RESUMO
BACKGROUND: Laparoscopy-assisted surgery (LAS) for colorectal cancer (CRC) was first described in 1991 and robotic-assisted surgery (RAS) for CRC was first reported in 2002; robotic-assisted colorectal surgery (RACS) is becoming increasingly popular. However, data comparing its outcomes to other established techniques remain limited to small case series. Our primary goal was to review the mortality outcome difference between laparoscopic versus robotic elective colon resection at a small, community hospital. STUDY DESIGN: We conducted a retrospective review of 2089 patients at the South Atlantic division for cases who underwent robotic and laparoscopic colectomies at our division in 2014-2018. All cases were elective surgeries and analysis was performed within these two subgroups. RESULTS: In this study, 306 patients underwent robotic colorectal surgery versus 1783 patients who underwent laparoscopic-assisted colorectal surgery. Readmission rate within 30 days of operation was significantly lower for laparoscopic-assisted colorectal resection (LACR) versus RACS (445.4% vs. 53.9%, p= 0.006). However, the length of hospital stay was significantly shorter for RACS with a median of three days (interquartile range {IQR}: 2-5) versus four days (IQR: 3-7) for LACR (p=0.0001). There were no significant differences between the two groups for post-operative incisional hernias, anastomotic leaks, post-operative pain control, surgical site infections, or rate of conversion to an open procedure. CONCLUSION: Our study showed a similar outcome between LACR and RACS for post-operative incisional hernias, anastomotic leaks, post-operative pain control, surgical site infections, and rate of conversion to an open procedure. Also, our study showed a readmission rate within 30 days of operation was significantly lower for LACR versus RACS. However, the length of hospital stay was significantly shorter for RACS with a median of three days when compared to LACR. Future research should focus on surgeon-specific variables, such as comfort, ergonomics, distractibility, and ease of use, as other ways to potentially distinguish robotic from laparoscopic colorectal surgery.
RESUMO
BACKGROUND: Breast cancer in very young patients represents a unique issue that needs more attention as the number of cases is increasing and it has special characteristics at presentation, diagnosis, and biologic behaviors which reflect on both treatment strategies and survival. The aim of the current study was to analyze and report the clinico-pathological characteristics and treatment procedures used for breast cancer in very young patients over the last decade in a single Egyptian cancer center. PATIENTS AND METHODS: A retrospective study was conducted in the Oncology Center - Mansoura University, where the data of all breast cancer patients, between September 2006 and August 2015, were reviewed. Among 4,628 patients who were diagnosed with breast cancer during this period, only 300 patients aged ≤35 years had complete registry data. Clinico-pathological characteristics, therapeutic procedures, and survival outcome were reported. RESULTS: Three hundred and seventy-nine patients (8.19%) were aged ≤35 years at the time of presentation. The age ranged between 21 and 35 years, and the mean age was 31 years (±3 standard deviation). Positive family history of breast cancer was found in 12.3%, and metastatic presentation was seen in 4.7%. The rate of axillary lymph nodes involvement was 75.7%. The estrogen receptor-negative disease was found in 51%, and among 217 patients who did HER2 test, 82 patients (37.8%) were HER2 positive, while triple-negative subtype was found in 57 patients (26.4%). Ki 67 percentage ranged between 3% and 66% (median was 35%). The median disease-free survival was 61 months (95% confidence interval 44-78 months); the 3-year and 5-year disease-free survival were 58% and 50%, respectively. The 3-year and 5-year overall survival were 88% and 68%, respectively. CONCLUSION: Very young Egyptian patients with breast cancer should be given focus and specially studied as the presentation has more aggressive biologic behavior at advanced stages, so the treatment strategies have to be tailored in a very precise manner.
