scholarly journals What is the advantage of rectal amputation with an initial perineal approach for primary anorectal carcinoma?

2019 ◽  
Author(s):  
Kimihiko Funahashi ◽  
Mayu Goto ◽  
Tomoaki Kaneko ◽  
Mitsunori Ushigome ◽  
Satoru Kagami ◽  
...  
Keyword(s):  
Disease Free Survival ◽  
Operation Time ◽  
Conventional Group ◽  
Wound Complications ◽  
Perineal Approach ◽  
Long Term Outcomes ◽  
Abdominal Approach ◽  
Short And Long Term ◽  
Anorectal Carcinoma

Abstract Background: Rectal amputation (RA) remains an important surgical procedure for salvage despite advances in sphincter-preserving resection, including intersphincteric resection. The aim of this study was to compare short- and long-term outcomes of RA with an initial perineal approach to those of RA with an initial abdominal approach (conventional abdominoperineal resection (APR)) for primary anorectal cancer. Methods: We retrospectively analyzed the short- and long-term outcomes of 48 patients who underwent RA with an initial perineal approach (perineal group) and 21 patients who underwent RA with an initial abdominal approach (conventional group). Results: For the perineal group, the operation time was shorter than that for the conventional group (313 vs. 388 minutes, p = 0.027). The postoperative complication rate was similar between the two groups (43.8 vs. 47.6%, p = 0.766). Perineal wound complications (PWCs) were significantly fewer in the perineal group than in the conventional group (22.9 vs. 57.1%, p = 0.006). All 69 patients underwent complete TME, but positive CRM was significantly higher in the conventional group than in the perineal group (0 vs. 19.0%, p = 0.011). There were no significant differences in the recurrence (43.8 vs. 47.6%, p = 0.689), 5-year disease-free survival (63.7% vs. 56.7%, p = 0.665) and 5-year overall survival rates (82.5% vs. 66.2%, p = 0.323) between the two groups. Conclusion: These data suggest that RA with an initial perineal approach for selective primary anorectal carcinoma is advantageous in minimizing PWCs and positive CRMs. Further investigations on the advantages of this approach are necessary.

scholarly journals What is the advantage of rectal amputation with an initial perineal approach for primary anorectal carcinoma?

2019 ◽  
Author(s):  
Kimihiko Funahashi ◽  
Mayu Goto ◽  
Tomoaki Kaneko ◽  
Mitsunori Ushigome ◽  
Satoru Kagami ◽  
...  
Keyword(s):  
Disease Free Survival ◽  
Operation Time ◽  
Conventional Group ◽  
Wound Complications ◽  
Perineal Approach ◽  
Long Term Outcomes ◽  
Abdominal Approach ◽  
Short And Long Term ◽  
Anorectal Carcinoma

Abstract Background: Rectal amputation (RA) remains an important surgical procedure for salvage despite advances in sphincter-preserving resection, including intersphincteric resection. The aim of this study was to compare short- and long-term outcomes of RA with an initial perineal approach to those of RA with an initial abdominal approach (conventional abdominoperineal resection (APR)) for primary anorectal cancer. Methods: We retrospectively analyzed the short- and long-term outcomes of 48 patients who underwent RA with an initial perineal approach (perineal group) and 21 patients who underwent RA with an initial abdominal approach (conventional group). Results: For the perineal group, the operation time was shorter than that for the conventional group (313 vs. 388 minutes, p = 0.027). The postoperative complication rate was similar between the two groups (43.8 vs. 47.6%, p = 0.766). Perineal wound complications (PWCs) were significantly fewer in the perineal group than in the conventional group (22.9 vs. 57.1%, p = 0.006). All 69 patients underwent complete TME, but positive CRM was significantly higher in the conventional group than in the perineal group (0 vs. 19.0%, p = 0.011). There were no significant differences in the recurrence (43.8 vs. 47.6%, p = 0.689), 5-year disease-free survival (63.7% vs. 56.7%, p = 0.665) and 5-year overall survival rates (82.5% vs. 66.2%, p = 0.323) between the two groups. Conclusion: These data suggest that RA with an initial perineal approach for selective primary anorectal carcinoma is advantageous in minimizing PWCs and positive CRMs. Further investigations on the advantages of this approach are necessary.

scholarly journals Transanal total mesorectal excision: short- and long-term results of the first hundred cases of a certified colorectal cancer center in Germany

2021 ◽  
Author(s):  
Vinzenz Völkel ◽  
Sabine Schatz ◽  
Teresa Draeger ◽  
Michael Gerken ◽  
Monika Klinkhammer-Schalke ◽  
...  
Keyword(s):  
Local Recurrence ◽  
Tumor Resection ◽  
Operation Time ◽  
Cancer Center ◽  
Transanal Total Mesorectal Excision ◽  
Local Tumor ◽  
Long Term Outcomes ◽  
Free Survival ◽  
Short And Long Term

Abstract Background Since 2010, laparoscopic transanal total mesorectal excision (TaTME) has been increasingly used for low and very low rectal cancer. It is supposed to improve visibility and access to the dissection planes in the pelvis. This study reports on short- and long-term outcomes of the first 100 consecutive patients treated with TaTME in a certified German colorectal cancer center. Patients and methods Data were derived from digital patient files and official cancer registry reports for patients with TaTME tumor surgery between July 2014 and January 2020. The primary outcome was the 3-year local recurrence rate and local recurrence-free survival (LRFS). Secondary endpoints included overall survival (OAS), disease-free survival (DFS), operation time, completeness of local tumor resection, lymph node resection, and postoperative complications. The Kaplan–Meier method was employed for the survival analyses; competing risks were considered in the time-to-event analysis. Results During the observation period, the average annual operation time decreased from 272 to 178 min. Complete local tumor resection was achieved in 97% of the procedures. Major postoperative complications (Clavien–Dindo 3–4) occurred in 11% of the cases. At a median follow-up time of 2.7 years, three patients had suffered from a local recurrence. Considering competing risks, this corresponds to a 3-year cumulative incidence rate for local recurrence of 2.2% and a 3-year LRFS of 81.9%. 3-year OAS was 82.9%, and 3-year DFS was 75.7%. Conclusion TaTME is associated with favorable short and long-term outcomes. Since it is technically demanding, structured training programs and more research on the topic are indispensable.

scholarly journals More Favorable Short and Long-Term Outcomes for Screen-Detected Colorectal Cancer Patients

2021 ◽  
Vol 11 ◽  
Author(s):  
Gaya Spolverato ◽  
Giulia Capelli ◽  
Jessica Battagello ◽  
Andrea Barina ◽  
Susi Nordio ◽  
...  
Keyword(s):  
Colorectal Cancer ◽  
Disease Free Survival ◽  
Target Population ◽  
Proximal Colon ◽  
Long Term Outcomes ◽  
Curative Intent ◽  
Diagnostic Modality ◽  
Screening Programs ◽  
Short And Long Term

BackgroundScreening significantly reduces mortality from colorectal cancer (CRC). Screen detected (SD) tumors associate with better prognosis, even at later stage, compared to non-screen detected (NSD) tumors. We aimed to evaluate the association between diagnostic modality (SD vs. NSD) and short- and long-term outcomes of patients undergoing surgery for CRC.Materials and MethodsThis retrospective cohort study involved patients aged 50–69 years, residing in Veneto, Italy, who underwent curative-intent surgery for CRC between 2006 and 2018. The clinical multi-institutional dataset was linked with the screening dataset in order to define diagnostic modality (SD vs. NSD). Short- and long-term outcomes were compared between the two groups.ResultsOf 1,360 patients included, 464 were SD (34.1%) and 896 NSD (65.9%). Patients with a SD CRC were more likely to have less comorbidities (p = 0.013), lower ASA score (p = 0.001), tumors located in the proximal colon (p = 0.0018) and earlier stage at diagnosis (p < 0.0001). NSD patients were found to have more aggressive disease at diagnosis, higher complication rate and higher readmission rate due to surgical complications (all p < 0.05). NSD patients had a significantly lower Disease Free Survival and Overall Survival (all p < 0.0001), even after adjusting by demographic, clinic-pathological, tumor, and treatment characteristics.ConclusionsSD tumors were associated with better long-term outcomes, even after multiple adjustments. Our results confirm the advantages for the target population to participate in the screening programs and comply with their therapeutic pathways.

723 TWO- VS. THREE-FIELD LYMPHADENECTOMY FOR ESOPHAGEAL CANCER. A SYSTEMATIC REVIEW AND META-ANALYSIS OF SHORT- AND LONG-TERM OUTCOMES.

2021 ◽  
Vol 34 (Supplement_1) ◽  
Author(s):  
Letícia Nogueira Datrino ◽  
Clara Lucato Santos ◽  
Guilherme Tavares ◽  
Luca Schiliró Tristão ◽  
Maria Carolina Andrade Serafim ◽  
...  
Keyword(s):  
Systematic Review ◽  
Esophageal Cancer ◽  
Meta Analysis ◽  
Operation Time ◽  
Extended Lymphadenectomy ◽  
Long Term Outcomes ◽  
Term Survival ◽  
Long Term Survival ◽  
Short And Long Term

Abstract   Nowadays, there is still no consensus about the benefits of adding neck lymphadenectomy to the traditional two-fields esophagectomy. An extended lymphadenectomy could potentially increase operation time and the risks for postoperative complications. However, extended lymphadenectomy allows resection of cervical nodes at risk for metastases, potentially increasing long-term survival rates. This study aims to estimate whether cervical prophylactic lymphadenectomy for esophageal cancer influences short- and long-term outcomes through a systematic review of literature and meta-analysis. Methods A systematic review was conducted in PubMed, Embase, Cochrane Library Central, and Lilacs (BVS). The inclusion criteria were: (1) studies that compare two-field vs. three-field esophagectomy; (2) adults (>18 years); (3) articles that analyze short- or long-term outcomes; and (4) clinical trials or cohort studies. The results were summarized by forest plots, with effect size (ES) or risk difference (RD) and 95% CI. Results Twenty-five articles were selected, comprising 8,954 patients. Three-field lymphadenectomy was associated to higher operation time (ES: -1.51; 95%CI -1.84, −1.18) and higher blood loss (ES: -0.24; 95%CI: −0.37, −0.11). Also, neck lymphadenectomy inputs additional risk for pulmonary complications (RD: 0.03; 95%CI: 0.01, 0.05). No difference was noted for morbidity (RD: 0.01; 95%CI: −0.01, 0.03); leak (−0.02; 95%CI: −0.07, 0.03); postoperative mortality (RD: 0.00; 95%CI: −0.00, 0.01), and hospital stay (ES: -0.05; 95%CI -0.20, 0.10). Three-field lymphadenectomy allowed higher number of retrieved lymph nodes (MD: -1.51; 95%CI -1.84, −1.18), but did not increase the overall survival (HR: 1.11; 95%CI: 0.96, 1.26). Conclusion Prophylactic neck lymphadenectomy for esophageal cancer should be performed with caution once it is associated with poorer short-term outcomes compared to traditional two-field lymphadenectomy and does not improve long-term survival. Future esophageal cancer studies should determine the subgroup of patients who could benefit from prophylactic neck lymphadenectomy in long-term outcomes.

scholarly journals Comparison of short- and long-term outcomes between 3-field and modern 2-field lymph node dissections for thoracic oesophageal squamous cell carcinoma: a propensity score matching analysis

2019 ◽  
Vol 29 (3) ◽  
pp. 434-441 ◽  
Author(s):  
Ningbo Fan ◽  
Han Yang ◽  
Jiabo Zheng ◽  
Dongni Chen ◽  
Weidong Wang ◽  
...  
Keyword(s):  
Squamous Cell Carcinoma ◽  
Cell Carcinoma ◽  
Squamous Cell ◽  
Disease Free Survival ◽  
Oesophageal Squamous Cell Carcinoma ◽  
Long Term Outcomes ◽  
Free Survival ◽  
Short And Long Term ◽  
Disease Free

Abstract OBJECTIVES Our goal was to compare short- and long-term outcomes between 3-field lymphadenectomy (3-FL) and modern 2-field lymphadenectomy (2-FL) in patients with thoracic oesophageal squamous cell carcinoma. METHODS We reviewed clinical outcomes for 298 patients with thoracic oesophageal squamous cell carcinoma who underwent 3-FL or modern 2-FL from March 2008 to December 2013 at a major cancer hospital in Guangzhou, southern China. Propensity score matching was used to balance baseline differences, and 83 pairs of cases were selected. Postoperative complications, recurrence patterns and survival outcomes were compared between the 2 groups. RESULTS Compared with modern 2-FL, 3-FL led to higher overall operative morbidity rates [78.3% vs 61.4%, odds ratio (OR) 2.266, 95% confidence interval (CI) 1.143–4.490; P = 0.019], with higher recurrent nerve palsy rates (47.0% vs 19.3%, OR 3.712, 95% CI 1.852–7.438; P < 0.0001), more respiratory failures (18.1% vs 6.0%, OR 3.441, 95% CI 1.189–9.963; P = 0.023) and longer postoperative hospital stays (23 vs 17 days, P = 0.002). The 5-year overall survival rate (58.5% vs 59.4%; P = 0.960) and the 5-year disease-free survival rate 50.1% vs 54.5%; P = 0.482) were comparable between the 2 groups. Multivariable analysis showed that additional cervical lymph node dissection was not associated with overall survival [hazard ratio (HR) 1.039, 95% CI 0.637–1.696; P = 0.878] and disease-free survival (HR 0.868, 95% CI 0.548–1.376; P = 0.547). The overall recurrence rate and cervical nodal recurrence rate were not significantly different between the 2 groups. CONCLUSIONS Additional cervical lymphadenectomy did not lead to added survival benefit when compared with modern 2-FL in patients with thoracic oesophageal squamous cell carcinoma. Recurrence was similar in patients undergoing 3-FL and modern 2-FL. 3-FL resulted in more postoperative complications.

scholarly journals Laparoscopic versus open rectal resection: a 1:2 propensity score–matched analysis of oncological adequateness, short- and long-term outcomes

2021 ◽  
Author(s):  
Giovanni Maria Garbarino ◽  
Giulia Canali ◽  
Giulia Tarantino ◽  
Gianluca Costa ◽  
Mario Ferri ◽  
...  
Keyword(s):  
Propensity Score ◽  
Anal Verge ◽  
Disease Free Survival ◽  
Oral Intake ◽  
High Volume ◽  
Long Term Outcomes ◽  
Surgical Specimen ◽  
N Stage ◽  
Short And Long Term

Abstract Background Laparoscopic resections for rectal cancer are routinely performed in high-volume centres. Despite short-term advantages have been demonstrated, the oncological outcomes are still debated. The aim of this study was to compare the oncological adequateness of the surgical specimen and the long-term outcomes between open (ORR) and laparoscopic (LRR) rectal resections. Methods Patients undergoing laparoscopic or open rectal resections from January 1, 2013, to December 31, 2019, were enrolled. A 1:2 propensity score matching was performed according to age, sex, BMI, ASA score, comorbidities, distance from the anal verge, and clinical T and N stage. Results Ninety-eight ORR were matched to 50 LRR. No differences were observed in terms of operative time (224.9 min. vs. 230.7; p = 0.567) and postoperative morbidity (18.6% vs. 20.8%; p = 0.744). LRR group had a significantly earlier soft oral intake (p < 0.001), first bowel movement (p < 0.001), and shorter hospital stay (p < 0.001). Oncological adequateness was achieved in 85 (86.7%) open and 44 (88.0%) laparoscopic resections (p = 0.772). Clearance of the distal (99.0% vs. 100%; p = 0.474) and radial margins (91.8 vs. 90.0%, p = 0.709), and mesorectal integrity (94.9% vs. 98.0%, p = 0.365) were comparable between groups. No differences in local recurrence (6.1% vs.4.0%, p = 0.589), 3-year overall survival (82.9% vs. 91.4%, p = 0.276), and disease-free survival (73.1% vs. 74.3%, p = 0.817) were observed. Conclusions LRR is associated with good postoperative results, safe oncological adequateness of the surgical specimen, and comparable survivals to open surgery.

scholarly journals Laparoscopic versus open major liver resection for hepatocellular carcinoma: A case-matched analysis of short- and long-term outcomes

Open Medicine ◽  
2021 ◽  
Vol 16 (1) ◽  
pp. 964-972
Author(s):  
Aoxiao He ◽  
Zhihao Huang ◽  
Jiakun Wang ◽  
Qian Feng ◽  
Rongguiyi Zhang ◽  
...  
Keyword(s):  
Hepatocellular Carcinoma ◽  
Liver Resection ◽  
Major Hepatectomy ◽  
Disease Free Survival ◽  
Perioperative Outcomes ◽  
Long Term Outcomes ◽  
Significant Difference ◽  
Short And Long Term ◽  
Laparoscopic Major Hepatectomy

Abstract Background The feasibility and safety of laparoscopic major hepatectomy (LMH) are still uncertain. The purpose of the present study is to compare the short- and long-term outcomes of LMH with those of open major hepatectomy (OMH) for hepatocellular carcinoma (HCC). Method Between January 2012 and December 2018, a total of 26 patients received laparoscopic major hepatectomy in our center. To minimize any confounding factors, a 1:3 case-matched analysis was conducted based on the demographics and extent of liver resection. Data of demographics, perioperative outcomes, and long-term oncologic outcomes were reviewed. Results Intraoperative blood loss (P = 0.007) was significantly lower in the LMH group. In addition, the LMH group exhibited a lower overall complication rate (P = 0.039) and shorter postoperative hospital stay (P = 0.024). However, no statistically significant difference was found between LMH and OMH regarding operation time (P = 0.215) and operative cost (P = 0.860). Two laparoscopic cases were converted to open liver resection. In regard to long-term outcomes, there was no significant difference between LMH and OMH regarding disease-free survival (DFS) (P = 0.079) and overall survival (OS) (P = 0.172). Conclusion LMH can be an effective and safe alternative to OMH for selected patients with liver cancer in short- and long-term outcomes.

scholarly journals Effect of High Body Mass Index on Short- and Long-term Outcomes of Patients who Underwent Laparoscopic Gastrectomy for Advanced Gastric Cancer: A Case Control Study

2020 ◽  
Author(s):  
Tianqi Luo ◽  
Guoming Chen ◽  
Chengcai Liang ◽  
Kaiming Jiang ◽  
Kai Lei ◽  
...  
Keyword(s):  
Gastric Cancer ◽  
Body Mass Index ◽  
Operation Time ◽  
High Body Mass Index ◽  
Long Term Outcomes ◽  
Intraoperative Bleeding ◽  
Significant Difference ◽  
Short And Long Term ◽  
High Bmi

Abstract Background High body mass index (BMI) is thought to be a preoperative risk factor for surgical treatment. Until now, few studies have investigated the long-term impact of preoperative high BMI on advanced gastric cancer (GC) patients who underwent laparoscopic gastrectomy (LG). Therefore, the present study was designed to compare clinical outcomes between high BMI and normal BMI patients who underwent LG. MethodsWe retrospectively investigated 282 pathological stage II~III GC cases who underwent radical LG plus D2 lymphadenectomy from February 2009 to May 2018. Based on the China BMI classification, the patients were classified into a high (BMI ≥ 24 kg/m2) or normal (BMI < 24 kg/m2) BMI group. The clinical characteristics, intraoperative findings, short-term and long-term outcomes of the two groups of patients were then compared. Results The high BMI group had longer operation time (160.1 ± 36.0 minutes vs. 147.7 ± 33.7 minutes; P = 0.005) and greater intraoperative bleeding (138.3 ± 239.4ml vs. 86.6 ± 67.7ml; P = 0.002) compared to the normal BMI group. Moreover, shorter time to flatus, starting the soft diet, removing drain tube and length of stay (all P < 0.05) were observed in the high BMI patients. However, there was no significant difference in relapse-free survival or overall survival between the two groups. Conclusion Patients with high BMI was associated with longer operation time and greater amount of intraoperative bleeding but had faster recovery as compared to those with normal BMI. Also, LG can be considered as safe with no significant difference in terms of short- and long-term outcomes on the peri- and post-operative outcomes between the two BMI groups of patients. Nevertheless, these surgeries for high BMI patients should be performed by experienced surgeons.

Effect of surgical start time on short- and long-term outcomes after minimally invasive esophagectomy: a propensity-score matching analysis

2020 ◽  
Author(s):  
Tao Bao ◽  
Xiao-Long Zhao ◽  
Kun-Kun Li ◽  
Ying-Jian Wang ◽  
Wei Guo
Keyword(s):  
Propensity Score ◽  
Minimally Invasive ◽  
Propensity Score Matching ◽  
Survival Rates ◽  
Disease Free Survival ◽  
Long Term Outcomes ◽  
Start Time ◽  
Short And Long Term ◽  
Mckeown Esophagectomy

Summary There is growing focus on the relationship between surgical start time and postoperative outcomes. However, the extent to which the operation start time affects the surgical and oncological outcomes of patients undergoing esophagectomy has not previously been studied. The purpose of this retrospective study was to investigate the potential effect of surgical start time on the short- and long-term outcomes for patients who underwent thoracoscopic–laparoscopic McKeown esophagectomy. From September 2009 to June 2019, a total of 700 consecutive patients suffering from esophageal cancer underwent thoracoscopic–laparoscopic McKeown esophagectomy in the Department of Thoracic Surgery at Daping Hospital. Among these patients, 166 esophagectomies were performed on the same day and were classified as the first- or second-start group. Patients in the first-start group were more likely to be older than those in the second-start group: (64.73 vs. 61.28, P = 0.002). In addition, patients with diabetes mellitus were more likely to be first-start cases (8.4 vs. 1.2%). After propensity score matching (52 matched patients in first-start cases and 52 matched patients in second-start cases), these findings were no longer statistically significant. There was no difference in the incidence rate of peri- or postoperative adverse events between the first- and second-start groups. The disease-specific survival rates and disease-free survival rates were comparable between the two groups (P = 0.236 and 0.292, respectively). On the basis of the present results, a later start time does not negatively affect the short- or long-term outcomes of patients undergoing minimally invasive McKeown esophagectomy.

Short- and Long-Term Outcomes of Single Incision Laparoscopic Surgery for Right-Side Colon Cancer

2021 ◽  
Author(s):  
Taishi Hata ◽  
Kenji Kawai ◽  
Atsushi Naito ◽  
Yoshinori Kagawa ◽  
Tomohiro Kitahara ◽  
...  
Keyword(s):  
Colon Cancer ◽  
Laparoscopic Surgery ◽  
Disease Free Survival ◽  
Single Incision Laparoscopic Surgery ◽  
Long Term Outcomes ◽  
Conventional Laparoscopic Surgery ◽  
Free Survival ◽  
Short And Long Term ◽  
Disease Free

Introduction: Currently, there is limited data regarding the long-term outcomes of single incision laparoscopic surgery (SILS) for colon cancer. Therefore, we investigated both the short- and long-term outcomes of SILS for right-sided colon cancer. Methods: We retrospectively compared the short- and long-term outcomes of SILS and conventional laparoscopic surgery (CLS) for right-sided colon cancer (specifically the cecum and ascending colon) in our institution. Inter-group differences of short-term outcomes were evaluated using the chi-squared or Fisher exact test and two-sample Student’s t-test. The disease-free survival rates (long-term outcome) of stage 0 to III patients were estimated using the Kaplan–Meier method and compared using log-rank tests. Results: There were 290 operations conducted for right-sided (cecum and ascending color) colorectal cancers between April 2011 and July 2018. Twelve patients underwent planned laparotomy. Of the remaining 278 patients, 55 underwent planned conventional laparoscopic surgery, 27 patients had planned reduced poet surgery (RPS), and 196 patients had planned SILS. The procedures had been selected by skilled surgeons. One patient underwent intraoperative conversion from SILS to laparotomy for bleeding control. In addition, one port was added to SILS in three cases. These four cases were included in the analysis as the SILS group, according to the principle of intent to treat. Background factors, including age, sex, body mass index, performance status, and tumor stage were not statistically different between the SILS and CLS groups. In the short-term outcomes, the number of harvested lymph-nodes was not statistically different. SILS required less operating time (P<0.001) and resulted in a reduced bleeding volume (P<0.001). There was no statistical difference in the frequency of overall complications (P=0.06). The disease-free survival of stage 0 to III patients was not statistically different between the two groups. Conclusions: Skilled surgeons can achieve adequate oncologic long-term outcomes in selected subgroups of SILS patients. Therefore, SILS could be a treatment option for right-sided colon cancer.

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