Laparoscopic Multivisceral Resection Research Articles

Feasibility and safety of minimally invasive multivisceral resection for T4b rectal cancer: A 9-year review.

Colorectal cancer is the third most common cancer and the second highest cause of cancer-related mortality worldwide. About 5%-10% of patients are diagnosed with locally advanced rectal cancer (LARC) on presentation. For LARC invading into other structures (i.e. T4b), multivisceral resection (MVR) and/or pelvic exenteration (PE) remains the only potential curative surgical treatment. MVR and/or PE is a major and complex surgery with high post-operative morbidity. Minimally invasive surgery (MIS) has been shown to improve short-term post-operative outcomes in other gastrointestinal malignancies, but there is little evidence on its use in MVR, especially so for robotic MVR. To assess the feasibility and safety of minimally invasive MVR (miMVR), and compare post-operative outcomes between robotic and laparoscopic MVR. This is a single-center retrospective cohort study from 1st January 2015 to 31st March 2023. Inclusion criteria were patients diagnosed with cT4b rectal cancer and underwent MVR, or stage 4 disease with resectable systemic metastases. Patients who underwent curative MVR for locally recurrent rectal cancer, or metachronous rectal cancer were also included. Exclusion criteria were patients with systemic metastases with non-resectable disease. All patients planned for elective surgery were enrolled into the standard enhanced recovery after surgery pathway with standard peri-operative management for colorectal surgery. Complex surgery was defined based on technical difficulty of surgery (i.e. total PE, bladder-sparing prostatectomy, pelvic lymph node dissection or need for flap creation). Our primary outcomes were the margin status, and complication rates. Categorical values were described as percentages and analysed by the chi-square test. Continuous variables were expressed as median (range) and analysed by Mann-Whitney U test. Cumulative overall survival (OS) and recurrence-free survival (RFS) were analysed using Kaplan-Meier estimates with life table analysis. Log-rank test was performed to determine statistical significance between cumulative estimates. Statistical significance was defined as P < 0.05. A total of 46 patients were included in this study [open MVR (oMVR): 12 (26.1%), miMVR: 36 (73.9%)]. Patients' American Society of Anesthesiologists score, body mass index and co-morbidities were comparable between oMVR and miMVR. There is an increasing trend towards robotic MVR from 2015 to 2023. MiMVR was associated with lower estimated blood loss (EBL) (median 450 vs 1200 mL, P = 0.008), major morbidity (14.7% vs 50.0%, P = 0.014), post-operative intra-abdominal collections (11.8% vs 50.0%, P = 0.006), post-operative ileus (32.4% vs 66.7%, P = 0.04) and surgical site infection (11.8% vs 50.0%, P = 0.006) compared with oMVR. Length of stay was also shorter for miMVR compared with oMVR (median 10 vs 30 d, P = 0.001). Oncological outcomes-R0 resection, recurrence, OS and RFS were comparable between miMVR and oMVR. There was no 30-d mortality. More patients underwent robotic compared with laparoscopic MVR for complex cases (robotic 57.1% vs laparoscopic 7.7%, P = 0.004). The operating time was longer for robotic compared with laparoscopic MVR [robotic: 602 (400-900) min, laparoscopic: Median 455 (275-675) min, P < 0.001]. Incidence of R0 resection was similar (laparoscopic: 84.6% vs robotic: 76.2%, P = 0.555). Overall complication rates, major morbidity rates and 30-d readmission rates were similar between laparoscopic and robotic MVR. Interestingly, 3-year OS (robotic 83.1% vs 58.6%, P = 0.008) and RFS (robotic 72.9% vs 34.3%, P = 0.002) was superior for robotic compared with laparoscopic MVR. MiMVR had lower post-operative complications compared to oMVR. Robotic MVR was also safe, with acceptable post-operative complication rates. Prospective studies should be conducted to compare short-term and long-term outcomes between robotic vs laparoscopic MVR.

A Multicenter Analysis of Short-term and Long-term Outcomes Following Laparoscopic Multivisceral Resection for Advanced Colorectal Cancer.

Recent research has demonstrated that laparoscopic multivisceral resection (MVR) for advanced colorectal cancer is safe, practicable, and yields satisfactory oncological results, which is in line with the growing usage of laparoscopic surgery. The effectiveness of laparoscopic MVR is still debatable, though. The goal of this study was to compare the short- and long-term results of patients with advanced colorectal cancer treated with open MVR with laparoscopic procedures. Data on 3,571 consecutive patients hospitalized at the Kyushu University National Kyushu Cancer Center for colorectal cancer surgery between 2004 and 2020 were gathered retrospectively. In the end, 84 individuals with advanced colorectal cancer who had a colectomy with MVR were examined. We evaluated invasiveness in terms of complications, blood loss, and operating time. Recurrence-free survival rates and overall 5-year survival were among the oncological outcomes. Of the 84 patients examined, 29 underwent laparoscopic treatment, and 55 underwent open treatment. The laparoscopic surgery group experienced shorter hospital stays (15 vs. 18 days, p<0.05) and much less blood loss (median volume: 167 vs. 1,058 g, p<0.005) than the open surgery group. Following the exclusion of patients with stage IV colorectal cancer from the study (groups undergoing laparoscopic surgery, n=25; open surgery, n=38), the groups displayed comparable pathologic results and no discernible variations in either the 5-year overall survival (p=0.87) or recurrence-free survival (p=0.86). In certain individuals with advanced colorectal cancer, a laparoscopic method of manipulation with MVR may be less invasive than an open method without compromising the prognosis.

Does Pathological T-Factor Affect Long-term Prognosis of Locally Advanced Colorectal Cancer Treated With Laparoscopic Multivisceral Resection?

Locally advanced colorectal cancer (LACC) has poor long-term outcomes. Our hypothesis was that the pathological tumor depth would affect postoperative outcomes in patients who underwent multivisceral resection with clear margins (R0). The aim of this study was to analyze short- and long-term outcomes in patients who underwent multivisceral resection for LACC, comparing between T3 and T4 stages. This was a propensity score-matched, retrospective study. All 8,764 consecutive patients who underwent surgery for colorectal cancer between April 2007 and January 2021 at the Saitama Medical University International Medical Center were screened; 572 underwent multivisceral resection for LACC. We compared the T3 and T4 groups to evaluate outcomes. The 5-year disease-free survival (DFS) rates did not significantly differ between the two groups (hazard ratio=1.344, 95% confidence interval=0.638-2.907, p=0.33). The 5-year overall survival (OS) rates were significantly worse for the T4 group than for the T3 group (hazard ratio=3.162, 95% confidence interval=1.077-11.44), p=0.037). To determine the association between American Society of Anesthesiologists (ASA) score, transfusion, pathological T and OS, we performed univariate and multivariate analyses. ASA, transfusion, and pathological T-stage were associated with worse OS in univariate analysis (T4 vs. T3, respectively). Our study showed that postoperative complications and DFS of the T4 group were similar to those of the T3 group of locally advanced colorectal cancer treated with laparoscopic multivisceral resection. However, OS was worse in the T4 group compared with the T3 group. Multivariate risk factors for poor OS were ASA>2, transfusion, and T4 stage.

Outcomes following open versus laparoscopic multi-visceral resection for locally advanced colorectal cancer: Asystematic review and meta-analysis.

This meta-analysis aims to compare morbidity, mortality, oncological safety, and survival outcomes after laparoscopic multi-visceral resection (MVR) of the locally advanced primary colorectal cancer (CRC) compared with open surgery. A systematic search of multiple electronic data sources was conducted, and all studies comparing laparoscopic and open surgery in patients with locally advanced CRC undergoing MVR were selected. The primary endpoints were peri-operative morbidity and mortality. Secondary endpoints were R0 and R1 resection, local and distant disease recurrence, disease-free survival (DFS), and overall survival (OS) rates. RevMan 5.3 was used for data analysis. Ten comparative observational studies reporting a total of 936 patients undergoing laparoscopic MVR (n = 452) and open surgery (n = 484) were identified. Primary outcome analysis demonstrated a significantly longer operative time in laparoscopic surgery compared with open operations (P = 0.008). However, intra-operative blood loss (P<0.00001) and wound infection (P = 0.05) favoured laparoscopy. Anastomotic leak rate (P = 0.91), intra-abdominal abscess formation (P = 0.40), and mortality rates (P = 0.87) were comparable between the two groups. Moreover the total number of harvested lymph nodes, R0/R1 resections, local/distant disease recurrence, DFS, and OS rates were also comparable between the groups. Although inherent limitations exist with observational studies, the available evidence demonstrates that laparoscopic MVR in locally advanced CRC seems to be a feasible and oncologically safe surgical option in carefully selected cohorts.

Laparoscopic multivisceral resection with bladder sparing in female patients with locally advanced sigmoid cancer infiltrating the urinary bladder and reproductive organs.

Laparoscopic multivisceral resection with bladder sparing in female patients with locally advanced sigmoid cancer infiltrating the urinary bladder and reproductive organs.

Effect of endoscopic surgical skill qualification system for laparoscopic multivisceral resection: Japanese multicenter analysis.

The efficacy of laparoscopic multivisceral resection (Lap-MVR) has been reported by several experienced high-volume centers. The Endoscopic Surgical Skill Qualification System (ESSQS) was established in Japan to improve the skill of laparoscopic surgeons and further develop surgical teams. We examined the safety and feasibility of Lap-MVR in general hospitals, and evaluated the effects of the Japanese ESSQS for this approach. We retrospectively reviewed 131 patients who underwent MVR between April 2016 and December 2019. Patients were divided into the laparoscopic surgery group (LAC group, n = 98) and the open surgery group (OPEN group, n = 33). The clinicopathological and surgical features were compared between the groups. Compared with the OPEN group, BMI was significantly higher (21.9 vs 19.3kg/m2, p = 0.012) and blood loss was lower (55 vs 380ml, p < 0.001) in the LAC group. Operation time, postoperative complications, and postoperative hospital stay were similar between the groups. ESSQS-qualified surgeons tended to select the laparoscopic approach for MVR (p < 0.001). In the LAC group, ESSQS-qualified surgeons had superior results to those without ESSQS qualifications in terms of blood loss (63 vs 137ml, p = 0.042) and higher R0 resection rate (0% vs 2.0%, p = 0.040), despite having more cases of locally advanced tumor. In addition, there were no conversions to open surgery among ESSQS-qualified surgeons, and three conversions among surgeons without ESSQS qualifications (0% vs 15.0%, p = 0.007). Multivariate analysis revealed blood loss (odds ratio 1.821; 95% CI 1.324-7.654; p = 0.010) as an independent predictor of postoperative complications. Laparoscopic approach was not a predictive factor. The present multicenter study confirmed the feasibility and safety of Lap-MVR even in general hospitals, and revealed superior results for ESSQS-qualified surgeons.

Feasibility and Safety of Laparoscopic Radical Colectomy for T4b Colon Cancer at a University Hospital in Vietnam.

Background The choice of optimal treatment strategies for T4b colon cancers has still been discussed, particularly the initiation of neoadjuvant therapy or surgery. We conducted this study to evaluate the safety and feasibility of laparoscopic multivisceral resection for T4b colon cancers. Methods We used the retrospective design to include all 43 patients with T4b colon cancer at a university hospital in Vietnam from March 2017 to March 2019. All patients were followed 30 days after the surgery, and information about the day of the first flatus, length of hospital stay, iatrogenic complications, postoperative morbidity, mortality, and adjuvant chemotherapy was collected. Results The mean operating time was 187 minutes (ranging from 80 to 310), the mean blood loss was 64.3 ml (5-200), and the conversion rate was 2.3%. The mean number of lymph nodes harvested was 15.5 (SD = 8.06), and 33 patients (76.7%) had at least 12 lymph nodes harvested. A total of 21 patients (48.8%) had lymph node metastases with a mean number of lymph node metastases of 1.89 (SD = 3.4). The radial resection margin was R0 in all 43 patients (100%). The median time until the first flatus and hospital stay were 3 days (2–5) and 7.1 (6–11) days, respectively. There was no mortality at 30 days postoperatively, and one patient had iatrogenic complication (2.3%). Conclusion Laparoscopic radical colectomy was feasible and safe for patients with T4b colon cancer except those requiring major and complicated reconstruction.

Short-term and long-term outcomes of laparoscopic colectomy with multivisceral resection for surgical T4b colon cancer: Comparison with open colectomy.

AimIn response to the rising use of laparoscopic surgery, recent studies have shown that laparoscopic multivisceral resections for locally advanced colon cancer are safe, feasible, and provide acceptable oncological outcomes. However, the usefulness of laparoscopic multivisceral resection remains controversial. Here, we aimed to compare short‐term and long‐term outcomes between laparoscopic and open multivisceral resection approaches for treating locally advanced colon cancer.MethodsWe retrospectively collected data on 1315 consecutive patients admitted to the National Hospital Organization, Osaka National Hospital, for surgical treatment of colorectal cancer between 2010 and 2017. We assessed invasiveness in terms of operating times, blood loss, and complications. Oncological outcomes included 5‐year survival rates and recurrences.ResultsWe included 85 patients that underwent a colectomy with a multivisceral resection for locally advanced colon cancer; of these, 38 were treated with a laparoscopic approach and 47 were treated with an open approach. Compared to the open surgery group, the laparoscopic group had significantly less blood loss (median volume: 25 vs 140 mL, P <0.001), a lower complication rate (10.5% vs 29.8%, P = 0.036), and shorter hospital stays (12 vs 15 days, P = 0.028). After excluding patients with stage Ⅳ colon cancer, the groups showed similar pathologic outcomes and no significant differences in 5‐year disease‐free survival (73.9% vs 67.4%; P = 0.664) or 5‐year overall survival (75.8% vs 67.7%; P = 0.695).ConclusionA laparoscopic approach for locally advanced colon cancer could be less invasive than an open approach without affecting oncological outcomes in selected patients.

Laparoscopic multivisceral resection for locally advanced colon cancer: a single-center analysis of short- and long-term outcomes.

We evaluated the technical and oncological safety of laparoscopic multivisceral resection (MVR) in selected patients with locally advanced colon cancer (LACC). We compared the clinical backgrounds, and short- and long-term outcomes of patients who underwent laparoscopic vs. those who underwent open MVR for LACC en bloc at our hospital. Between January, 2004 and December, 2015, 140 patients underwent MVR of the primary tumor en bloc via laparoscopic surgery (laparoscopic group; LG, n = 69) or open surgery (open group; OG, n = 71). Laparoscopic surgery was selected mainly for tumors that invaded the bladder and abdominal wall. The LG patients had smaller tumors (60 vs. 80mm, p < 0.001), less blood loss (30 vs. 181g, p < 0.001), and shorter hospital stays (12 vs. 19days, p < 0.001) than the OG patients. Open conversion was required for two patients. Postoperative complications and R0 resection were comparable between the groups. Local recurrence occurred in two LG patients and two OG patients. The 5-year cancer-specific survival, disease-free survival, and local disease-free survival of patients with pT4b disease were not significantly different between the LG and OG groups (90.3% vs. 75.2%, 71.2% vs. 67.6%, and 97.1% vs. 94.2%). Although the LG included patients with lower risk, the short- and long-term outcomes were equivalent to those of the OG, which included patients with higher risk.

Laparoscopic Multivisceral Resection of Gastrointestinal Stromal Tumor Post Neoadjuvant Imatinib Therapy: A Series Of Two Cases.

Title: Laparoscopic Multivisceral Resection of Gastrointestinal Stromal Tumor Post Neoadjuvant Imatinib Therapy: A Series Of Two Cases. Introduction: Gastrointestinal stromal tumor is the most common mesenchymal tumor of gastrointestinal tract. Surgery is the cornerstone of management. Targeted chemotherapy viz. Imatinib, sunitinib, regorafenib had reported to be useful in locally advanced cases for downstaging. Here we are presenting two cases, one was arising from the stomach another from tail of the pancreas. Both were successfully managed by laparoscopic multivisceral resection of gastrointestinal stromal tumor after downstaging of tumors. Case report 1: A 47 years old male presented with postprandial fullness and early satiety for 8 months associated with on an off episode of melena. His general, physical and abdominal examination was unremarkable. Endoscopy revealed, normal gastric mucosa with an extrinsic bulge. USG abdomen and CECT revealed a heterogeneously enhancing lesion probably arising from the greater curvature of the stomach and abutting spleen and pancreas. Neoadjuvant therapy started in view of locally advanced disease. He underwent laparoscopic sleeve resection of gastric GIST with distal pancreatico-splenectomy. After a year follow up, no signs of recurrence seen. Case report 2: A 64 years old male presented with dyspepsia and postprandial fullness for 2 years with no history of melena. He also had a loss of appetite and weight. UGI endoscopy revealed extrinsic compression with normal mucosa. USG abdomen and CECT revealed a 17.2 x 11 x 10.5 cm solid cystic lesion abutting greater curvature of the stomach and extending up to splenic hilum and effacing pancreas. In view of locally advanced disease he received imatinib for 1 year followed by laparoscopic distal pancreaticosplenectomy. On six months follow up he is doing well. Conclusion: Gastrointestinal stromal tumor is a rare mesenchymal tumor that has metastatic potential. Open surgery is the preferred view to avoid spill and positive resection margins. Here both patients were managed by multivisceral resection, laparoscopically. Though there is a dearth of literature regarding laparoscopic surgery. However, it is feasible in experienced hands.

Comparison of short and long-time outcomes between laparoscopic and conventional open multivisceral resection for primary T4b colorectal cancer

This study aimed to compare laparoscopic multivisceral resection (LMVR) with conventional open multivisceral resection (OMVR) for primary T4b colorectal cancer (CRC) in short and long-time outcomes. Patients receiving LMVR or OMVR for primary T4b CRC from January 2009 to June 2016 were enrolled. Patients' clinicopathological characteristics and survival data were collected and analyzed. Multivariable analysis was performed to find the factors related with survival. All statistical analysis was performed by SPSS 22.0. A total of 91 patients (LMVR 38, OMVR 53) were included in this study. Patients undergoing LMVR were associated with smaller incision length (P<0.001), less blood loss (P=0.01) and comparable operative time (P=0.071). Patients in LMVR group also had less time to first flatus (P=0.025). The results also suggested LMVR could reduce the incidence of postoperative complication. The conversion rate was 28.9%. The 3-year OS was 64.2%, 68.4% in OMVR, LMVR group respectively and the 3-year DFS was 56.6%, 52.6% in OMVR, LMVR group respectively. The Kaplan curves demonstrated that LMVR group had similar OS (P=0.896) and DFS (P=0.806) when compared with OMVR group. In addition, the multivariate analysis demonstrated that laparoscopic surgery was not associated with poorer survival. Not all MVR for T4b CRC should be performed by open procedure, LMVR can be safe and feasible for primary T4b CRC in selected patients. It can faster the postoperative recovery and reduce the incidence of postoperative complication. The OS and DFS are also not inferior to open group.

Safety and feasibility of single-port laparoscopic multivisceral resection for locally advanced left colon cancer.

The aim of the present study was to evaluate the safety and feasibility of single-port laparoscopic multivisceral resection (S-MVR) for locally advanced left colon cancer. S-MVR is a challenging technique and to the best of our knowledge this is the first report of S-MVR for left colon cancer invading or adhering to neighboring organs. A retrospective review was conducted of patients who underwent laparoscopic multivisceral resection for locally advanced left colon cancer invading or adhering to neighboring organs from January 2008 to December 2014. Short-term and long-term outcomes were analyzed between groups of patients who underwent S-MVR and multi-port laparoscopic multivisceral resection (M-MVR) retrospectively. A total of 14 patients underwent S-MVR and 15 patients underwent M-MVR. There were no significant differences between groups in terms of operative factors and postoperative complications. The length of hospital stay was significantly shorter in the S-MVR group compared with the M-MVR group (P=0.048). Three-year overall survival was 61.9% in the S-MVR group (n=14). In patients with stage II (P=0.600) and III (P=0714) disease the three-year overall and disease-free survival was 81.8 and 58.3% in the S-MVR group and 80.0 and 70% in the M-MVR groups over a median follow-up of 34 months. In conclusion, S-MVR for locally advanced left colon cancer is safe and feasible in selected patients.

Initial Experience of Single-port Laparoscopic Multivisceral Resection for Locally Advanced Colon Cancer.

The aim of this study was to evaluate the safety and feasibility of single-port laparoscopic multivisceral resection (SLMVR) for locally advanced colon cancer invading or adhering to neighboring organs. A prospectively collected database was collated of all patients undergoing SLMVR from January 2011 to December 2014. Short-term and long-term oncologic outcomes were evaluated. Thirty consecutive patients who underwent SLMVR were identified and the completion rate was 90%. The R0 resection rate of the primary tumor was 100%. The postoperative complication rate was 23.3%. The 3-year relapse-free survival rates of patients with stage II (n=11) and stage III (n=12) disease were 80.8% and 54.6%, respectively. The 5-year overall survival rates of patients with stage II and stage III disease were 75.8% and 75.0% over a median follow-up of 42 months, respectively. SLMVR for locally advanced colon cancer is safe and feasible in selected patients.

Laparoscopic assisted multi-visceral resection in stage IV rectal cancer

Hepatic metastasis is the difficult part and key point in treating colorectal cancer. Meanwhile, there still exists an argument that if doing hepatic metastasis of colorectal cancer resection simultaneously. Our center is carrying on multidisciplinary treatments of hepatic metastasis of colorectal cancer and has gained some outcomes from the clinical trials. According to the features of this case, we should get simultaneous resection of both primary and metastatic tumor following by the pre-operation MDT discussion. Here, we show the achievement of laparoscopy-assisted right hemicolectomy combined with liver resection. We want to share the experiences and discuss with each other.

Short- and Long-Term Outcomes of Laparoscopic Multivisceral Resection for Clinically Suspected T4 Colon Cancer.

The use of laparoscopic surgery for colorectal cancer has become widespread recently. However, the safety and oncological outcomes of laparoscopic surgery for primary advanced colorectal cancer need extensive investigation. We analyzed the short- and long-term outcomes after laparoscopic multivisceral resection for primary colon cancer with suspected invasion of other organs at a single institution. Between January 2000 and December 2014, 118 patients underwent laparoscopic multivisceral resection for primary colon cancer invading or adhering to adjacent organs or structures; their short- and long-term outcomes were retrospectively evaluated. The median operating time was 254min (range 130-1051min), and median blood loss was 48ml (range 0-2777ml). The overall conversion rate was 6.8%. The postoperative complication rate was 17.8%. The number of patients with R0 and R1 resection was 112 (94.9%) and 6 (5.1%), respectively. At a median follow-up period of 32months (range 0-157months), the local recurrence rate in patients who underwent R0 resection was 1.8%, while for R1 resection it was 66.7%. In multivariate analysis, R1 resection and LN metastases were found to be predictors of poor prognosis. The cancer-specific 5-year survival was 87% when R0 resection was achieved; within these, the 5-year survival rates for patients with stages II, III, and IV disease were 94, 81, and 40%, respectively. Laparoscopic en bloc multivisceral resection for clinically suspected T4 colon cancer is a safe and feasible procedure for precisely selected patients, attaining satisfactory oncological outcomes when R0 resection is achieved.

Safety and feasibility of laparoscopic multivisceral resection for surgical T4b colon cancers: Retrospective analyses.

Laparoscopic (Lap) surgery has not been established as a standard procedure for locally advanced colon cancers. Here, we evaluated the safety and feasibility of Lap multivisceral resection (MVR) for tumors that had invaded adjacent organs (T4b). We performed retrospective analyses using a single institutional database. Eighty-four patients who underwent Lap or open MVR for surgical T4b primary colon cancers satisfied the inclusion criteria. Among the 84 patients, 48 underwent Lap MVR and 36 underwent open MVR. More patients in the open group were clinical T4b and were receiving neoadjuvant chemotherapy. Patients in the open group had worse performance status (P=0.037) and tumors of greater diameter. Lap completion was achieved in 42 cases (87.5%); the conversion rate was highest in cases involving the urinary tract (40.0%). Lap reconstruction of the bladder or ureter was extremely challenging, and therefore, adjacent organ reconstruction influenced Lap completion. Regarding perioperative outcomes, Lap was superior to open surgery in terms of intraoperative blood loss, morbidity, and postoperative hospital stay. Conversion was required in six cases; five were strategic conversions, and conversion was not associated with severe morbidity. The microscopic positive surgical margin rate was not higher in the Lap group than in the open group. Kaplan-Meier analyses of overall and disease-free survival were comparable between the groups. Cox regression analyses revealed that the operative approach did not have a significant adverse effect on long-term outcomes. The Lap approach could be considered for surgical T4b cancers, except for urinary tract invasion cases that require complicated reconstruction.

The short-term outcomes of laparoscopic multivisceral resection for locally advanced colorectal cancer: our experience of 39 cases.

Laparoscopic surgery for locally advanced colorectal cancer suspected of direct invasion to adjacent organs or structures remains controversial because of its high conversion rate, inadequate oncologic clearance and surgical outcomes. This study retrospectively evaluated the short-term outcomes of laparoscopic multivisceral resection for colorectal cancer and investigated the factors influencing conversion to open surgery. Between 2010 and 2015, 39 patients who underwent laparoscopic multivisceral resection for colorectal cancer intraoperatively suspected of direct invasion to adjacent organs or structures were included. The conversion rate, resection margin status, surgical results, and morbidity and mortality rates were evaluated. We also investigated the factors influencing conversion. The conversion rate was 28%. The resection margin was negative in all cases. The median operative time was 247min, and the median blood loss was 80ml. The postoperative mortality rate was 0%, and the morbidity rate was 28%; complications of Grade 3 or more were observed in 2 patients (5%). The factors influencing conversion were≥2 adherent organs (p=0.028) and clinical suspicion of direct invasion to adjacent organs (cT4b) (p=0.076). Laparoscopic multivisceral resection for colorectal cancer intraoperatively suspected of direct invasion to adjacent organs or structures is feasible in selected patients. Conversion is more likely with≥2 adherent organs and cT4b.

Laparoscopic Versus Open Multivisceral Resection for Primary Colorectal Cancer: Comparison of Perioperative Outcomes

BackgroundThe role of laparoscopic surgery for locally advanced colorectal cancer invading or adhering to neighboring organs is controversial. This study evaluated the safety and feasibility of laparoscopic multivisceral resection for colorectal cancer. MethodsThis study included 126 patients who underwent multivisceral resection for primary colorectal cancer invading or adhering to neighboring organs or structures between July 2005 and November 2012 at our institution. Perioperative outcomes were compared between laparoscopic and open resections. ResultsLaparoscopic and open multivisceral resections were performed in 60 and 66 patients, respectively. Conversion to open surgery occurred in 6.7 % of patients. The median operative time was significantly longer (271 vs. 227 min), but the median blood loss was significantly less (40 vs. 205 mL), in the laparoscopic compared with the open group. The R0 resection rate of the primary tumor (95 vs. 98.5 %), number of lymph nodes harvested (18 vs. 18), and postoperative complications (28 vs. 24 %) were comparable between the groups. The median length of hospital stay was significantly shorter (13.5 vs. 18 days) in the laparoscopic compared with the open group. ConclusionsLaparoscopic multivisceral resection for colorectal cancer invading or adhering to neighboring organs is safe and feasible in selected patients.

A single surgeon’s experience with 54 consecutive cases of multivisceral resection for locally advanced primary colorectal cancer: can the laparoscopic approach be performed safely?

Laparoscopic resection for colorectal cancer has become popular. However, no previous studies have compared the laparoscopic and open approaches for colorectal cancer adherent to adjacent organs. This study analyzed the short- and long-term survival outcomes after laparoscopic multivisceral resection of the locally advanced primary colorectal cancer compared with open procedure in an effort to address appropriate patient selection. From a prospectively collected database, 54 patients with locally advanced primary colorectal cancer who had undergone multivisceral resection from March 2001 to September 2009 were identified. Laparoscopic and open surgeries were selectively performed for 38 and 16 patients, respectively. The two groups had similar demographics, with no differences in age, sex, and comorbidity. However, five emergency or urgency operations were included in the open group. No differences existed between the two groups in terms of tumor node metastasis (TNM) staging, histologic tumor infiltration rates, or curative resection rates. Three patients (7.9%) in the laparoscopic group required conversion to open procedure. In the laparoscopic group, the operation time was longer (330 vs. 257 min; p = 0.018), the volume of blood loss was less (269 vs. 638 ml; p = 0.000), and the time until return of bowel movement was shorter (3.7 vs. 4.7 days; p = 0.029) than in the open group. The perioperative morbidity rates were similar in the two groups (21.1% vs. 43.7%; p = 0.107), and no perioperative mortality occurred in either group. The mean follow-up period after curative resection was 40 months in the laparoscopic group and 35 months in the open group. The two groups showed similar rates for local recurrence (7.7% vs. 27.3%; p = 0.144) and distant metastasis (15.4% vs. 45.5%; p = 0.091). The overall 5-year survival rate was 60.5% for the laparoscopic group and 47.7% for the open group (p = 0.044, log-rank test). In terms of TNM stages, the overall 5-year survival rate for pathologic stage 3 disease was 58.3% for the laparoscopic group and 25% for the open group (p = 0.022, log rank test), but no difference was noted for the stage 2 patients (p = 0.384). No adverse long-term oncologic outcomes of laparoscopic resection were observed in this study. Although inherent limitations exist in this nonrandomized study, laparoscopic multivisceral resection seems to be a feasible and effective treatment option for colorectal cancer for carefully selected patients. Patients with colon cancer should be much more carefully selected for laparoscopic multivisceral resection than patients with rectal cancer because anatomic uncertainty can make oncologic en bloc resection incomplete.

Laparoscopic Multivisceral Resection for Infiltrating Primary Pancreatic Non-Hodgkin's Lymphoma Mimicking a Vast Cystic Neoplasm

Laparoscopic Multivisceral Resection for Infiltrating Primary Pancreatic Non-Hodgkin's Lymphoma Mimicking a Vast Cystic Neoplasm