scholarly journals Comparison of Short-Term Outcomes Between Robotic-Assisted and Laparoscopic Surgery in Colorectal Cancer

2018 ◽  
Vol 26 (1) ◽  
pp. 57-65 ◽  
Author(s):  
Xiao-Long Zhu ◽  
Pei-Jing Yan ◽  
Liang Yao ◽  
Rong Liu ◽  
De-Wang Wu ◽  
...  
Keyword(s):  
Colorectal Cancer ◽  
Laparoscopic Surgery ◽  
Colorectal Surgery ◽  
Hospital Stay ◽  
Bowel Function ◽  
Postoperative Recovery ◽  
Postoperative Hospital Stay ◽  
Robot Assisted ◽  
Short Term ◽  
Robotic Colorectal Surgery

Aim. The robotic technique has been established as an alternative approach to laparoscopy in colorectal surgery. The aim of this study was to compare short-term outcomes of robot-assisted and laparoscopic surgery in colorectal cancer. Methods. The cases of robot-assisted or laparoscopic colorectal resection were collected retrospectively between July 2015 and October 2017. We evaluated patient demographics, perioperative characteristics, and pathologic examination. A multivariable linear regression model was used to assess short-term outcomes between robot-assisted and laparoscopic surgery. Short-term outcomes included time to passage of flatus and postoperative hospital stay. Results. A total of 284 patients were included in the study. There were 104 patients in the robotic colorectal surgery (RCS) group and 180 in the laparoscopic colorectal surgery (LCS) group. The mean age was 60.5 ± 10.8 years, and 62.0% of the patients were male. We controlled for confounding factors, and then the multiple linear model regression indicated that the time to passage of flatus in the RCS group was 3.45 days shorter than the LCS group (coefficient = −3.45, 95% confidence interval [CI] = −5.19 to −1.71; P < .001). Additionally, the drainage of tube duration (coefficient = 0.59, 95% CI = 0.3 to 0.87; P < .001) and transfers to the intensive care unit (coefficient = 7.34, 95% CI = 3.17 to 11.5; P = .001) influenced the postoperative hospital stay. The total costs increased by 15501.48 CNY in the RCS group compared with the LCS group ( P = .008). Conclusions. The present study suggests that colorectal cancer robotic surgery was more beneficial to patients because of shorter postoperative recovery time of bowel function and shorter hospital stays.

scholarly journals Comparison of Intestinal Stent Placement Followed By Laparoscopic Surgery and Emergency Surgery in Obstructive Colorectal Cancer: A Retrospective Analysis and Meta-analysis

2022 ◽  
Author(s):  
Zhengwei Li ◽  
Yan Lu ◽  
Kang Wang ◽  
Tianyou Liao ◽  
Yongle Ju ◽  
...  
Keyword(s):  
Colorectal Cancer ◽  
Laparoscopic Surgery ◽  
Hospital Stay ◽  
Stent Placement ◽  
Emergency Surgery ◽  
Operating Time ◽  
Postoperative Hospital Stay ◽  
Postoperative Wound Infection ◽  
Intraoperative Blood Loss ◽  
Perioperative Mortality

Abstract Background: For patients with colorectal cancer and malignant intestinal obstruction, it is still controversial to perform endoscopic intestinal stent placement followed by laparoscopic surgery. This study compares the endoscopic intestinal stent placement followed by laparoscopic surgery and emergency surgery in patients with colorectal cancer and malignant intestinal obstruction.Method: 11 compliant publications from Pubmed, Cochrane and Embase databases were analyzed using Revies Manager 5.2 software. SPSS 21 was used to retrospectively analyze 99 patients admitted to our center from 2014 to 2019.Results: There were significant differences between the two groups in three of the five criteria. In the SBTS group, the perioperative mortality rate was lower, with an OR of 0.46 (95% CI: 0.22-0.95, P=0.04), the incidence of postoperative wound infection was lower; OR was 0.44 (95% CI: 0.24-0.82, P=0.009); Postoperative hospital stay was shorter, MD was -2.07 (95% CI: -2.55--1.59, P<0.00001).Retrospective analysis of the clinical outcome differences between the SBTS group and ES group in our center: Compared to the ES group, the SBTS group displayed lower infection rate of surgical incision (χ2=3.94,P =0.04) ); no difference in the frequency of occurrence of anastomotic leakage (χ2=0.18,P=0.67), did not reduce perioperative mortality (χ2=0.94,P=0.33);shorter operating time (204.13±37.35 min) (t=5.08,P=0.000), lower intraoperative blood loss (155.65±94.90 ml) (t=3.90,P=0.001); and shorter postoperative hospital stay (12.91±5.47 d) (t=2.64, P=0.01).Conclusion: Compared the emergency surgery group, endoscopic intestinal stent placement followed by the laparoscopic surgery can reduce perioperative mortality, postoperative wound infection, intraoperative blood loss, and the length of postoperative hospital stay. There was no difference between the two methods as far as the incidence of posterior anastomotic leakage and operating time were concerned.

scholarly journals Effective implementation and adaptation of structured robotic colorectal programme in a busy tertiary unit

2020 ◽  
Author(s):  
A. Thomas ◽  
K. Altaf ◽  
D. Sochorova ◽  
U. Gur ◽  
A. Parvaiz ◽  
...  
Keyword(s):  
Colorectal Cancer ◽  
Colorectal Surgery ◽  
Length Of Stay ◽  
Blood Loss ◽  
Resection Margin ◽  
Training Programme ◽  
Short Term ◽  
Oncological Outcomes ◽  
Robotic Colorectal Surgery ◽  
Tertiary Center

Abstract Background Safety and feasibility of robotic colorectal surgery has been reported as increasing over the last decade. However safe implementation and adaptation of such a programme with comparable morbidities and acceptable oncological outcomes remains a challenge in a busy tertiary unit. We present our experience of implementation and adaptation of a structured robotic colorectal programme in a high-volume center in the United Kingdom. Methods Two colorectal surgeons underwent a structured robotic colorectal training programme consisting of time on simulation console, dry and wet laboratory courses, case observation, and initial mentoring. Data were collected on consecutive robotic colorectal cancer resections over a period of 12 months and compared with colorectal cancer resections data of the same surgeons’ record prior to the adaptation of the new technique. Patient demographics including age, gender, American Society of Anesthesiologist score (ASA), Clavien–Dindo grading, previous abdominal surgeries, and BMI were included. Short-term outcomes including conversion to open, length of stay, return to theatre, 30- and 90-days mortality, blood loss, and post-operative analgesia were recorded. Tumour site, TNM staging, diverting stoma, neo-adjuvant therapy, total mesorectal excision (TME) grading and positive resection margins (R1) were compared. p values less than or equal to 0.05 were considered statistically significant. Results Ninety colorectal cancer resections were performed with curative intent from June 2018 to June 2020. Thirty robotic colorectal cancer resections (RCcR) were performed after adaption of programme and were compared with 60 non-robotic colorectal cancer resections (N-RCcR) prior to implementation of technique. There was no conversion in the RCcR group; however, in N-RCcR group, five had open resection from start and the rest had laparoscopic surgery. In laparoscopic group, there were six (10.9%) conversions to open (two adhesions, three multi-visceral involvements, one intra-operative bleed). Male-to-female ratio was 20:09 in RCcR group and 33:20 in N-RCcR groups. No significant differences in gender (p = 0.5), median age (p = 0.47), BMI (p = 0.64) and ASA scores (p = 0.72) were present in either groups. Patient characteristics between the two groups were comparable aside from an increased proportion of rectal and sigmoid cancers in RCcR group. Mean operating time, and returns to theaters were comparable in both groups. Complications were fewer in RCcR group as compared to N-RCcR (16.6% vs 25%). RCcR group patients have reduced length of stay (5 days vs 7 days) but this is not statistically significant. Estimated blood loss and conversion to open surgery was significantly lesser in the robotic group (p < 0.01). The oncological outcomes from surgery including TNM, resection margin status, lymph node yield and circumferential resection margin (for rectal cancers) were all comparable. There was no 30-day mortality in either group. Conclusion Implementation and integration of robotic colorectal surgery is safe and effective in a busy tertiary center through a structured training programme with comparable short-term survival and oncological outcomes during learning curve.

scholarly journals Laparoscopic colorectal cancer surgery - a prospective study of short-term outcomes of consecutive cases over 3 years

2021 ◽  
Vol 14 (2) ◽  
pp. 25-31
Author(s):  
Nitin Patel ◽  
Vipul D. Yagnik
Keyword(s):  
Colorectal Cancer ◽  
Colorectal Surgery ◽  
Blood Loss ◽  
Hospital Stay ◽  
Median Time ◽  
Laparoscopic Colorectal Surgery ◽  
Team Approach ◽  
Short Term ◽  
Early Recovery ◽  
Postoperative Stay

This study was carried out with the objectives to study the feasibility of laparoscopic colorectal cancer resection, to observe short term outcome such as recovery parameters, oncologic safety, morbidity and mortality, and to analyze the experience of laparoscopic colorectal surgery in a teaching hospital. Between January 2007 and July 2009, all consecutive adult cases admitted to our department for colorectal cancer were assessed for eligibility. The ethical committee approved the protocol at the Sterling Hospital. Out of 31 patients,17 were males and 14 females. The mean age was 59 years. The most common clinical presentation was weight loss and altered bowel habits. Rectum (51.61%) was the most commonly involved organ followed by cecum (22.58%). - median time to liquid diet was two days (range 1-22), and a solid diet was three days (range 3-30). The median time to first flatus was two days (range 1-5), and the first stool was five days (range 3-7). The postoperative stay was eight days (range 6-30) median time to mobilization was 2.5 days. The postoperative stay is cumulative and includes patients who underwent reoperation for the anastomotic leak. The median operating time was 240 mins (range 116 – 520). The median length of incision was 6 cm (range 4 – 10 cm). The median blood loss was 170 ml. Blood loss was higher in patients with hemorrhage and tumor adhesions, and both of them were converted to open. These patients incidentally had a more extended hospital stay. The laparoscopic technique for colorectal cancer is feasible and safe. Laparoscopic colorectal surgery (LCS) is associated with short term benefits like the earlier return of gastrointestinal function and shorter length of hospital stay. From the oncologic point of view, tumor resections are adequate, taking into context numbers of lymph nodes retrieved and resectional margins in context to oncologic safety. The decreased postoperative wound infections and early recovery facilitate appropriate adjuvant therapy. Advanced laparoscopic surgery requires a team approach with proper case selection. Transvaginal delivery of specimens can give scar-less surgery and the option for assisted natural orifice surgery.

Short-term outcomes of laparoscopic surgery after insertion of self-expandable metallic stent as a “bridge to surgery” for left-sided obstructive colorectal cancer.

2014 ◽  
Vol 32 (3_suppl) ◽  
pp. 643-643
Author(s):  
Yuhei Waki ◽  
Kazunori Tokuda ◽  
Masayoshi Obatake ◽  
Miya Nagahashi ◽  
Masanori Hotchi ◽  
...  
Keyword(s):  
Colorectal Cancer ◽  
Laparoscopic Surgery ◽  
Blood Loss ◽  
Hospital Stay ◽  
Metallic Stent ◽  
Bridge To Surgery ◽  
Short Term ◽  
Obstructive Colorectal Cancer ◽  
Expandable Metallic Stent ◽  
Significant Difference

643 Background: Safety and validity of performing laparoscopic surgery after preoperative lavege using the self-expandable metallic stent (SEMS) for left-sided obstructive colorectal cancer were examined. We evaluated the short-term outcome of SEMS insertion compared with laparoscopic surgery without SEMS. Methods: Patients with left-sided colorectal cancer treated by either laparoscopic surgery with stent placement (n = 8) or laparoscopic surgery only (n = 42) in our hospital between April, 2012 and January, 2013 were registered. Short-term outcomes were compared with the two groups about patient characteristics (sex, age, American Society of Anesthesiologists Physical Status, body mass index, prior abdominal surgery), pathological data of patients (tumor location, size of tumor , tumor differentiation, number of harvested lymph nodes, pTNM classification, UICC pathological stage), and operative and post operative results (procedures, conversion, operative time, blood loss, morbidity, solid food intake, postoperative hospital stay, total hospital stay). Results: Except for tumor size in the patient characteristic parameters, there were no statistically significant difference between the two groups. Conversion rate to laparotomy was higher in the stent group (2 versus 1, p = 0.013). There was no difference in operation time, blood loss and postoperative complications between the two groups. Conclusions: Although the long-term oncological result requires further investigation, laparoscopic surgery after self-expandable metallic stent is a safe and feasible treatment as a “brige to surgery” for left-sided obstructive colorectal cancer.

scholarly journals The single-incision laparoscopic surgery technique has questionable advantages in colorectal surgery

2018 ◽  
Vol 3 (1) ◽  
pp. 77-84
Author(s):  
Bernd Schneider ◽  
Anne Catharina Brockhaus ◽  
Marcos Gelos ◽  
Claudia Rudroff
Keyword(s):  
Laparoscopic Surgery ◽  
Colorectal Surgery ◽  
Hospital Stay ◽  
Single Incision ◽  
Laparoscopic Colorectal Surgery ◽  
Postoperative Hospital Stay ◽  
Colorectal Disease ◽  
Single Incision Laparoscopic Surgery ◽  
Surgery Technique ◽  
Significant Difference

AbstractBackground:Laparoscopic procedures have increasingly been accepted as standard in surgical treatment of benign and malignant entities, resulting in a continuous evolution of operative techniques. Since one of the aims in laparoscopic colorectal surgery is to reduce access trauma, one possible way is to further reduce the surgical site by the single-incision laparoscopic surgery technique (SLS). One of the main criticisms concerning the use of SLS is its questionable benefit combined with its technical demands for the surgeon. These questions were addressed by comparing SLS versus conventional laparoscopic multitrocar surgery (LMS) in benign and malignant conditions with respect to technical operative parameters and early postoperative outcome of the patients.Methods:Between 2010 and 2013, we performed SLS for colorectal disease. Of the 111 patients who underwent colorectal resection, 47 patients were operated by SLS and 31 using the LMS technique. The collected data for our patients were compared according to operating time, postoperative morbidity and mortality, pain score numeric rating scale on day 1 and day 5 postoperatively and postoperative hospital stay. To complement the pain scores, the required pain medication for adequate pain relief on these days was given.Results:There was no significant difference in age, BMI or sex ratio between the two groups. The intraoperative and early postoperative course was comparable as well. Postoperative hospital stay was the only parameter with a significant difference, showing an advantage for SLS.Conclusion:SLS is a feasible surgical method and a technical option in laparoscopic colorectal surgery. However, we were not able to identify substantial advantages of SLS that would favor this technique.

scholarly journals Distinct Chemokine Dynamics in Early Postoperative Period after Open and Robotic Colorectal Surgery

2019 ◽  
Vol 8 (6) ◽  
pp. 879 ◽  
Author(s):  
Malgorzata Krzystek-Korpacka ◽  
Marek Zawadzki ◽  
Paulina Lewandowska ◽  
Krzysztof Szufnarowski ◽  
Iwona Bednarz-Misa ◽  
...  
Keyword(s):  
Colorectal Surgery ◽  
Blood Loss ◽  
Surgical Site Infections ◽  
Fold Increase ◽  
Bowel Function ◽  
Early Postoperative Period ◽  
Robot Assisted ◽  
Angiogenic Potential ◽  
Robotic Colorectal Surgery ◽  
Colorectal Cancer Patients

Stress response to robot-assisted colorectal surgery is largely unknown. Therefore, we conducted a prospective comparative nonrandomized study evaluating the perioperative dynamics of chemokines: IL-8/CXCL8, MCP-1/CCL2, MIP-1α/CCL3, MIP-1β/CCL4, RANTES/CCL5, and eotaxin-1/CCL11 in 61 colorectal cancer patients following open colorectal surgery (OCS) or robot-assisted surgery (RACS) in reference to clinical data. Postoperative IL-8 and MCP-1 increase was reduced in RACS with a magnitude of blood loss, length of surgery, and concomitant up-regulation of IL-6 and TNFα as its independent predictors. RANTES at 8 h dropped in RACS and RANTES, and MIP1α/β at 24 h were more elevated in RACS than OCS. IL-8 and MCP-1 at 72 h remained higher in patients subsequently developing surgical site infections, in whom a 2.6- and 2.5-fold increase was observed. IL-8 up-regulation at 24 h in patients undergoing open procedure was predictive of anastomotic leak (AL; 94% accuracy). Changes in MCP-1 and RANTES were predictive of delayed restoration of bowel function. Chemokines behave differently depending on procedure. A robot-assisted approach may be beneficial in terms of chemokine dynamics by favoring Th1 immunity and attenuated angiogenic potential and postoperative ileus. Monitoring chemokine dynamics may prove useful for predicting adverse clinical events. Attenuated chemokine up-regulation results from less severe blood loss and diminished inflammatory response.

scholarly journals One-Stage Total Laparoscopic Treatment for Colorectal Cancer With Synchronous Metastasis. Is It Safe and Feasible?

2021 ◽  
Vol 8 ◽  
Author(s):  
Giuseppe Sena ◽  
Arcangelo Picciariello ◽  
Fabio Marino ◽  
Marta Goglia ◽  
Aldo Rocca ◽  
...  
Keyword(s):  
Colorectal Cancer ◽  
Laparoscopic Surgery ◽  
Blood Loss ◽  
Hospital Stay ◽  
Open Surgery ◽  
Disease Free Survival ◽  
Long Term Outcomes ◽  
Short Term ◽  
One Stage

Liver is the main target organ for colorectal cancer (CRC) metastases. It is estimated that ~25% of CRC patients have synchronous metastases at diagnosis, and about 60% of CRC patients will develop metastases during the follow up. Although several teams have performed simultaneous laparoscopic resections (SLR) of liver and colorectal lesions, the feasibility and safety of this approach is still widely debated and few studies on this topic are present in the literature. The purpose of this literature review is to understand the state of the art of SLR and to clarify the potential benefits and limitations of this approach. Several studies have shown that SLR can be performed safely and with short-term outcomes similarly to the separated procedures. Simultaneous laparoscopic colorectal and hepatic resections combine the advantages of one stage surgery with those of laparoscopic surgery. Several reports compared the short-term outcomes of one stage laparoscopic resection with open resections and showed a similar or inferior amount of blood loss, a similar or lower complication rate, and a significant reduction of hospital stay for laparoscopic surgery respect to open surgery but much longer operating times for the laparoscopic technique. Few retrospective studies compared long term outcomes of laparoscopic one stage surgery with the outcomes of open one stage surgery and did not identify any differences about disease free survival and the overall survival. In conclusion, hepatic and colorectal SLR are a safe and effective approach characterized by less intraoperative blood loss, faster recovery of intestinal function, and shorter length of postoperative hospital stay. Moreover, laparoscopic approach is associated to lower rates of surgical complications without significant differences in the long-term outcomes compared to the open surgery.

Comparative assessment of the short-term outcomes of robotassisted and laparoscopic surgery for colorectal cancer

2016 ◽  
Vol 21 (1-2) ◽  
pp. 32-37
Author(s):  
M. V Kazantseva ◽  
Roman. A. Murashko ◽  
I. B Uvarov ◽  
V. B Kaushansky
Keyword(s):  
Colorectal Cancer ◽  
Laparoscopic Surgery ◽  
Comparative Assessment ◽  
Long Term Results ◽  
Resection Margins ◽  
R0 Resection ◽  
Short Term ◽  
Robotic Colorectal Surgery ◽  
Significant Difference ◽  
The Difference

Aim of the study. a comparative assessment of perioperative parameters and short-term outcomes of robotic and laparoscopic surgery for colorectal cancer (CRC). Material and methods. The results of surgical treatment of 101 patients with colorectal cancer underwent robotic (I group, n = 30) and laparoscopic (II group, n = 71) radical operations were analyzed. Results. Surgery duration in I group ranged from 140 to 420 minutes (on average 260,9 ± 80,1 min.), in II group - 120-465 minutes (on average - 243,3 ± 72,9 min.; P = 0,314). Blood loss in I group averaged on 100 ± 29,4 ml (50,0-150,0 ml) compared to 141,7 ± 76 ml in II group (the difference is statistically significant, P = 0,006). Conversion rate, complications, duration of the postoperative period did not have a statistically significant difference between the groups. The study of circular resection margins after robotic surgeries confirmed the radical intervention (R0-resection) in all cases. Differences in the number of lymph nodes (12-22) between the groups were not observed. Conclusion. Safety and efficacy of robotic colorectal surgery is comparable to laparoscopic surgery. Long-term results require further study.

scholarly journals Short-term clinical outcomes of a European training programme for robotic colorectal surgery

2020 ◽  
Author(s):  
Sofoklis Panteleimonitis ◽  
◽  
Danilo Miskovic ◽  
Rachelle Bissett-Amess ◽  
Nuno Figueiredo ◽  
...  
Keyword(s):  
Colorectal Surgery ◽  
Blood Loss ◽  
Hospital Stay ◽  
Clinical Outcomes ◽  
Operative Time ◽  
Training Programme ◽  
Short Term ◽  
R1 Resection ◽  
Robotic Colorectal Surgery ◽  
Baseline Characteristics

Abstract Background Despite there being a considerable amount of published studies on robotic colorectal surgery (RCS) over the last few years, there is a lack of evidence regarding RCS training pathways. This study examines the short-term clinical outcomes of an international RCS training programme (the European Academy of Robotic Colorectal Surgery—EARCS). Methods Consecutive cases from 26 European colorectal units who conducted RCS between 2014 and 2018 were included in this study. The baseline characteristics and short-term outcomes of cases performed by EARCS delegates during training were analysed and compared with cases performed by EARCS graduates and proctors. Results Data from 1130 RCS procedures were collected and classified into three cohort groups (323 training, 626 graduates and 181 proctors). The training cases conversion rate was 2.2% and R1 resection rate was 1.5%. The three groups were similar in terms of baseline characteristics with the exception of malignant cases and rectal resections performed. With the exception of operative time, blood loss and hospital stay (training vs. graduate vs. proctor: operative time 302, 265, 255 min, p < 0.001; blood loss 50, 50, 30 ml, p < 0.001; hospital stay 7, 6, 6 days, p = 0.003), all remaining short-term outcomes (conversion, 30-day reoperation, 30-day readmission, 30-day mortality, clinical anastomotic leak, complications, R1 resection and lymph node yield) were comparable between the three groups. Conclusions Colorectal surgeons learning how to perform RCS under the EARCS-structured training pathway can safely achieve short-term clinical outcomes comparable to their trainers and overcome the learning process in a way that minimises patient harm.

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