Laparoscopic Versus Robot-Assisted Versus Transanal Low Anterior Resection: 3-Year Oncologic Results for a Population-Based Cohort in Experienced Centers

Background Laparoscopic, robot-assisted, and transanal total mesorectal excision are the minimally invasive techniques used most for rectal cancer surgery. Because data regarding oncologic results are lacking, this study aimed to compare these three techniques while taking the learning curve into account. Methods This retrospective population-based study cohort included all patients between 2015 and 2017 who underwent a low anterior resection at 11 dedicated centers that had completed the learning curve of the specific technique. The primary outcome was overall survival (OS) during a 3-year follow-up period. The secondary outcomes were 3-year disease-free survival (DFS) and 3-year local recurrence rate. Statistical analysis was performed using Cox-regression. Results The 617 patients enrolled in the study included 252 who underwent a laparoscopic resection, 205 who underwent a robot-assisted resection, and 160 who underwent a transanal low anterior resection. The oncologic outcomes were equal between the three techniques. The 3-year OS rate was 90% for laparoscopic resection, 90.4% for robot-assisted resection, and 87.6% for transanal low anterior resection. The 3-year DFS rate was 77.8% for laparoscopic resection, 75.8% for robot-assisted resection, and 78.8% for transanal low anterior resection. The 3-year local recurrence rate was in 6.1% for laparoscopic resection, 6.4% for robot-assisted resection, and 5.7% for transanal procedures. Cox-regression did not show a significant difference between the techniques while taking confounders into account. Conclusion The oncologic results during the 3-year follow-up were good and comparable between laparoscopic, robot-assisted, and transanal total mesorectal technique at experienced centers. These techniques can be performed safely in experienced hands.

Five Osteosarcoma of the Lower Extremity Treated by Rotationplasty: University of the Philippines - Philippine General Hospital Experience

Functional and oncologic results of the initial series of children with osteosarcoma treated with rotationplasty at the University of the Philippines - Philippine General Hospital from 2014 to 2015 are reported. Five children (mean 13.2 years) with Enneking IIB osteosarcoma of the lower extremity underwent neoadjuvant chemotherapy, tumor resection with wide margins, and rotationplasty – four Winkelmann Type AI and one Type AII. The four Type-A cases were fixed using an intramedullary nail and the Type A2 case with a plate. Two cases had >90% tumor necrosis. Adjuvant chemotherapy was started 10 to 21 days following surgery. Functional results for the AI rotationplasty showed a good range of motion of the ankle (neo-knee) with preserved muscle strength. The patient with AII rotationplasty had a fair range of motion of the ankle with some muscle weakness. All had radiographic evidence of healing at an average of 12 weeks. The oncologic outcome showed two with local recurrences at five months from surgery; three died of disease at 7, 20, and 38 months; while two are alive without evidence of disease at 72 and 84 months. Three patients were able to fit with a prosthesis with good utility, ambulation status, and satisfaction.

Updates on Robotic CME for Right Colon Cancer: A Qualitative Systematic Review

Background. Complete mesocolic excision (CME) is a surgical technique introduced with the aim of ameliorating the oncologic results of colectomy. Various experiences have demonstrated favorable oncologic results of CME in comparison with standard colectomy, in which the principles of CME are not respected. The majority of the literature refers to open or laparoscopic CME. This review analyses current evidence regarding robotic CME for right colectomy. Methods. An extensive Medline (Pub Med) search for relevant case series, restricted to papers published in English, was performed, censoring video vignettes and case reports. Results. Fourteen studies (ten retrospective, four comparative series of robotic versus laparoscopic CME) were included, with patient numbers ranging from 20 to 202. Four different approaches to CME are described, which also depend on the robotic platform utilized. Intraoperative and early clinical results were good, with a low conversion and anastomotic leak rate and a majority of Clavien–Dindo complications being Grades I and II. Oncologic adequacy of the surgical specimens was found to be good, although a homogeneous histopathologic evaluation was not provided. Conclusions. Further large studies are warranted to define long-term oncologic results of robotic right colectomy with CME and its eventual benefits in comparison to laparoscopy.

The Role of Minimally Invasive Surgery in the Treatment of Lung Cancer

Lobectomy plus regional lymph node dissection remains the gold standard treatment method in early-stage lung cancer. However, with the demonstration of the safety and efficacy of minimally invasive approaches, the expression of surgery in this statement, replaced by thoracoscopic anatomical lung resection. Clinical studies have demonstrated the superiority of VATS in terms of postoperative pain, drainage time, length of hospital stay, and complications, moreover, long-term oncologic results are similar or better than thoracotomy. Therefore, VATS lobectomy is the preferred surgical method in early-stage lung cancer. Different surgical techniques are available in VATS and can be modified according to the surgeon’s personal experience. Uniport can be applied as well as two or three port incisions. In this book section, I plan to focus on VATS lobectomy, technique-related tricks, complication management, and long-term oncologic results in early and locally advanced lung cancer.

Quality of life after Supracricoid Partial Laryngectomy

Background Supracricoid partial laryngectomy has good oncologic results in the treatment of advanced laryngeal cancer with the advantage of preserving larynx phonatory function when compared with total laryngectomy. However the rehabilitation could be a challenge, especially regarding swallowing function. Is supracricoid partial laryngectomy associated with better quality of life than total laryngectomy? Methods Survey study that included 33 patients (16 total laryngectomy and 17 supracricoid partial laryngectomy) with advanced larynx cancer surgically treated and fully rehabilitated. The quality of life were evaluated with EORTC QLQ C30 and H&N 35 instrument. Results Patients who underwent supracricoid partial laryngectomy obtained better scores in global health status-quality of life and general activities and had lower levels of sensory and speech-related symptoms. Conclusion SPL was associated with better quality of life when compared with TL. Graphical abstract

Renal Function: Implications on the Surgical Treatment of RCC

The good oncologic results after partial nephrectomy for stage 1 RCC show that radical nephrectomy is an overtreatment in most cases, and that many healthy nephrons are removed unnecessarily. However, partial nephrectomy is a difficult operation, with increased blood loss and a higher risk of complications. Therefore, the advantage of preserved function has to be weighed up against the increased trauma of surgery in each individual patient, and the assessment of preoperative function may influence this decision, among other factors such as comorbidities and age. In most studies, renal function has been assessed by means of estimated glomerular filtration rate, and this parameter is very helpful for long-term studies in large populations. However, more precise measurement based on clearance studies are sometimes required for more sophisticated investigations. The technique of partial nephrectomy has evolved substantially in recent years, resulting in the preservation of more nephrons, less damage to the remaining parenchyma, less blood loss, and a decreased risk of complications. The introduction of minimally invasive surgery for this purpose has also decreased the overall morbidity of surgery. In the long-term, chronic kidney disease may result in increased cardiac mortality. There is ongoing discussion on this problem, however, this potential negative influence on overall survival is not only influenced by the rate of renal insufficiency, but also to a great extent by other comorbidities such as hypertension and diabetes. Therefore, in addition to providing the best surgery for any given patient, we have to make sure that the treatment of the comorbidities will also be part of our patient management, since the risk of cardiac failure may be greater than the risk of poor oncologic outcome.

Transhyoid approach in surgical treatment of oropharyngeal carcinoma

The study objective is to assess functional and oncologic results of transhyoid approach used for surgical treatment of oropharyngeal carcinoma.Materials and methods. Operative records, hospital charts and data from out-patient department of 55 patients (T1 – 6, T2 – 16, T3 – 19, T4 – 14) with oropharyngeal carcinoma operated via a transhyoid approach were reviewed. Postoperative period was reviewed for complications. All oncologic adverse events were registered with special emphasis on the rate of local recurrence. A univariate analysis with chisquare and Fisher’s exact test was used to check the correlation between tumor factors and surgical variables (complications, mode of reconstruction). The influence of tumor- and treatment-related variables (T stage, differentiation, perineural invasion, p16 status, depth of invasion, extension to the oral cavity, adjuvant treatment) on the rate of local recurrence was studied in the same way. The log-rank test was used to assess differences in survival curves. The data was compared with other series of patients treated with the same technique.Results. Seventeen (30,9 %) patients developed 29 complications. There was 1 postoperative death. Five (9,1 %) patients required repeated operation. The mode of reconstruction (primary closure vs flaps) was a major factor influencing the rate of complications. Fifty (92,6 %) patients were able to resume oral diet with a duration of nasogastric tube feeding of 7–35 days. Three-year overall/disease-specific survival for the whole cohort were 47 and 51,1 %, for p16-positive (22 %) cohort – 65,6 and 87,5 %, for p16-negative (78 %) cohort – 40,6 and 46,8 %. Thirteen (24 %) patients developed a local recurrence. The rate of local recurrence was negatively affected by p16 negativity (p = 0,048), depth of invasion >10 mm (p = 0,044) and depth of invasion >15 mm (p = 0,003).Conclusion. Transhyoid approach may be considered as a surgical option for treatment of oropharyngeal carcinoma with acceptable rate of complications.