Laparoscopic Resection For Colorectal Cancer Research Articles

Conversion of laparoscopic colorectal resection for cancer: What is the impact on short-term outcomes and survival?

Laparoscopic resection for colon and rectal cancer is associated with quicker return of bowel function, reduced postoperative morbidity rates and shorter length of hospital stay compared to open surgery, with no differences in long-term survival. Conversion to open surgery is reported in up to 30% of patients enrolled in randomized control trials comparing open and laparoscopic colorectal resection for cancer. In this review, reasons for conversion are anatomical-related factors, disease-related-factors and surgeon-related factors. Body mass index, local tumour extension and co-morbidities are independent predictors of conversion. The current evidence has shown that patients with converted resection for colon cancer have similar outcomes compared to patients undergoing a laparoscopic completed or open resection. The few studies that have assessed the outcomes after conversion of laparoscopic rectal resection reported significantly higher rates of complications and longer length of hospital stay in converted patients compared to laparoscopically treated patients. No definitive conclusions can be drawn when converted and open rectal resections are compared. Early and pre-emptive conversion appears to have more favourable outcomes than reactive conversion; however, further large studies are needed to better define the optimal timing of conversion. With regard to long-term oncologic outcome, overall and disease-free survival in the case of conversion in laparoscopic colorectal cancer surgery seems to be worse than those achieved in patients in whom resection was successfully completed by laparoscopy. Although a worse long-term oncologic outcome has been suggested, it remains difficult to draw a proper conclusion due to the heterogeneity of the long-term outcomes as well as the inclusion of both colon and rectal cancer patients in most of the studies. Therefore, we discuss the currently available evidence of the impact of conversion in laparoscopic resection for colon and rectal cancer on both short-term outcomes and long-term survival.

Key points of tumor-free operation in laparoscopic resection for colorectal cancer

Key points of tumor-free operation in laparoscopic resection for colorectal cancer

Single port laparoscopic liver surgery: A minireview.

Nowadays, the trend is to perform surgeries with "scarless" incisions. In light of this, the single-port laparoscopic surgery (SPLS) technique is rapidly becoming widespread due to its lack of invasiveness and its cosmetic advantages, as the only entry point is usually hidden in the umbilicus. The interest in "scarless" liver resections did not grow as rapidly as the interest in other scarless surgeries. Hepatopancreatobiliary surgeons are reluctant to operate a malignant lesion through a narrow incision with limited exposure. There are concerns over adverse oncological outcomes for single-port laparoscopic liver resections (SPL-LR) for hepatocellular carcinoma or metastatic colorectal cancer. In addition, getting familiar with using the operating instruments through a narrow incision with limited exposure is very challenging. In this article, we reviewed the published literature to describe history, indications, contraindications, ideal patients for new beginners, technical difficulty, advantages, disadvantages, oncological concern and the future of SPL-LR.

Laparoscopic combined colorectal and liver resections for primary colorectal cancer with synchronous liver metastases.

Backgrounds/AimsSynchronous liver metastases (SLMs) are found in 15-25% of patients at the time of diagnosis with colorectal cancer, which is limited to the liver in 30% of patients. Surgical resection is the most effective and potentially curative therapy for metastatic colorectal carcinoma (CRC) of the liver. The comparison of simultaneous resection of primary CRC and synchronous liver metastases with staged resections is the subject of debate with respect to morbidity. Laparoscopic surgery improves postoperative recovery, diminishes postoperative pain, reduces wound infections, shortens hospitalization, and yields superior cosmetic results, without compromising the oncological outcome. The aim of this study is therefore to evaluate our initial experience with simultaneous laparoscopic resection of primary CRC and SLM.MethodsCurrently, laparoscopic resection of primary CRC is performed in more than 53% of all patients in our surgical department. Twenty-six patients with primary CRC and a clinical diagnosis of SLM underwent combined laparoscopic colorectal and liver surgery. Six of them underwent laparoscopic colorectal resection combined with major laparoscopic liver resection.ResultsThe surgical approaches were total laparoscopic (25 patients) or hybrid technique (1 patients). The incision created for the extraction of the specimen varied between 5 and 8cm. The median operation time was 223 minutes (100 to 415 min.) with a total blood loss of 180 ml (100-300 ml). Postoperative hospital stay was 6.8 days (6-14 days). Postoperative complications were observed in 6 patients (22.2%).ConclusionsSimultaneous laparoscopic colorectal and liver resection appears to be safe, feasible, and with satisfying short-term results in selected patients with CRC and SLM.

A Review of the Long-Term Oncologic Outcomes of Robotic Surgery Versus Laparoscopic Surgery for Colorectal Cancer.

The goal of this review was to compare long-term oncologic outcomes of robotic versus laparoscopic resection of colorectal cancer. A literature search was performed using PubMed, EMBASE, Cochrane, and Medline (2002-2014). Search terms: laparoscopic, robotic, rectal, colon, surgery, oncologic, and outcomes. Studies comparing overall and disease free survival of robotic versus laparoscopic surgery for colorectal cancer were included. Meta-analysis was performed using OpenMeta[Analyst] for Windows 8. Five studies were identified reporting on overall survival, disease free survival, lymph node extraction, and distal and circumferential resection margin. Three hundred and seventeen patients underwent robotic resection and 368 underwent laparoscopic resection, with similar demographics. Operative times were longer with robotic resections, with no difference in estimated blood loss (EBL) or length of stay. The disease stage was distributed similarly in both groups. Similar numbers underwent neo-adjuvant therapy. Laparoscopic resection was associated with 3.2mm larger distal resection margins (p = 0.04) and 2.2 more lymph nodes removed (p = 0.001), but with equivalent circumferential resection margin status. Disease-free and overall survival was equivalent. Robotic and laparoscopic surgery for colorectal cancer offer comparable overall and disease free survival. Laparoscopic surgery offered a slight advantage in operative time, distal margin, and lymph node yield. Larger, prospective trials are needed to confirm the equivalence of these approaches.

Epidermal Sutureless Closure of the Umbilical Base Following Laparoscopic Colectomy for Colon Cancer

At our institute, a non-suturing method for closure of the umbilical epidermis has been used in laparoscopic colorectal resection to prevent umbilical wound infection. We performed a retrospective evaluation of the incidence of umbilical wound infection using this technique for patients with colorectal cancer. From 2010 to 2014, 178 consecutive patients underwent elective laparoscopic resection of colorectal cancer. The umbilical fascia was closed using interrupted multifilament absorbable sutures. The skin surface of the umbilicus was compressed using a cotton ball and sealed by water vapor-permeable film. Three (1.7%) patients required conversion from laparoscopic to open surgery. The mean surgery time was 174 ± 48min, intraoperative blood loss was 29 ± 75mL, and postoperative hospital stay was 10.5 ± 6.7days. According to the Centers for Disease Control and Prevention criteria, umbilical superficial wound infection occurred in two (1.1%) patients. The two patients recovered from their wound infections after a few days of drainage, and their hospital discharge was not delayed. Deep umbilical wound infection did not occur in any patient. Our non-suturing closure technique appeared to be effective in preventing wound infection after laparoscopic resection of colon cancer.

Laparoscopic simultaneous resection of colorectal primary tumor and liver metastases: a propensity score matching analysis.

Preliminary series have shown the feasibility of combined laparoscopic resection of colorectal cancer (CRC) and synchronous colorectal liver metastases (SCRLM). The aim of this study was to compare the short- and long-term outcomes for matched patients undergoing combined resections. An international multicenter database of 142 patients that underwent combined laparoscopic resection of CRC and SCRLM between 1997 and 2013 was compared to a database of 241 patients treated by open during the same period. Comparison of short- and long-term outcomes was performed after propensity score adjustment. After matching, 89 patients were compared in each group including mostly ASA I-II patients, presenting with mean number of 1.5 CRLM, with a mean diameter of 30mm, and resectable by a wedge resection or a left lateral sectionectomy. A rectal resection was required in 46 and 43% of laparoscopic and open procedures, respectively (p=0.65). There was no difference in global operative time, blood loss and transfusion rates between the two groups. A conversion was required in 7% of the laparoscopic procedures. Morbidity rates were similar in the two groups (p=1.0). The 3-year overall survival in the laparoscopy and open groups were 78 and 65%, respectively (p=0.17). In patients without severe comorbidities presenting with one, small (≤3cm), CRLM resectable by a wedge resection or a left lateral sectionectomy, combined laparoscopic resection of CRC and SCRLM allowed similar short- and long-term outcomes compared with the open approach.

Short-term and long-term outcomes of single-incision versus multi-incision laparoscopic resection for colorectal cancer: a propensity-score-matched analysis of 214 cases.

The aim of this study was to reveal the short-term and long-term outcomes of single-incision laparoscopic colorectal resection (SILC) compared with multi-incision laparoscopic colorectal resection (MILC) for colorectal cancer using propensity score matching analysis. The study group included 235 patients who underwent SILC and 730 patients who underwent MILC for colorectal cancer between April 2009 and September 2014. The propensity score matching for age, gender, body mass index, tumor location (right-sided colon/sigmoid colon/upper rectum), lymph node dissection (D1/D2/D3), pathologic T (≤T3) stage and TNM (0-I/II/III) stage produced 107 matched pairs. The exclusion criteria for SILC were as follows: (1) tumors located at the transverse, descending colon or lower rectum, (2) stage IV tumors, synchronous or previous malignancies, (3) locally advanced tumors >T4, (4) acute obstructions or previous major abdominal surgery and (5) obese patients: BMI > 30. No significant differences were observed in operating time, bleeding volumes, starting time of liquid diet and length of hospital stay between the SILC and MILC groups. However, the SILC group showed less analgesic requirements (1.1 vs. 1.9 times; p = 0.0006) and shorter length of incision (2.7 vs. 4.3 cm; p = 0.0000) compared to MILC group. The overall rate of postoperative complications was similar in both groups (2.8 vs. 3.7%, p = 0.70). The 5-year overall survival rate of SILC and MILC was 100 and 95% (p = 0.125) and 5-year disease-free survival rates in stages 0-III were 97 and 94% (p = 0.189), 100 and 92% in stage II and 90 and 85% in stage III, respectively. This study suggests that SILC for colorectal cancer is a safe and feasible option with better cosmetic results and less pain in strictly selected patients. SILC can also produce good oncological results with similar postoperative outcomes to MILC.

PWE-260 Elderly patients undergoing laparoscopic resection for colorectal cancer have better survival than patients undergoing open surgery

Introduction Elderly patients are at increased risk of death following surgery for colorectal cancer, even in the elective setting. This national study aims to examine the relationship between patient selection for laparoscopic resection and survival in an elderly cohort. Method Elderly patients (80 years and over) undergoing elective colorectal cancer resection between the years 2001–2011 were identified from the Hospital Episode Statistics (HES) database. Mortality data from Office for National Statistics (ONS) were obtained. Survival analyses using multivariable cox proportional hazard regression were carried. Confounding variables such as gender, medical comorbidity, type of operation and chemotherapy were adjusted for. Results In the time period, 5,398 elderly patients underwent elective colorectal cancer resection, of which 1,479 patients (27.4%) underwent laparoscopic resection. The mean 5-year survival in the open group was 41.0 months (95% CI 40.3–41.7) in the open group compared with 52.3 months (95% CI 51.2–53.3) in the laparoscopic group (p Conclusion Laparoscopic resections for colorectal cancer confer a survival advantage beyond the immediate post operative period in elderly patients. Offering this high-risk patient group elective laparoscopic resections in experienced units could help deliver better outcomes. Disclosure of interest None Declared.

PTH-345 Fat ratio – a novel parameter for predicting conversion in laparoscopic colorectal surgery

Introduction Laparoscopic surgery has become the standard for colorectal cancer in the UK but can be technically challenging in obese patients. Many of these patients can be safely operated on laparoscopically but we hypothesised that there is a subgroup whose fat is mainly internal in whom the risk of conversion is unacceptably high. We propose a highly reproducible parameter that may be able to identify this group preoperatively with no additional scans. Method All patients who underwent elective, laparoscopic colorectal cancer resections from March 2010 to November 2013 were included in the study. Data was collected on age, sex, size of tumour, site of tumour, BMI and whether or not the procedure was converted (i.e. any incision larger than that required to extract the specimen). For obese patients (BMI >30), preoperative staging CT scans were used to determine a “Fat Ratio”, which we define as the ratio between anterior abdominal wall fat at the level of the umbilicus and the distance from the rectus sheath to the anterior aspect of the vertebral body at the same level (see Figure 1). Results 197 patients were included. There were 60 patients (30.5%) in the obese group and 137 (69.5%) in the non-obese group. Comparing the two groups we found conversion rates to be 27% and 16% respectively. The median FR of the obese patients that were converted to open surgery was significantly higher at 5.9 (95% CI 4.8–8.1) compared to those completed laparoscopically (3.3, 95% CI 3.2–4.2, p = 0.0001 Mann-Whitney). We found no significant difference in conversion rate when looking at tumour site or size. Conclusion Fat Ratio is a simple, reproducible parameter that was found to be significantly higher in obese patients whose laparoscopic procedures were converted to open. With further work, this has the potential to become an accurate predictor of conversion risk. Disclosure of interest None Declared.

PWE-339 Colorectal cancer resection – lap or open: is the same amount being removed?

Introduction A surrogate marker of the quality of colorectal cancer resection is the number of lymph nodes harvested from the specimen. Recent attention has focused on the completeness of mesenteric resection in order to maximise lymph node clearance. Laparoscopic resection, where feasible, is accepted as the preferred approach, but concern remains as to the oncologic adequacy of resection compared to traditional open surgery. The aim of this study was to compare colorectal cancer specimens removed by laparoscopic resection with open surgical specimens, as regards lymph node harvest and extent of mesenteric resection. Method A consecutive series of 282 consecutive open and laparoscopic colorectal cancer resections, performed by 5 colorectal surgeons, was studied. 78 patients undergoing Hartmann’s or abdomino perineal resection, subtotal colectomy or proctocolectomy were excluded. Pathological examination of the excised specimen was performed by one of 3 colorectal pathologists to a standard protocol. Distance from the tumour to the high tie and number of lymph nodes harvested was recorded for each specimen. Results 204 patients (109 male) were included in the analysis. Tumours were divided into 3 groups: right hemi colectomy (82), left hemi colectomy (43) and anterior resection (79). For right sided tumours (32 laparoscopic, 50 open), mean distance to high tie was 87.5 mm for laparoscopic resection and 78.6 mm for open resection (p = 0.07). Mean lymph node harvest was 17.0 nodes laparoscopically compared to 21.8 nodes for open resection (p = 0.008). For left sided tumours (10 laparoscopic, 33 open), mean distance to high tie was 105.2 mm for laparoscopic resection and 102.7 mm for open resection (p = 0.41). Mean lymph node harvest was 18.1 nodes laparoscopically compared to 20.6 for open resection (p = 0.14). For rectal tumours (32 laparoscopic, 47 open), mean distance to high tie was 130.6 mm for laparoscopic resection and 131.5 mm for open resection (p = 0.49). Mean lymph node harvest was 18.1 nodes laparoscopically compared to 21.5 nodes for open resection (p = 0.009). More patients undergoing open resection for rectal cancer patients underwent pre-operative neo-adjuvant treatment (laparoscopic 4/32, 12.5%; open 11/47, 23.4%). Conclusion This study indicates that there is no significant difference in the extent of mesenteric resection between open and laparoscopic colectomy specimens from any of the three sites. However, despite comparable lengths of mesenteric resection, significantly more lymph nodes were removed by open resection compared to laparoscopic resection of right sided and rectal tumours. Disclosure of interest None Declared.

Impact of previous abdominal surgery on the outcome of laparoscopic resection for colorectal cancer: a case-control study in 756 patients

BackgroundA history of previous abdominal surgery (PAS) may increase the complexity of laparoscopic colorectal surgery. The aim of this study was to investigate the impact of PAS on the outcomes of laparoscopic colorectal resection for colorectal cancer. MethodsA total of 378 colorectal cancer patients (group A) with a history of PAS were 1:1 matched to 378 controls (group B) without PAS from our prospective laparoscopic colorectal surgery database. The two groups were matched for age, gender, body mass index, American Society of Anesthesiology score, tumor location, type of surgical procedure, and tumor stage. ResultsPatients in the two groups were well balanced with respect to baseline demographic and clinical characteristics. Group A was associated with significantly longer median operating time (220 versus 200 min; P = 0.002). Conversion rate in group A (63/378, 16.67%) was almost twice as high as that in group B (36/378, 9.55%; P = 0.004). Conversions caused by adhesion were more common in patients with a history of PAS (55.56% [35/63] versus 27.78% [10/36], P = 0.008). Postoperative recovery time, length of postoperative hospital stay, perioperative mortality and morbidity rate, lymph nodes harvested, circumferential resection margin positive rate, 3-y disease-free survival, and overall survival rate were not significantly different between the two groups. ConclusionsLaparoscopic colorectal surgery for colorectal cancer patients with PAS is time consuming, but the incidence of a successfully completed laparoscopic colorectal resection remains high, and the short- and long-term outcomes are not affected by PAS.

Effect of Visceral Obesity on Surgical Outcomes of Patients Undergoing Laparoscopic Colorectal Surgery.

Visceral obesity has been known to be more pathogenic than body mass index (BMI). There have been a few reports about the association between visceral obesity and surgical outcomes in laparoscopic surgery. The aim of this study was to evaluate the effect of visceral obesity on surgical outcomes undergoing laparoscopic colorectal surgery. Between January 2005 and December 2012, a total of 543 patients who underwent laparoscopic resection for colorectal cancer and had available computed tomography (CT) scans were included in this retrospective study. Visceral fat volumes (VFVs) were measured in preoperative CT scans from S1 to 12.5 cm above. Patients were divided into an obese group and a non-obese group according to VFV and BMI. Obesity was defined by VFV ≥1.92 dm(3) (75% value of VFV) or BMI ≥25 kg/m(2). There were 136 (25.0%) and 150 (27.6%) obese patients according to VFV and BMI, respectively. The high VFV group had a longer operative times (165.2 ± 84.4 vs. 146.1 ± 58.9 min; P = 0.016), higher blood loss during surgery (132.5 ± 144.8 vs. 98.3 ± 109.6 ml; P = 0.012), more frequent conversion to laparotomy (5.9 vs. 1.5%; P = 0.010), and more frequent major complications (Dindo score ≥3; 11.0 vs. 4.7%; P = 0.008), whereas there was no significant difference between the high and low BMI groups. High VFV was a significant independent risk factor for open conversion (odds ratio 4.964, 95% confidence interval 1.336-18.438, P = 0.017). Visceral obesity can be a more clinically useful predictor than BMI in predicting surgical outcomes for laparoscopic colorectal cancer surgery.

Laparoscopic Colorectal Cancer Resection in High-Volume Surgical Centers: Long-Term Outcomes from the LAPCOLON Group Trial.

Strong evidence has confirmed the benefit of laparoscopy in colorectal cancer resection but remains a challenging procedure. It is not clear that such promising results in selected patients translate into a favorable risk-benefit balance in real practice. We conducted a multicenter national observational registry to assess operative and oncologic long-term outcomes following laparoscopic colorectal cancer resection. All patients with laparoscopic colorectal cancer resection between 2001 and 2004 were included. Data were extracted from the prospective Italian national database of 10 high-volume centers (≥40 colorectal cancer laparoscopic resections per year). Surgical technique and follow-up were standardized. Survivals were analyzed by Kaplan-Meier method. We reported 1832 patients with colon (58.5%) and rectal cancer (41.5%). TNM stage was 0-I-II in 1044 patients (57%) and III-IV in 788 patients (43%). Surgery included a totally laparoscopic procedure in 1820 patients (99.3%). Conversion was 10.5%. Postoperative morbidity and 30-day mortality rates were 17 and 1.2%, respectively. Clinical anastomotic leakage rate was 8.3% (n=152). R0 resection was 95%. With a median follow-up of 54.2 months, cancer recurrence rate was 13.3%. At 5 years, cancer-free survival was 86.7%. Upon multivariate analysis, age (P=0.001) and TNM stage (P<0.001) were associated with cancer-free survival. Predictive factors of cancer recurrence were gender (P=0.029) and TNM stage (P<0.001). In high-volume centers and non-selective patients, laparoscopic colorectal resection for cancer achieves good operative results with satisfactory long-term oncologic results. Even in the laparoscopy era, age, gender, and TNM stage remain the most powerful predictor of oncologic outcomes.

The application of laparoscopic resection of colorectal cancer in elderly patients

Objective To explore the application effect of laparoscopic resection of colorectal cancer in elderly patients. Methods 220 patients with colorectal cancer were selected and divided into the study group and the control group,110 cases in each group.The patients of the control group were treated with abdominal surgery. The patients of the study group were given laparoscopic surgery.The operative time, blood loss, anal exhaust time, postoperative hospital stay, and postoperative complications, pull tube time of the two groups were compared. Results The operative time of the study group was(245.4±23.2)min,which was significantly longer than(214.8±25.1)min of the control group(t= 8.759,P= 0.026);The blood loss, anal exhaust time, postoperative hospital stay, time to pull the tube of the study group were(175.3±18.4)m L,(2.1±0.5)d,(13.2±0.1)d and(1.2±0.3)d,respectively,which were significantly better than those of the control group(t= 9.041,9.757,8.969,8.704,P= 0.025,0.023,0.027,0.028); The incidence rate of complication of the study group was 14.5%,which was significantly lower than 24.5% of the control group(χ2= 11.704,P= 0.019). Conclusion Laparoscopic resection of colorectal cancer had better effect, and it can lower blood loss, shorter hospital stays, and has fewer complications. Key words: Laparoscopy; Colorectal Neoplasms

Synchronous totally laparoscopic management of colorectal cancer and resectable liver metastases: a single center experience.

The simultaneous management of primary colorectal cancer and synchronous liver metastases has been reported extensively in open surgery. Data regarding feasibility, safety, and outcomes of the laparoscopic procedure is emerging from the experience of a few surgical centers. This paper aims at discussing the technique and results of a one-step laparoscopic approach for colorectal cancer and liver metastases resection on a series of 35 patients. Between January 2008 and December 2013, 18 males and 17 females (median age 71years) underwent colorectal and hepatic laparoscopic resection for colorectal metastatic cancer. Thirty-five colorectal resections and 66 liver resections were performed; no conversion to open surgery has been indicated. Median blood loss was 200ml, median operative time 240min, and median hospital stay was 8days (range 4-30). According to Clavien-Dindo classification, two class II complications, two class IIIb complications, and one class IV complicationwere recorded. Two high-risk patients died within 30days from surgery. This series confirms the feasibility of synchronous laparoscopic colorectal and hepatic resections. To ensure the best outcomes, a careful selection of patients is needed. However, most patients can benefit from this surgical approach.

Age Over 80 is a Possible Risk Factor for Postoperative Morbidity After a Laparoscopic Resection of Colorectal Cancer.

PurposeWith extended life expectancy, the mean age of patients at the time of diagnosis of colorectal cancer and its treatment, including radical resection, is increasing gradually. We aimed to evaluate the impact of age on postoperative clinical outcomes after a laparoscopic resection of colorectal cancers.MethodsThis is a retrospective review of prospectively collected data. Patients with primary colorectal malignancies or premalignant lesions who underwent laparoscopic colectomies between January 2009 and April 2013 were identified. Patients were divided into 6 groups by age using 70, 75, and 80 years as cutoffs: younger than 70, 70 or older, younger than 75, 75 or older, younger than 80, and 80 or older. Demographics, pathological parameters, and postoperative clinical outcomes, including postoperative morbidity, were compared between the younger and the older age groups.ResultsAll 578 patients underwent a laparoscopic colorectal resection. The overall postoperative complication rate was 21.1% (n = 122). There were 4 cases of operative mortality (0.7%). Postoperative complication rates were consistently higher in the older groups at all three cutoffs; however, only the comparison with a cutoff at 80 years showed a statistically significant difference between the younger and the older groups.ConclusionAge over 80 is a possible risk factor for postoperative morbidity after a laparoscopic resection of colorectal cancer.

The Use of the Enhanced Recovery After Surgery (ERAS) Protocol in Patients Undergoing Laparoscopic Surgery for Colorectal Cancer – A Comparative Analysis of Patients Aged above 80 and below 55

Age is one of the principal risk factors for colorectal adenocarcinoma. To date, older patients were believed to achieve worse treatment results in comparison with younger patients due to reduced vital capacity. However, papers have emerged in recent years which confirm that the combination of laparoscopy and postoperative care based on the ERAS protocol improves treatment results and may be particularly beneficial also for elderly patients. The aim of the study was to compare the outcomes of laparoscopic surgery for colorectal cancer in combination with the ERAS protocol in patients aged above 80 and below 55. The analysis included patients aged above 80 and below 55 undergoing elective laparoscopic colorectal resection for cancer at the 2nd Department of General Surgery of the Jagiellonian University. They were divided into two groups according to their age: ≥ 80 years of age (group1) and ≤ 55 years of age (group 2). Both groups were compared with regard to the outcome of surgery: length hospital stay, complications, hospital readmissions, degree of compliance with the ERAS protocol, and recovery parameters (tolerance of oral nutrition, mobilisation, need for opioids, restored gastrointestinal function). Group 1 comprised 34 patients and group 2, 43 patients. No differences were found between both groups in terms of gender, BMI, tumour progression or surgical parameters. Older patients typically had higher ASA scores. No statistically significant differences were found with regard to the length hospital stay following surgery (5.4 vs 7 days, p=0.446481), the occurrence of complications (23.5% vs 37.2%, p=0.14579) or hospital readmissions (2.9% vs 2.4%). The degree of compliance with the ERAS protocol in group 1 and 2 was 85.2% and 83.0%, respectively (p=0.482558). Additionally, recovery parameters such as tolerance of oral nutrition (82.4% vs 72.1%, p=0.28628) and mobilisation (94.1% vs 83.7%, p=0.14510) within 24 hours of surgery did not differ among the groups. However, a smaller proportion of older patients required opioids in comparison with younger patients (26.5% vs 55.8%, p=0.00891). Similar levels of compliance with the ERAS protocol may be achieved among patients aged ≥ 80 and younger patients. When laparoscopy is combined with the ERAS protocol, age does not seem to be a significant factor that could account for worse outcomes. Therefore, older patients should not be excluded from perioperative care based on ERAS principles.

The effect of individualized nursing intervention on the perioperative psychological disorder of laparoscopic colorectal cancer patients with radical prostatectomy

Objective To explore the effect of individualized nursing intervention on the perioperative psychological disorder of laparoscopic colorectal cancer patients with radical prostatectomy.Methods The self-rating depression scale （ SDS） Self-Rating Anxiety Scale （ SAS） for psychological evaluation were used to estimate 64 cases with laparoscopic resection of colorectal cancer in the next day and 1 week after hospitalization, the two test results were statistically analyzed.Results The SDS, SAS scores in all patients were significantly decreased when compared with the personalized care before the intervention （P〈0.01） .Conclusions The nursing intervention can help patients improve endurance, eliminate psychological barriers, get best state for surgery and get through the perioperative period. Key words: Perioperation; Colorectal cancer; Psychological disorder; Nursing intervention

Laparoscopic versus open liver resection for metastatic colorectal cancer: A metaanalysis of 610 patients

Laparoscopic liver resection (LLR) for metastatic colorectal cancer (mCRC) remains controversial. The objective of this manuscript was to perform a metaanalysis comparing outcomes of LLR with open liver resection (OLR) in patients with hepatic mCRC, and to identify which patients were suitable candidates for LLR. A PubMed search identified 2,122 articles. When filtered for case-matched articles comparing LLR with OLR for mCRC, 8 articles were identified consisting of 610 patients (242 LLR, 368 OLR). A random effects metaanalysis was performed. The 2 groups were well-matched for age, sex, American Society of Anesthesiologists score, tumor size, number of metastases, extent of major hepatectomy, and use of neoadjuvant/adjuvant chemotherapy. The mean number of metastases in the LLR and OLR groups were 1.4 and 1.5, respectively (P = .14). Estimated blood loss was less in LLR group (262 vs 385 mL; P = .049). Transfusion rate was significantly less in LLR group (9.9 vs 19.8%; P = .004). There was no difference in operative time (248.7 vs 262.8 min; P = .85). Length of stay (LOS) was less in the LLR group (6.5 vs 8.8 days; P = .007). The overall complication rate was less in LLR group (20.3% vs 33.2%; P = .03). Importantly, there was no difference in the 1-, 3-, and 5-year disease-free survival (DFS) or overall survival (OS) rates. In carefully selected patients with limited mCRC (1 or 2 tumors), LLR provides marked perioperative benefits without compromising oncologic outcomes or long-term survival. Specifically, LLR offers decreased blood loss, LOS, and overall complication rates with comparable 5-year OS and DFS.