scholarly journals Impact of Previous Abdominal Surgery on Robotic-assisted Rectal Surgery in Patients With Rectal Cancer Undergoing Preoperative Chemoradiotherapy: A Propensity Score Matching Study

2020 ◽  
Author(s):  
Ching-Wen Huang ◽  
Wei-Chih Su ◽  
Tsung-Kun Chang ◽  
Cheng-Jen Ma ◽  
Tzu-Chieh Yin ◽  
...  
Keyword(s):  
Rectal Cancer ◽  
Propensity Score ◽  
Abdominal Surgery ◽  
Propensity Score Matching ◽  
Rectal Surgery ◽  
Perioperative Outcomes ◽  
Group Differences ◽  
Complication Rates ◽  
Robotic Assisted ◽  
Previous Abdominal Surgery

Abstract Background: The application of minimally invasive surgery in patients with colorectal cancer (CRC) and a history of previous abdominal surgery (PAS) remains controversial. This retrospective study with propensity score matching (PSM) investigated the impact of PAS on robotic-assisted rectal surgery outcomes in patients with rectal cancer undergoing preoperative concurrent chemoradiotherapy (CCRT).Methods: In total, 203 patients with rectal cancer who underwent preoperative CCRT and robotic-assisted rectal surgery between May 2013 and December 2019 were enrolled. Patients were categorized into PAS and non-PAS groups based on the PAS history. The PSM caliper matching method with 1-to-3 match was used to match PAS patients with non-PAS.Results: Of the 203 enrolled patients, 35 were PAS patients 168 were non-PAS patients. After PSM, 32 PAS patients and 96 non-PAS patients were included for analysis. No significant between-group differences were noted in the perioperative outcomes, including median console time [165 min (PAS) vs 175 min (noon-PAS), P = 0.4542)] and median operation time [275 min (PAS) vs 290 min (non-PAS), P = 0.5943)] after PSM. Postoperative recovery and overall complication rates were also similar (all P > 0.05). Moreover, the between-group differences in pathological or short-term oncological outcomes were also nonsignificant (all P > 0.05). No 30-day postoperative deaths were observed in either group.Conclusion: The current results indicate that robotic-assisted surgery is safe and feasible for PAS patients with rectal cancer undergoing preoperative CCRT. However, future prospective randomized clinical trials are required to verify these findings.

scholarly journals Impact of Previous Abdominal Surgery on Robotic-Assisted Rectal Surgery in Patients with Rectal Cancer Undergoing Preoperative Chemoradiotherapy: A Propensity Score Matching Study

2020 ◽  
Author(s):  
Ching-Wen Huang ◽  
Wei-Chih Su ◽  
Tsung-Kun Chang ◽  
Cheng-Jen Ma ◽  
Tzu-Chieh Yin ◽  
...  
Keyword(s):  
Rectal Cancer ◽  
Propensity Score ◽  
Abdominal Surgery ◽  
Propensity Score Matching ◽  
Rectal Surgery ◽  
Perioperative Outcomes ◽  
Group Differences ◽  
Complication Rates ◽  
Robotic Assisted ◽  
Previous Abdominal Surgery

Abstract Background: The application of minimally invasive surgery in patients with colorectal cancer (CRC) and a history of previous abdominal surgery (PAS) remains controversial. This retrospective study with propensity score matching (PSM) investigated the impact of PAS on robotic-assisted rectal surgery outcomes in patients with rectal cancer undergoing preoperative concurrent chemoradiotherapy (CCRT).Methods: In total, 203 patients with rectal cancer who underwent preoperative CCRT and robotic-assisted rectal surgery between May 2013 and December 2019 were enrolled. Patients were categorized into PAS and non-PAS groups based on the PAS history. The PSM caliper matching method with 1-to-3 match was used to match PAS patients with non-PAS.Results: Of the 203 enrolled patients, 35 were PAS patients 168 were non-PAS patients. After PSM, 32 PAS patients and 96 non-PAS patients were included for analysis. No significant between-group differences were noted in the perioperative outcomes, including median console time [165 min (PAS) vs 175 min (noon-PAS), P = 0.4542)] and median operation time [275 min (PAS) vs 290 min (non-PAS), P = 0.5943)] after PSM. Postoperative recovery and overall complication rates were also similar (all P > 0.05). Moreover, the between-group differences in pathological or short-term oncological outcomes were also nonsignificant (all P > 0.05). No 30-day postoperative deaths were observed in either group.Conclusion: The current results indicate that robotic-assisted surgery is safe and feasible for PAS patients with rectal cancer undergoing preoperative CCRT. However, future prospective randomized clinical trials are required to verify these findings.

scholarly journals Impact of previous abdominal surgery on robotic-assisted rectal surgery in patients with locally advanced rectal adenocarcinoma: a propensity score matching study

2020 ◽  
Vol 18 (1) ◽  
Author(s):  
Ching-Wen Huang ◽  
Wei-Chih Su ◽  
Tsung-Kun Chang ◽  
Cheng-Jen Ma ◽  
Tzu-Chieh Yin ◽  
...  
Keyword(s):  
Propensity Score ◽  
Abdominal Surgery ◽  
Propensity Score Matching ◽  
Locally Advanced ◽  
Rectal Adenocarcinoma ◽  
Rectal Surgery ◽  
Perioperative Outcomes ◽  
Group Differences ◽  
Robotic Assisted ◽  
Previous Abdominal Surgery

Abstract Background The application of minimally invasive surgery in patients with colorectal cancer (CRC) and a history of previous abdominal surgery (PAS) remains controversial. This retrospective study with propensity score matching (PSM) investigated the impact of PAS on robotic-assisted rectal surgery outcomes in patients with locally advanced rectal adenocarcinoma undergoing preoperative concurrent chemoradiotherapy (CCRT). Methods In total, 203 patients with locally advanced rectal adenocarcinoma who underwent preoperative CCRT and robotic-assisted rectal surgery between May 2013 and December 2019 were enrolled. Patients were categorized into PAS and non-PAS groups based on the PAS history. The PSM caliper matching method with 1-to-3 matches was used to match PAS patients with non-PAS. Results Of the 203 enrolled patients, 35 were PAS patients and 168 were non-PAS patients. After PSM, 32 PAS patients and 96 non-PAS patients were included for analysis. No significant between-group differences were noted in the perioperative outcomes, including median console time (165 min (PAS) vs. 175 min (non-PAS), P = 0.4542) and median operation time (275 min (PAS) vs. 290 min (non-PAS), P = 0.5943) after PSM. Postoperative recovery and overall complication rates were also similar (all P > 0.05). Moreover, the between-group differences in pathological or short-term oncological outcomes were also nonsignificant (all P > 0.05). No 30-day postoperative deaths were observed in either group. Conclusion The current results indicate that robotic-assisted surgery is safe and feasible for PAS patients with locally advanced rectal adenocarcinoma undergoing preoperative CCRT. However, future prospective randomized clinical trials are required to verify these findings.

scholarly journals Impact of Previous Abdominal Surgery on Robotic-Assisted Rectal Surgery in Patients with Locally Advanced Rectal Adenocarcinoma: A Propensity Score Matching Study

2020 ◽  
Author(s):  
Ching-Wen Huang ◽  
Wei-Chih Su ◽  
Tsung-Kun Chang ◽  
Cheng-Jen Ma ◽  
Tzu-Chieh Yin ◽  
...  
Keyword(s):  
Propensity Score ◽  
Abdominal Surgery ◽  
Propensity Score Matching ◽  
Locally Advanced ◽  
Rectal Adenocarcinoma ◽  
Rectal Surgery ◽  
Perioperative Outcomes ◽  
Group Differences ◽  
Robotic Assisted ◽  
Previous Abdominal Surgery

Abstract Background: The application of minimally invasive surgery in patients with colorectal cancer (CRC) and a history of previous abdominal surgery (PAS) remains controversial. This retrospective study with propensity score matching (PSM) investigated the impact of PAS on robotic-assisted rectal surgery outcomes in patients with locally advanced rectal adenocarcinoma undergoing preoperative concurrent chemoradiotherapy (CCRT).Methods: In total, 203 patients with locally advanced rectal adenocarcinoma who underwent preoperative CCRT and robotic-assisted rectal surgery between May 2013 and December 2019 were enrolled. Patients were categorized into PAS and non-PAS groups based on the PAS history. The PSM caliper matching method with 1-to-3 match was used to match PAS patients with non-PAS.Results: Of the 203 enrolled patients, 35 were PAS patients 168 were non-PAS patients. After PSM, 32 PAS patients and 96 non-PAS patients were included for analysis. No significant between-group differences were noted in the perioperative outcomes, including median console time [165 min (PAS) vs 175 min (non-PAS), P = 0.4542)] and median operation time [275 min (PAS) vs 290 min (non-PAS), P = 0.5943)] after PSM. Postoperative recovery and overall complication rates were also similar (all P > 0.05). Moreover, the between-group differences in pathological or short-term oncological outcomes were also nonsignificant (all P > 0.05). No 30-day postoperative deaths were observed in either group.Conclusion: The current results indicate that robotic-assisted surgery is safe and feasible for PAS patients with locally advanced rectal adenocarcinoma undergoing preoperative CCRT. However, future prospective randomized clinical trials are required to verify these findings.

Laparoscopic versus Open Hepatectomy for Hepatocellular Carcinoma in Elderly Patients: A Single-Institutional Propensity Score Matching Comparison

2020 ◽  
Vol 37 (6) ◽  
pp. 495-504
Author(s):  
Wethit Dumronggittigule ◽  
Ho-Seong Han ◽  
Soyeon Ahn ◽  
Yoo-Seok Yoon ◽  
Jai Young Cho ◽  
...  
Keyword(s):  
Hepatocellular Carcinoma ◽  
Propensity Score ◽  
Elderly Patients ◽  
Propensity Score Matching ◽  
Laparoscopic Hepatectomy ◽  
Perioperative Outcomes ◽  
High Morbidity ◽  
Complication Rates ◽  
High Morbidity Rate ◽  
Open Hepatectomy

<b><i>Background:</i></b> The incidence of hepatocellular carcinoma (HCC) in elderly patients is increasing worldwide. Although open hepatectomy (OH) yields acceptable outcomes, high morbidity rate is concerned. Laparoscopic hepatectomy (LH) has evolved to improve perioperative outcomes. However, comparative study between both techniques for elderly patients with HCC is scarce. <b><i>Objective:</i></b> This study aimed to compare outcomes between LH and OH specifically. <b><i>Methods:</i></b> HCC patients aged ≥70 years after hepatectomy (2003–2018) were included. The propensity score matching (PSM) and comparative analyses between groups were performed. <b><i>Results:</i></b> After PSM, there were 41 patients in each group with similar demographics, radiographic tumor characteristics, cirrhotic status, and extent of resection. The LH group had a shorter hospital stay (7 vs. 11 days, <i>p</i> = 0.002) compared with the OH group. The completeness of resection and complication rates were not statistically different between groups. The 5-year overall survival and recurrence-free survival rates were 86.7 and 43.4% in the LH group and 62.2 and 30.8% in the OH group (<i>p</i> = 0.221 and 0.500). <b><i>Conclusion:</i></b> Our study confirmed the operative and oncological safety of LH in elderly HCC patients with improved perioperative outcomes compared with OH.

scholarly journals Robotic-Assisted versus Conventional Laparoscopic Approach for Rectal Cancer Surgery, First Egyptian Academic Center Experience, RCT

2018 ◽  
Vol 2018 ◽  
pp. 1-11 ◽  
Author(s):  
Yasser Debakey ◽  
Ashraf Zaghloul ◽  
Ahmed Farag ◽  
Ahmed Mahmoud ◽  
Inas Elattar
Keyword(s):  
Rectal Cancer ◽  
Rectal Surgery ◽  
Laparoscopic Approach ◽  
Laparoscopic Group ◽  
Distal Margin ◽  
Complication Rates ◽  
Safe Procedure ◽  
Short Term ◽  
Robotic Assisted ◽  
Estimated Blood Loss

Background. Undoubtedly, robotic systems have largely penetrated the surgical field. For any new operative approach to become an accepted alternative to conventional methods, it must be proved safe and result in comparable outcomes. The purpose of this study is to compare the short-term operative as well as oncologic outcomes of robotic-assisted and laparoscopic rectal cancer resections. Methods. This is a prospective randomized clinical trial conducted on patients with rectal cancer undergoing either robotic-assisted or laparoscopic surgery from April 2015 till February 2017. Patients’ demographics, operative parameters, and short-term clinical and oncological outcomes were analyzed. Results. Fifty-seven patients underwent permuted block randomization. Of these patients, 28 were assigned to undergo robotic-assisted rectal surgery and 29 to laparoscopic rectal surgery. After exclusion of 12 patients following randomization, 45 patients were included in the analysis. No significant differences exist between both groups in terms of age, gender, BMI, ASA score, clinical stage, and rate of receiving upfront chemoradiation. Estimated blood loss was evidently lower in the robotic than in the laparoscopic group (median: 200 versus 325 ml, p= 0.050). A significantly more distal margin is achieved in the robotic than in the laparoscopic group (median: 2.8 versus 1.8, p< 0.001). Although the circumferential radial margin (CRM) was complete in 18 patients (85.7%) in the robotic group in contrast to 15 patients (62.5%) in the laparoscopic group, it did not differ statistically (p=0.079). The overall postoperative complication rates were similar between the two groups. Conclusion. To our knowledge, this is the first prospective randomized trial of robotic rectal surgery in the Middle East and Northern Africa region. Our early experience indicates that robotic rectal surgery is a feasible and safe procedure. It is not inferior to standard laparoscopy in terms of oncologic radicality and surgical complications. Organization number is IORG0003381. IRB number is IRB00004025.

scholarly journals Postoperative non-steroidal anti-inflammatory drug use and oncological outcomes of rectal cancer

BJS Open ◽  
2021 ◽  
Vol 5 (1) ◽  
Author(s):  
O Grahn ◽  
M Lundin ◽  
M-L Lydrup ◽  
E Angenete ◽  
M Rutegård
Keyword(s):  
Rectal Cancer ◽  
Propensity Score ◽  
Propensity Score Matching ◽  
Instrumental Variables ◽  
Cox Regression ◽  
Recurrence Free Survival ◽  
Free Survival ◽  
Oncological Outcomes ◽  
Anti Inflammatory ◽  
Instrumental Variables Approach

Abstract Background Non-steroidal anti-inflammatory drugs (NSAIDs) are known to suppress the inflammatory response after surgery and are often used for pain control. This study aimed to investigate NSAID use after radical surgical resection for rectal cancer and long-term oncological outcomes. Methods A cohort of patients who underwent anterior resection for rectal cancer between 2007 and 2013 in 15 hospitals in Sweden was investigated retrospectively. Data were obtained from the Swedish Colorectal Cancer Registry and medical records; follow-up was undertaken until July 2019. Patients who received NSAID treatment for at least 2 days after surgery were compared with controls who did not, and the primary outcome was recurrence-free survival. Cox regression modelling with confounder adjustment, propensity score matching, and an instrumental variables approach were used; missing data were handled by multiple imputation. Results The cohort included 1341 patients, 362 (27.0 per cent) of whom received NSAIDs after operation. In analyses using conventional regression and propensity score matching, there was no significant association between postoperative NSAID use and recurrence-free survival (adjusted hazard ratio (HR) 1.02, 0.79 to 1.33). The instrumental variables approach, including individual hospital as the instrumental variable and clinicopathological variables as co-variables, suggested a potential improvement in the NSAID group (HR 0.61, 0.38 to 0.99). Conclusion Conventional modelling did not demonstrate an association between postoperative NSAID use and recurrence-free survival in patients with rectal cancer, although an instrumental variables approach suggested a potential benefit.

scholarly journals Cost analysis of staged versus simultaneous bilateral total knee and hip arthroplasty using a propensity score matching

BMJ Open ◽  
2021 ◽  
Vol 11 (3) ◽  
pp. e041147
Author(s):  
Ji-Fei Hou ◽  
Chuan Hu ◽  
Yun Zhang ◽  
Li-Qi Tian ◽  
Yan-Zheng Liu ◽  
...  
Keyword(s):  
Blood Transfusion ◽  
Propensity Score ◽  
Propensity Score Matching ◽  
Nursing Care ◽  
Hip Arthroplasty ◽  
Medical Costs ◽  
Complication Rates ◽  
Propensity Score Matching Analysis ◽  
Total Knee ◽  
The Difference

BackgroundTotal joint arthroplasty (TJA), including total knee arthroplasty (TKA) and total hip arthroplasty (THA), is required for many patients. This study aimed to evaluate the medical costs, length of stay (LOS), blood transfusion and in-hospital complications in patients undergoing simultaneous and staged TJA.MethodsAll patients who underwent primary bilateral TJA from 2013 to 2018 in our institute were included. The propensity score matching analysis was performed between simultaneous and staged TJA patients. The difference in medical costs, LOS, blood transfusion and in-hospital complications was compared between simultaneous and staged groups.ResultsExcept for materials fees and general therapy fees, medical costs (bed fees, general therapy fees, nursing care fees, check-up and laboratory test fees, surgical fees and drug fees) were significantly lower in the simultaneous TKA, THA and TJA group. The total average medical costs in simultaneous and staged TKA groups were $15 385 and $16 729 (p<0.001), respectively; THA groups were $14 503 and $16 142 (p=0.016), respectively; TJA groups were $15 389 and $16 830 (p<0.001), respectively. The highest and lowest costs were materials fees and nursing care fees. No significant differences were found for five common comorbidities and postoperative complications between the two subgroups. The simultaneous groups had a shorter LOS and the differences from the staged group for TKA, THA and the TJA group were 8, 6 and 8 days, respectively. The incidence of blood transfusion is higher for simultaneous groups and the difference from the staged group for TKA, THA and TJA is 32.69%, 18% and 29.3%, respectively.ConclusionsOur results indicate that simultaneous TKA and THA with a shorter LOS would cost fewer (costs incurred during hospitalisation) than staged TKA and THA. Complication rates were not affected by the choice for staged or simultaneous arthroplasty, but the incidence of blood transfusion was higher in the simultaneous groups.

scholarly journals Evolution and trends in the adoption of laparoscopic liver resection in Singapore: Analysis of 300 cases

2021 ◽  
Vol 50 (10) ◽  
pp. 742-750
Author(s):  
Brian K Goh ◽  
Zhongkai Wang ◽  
Ye-Xin Koh ◽  
Kai-Inn Lim
Keyword(s):  
Liver Resection ◽  
Blood Loss ◽  
Abdominal Surgery ◽  
Laparoscopic Liver Resection ◽  
Conversion Rate ◽  
Perioperative Outcomes ◽  
Transfusion Rate ◽  
Open Conversion ◽  
Previous Abdominal Surgery ◽  
Surgeon Experience

ABSTRACT Introduction: The introduction of laparoscopic surgery has changed abdominal surgery. We evaluated the evolution and changing trends associated with adoption of laparoscopic liver resection (LLR) and the experience of a surgeon without prior LLR experience. Methods: A retrospective review of 310 patients who underwent LLR performed by a single surgeon from 2011 to 2020 was conducted. Exclusion criteria were patients who underwent laparoscopic liver surgeries such as excision biopsy, local ablation, drainage of abscesses and deroofing of liver cysts. There were 300 cases and the cohort was divided into 5 groups of 60 patients. Results: There were 288 patients who underwent a totally minimally invasive approach, including 28 robotic-assisted procedures. Open conversion occurred for 13 (4.3%) patients; the conversion rate decreased significantly from 10% in the initial period to 3.3% subsequently. There were 83 (27.7%) major resections and 131 (43.7%) resections were performed for tumours in the difficult posterosuperior location. There were 152 (50.7%) patients with previous abdominal surgery, including 52 (17.3%) repeat liver resections for recurrent tumours, and 60 patients had other concomitant operations. According to the Iwate criteria, 135 (44.7%) were graded as high/expert difficulty. Major morbidity (>grade 3a) occurred in 12 (4.0%) patients and there was no 30-day mortality. Comparison across the 5 patient groups demonstrated a significant trend towards older patients, higher American Society of Anesthesiologists (ASA) score, increasing frequency of LLR with previous abdominal surgery, increasing frequency of portal hypertension and huge tumours, decreasing blood loss and decreasing transfusion rate across the study period. Surgeon experience (≤60 cases) and Institut Mutualiste Montsouris (IMM) high grade resections were independent predictors of open conversion. Open conversion was associated with worse perioperative outcomes such as increased blood loss, transfusion rate, morbidity and length of stay. Conclusion: LLR can be safely adopted for resections of all difficulty grades, including major resections and for tumours located in the difficult posterosuperior segments, with a low open conversion rate. Keywords: Laparoscopic hepatectomy, laparoscopic liver resection, robotic hepatectomy, robotic liver resection, Singapore

Sign in / Sign up

Export Citation Format

Share Document