scholarly journals The Impact of Complications on Short-Term Outcomes of Pelvic Peritoneum Reconstruction with Barbed Suture in Laparoscopic Rectal Resection for Rectal Cancer

2021 ◽  
Author(s):  
Jing Wen ◽  
Jian Shen ◽  
Qiushi Huang ◽  
Shan He
Keyword(s):  
Rectal Cancer ◽  
Lymph Nodes ◽  
Rectal Resection ◽  
Pathological Examination ◽  
Barbed Suture ◽  
Short Term ◽  
Pelvic Peritoneum ◽  
Laparoscopic Rectal Resection ◽  
Significant Difference ◽  
The Impact

Abstract Objective: This study aimed to evaluate the safety and short-term outcomes of pelvic peritoneum reconstruction with barbed sutures in laparoscopic rectal resection for rectal cancer. Methods: This is a retrospective cohort study conducted in Chengdu second’s people hospital. The clinicopathological data of 402 patients with rectal cancer admitted to our department hospital from January to December 2019 were collected. There was total of 402 patients, including 218 males and 174 females, with an average age of 68 years. Among them, 216 patients who underwent laparoscopic rectal resection with pelvic peritoneum reconstruction (PPR) were allocated into the PPR group, and 186 patients who underwent conventional laparoscopic rectal resection were allocated into a non-PPR group. All the patients received standard preoperative and postoperative treatments. Observational indicators (1) surgical and postoperative conditions; (2) postoperative pathological examination. (3) postoperative complications. Results (1) Surgery condition: all patients in the two groups underwent successful surgery without conversion to open surgery. There were no differences between the two groups in terms of surgical approach, resection margin, tumor size, postoperative T-stage, postoperative N-stage, positive lymph nodes, harvest lymph nodes, perineal wound infection, perineal hernia, postoperative pneumonia, postoperative hemorrhage, presacral fluid, or abscess. The operative time, blood loss, the incidence of anastomotic leakage, and small-bowel obstruction showed a significant difference between the two groups. Conclusion pelvic peritoneum reconstruction with barbed suture in laparoscopic rectal resection is safe and feasible for the treatment of rectal cancer, which can significantly reduce postoperative perineal-related complications.

Short-Term Outcomes of Pelvic Peritoneum Reconstruction with Barbed Suture After Laparoscopic Rectal Resection for Rectal Cancer

2021 ◽  
Author(s):  
Jing Wen ◽  
Jian Shen ◽  
Qiushi Huang ◽  
Shan He
Keyword(s):  
Rectal Cancer ◽  
Small Bowel ◽  
Lymph Nodes ◽  
Small Bowel Obstruction ◽  
Rectal Resection ◽  
Perineal Hernia ◽  
Barbed Suture ◽  
Short Term ◽  
Pelvic Peritoneum ◽  
Laparoscopic Rectal Resection

Abstract Background: Laparoscopic rectal resection may cause various surgical complications including perineal hernia and adhesive small-bowel obstruction. Pelvic peritoneum reconstruction (PPR) could prevent those complications. The aim of the study is to evaluate the short-term clinical, technical and safety outcomes of PPR using the barbed suture in laparoscopic rectal resection. Methods: This is a retrospective cohort study conducted in Chengdu second’s people hospital. Between January 2014 and December 2019, a total of 402 patients who underwent curative surgery for rectal cancer in Chengdu Second People’s Hospital were enrolled in the study. Among them, 216 patients who underwent laparoscopic rectal resection with PPR were allocated into the experimental group, and 186 patients who underwent laparoscopic rectal resection without PPR were allocated into control group. All the patients received standard preoperative and postoperative treatments. Observational indicators (1) surgical and postoperative conditions; (2) postoperative pathological examination. (3) postoperative complications. The data were represented by X ± s. t-test and X2 test were used for counting data. Results (1) Surgery condition: all patients in the two groups underwent successful surgery without conversion to open surgery. There were no differences between the two groups in terms of surgical approach, resection margin, tumor size, postoperative T-stage, postoperative N-stage, positive lymph nodes, harvest lymph nodes, perineal wound infection, perineal hernia, postoperative pneumonia, postoperative hemorrhage, presacral fluid, or abscess. The operative time, blood loss, the incidence of anastomotic leakage, and small-bowel obstruction showed a significant difference between the two groups. Conclusion We hypothesized that pelvic peritoneum reconstruction with barbed suture could improve the efficiency of intracorporeal closure of the pelvic cavity after in laparoscopic rectal resection, which can significantly reduce postoperative perineal-related complications. Further, we expect that use of the barbed sutures will reduce intra-operative stress on the endoscopic surgeon.

Impact of total lymph node count on staging and survival after neoadjuvant chemoradiation therapy for rectal cancer.

2015 ◽  
Vol 33 (3_suppl) ◽  
pp. 736-736
Author(s):  
Matthew David Hall ◽  
Timothy E. Schultheiss ◽  
Jeffrey Y.C. Wong ◽  
Yi-Jen Chen
Keyword(s):  
Rectal Cancer ◽  
Lymph Node ◽  
Lymph Nodes ◽  
Cancer Patients ◽  
Neoadjuvant Chemoradiation ◽  
Chemoradiation Therapy ◽  
Neoadjuvant Chemoradiation Therapy ◽  
Significant Difference ◽  
The Impact ◽  
Positive Lymph Nodes

736 Background: Neoadjuvant chemoradiation therapy (CRT) results in fewer retrieved lymph nodes at the time of surgery for rectal cancer. The extent of optimal regional nodal dissection is based on guidelines developed before neoadjuvant CRT was commonly used. The purpose of this study is to assess the impact of the number of dissected and positive lymph nodes on overall survival (OS) for rectal cancer patients treated with neoadjuvant CRT. Methods: Treatment data were obtained by structured query on all patients with rectal adenocarcinoma (2000-2013) in the National Oncology Data Alliance, a proprietary database of merged tumor registries. Eligible patients were treated with neoadjuvant CRT followed by surgery and had complete data on the number of positive and dissected lymph nodes and dates of treatment. The relationships between number of lymph nodes examined and OS were separately analyzed in patients with 0, exactly 1, or any number of positive nodes. Results: The median number of lymph nodes examined was 11 (interquartile range 6-16). In 4,581 evaluable patients, there was a significant improvement in OS with the examination of more lymph nodes. Number of positive lymph nodes, number of lymph nodes dissected, age, gender, grade, marital status, and race were significant predictors of OS on multivariate analysis. On subset analysis, patients with 0, exactly 1, and any number of positive nodes were found to have better OS with increasing number of lymph nodes dissected up to eight. Increasing overall mortality was observed in patients with 0, 1, 2-4, 5-7, and ≥8 positive lymph nodes. The Kaplan-Meier curves showed a clear statistically significant difference in OS in patients divided into these five nodal groupings (p<0.0001). Conclusions: Patients with eight or more lymph nodes examined had the greatest improvement in OS in rectal cancer patients treated with neoadjuvant CRT. This should be considered the threshold for an adequate lymph node sampling in this population. A five-tier nodal grouping was found to best forecast prognosis based on the number of positive lymph nodes identified.

scholarly journals Age and comorbidities do not affect short-term outcomes after laparoscopic rectal cancer resection in elderly patients. A multi-institutional cohort study in 287 patients

2021 ◽  
Author(s):  
Roberto Peltrini ◽  
Nicola Imperatore ◽  
Filippo Carannante ◽  
Diego Cuccurullo ◽  
Gabriella Teresa Capolupo ◽  
...  
Keyword(s):  
Rectal Cancer ◽  
Postoperative Complications ◽  
Elderly Patients ◽  
Rectal Resection ◽  
Laparoscopic Approach ◽  
Postoperative Outcomes ◽  
Rectal Cancer Surgery ◽  
Short Term ◽  
Number Of Patients ◽  
Laparoscopic Rectal Resection

AbstractPostoperative complications and mortality rates after rectal cancer surgery are higher in elderly than in non-elderly patients. The aim of this study is to evaluate whether, like in open surgery, age and comorbidities affect postoperative outcomes limiting the benefits of a laparoscopic approach. Between April 2011 and July 2020, data of 287 patients with rectal cancer submitted to laparoscopic rectal resection from different institutions were collected in an electronic database and were categorized into two groups: < 75 years and ≥ 75 years of age. Perioperative data and short-term outcomes were compared between these groups. Risk factors for postoperative complications were determined on multivariate analysis, including age groups and previous comorbidities as variables. Seventy-seven elderly patients had both higher ASA scores (p < 0.001) and cardiovascular disease rates (p = 0.02) compared with 210 non-elderly patients. There were no significative differences between groups in terms of overall postoperative complications (p = 0.3), number of patients with complications (p = 0.2), length of stay (p = 0.2) and death during hospitalization (p = 0.9). The only independent variables correlated with postoperative morbidity were male gender (OR 2.56; 95% CI 1.53–3.68, p < 0.01) and low-medium localization of the tumor (OR 2.12; 75% CI 1.43–4.21, p < 0.01). Although older people are more frail patients, short-term postoperative outcomes in patients ≥ 75 years of age were similar to those of younger patients after laparoscopic surgery for rectal cancer. Elderly patients benefit from laparoscopic rectal resection as well as non-elderly patient, despite advanced age and comorbidities.

scholarly journals T stage-dependent lymph node and distant metastasis and the accuracy of lymph node assessment in rectal cancer

2021 ◽  
Author(s):  
Henry Ptok ◽  
Frank Meyer ◽  
Roland S. Croner ◽  
Ingo Gastinger ◽  
Benjamin Garlipp
Keyword(s):  
Rectal Cancer ◽  
Overall Survival ◽  
Lymph Node ◽  
Lymph Nodes ◽  
False Negative ◽  
Cumulative Risk ◽  
Distant Metastases ◽  
Number Of Patients ◽  
Tumor Stages ◽  
The Impact

Summary Objective To analyze data obtained in a representative number of patients with primary rectal cancer with respect to lymph node diagnostics and related tumor stages. Methods In pT2-, pT3-, and pT4 rectal cancer lesions, the impact of investigated lymph nodes on the frequency of pN+ status, the cumulative risk of metachronous distant metastases, and overall survival was studied by means of a prospective multicenter observational study over a defined period of time. Results From 2000 to 2011, the proportion of surgical specimens with ≥ 12 investigated lymph nodes increased significantly, from 73.6% to 93.2% (p < 0.001; the number of investigated lymph nodes from 16.2 to 20.8; p < 0.001). Despite this, the percentage of pN+ rectal cancer lesions varied only non-significantly (39.9% to 45.9%; p = 0.130; median, 44.1%). For pT2-, pT3-, and pT4 rectal cancer lesions, there was an increasing proportion of pN+ findings correlating significantly with the number of investigated lymph nodes up to n = 12 investigated lymph nodes. Only in pT3 rectal cancer was there a significant increase in pN+ findings in case of > 12 lymph nodes (p = 0.001), but not in pT2 (p = 0.655) and pT4 cancer lesions (p = 0.256). For pT3pN0cM0 rectal cancer, the risk of metachronous distant metastases and overall survival did not depend on the number of investigated lymph nodes. Conclusion In rectal cancer, at least n = 12 lymph nodes are to be minimally investigated. The investigation of fewer lymph nodes is associated with a higher risk of false-negative pN0 findings. In particular, in pT3 rectal cancer, the investigation of more than 12 lymph nodes lowers the risk of false-negative pN0 findings. An upstaging effect by the investigation of a possibly maximal number of lymph nodes could not be detected.

Laparoscopic rectal resection following regrowth of rectal cancer in watch and wait programme

2021 ◽  
Author(s):  
AF Ramzee ◽  
A Mureb ◽  
M Al Dhaheri ◽  
K Qadir ◽  
M Abu Nada ◽  
...  
Keyword(s):  
Rectal Cancer ◽  
Rectal Resection ◽  
Watch And Wait ◽  
Laparoscopic Rectal Resection

scholarly journals Effect of intermittent versus continuous calorie restriction on body weight and cardiometabolic risk markers in subjects with overweight or obesity and mild-to-moderate hypertriglyceridemia: a randomized trial

2020 ◽  
Vol 19 (1) ◽  
Author(s):  
Mahsa Maroofi ◽  
Javad Nasrollahzadeh
Keyword(s):  
Body Weight ◽  
Calorie Restriction ◽  
Density Lipoprotein ◽  
The Body ◽  
Trial Registration ◽  
Lipoprotein Cholesterol ◽  
Short Term ◽  
Significant Difference ◽  
The Impact ◽  
Overweight Or Obesity

Abstract Background Intermittent calorie restriction (ICR) is a novel method of dietary restriction for body weight control with the potential to improve obesity-related cardiometabolic markers, but the impact of this diet on subjects with hypertriglyceridemia (HTG) remains unknown. Methods Eighty-eight subjects with overweight or obesity and mild-to-moderate HTG were randomized to the continuous calorie restriction (CCR) group, or ICR group (a very low-calorie diet during 3 days of the week) for 8 weeks (44 patients in each group). Body composition, plasma lipids, glucose, insulin, adiponectin, and liver enzymes were measured at baseline and after 8 weeks. An intention-to-treat analysis was performed. Results The body weight decreased in both groups (4.07 ± 1.83 kg in the CCR group and 4.57 ± 2.21 kg in the ICR group) with no significant difference between the groups. There was no significant difference between the two groups in the reduced amount of fat mass, fat-free mass, and waist circumference. Both groups achieved a significant reduction in plasma triglycerides after 8 weeks (by 15.6 and 6.3% in ICR and CCR groups, respectively) with no difference between treatment groups. HOMA-IR improved significantly in ICR compared to the CCR group (P = 0.03). Plasma glucose, insulin, low-density lipoprotein cholesterol, high-density lipoprotein cholesterol, liver enzyme, and adiponectin were not different between the two groups. Conclusions The results of this short-term study suggest that three-days a week of the ICR is comparable to a CCR diet for the reduction of triglycerides level in patients with HTG and in the short-term it appears to be more effective than continuous dieting in improving insulin resistance. However, longer-term studies are needed to confirm these findings. Trial registration Trial registration number:NCT04143971.

scholarly journals No Downstaging After Short-Term Preoperative Radiotherapy in Rectal Cancer Patients

2001 ◽  
Vol 19 (7) ◽  
pp. 1976-1984 ◽  
Author(s):  
C.A.M. Marijnen ◽  
I.D. Nagtegaal ◽  
E. Klein Kranenbarg ◽  
J. Hermans ◽  
C.J.H. van de Velde ◽  
...  
Keyword(s):  
Rectal Cancer ◽  
Lymph Nodes ◽  
Cancer Patients ◽  
Tumor Size ◽  
Preoperative Radiotherapy ◽  
Multicenter Trial ◽  
Short Term ◽  
Size Number ◽  
Tumor Node Metastasis Stage ◽  
Poorly Differentiated

PURPOSE: In retrospective studies, total mesorectal excision (TME) surgery has been demonstrated to result in a reduction in the number of local recurrences of rectal cancer. Reports on improved local control after preoperative, hypofractionated radiotherapy have led to the introduction of a randomized multicenter trial to evaluate the effect of TME surgery with and without preoperative radiotherapy. Treatment with preoperative radiotherapy might have an effect on the pathologic characteristics that determine staging of rectal cancer. We investigated the occurrence of downstaging in rectal cancer patients treated with and without preoperative radiotherapy. PATIENTS AND METHODS: We analyzed the differences in tumor size, number of examined lymph nodes, tumor-node-metastasis stage, and histopathologic features in 1,321 patients entered onto a randomized trial. The trial compared preoperative radiotherapy (5 × 5 Gy) followed by TME surgery with TME surgery alone. Patients who had an interval of more than 10 days between the start of radiotherapy and surgery were excluded from analysis. RESULTS: Differences were observed in tumor size (P < .001) and total number of examined lymph nodes (P < .001). No difference in tumor or node classification was detected. The irradiated group demonstrated more poorly differentiated tumors as well as more mucinous tumors. CONCLUSION: In rectal cancer patients, short-term, preoperative radiotherapy with 5 × 5 Gy does not lead to downstaging if the interval between the start of radiotherapy and surgery does not exceed 10 days.

Impact of robotic-assisted approach on lymphadenectomy for colorectal cancer.

2017 ◽  
Vol 35 (4_suppl) ◽  
pp. 787-787
Author(s):  
Reza Gamagami ◽  
Paul Kozak ◽  
Venkata R. Kakarla
Keyword(s):  
Colorectal Cancer ◽  
Lymph Node ◽  
Laparoscopic Surgery ◽  
Lymph Nodes ◽  
Demographic Data ◽  
Robotic Assisted ◽  
Lymph Node Harvest ◽  
Significant Difference ◽  
The Mean ◽  
The Impact

787 Background: In most recent years, robotic assisted laparoscopic surgery (RALS) has proven to be a viable alternative to laparoscopic and traditional open surgery for colorectal cancer. Obtaining the adequate number of lymph nodes is not only essential for accurate staging, but also impacts both prognosis and the need for adjuvant chemotherapy. To date, the efficacy of lymph node harvest for RALS is not well studied or established. The aim of our study is to analyze the impact of RALS on lymphadenectomy for colorectal cancer. Methods: We performed a retrospective review of patients who underwent curative resections for colorectal cancer over a five-year period at a single institution by a single surgeon. Resections were classified as right-sided, sigmoid, or rectal, and subdivided into robotic and non-robotic surgery groups. The demographic data and histopathology were obtained, with an emphasis on the number lymph nodes harvested (LNH) during resections. Emergencies and non-curative resections were excluded. Results: Between January 2010 and December 2015, 136 patients with colorectal cancer underwent curative resections. Sixty-four underwent right-sided resections (28 laparoscopic, 36 robotic). Twenty-five underwent sigmoid resections (11 laparoscopic, 14 robotic), and 47 underwent rectal resections (15 open, 32 robotic). There was no significant difference in age, sex, BMI and ASA scores between the cohorts examined. The mean number of LNH with RALS was significantly higher in all three groups (right-sided—24 vs. 15 ( p= .0001), sigmoid—16 vs. 12 ( p= .046), rectal—19 vs. 4 ( p= .0016)). There was no difference in the rate of adequate lymph node extraction for staging purpose, i.e., 12 lymph nodes in all three groups. Conclusions: Robotic-assisted laparoscopic surgery is associated with a statistically significant increase in lymph node harvest for right-sided, sigmoid and rectal resections for malignancy. Future studies with larger sample sizes are necessary to validate these findings.

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