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(a) Postoperative pulmonary complications after laparoscopic surgery and open surgery. (b) Operative time for laparoscopic surgery and open surgery. (c) Pain score after open surgery and laparoscopic surgery.
Source publication
Aim
To evaluate the impact of open or laparoscopic rectal surgery on pulmonary complications in elderly (>75 years old) patients.
Methods
Data from consecutive patients who underwent elective laparoscopic or open rectal surgery for cancer were collected prospectively from 3 institutions. Pulmonary complications were defined according to the ACS/NS...
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Citations
... Although the benefits of the minimally invasive surgery in the treatment of the colorectal pathologies are well known (11)(12)(13)(14)(15), anastomotic leakage (AL) remains one of the most common complications in colorectal surgery. It increases morbidity and mortality, healthcare costs, and worsening long-term oncological outcomes. ...
PurposesThe aim of this study was to evaluate the importance of Indocyanine Green in control of anastomosis perfusion and on anastomotic leakage rates during laparoscopic and robotic colorectal procedures.MethodsA retrospective review of patients who underwent elective minimally invasive surgery for colorectal cancer from 1 January 2018 to 31 December 2020 was performed. All patients underwent Near-Infrared Fluorescence-Indocyanine Green system in two moments: before performing the anastomosis and after completing the anastomotic procedure. Primary outcomes were the rate of intraoperative change in the surgical resection due to an inadequate vascularization and the rate of postoperative anastomotic leakage. Secondary outcomes were the postoperative complications, both medical and surgical (intra-abdominal bleeding, anastomotic leakage).ResultsOur analysis included 93 patients. Visible fluorescence was detected in 100% of the cases. In 7 patients (7.5%), the planned site of resection was changed due to inadequate perfusion. The mean extension of the surgical resection in these 7 patients was 2.2 ± 0.62. Anastomotic leakage occurred in 2 patients (2.1%). Other complications included 8 postoperative bleedings (8.6%) and 1 pulmonary thromboembolism.Conclusions
The intraoperative use of Near-Infrared Fluorescence-Indocyanine Green in colorectal surgery is safe, feasible, and associated with a substantial reduction in postoperative anastomotic leakage rate.
... A loop at the end of the suture can be used for knotless suturing, and the first 2 cm of the suture lacks barbs to allow throws to be readjusted before the barbs are engaged. (20).Since its introduction in 1990s, minimally invasive surgery has gained widespread acceptance in many surgical fields due to its safety and advantages that this kind of procedure can offer as compared to open surgery (21)(22)(23)(24)(25)(26)(27)(28). Nevertheless, the possibility to perform intra-corporeal anastomosis in minimally invasive surgery has underlined the importance of being able to perform a laparoscopic knot, the most difficult skill in laparoscopic surgery. ...
To observe the impact of barbed suture and study its safety and feasibility in laparoscopic gastrointestinal surgeries. The study was conducted in the Post Graduate Department of General and Minimal and Access Surgery from June 2018 to June 2021. Our study was conducted on 34 patients and following observation was made.: The mean age in our study was 59.76 ± 12.497 Yrs. (Range from 21to 85 Yrs.). Maximum were present in the age range of 60 to 79 (52.9%) and out of 34 patients, 22 (64.7 %) were males and 12 (35.3 %) females. The peri-operative diagnosis were malignancy 28 (82.4 %) (Ca stomach 21 (61.8 %), Ca colorectum 7 (20.6%)) with 6 (17.
... Furthermore, it has been widely demonstrated that the minimally invasive approach has obtained wide acceptance for the treatment of a lot of pathologic conditions of the colon and the rectum. [13][14][15][16][17][18]. ...
A modified caudal-to-cranial approach to perform laparoscopic left colectomy for benign diseases has been recently designed to facilitate the low-tie mesenteric dissection. A chart review has been performed including all consecutive patients with uncomplicated diverticulitis who have been treated by segmental left colectomy with a caudal-to-cranial approach. A total of 34 patients were included in the study. 21 patients were male, mean age was 54.1±11.3, and mean BMI was 26±5.5. Patients with ASA Score I were 7, with ASA II were 9, and with ASA Score III were 5. Incontinence Score (IS) resulted in an average of 5±2,2 grade of incontinence and the CS score showed an average of 10±3,2 grade of constipation. Health status, evaluated by Short Form-36 questionnaire, was demonstrated in these patients’ great physical function, role, general health, and social function. The anorectal manometry performed 6 months after surgery showed a normal value in terms of the anal resting pressure (47±13 mmHg) and an increased volume to stimulate desire to defecate (197±25 ml). The length of the anal sphincter was normal compared to the reference value (37±5.4 mm). Although further studies are required to obtain definitive conclusions, our results are encouraging to propose low-tie segmental colectomy as the standard procedure for the treatment of uncomplicated diverticulitis, and our modified surgical approach could be considered useful to facilitate the surgical approach.
... Third, our study population included middle-aged adults with healthy lungs who underwent laparoscopic colorectal surgery. Laparoscopic surgery is reported to have fewer pulmonary complications than conventional abdominal surgery with laparotomy incision [28][29][30][31][32]. Thus, our results should not be extrapolated to older patients with decreased functional residual capacity or with preoperative pulmonary diseases and to patients undergoing open abdominal surgery. ...
We evaluated the effects of three different inspired oxygen concentrations (40%, 80%, and 100%) at anaesthesia emergence on postoperative lung volumes as measured by global impedance of electrical impedance tomography (EIT). This is a randomised, controlled, and assessor-blinded study in single-centre from May 2017 to August 2017. Seventy-one patients undergoing elective laparoscopic colorectal surgery with healthy lung condition were randomly allocated into the three groups based on the concentration of inspired oxygen applied during anaesthesia emergence: 40%-, 80%- or 100%-oxygen. End-expiratory lung impedance (EELI) with normal tidal ventilation and total lung impedance (TLI) with full respiratory effort were measured preoperatively and before discharge in the post-anaesthesia care unit by EIT, and perioperative changes (the ratio of difference between preoperative and postoperative value to preoperative value) were compared among the three groups. Postoperative lung impedances were significantly reduced compared with preoperative values in all patients (P < 0.001); however, perioperative lung impedance reduction (%) did not differ among the three oxygen groups. The mean reduction ratio in each 40%-, 80%-, and 100%-oxygen group were 37% ± 13%, 41% ± 14%, and 46% ± 14% for EELI (P = 0.125) and 40% ± 20%, 44% ± 17% and 49% ± 20% for TLI (P = 0.276), respectively. Inspired oxygen concentrations applied during anaesthesia emergence did not show a significant difference in postoperative lung volume as measured by EIT in patients undergoing laparoscopic colorectal surgery with healthy lungs.
Trial registration cris.nih.go.kr (KCT0002642).
... Despite these concerns, several studies have reported that MIS does not increase PPC [2,7]. Furthermore, MIS is associated with decreased pain, accelerated functional recovery, and shorter length of stay when compared to open surgery [8][9][10]. ...
Objective
To determine the risk factors for developing primary postoperative pulmonary complications (PPC) in patients undergoing minimally invasive colorectal surgery (MIS) for the treatment of cancer and to identify the potential indicators for more extensive preoperative evaluation.
Materials and methods
The ACS-NSQIP® database was interrogated to capture patients who had elective colon or rectal cancer and underwent MIS between 2012 and 2017. Patients who had primary PPC including pneumonia, unplanned intubation and/or failure to wean from mechanical ventilation for > 48 h were compared to patients without PPC. Significant risk factors for PPC were retained to build a predictive risk model through logistic regression analysis. The model was then internally validated using 2018 data.
Results
Of 50,150 patients identified, 637 (1.3%) had PPC. The final risk prediction model included six variables: history of chronic obstructive pulmonary disease, age, smoking status, functional health status, pre-operative congestive heart failure, and American Society of Anesthesiology class ≥ 3. The model achieved good calibration (Hosmer–Lemeshow goodness-of-fit test, p = 0.614) and discrimination (c statistics = 0.757). Internal validation achieved similar discrimination (c statistics = 0.798).
Conclusion
Primary postoperative pulmonary complications affected 1.3% of patients undergoing MIS for colon or rectal cancer. The novel predictive risk score showed good discrimination and may help to identify patients who may benefit from perioperative optimization.
... Furthermore, even if the minimally invasive surgery is nowadays considered the gold standard approach for colorectal cancers 13,14 , and the intracorporeal anastomosis seems to be related with better postoperative outcomes [15][16][17] , data about minimally invasive approaches for the TCC are scarce. Thus, at present, the lack of a 'gold standard' technique leaves the surgeon the choice of which technique to perform, based on his preferences. ...
Introduction
Transverse colon cancer (TCC) is poorly studied, and TCC cases are often excluded from large prospective randomized trials because of their complexity and their potentially high complication rate. The best surgical approach for TCC has yet to be established. The aim of this large retrospective multicenter Italian series is to investigate the advantages and disadvantages of both hemicolectomy and transverse colectomy in order to identify the best surgical approach.
Materials and methods
This was a retrospective cohort study of patients with mid-transverse colon cancer treated with a segmental colon resection or an extended hemicolectomy (right or left) between 2006 and 2016 in 28 high-volume (more than 70 procedures/year) Italian referral centers for colorectal surgery.
Results
The study included 1529 patients, 388 of whom underwent a segmental resection while 1141 underwent an extended resection. A higher number of complications has been reported in the segmental group than in the extended group (30.1% versus 23.6%; p 0.010). In 42 cases the main complication was the anastomotic leak (4.4% versus 2.2%; p 0.020). Recovery outcomes also showed statistical differences: time to first flatus (p 0.014), time to first mobilization (p 0.040), and overall hospital stay (p < 0.001) were significantly shorter in the extended group. Even if overall survival were similar between the groups (95.1% versus 97%; p 0.384), 3-year disease-free survival worsened after segmental resection (78.1% versus 86.2%; p 0.001).
Conclusions
According to our results, an extended right colon resection for TCC seems to be surgically safer and more oncologically valid.
... Since its introduction in 1990s, minimally invasive surgery has gained widespread acceptance in many surgical fields due to its safety and advantages that this kind of procedure can offer as compared to open surgery [16][17][18][19][20][21][22][23]. ...
Although minimally invasive surgery is recognized as the gold standard of many surgical procedures, laparoscopic suturing is still considered as the most difficult skill in laparoscopic surgery.
The introduction of barbed sutures facilitates laparoscopic suturing because it is not necessary to tie a knot. The efficacy of this method has been evaluated in different types of surgery; however, less is known about general surgery.
We retrospectively analysed data from 378 patients who had undergone bariatric or surgical treatment for colic or gastric malignancy requiring a closure of gastroentero, entero-entero or enterocolotomy from January 2014 to January 2019, admitted to the General Surgery Unit and Operative Unit of Surgical Endoscopy of the University Federico II (Naples, Italy).
We registered 12 anastomotic leaks (3.1%), 16 anastomotic intraluminal bleedings (4.2%) and 7 extraluminal bleedings. Other complications included 23 cases of postoperative nausea and vomit (6%), 14 cases of postoperative ileus (3.7%) and 3 cases of intra-abdominal abscess (0.8%). Overall complications rate was 19.8% (75/378). No postoperative death was registered.
Thus, by pooling together 378 patients, we can assess that barbed suture could be considered safe and effective for closure of holes used for the introduction of a branch of mechanical stapler to perform intracorporeal anastomosis.
Purpose
Surgical removal of the cancerous tissue remains the cornerstone of curative treatment for colorectal cancer and results in an inflammatory response. An exaggerated inflammatory response has been implicated in the promotion of tumor proliferation and has shown associations with postoperative complications. Literature on the preferred surgical technique to minimize inflammatory response is inconclusive. Therefore, the aim of this study was to assess the inflammatory response and postoperative incidence of infectious complications following surgery for colorectal cancer.
Methods
Embase, PubMed, and Cochrane databases were searched for RCTs that reported inflammatory parameters as a function of surgical modality only. Data related to CRP or IL-6 levels on postoperative days 1 and 3 and data related to postoperative infections were subject to a pairwise meta-analysis to compare open versus laparoscopic techniques.
Results
The literature search and screening process yielded 4151 studies. Ten studies met criteria, including 568 patients. Only studies on laparoscopic and open surgery were found. Pooled analyses found lower Il-6 and CRP levels on postoperative day 1 and lower CRP levels on postoperative day 3 for laparoscopic surgery compared to open surgery. However, there was no difference in incidence of postoperative infectious complications.
Conclusion
The findings of this study indicate a superior inflammatory profile for laparoscopic surgery compared to an open approach for colorectal cancer surgery. For future research, it would be worthwhile to conduct a randomized controlled trial to compare the postoperative inflammatory response and related clinical outcomes between minimally invasive surgical approaches, including laparoscopic and robot-assisted surgery.
Postoperative complications are a potential outcome of any colorectal operation. These complications can occur in any organ system, but the most common ones include ileus, bleeding, and surgical site infections. Numerous strategies exist to reduce the harmful effects of complications including optimization of modifiable risk factors preoperatively and early identification/treatment of complications if they occur. Ultimately, all colorectal surgeons should be equipped with the knowledge, skills, and experience to manage general postoperative complications.
Aim
Randomized controlled trials (RCT) are the gold standard in surgical research, and case‐matched studies, such as studies with propensity score matching, are expected to serve as an alternative to RCT. Both study designs have been used to investigate the potential superiority of laparoscopic surgery to open surgery for rectal cancer, but it remains unclear whether there are any differences in the findings obtained using these study designs. We aimed to examine similarities and differences between findings from different study designs regarding laparoscopic surgery for rectal cancer.
Methods
Systematic review and meta‐analyses. A comprehensive literature search was conducted using PubMed, Scopus, and Cochrane. RCT, case‐matched studies, and cohort studies comparing laparoscopic low anterior resection and open low anterior resection for rectal cancer were included. In total, 8 short‐term outcomes and 3 long‐term outcomes were assessed. Meta‐analysis was conducted stratified by study design using a random‐effects model.
Results
Thirty‐five studies were included in this review. Findings did not differ between RCT and case‐matched studies for most outcomes. However, the estimated treatment effect was largest in cohort studies, intermediate in case‐matched studies, and smallest in RCT for overall postoperative complications and 3‐year local recurrence.
Conclusion
Findings from case‐matched studies were similar to those from RCT in laparoscopic low anterior resection for rectal cancer. However, findings from case‐matched studies were sometimes intermediate between those of RCT and unadjusted cohort studies, and case‐matched studies and cohort studies have a potential to overestimate the treatment effect compared with RCT.
