Frailer Patients Undergoing Robotic Colectomies for Colon Cancer Experience Increased Complication Rates Compared With Open or Laparoscopic Approaches

BACKGROUND: Minimally invasive surgical techniques are routinely promoted as alternatives to open surgery because of improved outcomes. However, the impact of robotic surgery on certain subsets of the population, such as frail patients, is poorly understood. OBJECTIVE: The purpose of our study was to examine the association between frailty and minimally invasive surgical approaches with colon cancer surgery. DESIGN: This is a retrospective study of prospectively collected outcomes data. Thirty-day surgical outcomes were compared by frailty and surgical approach using doubly robust multivariable logistic regression with propensity score weighting, and testing for interaction effects between frailty and surgical approach. SETTING: Patients undergoing an open, laparoscopic, or robotic colectomy for primary colon cancer, 2012 to 2016, were identified from the American College of Surgeons National Surgical Quality Improvement Program database. PATIENTS: Patients undergoing a colectomy with an operative indication for primary colon cancer were selected. MAIN OUTCOME MEASURES: The primary outcomes measured were 30-day postoperative complications. RESULTS: After propensity score weighting of patients undergoing colectomy, 33.8% (n = 27,649) underwent an open approach versus 34.3% (n = 28,058) underwent laparoscopic surgery versus 31.9% (n = 26,096) underwent robotic surgery. Robotic (OR, 0.53; 95% CI, 0.42–0.69, p
Source: Diseases of the Colon and Rectum - Category: Gastroenterology Tags: Original Contributions: Colorectal Cancer Source Type: research

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ConclusionThe 3D vision revealed an important advantage in order to achieve the correct identification of surgical anatomy allowing a safe and effective right colectomy with CME, CVL, and intracorporeal anastomosis, either using laparoscopic or with robotic approach, providing similar short-term outcomes. Taking into account the high costs and the longer operative time of robotic procedure, the 3D laparoscopy could be considered in performing right colectomy with CME, while the robotic approach should be considered as a first choice approach for challenging situations (obese patient, complex associated procedures).
Source: Surgical Endoscopy - Category: Surgery Source Type: research
AbstractPurposeTo compare the short-term outcomes of conventional open colectomy with those of laparoscopic colectomy for colon cancer.MethodsWe retrieved data between January 2014 and March 2016 from the Diagnosis Procedure Combination database. A total of 69,418 patients who underwent colectomy for colon cancer were analyzed from among 15,901,766 cases of colorectal cancer. We applied a multilevel logistic regression model using a 2-level structure of individuals nested from 1065 hospitals.ResultsA total of 22,440 open colectomy and 46,978 laparoscopic colectomy procedures were performed. The in-hospital mortality rate w...
Source: Surgery Today - Category: Surgery Source Type: research
ConclusionMajority of resections were ‘optimal’ mesocolic plane dissections. Open resections yielded better quality specimens, but incurred more morbidity. There is room for improvement in the quality of laparoscopic colon cancer surgery, particularly those performed as emergency.
Source: International Journal of Colorectal Disease - Category: Gastroenterology Source Type: research
Source: Nutrition and Cancer - Category: Cancer & Oncology Authors: Source Type: research
Abstract The feasibility of laparoscopic surgery for elderly patients remains unclear, as these patients usually present with comorbidities. Recently, the controlling nutritional status (CONUT) score has drawn attention as an evaluation score of patients' general status as well as a predictor of survival. We retrospectively analyzed overall survival in 424 patients aged ≥75 years with colon cancer, who underwent curative surgery (laparoscopic (n = 167) or open surgery (n = 257)) between January 2004 and December 2013. To adjust for heterogeneity in both groups, a propensity sc...
Source: Nutrition and Cancer - Category: Cancer & Oncology Authors: Tags: Nutr Cancer Source Type: research
CONCLUSIONS: Our cumulative findings support the use of SILS or SILS+1 in patients with colorectal cancer. The long-term oncologic outcomes make them acceptable technical alternatives to conventional multiport laparoscopic colectomy. Further trials are still needed to fully document the non-cosmetic benefits. PMID: 32196563 [PubMed - as supplied by publisher]
Source: Surgical Technology International - Category: Surgery Tags: Surg Technol Int Source Type: research
This study was conducted following theCochrane Handbook for Systematic Reviews of Interventions and the PRISMA guidelines. A systematic screening of the electronic databases was performed (Medline, Web of Science and Scopus). The validity of the pooled results was verified through the performance of trial sequential analysis (TSA). The level of evidence was estimated using the GRADE approach.ResultsOverall, 21 studies and 2498 patients were included in our study. Pooled comparisons and TSA analyses reported a superiority of LC over OC in terms of postoperative complications (OR 0.64,p = 0.0003), blood loss (W...
Source: International Journal of Colorectal Disease - Category: Gastroenterology Source Type: research
This report discusses the oldest reported patient with HFS and is the first to describe the management of epidural anesthesia in a patient with HFS.
Source: A&A Case Reports - Category: Anesthesiology Tags: Case Reports Source Type: research
Conclusion: The majority of colectomies such as open or laparoscopic are able to retrieve 12 or more LNs. However, there are greater odds of retrieving more than 12 LNs with the open approach compared to the laparoscopic approach. By allowing for more LN retrieval, open colectomies suggest improvement in tumour clearance and decrease metastatic spread. Additional research is needed to further investigate the specific factors influencing the ability to retrieve an adequate number of LNs, such as viewing angles provided with an open approach versus laparoscopic approach. PMID: 31921339 [PubMed]
Source: Ecancermedicalscience - Category: Cancer & Oncology Tags: Ecancermedicalscience Source Type: research
Abstract Background. Our aim was to compare the emerging technique of single-incision laparoscopic surgery complete mesocolic excision (SILS CME) colectomy with the standard multiport laparoscopic CME (MPL CME) colectomy. Methods. MEDLINE (PubMed), Scopus, EMBASE, Ovid, and the Cochrane library were searched. Studies comparing the SILS CME with MPL CME in adults with colon adenocarcinoma were included. The Jadad and Newcastle Ottawa Scales were used to critically appraise the studies. The presence of statistical heterogeneity or publication bias was examined. Results. Seven studies (3 randomized) with a total numb...
Source: Surgical Innovation - Category: Surgery Authors: Tags: Surg Innov Source Type: research
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