Laparoscopic Surgery For Colon Cancer Research Articles

Virtual laparoscopic imaging for performing central vascular ligation through laparoscopic surgery for transverse colon cancer.

Virtual laparoscopic imaging for performing central vascular ligation through laparoscopic surgery for transverse colon cancer.

Does the Endoscopic Surgical Skill Qualification System improve patients\u2019 outcome following laparoscopic surgery for colon cancer? A multicentre, retrospective analysis with propensity score matching

BackgroundThis study aimed to investigate the short-term and oncological impact of the Endoscopic Surgical Skill Qualification System (ESSQS) by the Japan Society for Endoscopic Surgery on the operator performing laparoscopic surgery for colon cancer.MethodsThis retrospective cohort study was based on medical records from a multicentre database. A total of 417 patients diagnosed with stage II/III colon and rectosigmoid cancer treated with curative resection were divided into two groups according to whether they were operated on by qualified surgeons (Q group, n=352) or not (NQ group, n=65). Through strict propensity score matching, 98 cases (49 in each group) were assessed.ResultsOperative time was significantly longer in the NQ group than in the Q group (199 vs. 168 min, p=0.029). The amount of blood loss, post-operative complications, and duration of hospitalisation were similar between both groups. No mortality was observed. One conversion case was seen in the NQ group. The 3-year recurrence-free survival rate was 86.6% in the NQ group and 88.2% in the Q group, which was not statistically significant (log-rank p=0.966).ConclusionDirect operation by ESSQS-qualified surgeons contributed to a shortened operation time. Under an organised educational environment, almost equivalent safety and oncological outcomes are expected regardless of the surgeon’s qualifications.

Laparoscopic abdominal perineal rectal resection for rectal cancer with a horseshoe kidney using preoperative 3D-CT angiography: a case report

BackgroundA horseshoe kidney is a congenital malformation involving the fusion of the bilateral kidneys and is often accompanied by anomalies of the ureteropelvic and vascular systems. When performing resection of colorectal cancer in a patient with horseshoe kidney, damage to the ureter or excessive renal arteries should be avoided. To achieve this purpose, comprehensive preoperative anatomical assessments and surgical planning are important. Here, we report a case of a laparoscopic abdominal perineal rectal resection for lower rectal cancer with a horseshoe kidney.Case presentationA 79-year-old woman presented with bloody stool and was diagnosed with advanced lower rectal cancer, immediately above the rectal dentate line, without metastasis. A preoperative computed tomography (CT) scan revealed a horseshoe kidney, while a three-dimensional CT (3D-CT) angiography revealed aberrant excess renal artery from the aorta to the renal isthmus. The left ureter ran in front of the isthmus of the horseshoe kidney and presented calculus formation. Laparoscopic abdominal perineal rectal resection was performed with D3 lymph node dissection. During the operation, we mobilized the sigmoid colon mesentery via a medial approach and preserved the left ureter, the left gonadal vessels, and the hypogastric nerve plexus in the retroperitoneum in front of the horseshoe kidney.ConclusionsWe report a rare case of rectal cancer surgery in a patient with a horseshoe kidney. We discuss the anatomical peculiarities of a horseshoe kidney, such as excess renal arteries, inferior vena cava, ureter, gonadal vessels, and nerves, that should be preserved according to the literature. We suggest that preoperative 3D-CT angiography is both useful for revealing the relationship between the vascular system and a horseshoe kidney and helpful when performing laparoscopic surgery for a left-sided colon and rectal cancer to avoid intraoperative injury.

Laparoscopic Surgery for Colon Cancer with Intestinal Malrotation: A Case Report and Review of the Literature in Japan

Colorectal cancer with intestinal malrotation is very rare, while intestinal malrotation is one of congenital anomaly that is rare in adults. We thus report a case of sigmoid colon cancer with intestinal malrotation treated by laparoscopic surgery. A 39-year-old woman was admitted to our hospital with constipation. A colonoscopy revealed the sigmoid colon tumor. Three-dimensional abdominal enhanced computed tomography showed that small and large intestines occupied the right- and left-side of the abdominal cavity, respectively. Her diagnosis was the sigmoid colon cancer with nonrotation type of intestinal malrotation, and she underwent laparoscopic sigmoidectomy. There have been 43 cases reports of colorectal cancer with intestinal malrotation who underwent laparoscopic surgery in Japan medical literatures. Colorectal cancer was in the right-side in 69.8% of these cases, although that in the left-side is generally more common. Three-dimensional abdominal enhanced computed tomography angiography can reveal vascular anatomic anomalies to allow laparoscopic surgery to be performed safety.

Minimally Invasive Surgery for Colorectal Cancer.

In recent years, minimally invasive surgery for colorectal cancer has seen remarkable improvement. For the laparoscopic surgery for colon cancer, earlier postoperative recovery and reduced hospital stays can be expected compared to those for open surgery. Also, no increase in perioperative morbidity and mortality has been shown. Furthermore, long-term oncological outcomes comparable to open surgery have been obtained. Although laparoscopic surgery for rectal cancer has shown good short-term postoperative outcomes, recent randomized controlled trials could not demonstrate non-inferiority to open surgery with respect to oncological safety. Further studies are required to confirm the impact of robotic surgery on colon and rectal cancer and the appropriate indications for transanal total mesorectal excision for rectal cancer.

Does Intracorporeal Anastomosis Decrease the Rate of Surgical Site Infection in Laparoscopic Colon Cancer Surgery?

Objective This study aimed to compare the surgical site infection (SSI) rates between intracorporeal anastomosis (ICA) and extracorporeal anastomosis (ECA). Summary of background data Laparoscopic surgery is recommended for colonic malignancies because of its superior clinical outcomes and comparable oncologic results. Laparoscopic colectomy with ICA has the advantages of incision length and free extraction site choice. However, ICA may be associated with a risk of SSI due to enterotomy inside the abdominal cavity. Methods We retrospectively analyzed patients with colon cancer who underwent radical surgery at Korea University Ansan Hospital between January 2017 and June 2020. We compared the SSI rates and other clinical variables between the ICA and ECA groups. Results Of the 502 patients who underwent radical surgery for colorectal cancer during the study period, 234 were eligible for inclusion. ECA and ICA were performed in 62.4% and 37.6% of patients, respectively. There were no statistically significant intergroup differences in clinicopathologic variables. The overall SSI rate did not differ between the groups (P = 0.801), but organ/space SSIs were more common in the ICA group than in the ECA group (P = 0.048). Conclusions There was no significant difference in overall SSI or anastomotic leakage (AL) rates between the ICA and ECA groups, but the organ/space SSI rate was higher in the ICA group when AL cases were excluded. Further high-quality studies are needed to assess the risk of organ/space SSIs in the ICA after colon cancer surgery.

A Case of Laparoscopic Surgery for Sigmoid Colon Cancer with an Anatomic Abnormality of the Inferior Mesenteric Artery

A Case of Laparoscopic Surgery for Sigmoid Colon Cancer with an Anatomic Abnormality of the Inferior Mesenteric Artery

Favorable short-term oncologic outcomes following laparoscopic surgery for small T4 colon cancer: a multicenter comparative study

BackgroundLaparoscopic surgery for T4 colon cancer may be safe in selected patients. We hypothesized that small tumor size might preoperatively predict a good laparoscopic surgery outcome. Herein, we compared the clinicopathologic and oncologic outcomes of laparoscopic and open surgery in small T4 colon cancer.MethodsIn a retrospective multicenter study, we reviewed the data of 449 patients, including 117 patients with tumors ≤ 4.0 cm who underwent surgery for T4 colon cancer between January 2014 and December 2017. We compared the clinicopathologic and 3-year oncologic outcomes between the laparoscopic and open groups. Survival curves were estimated using the Kaplan–Meier method and compared using the log-rank test. Univariate and multivariate analyses were performed using the Cox proportional hazards model. A p < 0.05 was considered statistically significant.ResultsBlood loss, length of hospital stay, and postoperative morbidity were lower in the laparoscopic group than in the open group (median [range], 50 [0–700] vs. 100 [0–4000] mL, p < 0.001; 8 vs. 10 days, p < 0.001; and 18.0 vs. 29.5%, p = 0.005, respectively). There were no intergroup differences in 3-year overall survival or disease-free survival (86.6 vs. 83.2%, p = 0.180, and 71.7 vs. 75.1%, p = 0.720, respectively). Among patients with tumor size ≤ 4.0 cm, blood loss was significantly lower in the laparoscopic group than in the open group (median [range], 50 [0–530] vs. 50 [0–1000] mL, p = 0.003). Despite no statistical difference observed in the 3-year overall survival rate (83.3 vs. 78.7%, p = 0.538), the laparoscopic group had a significantly higher 3-year disease-free survival rate (79.2 vs. 53.2%, p = 0.012).ConclusionsLaparoscopic surgery showed similar outcomes to open surgery in T4 colon cancer patients and may have favorable short-term oncologic outcomes in patients with tumors ≤ 4.0 cm.

Time trial of dry box laparoscopic surgical training improves laparoscopic surgical skills and surgical outcomes.

The present study assessed the utility of a dry box time trial during laparoscopic surgical training to improve laparoscopic surgical skills and surgical outcomes. In a monthly time trial, surgeon trainees twice completed a set task that involved grasping a suture, aligning a needle with a needle holder, passing the suture, making three knots, and cutting the two tails of the suture. The mean suturing time was then analyzed. To assess the utility of this time trial, we analyzed the short-term outcomes of patients with stage I to III colon cancer who had undergone laparoscopic colectomy before and after the introduction of the time trial. The monthly time trial was introduced in October 2018, and 52 surgeon trainees participated in the trials examined in this study. Within 6months of the program's introduction, the mean suturing time had significantly declined to less than 70% of the time trial, while the standard deviations had declined to less than 30%. In comparisons of the short-term outcomes of laparoscopic colon cancer surgery before (n=49) and after (n=46) the introduction of the time trial, the operative time tended to decline (P=.074) after the introduction of the time trial, and blood loss was significantly reduced (P=.018). The rate of postoperative complications was similar before and after the introduction. Regular time trials of laparoscopic surgical suture training using a dry box can be useful for improving laparoscopic surgical skills and surgical outcomes. Moreover, time trials can keep trainees motivated.

Procedural and post-operative complications associated with laparoscopic versus open abdominal surgery for right-sided colonic cancer resection: A systematic review and meta-analysis.

Background:In this analysis, we aimed to systematically compare the procedural and post-operative complications (POC) associated with laparoscopic versus open abdominal surgery for right-sided colonic cancer resection.Methods:We searched MEDLINE, http://www.ClinicalTrials.gov, EMBASE, Web of Science, Cochrane Central, and Google scholar for English studies comparing the POC in patients who underwent laparoscopic versus open surgery (OS) for right colonic cancer. Data were assessed by the Cochrane-based RevMan 5.4 software (The Cochrane Community, London, UK). Mean difference (MD) with 95% confidence intervals (CIs) were used to represent the results for continuous variables, whereas risk ratios (RR) with 95% CIs were used for dichotomous data.Results:Twenty-six studies involving a total number of 3410 participants with right colonic carcinoma were included in this analysis. One thousand five hundred and fifteen participants were assigned to undergo invasive laparoscopic surgery whereas 1895 participants were assigned to the open abdominal surgery. Our results showed that the open resection was associated with a shorter length of surgery (MD: 48.63, 95% CI: 30.15–67.12; P = .00001) whereas laparoscopic intervention was associated with a shorter hospital stay [MD (–3.09), 95% CI [–5.82 to (–0.37)]; P = .03]. In addition, POC such as anastomotic leak (RR: 0.96, 95% CI: 0.60–1.55; P = .88), abdominal abscess (RR: 1.13, 95% CI: 0.52–2.49; P = .75), pulmonary embolism (RR: 0.40, 95% CI: 0.09–1.69; P = .21) and deep vein thrombosis (RR: 0.94, 95% CI: 0.39–2.28; P = .89) were not significantly different. Paralytic ileus (RR: 0.87, 95% CI: 0.67–1.11; P = .26), intra-abdominal infection (RR: 0.82, 95% CI: 0.15–4.48; P = .82), pulmonary complications (RR: 0.83, 95% CI: 0.57–1.20; P = .32), cardiac complications (RR: 0.73, 95% CI: 0.42–1.27; P = .27) and urological complications (RR: 0.83, 95% CI: 0.52–1.33; P = .44) were also similarly manifested. Our analysis also showed 30-day re-admission and re-operation, and mortality to be similar between laparoscopic versus OS for right colonic carcinoma resection. However, surgical wound infection (RR: 0.65, 95% CI: 0.50–0.86; P = .002) was significantly higher with the OS.Conclusions:In conclusion, laparoscopic surgery was almost comparable to OS in terms of post-operative outcomes for right-sided colonic cancer resection and was not associated with higher unwanted outcomes. Therefore, laparoscopic intervention should be considered as safe as the open abdominal surgery for right-sided colonic cancer resection, with a decreased hospital stay.

Laparoscopic surgery for colon cancer

Abstract Background To evaluate a new procedure in daily clinical practice, it might not be sufficient to rely exclusively on the findings of randomized clinical trials (RCTs). This is the first systematic review providing a synthesis of the most important RCTs and relevant retrospective cohort studies on short- and long-term outcomes of laparoscopic surgery in colon cancer patients. Materials and methods In a literature search, more than 1800 relevant publications on the topic were identified. Relevant RCTs and representative high-quality retrospective studies were selected based on the widely accepted Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) criteria. Finally, 9 RCTs and 14 retrospective cohort studies were included. Results Laparoscopic surgery for colon cancer is associated with a slightly longer duration of surgery, but a variety of studies show an association with a lower rate of postoperative complications and a shorter duration of hospital stay. Particularly in older patients with more frequent comorbidities, laparoscopy seems to contribute to decreasing postoperative mortality. Concerning long-term oncologic outcomes, the laparoscopic and open techniques were shown to be at least equivalent. Conclusion The findings of the existing relevant RCTs on laparoscopic surgery for colon cancer are mostly confirmed by representative retrospective cohort studies based on real-world data; therefore, its further implementation into clinical practice can be recommended.

Visualization of lymphatic flow in laparoscopic colon cancer surgery using indocyanine green fluorescence imaging

Intraoperative visualization of lymphatic flow could guide surgeons performing laparoscopic colon cancer surgery on the extent of intestinal resection required. The purpose of this study was to investigate indocyanine green fluorescence imaging for intraoperative detection of lymphatic flow and nodes in such patients. All patients undergoing elective laparoscopic surgery for colorectal cancer from October 2016 to July 2017 were included in this study. Indocyanine green was injected submucosally around the tumors via a colonoscope and lymphatic flow assessed with a laparoscopic near-infrared camera system intraoperatively. Lymphatic flow was visualized perioperatively in 43 of 57 patients (75.4%). The rate of visualized lymphatic flow was significantly higher in patients with a lower clinical stage than in those with a higher clinical stage (p = 0.0103). Among the 14 patients in whom lymphatic flow was not visualized, 10 (71.4%) had cStage III or IV cancer. Our results indicate the potential role of intraoperative navigation in colon cancer surgery in early-stage colon cancers. This method allows the surgeon to clearly identify lymphatic flow during surgery and allows the determination and individualization of the lymph node dissection range.

Đánh giá kết quả sớm ứng dụng phẫu thuật nội soi 3D trong điều trị ung thư đại tràng tại Bệnh viện Trung ương Huế

Tóm tắt Mục tiêu: Đánh giá kết quả sớm điều trị ung thư đại tràng bằng phẫu thuật nội soi 3D. Đối tượng và phương pháp nghiên cứu: Nghiên cứu mô tả bao gồm 38 người bệnh (NB) được chẩn đoán ung thư đại tràng, được điều trị bằng phẫu thuật nội soi 3D tại bệnh viện Trung ương Huế từ tháng 1/2018 đến tháng 6/2019. Kết quả: Độ tuổi trung bình: 59,61 ± 14,37. Tỷ lệ nam / nữ là 2,5/1. Đau bụng là lý do vào viện thường gặp nhất (60,5%). Triệu chứng đau bụng là 86,8%, CEA tăng trước mổ (38,9%). Tỷ lệ phát hiện khối u trên CTscaner là 81,6%. Khối u trên 5 cm là 26,3%. Nội soi đại tràng thể sùi chiếm tỷ lệ cao nhất (71,1%). Khối u đại tràng phải có tỷ lệ là 52,6%. Khối u giai đoạn T3 có tỷ lệ 68,4%. Thời gian mổ trung bình là 144,5 ± 56,4 phút, thấp nhất là 90 phút, cao nhất là 210 phút. Không gặp tai biến trong mổ. Không có trường hợp nào chuyển sang mổ mở. Kích thước đường mổ trung bình là 5,08 ± 1,65cm, nhiễm trùng vết mổ là 7,9%. Thời gian nằm viện trung bình là 9,1 ± 2,4 ngày. 100% ung thư biểu mô tuyến. Đau bụng sau mổ 1 tháng có 18 người bệnh (47,3%), sau mổ 6 tháng có 5 người bệnh (20,8%). Rối loạn tiêu hóa sau mổ 1 tháng có 9 người bệnh (23,7%), sau mổ 3 tháng có 3 người bệnh (10,3 %), sau mổ 6 tháng có 2 người bệnh (8,3%). Sau mổ 3 tháng tỷ lệ tăng CEA có 2 người bệnh (6,9%), sau mổ 6 tháng có 3 người bệnh (12,5%). Nội soi đại tràng cho kết quả viêm phù nề miệng nối sau 3 tháng có 6 người bệnh (20,7%), sau 6 tháng có 6 người bệnh (25%). Không thấy thương tổn trên CT scan bụng có thuốc sau 3 và 6 tháng. Kết luận: Phẫu thuật nội soi 3D trong điều trị ung thư đại tràng là phương pháp phẫu thuật an toàn, hiệu quả. Abstract Objective: Evaluating the early results of application of 3D laparoscopic surgery for rectal cancer. Material and methods: The descriptive research enrolled 38 patients were diagnosed colon cancer, treated by 3D laparoscopic surgery at Hue Central Hospital from January 2018 to June 2019. Result: The age average was 59.61 ± 14.37. The male / female rate was 2.5/1. Abdominal pain is the most common reason for hospitalization 60.5%. Abdominal pain accounted for 86.8%, pre-operative CEA increased was in 38.9%. The detection on CTscaner was 81.6%. The size of tumors above 5 cm 26.3%. Type of fold convergence appearance is highest rate on endoscopic feature 71.1%. Right colon tumor was the highest 52.6%. T3 accounts for the highest rate of 68.4%. The average time of surgery is 144.5 ± 56.4 minutes, shorted is 90 minutes, longest is 210 minutes. No accident was observed during surgery. There are no cases converted to open surgery. The average size of surgical incision was 5.08 ± 1.65cm, surgical site infection accounts for 7.9%. The average hospital length stay is 9.1 ± 2.4 days. Adenocarcinoma 100%. Postoperative abdominal pain in 1 month were 18 patients (47,3%), in 6 months were 5 patients (20.8%). Postoperative gastrointestinal disorders in 1 month were observed in 9 patients (23.7%), in 3 months were 3 patients (10.3%), 6 months were 2 patients (8.3%). The rate of CEA increased in 3 months after operation were 2 patients (6.9%), after 6 months were 3 patients (12.5%). The inflammation anastomosis by colonoscopy check after 3 months were 6 patients (20.7%), after 6 months were 6 patients (25%). No findings of lesions on CT scan after 3 and 6 months. Conclusion: Laparoscopic 3D surgery is safe and effective treatment for colon cancers. Key words: Laparoscopic 3D surgery, colon cancer.

Oncological outcomes following laparoscopic surgery for pathological T4 colon cancer: a propensity score-matched analysis.

Whether laparoscopic colectomy (LC) is safe and effective for patients with locally advanced T4 colon cancer remains controversial. This study aimed to compare the oncological outcomes of LC and open colectomy (OC) for patients with pathological (p) T4 colon cancer. We retrospectively analyzed 151 consecutive patients with pT4M0 colon cancer who underwent curative surgery between 2010 and 2017 using a propensity score-matched analysis. After propensity score-matching, we enrolled 100 patients (n = 50 in each group). Median follow-up was 43.5months. The conversion rate to laparotomy in this study was 5.5% for the entire patient cohort and 6.0% for the matched cohort. Compared to the OC group, the LC group showed reductions in estimated blood loss and length of postsurgical stay. Clavien-Dindo classification grade ≥ II and all-grade complication rates were significantly lower in the LC group than in the OC group. R0 resection was achieved in all patients with LC. No significant differences were found between the groups in terms of overall, cancer-specific, recurrence-free survival, or incidence of local recurrence among the entire patient cohort and matched cohort. The oncological outcomes were similar between the LC and OC groups. LC offers a safe, feasible option for patients with pT4 colon cancer.

Increased oxidative stress with substantial dysregulation of genes related to oxidative stress and DNA repair after laparoscopic colon cancer surgery

Surgical stress is followed by oxidative stress, where reactive oxygene species may act as regulators of pathways related to cancer cell survival and metastatic ability. Furthermore, reactive oxygene species may cause DNA and RNA damage.The aim of this study was to examine whether laparoscopic colon cancer surgery causes oxidative stress and dysregulation of related pathways. MethodsPatients undergoing elective laparoscopic surgery for colon cancer were included. Blood and urine samples were drawn on the day prior to surgery and on day 1 and 10 after surgery. ResultsTwenty-six patients were included.Out of 140 genes previously identified as sensitive to regulation by reactive oxygene species, 46 were significantly differentially expressed on day 1 after surgery (FDR < 0.05). Upregulated genes were related to cellular immune suppression, proliferation, migration and epithelial to mesenchymal transition. Downregulated genes were related to IFN pathways and cytotoxic immunological reactions.Genes related to DNA repair were primarily downregulated on day one after surgery, and urinary excretion of 8oxdG was decreased on day two after (p = 0.004), and increased on day 10 after surgery (p = 0.01). ConclusionLaparoscopic colon cancer surgery causes oxidative stress, and impaired DNA repair. Gene expression profiling indicates that reactive oxygen species may act as regulators of pathways related to increased risk of metastasis and cellular immune suppression after surgery. Measures of intracellular oxidative stress, indicates impaired DNA repair on day two after surgery, and sustained oxidative stress on day 10 after surgery.

Adenocarcinoma arising from a heterotopic pancreas in the first portion of the duodenum: a case report

BackgroundHeterotopic pancreas (HP) is defined as pancreatic tissue in organs with no anatomical continuity with the orthotopic pancreas. Based on the number of cases reported in the literature between the year 2000 and 2020, HP is rarely found causing malignant transformation of the duodenum. We herein report a case of adenocarcinoma arising from the HP in the first portion of the duodenum.Case presentationA 77-year-old Japanese man presented to our hospital with epigastric pain. Despite having undergone laparoscopic surgery for early sigmoid colon cancer a month earlier, serum levels of tumor-specific antigens, such as CA19-9, were elevated. After undergoing a series of radiologic examinations, the first portion of the duodenum was found thickened. However, a biopsy of the lesion showed no malignancy. Four months later, follow-up computed tomography (CT) scans showed that the lesion was thicker and involved the gastroduodenal artery (GDA), suggesting tumor invasion. A new biopsy did not detect the malignancy. However, serum tumor-specific antigen levels increased, especially duke pancreatic monoclonal antigen type 2 (5287 U/mL), in the absence of tumor in the orthotopic pancreas. The follow-up CT imaging showed a malignant tumor in the first portion of the duodenum. Five months later, we performed a subtotal stomach-preserving pancreaticoduodenectomy (SSPPD) for duodenal or HP cancer in the first portion of the duodenum, finding a lesion from the pyloric bulbs to the first portion of the duodenum, which invaded the adjacent pancreas and GDA. The pathological examination of the specimens revealed adenocarcinoma arising from HP. Nine months after surgery, no recurrence was found by radiologic imaging or tumor-specific antigen laboratory testing.ConclusionsHP adenocarcinoma is rare and difficult to diagnose preoperatively due to its submucosal location. Therefore, a careful follow-up with blood testing and radiologic imaging, as well as diagnostic surgery, is recommended.

CDX2 expression and perioperative patient serum affects the adhesion properties of cultured colon cancer cells

BackgroundColon cancer is one of the most commonly diagnosed types of cancer with surgical resection of the tumor being the primary choice of treatment. However, the surgical stress response induced during treatment may be related to a higher risk of recurrence. The aim of this study was to examine the effect of surgery on adhesion of cultured colon cancer cells with or without expression of the tumour suppressor CDX2.MethodWe enrolled 30 patients undergoing elective, curatively intended laparoscopic surgery for colon cancer in this study. Blood samples were drawn 1 day prior to surgery and 24 h after surgery. The samples of pre- and postoperative serum was applied to wild type colon cancer LS174T cells and CDX2 inducible LS174T cells and adhesion was measured with Real-Time Cell-Analysis iCELLigence using electrical impedance as a readout to monitor changes in the cellular adhesion.ResultsAdhesion abilities of wild type LS174T cells seeded in postoperative serum was significantly increased compared to cells seeded in preoperative serum. When seeding the CDX2 inducible LS174T cells without CDX2 expression in pre- and postoperative serum, no significant difference in adhesion was found. However, when inducing CDX2 expression in these cells, the adhesion abilities in pre- and postoperative serum resembled those of the LS174T wild type cell line.ConclusionsWe found that the adhesion of colon cancer cells was significantly increased in postoperative versus preoperative serum, and that CDX2 expression affected the adhesive ability of cancer cells. The results of this study may help to elucidate the pro-metastatic mechanisms in the perioperative phase and the role of CDX2 in colon cancer metastasis.

Indocyanine green fluorescence imaging to assess bowel perfusion during totally laparoscopic surgery for colon cancer

BackgroundTo retrospectively evaluate the feasibility and safety of intraoperative assessment of bowel perfusion in totally laparoscopic surgery for colon cancer using indocyanine green fluorescence imaging (IGFI).MethodsFrom October 2017 to June 2019, consecutive patients with colon cancer who underwent totally laparoscopic surgery were enrolled retrospectively and grouped into the IGFI group (n = 84) and control group (n = 105). In the IGFI group, indocyanine green (ICG) was injected intravenously, and the bowel perfusion was observed using a fluorescence camera system prior to and after completion of the anastomosis.ResultsThe two groups were demographically comparable. The IGFI group exhibited a significantly shorter operative time (p = 0.0374) while intraoperative blood loss did not significantly differ among the groups (p = 0.062). In the IGFI group, average time to perfusion fluorescence was 48.4 ± 14.0 s after ICG injection, and four patients (4.8%) were required to choose a more proximal point of resection due to the lack of adequate fluorescence at the point previously selected. There were no differences in terms of pathological outcomes, postoperative recovery and the postoperative complication rates between the groups (p>0.05).ConclusionIGFI shows promise as a safe and feasible tool to assess bowel perfusion during a totally laparoscopic surgery for colon cancer and may reduce the operative time.

Comprehensive Analysis of Gastroparesis after Laparoscopic Surgery for Gastric and Colon Cancer

Comprehensive Analysis of Gastroparesis after Laparoscopic Surgery for Gastric and Colon Cancer

Long-term outcomes after complete mesocolic excision for colon cancer at a tertiary care center in Saudi Arabia.

ABSTRACTBACKGROUND: Data on long-term survival and recurrence of cancer after complete mesocolic excision (CME) for colon cancer has not been reported from our center and related to international data.OBJECTIVE: Describe overall and disease-free survival, survival by surgery site and stage, and recurrence rates after curative surgery.DESIGN: Retrospective chart review.SETTINGS: Academic tertiary care center.PATIENTS AND METHODS: The study included all patients who underwent either laparoscopic or open surgery for colon cancer with curative intent between 2001 and 2011. The colorectal database was reviewed for the following: demographic data, comorbidities, radiologic investigations, clinical stage, type of operation, complications, pathologic assessment, adjuvant treatment, recurrence and survival. Survival and recurrence rates were calculated, and survival curves were generated.MAIN OUTCOME MEASURES: 5-year overall survival, secondary endpoints were 5-year disease-free survival, survival by surgery site and stage, and recurrence rates.SAMPLE SIZE: 220.RESULTS: The mean (SD) age at diagnosis was 57 (13) years (CI 95%: 55-59 years). There were 112 males. Mean (SD) body mass index was 27.6 (5.7) kg/m2 (CI 95%: 27-28). Pathological assessment revealed R0 (microscopically margin-negative) resection in 207 (94%). The overall 5-year survival and disease-free survival was 77.9% and 70%, respectively. The 5-year disease-free survival was 69% for the sigmoid/left colon and 69% for the right colon (difference statistically nonsignificant). Stages at the time of resection were stage 0 for 2 (0.01%) patients, stage I for 18 (8%), stage II for 92 (42%), stage III for 100 (46%), and stage IV for 6 (3%). The 5-year overall survival by stages I, II, III and IV was 94%, 80%, 75% and 50%, respectively (difference statistically non-significant). The overall 5-year recurrence rate was 23.4%.CONCLUSION: The outcomes of surgical treatment for colon cancer at our institution are equivalent to international sites. No difference was noted between left and right colon in terms of survival after CME.LIMITATIONS: Single center, retrospective, small sample size.CONFLICT OF INTEREST: None.