One-Stage Total Laparoscopic Treatment for Colorectal Cancer With Synchronous Metastasis. Is It Safe and Feasible?

Liver is the main target organ for colorectal cancer (CRC) metastases. It is estimated that ~25% of CRC patients have synchronous metastases at diagnosis, and about 60% of CRC patients will develop metastases during the follow up. Although several teams have performed simultaneous laparoscopic resections (SLR) of liver and colorectal lesions, the feasibility and safety of this approach is still widely debated and few studies on this topic are present in the literature. The purpose of this literature review is to understand the state of the art of SLR and to clarify the potential benefits and limitations of this approach. Several studies have shown that SLR can be performed safely and with short-term outcomes similarly to the separated procedures. Simultaneous laparoscopic colorectal and hepatic resections combine the advantages of one stage surgery with those of laparoscopic surgery. Several reports compared the short-term outcomes of one stage laparoscopic resection with open resections and showed a similar or inferior amount of blood loss, a similar or lower complication rate, and a significant reduction of hospital stay for laparoscopic surgery respect to open surgery but much longer operating times for the laparoscopic technique. Few retrospective studies compared long term outcomes of laparoscopic one stage surgery with the outcomes of open one stage surgery and did not identify any differences about disease free survival and the overall survival. In conclusion, hepatic and colorectal SLR are a safe and effective approach characterized by less intraoperative blood loss, faster recovery of intestinal function, and shorter length of postoperative hospital stay. Moreover, laparoscopic approach is associated to lower rates of surgical complications without significant differences in the long-term outcomes compared to the open surgery.

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Laparoscopic Versus Open Surgery for Early-Stage Intrahepatic Cholangiocarcinoma After Mastering the Learning Curve: A Multicenter Data-Based Matched Study

Frontiers in Oncology ◽

10.3389/fonc.2021.742544 ◽

2022 ◽

Vol 11 ◽

Author(s):

Yang Jinhuan ◽

Wang Yi ◽

Zheng Yuanwen ◽

Ma Delin ◽

Chen Xiaotian ◽

...

Keyword(s):

Blood Loss ◽

Hospital Stay ◽

Intrahepatic Cholangiocarcinoma ◽

Open Surgery ◽

Early Stage ◽

Long Term Results ◽

Perioperative Outcomes ◽

Long Term Outcomes ◽

Short Term

BackgroundSurgical resection is the only widely accepted curative method for intrahepatic cholangiocarcinoma (ICC). However, little is known about the efficacy of laparoscopic liver resection for ICC, especially in patients with early-stage disease. The aim of this study was to compare the short-term and long-term effects of laparoscopy and open surgery for the treatment of ICC.MethodsData from 1,084 patients treated at three hospitals from January 2011 to December 2018 were selected and analyzed. Propensity score matching was performed to compare the long-term outcomes (overall survival and recurrence-free survival) and short-term outcomes (perioperative outcomes) of all-stage and early-stage patients.ResultsAfter matching, 244 patients (122 vs. 122) in the all-stage group and 65 patients (27 vs. 38) in the early-stage group were included. The baseline of the two groups was balanced, and no significant differences were found in sex or age. The short-term results of the laparoscopic group were better than those of the open group, including less blood loss [blood loss ≥400 ml 27 (22.1%) vs. 6 (4.92%), p<0.001 for all-stage, 12 (31.6%) vs. 2 (7.41%), p=0.042 for early stage), shorter surgery [200 (141; 249) min vs. 125 (115; 222) min, p=0.025 for early stage] and shorter hospital stay [11.0 (9.00; 16.0) days vs. 9.00 (7.00; 12.0) days, p=0.001 for all stage, 11.0 (8.50; 17.8) days vs. 9.00 (6.50; 11.0) days, p=0.011 for early stage]. Regarding long-term outcomes, no significant differences were found for all-stage patients, while there were significant differences observed for the early-stage group (p=0.013 for OS, p=0.014 for RFS). For the early-stage patients, the 1-, 3-, and 5-year OS rates of the OLR group were 84.2, 65.8, and 41.1%, respectively, and those of the LLR group were 100, 90.9, and 90.9%, respectively. The RFS rates of the OLR group were 84.2, 66.7, and 41.7%, respectively, and those of the LLR group were and 92.3, 92.3, and 92.3%, respectively.ConclusionPatients treated with laparoscopy seemed to have better short-term outcomes, such as less blood loss, shorter operation duration, and shorter hospital stay, than patients undergoing open surgery. Based on the long-term results, laparoscopic treatment for early ICC may have certain advantages.

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Economic evaluation of laparoscopic surgery for colorectal cancer

International Journal of Technology Assessment in Health Care ◽

10.1017/s0266462307070559 ◽

2007 ◽

Vol 23 (4) ◽

pp. 464-472 ◽

Cited By ~ 7

Author(s):

Robyn M. de Verteuil ◽

Rodolfo A. Hernández ◽

Luke Vale ◽

Keyword(s):

Colorectal Cancer ◽

Systematic Review ◽

Laparoscopic Surgery ◽

Cost Effectiveness ◽

Incremental Cost ◽

Open Surgery ◽

Disease Free Survival ◽

Cost Effective ◽

Economic Evaluations ◽

Short Term

Objectives: The aim of this study was to assess the cost-effectiveness of laparoscopic surgery compared with open surgery for the treatment of colorectal cancer.Methods: A Markov model was developed to model cost-effectiveness over 25 years. Data on the clinical effectiveness of laparoscopic and open surgery for colorectal cancer were obtained from a systematic review of the literature. Data on costs came from a systematic review of economic evaluations and from published sources. The outcomes of the model were presented as the incremental cost per life-year gained and using cost-effectiveness acceptability curves to illustrate the likelihood that a treatment was cost-effective at various threshold values for society's willingness to pay for an additional life-year.Results: Laparoscopic surgery was on average £300 more costly and slightly less effective than open surgery and had a 30 percent chance of being cost-effective if society is willing to pay £30,000 for a life-year. One interpretation of the available data suggests equal survival and disease-free survival. Making this assumption, laparoscopic surgery had a greater chance of being considered cost-effective. Presenting the results as incremental cost per quality-adjusted life-year (QALY) made no difference to the results, as utility data were poor. Evidence suggests short-term benefits after laparoscopic repair. This benefit would have to be at least 0.01 of a QALY for laparoscopic surgery to be considered cost-effective.Conclusions: Laparoscopic surgery is likely to be associated with short-term quality of life benefits, similar long-term outcomes, and an additional £300 per patient. A judgment is required as to whether the short-term benefits are worth this extra cost.

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Short-term and long-term outcomes after laparoscopic surgery for elderly patients with colorectal cancer aged over 80 years: a propensity score matching analysis

International Journal of Colorectal Disease ◽

10.1007/s00384-021-03973-z ◽

2021 ◽

Author(s):

Masako Utsumi ◽

Takeru Matsuda ◽

Kimihiro Yamashita ◽

Hiroshi Hasegawa ◽

Kyosuke Agawa ◽

...

Keyword(s):

Colorectal Cancer ◽

Laparoscopic Surgery ◽

Propensity Score ◽

Elderly Patients ◽

Propensity Score Matching ◽

Long Term Outcomes ◽

Short Term ◽

Propensity Score Matching Analysis

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Short-term outcomes of laparoscopic surgery after insertion of self-expandable metallic stent as a “bridge to surgery” for left-sided obstructive colorectal cancer.

Journal of Clinical Oncology ◽

10.1200/jco.2014.32.3_suppl.643 ◽

2014 ◽

Vol 32 (3_suppl) ◽

pp. 643-643

Author(s):

Yuhei Waki ◽

Kazunori Tokuda ◽

Masayoshi Obatake ◽

Miya Nagahashi ◽

Masanori Hotchi ◽

...

Keyword(s):

Colorectal Cancer ◽

Laparoscopic Surgery ◽

Blood Loss ◽

Hospital Stay ◽

Metallic Stent ◽

Bridge To Surgery ◽

Short Term ◽

Obstructive Colorectal Cancer ◽

Expandable Metallic Stent ◽

Significant Difference

643 Background: Safety and validity of performing laparoscopic surgery after preoperative lavege using the self-expandable metallic stent (SEMS) for left-sided obstructive colorectal cancer were examined. We evaluated the short-term outcome of SEMS insertion compared with laparoscopic surgery without SEMS. Methods: Patients with left-sided colorectal cancer treated by either laparoscopic surgery with stent placement (n = 8) or laparoscopic surgery only (n = 42) in our hospital between April, 2012 and January, 2013 were registered. Short-term outcomes were compared with the two groups about patient characteristics (sex, age, American Society of Anesthesiologists Physical Status, body mass index, prior abdominal surgery), pathological data of patients (tumor location, size of tumor , tumor differentiation, number of harvested lymph nodes, pTNM classification, UICC pathological stage), and operative and post operative results (procedures, conversion, operative time, blood loss, morbidity, solid food intake, postoperative hospital stay, total hospital stay). Results: Except for tumor size in the patient characteristic parameters, there were no statistically significant difference between the two groups. Conversion rate to laparotomy was higher in the stent group (2 versus 1, p = 0.013). There was no difference in operation time, blood loss and postoperative complications between the two groups. Conclusions: Although the long-term oncological result requires further investigation, laparoscopic surgery after self-expandable metallic stent is a safe and feasible treatment as a “brige to surgery” for left-sided obstructive colorectal cancer.

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Oncologic long-term outcome of single-incision laparoscopic surgery (SILS) for colorectal cancer

International Journal of Colorectal Disease ◽

10.1007/s00384-021-03902-0 ◽

2021 ◽

Author(s):

Andreas D. Rink ◽

Vitaly Golubev ◽

Boris Vestweber ◽

Claudia Paul ◽

Hauke Lang ◽

...

Keyword(s):

Colorectal Cancer ◽

Laparoscopic Surgery ◽

Surgical Training ◽

Open Surgery ◽

Single Incision ◽

Disease Free Survival ◽

Single Incision Laparoscopic Surgery ◽

Term Outcome ◽

Long Term Outcome

Abstract Purpose Single-incision laparoscopic surgery (SILS) has been introduced as a less invasive alternative to multi-port laparoscopic surgery (MLS). MLS is widely accepted for the treatment of colorectal cancer, but there remains minimal evidence for the use of SILS. Thus, we compared both short- and long-term outcomes of SILS and open surgery (OS) in matched cohorts of colorectal cancer patients. Methods Some 910 patients had colorectal resections for cancer between 2006 and 2013, and 134 of them were operated on using SILS. Eighty of these SILS patients were compared to a cohort of patients who had open surgery that were matching in tumour stage and location, type of resection, sex, age and ASA Score. Disease-free survival at 5 years (5y-DFS) was the primary endpoint; morbidity and hospitalization were secondary parameters. The role of surgical training in SILS was also investigated. Results Clavien Dindo ≥ IIIb complications occurred in 13.8% in both groups. 5y-DSF were 82% after SILS and 70% after OS (p = 0.11). Local recurrence after rectal cancer tended to be lower after SILS (0/43 (SILS) vs. 4/35 (OS), p = 0.117). Length of stay was significantly shorter after SILS (10 vs. 14 days, p = 0.0004). The rate of operations performed by surgical residents was equivalent in both groups (44/80 (SILS) vs. 46/80 (OS), p = 0.75). Conclusion The data demonstrates that SILS results in similar long-term oncological outcomes when compared to open surgery as well as morbidity rates. The hospital stay in the SILS group was shorter. SILS can also be incorporated in surgical training programmes.

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Advantage of laparoscopy surgery for elderly colorectal cancer patients without compromising oncologic outcome

10.21203/rs.3.rs-27987/v2 ◽

2020 ◽

Author(s):

Yih Jong Chern ◽

Hsin-Yuan Hung ◽

Jeng-Fu You ◽

Yu-Jen Hsu ◽

Jy-Ming Chiang ◽

...

Keyword(s):

Colorectal Cancer ◽

Laparoscopic Surgery ◽

Elderly Patients ◽

Open Surgery ◽

Medical Center ◽

Postoperative Mortality ◽

Long Term Outcomes ◽

Postoperative Stay ◽

Conversion Rates

Abstract Background: Laparoscopic surgery has achieved good results in elderly patients with colorectal cancer (CRC). In this study, we compared the short-term and long-term outcomes of open surgery and laparoscopic surgery in CRC patients aged above 75 years at a single tertiary medical center.Methods: Between January 2009 and December 2015, we studied 967 patients who underwent curative resection for primary colorectal adenocarcinoma without distant metastasis in a single institution. Of the enrolled subjects, 305 underwent laparoscopic surgery, and 662 received open laparotomy surgery.Results: Compared to the patients who received open surgery, those received laparoscopic surgery had prominent shorter postoperative stay (10.3 vs. 13.5 days p < 0.001) and similar postoperative mortality (p = 0.082) and morbidity (p = 0.354). In the laparoscopy cohort, 6 of 305 patients were converted to open surgery and 1 died. The long-term overall survival, cancer-specific survival and recurrence rate were all similar between both cohorts in each stage.Conclusions: Laparoscopic surgery is suitable for elderly patients due to shorter postoperative stay, similar long-term outcomes with open surgery and acceptably low conversion rates. For long-term overall and oncological outcome, the results of laparoscopic surgery were similar to that of open surgery in each TNM stage.

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Decreasing Postoperative Pulmonary Complication Following Laparoscopic Surgery in Elderly Individuals with Colorectal Cancer: A Competing Risk Analysis in a Propensity Score–Weighted Cohort Study

Cancers ◽

10.3390/cancers14010131 ◽

2021 ◽

Vol 14 (1) ◽

pp. 131

Author(s):

Yih-Jong Chern ◽

Jeng-Fu You ◽

Ching-Chung Cheng ◽

Jing-Rong Jhuang ◽

Chien-Yuh Yeh ◽

...

Keyword(s):

Colorectal Cancer ◽

Laparoscopic Surgery ◽

Risk Analysis ◽

Elderly Patients ◽

Open Surgery ◽

Competing Risk ◽

Competing Risk Analysis ◽

Long Term Outcomes ◽

Laparoscopy Group

Advanced age is a risk factor for major abdominal surgery due to a decline in physical function and increased comorbidities. Although laparoscopic surgery provides good results in most patients with colorectal cancer (CRC), its effect on elderly patients remains unclear. This study aimed to compare the short- and long-term outcomes between open and laparoscopic surgeries in elderly patients with CRC. Total 1350 patients aged ≥75 years who underwent curative resection for stage I–III primary CRC were enrolled retrospectively and were divided into open surgery (846 patients) and laparoscopy (504 patients) groups. After propensity score weighting to balance an uneven distribution, a competing risk analysis was used to analyze the short-term and long-term outcomes. Postoperative mortality rates were lower in the laparoscopy group, especially due to pulmonary complications. Postoperative hospital stay was significantly shorter in the laparoscopy group than in the open surgery group. Overall survival, disease-free survival, and competing risk analysis showed no significant differences between the two groups. Laparoscopic surgery for elderly patients with CRC significantly decreased pulmonary-related postoperative morbidity and mortality in this large cohort study. Laparoscopic surgery is a favorable method for elderly patients with CRC than open surgery in terms of less hospital stay and similar oncological outcomes.

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Advantage of Laparoscopy Surgery for Elderly Colorectal Cancer Patients without Compromising Oncologic Outcome

10.21203/rs.3.rs-27987/v1 ◽

2020 ◽

Author(s):

Yih Jong Chern ◽

Hsin-Yuan Hung ◽

Jeng-Fu You ◽

Yu-Jen Hsu ◽

Jy-Ming Chiang ◽

...

Keyword(s):

Colorectal Cancer ◽

Laparoscopic Surgery ◽

Elderly Patients ◽

Open Surgery ◽

Medical Center ◽

Postoperative Mortality ◽

Long Term Outcomes ◽

Postoperative Stay ◽

Conversion Rates

Abstract Backgrounds: Laparoscopic surgery has achieved good results in elderly patients with colorectal cancer (CRC). In this study, we compared the short-term and long-term outcomes of open surgery and laparoscopic surgery in CRC patients aged above 75 years at a single tertiary medical center.Methods: Between January 2009 and December 2015, we studied 967 patients who underwent curative resection for primary colorectal adenocarcinoma without distant metastasis in a single institution. Of the enrolled subjects, 305 underwent laparoscopic surgery, and 662 received open laparotomy surgery.Results: Compared to the patients who received open surgery, those received laparoscopic surgery had prominent shorter postoperative stay (10.3 vs. 13.5 days p < 0.001) and similar postoperative mortality (p = 0.082) and morbidity (p = 0.354). In the laparoscopy cohort, 6 of 305 patients were converted to open surgery and 1 died. The long-term overall survival, cancer-specific survival and recurrence rate were all similar between both cohorts in each stage.Conclusions: Laparoscopic surgery is suitable for elderly patients due to shorter postoperative stay, similar long-term outcomes with open surgery and acceptably low conversion rates. For long-term overall and oncological outcome, the results of laparoscopic surgery were similar to that of open surgery in each TNM stage.

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Advantage of laparoscopy surgery for elderly colorectal cancer patients without compromising oncologic outcome

10.21203/rs.3.rs-27987/v3 ◽

2020 ◽

Author(s):

Yih Jong Chern ◽

Hsin-Yuan Hung ◽

Jeng-Fu You ◽

Yu-Jen Hsu ◽

Jy-Ming Chiang ◽

...

Keyword(s):

Colorectal Cancer ◽

Laparoscopic Surgery ◽

Elderly Patients ◽

Open Surgery ◽

Medical Center ◽

Long Term Outcomes ◽

Cancer Specific Survival ◽

Postoperative Stay ◽

Conversion Rates

Abstract Background: Laparoscopic surgery has achieved significant results in elderly patients with colorectal cancer (CRC). In this study, we compared the short-term and long-term outcomes of open surgery and laparoscopic surgery in patients with CRC aged above 75 years at a single tertiary medical center.Methods: We analyzed 967 patients who underwent curative resection for primary colorectal adenocarcinoma without distant metastasis between January 2009 and December 2015, in a single institution. Of the enrolled patients, 305 underwent laparoscopic surgery, and 662 received open laparotomy surgery.Results: Compared to the patients who underwent open surgery, those who received laparoscopic surgery had significantly shorter postoperative stay (10.3 vs. 13.5 days p < 0.001) and similar postoperative morbidity (p = 0.354) and mortality (p = 0.082). In the laparoscopy cohort, six of 305 patients were converted to open surgery and one died. The long-term overall survival, cancer-specific survival, and recurrence rate were similar between both cohorts in each stage.Conclusions: Laparoscopic surgery is suitable for elderly patients owing to shorter postoperative stay, similar long-term outcomes with open surgery, and acceptable low conversion rates. For long-term overall and oncological outcomes, the results of laparoscopic surgery were similar to that of open surgery in each TNM stage.

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Laparoscopic vs open colorectal cancer surgery in elderly patients: short- and long-term outcomes and predictors for overall and disease-free survival

BMC Surgery ◽

10.1186/s12893-019-0596-3 ◽

2019 ◽

Vol 19 (1) ◽

Cited By ~ 4

Author(s):

Sicheng Zhou ◽

Xuewei Wang ◽

Chuanduo Zhao ◽

Qian Liu ◽

Haitao Zhou ◽

...

Keyword(s):

Colorectal Cancer ◽

Elderly Patients ◽

Open Surgery ◽

Perineural Invasion ◽

Disease Free Survival ◽

Short Term ◽

Free Survival ◽

Disease Free ◽

Surgery In Elderly

Abstract Background Colorectal cancer is common in elderly patients. Laparoscopy is widely used to approach this kind of disease. This study was to examine short-term outcomes and long-term survival for laparoscopic and open surgery in elderly patients with colorectal cancer. Methods From January 2007 to December 2018, patients with colorectal cancer older than 80 operated at China National Cancer Center were included in the study. Propensity score matching (PSM) was used to minimize the adverse effects. The clinical data between open and laparoscopic surgery was compared, and the effect of factors on overall survival (OS) and disease-free survival (DFS) was analyzed by Cox proportional hazard model. Results Ninety-three pairs were selected after PSM. Patients in laparoscopic group had less intraoperative blood loss, postoperative complications, time to first flatus, time to oral feeding, postoperative hospital stay, and higher retrieved lymph node (P < 0.05). The OS and DFS rates were similar (P > 0.05), besides the CEA level, III/IV stage, and perineural invasion were independent predictors of survival (P < 0.05). Conclusion In elderly patients with colorectal cancer, laparoscopic surgery had better short-term outcomes than open surgery. CEA level, III/IV stage, and perineural invasion were reliable predictors for OS and DFS.

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