. Mean operative time was 282 minutes, mean intraoperative blood loss was 120 ml, median time for ambulation and oral feeding was 3 days and 6 days respectively. Median time of hospital stay was 16 days and 2 patients had complications as pancreatic fistula and port site abscess. No mortality was observed. Conclusion: With zero mortality and accepted rate of complications, laparoscopic total gastrectomy appears to be technically feasible and safe for management of gastric cancer. But more studies have to be conducted with comparison to other standard gastrectomies and long term follow up to be done to establish its standardized application.

Download Full-text

Endoscopic clipping of duodenal stump leakage after Billroth II gastrectomy in gastric cancer patient

Journal of Surgical Oncology ◽

10.1002/jso.21285 ◽

2009 ◽

Vol 100 (1) ◽

pp. 80-81 ◽

Cited By ~ 9

Author(s):

Jong Yeul Lee ◽

Keun Won Ryu ◽

Soo-Jeong Cho ◽

Chan Gyoo Kim ◽

Il Ju Choi ◽

...

Keyword(s):

Gastric Cancer ◽

Cancer Patient ◽

Gastric Cancer Patient ◽

Duodenal Stump ◽

Billroth Ii ◽

Billroth Ii Gastrectomy ◽

Duodenal Stump Leakage ◽

Endoscopic Clipping

Download Full-text

The Hand-Assisted Laparoscopic Approach to Resection of Pancreatic Mucinous Cystic Neoplasms: An Underused Technique?

The American Surgeon ◽

10.1177/000313481808400123 ◽

2018 ◽

Vol 84 (1) ◽

pp. 56-62

Author(s):

Lauren M. Postlewait ◽

Cecilia G. Ethun ◽

Mia R. Mcinnis ◽

Nipun Merchant ◽

Alexander Parikh ◽

...

Keyword(s):

Blood Loss ◽

Minimally Invasive ◽

Hospital Stay ◽

Distal Pancreatectomy ◽

Operative Time ◽

Operative Blood Loss ◽

Specimen Length ◽

Cystic Neoplasms ◽

Invasive Approach ◽

Mucinous Cystic Neoplasms

Pancreatic mucinous cystic neoplasms (MCNs) are rare tumors typically of the distal pancreas that harbor malignant potential. Although resection is recommended, data are limited on optimal operative approaches to distal pancreatectomy for MCN. MCN resections (2000–2014; eight institutions) were included. Outcomes of minimally invasive and open MCN resections were compared. A total of 289 patients underwent distal pancreatectomy for MCN: 136(47%) minimally invasive and 153(53%) open. Minimally invasive procedures were associated with smaller MCN size (3.9 vs 6.8 cm; P = 0.001), lower operative blood loss (192 vs 392 mL; P = 0.001), and shorter hospital stay(5 vs 7 days; P = 0.001) compared with open. Despite higher American Society of Anesthesiologists class, hand-assisted (n = 46) had similar advantages as laparoscopic/robotic (n = 76). When comparing hand-assisted to open, although MCN size was slightly smaller (4.1 vs 6.8 cm; P = 0.001), specimen length, operative time, and nodal yield were identical. Similar to laparoscopic/robotic, hand-assisted had lower operative blood loss (161 vs 392 mL; P = 0.001) and shorter hospital stay (5 vs 7 days; P = 0.03) compared with open, without increased complications. Hand-assisted laparoscopic technique is a useful approach for MCN resection because specimen length, lymph node yield, operative time, and complication profiles are similar to open procedures, but it still offers the advantages of a minimally invasive approach. Hand-assisted laparoscopy should be considered as an alternative to open technique or as a successive step before converting from total laparoscopic to open distal pancreatectomy for MCN.

Download Full-text

Perioperative morbidity of different operative approaches in early cervical carcinoma: a systematic review and meta-analysis comparing minimally invasive versus open radical hysterectomy

Archives of Gynecology and Obstetrics ◽

10.1007/s00404-021-06248-8 ◽

2021 ◽

Author(s):

J. Kampers ◽

E. Gerhardt ◽

P. Sibbertsen ◽

T. Flock ◽

H. Hertel ◽

...

Keyword(s):

Blood Loss ◽

Minimally Invasive ◽

Hospital Stay ◽

Radical Hysterectomy ◽

Postoperative Morbidity ◽

Meta Analysis ◽

Operation Time ◽

Mean Difference ◽

Inclusion Criteria ◽

Estimated Blood Loss

Abstract Purpose Radical hysterectomy and pelvic lymphadenectomy is the standard treatment for early cervical cancer. Studies have shown superior oncological outcome for open versus minimal invasive surgery, but peri- and postoperative complication rates were shown vice versa. This meta-analysis evaluates the peri- and postoperative morbidities and complications of robotic and laparoscopic radical hysterectomy compared to open surgery. Methods Embase and Ovid-Medline databases were systematically searched in June 2020 for studies comparing robotic, laparoscopic and open radical hysterectomy. There was no limitation in publication year. Inclusion criteria were set analogue to the LACC trial. Subgroup analyses were performed regarding the operative technique, the study design and the date of publication for the endpoints intra- and postoperative morbidity, estimated blood loss, hospital stay and operation time. Results 27 studies fulfilled the inclusion criteria. Five prospective, randomized-control trials were included. Meta-analysis showed no significant difference between robotic radical hysterectomy (RH) and laparoscopic hysterectomy (LH) concerning intra- and perioperative complications. Operation time was longer in both RH (mean difference 44.79 min [95% CI 38.16; 51.42]), and LH (mean difference 20.96 min; [95% CI − 1.30; 43.22]) than in open hysterectomy (AH) but did not lead to a rise of intra- and postoperative complications. Intraoperative morbidity was lower in LH than in AH (RR 0.90 [0.80; 1.02]) as well as in RH compared to AH (0.54 [0.33; 0.88]). Intraoperative morbidity showed no difference between LH and RH (RR 1.29 [0.23; 7.29]). Postoperative morbidity was not different in any approach. Estimated blood loss was lower in both LH (mean difference − 114.34 [− 122.97; − 105.71]) and RH (mean difference − 287.14 [− 392.99; − 181.28]) compared to AH, respectively. Duration of hospital stay was shorter for LH (mean difference − 3.06 [− 3.28; − 2.83]) and RH (mean difference − 3.77 [− 5.10; − 2.44]) compared to AH. Conclusion Minimally invasive radical hysterectomy appears to be associated with reduced intraoperative morbidity and blood loss and improved reconvalescence after surgery. Besides oncological and surgical factors these results should be considered when counseling patients for radical hysterectomy and underscore the need for new randomized trials.

Download Full-text

Duodenal Stump Reinforcement with Purse-string Suture in Distal Gastrectomy under Laparoscope Combined with Uncut Roux-en-Y Reconstruction in Patients with Gastric Cancer

10.21203/rs.3.rs-94552/v1 ◽

2020 ◽

Author(s):

Fengyuan Li ◽

Jianghao Xu ◽

Hao Xu ◽

Weizhi Wang ◽

Diancai Zhang ◽

...

Keyword(s):

Gastric Cancer ◽

Patient Outcomes ◽

Distal Gastrectomy ◽

Patient Characteristics ◽

Linear Stapler ◽

Duodenal Stump ◽

Purse String Suture ◽

Purse String ◽

Significant Difference ◽

Duodenal Stump Leakage

Abstract Background: This study aimed to compare patient outcomes after laparoscopic distal gastrectomy with uncut Roux-en-Y reconstruction for gastric cancer between a group who underwent a duodenal stump reinforcement procedure and those who did not.Methods: Data from 233 patients with gastric cancer (GC) undergoing distal gastrectomy under laparoscope combined with uncut Roux-en-Y reconstruction were retrospectively investigated. Patients were divided into two groups. The non-reinforcement group (NR) underwent surgery from June 2014 to March 2015 with no reinforcement of the duodenal stump (n=54) and the reinforcement group (R) underwent surgery from April 2015 to June 2018 with reinforcement of the duodenal stump (n=179). In group R, the duodenum was divided using an endoscope-assisted linear stapler, which was reinforced by a purse-string suture along the duodenal staple line. Results: Duodenal stump leakage was observed in 2 patients from group NR (3.7%), while no duodenal stump leakage or fistula was detected in group R. In addition, no significant difference was observed in the patient characteristics between group NR and R.Conclusions: The incidence of duodenal stump leakage can be reduced by reinforcement with a purse-string suture.

Download Full-text

Comparison of Hand-assisted Laparoscopic and Open Radical Distal Gastrectomy for Obese Patients

The American Surgeon ◽

10.1177/000313481307901219 ◽

2013 ◽

Vol 79 (12) ◽

pp. 1273-1278 ◽

Cited By ~ 2

Author(s):

Guang-Tan Zhang ◽

Dong Liang ◽

Xue-Dong Zhang

Keyword(s):

Gastric Cancer ◽

Blood Loss ◽

Hospital Stay ◽

Distal Gastrectomy ◽

Postoperative Hospital Stay ◽

Obese Patients ◽

Injection Time ◽

Open Distal Gastrectomy ◽

Estimated Blood Loss ◽

Wound Length

To evaluate the feasibility and safety of hand-assisted laparoscopic surgery for gastric cancer in obese patients, we compare the operative outcomes in obese patients who underwent hand-assisted laparoscopic distal gastrectomy (HALDG) and open distal gastrectomy (ODG). One hundred sixty-two obese patients with gastric cancer operated on in our department from January 2009 to December 2011 were divided into two groups: the open distal gastrectomy group (the ODG group) and the hand-assisted laparoscopic distal gastrectomy group (the HALDG group). Operative time, estimated blood loss, number of lymph node retrieval, wound length, times of analgesic injection, time to the first flatus, and postoperative hospital stay were compared between the two groups. Estimated blood loss, wound length, times of analgesic injection, time to the first flatus, and postoperative hospital stay were significantly less or shorter in the HALDG group than in the ODG group. There were no significant differences in tumor size, retrieved lymph nodes, American Joint Cancer Committee /Union Internationale Contre le Cancer staging, and resection margins between the two groups. Obesity should not be seen as a contraindication for HALDG. HALDG for obese patients is a safe, feasible, and oncologically sound procedure and has advantages over ODG.

Download Full-text

Comparison of Minimally Invasive Surgery versus Laparotomy for Surgical Staging of Endometrial Carcinoma: A Retrospective Study

Birat Journal of Health Sciences ◽

10.3126/bjhs.v5i1.29613 ◽

2020 ◽

Vol 5 (1) ◽

pp. 916-920

Author(s):

Mona Priyadarshini ◽

Rani Akhil Bhat

Keyword(s):

Endometrial Cancer ◽

Minimally Invasive Surgery ◽

Blood Loss ◽

Minimally Invasive ◽

Hospital Stay ◽

Endometrial Carcinoma ◽

Invasive Surgery ◽

Surgical Staging ◽

Duration Of Hospital Stay ◽

Significant Difference

Introduction: Endometrial carcinoma is one of the commonest gynaecological cancer in developed countries as well as developing countries. The mainstay of initial treatment of endometrial carcinoma is surgical staging which may be performed by either the conventional abdominal approach or by minimally invasive route i.e. laparoscopic or robotic. Objectives: The purpose of this study was to compare and evaluate the surgical staging, safety and clinical benefits of minimally invasive surgeries versus. laparotomy in patients with endometrial cancer. Methodology: We retrospectively analyzed 105 patients with endometrial cancer over a period of five years and compared the outcome of total hysterectomy with pelvic and para-aortic lymphadenectomy by abdominal, laparoscopic approach or robotic-assisted surgery. Comparison was done with respect to operative time, blood loss, number of lymph nodes retrieved, length of hospital stay, intraoperative and postoperative complications. The data were analyzed using paired “t”- test / Wilcoxon signed rank test ,χ2 - test, Pearson correlation coefficient “r” whenever found suitable. P value of less than 0.05 was considered as statistically significant. Result: There was no statistically significant difference seen in the baseline characteristics like age and BMI between the two groups. The laparotomies were done in a shorter time than the minimally invasive approach (p<0.001). The amount of blood loss (p=0.002), and the duration of hospital stay (p<0.001) was significantly less in the minimally invasive surgery group than the laparotomies. Not much difference in the lymph node retrieval was observed between the two arms (p=0.614). The number of complications were almost similar in both the groups. Conclusion: Minimally invasive surgery for surgical staging of endometrial carcinoma is feasible and effective than laparotomy. The amount of blood loss and duration of hospital stay is seen much lesser with MIS than laparotomy.

Download Full-text

Risk Factors for Duodenal Stump Leakage after Laparoscopic Gastrectomy for Gastric Cancer

Journal of Gastric Cancer ◽

10.5230/jgc.2020.20.e4 ◽

2020 ◽

Vol 20 (1) ◽

pp. 81

Author(s):

Lihu Gu ◽

Kang Zhang ◽

Zefeng Shen ◽

Xianfa Wang ◽

Hepan Zhu ◽

...

Keyword(s):

Risk Factors ◽

Gastric Cancer ◽

Laparoscopic Gastrectomy ◽

Duodenal Stump ◽

Duodenal Stump Leakage

Download Full-text

Systematic review and updated network meta-analysis comparing open, laparoscopic, and robotic pancreaticoduodenectomy

Updates in Surgery ◽

10.1007/s13304-020-00916-1 ◽

2020 ◽

Author(s):

Alberto Aiolfi ◽

Francesca Lombardo ◽

Gianluca Bonitta ◽

Piergiorgio Danelli ◽

Davide Bona

Keyword(s):

Minimally Invasive ◽

Hospital Readmission ◽

Meta Analysis ◽

Postoperative Bleeding ◽

Pancreatic Head ◽

Postoperative Mortality ◽

Hospital Length Of Stay ◽

Oncologic Outcomes ◽

Estimated Blood Loss ◽

Robotic Pancreaticoduodenectomy

AbstractThe treatment of periampullary and pancreatic head neoplasms is evolving. While minimally invasive Pancreaticoduodenectomy (PD) has gained worldwide interest, there has been a debate on its related outcomes. The purpose of this paper was to provide an updated evidence comparing short-term surgical and oncologic outcomes within Open Pancreaticoduodenectomy (OpenPD), Laparoscopic Pancreaticoduodenectomy (LapPD), and Robotic Pancreaticoduodenectomy (RobPD). MEDLINE, Web of Science, PubMed, Cochrane Central Library, and ClinicalTrials.gov were referred for systematic search. A Bayesian network meta-analysis was executed. Forty-one articles (56,440 patients) were included; 48,382 (85.7%) underwent OpenPD, 5570 (9.8%) LapPD, and 2488 (4.5%) RobPD. Compared to OpenPD, LapPD and RobPD had similar postoperative mortality [Risk Ratio (RR) = 1.26; 95%CrI 0.91–1.61 and RR = 0.78; 95%CrI 0.54–1.12)], clinically relevant (grade B/C) postoperative pancreatic fistula (POPF) (RR = 1.12; 95%CrI 0.82–1.43 and RR = 0.87; 95%CrI 0.64–1.14, respectively), and severe (Clavien-Dindo ≥ 3) postoperative complications (RR = 1.03; 95%CrI 0.80–1.46 and RR = 0.93; 95%CrI 0.65–1.14, respectively). Compared to OpenPD, both LapPD and RobPD had significantly reduced hospital length-of-stay, estimated blood loss, infectious, pulmonary, overall complications, postoperative bleeding, and hospital readmission. No differences were found in the number of retrieved lymph nodes and R0. OpenPD, LapPD, and RobPD seem to be comparable across clinically relevant POPF, severe complications, postoperative mortality, retrieved lymphnodes, and R0. LapPD and RobPD appears to be safer in terms of infectious, pulmonary, and overall complications with reduced hospital readmission We advocate surgeons to choose their preferred surgical approach according to their expertise, however, the adoption of minimally invasive techniques may possibly improve patients’ outcomes.

Download Full-text