Open Surgery For Colorectal Cancer Research Articles

Resection margins, lymph node harvest and 3 year survival in open and laparoscopic colorectal cancer surgery; a prospective cohort study

IntroductionLaparoscopic colorectal cancer surgery has been gaining popularity in the last decade. However, there are concerns about adequate lymph node dissection and safe resection margins in laparoscopic colorectal cancer surgery. This study was aimed at comparing the lymph node (LN) clearance and surgical resection margins and 3-year survival for open and laparoscopic colorectal cancer surgery.MethodA pre-tested interviewer administered questionnaire was used to assess the adoption of the laparoscopic approach by Sri Lankan surgeons. Data was collected prospectively from patients who underwent open or laparoscopic colorectal cancer surgery at the University Surgical Unit of the National Hospital of Sri Lanka from April 2016 to May 2019. The histopathology records were analysed to determine the longitudinal and circumferential resection margins(CRM) and the number of lymph nodes harvested. The resection margins were classified as positive or negative. The total number of LN examined was evaluated. Presence of local recurrence and liver metastasis was determined by contrast enhanced CT scan during 3-years of follow up. Chi square, T test and z test for proportions were used to compare CRM, LN harvest and survival rates between the groups.ResultsOf the surgeons interviewed only 11 (18.4%) performed laparoscopic colorectal cancer surgery. A total of 137 patients (83 males and 54 females) were studied. Eighty-one procedures were laparoscopic and 56 procedures were open. All patients had clear longitudinal resection margins. Seventy-eight patients in the laparoscopic group (96%) and 51 patients (91%) in the open group had clear CRM (p > 0.05). A total of 2188 LNs (mean 15.9) were resected in all procedures. Six-hundred-eighty-nine lymph nodes were removed during open procedures (mean 12.3, SD 0.4) and 1499 (mean 18.5, SD 0.6) were removed during laparoscopy (p < 0.05). At 3 years follow-up the disease-free survival in the laparoscopic and open colon cancer patients was 27/41 (65.8%) and 16/29 (55.1%) respectively (p = 0.35). Disease free survival in the laparoscopic and open rectal cancer patients was 23/38 (60.5%) and 13/25 (52.0%) respectively (p = 0.40). Four patients were lost during follow-up.Discussion and conclusionCRM was comparable in the two groups. Laparoscopic group had a significantly higher LN harvest. Three-year survival rates were similar in the two groups. Acceptable results can be obtained with laparoscopic colorectal cancer surgery.

Propensity Score-Matched Analysis of Minimal Invasive Surgery versus Open Surgery for Colorectal Cancer in Older Patients.

Introduction: Currently, surgeons deal with an older patient cohort, confronting new challenges brought by the raised life expectancy. This population is unrepresented in surgical trials; therefore, the optimal therapy is still a matter of debate. The efficacy of open versus minimal invasive management of colorectal cancer (CRC) in an elderly cohort is not clearly established. The current study assesses the minimal invasive approach in elderly patients undergoing colorectal surgery. Material and Methods: The General Surgery Department database was inquired between 2012 and 2015 using the following filters: age â?¥ 65 and rectal or colon adenocarcinoma. After applying the exclusion criteria, 975 cases were obtained: 842 underwent open surgery (OS) and 133 underwent minimal invasive surgery (MIS). A propensity score matching was performed to reduce patient selection bias. Results: After the propensity score matching, the MIS group had a shorter postoperative hospital stay than the OS group (p = 0.025). From the preoperative variables, the presence of chronic lung disease was significantly higher in the OS group (p = 0.039). The presence of chronic lung disease positively associates with the Clavien-Dindo classification (p 0.001) and with the number of days from surgery to discharge (p = 0.028). Conclusion: The chronological age alone should not be a limit to MIS granting that it showed no inferiority to the OS in terms of postoperative morbidity, correlating with lower postoperative stay in the elderly. Further prospective studies are needed to assess the outcome of MIS in elderly population.

The Effect of Intravenous Lidocaine, Ketamine, and Lidocaine-Ketamine Combination in Colorectal Cancer Surgery: A Randomized Controlled Trial.

Colorectal resections are associated with a pronounced inflammatory response, severe postoperative pain, and postoperative ileus. The aim of this study was to evaluate the main effects of lidocaine and ketamine, and their interaction in colorectal cancer (CRC) patients after open surgery. The interaction could be additive if the effect of 2 drugs given in combination equals the sum of their individual effects, or multiplicative if their combined effect exceeds the sum of their individual effects. We hypothesized that the combination of lidocaine and ketamine might reduce the inflammatory response additively or synergistically. Eighty-two patients undergoing elective open colorectal resection were randomized to receive either lidocaine or placebo and either ketamine or placebo in a 2 × 2 factorial design. After induction of general anesthesia, all subjects received an intravenous bolus (lidocaine 1.5 mg/kg and/or ketamine 0.5 mg/kg and/or a matched saline volume) followed by a continuous infusion (lidocaine 2 mg·kg-1·h-1 and/or ketamine 0.2 mg·kg-1·h-1 and/or a matched saline volume) until the end of surgery. Primary outcomes were serum levels of white blood cell (WBC) count, interleukins (IL-6, IL-8), and C-reactive protein (CRP) measured at 2 time points: 12 and 36 hours after surgery. Secondary outcomes included intraoperative opioid consumption; visual analog scale (VAS) pain scores at 2, 4, 12, 24, 36, and 48 hours postoperatively; cumulative analgesic consumption within 48 hours after surgery; and time to first bowel movement. We assessed the main effects of each of lidocaine and ketamine and their interaction on the primary outcomes using linear regression analyses. A Bonferroni-adjusted significance level was set at .05/8 = .00625 for primary analyses. No statistically significant differences were observed with either lidocaine or ketamine intervention in any of the measured inflammatory markers. No multiplicative interaction between the 2 treatments was confirmed at 12 or 36 hours after surgery: WBC count, P = .870 and P = .393, respectively; IL-6, P = .892 and P = .343, respectively; IL-8, P = .999 and P = .996, respectively; and CRP, P = .014 and P = .445, respectively. With regard to inflammatory parameters, no evidence of additive interactions was found. Lidocaine and ketamine, either together or alone, significantly reduced intraoperative opioid consumption versus placebo, and, except for lidocaine alone, improved pain scores. Neither intervention significantly influenced gut motility. Our study results do not support the use of an intraoperative combination of lidocaine and ketamine in patients undergoing open surgery for CRC.

Influence of opioid analgesia type on circulating tumor cells in open colorectal cancer surgery (POACC-1): study protocol for a prospective randomized multicenter controlled trial

BackgroundOpioids and epidural analgesia are a mainstay of perioperative analgesia but their influence on cancer recurrence remains unclear. Based on retrospective data, we found that cancer recurrence following colorectal cancer surgery correlates with the number of circulating tumor cells (CTCs) in the early postoperative period. Also, morphine- but not piritramide-based postoperative analgesia increases the presence of CTCs and shortens cancer-specific survival. The influence of epidural analgesia on CTCs has not been studied yet.MethodsWe intend to enroll 120 patients in four centers in this prospective randomized controlled trial. The study protocol has been approved by Ethics Committees in all participating centers. Patients undergoing radical open colorectal cancer surgery are randomized into epidural, morphine, and piritramide groups for perioperative analgesia. The primary outcome is the difference in the number of CTCs in the peripheral blood before surgery, on the second postoperative day, and 2–4 weeks after surgery. The number of CTCs is measured using molecular biology methods. Perioperative care is standardized, and relevant data is recorded. A secondary outcome, if feasible, would be the expression and activity of various receptor subtypes in cancer tissue. We intend to perform a 5-year follow-up with regard to metastasis development.DiscussionThe mode of perioperative analgesia favorably affecting cancer recurrence would decrease morbidity/mortality. To identify such techniques, trials with long-term follow-up periods seem suboptimal. Given complex oncological therapeutic strategies, such trials likely disable the separation of perioperative analgesia effects from other factors. We believe that early postoperative CTCs presence/dynamics may serve as a sensitive marker of various perioperative interventions´ influences on cancer recurrence. Importantly, it is unbiased to the influence of long-term factors and minimally invasive. Analysis of opioid/cannabinoid receptor subtypes in cancer tissue would improve understanding of underlying mechanisms and promote personalization of treatment. We are not aware of any similar ongoing studies.Trial registration numberNCT03700411, registration date: October 3, 2018. Study status: recruiting.

Outcomes of Open Versus Laparoscopic Surgery for Colorectal Cancer in the Emergency Setting

Aim: The study aim is to do the comparison of oncological and short-term results of open and laparoscopic surgery for colorectal cancer in emergency setting. Study Design: This retrospective cohort research was held in the Department of Surgery, Civil Hospital, Karachi and Sheikh Zayed Medical College/ Hospital, Rahim Yar Khan for two-years duration from January 2020 to December 2021. Patients and Methods: after approval of this study and an informed consent agreement was signed by each participant. We performed an emergency analysis on 55 consecutive patients who received emergency open (n=40) or laparoscopic (n=15) resection for colorectal cancer. Results: The gender, age, BMI, American Society of Anesthesiologists (ASA) score, tumor location and prior abdominal surgery history were not significantly different between the laparoscopic and open groups. The T4 pathological tumors were more frequent in the open surgery group (50% vs. 13.3%; p=0.031) than in the laparoscopic group. The open surgery group also experienced high proportion of perforation (42.5% vs. 33.3%) and obstruction (47.5% vs. 26.7%) cases. In the laparoscopic group, bleeding or anemia were much common (33.3% vs. 7.5%; p=0.032). The laparoscopic group did not experience any open conversions. The open surgery group had a high pervasiveness of Hartmann's surgery (35%), whereas the laparoscopic group had high pervasiveness of low anterior resection (26.7%; p=0.064). The complication ration at 30-days for laparoscopy (37.5%) and open surgery (33.3%) was comparable (p=0.900). Conclusions: In some individuals with colorectal cancer, emergency laparoscopic surgery has advantages in relation of short-term and oncologic outcomes. As a result, skilled laparoscopic surgeons may actively consider using laparoscopy in life-threatening situations. Keywords: Laparoscopy, colorectal cancer, and emergency.

Effects of Preoperative Oral Carbohydrate Loading on Neutrophil/Lymphocyte Ratio and Postoperative Complications following Colorectal Cancer Surgery: A Randomized Controlled Study

Introduction: Preoperative carbohydrate oral (CHO) drinks attenuate the surgical stress response; however, the effects of CHO supplementation on the neutrophil-to-lymphocyte ratio (NLR) as an inflammatory and immunology-based predictor remain unclear. This study evaluated the effects of preoperative CHO loading on NLR values and complications following open colorectal surgery compared with a conventional fasting protocol. Methods: Sixty eligible participants having planned for routine and open colorectal cancer surgery from May 2020 to January 2022 were prospectively and randomly allocated to either the control (fasting) group, whose members discontinued oral intake beginning the midnight before surgery, or the intervention (CHO) group, whose members consumed a CHO solution the night before surgery and 2 h prior to anaesthesia. NLR was assessed at 06:00 h before surgery (baseline) and at 06:00 h on postoperative days 1, 3, and 5. The incidence and severity of postoperative complications were assessed by Clavien-Dindo Classification up to postoperative day 30. All data were analysed using descriptive statistics. Results: Postoperative NLR and delta NLR values were significantly higher in controls (p < 0.001; p < 0.001). Control group participants also demonstrated grade IV (n = 5; 16.7%, p < 0.01) and grade V (n = 1; 3.3%, p < 0.313) postoperative complications. There were no major postoperative complications in the CHO group. Conclusion: Preoperative CHO consumption reduced postoperative NLR values and the incidence and severity of postoperative complications following open colorectal surgery, compared with a preoperative fasting protocol. Preoperative carbohydrate loading may improve recovery following colorectal cancer surgery.

Perioperative Probiotics Application for Preventing Postoperative Complications in Patients with Colorectal Cancer: A Systematic Review and Meta-Analysis.

Background and Objectives: Perioperative probiotic administration in patients who undergo gastrointestinal surgery can reduce postoperative infectious complications. This systematic review and meta-analysis aimed to evaluate the effect of probiotics on postoperative outcomes in patients who underwent colorectal cancer surgery. Materials and Methods: For this study, we followed the protocol published by PROSPERO (registration number: CRD42021247277). We included studies on patients undergoing open, laparoscopic, or robotic colorectal cancer surgery for curative intent. We conducted a comprehensive search with online databases (trial registries and ClinicalTrials.gov), other literature sources, and conference proceedings, with no language restriction, up until 12 August 2022. We assessed risk of bias, extracted data, and conducted statistical analyses by using a random-effects model and interpreted the results based on the Cochrane Handbook for Systematic Reviews of Interventions. We rated the certainty of evidence (CoR) according to the GRADE approach. Results: We identified 20 published full-text studies. The use of probiotics probably results in little to no difference in perioperative mortality (risk ratio (RR): 0.17, 95% CI: 0.02 to 1.38; I2 = 0%; moderate CoE) and may result in reducing the overall postoperative infectious complications (RR: 0.45, 95% CI: 0.27 to 0.76; I2 = 38%; low CoE) after colorectal cancer surgery. Probiotics may result in little to no difference in probiotics-related adverse events (RR: 0.73, 95% CI: 0.45 to 1.19; I2 = 0%; low CoE). While probiotics may result in reducing the overall postoperative complications (RR: 0.47, 95% CI: 0.30 to 0.74; I2 = 8%; low CoE), it may result in little to no difference in hospital length of stay (LOS) (MD: -1.06, 95% CI: -1.64 to -0.47; I2 = 8%; low CoE) and postoperative quality of life (QOL) (MD: +5.64, 95% CI: 0.98 to 10.3; low CoE). Conclusions: Perioperative probiotic administration may reduce complications, including overall infectious complications, in patients undergoing colorectal cancer surgery without any additional adverse effects. In addition, probiotics may have similar effects on perioperative mortality; procedure-related complications such as anastomotic leakage, and hospital LOS; or improve the QOL. Thus, probiotics may be considered a beneficial supplement to routine perioperative care for colorectal cancer surgery.

Comparison of Oncological Outcomes After Colorectal Cancer Surgery in Patients Undergoing Laparoscopic Versus an Open Procedure

Objective: To compare the oncological outcomes after colorectal cancer surgery in patients undergoing laparoscopic versus open procedures for colorectal carcinoma.&#x0D; Study Design: Comparative Cross-sectional Study.&#x0D; Place and Duration of Study: Surgical Department Combined Military Hospital, Rawalpindi and Histopathology Department Armed Forces Institute of Pathology Rawalpindi Pakistan, from June 2021 to March 2022.&#x0D; Methodology: This study was conducted on 60 patients who underwent oncological surgery for colorectal cancer via the open or laparoscopic method. Data were collected for all the patients from the Histopathology Department regarding proximal margin involvement, circumferential margin involvement, distal margin involvement, tumour perforation and lymph nodes resected. These parameters were compared in patients undergoing open or laparoscopic methods.&#x0D; Results: Out of 60 patients included in the final analysis, 41(68.3%) were males, and 19(31.7%) were females. The mean age of patients who underwent open or laparoscopic surgery for colorectal cancer in our study was 44.67±7.537 years. 32(53.3%)patients underwent laparoscopic surgery, while 28(46.7%) underwent an open surgical procedure. Statistical tests revealed that both Groups found that proximal margin involvement, circumferential margin involvement, distal margin involvement,tumour perforation, and the number of lymph nodes resected were not statistically significant (p-value&gt;0.05).&#x0D; Conclusion: Oncological outcomes on histopathology were not different in patients undergoing the open or laparoscopic procedure. Therefore, laparoscopic colonic resection is oncologically equivalent to open resection.&#x0D;

Laparoscopic Vs Open Surgery for Colorectal Cancer: Comparing Short-Term Results

Background: In developed countries, colorectal cancer continues to rank as the third-most prevalent cancer to be reported and the third-most popular reason for cancer mortality in both genders. Objective: The purpose of the retrospective research was to compare the operational parameters and short-term oncological effects of laparoscopic surgery (LS) with traditional open surgery (OS) in colorectal cancer patients in our hospital. Methods: In this study, 148 patients who underwent CRC surgery between January 2020 and January 2022 at the Medical Teaching Institute (MTI) Peshawar, Pakistan's Khyber Teaching Hospital and Hayatabad Medical Complex Hospital were included. 64 people who had all had LS were included in the study. On the other hand, 84 people who had had OS were randomly selected from groups of people who were of the same gender and age. Result: In the group undergoing OS, the median of dissected lymph nodes was 22.8 (9–35) and 3 (0–14), whereas, in the group undergoing laparoscopy, the median number was 21.56 (8–32) and 6.2 (0–9). For 13 (15.47%) patients undergone through and 9 patients (14.06%) undergone through laparoscopy, blood transfusions were necessary. Although the LS group's procedure took longer than the OS group, their time in the ICU, time to start feeding and duration of stay at the hospital were all shorter. Practical implication Importance Laparoscopic surgery has not been proven to be more effective than open surgery for patients with low rectal cancer. Conclusion: LS provides the benefits of a shorter hospital stay and fewer problems and delivers relatively adequate lymph node dissection. Keywords: laparoscopic surgery, open surgery, colorectal cancer, oncological outcomes, developing countries

Need for nursing care after laparoscopic and open colorectal cancer surgery: a claims data analysis in German primary care

PurposeOur study analyzes the influence of minimally invasive vs. open surgery on the postoperative need for nursing care in patients with colorectal carcinoma. Colorectal cancer is an age-related disease, and oncologic surgery is increasingly performed in elderly patients. Long-term effects of the procedural choice on patients’ self-sufficiency and autonomy have not been scientifically addressed so far.MethodsMultivariable logistic regression models based on claims data from a statutory health insurer (AOK, Baden-Württemberg, Germany) were applied to assess potential risk factors for assignment patients to a nursing care level, a German scale to categorize individual need for nursing care, at 12 and 36 months after colorectal cancer surgery.ResultsA total of 3996 patients were eligible to be included in the analysis. At 36 months postoperatively, 44 of 427 (10.3%) patients after minimally invasive colon cancer surgery and 231 of 1287 (17.9%) patients after open procedure were newly graded into a nursing care level (OR = 0.62, 95%CI = 0.44–0.90, p = 0.010). Thirty-four of 251 (13.5%) patients receiving minimally invasive rectal cancer surgery compared to 142 of 602 (23.6%) patients after open approach were newly assigned to a nursing care level (OR = 0.53, 95%CI = 0.34–0.81, p = 0.003).ConclusionsLaparoscopically assisted resection of colorectal cancer seems to be superior in preserving physical autonomy of elderly patients with colorectal cancer.

Incidence of incisional hernia after major colorectal cancer surgery & analysis of associated risk factors in Asian population: Is laparoscopy any better?

Incisional hernia is one of the common morbidities after major colorectal cancer surgery. We aim to compare the incidence of incisional hernias between laparoscopic and open surgery. We also aim to identify associated risk factors of incisional hernia among Asian population who has undergone major resection for colorectal cancer. Data of patients who had undergone major colorectal cancer surgery in year 2015 from a single institution was collected. Data were extracted from electronic clinical records from our institution's database. Incisional hernias were identified by clinical examination and computed tomography (CT) scan performed during post-operative follow up as part of colorectal cancer surveillance. Follow up data of up to 3 years were extracted. Univariate and multivariable logistic regression analysis were performed to identify associated risk factors for development of incisional hernia. Propensity score matching analysis was performed for laparoscopic and open resection. 502 patients were included in the study. With a minimum follow up of 3 years, overall incisional hernia incidence rate of 13% was identified. Incisional hernias after laparoscopic and open surgery were 12.3% and 13.8% (p=0.688) respectively. Univariate logistic regression analysis showed that body mass index (BMI) of >23kg/m2, ASA of III/IV and post-operative anastomotic leak were associated with development of incisional hernias. On multivariable analysis, female gender (OR 2.102, 95%CI: 1.155, 3.826), BMI of ≥23kg/m2 (OR 2.862 95%CI: 1.582, 5.181), ASA III/IV (OR 2.052, 95%CI: 1.169, 3.602), were significantly associated with development of incisional hernia. Propensity scores matched analysis showed laparoscopic surgery did not significantly reduce the incidence of incisional hernia. The overall incidence of incisional hernia seems lower in Asian population. Our study demonstrated no significant difference in incisional hernia rates between patients undergoing laparoscopic versus open colorectal cancer surgery. Female gender, higher BMI, and higher ASA are associated with increased risk of developing incisional hernia after major colorectal cancer resection.

Long-term and short-term outcomes of laparoscopic versus open resection following tube decompression for obstructive colorectal cancer: a single-center retrospective study.

The benefits of laparoscopic surgery over open surgery are well documented; however, the suitability of laparoscopic surgery for obstructive colorectal cancer is still controversial. The aim of this retrospective study was to compare the clinical benefits of laparoscopic surgery vs. open surgery for obstructive colorectal cancer after tube decompression. We analyzed the outcomes of patients who underwent laparoscopic surgery vs. open surgery for curative resection after tube decompression for obstructive colorectal cancer at our hospital between January, 2007 and March, 2018. This study comprised 67 patients: 29 patients who underwent open surgery and 38 patients who underwent laparoscopic surgery. The morbidity within 30days after surgery was comparable between the groups. The 3-year overall survival rates of the open and laparoscopic groups were 83.3 and 79.4%, respectively (p = 0.6244), and the 3-year disease-free survival rates were 59.3 and 71.2%, respectively (p = 0.3200). Multivariate analysis showed that nodal stage (p = 0.021) was an independent prognostic factor for OS and sex (p = 0.010) and side-ness (p = 0.048) were independent prognostic factors for DFS. If adequate decompression is achieved, laparoscopic resection following tube decompression for obstructive colorectal cancer can be a safe alternative to open surgery.

The impact of open or laparoscopic surgery for colorectal cancer on the development of metachronous peritoneal metastases – results from a population-based cohort study

Background: This study aimed to assess the impact of open or laparoscopic surgery for primary colorectal cancer (CRC) on the development of metachronous colorectal peritoneal metastases (CPM) in a population-based cohort.

Comparison of Short-Term Results of Laparoscopy and Open Surgery for Colorectal Cancer: A Single-Center Experience

Objective: Although laparoscopic colon cancer surgeries have increased in recent years, their oncological competence is questioned. In our study, we aimed to evaluate oncological competence by comparing laparoscopic and open surgery. Material and Methods: The study was planned retrospectively. A total of 94 patients were included in the study, 42 of whom underwent laparoscopy, and 52 patients underwent open surgery. Both groups were compared in terms of demographic characteristics, staging, number of benign/malignant lymph nodes, histological findings and complications. Result: The final pathology report of all patients was adenocarcinoma. The median number of dissected lymph nodes was 20.9 in the open group (8-34) and 19.46 in the laparoscopy group (7-31) (p=0.639). The median number of dissected malignant lymph nodes was 1 (0-13) in the open surgery group and 3.1 (0-8) in the laparoscopy group (p=0.216). The laparoscopy group exhibited a longer operation time (281.2±54.2 and 221.0±51.5 min, respectively; P=0.036) than the open surgery group, but a shorter intensive care unit(ICU) discharge, quicker initiation oral feeding, and shorter length of hospital stay (4.0±0.9 vs. 5.7±2.0 days, respectively; P&lt;0.001). Discussion: Laparoscopic surgery elicits many benefits such as less wound infection, lower requirement for blood transfusion, shorter hospitalization, quicker initiation of oral feeding and mobilization. Our study has shown that laparoscopic surgery provides quite adequate lymph node dissection when compared with oncological surgery, which is viewed with suspicion in the light of these benefits of laparoscopy.

Long-term results of laparoscopic surgery and open surgery for colorectal cancer in Huaihe River Basin of China

In this study, we aimed to compare clinical efficacy of laparoscopic surgery and open surgery for colorectal cancer in the Huaihe River Basin in China. A total of 92 patients with colorectal cancer were selected as subjects. Patients were divided into control group (open surgery, n = 27 cases) and test group (laparoscopic surgery, n = 28 cases). Our results showed that the duration of operation (122.54 ± 14.85) min and length of incision (4.51 ± 1.065) cm were shorter in the experimental group than those in the control group. The intraoperative blood loss of the experimental group was (161.12 ± 10.694) ml, which was less than that of the control group (218.53 ± 15.369) ml (P < 0.05). Patients in the experimental group have higher Five-year survival rate and lower incidence of postoperative complications than those in the control group (all P < 0.05). In conclusion, in the treatment of colorectal cancer, laparoscopic surgery has a better clinical effect than open surgery, which is worthy of clinical application.

Outcome of Laparoscopic versus Open Colorectal Cancer Surgery

Introduction: Since the first laparoscopic-assisted colon resection was introduced in 1991 by Jacobs et al., it has gradually become popular. Increasingly more colorectal surgeons admit that the laparoscopic technique leads to quicker functional recovery and improved short-term results when compared with the open approach. However, the laparoscopic technique has not previously been proven to gain significant benefits in colorectal surgeries. Recently, oncologic outcomes of colorectal cancer resection, in terms of lymph node harvest number and excision safety margin lengths, achieved under laparoscopy could be comparable to those obtained using the conventional open technique. However, the curability of colorectal cancer under the laparoscopic technique remains controversial because of the uncertainty about the overall recurrence rate. Objective: To study the outcome of colorectal surgeries in our department in order to compare laparoscopic surgery (LS) versus open surgery (OS) of colorectal cancer procedures in terms of operations duration, blood loss, intra and post-operative complications. Methods: Review of all colorectal cancer patients who underwent open and laparoscopic procedures between January 2014 and January 2020. Excluding patients, those have non-malignant tumors. Included in data collection are the patients’ demographic information, type of surgery, diagnostic test, complications, operative time, and hospital admission period. We will take the information from files of patients and our documentations during clinic visits. Results: A total of 101 patients underwent colorectal cancer surgery at King Salman Armed Forces Hospital from 1/1/2014 till 1/1/2020. Of these, 63 were male (62.3%). Of these colon cancer 68 cases (67%). The mean age was 47.2 years. Comorbidities included diabetes 13 (12%), hypertension 10 (9.9%), IHD 16 (15%), ESRD 4 (3.9%). Of these 41 were smokers (40.5%). Mean Body Mass Index (BMI) was 31.2 kg/m2. Mean hospital stay 7 ± 2 days for OS and 5 ± 2 for LS. Fifty nine patients (58.4%) underwent OS. 7 cases (6.9%) of LR had conversion. Conclusion: LS of colorectal cancer has better short-term results than OS but longer operative time.

Increased long-term mortality after open colorectal cancer surgery: A multicentre population-based study.

Unlike meta-analyses of randomized controlled trials, population-based studies in colorectal cancer (CRC) patients have shown a significant association between open surgery and increased 30- and 90-day mortality compared with laparoscopic surgery. Long-term mortality, however, is scarcely reported. This retrospective population-based study aimed to compare long-term mortality after open and laparoscopic surgery for CRC. The Dutch Colorectal Audit and the Dutch Cancer Centre registry were used to identify patients from three large nonacademic teaching hospitals who underwent curative resection for CRC between 2009 and 2018. Patients with relative contraindications for laparoscopic surgery (cT4 or pT4 tumours, distant metastasis requiring additional resection and emergency surgery) were excluded. Multivariable regression was used to assess the effect of laparoscopic surgery on long-term mortality with adjustment for gender, age, American Society of Anesthesiologists score, TNM stage, chemoradiation therapy and other confounders. We included 4531 patients, of whom 1298 (29%) underwent open surgery. The median follow-up was 43months (interquartile range 23-71months). Open surgery was associated with an increased risk of long-term mortality (adjusted hazard ratio 1.26, 95% confidence interval 1.10-1.45, p=0.001). Mixed-effects Cox regression with year of surgery as a random effect also showed an increased risk after open surgery (adjusted hazard ratio 1.33, 95% confidence interval 1.11-1.52, p=0.004). Open surgery seems to be associated with increased long-term mortality in the elective setting for CRC patients. A minimally invasive approach might improve long-term outcomes.

Hyaluronate carboxymethylcellulose sheets for the prevention of adhesive complications: a model-based cost-utility analysis.

Clinical trials suggest that hyaluronate carboxymethylcellulose (HA/CMC) prevents adhesion-related complications after intra-abdominal surgery, but at a high upfront cost. This study evaluated the cost-effectiveness of HA/CMC for patients undergoing curative-intent open colorectal cancer surgery. Using a Markov Monte Carlo microsimulation model, we conducted a cost-utility analysis comparing the cost-effectiveness of HA/CMC at curative-intent open colorectal cancer surgery versus standard management. We considered a scenario where HA/CMC was used at the index operation only, as well as where it was used at the index operation and any subsequent operations. The perspective was that of the third-party payer. Costs and utilities were discounted 1.5% annually, with a 1-month cycle length and 5-year time horizon. Model input data were obtained from a literature review. Outcomes included cost, quality-adjusted life-years (QALYs), small bowel obstructions (SBOs) and operations for SBO. Using HA/CMC at the index operation results in an incremental cost increase of CA$316 and provides 0.001 additional QALYs, for an incremental cost-effectiveness ratio of CA$310,000 per QALY compared to standard management. In our simulated cohort of 10,000 patients, HA/CMC prevented 460 SBOs and 293 surgeries for SBO. Probabilistic sensitivity analysis found that HA/CMC was cost-effective in 18.5% of iterations, at a cost-effectiveness threshold of CA$50,000 per QALY. Results of the scenario analysis where HA/CMC was used at the index operation and any subsequent operations were similar. Hyaluronate carboxymethylcellulose prevents adhesive bowel obstruction after open colorectal cancer surgery but is unlikely to be cost-effective given minimal long-term impact on healthcare costs and QALYs.

Epidural analgesia and mortality after colorectal cancer surgery: A retrospective cohort study

BackgroundEpidural analgesia (EA) has been the standard of care after major abdominal surgery for many years. This study aimed to correlate EA with postoperative complications, short- and long-term mortality in patients with and without EA after open surgery (OS) and minimally invasive surgery (MIS) for colorectal cancer. MethodsPatient, clinical and outcome data were obtained from the Swedish Colorectal Cancer Registry and the Swedish Perioperative Registry. All adult patients diagnosed with colorectal cancer without metastases who underwent elective curative MIS or OS for colorectal cancer between January 2016 and December 2018 and who had data recorded in both registries, were included in the study. Data were analyzed for OS and MIS procedures separately. A Poisson regression model was used to investigate the association between EA and the outcomes of interest. ResultsFive thousand seven hundred sixty-two patients were included in the study, 2712 in the MIS and 3050 patients in the OS group. After adjusting for patient specific and clinically relevant variables in the regression model, no statistically significant difference in risk for complications; 30-day, 90-day, and up to 3-year mortality following either MIS or OS could be detected between the EA+ and EA-cohorts. ConclusionsIn this large study cohort, EA as part of the comprehensive care provided was not associated with a reduction in postoperative complications risk or improved 30-day, 90-day, or 3-year survival after MIS or OS for colorectal cancer.

Effects of analgesic and surgical modality on immune response in colorectal cancer surgery

Background and objectiveDifferent surgical methods, anesthesia, and analgesia are known to modify the surgical stress response, especially in patients with malignancy. We compared the impact of patient-controlled intravenous (PCA) versus epidural analgesia (EDA) on tumor-related mucosal immune response in patients undergoing open or laparoscopic surgery for colorectal cancer. MethodsIn a University Hospital subgroup (n = 43) of a larger cohort (n = 235) of patients undergoing open or laparoscopic surgery for colorectal carcinoma randomized to PCA or EDA, colorectal tissues were stained for interleukin-10 (IL-10), tumor necrosis factor (TNF), and mast cell tryptase and then examined by immunofluorescence microscopy. ResultsMore IL-10+-cells were found in patients undergoing open compared to laparoscopic surgery in the PCA (P < 0.05) and EDA group (P < 0.0005), respectively, and numbers of TNF+-cells were higher in the open surgery group who received PCA (P < 0.05). No differences in IL-10 or TNF expressions were detected between EDA/PCA within the open or laparoscopic surgery groups, respectively. Fewer mast cells were observed in patients undergoing laparoscopic compared to open surgery combined with PCA (P < 0.05). Within the open surgery group, EDA resulted in fewer mucosal mast cells compared to the PCA group (P < 0.05). ConclusionsThe surgical method, rather than type of analgesia, may have higher impact on peri-operative inflammation. Laparoscopic surgery when combined with EDA for colorectal cancer caused a decrease in the TNF and IL-10 expression and mast cells. EDA seems to have an anti-inflammatory effect on cancer-related inflammation during open surgery.