Robotic Colorectal Cancer Surgery. How to Reach Expertise? A Single Surgeon-Experience

The complexity associated with laparoscopic colorectal surgery requires several skills to overcome the technical difficulties related to this procedure. To overcome the technical challenges of laparoscopic surgery, a robotic approach has been introduced. Our study reports the surgical outcomes obtained by the transition from laparoscopic to robotic approach in colorectal cancer surgery to establish in which type of approach the proficiency is easier to reach. Data about the first consecutive 15 laparoscopic and the first 15 consecutive robotic cases are extracted, adopting as a comparator of proficiency the last 15 laparoscopic colorectal resections for cancer. The variables studied are operative time, number of harvested nodes, conversion rate, postoperative complications, recovery outcomes. Our analysis includes 15 patients per group. Our results show that operative time is significantly longer in the first 15 laparoscopic cases (p = 0.001). A significantly lower number of harvested nodes was retrieved in the first 15 laparoscopic cases (p = 0.003). Clavien Dindo I complication rate was higher in the first laparoscopic group, but without a significant difference among the three groups (p = 0.09). Our results show that the surgeon needed no apparent learning curve to reach their laparoscopic standards. However, further multicentric prospective studies are needed to confirm this conclusion.

Download Full-text

Daikenchuto improved perioperative nutritional status of the patients with colorectal cancer: A prospective open-labeled randomized exploratory study

Interventional Medicine and Applied Science ◽

10.1556/1646.11.2019.13 ◽

2019 ◽

Vol 11 (2) ◽

pp. 84-88

Author(s):

Fumihiko Fujita ◽

Yasuhiro Torashima ◽

Yusuke Inoue ◽

Shinichiro Ito ◽

Kazuma Kobayashi ◽

...

Keyword(s):

Colorectal Cancer ◽

Body Weight ◽

Weight Gain ◽

Adverse Events ◽

Rating Scale ◽

Body Weight Gain ◽

Cancer Surgery ◽

Colorectal Cancer Surgery ◽

Abdominal Symptoms ◽

Significant Difference

Background and aims The aim of this study is to exploratively evaluate the effect of Tsumura Daikenchuto Extract Granules (DKT, TJ-100) on abdominal symptoms, body weight, and nutritional function following colorectal cancer surgery. Methods The subjects included 20 patients for curative resection of colorectal cancer. A TJ-100 administration group (n = 10) and non-administration group (n = 10) were randomized and compared. In the administration group, TJ-100 was administered from 2 days prior to surgery up to 12 weeks following surgery. The endpoints included body weight gain, Gastrointestinal Symptom Rating Scale (GSRS), and blood biochemical factors. For the purpose of observing safety, drug adverse events were evaluated including liver function tests. Results Excluding one patient, we compared 9 cases in the administration group and 10 cases in the non-administration group. No obvious adverse events were observed in any of the cases. In the comparison of body weight gain, the TJ-100 administration group showed significantly higher values at 2, 4, and 12 weeks following the surgery. There was a tendency for lower stable GSRS scores in the administration group overall, with no statistically significant difference. Conclusion It is suggested that TJ-100 can be safely administered in the perioperative period for cases undergoing colorectal cancer surgery, potentially preventing weight loss during the early postoperative period.

Download Full-text

Ultrasonography guided rectus sheath catheters versus epidural analgesia for open colorectal cancer surgery in a single centre

Annals of The Royal College of Surgeons of England ◽

10.1308/rcsann.2013.95.8.591 ◽

2013 ◽

Vol 95 (8) ◽

pp. 591-594 ◽

Cited By ~ 14

Author(s):

AR Godden ◽

MJ Marshall ◽

AS Grice ◽

IR Daniels

Keyword(s):

Colorectal Cancer ◽

Postoperative Analgesia ◽

Randomised Trial ◽

Significant Risk ◽

Rectus Sheath ◽

Cancer Surgery ◽

Pelvic Surgery ◽

Wound Complications ◽

Colorectal Cancer Surgery ◽

Significant Difference

Introduction Epidural anaesthesia (EA) has been the accepted standard for postoperative analgesia in open abdominal surgery. However, it is not without significant risk. This study aimed to audit the effect of EA and ultrasonography placed rectus sheath catheters (RSCs) on analgesia as well as the incidence of postoperative complications following open colorectal cancer surgery. Methods A three-year retrospective case note review was undertaken of all patients undergoing open colorectal cancer surgery at the Royal Devon and Exeter Hospital NHS Foundation Trust who received either EA or RSC for postoperative analgesia under the care of the senior authors. A single surgeon and single anaesthetist were practitioners. Results The case notes of 120 patients were reviewed retrospectively: 85 patients had EA and 24 RSC while 11 patients were excluded from the study. The EA group experienced a significantly higher incidence of hypotension (systolic blood pressure <130mmHg) than the RSC group on the first postoperative day (p=0.0001). There was no significant difference in pain score or opiate sparing properties between the groups (p=0.92). There was no significant difference in postoperative respiratory tract infection, anastomotic leak or wound complications between the groups (p=0.2, p=1.0 and p=0.5 respectively). The RSC group had a higher incidence of ileus than the EA group (4/24 vs 2/85, p=0.026). However, the numbers were too small to draw a reliable conclusion. Conclusions The use of ultrasonography guided RSCs has demonstrated effective postoperative analgesia equivalent to EA with the potential benefits of a reduced incidence of hypotension. A prospective randomised trial is now underway to compare RSC and EA in open abdominal and pelvic surgery.

Download Full-text

Causes and management of bleeding during laparoscopic colorectal cancer surgery

Reports in Clinical Studies and Medicine ◽

10.18282/cs.v1.i1.26 ◽

2018 ◽

Vol 1 (1) ◽

pp. 15

Author(s):

Ming Xu ◽

Weiqiang Wu ◽

Zengqiang Yang ◽

Feng Gao

Keyword(s):

Colorectal Cancer ◽

Colorectal Surgery ◽

Laparoscopic Colorectal Surgery ◽

Anatomic Variation ◽

Anatomical Structure ◽

Cancer Surgery ◽

Cognitive Level ◽

Colorectal Cancer Surgery

<p class="Abstract">In this paper, the causes of bleeding during laparoscopic colorectal surgery and the measures to solve it are discussed. 386 cases of laparoscopic colorectal cancer surgery in our hospital from January to December 2015 were selected. There were 17 cases of bleeding during surgery, which accounted for 4.4% of the total amount. 2 cases were converted to laparotomy, and 15 cases were surgery via laparoscopy. In the surgical process, improper surgery, lack of good laparoscopic anatomical structure of the cognitive level, and congenital anatomic variation may have caused the accidental bleeding during surgery. Corresponding measures should be taken to stop accidental bleeding. </p>

Download Full-text

Differences in colorectal cancer surgery outcomes in Serbia: Hospitals in organized colorectal cancer screening and other hospitals

PONS - medicinski casopis ◽

10.5937/pomc18-31181 ◽

2021 ◽

Vol 18 (1) ◽

pp. 8-13

Author(s):

Dušica Banković-Lazarević ◽

Verica Jovanović ◽

Biljana Mijović ◽

Jelena Brcanski ◽

Marina Jelić ◽

...

Keyword(s):

Colorectal Cancer ◽

Cancer Screening ◽

Colorectal Cancer Screening ◽

Screening Program ◽

Postoperative Mortality ◽

Cancer Surgery ◽

Target Group ◽

Colorectal Cancer Surgery ◽

Significant Difference ◽

The Right

Objective. The aim of this study was to compare mortality of patients after colorectal cancer surgery between hospitals in Serbia, which performed organized colorectal cancer screening and those which did not. Methods. The database included all patients who underwent surgery for colorectal cancer after the introduction of organized colorectal cancer screening Program in Serbia, in 2014-2015. The target group were patients 50-74 years old in the colorectal screening program, and the data was compared to the age-matched group from hospitals which did not perform the program logistic regression. Results. The was used to determine the significance of the differences in the observed variables, and the predictors of mortality after colorectal cancer surgery. Results. The 3631 patients were included in this study. The majority of them were operated due to the rectal cancer 2111 (58%), while 1062 (29.2%) were operated due to the colon cancer. Postoperative survival was significantly better in the target group in organized screening program (p<0.001; OR=0.46; 95%CI 0.33-0.62). There was a significant difference between patients who underwent surgery for colorectal cancer localized in the left colon, compared to the patients with localization in the right colon (p<0.001). The mortality after the surgery of colorectal cancer (4.7%) was followed by high comorbidity of cardiovascular diseases (24%). Conclusion. Patients included in the organized colorectal cancer screening have lower postoperative mortality than these not included. This indicates the necessity for further work on organized colorectal cancer screening, in order to reduce postoperative and overall mortality.

Download Full-text

Causes and management of bleeding during laparoscopic colorectal cancer surgery

Reports in Clinical Studies and Medicine ◽

10.18282/rcsm.v1.i1.26 ◽

2018 ◽

Vol 1 (1) ◽

pp. 15

Author(s):

Ming Xu ◽

Weiqiang Wu ◽

Zengqiang Yang ◽

Feng Gao

Keyword(s):

Colorectal Cancer ◽

Colorectal Surgery ◽

Laparoscopic Colorectal Surgery ◽

Anatomic Variation ◽

Anatomical Structure ◽

Cancer Surgery ◽

Cognitive Level ◽

Colorectal Cancer Surgery

Download Full-text

Nadroparin 0.3 mL Versus Enoxaparin 40 mg in the Prevention of Venous Thromboembolism in Abdominal Surgery for Colorectal Cancer: A Randomized Double-Blind Comparative Study.

Blood ◽

10.1182/blood.v106.11.552.552 ◽

2005 ◽

Vol 106 (11) ◽

pp. 552-552

Author(s):

Gerald Simonneau

Keyword(s):

Colorectal Cancer ◽

Venous Thromboembolism ◽

Major Bleeding ◽

Cancer Surgery ◽

Efficacy And Safety ◽

Double Blind ◽

Colorectal Cancer Surgery ◽

Enoxaparin Group ◽

Significant Difference ◽

Chi Squared

Abstract Background: The relative benefit-to-risk ratio of various LMWH in the setting of colorectal cancer surgery has never been directly compared. Objective: We performed a multicenter, randomized, double-blind study to compare the efficacy and safety of enoxaparin 40 mg (4000 anti-Xa IU) and nadroparin 0.3 mL (2850 anti-Xa IU) in the prevention of venous thromboembolism (VTE) after colorectal cancer surgery. Methods: Patients undergoing elective colorectal adenocarcinoma resection under general anesthesia were recruited. They were randomized to receive once daily either nadroparin 0.3 mL or enoxaparin 40 mg subcutaneously for 9±2 days, starting 2 to 4 hours preoperatively. The primary efficacy outcome was the composite of deep-vein thrombosis (DVT) detected by bilateral venography or documented symptomatic DVT or pulmonary embolism (PE) up to Day 12. The main safety outcomes were major bleeding and all-cause death. A blinded independent committee adjudicated all outcomes. Results: A total of 1288 patients (median age: 69, range: 26–97 years; men: 61.4%) were randomized either to nadroparin (n=653) or to enoxaparin (n=635). Efficacy was evaluable in 950 (73.8%) patients who underwent contrast venography or had a symptomatic thromboembolic event. The rate of VTE at Day 12 was 15.9% for nadroparin and 12.6% for enoxaparin (relative risk reduction 21.3% [95% CI: −7.75; 42.5]). This difference was not statistically significant (p=0.13, Chi-squared test). In contrast, there were more symptomatic VTE, including symptomatic PE, in the enoxaparin group than in the nadroparin group (Table). Furthermore, the rate of major bleeding was significantly lower in nadroparin-treated patients than in enoxaparin-treated patients (Table). By Day 12, there were three (0.5%) deaths related to VTE or major bleeding in enoxaparin patients compared with none in nadroparin patients. By Day 60, 23 (3.5%) patients receiving nadroparin and 23 (3.5%) patients receiving enoxaparin had died. Conclusion: Enoxaparin 40 mg was not more effective than nadroparin 0.3 mL in the prevention of total VTE in patients undergoing colorectal cancer surgery. The non-significant difference between the two groups was mainly due to a lower rate of asymptomatic distal DVT in the enoxaparin group than in the nadroparin group. However, nadroparin was more effective than enoxaparin for reducing symptomatic VTE, including PE, and was associated with significantly less major bleeding. Efficacy and safety results at Day 12 Nadroparin 0.3 mL, n/N (%) Enoxaparin 40 mg, n/N (%) p *Chi-squared test Total VTE 74/464 (15.9) 61/486 (12.7) 0.13* Asymptomatic proximal DVT 15/503 (3.0) 14/515 (2.7) 0.81 Asymptomatic distal DVT 58/503 (11.5) 42/515 (8.2) 0.07 Symptomatic VTE 1/643 (0.2) 9/628 (1.4) 0.01 Symptomatic proximal DVT 1/643 (0.2) 4/628 (0.6) 0.22 Symptomatic PE 0/643 (0.0) 5/628 (0.8) 0.03 Major bleeding 47/643 (7.3) 72/628 (11.5) 0.01 All-cause death 2/643 (0.3) 8/628 (1.3) 0.06

Download Full-text