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Purpose@#This study aimed to compare the postoperative outcomes and patient-surveyed scar assessments of single-port laparoscopic appendectomy (SPLA) with the outcomes of multiport laparoscopic appendectomy (MPLA). @*Methods@#Between August 2014 and November 2017, the prospective randomized study comprised 98 patients diagnosed with acute appendicitis and indicated for surgery. Fifty-one patients had MPLA and 47 patients received SPLA. The primary endpoint was the total score of Patient Scar Assessment Questionnaire (PSAQ) administered to patients 6 weeks after surgery. @*Results@#SPLA involved a shorter median operative time than MPLA (47.5 minutes vs. 60.0 minutes, p = 0.02). There were no apparent differences in the time before diet tolerance, length of hospital stay, and postoperative complication. SPLA patients had shorter total incision length (2.0 cm vs. 2.5 cm, p < 0.01) and required fewer analgesics on the day of surgery than MPLA patients (p = 0.011). The PSAQ favored the SPLA approach, revealing significant differences in total score (48 vs. 55, p = 0.026), appearance (15 vs. 18, p = 0.002), and consciousness (8 vs. 10, p = 0.005), while satisfaction with appearance and symptoms scale did not (p = 0.162 and p = 0.690, respectively). @*Conclusion@#The postoperative scar evaluated by the patient was better with SPLA than with MPLA, and patient satisfaction with the scar was comparable between the two techniques.
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Purpose@#Laparoscopic right colectomy (LRC) with extracorporeal anastomosis (ECA) remains the most widely adopted technique despite mounting evidence that intracorporeal anastomosis (ICA) offers several advantages. This study aimed to compare the postoperative outcomes of ICA and ECA and to investigate the effect of ICA on postoperative ileus after LRC. @*Methods@#This retrospective study included 45 patients who underwent ICA and 63 who underwent ECA in LRC for rightsided colonic diseases between January 2015 and December 2019. @*Results@#There were no significant differences in total operation time, blood loss, total length of incisions, tolerance of diet, postoperative pain score on postoperative days 1 and 2, or length of hospital stays between the 2 groups. However, the ICA group had a significantly shorter time to first flatus passage (3.0 ± 0.9 days vs. 3.8 ± 1.9 days, P = 0.013). The rate of postoperative ileus was significantly higher in the ECA group (2.2% vs. 14.3%, P = 0.033); however, there was no significant difference in the overall morbidity within 30 days after surgery. Multivariate logistic regression analysis showed that the ECA technique (odds ratio [OR], 0.098; 95% confidence interval [CI]; 0.011–0.883, P = 0.038) and previous abdominal operation (OR, 5.269; 95% CI, 1.193–23.262; P = 0.028) were independent risk factors for postoperative ileus. @*Conclusion@#The postoperative outcomes of patients who underwent LRC with ICA or ECA were comparable, and ICA could reduce the incidence of postoperative ileus after LRC compared with ECA.
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Purpose@#Endoscopic treatment and laparoscopic surgery are minimally invasive options for early treatment of colorectal cancer, however, more evidence of the long-term outcomes between the two procedures is needed to guide clinical decisions. Therefore, this study aimed to compare the oncologic outcomes between endoscopic and laparoscopic treatment for early colorectal cancer. @*Methods@#The study group included 60 patients who underwent endoscopic treatment and 38 patients who underwent laparoscopic surgery for early colorectal adenocarcinoma between January 2010 and December 2013 at a single study site. @*Results@#Histopathological diagnoses showed that 43 (78.3%) carcinomas in the endoscopic submucosal dissection group were mucosal to sm1, 13 (21.7%) were sm2 or deeper, and 17 high-risk cases (28.3%) in the endoscopic group underwent additional surgery. The median operation time, time to sips of water, and length of hospital stay were significantly shorter in the endoscopic group than in the laparoscopic group. The overall survival rates of patients in the endoscopic group and laparoscopic groups were 91.5% and 87.4%, respectively (P=0.391), and the disease-free survival rates were 90.4% and 87.4% (P=0.614), respectively. Systemic recurrences occurred in two patients (1.6%) in the endoscopic group and one patient (2.0%) in the laparoscopic group. Local recurrence combined with systemic recurrence in one patient (0.8%) in the endoscopic group. @*Conclusion@#Endoscopic resection for early colorectal cancer can be performed safely with better short-term outcomes and comparable longterm oncological outcomes compared to laparoscopic surgery.
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Purpose@#This study investigated the relationship between the visceral fat area (VFA) and clinico-pathological outcomes in patients with colorectal cancer (CRC). @*Methods@#This retrospective study included 204 patients who underwent anthropometric measurement by bioelectrical impedance analysis (BIA) before surgical treatment for CRC between January 2016 and June 2020. @*Results@#According to the average value of the visceral fat area, 119 (58.3%) patients had a low visceral fat area, and 85 (59.1%) patients had a high visceral fat area. Patients with visceral obesity showed a higher BMI compared to patients without visceral obesity, (21.8±1.9 vs. 25.7±2.5, P＜0.001). There was no significant difference in the overall perioperative outcomes including total operation time, time to gas out, sips of water, soft diet, hospital stay, and morbidity between patients in the low and high VFA groups. We divided patients into two subgroups according to the degree of cancer progression and more advanced cases with low VFA showed significantly more total and positive retrieved lymph nodes (LNs) (20.9±10.3 vs. 16.1±7.1, P=0.021 and 3.3±2.9 vs. 2.2±2.3, P=0.019, respectively) and a higher proportion of more than 12 retrieved LNs compared to patients with a high VFA (95.1% vs. 90.0%, P=0.047). Body composition analysis showed that phase angle, muscle composition, and body fluid composition were not statistically different between the two groups. However, body fat mass was statistically higher in the high VFA group (22.0±4.6 vs. 12.8±3.1, P＜0.001). @*Conclusion@#Visceral obesity measured by BIA showed lower total and positive retrieved LNs and was not associated with adverse peri-operative outcomes, inflammatory and nutritional, and pathologic outcomes for CRC.
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Purpose@#This study investigated the relationship between the visceral fat area (VFA) and clinico-pathological outcomes in patients with colorectal cancer (CRC). @*Methods@#This retrospective study included 204 patients who underwent anthropometric measurement by bioelectrical impedance analysis (BIA) before surgical treatment for CRC between January 2016 and June 2020. @*Results@#According to the average value of the visceral fat area, 119 (58.3%) patients had a low visceral fat area, and 85 (59.1%) patients had a high visceral fat area. Patients with visceral obesity showed a higher BMI compared to patients without visceral obesity, (21.8±1.9 vs. 25.7±2.5, P＜0.001). There was no significant difference in the overall perioperative outcomes including total operation time, time to gas out, sips of water, soft diet, hospital stay, and morbidity between patients in the low and high VFA groups. We divided patients into two subgroups according to the degree of cancer progression and more advanced cases with low VFA showed significantly more total and positive retrieved lymph nodes (LNs) (20.9±10.3 vs. 16.1±7.1, P=0.021 and 3.3±2.9 vs. 2.2±2.3, P=0.019, respectively) and a higher proportion of more than 12 retrieved LNs compared to patients with a high VFA (95.1% vs. 90.0%, P=0.047). Body composition analysis showed that phase angle, muscle composition, and body fluid composition were not statistically different between the two groups. However, body fat mass was statistically higher in the high VFA group (22.0±4.6 vs. 12.8±3.1, P＜0.001). @*Conclusion@#Visceral obesity measured by BIA showed lower total and positive retrieved LNs and was not associated with adverse peri-operative outcomes, inflammatory and nutritional, and pathologic outcomes for CRC.
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Purpose@#This study aimed to evaluate and compare the quality of total mesorectal excision (TME) and disease-free and overall survival rates between robotic and laparoscopic surgeries for rectal cancer. @*Methods@#From January 2015 to December 2018, 234 patients underwent curative robotic or laparoscopic surgery for rectal cancer at two centers. Ultimately, 201 patients were enrolled. To control for different demographic factors in the two groups, propensity score matching was used at a 1:1 ratio. Propensity scores were generated with the baseline characteristics, including age, sex, body mass index, American Society of Anesthesiologists score, previous abdominal surgery, tumor location, preoperative chemotherapy, and preoperative radiation. Finally, 134 patients were matched with 67 patients in the robotic surgery group and 67 patients in the laparoscopic surgery group. @*Results@#There was no significant difference in the pathologic stages between the robotic and laparoscopic surgery groups. Distal margin involvement was only observed in the robotic surgery group (1/67, 1.5%). Circumferential resection margin involvement was not different between the robotic surgery and laparoscopic surgery groups (3/67 [4.5%] and 4/67 [6.0%], respectively, P = 1.000). The quality of TME (complete, nearly complete, and incomplete) was similar between the robotic surgery and laparoscopic surgery groups (88.0%, 6.0%, 6.0% and 79.1%, 9.0%, 11.9%, respectively, P = 0.358). The disease-free and overall survival rates were not significantly different between the groups. @*Conclusion@#The quality of TME and disease-free and overall survival rates between the two surgeries were similar. There was no oncologic advantage of robotic surgery for rectal cancer compared to laparoscopic surgery.
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Actinomycosis is an inflammatory disease with various clinical presentations including inflammation and formation of masses. There are several reports suggesting the infiltrative mass-like nature of actinomycosis that is misunderstood as a tumor. A 39-year-old male clinically presented with a fungating mass-like lesion during colonoscopy for healthcare screening. Biopsy was performed for the lesion, and chronic inflammation was diagnosed. Abdominal computed tomography (CT) suggested severe edematous changes in the appendix with an appendicolith, suspected chronic inflammation, and wall thickening of the cecal base, but malignancy could not be definitively ruled out. The patient underwent a laparoscopic single-port cecectomy based on the possibility of cecal cancer. The final biopsy was diagnosed as actinomycosis, and the patient was prescribed antibiotics and showed no recurrence in the follow-up CT scan. We present this rare case of mass-like appendiceal actinomycosis treated with the single-port laparoscopic method.
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Purpose@#Early initiation of adjuvant chemotherapy after colon cancer surgery has shown better oncologic outcomes in previous studies. However, the clinical impact of robotic and laparoscopic surgeries on the initiation of adjuvant chemotherapy has not been widely evaluated. Hence, the study’s aim was to compare the influence of both surgical approaches on the initiation of adjuvant chemotherapy after colon cancer surgery. @*Methods@#From June 2011 to September 2017, 289 patients underwent curative robotic or laparoscopic surgery followed by adjuvant chemotherapy for stage II and III colon cancer. To control for different demographic factors in the two groups, propensity score case matching was used at a 1:4 ratio. Finally, 190 patients were matched with 38 patients of the robotic surgery group and 152 patients of the laparoscopic surgery group. @*Results@#The operation time was longer in the robotic surgery group (297 minutes vs. 170 minutes, respectively; P<0.001). However, conversion rate, number of retrieved lymph nodes, first flatus, first soft diet, length of stay, postoperative complication rate, and Clavien-Dindo grade were not significantly different between the two groups. Additionally, there was no difference in the time to initiation of adjuvant chemotherapy between the two groups (31.5 days vs. 29.0 days, respectively; P=0.226). Disease-free and overall survival rates were also not significantly different. @*Conclusion@#Robotic and laparoscopic surgeries showed no different impact on the initiation of adjuvant chemotherapy. This finding suggests that the two surgical approaches offer similar postoperative outcomes.
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PURPOSE: Dysbiosis of gut microbiota has been reported to participate in the pathogenesis of colorectal cancer, but changes in microbiota due to radiotherapy have not been studied. In this study, we tried to elucidate the changes in the microbiome in rectal cancer after chemoradiotherapy using RNA sequencing analysis.MATERIALS AND METHODS: We included 11 pairs of human rectal cancer tissues before and after irradiation between August 2016 and December 2017 and performed RNA sequencing analysis. Mapped reads to human reference genomes were used for pair-wise transcriptome comparisons, and unmapped (non-human) reads were then mapped to bacterial marker genes using PathSeq.RESULTS: At microbiome level, interindividual variability of mucosal microbiota was greater than the change in microbial composition during radiotherapy. This indicates that rapid homeostatic recovery of the mucosal microbial composition takes place short after radiotherapy. At single microbe level, Prevotella and Fusobacterium, which were identified as important causative microbes of the initiation and progression of rectal cancer were decreased by radiotherapy. Moreover, changes in Prevotella were associated with changes in the human transcriptome of rectal cancer. We also found that there was a gene cluster that increased and decreased in association with changes in microbial composition by chemoradiation.CONCLUSION: This study revealed changes in tumor-associated microbial community by irradiation in rectal cancer. These findings can be used to develop a new treatment strategy of neoadjuvant therapy for locally advanced rectal cancer by overcoming radio-resistance or facilitating radio-sensitivity.
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Humanos , Quimioradioterapia , Neoplasias Colorrectales , Disbiosis , Fusobacterium , Microbioma Gastrointestinal , Genes vif , Genoma , Microbiota , Terapia Neoadyuvante , Prevotella , Radioterapia , Neoplasias del Recto , Análisis de Secuencia de ARN , TranscriptomaRESUMEN
Colorectal carcinoma invading the submucosa but not the muscularis propria (pT1) represents the earliest form of clinically relevant colorectal cancer in most patients. T1 colorectal cancer with synchronous liver metastasis is considered to be rare. We report a rare case of T1 colon cancer with synchronous liver metastasis not detected by preoperative imaging study. A 54-year-old male patient presented to our department for treatment of sigmoid colon cancer following an endoscopic submucosal dissection. Histopathological examination revealed the pedunculated mass was moderately differentiated adenocarcinoma without lymphovascular invasion and the depth of submucosal invasion was 2,000 µm, the resection margin was not involved. We performed a laparoscopic anterior resection with lymph node dissection. After the 3 months, the patient's carcinoembryonic antigen level elevated from 1.4 to 7.26 ng/mL (normal level: <1.5 ng/mL) and the abdominal computed tomography and FDG-PET/CT (positron emission tomography-computed tomography) showed multiple hepatic metastases in both hepatic lobes (SUVmax: 5.6) without evidence of local recurrence or lymphadenopathy. We strongly suspected a synchronous liver metastasis not detected by imaging study as opposed to a systemic recurrence. Therefore, evaluation and follow-up protocol of T1 colorectal cancer should be changed for discovery and prediction of synchronous liver metastasis; because we cannot exclude the possibility of synchronous liver metastasis.
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Humanos , Masculino , Persona de Mediana Edad , Adenocarcinoma , Antígeno Carcinoembrionario , Colon , Neoplasias del Colon , Neoplasias Colorrectales , Estudios de Seguimiento , Hígado , Escisión del Ganglio Linfático , Enfermedades Linfáticas , Metástasis de la Neoplasia , Recurrencia , Neoplasias del Colon SigmoideRESUMEN
PURPOSE: This study investigated the relationship between body composition and platelet-to-lymphocyte ratio (PLR) in patients with colorectal cancer (CRC).METHODS: This retrospective study included 110 patients who underwent anthropometric measurement by bioelectrical impedance analysis before surgical treatment for CRC between May 2015 and June 2018.RESULTS: According to PLR, 45 patients (40.9%) had low PLR (PLR<150), and 65 patients (59.1%) had high PLR (PLR≥150). Serum hemoglobin (P<0.001) and albumin levels (P=0.021) were significantly lower in high PLR group. Tumor mass diameter was significantly larger in high PLR group (P=0.048) and the proportion of poorly differentiated or mucinous tumors was significantly higher in high PLR group (P=0.037). All indices related to fat (body fat mass, percent body fat, body fat mass of trunk, visceral fat area, fat mass index, measured fat thickness of abdomen) and two indices related to muscle (arm muscle circumference, measured muscle circumference of abdomen) were significantly lower in high PLR group (P<0.05). According to subgroup analysis based on the sex, all indices significantly differed between PLR groups; however, in females no index was significantly different between PLR groups.CONCLUSION: Body composition indices including fat and muscle indices measured by InBody 770 were related to PLR in CRC, especially in male patients. These results suggest that low muscle and fat indices may be related to poor prognosis of CRC.
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Femenino , Humanos , Masculino , Tejido Adiposo , Composición Corporal , Neoplasias Colorrectales , Impedancia Eléctrica , Grasa Intraabdominal , Mucinas , Evaluación Nutricional , Pronóstico , Estudios RetrospectivosRESUMEN
PURPOSE: This study compared the oncologic impact of postoperative chemotherapy and chemoradiotherapy on patients with rectal cancer without preoperative chemoradiation. METHODS: This retrospective study analyzed 713 patients with a mean follow-up of 58 months who had undergone radical resection for stage II/III rectal cancer without preoperative treatment in nine hospitals from January 2004 to December 2009. The study population was categorized a chemotherapy group (CG, n = 460) and a chemoradiotherapy group (CRG, n = 253). Five-year overall survival (OS) and disease-free survival (DFS) were analyzed, and independent factors predicting survival were identified. RESULTS: The patients in the CRG were significantly younger (P < 0.001) and had greater incidences of low rectal cancer (P < 0.001) and stage III disease (P < 0.001). Five-year OS (P = 0.024) and DFS (P = 0.012) were significantly higher in the CG for stage II disease; however, they were not significantly different for stage III disease. In the multivariate analysis, independent predictive factors were male sex, low rectal cancer and stage III disease for OS and male sex, abdominoperineal resection, stage III disease and tumor-positive circumferential margin for DFS. However, adjuvant therapy type did not independently affect OS (hazard ratio [HR], 1.243; 95% confidence interval [CI], 0.794–1.945; P = 0.341) and DFS (HR, 1.091; 95% CI, 0.810–1.470; P = 0.566). CONCLUSION: Adjuvant therapy type did not affect survival of stage II/III rectal cancer patients without neoadjuvant chemoradiotherapy. These results suggest that adjuvant therapy can be chosen based on the patient’s condition and the policies of the surgeons and hospital facilities.
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Humanos , Masculino , Quimioradioterapia , Supervivencia sin Enfermedad , Quimioterapia , Estudios de Seguimiento , Incidencia , Análisis Multivariante , Neoplasias del Recto , Estudios Retrospectivos , CirujanosRESUMEN
In rectal cancer surgery, gentle opening of the plane by continuous traction and optimized visualization is essential. Recently, a wristed robotic suction-irrigation device was developed for efficient traction of the rectum and good surgical visualization. This video shows a technique of robotic total mesorectal excision using a wristed robotic suction-irrigation device. A 74-year-old woman with rectal cancer had a biopsy-proven adenocarcinoma within 9 cm of the anal verge. She underwent totally robotic total mesorectal excision using a dual-docking technique. Total procedure time was 445 minutes. The patient was discharged on postoperative day 8 without any complications. Total number of lymph nodes harvested was 12, and proximal and distal resection margins were 11.2 and 4.7 cm, respectively. Totally robotic total mesorectal excision using a wristed robotic suctionirrigation device was an efficient and useful procedure for rectal cancer.
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Anciano , Femenino , Humanos , Adenocarcinoma , Laparoscopía , Escisión del Ganglio Linfático , Ganglios Linfáticos , Neoplasias del Recto , Recto , Procedimientos Quirúrgicos Robotizados , Tracción , MuñecaRESUMEN
PURPOSE: Colonic stenting as a bridge to surgery is an alternative to emergency surgery in patients with acute malignant colonic obstruction. This study aimed to compare the outcomes of early and late surgery after colonic stenting for obstructive colorectal cancer.METHODS: From March 2004 to August 2014, the medical records of obstructive colorectal cancer patients who underwent surgery after colonic stent insertion were retrospectively reviewed. The patients were divided into early surgery (≤7 days after stenting) and late surgery (>7 days after stenting) groups.RESULTS: Eighty-four patients underwent colonic stenting for obstructive colorectal cancer. Forty-six patients were ultimately enrolled: 18 in the early and 28 in the late surgery groups. The mean ages were 63.7 and 71.8 years, respectively (P=0.01). Blood loss was lower in the early surgery group (median [interquartile range], 50 [50–50] mL vs. 50 [50–100] mL; P=0.020). The time to first flatus was longer in the early surgery group (3.0 [3.0–5.0] days vs. 2.0 [2.0–3.0] days; P=0.010). The time to first soft food intake was similar. Postoperative complications did not differ (16.7% vs. 14.3%, respectively; P=0.525) and no patients died.CONCLUSION: Surgical outcomes were similar between early and late surgery. However, the former featured less blood loss, indicating less surgical difficulty. These results show that early surgery can be performed safely in obstructive colorectal cancer patients after colonic stenting if the patient's clinical condition is amenable to early surgery.
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Humanos , Colon , Neoplasias Colorrectales , Ingestión de Alimentos , Urgencias Médicas , Flatulencia , Obstrucción Intestinal , Registros Médicos , Complicaciones Posoperatorias , Estudios Retrospectivos , StentsRESUMEN
The concept of complete mesocolic excision and central vascular ligation for colonic cancer has been recently introduced. The paper describes a technique of right-sided complete mesocolic excision and intracorporeal anastomosis by using a single-port robotic approach with an additional conventional robotic port. We performed a single-port plus an additional port robotic surgery using the Da Vinci Single-Site platform via the Pfannenstiel incision and the wristed robotic instruments via an additional robotic port in the left lower quadrant. The total operative and docking times were 280 and 25 minutes, respectively. The total number of lymph nodes harvested was 36 and the proximal and distal resection margins were 31 and 50 cm, respectively. Single-port plus an additional port robotic surgery for right-sided complete mesocolic excision and intracorporeal anastomosis appears to be feasible and safe. This system can overcome certain limitations of the previous robotic systems and conventional single-port laparoscopic surgery.
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Colon , Neoplasias del Colon , Laparoscopía , Ligadura , Escisión del Ganglio Linfático , Ganglios Linfáticos , Mesocolon , Procedimientos Quirúrgicos Robotizados , MuñecaRESUMEN
No abstract available.
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Adulto , Humanos , Masculino , Abdomen/diagnóstico por imagen , Colonoscopía , Hiperplasia/diagnóstico , Venas Mesentéricas/patología , Tomografía Computarizada por Rayos XRESUMEN
PURPOSE: Nonoperative management followed by an interval appendectomy is a commonly used approach for treating patients with perforated appendicitis with abscess formation. As minimally-invasive surgery has developed, single-port laparoscopic surgery (SPLS) is increasingly being used to treat many conditions. We report our initial experience with this procedure using a multichannel single-port. METHODS: The study included 25 adults who underwent a single-port laparoscopic interval appendectomy for perforated appendicitis with periappendiceal abscess by using a single-port with or without needlescopic grasper between June 2014 and January 2016. RESULTS: Of the 25 patients, 9 (36%) required percutaneous drainage for a median of 7 days (5-14 days) after insertion, and 3 (12%) required conversion to reduced-port laparoscopic surgery with a 5-mm port insertion because of severe adhesions to adjacent organs. Of 22 patients undergoing SPLS, 13 underwent pure SPLS (52.0%) whereas 9 patients underwent SPLS with a 2-mm needle instrument (36.0%). Median operation time was 70 minutes (30-155 minutes), and a drainage tube was placed in 9 patients (36.0%). Median total length of incision was 2.5 cm (2.0-3.0 cm), and median time to soft diet initiation and length of stay in the hospital were 2 days (0-5 days) and 3 days (1-7 days), respectively. Two patients (8.0%) developed postoperative complications: 1 wound site bleeding and 1 surgical site infection. CONCLUSION: Conservative management followed by a single-port laparoscopic interval appendectomy using a multichannel single-port appears feasible and safe for treating patients with acute perforated appendicitis with periappendiceal abscess.