Robotic Resection of Duodenal Gastrointestinal Stromal Tumour: Preliminary Experience from a Single Centre

Abstract Background: The experience of minimally invasive surgery in the treatment of duodenal gastrointestinal stromal tumours (DGISTs) is accumulating, but there is no consensus on the choice of surgical method. The purpose of this study is to summarize the technique and feasibility of robotic resection of DGIST.Methods: The demographics and perioperative outcomes of a consecutive series of patients who underwent robotic resection and open resection of DGIST between May 1, 2010 and May 1, 2020 were retrospectively analysed. Patients were divided into an open surgery group and a robotic surgery group. Pancreaticoduodenectomy (PD) or limited resection was performed based on the location of the tumour and the distance between the tumour and duodenal papilla. Age, sex, tumour location, tumour size, operation time (OT), estimated blood loss (EBL), postoperative hospital stay (PHS), tumour mitosis, postoperative risk classification, postoperative recurrence and recurrence-free survival were compared between the two groups.Results: Among the 28 patients, there were 19 males and 9 females aged 51.3± 13.1 years. Limited resection was performed in 17 patients, and PD was performed in 11 patients. Eleven patients underwent open surgery, and 17 patients underwent robotic surgery. Two patients in the robotic surgery group underwent conversion to open surgery. All the tumours were R0 resected, and there was no significant difference in age, sex, tumour size, operation mode, PHS, tumour mitosis, incidence of postoperative complications, risk classification, postoperative targeted drug therapy or postoperative recurrence between the two groups (p>0.05). OT and EBL in the robotic group were significantly different from those in the open surgery group (p<0.05). All the patients survived during the follow-up period, and 4 patients had recurrence and metastasis. No significant difference in recurrence-free survival was noted between the open surgery group and the robotic surgery group (p>0.05).Conclusions: Robotic resection is safe and feasible for patients with duodenal gastrointestinal stromal tumours, and its therapeutic effect is equivalent to open surgery.

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Comprehensive Analysis of Imaging Features, Immunohistochemistry and Prognosis of Hepatocellular Carcinoma Patients with Human Immunodeficiency Virus

10.21203/rs.2.21987/v1 ◽

2020 ◽

Author(s):

Xi Xu ◽

Qingxin Gan ◽

Lieguang Zhang ◽

Deyang Huang ◽

Chengcheng Yu ◽

...

Keyword(s):

Hepatocellular Carcinoma ◽

Human Immunodeficiency Virus ◽

Tumour Size ◽

Postoperative Recurrence ◽

Recurrence Free Survival ◽

Ki 67 ◽

Free Survival ◽

Imaging Characteristics ◽

Immunodeficiency Virus ◽

Age Range

Abstract Background: This study aims to provide clues for the preoperative and prognostic assessment of hepatocellular carcinoma (HCC) patients with human immunodeficiency virus (HIV) by comparing the imaging characteristics, immunohistochemistry and prognosis of HCC patients with and without HIV infection.Methods: The study reviewed two databases, one for HIV-HCC patients and the other for HCC patients who were not infected with HIV. The inclusion criteria were surgically resected and pathologically diagnosed hepatocellular carcinoma patients from October 2013 to August 2016. This study collected 11 HIV-HCC patients (11 men; median age 45 years old, age range 33~71 years) and 11 HCC patients without HIV infection (11 men; median age 50 years old, age range 42~61 years). The image characteristics of HCC were analysed by computed tomography (CT) imaging. In addition, samples were obtained from resected specimens for immunohistochemical analysis, and the expression of glypican-3 (GPC-3), CD34 and Ki-67 were measured. The independent-samples t test, Fisher exact test and Wilcoxon test were used for comparisons. Kaplan-Meier plots were used for postoperative recurrence-free survival analysis.Results: The median diameter of the largest nodule was significantly larger in the HIV-HCC patients than in the HCC group (P=0.027). In addition, the HIV-HCC patients presented significantly higher CD34 and GPC-3 expression than the HCC patients (P=0.031, 0.007, respectively). Moreover, the postoperative recurrence-free survival time was significantly shorter in the HIV-HCC patients than in the HCC patients (Log-Rank test, c2=6.076, P=0.014), with respective median durations of 4 months and 28 months, respectively. Multivariate Cox model analysis revealed that GPC-3 expression and tumour size were independent prognosis factors in the HCC patients (HR = 4.506, 95% CI :1.247-16.278, P= 0.022; HR = 1.479, 95% CI :1.137-1.923, P = 0.022, respectively).Conclusion: Compared to HCC patients with non-HIV infection, HIV-HCC patients frequently present a larger tumour size and high expression of CD34 and GPC-3, which result in shorter postoperative recurrence-free survival. Observing the tumour expression of CD34, GPC-3, and Ki-67 and imaging characteristics could be helpful in providing a basis for the choice of treatment strategies and the prognosis evaluation of patients.

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Comparison of Laparoscopic and Open Surgery for Patients With Borderline Ovarian Tumors

International Journal of Gynecological Cancer ◽

10.1097/igc.0000000000001358 ◽

2018 ◽

Vol 28 (9) ◽

pp. 1657-1663 ◽

Cited By ~ 1

Author(s):

Hee-Jung Jung ◽

Jeong-Yeol Park ◽

Dae-Yeon Kim ◽

Dae-Shik Suh ◽

Jong-Hyeok Kim ◽

...

Keyword(s):

Overall Survival ◽

Laparoscopic Surgery ◽

Surgical Outcomes ◽

Open Surgery ◽

Disease Free Survival ◽

Free Survival ◽

Borderline Ovarian Tumors ◽

Surgery Group ◽

Significant Difference ◽

Disease Free

ObjectivesThe aim of this study was to compare surgical and oncologic outcomes of open and laparoscopic surgery in patients with borderline ovarian tumors (BOTs).Materials and MethodsThis study included patients with BOTs who underwent open (n = 433) or laparoscopic (n = 210) surgery between 1990 and 2015. Surgical outcomes, perioperative morbidity, and disease-free survival and overall survival were compared.ResultsThere was no significant difference in age, histologic type of tumor, and laterality of tumor. However, body mass index was slightly higher for the open surgery group (P = 0.046). The open surgery group had a higher serum cancer antigen 125 level (P < 0.001), larger tumor size (P < 0.001), more frequent radical surgery (P = 0.001), higher stage (P = 0.034), and higher incidence of invasive implants (P = 0.035). The operative time (P < 0.001), time interval to return of bowel movement (P < 0.001), and length of postoperative hospital stay (P < 0.001) were significantly shorter and estimated blood loss was significantly less (P < 0.001) in the laparoscopic group. Perioperative complications were documented in 5 (2.4%) patients in the laparoscopic surgery group and 17 (3.9%) in the open surgery group (P = 0.064). Twenty-three (5.3%) patients in the open surgery group and 9 (4.3%) in the laparoscopic surgery group had recurrence (P = 0.902) at a median follow-up of 57 months. The 10-year disease-free survival was 96% and 97% for the open and laparoscopic groups, respectively (P = 0.851), with no significant difference between the groups after adjusting for independent factors (odds ratio, 1.0; 95% confidence interval, 0.4–2.4; P = 0.999). The 10-year overall survival was 99% for both groups, respectively (P = 0.441).ConclusionsLaparoscopic surgery and open surgery showed similar survival outcomes in BOTs. The surgical outcomes of laparoscopic surgery were more favorable.

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Comparison of survival outcomes between laparoscopic and open surgery in patients with low-risk endometrial cancer

Japanese Journal of Clinical Oncology ◽

10.1093/jjco/hyaa116 ◽

2020 ◽

Vol 50 (11) ◽

pp. 1261-1264

Author(s):

Shinichi Togami ◽

Toshihiko Kawamura ◽

Shintaro Yanazume ◽

Masaki Kamio ◽

Hiroaki Kobayashi

Keyword(s):

Overall Survival ◽

Endometrial Cancer ◽

Laparoscopic Surgery ◽

Open Surgery ◽

Low Risk ◽

Recurrence Free Survival ◽

Free Survival ◽

Surgery Group ◽

Gynecology And Obstetrics ◽

Surgical Data

Abstract Objective To evaluate the feasibility, safety and surgical outcomes of laparoscopic surgery for the treatment of low-risk endometrial cancer. Methods Of 155 patients with low-risk endometrial cancer, who were included in this retrospective study between May 2008 and March 2017, 82 and 73 underwent laparoscopic and open surgery, respectively. Clinicopathological and surgical data, recurrence-free survival and overall survival were analyzed. Results No statistically significant differences in median age, final pathological type, International Federation of Gynecology and Obstetrics stage and lymphovascular space involvement were observed between the laparoscopic and open surgery groups. No procedure in the laparoscopic surgery group was converted to open surgery. The median follow-up period was 60 months, with oncologic recurrence identified in three cases (one lung carcinoma and two pelvic cavity carcinomas) in the laparoscopic surgery group. There was no significant between-group difference in 5-year recurrence-free survival (laparoscopic surgery group: 96.3%, open surgery group: 92.6%) and overall survival (laparoscopic surgery group: 100%, open surgery group: 95.4%). Conclusions Laparoscopic surgery is a feasible and safe treatment for endometrial cancer and should be considered as a standard treatment option for low-risk endometrial cancer.

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Transoral Robotic Surgery Versus Chemoradiation Treatment in Oropharyngeal Cancer: Case-matched Comparison of Survival and Swallowing Outcomes

10.21203/rs.2.13186/v1 ◽

2019 ◽

Author(s):

Connor Sommerfeld ◽

Caroline Jeffery ◽

Jessica M Clark ◽

Daniel A O'Connell ◽

Jeffrey Harris ◽

...

Keyword(s):

Overall Survival ◽

Robotic Surgery ◽

Transoral Robotic Surgery ◽

Gastrostomy Tube ◽

Tube Placement ◽

Recurrence Free Survival ◽

Curative Intent ◽

Free Survival ◽

Significant Difference ◽

Swallowing Outcomes

Abstract Background As the incidence of HPV/p16-positve oropharyngeal squamous cell carcinoma (OPSCC) continues to rise, a large population of survivors with treatment related morbidity is emerging. Transoral robotic surgery (TORS) is an excellent surgical option for p16-positive OPSCC but data comparing both survival and swallowing outcomes of this treatment versus radiotherapy/chemoradiotherapy (RT/CRT) remains limited. Methods Data was prospectively collected (05/2014 - 02/2019) in a tertiary care referral center from OPSCC patients treated with curative intent by TORS (+/-post-operative RT/CRT) or RT/CRT. Surgical and non-surgical treatment groups were case-matched for smoking status, T-stage, and N-stage based on AJCC 8th edition staging. Patients who were treated with curative intent by TORS (+/-post-operative RT/CRT) or RT/CRT for OPSCC were included. Overall survival, recurrence free survival, aspiration free survival and gastrostomy tube outcomes were compared using univariate and multivariate statistical analyses. Results A total of 82 patients treated with TORS were case-matched with 61 patients who received RT/CRT. TORS patients demonstrated a significantly (p=0.02) higher overall survival (OS) at 3 years (OS=93.2%) compared to RT/CRT patients (OS=78.9%). No statistically significant difference was seen in recurrence free survival when comparing the two groups. TORS patients demonstrated an aspiration free survival (AFS) of 64.7% compared to 26.1% in RT/CRT patients (p=0.02 Log-Rank, 0.018 Breslow). TORS patients also had significantly (p < 0.01) lower gastrostomy tube placement (13.4%) compared to RT/CRT (22.9%) at any point during treatment. Conclusion Patients undergoing treatment by TORS may have comparable survival and improved swallowing outcomes when compared to those undergoing RT/CRT for HPV-OPSCC.

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Inflammatory indexes in preoperative blood routine to predict early recurrence of hepatocellular carcinoma after curative hepatectomy

BMC Surgery ◽

10.1186/s12893-021-01180-9 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

YiFeng Wu ◽

ChaoYong Tu ◽

ChuXiao Shao

Keyword(s):

Risk Factors ◽

Hepatocellular Carcinoma ◽

Tumour Size ◽

Area Under The Curve ◽

Early Recurrence ◽

Recurrence Free Survival ◽

Free Survival ◽

Lymphocyte Ratio ◽

Inflammatory Index ◽

Curative Hepatectomy

Abstract Background The inflammation indexes in blood routine play an essential role in evaluating the prognosis of patients with hepatocellular carcinoma, but the effect on early recurrence has not been clarified. The study aimed to investigate the risk factors of early recurrence (within 2 years) and recurrence-free survival after curative hepatectomy and explore the role of inflammatory indexes in predicting early recurrence. Methods The baseline data of 161 patients with hepatocellular carcinoma were analyzed retrospectively. The optimal cut-off value of the inflammatory index was determined according to the Youden index. Its predictive performance was compared by the area under the receiver operating characteristic curve. Logistic and Cox regression analyses were used to determine the risk factors of early recurrence and recurrence-free survival. Results The area under the curve of monocyte to lymphocyte ratio (MLR) for predicting early recurrence was 0.700, which was better than systemic inflammatory response index (SIRI), neutrophil to lymphocyte ratio (NLR), platelet to lymphocyte ratio (PLR) and systemic immune-inflammatory index (SII). MLR, tumour size, tumour differentiation and BCLC stage are all risk factors for early recurrence and recurrence-free survival of HCC. Combining the above four risk factors to construct a joint index, the area under the curve for predicting early recurrence was 0.829, which was better than single MLR, tumour size, tumour differentiation and BCLC stage. Furthermore, with the increase of risk factors, the recurrence-free survival of patients is worse. Conclusion The combination of MLR and clinical risk factors is helpful for clinicians to identify high-risk patients with early recurrence and carry out active postoperative adjuvant therapy to improve the prognosis of patients.

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

QJM ◽

10.1093/qjmed/hcab097.024 ◽

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.

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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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Transoral Surgery Alone for Human-Papillomavirus–Associated Oropharyngeal Squamous Cell Carcinoma

Ear Nose & Throat Journal ◽

10.1177/014556131309200211 ◽

2013 ◽

Vol 92 (2) ◽

pp. 76-83 ◽

Cited By ~ 35

Author(s):

Steven M. Olsen ◽

Eric J. Moore ◽

Rebecca R. Laborde ◽

Joaquin J. Garcia ◽

Jeffrey R. Janus ◽

...

Keyword(s):

Squamous Cell Carcinoma ◽

Human Papillomavirus ◽

Robotic Surgery ◽

Cell Carcinoma ◽

Neck Dissection ◽

Transoral Robotic Surgery ◽

Recurrence Free Survival ◽

Free Survival ◽

Kaplan Meier ◽

Disease Specific

The aim of this retrospective study was to describe the oncologic and functional results of treating oropharyngeal squamous cell carcinoma with transoral robotic surgery and neck dissection as monotherapy. A review was performed, including all patients who underwent transoral robotic surgery and neck dissection as the only means of therapy for oropharyngeal carcinoma from March 2007 to July 2009 at a single tertiary care academic medical center. We reviewed all cases with ≥ 24-month follow-up. Functional outcomes included tracheostomy dependence and oral feeding ability. Oncologic outcomes were stratified by human papillomavirus (HPV) status and tobacco use and included local, regional, and distant disease control, as well as disease-specific and recurrence-free survival. Eighteen patients met study criteria. Ten patients (55.6%) were able to eat orally in the immediate postoperative period, and 8 (44.4%) required a temporary nasogastric tube for a mean duration of 13.6 days (range 3 to 24 days) before returning to an oral diet. No patient required placement of a gastrostomy tube, and all patients are tracheostomy-tube–free. Among the HPV-positive nonsmokers (12/18, 66.7%), Kaplan-Meier estimated 3-year local, regional, and distant control rates were 90.9%, 100%, and 100%, respectively. Kaplan-Meier estimated disease-specific survival and recurrence-free survival were 100% and 90.9%, respectively. No complications occurred.

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Homeostatic Model Assessment of Insulin Resistance for Predicting the Recurrence of Hepatocellular Carcinoma after Curative Treatment

International Journal of Molecular Sciences ◽

10.3390/ijms20030605 ◽

2019 ◽

Vol 20 (3) ◽

pp. 605 ◽

Cited By ~ 3

Author(s):

Kenji Imai ◽

Koji Takai ◽

Tatsunori Hanai ◽

Atsushi Suetsugu ◽

Makoto Shiraki ◽

...

Keyword(s):

Hepatocellular Carcinoma ◽

Insulin Resistance ◽

Curative Treatment ◽

Diabetic Patients ◽

Model Assessment ◽

Recurrence Free Survival ◽

Free Survival ◽

Significant Difference ◽

The Impact ◽

Hcc Recurrence

Diabetes mellitus (DM) is a risk factor for hepatocellular carcinoma (HCC). The purpose of this study was to investigate the impact of the disorder of glucose metabolism on the recurrence of HCC after curative treatment. Two hundred and eleven patients with HCC who received curative treatment in our hospital from 2006 to 2017 were enrolled in this study. Recurrence-free survival was estimated using the Kaplan–Meier method, and the differences between the groups partitioned by the presence or absence of DM and the values of hemoglobin A1c (HbA1c), fasting plasma glucose (FPG), fasting immunoreactive insulin (FIRI), and homeostasis model assessment-insulin resistance (HOMA-IR) were evaluated using the log-rank test. There were no significant differences in the recurrence-free survival rate between the patients with and without DM (p = 0.144), higher and lower levels of HbA1c (≥6.5 and <6.5%, respectively; p = 0.509), FPG (≥126 and <126 mg/dL, respectively; p = 0.143), and FIRI (≥10 and <10 μU/mL, respectively; p = 0.248). However, the higher HOMA-IR group (≥2.3) had HCC recurrence significantly earlier than the lower HOMA-IR group (<2.3, p = 0.013). Moreover, there was a significant difference between the higher and lower HOMA-IR groups without DM (p = 0.009), and there was no significant difference between those groups with DM (p = 0.759). A higher HOMA-IR level, particularly in non-diabetic patients, was a significant predictor for HCC recurrence after curative treatment.

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Laparoscopic Versus Open Appendectomy for the Treatment of Complicated Acute Appendicitis

Advances in Bioscience and Clinical Medicine ◽

10.7575/aiac.abcmed.v.8n.1p.15 ◽

2020 ◽

Vol 8 (1) ◽

pp. 15

Author(s):

Alireza Barband ◽

Amir Mangouri ◽

Changiz Gholipouri ◽

Abasad Gharedaghi

Keyword(s):

Laparoscopic Surgery ◽

Surgical Treatment ◽

Postoperative Pain ◽

Acute Appendicitis ◽

Open Surgery ◽

Surgery Group ◽

Significant Difference ◽

Duration Of Surgery ◽

Duration Of Hospitalization ◽

Complicated Acute Appendicitis

Background and Objective: Acute appendicitis is one of the most common and at the same time lethal if not treated promptly. Failure to treat this medical condition in a timely manner then it can lead to major complications that endanger the patient’s health. In these cases, surgical treatment can be done in an open or laparoscopic method. Despite some limited studies comparing the results of these two therapies, there is still insufficient information in patients with this complicated situation. The aim of this study was to evaluate the results of these two therapies in patients with complicated acute appendicitis. Materials and Methods: In this randomized controlled clinical trial, 52 patients with complicated acute appendicitis in the laparoscopic surgery group and 56 patients in the open surgery group were studied. Primary outcomes in this study were duration of surgery and secondary outcomes including wound infection, intra-abdominal abscess, postoperative pain, miscarriage, hospitalization, and need for re-surgery that were compared between the two groups. Results: Both groups were matched for age (mean 31.0 years in laparoscopic surgery group, 30.5 years in open surgery group, p = 0.81) and gender (28 men in laparoscopic surgery group, 32 men in surgical group, p = 0.73). The mean duration of surgery in the laparoscopic group was significantly longer (mean 66.8 vs. 55.1 min, p <0.001). In contrast, mean duration of hospitalization (85.2 vs 98.6 hours, p <0.001) and mean postoperative pain severity (6.3 vs 7.2, p <0.001) was more significant high in open surgery group. In other cases there was no significant difference between the two groups. Conclusion: Although in surgical treatment of complicated acute appendicitis the duration of laparoscopic surgery is longer than the open method, but the duration of hospitalization and pain intensity in laparoscopic method is significantly reduced.

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