Intracorporeal Versus Extracorporeal Anastomosis for Laparoscopic Resection of the Splenic Flexure Colon Cancer: A Multicenter Propensity Score Analysis.

PURPOSE: The aim of this study is to compare the short and long-term outcomes of intracorporeal anastomosis (IA) versus extracorporeal anastomosis (EA) during laparoscopic resection of splenic flexure for cancer, in 3 high-volume Italian centers. MATERIALS AND METHODS: A retrospective analysis was conducted on a multicenter database of a consecutive series of patients who underwent an elective laparoscopic resection of the splenic flexure for colon cancer in 3 high-volume centers between January 2008 and August 2017. Propensity score matching analysis was performed to overcome patients' selection bias between the 2 surgical techniques. Data on patients' demographics, operative details, short-term and long-term outcomes were prospectively recorded. RESULTS: In total, 102 patients were selected. After propensity score match, 72 patients were compared: 36 for the IA group, 36 for the EA group. The IA group showed a significantly shorter median time to first flatus, time to first stool, time to oral feeding, and time to discharge, as well as significantly lower incidence of postoperative severe surgical complications, especially in terms of wound infections, and of incisional hernia (IH).Risk factors for IH on logistic regression were longer operative time, EA, longer incision, postoperative blood transfusions, and longer specimen. CONCLUSIONS: The IA in laparoscopic resection of the splenic flexure is feasible and safe in terms of short-term and long-term outcomes. Major advantages are shorter time to first flatus and first stool, complete oral feeding and time to discharge, with minor incidence of severe surgical complications, such as wound infection, and lower incidence of IH.

Laparoscopic resection of splenic flexure colon cancers: a retrospective multi-center study with 117 cases.

The objective is to investigate the short- and long-term outcomes of laparoscopic resections of splenic flexure colon cancers in three Italian high-volume centers. The laparoscopic resection of splenic flexure colon cancers is a challenging procedure and has not been completely standardized, mainly due to the technical difficulty, the arduous identification of major blood vessels, and the problems associated with anastomosis construction. In this retrospective cohort observational study, a consecutive series of patients treated in three Italian high-volume centers with elective laparoscopic resection of the splenic flexure for cancer is analyzed. The observational period was from January 2008 to August 2017. Patient demographics and clinical features, operative data, and short- and long-term outcomes were prospectively recorded in a specific database and were retrospectively analyzed. During the observation period, 117 patients were selected. Conversion to open surgery was necessary in 15 patients (12.8%). Of 102 complete laparoscopic procedures, multi-visceral resection was performed in 13 cases (12.7%). Postoperative surgical complications occurred in 13 patients (12.7%), with 3 cases of anastomotic leak (2.9%) and 3 cases of re-operation (2.9%). The postoperative mortality in this population was null. The 5-year overall survival rate was 84.3%, and the 5-year disease-free survival rate was 87.8%. Laparoscopic resection of the splenic flexure is feasible and safe in high-volume centers. Compared to the results of other laparoscopic colonic resections, the short- and long-term outcomes are similar, but the conversion rate is higher.

Robotic laparoscopic surgery with the da Vinci® system: an early experience.

Theoretically, robotic surgery is likely to overcome the intrinsic limitations of laparoscopic surgery, such as a view not under the direct surgeon's control, two-dimensional imaging, and limited motion of instruments. In this chapter, the preliminary experience with a robotic laparoscopic surgery system in the Surgical Department of the Alessandria Hospital, Italy, is reported. From November 2005 to August 2007, a total of 162 laparoscopic robotic operations were performed, in which robotic surgery was found to be feasible and safe. It takes a longer time than standard laparoscopy but seems able to reduce the need of a steep learning curve.

Thoracoscopic and Laparoscopic Esophagectomy in a Case of Spontaneous Rupture of the Esophagus (Boerhaave's Syndrome).

Spontaneous barogenic rupture of the esophagus is a rare disease with high morbidity and mortality. Many therapeutic options are available. Esophagectomy is indicated when a large rupture is found with huge mediastinal contamination. Here, we describe a minimal invasive esophagectomy procedure for an esophageal barogenic rupture. A thoracoscopic esophagectomy was performed with the patient in a prone position. After a laparoscopic gastric tubulization, a cervical esopagho-gastro anastomosis was performed with a retro-sternal passage of the stomach in order to avoid the heavily contaminated posterior mediastinum. The postoperative outcome was almost uneventful. This minimal-invasive approach allowed direct optimal visualization of the esophageal laceration and a thorough mediastinal cleansing, thereby avoiding any septic complications, which are the major concern in this particular clinical procedure. In our case, the esophagectomywas mandatory because of the large laceration and massive mediastinal contamination. The minimal invasive thoracoscopic and laparoscopic esophagectomy approach is feasible even in an emergency setting. This is the first report of this procedure being used in a high-risk patient with Boerhaave's syndrome.

Robotic colorectal surgery: first 50 cases experience.

PURPOSE: Laparoscopic colorectal surgery is believed to be technically and oncologically feasible. However, some limitation of traditional laparoscopic surgery may cause difficulties. Robotic-assisted surgery may overcome these pitfalls. METHODS: From December 2005 to July 2007, 50 patients were selected for robotic-assisted colorectal resection mainly for cancer. RESULTS: Of the 50 patients enrolled, 32 (64 percent) were men and 18 (36 percent) were women. Their mean age was 66.7 (range, 37-92) years. The American Society of Anesthesiologists' (ASA) class distribution was 13 (26 percent) ASA I, 24 (48 percent) ASA II, 12 (24 percent) ASA III, and 1 (2 percent) ASA IV. Forty-four patients suffered from cancer and six patients from benign disease. Amongst the cancer patients, 3 percent were at UICC (International Union Against Cancer) Stage 0, 36 percent at UICC Stage I, 24 percent at Stage II, 28 percent at Stage III, and 9 percent at Stage IV. The global conversion rate was 4 percent. The mean operative time was 338.8 minutes. It decreased as the experience increased (419 minutes in the first 20 cases vs. 346 minutes in the last 30 cases; P = 0.036). As a gross comparison, the results of a coeval standard laparoscopy group of patients were shown. CONCLUSIONS: Robotic laparoscopic colon surgery is feasible and safe. A longer operating time is needed.