Background
The surgical resection of the splenic flexure carcinoma (SFC) is challenging and the optimal surgical procedure for SFCs remains a matter of debate. The present study aimed to compare in a ...multicenter European sample of patients the short- and long-term outcomes of extended right (ERC) vs. left (LC) vs. segmental left colectomy (SLC) for SFCs.
Methods
This retrospective multicenter study analyzed the surgical and oncological outcomes of SFC patients undergoing elective curative intent surgery between 2000 and 2018. Descriptive and exploratory analyses were first conducted on the whole sample. Outcomes of the different procedures (ERC vs. LC vs. SLC) were then compared using propensity score matching for multilevel treatment. Overall (OS) and disease-free survival (DFS) were evaluated by Kaplan–Meier method.
Results
From a total of 399 SFC patients, 143 (35.8%) underwent ERC, 131 (32.8%) underwent LC, and 125 (31.4%) underwent SLC. Overall, 297 (74.4%) were laparoscopic procedures. An increase in operative time, time to flatus, time to regular diet, and hospital stay was observed with the progressive extension of SFC resection. ERC was associated with significantly increased risk of postoperative ileus compared to both LC and SLC. A significantly greater number of lymph nodes were retrieved by ERC, but the objective of at least 12 retrieved lymph nodes was achieved in 85% of patients, without procedure-related differences. No differences were observed in OS or DFS between ERC, LC, and SLC.
Conclusion
The present study supports the resection of SFCs by colon-sparing surgical techniques, such as SLC.
Background
The aim of this study was to assess the performance of our augmented reality (AR) software (Hepataug) during laparoscopic resection of liver tumours and compare it to standard ...ultrasonography (US).
Materials and methods
Ninety pseudo-tumours ranging from 10 to 20 mm were created in sheep cadaveric livers by injection of alginate. CT-scans were then performed and 3D models reconstructed using a medical image segmentation software (MITK). The livers were placed in a pelvi-trainer on an inclined plane, approximately perpendicular to the laparoscope. The aim was to obtain free resection margins, as close as possible to 1 cm. Laparoscopic resection was performed using US alone (
n
= 30, US group), AR alone (
n
= 30, AR group) and both US and AR (
n
= 30, ARUS group). R0 resection, maximal margins, minimal margins and mean margins were assessed after histopathologic examination, adjusted to the tumour depth and to a liver zone-wise difficulty level.
Results
The minimal margins were not different between the three groups (8.8, 8.0 and 6.9 mm in the US, AR and ARUS groups, respectively). The maximal margins were larger in the US group compared to the AR and ARUS groups after adjustment on depth and zone difficulty (21 vs. 18 mm,
p
= 0.001 and 21 vs. 19.5 mm,
p
= 0.037, respectively). The mean margins, which reflect the variability of the measurements, were larger in the US group than in the ARUS group after adjustment on depth and zone difficulty (15.2 vs. 12.8 mm,
p
< 0.001). When considering only the most difficult zone (difficulty 3), there were more R1/R2 resections in the US group than in the AR + ARUS group (50% vs. 21%,
p
= 0.019).
Conclusion
Laparoscopic liver resection using AR seems to provide more accurate resection margins with less variability than the gold standard US navigation, particularly in difficult to access liver zones with deep tumours.
Background
The creation of a pneumoperitoneum for laparoscopic surgery is performed by the insufflation of carbon dioxide (CO
2
). The insufflated CO
2
is generally at room temperature (20–25 °C) and ...dry (0–5 % relative humidity). However, these physical characteristics could lead to alterations of the peritoneal cavity, leading to operative and postoperative complications. Warming and humidifying the insufflated gas has been proposed to reduce the iatrogenic effects of laparoscopic surgery, such as pain, hypothermia and peritoneal alterations. Two medical devices are currently available for laparoscopic surgery with warm and humidified CO
2
.
Methods
Clinical studies were identified by searching PubMed with keywords relating to humidified and warmed CO
2
for laparoscopic procedures. Analysis of the literature focused on postoperative pain, analgesic consumption, duration of hospital stay and convalescence, surgical techniques and hypothermia.
Results
Bibliographic analyses reported 114 publications from 1977 to 2015, with only 17 publications of clinical interest. The main disciplines focused on were gynaecological and digestive surgery ). Analysis of the studies selected reported only a small beneficial effect of warmed and humidified laparoscopy compared to standard laparoscopy on immediate postoperative pain and per procedure hypothermia. No difference was observed for later postoperative shoulder pain, morphine equivalent daily doses, postoperative body core temperature, recovery room and hospital length of stay, lens fogging and procedure duration.
Conclusions
Only few beneficial effects on immediate postoperative pain and core temperature have been identified in this meta-analysis. Although more studies are probably needed to close the debate on the real impact of warmed and humidified CO
2
for laparoscopic procedures.
IntroductionPerioperative chemotherapy is the gold standard treatment of the resectable gastro-oesophageal adenocarcinoma. However, 70% of patients cannot receive the complete sequence because of a ...postoperative complication or a decrease in functional and nutritional reserves. Recently, a new concept appeared in digestive surgery: prehabilitation. This interventional process consists of patient preparation, between surgical consultation and surgery, and is based on 3 components: (1) physical management, (2) nutritional care and (3) psychological care. Prehabilitation should decrease postoperative complications and improve nutritional and physical status during the preoperative and postoperative periods. Therefore, it is becoming essential to evaluate the effect of prehabilitation, compared to conventional care, on the percentage of patients reaching the complete oncological treatment.Methods and analysisThe PREHAB trial aimed to evaluate the efficacy of prehabilitation compared to conventional care, in patients with gastro-oesophageal cancer with perioperative chemotherapy. This trial is a prospective, randomised, controlled, open-blind and interventional study in 4 centres. Patients (n=60 per group) will be randomly assigned for management with either prehabilitation or conventional care. The primary outcome is the percentage of patients reaching the complete oncological treatment decided in a multidisciplinary tumour board. The secondary outcomes are the postoperative morbidity, disease-free survival, overall survival, feasibility of the protocol, length of stay, variation of the functional reserve after the preoperative chemotherapy (defined by the VO2peak, ventilatory threshold and 6-min walk test), preoperative and postoperative nutritional status, preoperative anxiety, quality of life, 30-day and 90-day mortality and cumulative dose of cytotoxic treatment received.Ethics and disseminationThe study was approved by an independent medical ethics committee (IRB00008526, CPP Sud-Est VI, Clermont-Ferrand, France) and by the competent French authority (ANSM, Saint Denis, France) and registered on Clinicaltrial.gov. The results will be disseminated in a peer-reviewed journal.Trial registration numberNCT02780921.
Background
There are still controversial data regarding the prognostic value of Venous ThromboEmbolism (VTE) in advanced Pancreatic Ductal AdenoCarcinoma (PDAC) and thromboprophylaxis is poorly ...prescribed despite international recommendations.
Methods
Medical charts of patients consecutively treated for advanced PDAC from 2010 to 2019 were retrospectively reviewed. Progression-free survival (PFS) and overall survival (OS) were estimated using Kaplan–Meier method. Prognostic Factors were identified using a multivariate Cox’s proportional hazard model. Early VTE was defined as VTE occurring within the three months following the PDAC diagnosis.
Results
A total of 174 patients were included (median age: 67 years; males: 55.2%; performance status (PS) 0–1: 88.5%) with metastatic disease in 74.7%. At baseline, Khorana score was high (≥ 3) in the vast majority of cases (93.7%). The cumulative incidences of VTE were 12.4% (95% CI 7.3–17.2) at 3 months, 20.4% (95% CI 13.9–26.4) at 6 months and 28.1% (95% CI 20.0–35.3) at 12 months. Patients who experienced early VTE had shorter PFS (3.8 months vs. 7.1 months; HR = 2.02; 95% CI 1.21–3.37;
p
= 0.006) and shorter OS (8.0 months vs. 14.1 months; HR = 2.42; 95% CI 1.37–4.30;
p
= 0.002) compared to the others, independently of prognostic factors such as PS, liver metastases, carcinomatosis, and chemotherapy regimen.
Conclusion
early VTE is a strong prognostic factor in advanced PDAC and occurs in about one in 10 patients.
Lymphadenectomy ensures accurate staging for patients with intrahepatic cholangiocarcinoma, especially for those without preoperatively suspected positive lymph nodes (clinically node-negative); ...however, its prognostic value has been poorly documented. The aim of this study was to evaluate the prognostic value of lymphadenectomy on long-term outcomes in patients undergoing surgery for clinically node-negative intrahepatic cholangiocarcinoma.
Data from all patients who underwent liver resection with or without lymphadenectomy for preoperatively diagnosed intrahepatic cholangiocarcinoma between 2000 and 2016 at 3 tertiary hepatobiliary centers were analyzed retrospectively. Propensity score matching in a 1:1 ratio was conducted based on clinically relevant covariates between patients with clinically node-negative intrahepatic cholangiocarcinoma who underwent liver resection with (LND group) and without (NLND group) lymphadenectomy. Overall survival and disease-free survival were compared in the matched cohort.
Among 350 patients who underwent surgery during the study period, 192 (55%) with clinically node-negative intrahepatic cholangiocarcinoma met the inclusion criteria. After propensity score matching, 2 well-balanced groups of 56 patients each were analyzed. There was no significant difference regarding postoperative variables among these 112 matched patients. Patients who underwent a liver resection with lymphadenectomy achieved better 3- and 5-year overall survival (78% and 65% vs 52% and 46%, P = .017) and disease-free survival (46% and 34% vs 31% and 31%; P = .042) compared with patients who underwent liver resection without lymphadenectomy.
Lymphadenectomy can be associated with better long-term outcomes in patients with node-negative intrahepatic cholangiocarcinoma. Our data may support routine lymphadenectomy for node-negative intrahepatic cholangiocarcinoma with the objective of achieving better long-term outcomes.
Abstract Aim Minimally invasive surgery has been increasingly adopted for locally advanced colon cancer. However, evidence comparing robotic (RRC) versus laparoscopic right colectomy (LRC) for ...nonmetastatic pT4 cancers is lacking. Methods This was a multicentre propensity score‐matched (PSM) study of a cohort of consecutive patients with pT4 right colon cancer treated with RRC or LRC. The two surgical approaches were compared in terms of R0, number of lymph nodes harvested, intra‐ and postoperative complication rates, overall (OS), and disease‐free survival (DFS). Results Among a total of 200 patients, 39 RRC were compared with 78 PS‐matched LRC patients. The R0 rate was similar between RRC and LRC (92.3% vs. 96.2%, respectively; p = 0.399), as was the odds of retrieving 12 or more lymph nodes (97.4% vs. 96.2%; p = 1). No significant difference was noted for the mean operating time (192.9 min vs. 198.3 min; p = 0.750). However, RRC was associated with fewer conversions to laparotomy (5.1% vs. 20.5%; p = 0.032), less blood loss (36.9 vs. 95.2 mL; p < 0.0001), fewer postoperative complications (17.9% vs. 41%; p = 0.013), a shorter time to flatus (2 vs. 2.8 days; p = 0.009), and a shorter hospital stay (6.4 vs. 9.5 days; p < 0.0001) compared with LRC. These results were confirmed even when converted procedures were excluded from the analysis. The 1‐, 3‐ and 5‐year OS ( p = 0.757) and DFS ( p = 0.321) did not significantly differ between RRC and LRC. Conclusion Adequate oncological outcomes are observed for RRC and LRC performed for pT4 right colon cancer. However, RRC is associated with lower conversion rates and improved short‐term postoperative outcomes.
Background
A standardized laparoscopic right hepatectomy (LRH) approach named the “caudal approach” was recently reported. Yet, the value of this approach compared with state-of-the-art open right ...hepatectomy (ORH) remains unknown. The purpose of this study was therefore to compare the short-term outcomes of LRH using the caudal approach and ORH with anterior approach and liver hanging maneuver.
Methods
One-hundred eleven consecutive patients who underwent LRH with caudal approach were prospectively collected; 346 patients who underwent ORH with anterior approach and liver hanging maneuver were enrolled as a control group. Propensity score matching (PSM) of patients in a ratio of 1: 1 was conducted and the perioperative outcomes were compared.
Results
After PSM, two well-balanced groups of 72 patients each were analyzed and compared. The conversion rate in the LRH group was 18.1%. Perioperative blood loss and transfusion rates were significantly lower in the LRH group as compared to the ORH group (median, 200 ml vs. 500 ml,
p
< 0.001 and 9.9% vs. 26.8%,
p
= 0.009, respectively), while operation time was significantly longer (median, 348 min vs. 290 min,
p
< 0.001). Overall (26.4% vs. 48.6%,
p
= 0.006) and symptomatic pulmonary (6.9% vs. 19.4%,
p
= 0.027) complication rates were significantly lower in the LRH group. Hospital stay was significantly shorter in the LRH group (median, 8 days vs. 9 days,
p
= 0.013).
Conclusions
LRH using the caudal approach is associated with improved short-term outcomes compared to state-of-the-art ORH in patients qualifying for both approaches, and can be proposed as standard practice.
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