Does obesity impact postoperative outcomes following robotic-assisted surgery for rectal cancer?

INTRODUCTION: Obesity has been identified as a risk factor for both conversion and severe postoperative morbidity in patients undergoing laparoscopic rectal resection. Robotic-assisted surgery (RAS) is proposed to overcome some of the technical limitations associated with laparoscopic surgery for rectal cancer. The aim of our study was to determine if obesity remains a risk factor for severe morbidity in patients undergoing robotic-assisted rectal resection. PATIENTS: This study was a retrospective review of a prospective database. A total of 183 patients undergoing restorative RAS for rectal cancer between 2007 and 2016 were divided into 2 groups: control (BMI < 30 kg/m2; n = 125) and obese (BMI ≥ 30 kg/m2; n = 58). Clinicopathologic data, 30-day postoperative morbidity, and perioperative outcomes were compared between groups. The main outcome was severe postoperative morbidity defined as any complication graded Clavien-Dindo ≥ 3. RESULTS: Control and obese groups had similar clinicopathologic characteristics. Severe complications were observed in 9 (7%) and 4 (7%) patients, respectively (p > 0.99). Obesity did not impact conversion, anastomotic leak rate, length of stay, or readmission but was significantly associated with increased postoperative morbidity (29 vs. 45%; p = 0.04) and especially more postoperative ileus (11 vs. 26%; p = 0.01). Obesity and male gender were the two independent risk factors for postoperative overall morbidity (OR 1.97; 95% CI 1.02-3.94; p = 0.04 and OR 2.23; 95% CI 1.10-4.76; p = 0.03, respectively). CONCLUSION: Obesity did not impact severe morbidity or conversion rate following RAS for rectal cancer but remained a risk factor for overall morbidity and especially postoperative ileus.

Does prolonged operative time impact postoperative morbidity in patients undergoing robotic-assisted rectal resection for cancer?

BACKGROUND: Several studies have shown a correlation between longer operative times and higher rates of postoperative morbidity for open and laparoscopic surgery for rectal cancer. The aim of the study was to determine the impact of prolonged operative time on early postoperative morbidity in patients undergoing robotic-assisted rectal cancer resection. METHODS: The study was a retrospective review of a prospectively maintained database conducted in two centers of the same institution. A total of 260 consecutive patients undergoing with robotic-assisted resection for rectal cancer between 2007 and 2016 were included. Patients were divided into two groups regarding median operative time: > 300 min (prolonged operative time; n = 133) and ≤ 300 min (control; n = 127). Patient characteristics, operative and postoperative data were compared between groups. Univariate and multivariate analyses were performed to determine whether prolonged operative time was a predictive factor of 30-day postoperative morbidity. RESULTS: Prolonged operative time was noted more frequently in males (p = 0.02), patients with higher BMI (p < 0.01), more severe comorbidities (p < 0.01), in tumors of the mid-rectum, and in surgery performed after neoadjuvant chemoradiation or upon surgeons' learning curve. The two groups had similar overall postoperative morbidity (32 vs. 41%; p = 0.16) and severe morbidity (6 vs. 6%; p = 0.92) rates. Prolonged operative time was associated with longer hospital stay (3.8 ± 2.5 vs. 5.0 ± 3.7 days; p = 0.004) in univariate analysis. Prolonged operative time was not independently associated with postoperative morbidity or with increased hospital stay on multivariate analysis. CONCLUSION: In our study, prolonged operative time was not associated with an over-risk of morbidity in patients undergoing robotic resection for rectal cancer. These results suggest that more difficult robotic procedures do not lead to increased postoperative morbidity.

What is the likelihood of colorectal cancer when surgery for ulcerative-colitis-associated dysplasia is deferred?

AIM: Surgery aims to prevent cancer-related morbidity for patients with ulcerative colitis (UC) associated dysplasia. The literature varies widely regarding the likelihood of dysplastic progression to higher grades of dysplasia or cancer. The aim of this study was to characterize the likelihood of the development of colorectal cancer (CRC) of patients with UC-associated dysplasia who chose to defer surgery. METHOD: A retrospective review was carried out of patients undergoing surgery for UC at the Mayo Clinic, who were diagnosed to have dysplasia between August 1993 and July 2012. The relationships between grade of dysplasia, time to surgery and the detection of unsuspected carcinoma were investigated. RESULTS: In all, 175 patients underwent surgery at a median of 4.9 (interquartile range 2.5-8.9) months after a diagnosis of dysplasia. Their median age was 52 (interquartile range 43-59) years. An initial diagnosis of indeterminate dysplasia was not associated with CRC [0/23; 17.7 (8.1-29.6) months]. Thirty-six patients who had an initial diagnosis of dysplasia progressed from indeterminate to low-grade dysplasia [24.2 (11.0-30.4) months]. Low-grade dysplasia was associated with a 2% (1/56; T2N0M0) risk of CRC when present in random surveillance biopsies and a 3% (2/61; T1N0M0, T4N0M0) risk if detected in endoscopically visible lesions [7.4 (5.2-33.3) months]. Eighteen patients progressed from indeterminate to high-grade dysplasia [19.1 (9.2-133.9) months]. Seventeen patients progressed from low to high-grade dysplasia [11.0 (5.8-30.1) months]. None of the patients with high-grade dysplasia (0/35) progressed to CRC [4.5 (1.7-9.9) months]. CONCLUSION: Dysplasia was associated with a low incidence of node negative CRC if surgery was deferred for up to 5 years. These findings may help inform the decision-making process for asymptomatic patients who are having to decide between intensive surveillance or surgery for UC-associated dysplasia.

Vesiculated erythrocytes as a determination of splenic reticuloendothelial function in pediatric patients with Hodgkin's disease.

PURPOSE: To determine the effect of low-dose total, or subtotal, nodal irradiation (TNI/sub-TNI) on splenic reticuloendothelial function in pediatric patients with Hodgkin's Disease (HD). PATIENTS AND METHODS: Pediatric and adolescent patients with advanced stage HD were accrued from two Pediatric Oncology Group studies and subdivided into three groups: the first had chemotherapy (CT) only; the second received chemotherapy and low-dose (2,100 cGy) TNI or subtotal TNI (sub-TNI); the third underwent staging laparotomy with splenectomy followed by CT, with or without low-dose radiotherapy. Vesiculated erythrocyte counts (VRBC) were performed on all patients using Nomarski interference phase optics at the conclusion of therapy. RESULTS: The mean VRBCs were 3.2%, and 3.8% for the non-splenectomized patients who received chemotherapy only, and chemotherapy plus low-dose splenic irradiation, respectively. For those who underwent splenectomy before chemotherapy, the VRBC was 36.7%. Statistical analysis revealed no difference in vesiculated erythrocyte percentages between the CT only group and the CT + TNI/sub-TNI patients; however, there was a significant difference between both of these groups and the splenectomized patients. CONCLUSIONS: Our results indicate that the addition of low-dose splenic irradiation to chemotherapy in children and adolescents with advanced-stage Hodgkin's disease does not adversely affect splenic reticuloendothial function.