Introducing Anatomically Correct CT-Guided Laparoscopic Right Colectomy with D3 Anterior Posterior Extended Mesenterectomy: Initial Experience and Technical Pitfalls.

BACKGROUND: Laparoscopic D3 anterior posterior extended mesenterectomy (D3APEM) in right colectomy has received increased attention. The aim of this study is to prove feasibility, systemize technical accomplishment, and provide short-term outcomes data. METHODS: From July 2013 to February 2017, 18 patients with adenocarcinoma in the right colon underwent right colectomy with laparoscopic D3APEM, including lymph nodes anterior and posterior to the superior mesenteric vessels. A reconstructed three-dimensional anatomy map derived from the staging computed tomography was used as a road map at surgery. The procedure was systematized into seven operative steps: Step 1, trocar placement and inspection; Step 2, release of the transverse colon; Step 3, identification of the terminal mesenteric vessels; Step 4, release of the anterior flap; Step 5, division of the transverse mesocolon; Step 6, release of the posterior flap; and Step 7, anastomosis and specimen removal. Patient disposition and variations regarding vascular anatomy and ability to expose consequentially may necessitate a variation in the sequence of the steps. RESULTS: A total of 7 (39%) cases were converted, 3 due to bleeding and 4 due to challenging dissection. Median operative time and blood loss were 276 minutes (168-439 minutes) and 200 mL (< 50-1300 mL), respectively. Postoperative complications occurred in 6 (33%), including 2 (11%) major complication requiring reoperation. Median hospital stay was 5 days (3-13 days). R0 resection was achieved in all cases. Median number of the lymph nodes harvested was 40 (25-86), including 11.5 (4-35) in the D3 volume. Six patients (33%) had positive nodes, 3 of them affecting the D3 zone, including 1 case of a skip metastasis. There was no mortality, and at present all the patients are alive. One patient developed distant lymph node metastases. CONCLUSION: Laparoscopic right colectomy with D3APEM is feasible, associated with acceptable morbidity and fast recovery; now in readiness for introduction in specialized colorectal institutions.

[Surgery without scars]. / Operasjoner uten arr.

In Natural Orifice Transluminal Endoscopic Surgery (NOTES), the procedures are performed through natural body openings, such as the mouth, vagina, urtehra and anus. By avoiding skin incisions, it is possible to prevent scars, hernias and wound infections. NOTES in humans should at this point in time only be performed within approved clinical studies.

Long-term outcome of laparoscopic surgery for colorectal cancer: a cochrane systematic review of randomised controlled trials.

BACKGROUND: The aim of this systematic review is to evaluate long-term outcome of laparoscopically assisted versus open surgery for non-metastasised colorectal cancer. METHODS: Cochrane library, EMBASE, Pub med and CancerLit were searched for published and unpublished randomised controlled trials. RevMan 4.2 was used for statistical analysis. RESULTS: Twelve trials (3346 patients) reported long-term outcome and were included in the current analyses. No significant differences were found between laparoscopic and open surgery in the occurrence of incisional hernias or the number of reoperations for adhesions (p=0.32 and 0.30, respectively). Port-site metastases and wound recurrences were rare and no differences in occurrence after laparoscopic and open surgery were observed (p=0.16). Cancer-related mortality at maximum follow-up was similar after laparoscopic and open surgery (p=0.15 and 0.16 for colon and rectal cancer, respectively). No significant difference in tumour recurrence after laparoscopic and open surgery for colon cancer was observed (3 RCTs, hazard ratio for tumour recurrence in the laparoscopic group 0.86; 95% CI 0.70-1.08). In colon cancer patients, no significant differences in overall mortality were found (2 RCTs, hazard ratio for overall mortality after laparoscopic surgery 0.86; 95% CI 0.86-1.07). CONCLUSIONS: Laparoscopic resection of carcinoma of the colon is associated with a long-term outcome that is similar to that after open colectomy. Laparoscopic surgery for cancer of the upper rectum is feasible, but more randomised trials need to be conducted to assess long-term outcome.

[Laparoscopic surgery for colorectal cancer]. / Laparoskopi ved kolorektal kreft.

BACKGROUND: It has been possible to perform colorectal operations for cancer with a laparoscopic approach for several years, but most operations are still performed by laparotomy. A systematic overview of randomized studies that compare the two techniques is presented. MATERIAL AND METHODS: Pubmed and Embase were systematically searched for relevant randomized clinical trials. RESULTS: 11 randomized clinical trials were identified. Most trials showed that laparoscopic surgery for colorectal cancer was associated with significantly longer operating time (8/11), significantly less intraoperative blood loss (5/7) and a shorter hospital stay (8/10) than open surgery. There were significantly fewer complications after laparoscopic surgery in four of 11 studies. None of the studies showed any significant differences in mortality (6/6). Survival after colon cancer surgery was reported in five studies. In one case, improved disease-free survival after laparoscopic surgery was found whereas the other four showed no significant differences. Two of these studies also included rectal cancer but did not report separate data for these patients. One study that included 28 patients found no difference in cancer-related survival after laparoscopic and open surgery for rectal cancer. INTERPRETATION: Laparoscopic surgery is an acceptable alternative to open surgery in patients with colon cancer. The procedure can be offered to patients in hospitals where experienced laparoscopic surgeons are available. In rectal cancer surgery, evidence is scarce and results from large randomized trials have to be awaited.