Laparoscopic versus open left colectomy in patients with sigmoid colon cancer: prospective cohort study with long-term follow-up.

BACKGROUND: Laparoscopic left colectomy has obtained a large spread in colon surgery for malignant disease despite the need for an adequate learning curve. However few studies reported long term data in comparison with open left colectomy and most of the authors of large series on colorectal surgery don't describe, in subgroup analysis, results obtained in left colonic resections. The aim of this study is to report the short and long term follow-up of laparoscopic left colon resection in comparison with the open approach, from a single centre, performed in the same timeframe. METHODS: Between January 2005 to January 2007, 55 patients with sigma adenocarcinoma underwent to laparoscopic or open left colectomy at the Department of Digestive Surgery, "S. Maria" hospital in Terni - Italy. Perioperative and histopathological data and results from oncological follow-up, until April 2013, are analyzed. RESULTS: 28 patients underwent laparoscopic left colectomy, while 27 patients open left colectomy. Mean hospital stay was 8.44 ± 1.21 in the laparoscopic group versus 6.86 ± 1.01 in the open group. The histopathological analysis shows a mean of 18.13 ± 6.8 lymph nodes removed after laparoscopy and 13.96 ± 5.72 after open surgery (P = 0.02). Kaplan-Meier analysis does not reveal significative differences in disease free survival (HR = 0.85; 95% CI = 0.21-3.40; P = 0.81). Overall survival up to 5 years shows one death per group. CONCLUSIONS: Laparoscopy, respect to the open approach, could improve perioperative clinical outcomes, hospital stay and harvested lymph nodes with comparable long term oncological follow-up in patients with sigmoid colon cancer.

Effects of laparoscopic sleeve gastrectomy in patients with morbid obesity and metabolic disorders.

PURPOSES: Obesity and its correlation with other pathological conditions determine the onset of the metabolic syndrome, which exposes the patient to a higher risk of major cardiovascular complications. Laparoscopic sleeve gastrectomy (LSG) is a bariatric surgical procedure that appears to influence both the reduction of fat mass and the action of some gastrointestinal hormones. PATIENTS AND METHODS: Between January 2011 and July 2013, 23 patients with morbid obesity underwent LSG and follow-up. In the evaluation of patients, the criteria for metabolic syndrome given by the International Diabetes Federation were followed. A multidisciplinary team of experts evaluated patients before surgery and in subsequent scheduled postoperative visits at 7, 30, 60, and 90 days and 4, 5, 6, 9, and 12 months. Anthropometric and metabolic parameters were analyzed. RESULTS: The mean excess weight loss was 8.57±3.02%, 17.65±6.40%, 25.47±7.90%, 33.76±9.27%, 41.83±10.71%, 46.02±13.90%, 52.60±14.05%, 58.48±16.07%, and 62.59±21.29% at 7, 30, 60, and 90 days and 4, 5, 6, 9, and 12 months, respectively. In the same observational period there was an excellent improvement of metabolic indices. None of the patients previously taking prescribed hypoglycemic drugs restarted therapy. Mean fasting plasma glucose significantly decreased compared with the preoperative values. Blood pressure had a statistically significant improvement. Modification in the lipid profile was more variable. During the period of observation 22 of 23 patients reported in this study did not fit the criteria for metabolic syndrome. CONCLUSIONS: Morbid obesity and related diseases may benefit from a surgical approach in selected patients. Randomized controlled trials are needed to evaluate the role of LSG.