MINIMALLY INVASIVE SURGERY FOR PSEUDOPAPILLARY NEOPLASM OF THE PANCREAS

ABSTRACT Background: Solid pseudopapillary pancreatic neoplasia is usually a large well-circumscribed pancreatic mass, with cystic and solid areas more frequently found in young women. It is a benign pancreatic neoplasia in most cases, therefore minimally invasive surgery could be an interesting approach. Aim: Evaluate the results of minimally invasive surgery for this neoplasia. Methods: Patients with this tumor who underwent minimally invasive pancreatectomies between 2009 and 2015 in a single institution, were analyzed regarding demographic, clinical-pathological futures, post-operative morbidity and disease-free survival. Results: All were women, and their median age was 39 (18-54) years. Two patients with tumor in the head of the pancreas underwent laparoscopic pancreaticoduodenectomy, and another one underwent laparoscopic enucleation. Two patients with tumor in the neck underwent central pancreatectomy. Distal pancreatectomies were performed in the other five, one with splenic preservation. None required blood transfusion or conversion to open surgery. Two (20%) developed clinical relevant pancreatic fistulas, requiring readmission. Median length of postoperative hospital stay was five days (2-8). All resection margins were negative. Patients were followed for a median of 38 months (14-71), and there was no recurrence. Conclusions: Minimally invasive surgery for solid pseudopapillary pancreatic neoplasia is feasible for tumors in different locations in the pancreas. It was associated with acceptable morbidity and respected the oncologic principles for treatment.

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SUCCOR study: an international European cohort observational study comparing minimally invasive surgery versus open abdominal radical hysterectomy in patients with stage IB1 cervical cancer

International Journal of Gynecological Cancer ◽

10.1136/ijgc-2020-001506 ◽

2020 ◽

Vol 30 (9) ◽

pp. 1269-1277 ◽

Cited By ~ 10

Author(s):

Luis Chiva ◽

Vanna Zanagnolo ◽

Denis Querleu ◽

Nerea Martin-Calvo ◽

Juan Arévalo-Serrano ◽

...

Keyword(s):

Cervical Cancer ◽

Minimally Invasive Surgery ◽

Minimally Invasive ◽

Invasive Surgery ◽

Open Surgery ◽

Disease Free Survival ◽

Free Survival ◽

Uterine Manipulator ◽

Surgery Group ◽

Disease Free

BackgroundMinimally invasive surgery in cervical cancer has demonstrated in recent publications worse outcomes than open surgery. The primary objective of the SUCCOR study, a European, multicenter, retrospective, observational cohort study was to evaluate disease-free survival in patients with stage IB1 (FIGO 2009) cervical cancer undergoing open vs minimally invasive radical hysterectomy. As a secondary objective, we aimed to investigate the association between protective surgical maneuvers and the risk of relapse.MethodsWe obtained data from 1272 patients that underwent a radical hysterectomy by open or minimally invasive surgery for stage IB1 cervical cancer (FIGO 2009) from January 2013 to December 2014. After applying all the inclusion-exclusion criteria, we used an inverse probability weighting to construct a weighted cohort of 693 patients to compare outcomes (minimally invasive surgery vs open). The first endpoint compared disease-free survival at 4.5 years in both groups. Secondary endpoints compared overall survival among groups and the impact of the use of a uterine manipulator and protective closure of the colpotomy over the tumor in the minimally invasive surgery group.ResultsMean age was 48.3 years (range; 23–83) while the mean BMI was 25.7 kg/m2 (range; 15–49). The risk of recurrence for patients who underwent minimally invasive surgery was twice as high as that in the open surgery group (HR, 2.07; 95% CI, 1.35 to 3.15; P=0.001). Similarly, the risk of death was 2.42-times higher than in the open surgery group (HR, 2.45; 95% CI, 1.30 to 4.60, P=0.005). Patients that underwent minimally invasive surgery using a uterine manipulator had a 2.76-times higher hazard of relapse (HR, 2.76; 95% CI, 1.75 to 4.33; P<0.001) and those without the use of a uterine manipulator had similar disease-free-survival to the open surgery group (HR, 1.58; 95% CI, 0.79 to 3.15; P=0.20). Moreover, patients that underwent minimally invasive surgery with protective vaginal closure had similar rates of relapse to those who underwent open surgery (HR, 0.63; 95% CI, 0.15 to 2.59; P<0.52).ConclusionsMinimally invasive surgery in cervical cancer increased the risk of relapse and death compared with open surgery. In this study, avoiding the uterine manipulator and using maneuvers to avoid tumor spread at the time of colpotomy in minimally invasive surgery was associated with similar outcomes to open surgery. Further prospective studies are warranted.

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Method of forming a pancreatogastric anastomosis after pancreatoduodenal resection

Annaly khirurgicheskoy gepatologii = Annals of HPB surgery ◽

10.16931/1995-5464.2021-4-97-104 ◽

2021 ◽

Vol 26 (4) ◽

pp. 97-104

Author(s):

V. Ya. Lishchishin ◽

A. G. Barishev ◽

A. N. Petrovsky ◽

A. N. Lishchenko ◽

A. Y. Popov ◽

...

Keyword(s):

Minimally Invasive Surgery ◽

Minimally Invasive ◽

Invasive Surgery ◽

Open Surgery ◽

Surgical Approaches ◽

Open Approach ◽

Malignant Tumours ◽

Minimally Invasive Approach ◽

Invasive Approach ◽

Pancreatic Fistulas

Aim. To evaluate the reproducibility and safety of the developed pancreatogastric anastomosis with various surgical approaches during pancreatoduodenectomy.Materials and methods. The experience of surgical treatment of 47 patients with malignant tumours of the periampullary zone, who underwent pancreatoduodenectomy, was considered. The proposed variant of anastomose was performed to 14 (29.8%) patients: in 7 cases with a minimally invasive approach to perform pancreatoduodenectomy; and in 7 cases with an open approach. To compare retrospectively 33 (70.2%) patients who underwent pancreatogastric anastomosis according to the Bassi technique: 9 – with minimally invasive surgery, 24 – with open surgery. The frequency of pancreatic fistulas, the number of repeated interferences, and hospital mortality were taken into account.Results. A significant advantage of the new method of forming an anastomosis in the duration of the operation was noted in comparison with the Bassi technique. There were no statistically significant differences in blood loss while various types of anastomoses (p > 0.05). When using the proposed technique, the formation of pancreatic fistulas was not revealed. The development of pancreatic fistula was observed in 4 (16.7%) patients after open surgery and in 7 (77.8%) patients after minimally invasive Bassi anastomose formation. Reoperations were performed after open surgery in 3 (12.5%) cases and in 4 (44.4%) cases of minimally invasive surgery according to the Bassi technique. There were 2 (22.2%) deaths in the minimally invasive group.Conclusion. The proposed pancreatogastric anastomosis is applicable in clinical practice. This method allows to create relatively fast and less challenging anastomosis, including with a minimally invasive approach. The use of this technique makes it possible to reduce mortality and postoperative complications in patients with a “complex” pancreas.

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The Surgeon’s Proficiency Affected Survival Outcomes of Minimally Invasive Surgery for Early-Stage Cervical Cancer: A Retrospective Study of 851 Patients

Frontiers in Oncology ◽

10.3389/fonc.2021.787198 ◽

2021 ◽

Vol 11 ◽

Author(s):

Ying Yang ◽

Yue Huang ◽

Zhengyu Li

Keyword(s):

Cervical Cancer ◽

Minimally Invasive Surgery ◽

Minimally Invasive ◽

Invasive Surgery ◽

Open Surgery ◽

Early Stage ◽

Disease Free Survival ◽

Survival Outcomes ◽

Surgery Group ◽

Early Stage Cervical Cancer

PurposeTo compare the clinical outcomes of patients with early-stage cervical cancer who underwent minimally invasive surgery (MIS) by surgeons in different phases and evaluate whether the proficiency of surgeons affects the survival outcomes.Materials and MethodsA total of 851 patients with early-stage cervical cancer who underwent radical hysterectomy between January 2008 and June 2018 (every year from January to June) at a tertiary hospital were retrospectively analyzed. We categorized patients into four phases according to their sequence (phase one, 1-10 cases; phase two: 11-20 cases; phase three: 21-30 cases; phase four: > 30 cases). Demographics and clinical and pathological data were collected and analyzed.ResultsThere were no statistical differences between the open surgery and MIS groups regarding three- and five-year overall survival (OS) and disease-free survival (DFS). The OS and DFS of patients in the MIS group in phase one were significantly lower than those in later phases and those in the open surgery group after adjustment (OS, P = 0.009; HR, 2.896; 95%CI, 1.303-6.435; DFS, P = 0.009; HR, 2.712; 95%CI, 1.289-5.706). Survival outcomes were not statistically significant when comparing different surgeons.ConclusionThe phase one cases of MIS had lower OS and DFS than those in later phases and those in the open surgery group. Thus, we suggest that the proficiency of surgeons is associated with survival outcomes of MIS. Favorable outcomes can be obtained after a certain number of MIS cases.

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Open Resection Compared to Mini-Invasive in Colorectal Cancer and Liver Metastases: A Meta-Analysis

Frontiers in Surgery ◽

10.3389/fsurg.2021.726217 ◽

2021 ◽

Vol 8 ◽

Author(s):

Jie Gong ◽

Fengwei Gao ◽

Qingyun Xie ◽

Xin Zhao ◽

Zehua Lei

Keyword(s):

Colorectal Cancer ◽

Minimally Invasive Surgery ◽

Minimally Invasive ◽

Liver Metastases ◽

Invasive Surgery ◽

Open Surgery ◽

Colorectal Liver Metastases ◽

Disease Free Survival ◽

Simultaneous Resection ◽

Synchronous Colorectal Liver Metastases

Background: We performed a meta-analysis to evaluate the outcomes of minimally invasive surgery and open surgery in the simultaneous resection of colorectal cancer and synchronous colorectal liver metastases.Methods: A systematic literature search up to April 2021 was done and 13 studies included 1,181 subjects with colorectal cancer and synchronous colorectal liver metastases at the start of the study; 425 of them were using minimally invasive surgery and 756 were open surgery. They were reporting relationships between the outcomes of minimally invasive surgery and open surgery in the simultaneous resection of colorectal cancer and synchronous colorectal liver metastases. We calculated the odds ratio (OR) or the mean difference (MD) with 95% CIs to assess the outcomes of minimally invasive surgery and open surgery in the simultaneous resection of colorectal cancer and synchronous colorectal liver metastases using the dichotomous or continuous method with a random or fixed-effect model.Results: Minimally invasive surgery in subjects with colorectal cancer and synchronous colorectal liver metastases was significantly related to longer operation time (MD, 35.61; 95% CI, 7.36–63.87, p = 0.01), less blood loss (MD, −151.62; 95% CI, −228.84 to −74.40, p < 0.001), less blood transfusion needs (OR, 0.61; 95% CI, 0.42–0.89, p = 0.01), shorter length of hospital stay (MD, −3.26; 95% CI, −3.67 to −2.86, p < 0.001), lower overall complications (OR, 0.59; 95% CI, 0.45–0.79, p < 0.001), higher overall survival (OR, 1.66; 95% CI, 1.21–2.29, p = 0.002), and higher disease-free survival (OR, 1.49; 95% CI, 1.13–1.97, p = 0.005) compared to open surgery.Conclusions: Minimally invasive surgery in subjects with colorectal cancer and synchronous colorectal liver metastases may have less blood loss, less blood transfusion needs, shorter length of hospital stay, lower overall complications, higher overall survival, and higher disease-free survival with longer operation time compared with the open surgery. Furthers studies are required to validate these findings.

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The Impact of Intra-Uterine Manipulators on Outcome and Recurrence Patterns of Endometrial Cancer Patients Undergoing Minimally Invasive Surgery

10.21203/rs.3.rs-538902/v1 ◽

2021 ◽

Author(s):

Ido Laskov ◽

Nadav Michaan ◽

Liron Kogan ◽

Xing Zeng ◽

Shannon Salvador ◽

...

Keyword(s):

Endometrial Cancer ◽

Minimally Invasive Surgery ◽

Minimally Invasive ◽

Recurrence Rate ◽

Adjuvant Treatment ◽

Invasive Surgery ◽

Disease Free Survival ◽

Positive Cytology ◽

Free Survival ◽

Disease Free

Abstract PurposeTo evaluate the use of an intrauterine manipulator on the oncologic outcome of women who had minimally invasive surgery for endometrial cancer. MethodsRetrospective analysis of consecutive patients who were operated with or without the use of an intrauterine manipulator. Univariate and multivariate analysis were used to adjust for possible confounders. Results699 patients were included, of whom 220 (32.8%) were operated with an intrauterine manipulator. The median follow-up was 44 months (range, 29-67). Disease-free survival was similar between groups. 19 (8.8%) patients had positive cytology in the manipulator group vs. 21 (4.4%) in the comparison group (p=0.02). Total recurrence rate was similar between the groups (12.3% vs. 11.9%; p = 0.8). Vaginal vault recurrence was the most common site of recurrence with higher incidence in the manipulator group (4.5% vs. 1.3%; p=0.007). Sub-group analysis of patients who did not receive adjuvant treatment showed higher recurrence rate (8.3% vs. 3%; p=0.023) and worse disease-free survival (p=0.01) for the manipulator group. After controlling for other variables, the use of a manipulator did not affect the risk of recurrence for the whole cohort (HR, 1.28; 95% CI, 0.7-2.1, p=0.3) and for the sub-group of patients who did not receive adjuvant treatment (HR, 2.47; 95% CI, 0.8-7, p=0.08).ConclusionThe use of a manipulator during surgery for endometrial cancer increases the risk of positive cytology as well as vaginal vault recurrences, but it does not reduce the disease-free and overall survival of patients.

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Applicability of minimally invasive surgery for clinically T4 colorectal cancer

Scientific Reports ◽

10.1038/s41598-020-77317-2 ◽

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.

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