Open Resection For Colorectal Cancer Research Articles

Medium-term surgical outcomes and health-related quality of life after laparoscopic vs open colorectal cancer resection: SF-36 health survey questionnaire.

Previous studies that compared the postoperative health-related quality of life (HRQoL) outcomes after receiving laparoscopic resection (LR) or open resection (OR) in patients with colorectal cancer (CRC) have different conclusions. To explore the medium-term effect of postoperative HRQoL in such patients. This study randomized 567 patients undergoing non-metastatic CRC surgery managed by one surgeon to the LR or OR groups. HRQoL was assessed during the preoperative period and 3, 6, and 12 mo postoperative using a modified version of the 36-Item Short Form (SF-36) Health Survey questionnaire, emphasizing eight specific items. This cohort randomly assigned 541 patients to receive LR (n = 296) or OR (n = 245) surgical procedures. More episodes of postoperative urinary tract infection (P < 0.001), wound infection (P < 0.001), and pneumonia (P = 0.048) were encountered in the OR group. The results demonstrated that the LR group subjectively gained mildly better general health (P = 0.045), moderately better physical activity (P = 0.006), and significantly better social function recovery (P = 0.0001) 3 mo postoperatively. Only the aspect of social function recovery was claimed at 6 mo, with a significant advantage in the LR group (P = 0.001). No clinical difference was found in HRQoL during the 12 mo. Our results demonstrated that LR resulted in better outcomes, including intra-operative blood loss, surgery-related complications, course of recovery, and especially some health domains of HRQoL at least within 6 mo postoperatively. Patients should undergo LR if there is no contraindication.

Minimally Invasive Compared to Open Colorectal Cancer Resection for Older Adults: A Population-based Analysis of Long-term Functional Outcomes.

We sought to compare long-term healthcare dependency and time-at-home between older adults undergoing minimally invasive surgery (MIS) for colorectal cancer (CRC) and those undergoing open resection. Although the benefits of MIS for CRC resection are established, data specific to older adults are lacking. Long-term functional outcomes, central to decision-making in the care for older adults, are unknown. We performed a population-based analysis of patients ≥70years old undergoing CRC resection between 2007 to 2017 using administrative datasets. Outcomes were receipt of homecare and "high" time-at-home, which we defined as years with ≤14 institution-days, in the 5years after surgery. Homecare was analyzed using time-to-event analyses as a recurrent dichotomous outcome with Andersen-Gill multivariable models. High timeat-home was assessed using Cox multivariable models. Of 16,479 included patients with median follow-up of 4.3 (interquartile range 2.1-7.1) years, 7822 had MIS (47.5%). The MIS group had lower homecare use than the open group with 22.3% versus 31.6% at 6 months and 14.8% versus 19.4% at 1 year [hazard ratio 0.87,95% confidence interval (CI) 0.83-0.92]. The MIS group had higher probability ofhigh time-at-home than open surgery with 54.9% (95% CI 53.6%-56.1%) versus 41.2% (95% CI 40.1%-42.3%) at 5years (hazard ratio 0.71, 95% CI 0.68-0.75). Compared to open surgery, MIS for CRC resection was associated with lower homecare needs and higher probability of high time-at-home in the 5 years after surgery, indicating reduced long-term functional dependence. These are important patient-centered endpoints reflecting the overall long-term treatment burden to be taken into consideration in decision-making.

Outcomes of simultaneous laparoscopic, hybrid, and open resection in colorectal cancer with synchronous liver metastases: a propensity score-matched study

We aimed to compare the short- and long-term outcomes of simultaneous laparoscopic, hybrid, and open resection for colorectal cancer and synchronous liver metastases. We retrospectively analyzed the data of 647 patients with simultaneous resection of colorectal cancer and liver metastases between January 2006 and December 2018 at three tertiary referral hospitals. Patient’s baseline characteristics, perioperative outcomes, pathological examination results, liver-specific recurrence rate and survivals were compared between the propensity score-matched groups. Forty-two and 81 patients were selected for the laparoscopic vs. hybrid groups, and 48 and 136 patients for laparoscopic vs. open groups, respectively. The laparoscopic group had fewer wound complications (2.1 vs. 13.2%; p = 0.028) than the open group, and a shorter postoperative hospital stay than the hybrid and open groups (8 vs. 11 days, p < 0.001 for both). The 5-year liver-specific recurrence rates were 38.7% and 46.0% in the laparoscopic and hybrid groups, respectively (p = 0.270), and 34.0% and 37.0% in the laparoscopic and open groups, respectively (p = 0.391). Simultaneous laparoscopic resection for colorectal cancer and liver metastases can be performed safely with significantly enhanced postoperative recovery and comparable long-term outcomes compared to hybrid and open resection.

A randomized comparative study of analgesic effect of erector spinae plane block versus quadratus lumborum block for open colorectal cancer surgeries

ABSTRACT Background The erector spinae plane block and quadratus lumborum block can provide analgesia for laparotomy surgeries. This study was conducted to compare their analgesic effects on patients posted for open colorectal cancer resection surgeries. We hypothesized that the erector spinae plane block is superior to the quadratus lumborum block at reducing postoperative pain scores. Therefore, we conducted this study to compare their analgesic efficacy and examine their validity for this type of surgeries. Patients and methods 76 patients scheduled for open colorectal cancer surgery, aged 40–60 years, either sex, and BMI 18.5–35 Kg/m2 of ASA physical status I or II were included. All patients were randomized into two groups of 38 patients each. Every patient received 20 ml bupivacaine 0.25% and 4 mg dexamethasone for each side. The numerical rating score for pain, morphine consumption, intensity of postoperative nausea and vomiting, serum cortisol and C- reactive protein, and duration of analgesia were recorded. Results The erector spinae plane block provided lower mean pain scores assessed by NRS with statistically significant differences (p < 0.001) during rest and movement, less frequent and easily controlled breakthrough pain than the quadratus lumborum block. There was no difference between the two groups at the time of the first postoperative morphine dose. The mean ± SD values of cumulative morphine consumption after the first and second postoperative 24 hours were 7.24 ± 0.987 and 3.62 ± 0.493, respectively, in the ESPB group, while they were 14.26 ± 2.206 and 7.32 ± 1.007, respectively, in the QLB group. The mean total postoperative nausea and vomiting intensity score was lower in the ESPB group withoutstatistically significant difference. There were no statistically significant differences between the two groups in the mean postoperative serum levels of cortisol and CRP except for CRP after 48 hours, which was 91.25 ± 46.172 in the ESPB group and 53.64 ± 15.324 in the QLB group (p < 0.001). Conclusion The erector spinae plane block is an easy and effective opioid sparing analgesic technique. It is recommended to be a part of multimodal analgesia for open colorectal surgeries.

Effects of Subcutaneous Jackson-Pratt Drain on Incisional Surgical Site Infection after Open Colorectal Resection for Cancer: a Prospective, Randomized, Multicenter Clinical Study

Incisional surgical site infections (SSI) are an important problem in patients undergoing surgery. The aim of the present study is to compare the effects of Jackson Pratt (JP) drain placement in patients with and without drains on incisional SSI after colorectal resection for cancer. The trial was designed as a prospective, randomized, controlled multicenter study. Patients who underwent colorectal resection for cancer were included in the study. Patients were randomized to subcutaneous JP drain group or control group (ND). The primary outcome was the presence of SSI. A total of 182 patients (89 in the JP group and 93 in the ND group) were analyzed. There was no significant difference between the groups in terms of demographic and surgical characteristics. SSI developed in 5.6% of patients in the JP group and in 19.4% of those in the ND group (p 70 years of age were the identified risk factors for incisional SSI. This study showed that elderly and obese patients and those with thick subcutaneous fat tissue should be placed JP drains to prevent SSI in open colorectal resections for cancer.

Laparoscopic Compared With Open Resection for Colorectal Cancer and Long-term Incidence of Adhesional Intestinal Obstruction and Incisional Hernia: A Systematic Review and Meta-analysis

Incisional hernia and adhesional intestinal obstruction are important complications of laparoscopic and open resection for colorectal cancer. This is the largest systematic review of comparative studies on this topic. This study aimed to investigate whether laparoscopic surgery decreases the incidence of incisional hernia and adhesional intestinal obstruction compared to open surgery for colorectal cancer. Online databases PubMed, EMBASE, and the Cochrane Library were searched. Abstracts from the annual meetings of the American Society of Colon and Rectal Surgeons and the European Society of Coloproctology were performed to cover gray literature. We included both randomized and nonrandomized comparative studies. Laparoscopic resection was compared to open resection for patients with colorectal cancer. The primary outcomes measured were incisional hernia and adhesional intestinal obstruction. Fifteen studies met inclusion criteria (6 randomized comparative studies/9 nonrandomized comparative studies); 84,172 patients. Meta-analysis showed decreased odds of developing incisional hernia in the laparoscopic cohort (OR, 0.79; 95% CI, 0.66-0.95; p = 0.01) but no difference in requirement for surgery (OR, 1.07; 95% CI, 0.64-1.79; p = 0.79). Similarly, there were decreased odds of developing adhesional intestinal obstruction in the laparoscopic cohort (OR, 0.81; 95% CI, 0.72-0.92, p = 0.001), but no difference in requirement for surgery (OR, 0.84; 95% CI, 0.53-1.35; p = 0.48). Incisional hernia and adhesional intestinal obstruction were poorly defined in many studies. Laparoscopic surgery is associated with decreased odds of incisional hernias and adhesional intestinal obstructions compared with open surgery for colorectal cancer.

Influence of Local Insufflation of Warm Humidified CO2 on the Wound Surface and Body Core Temperature as well as on Wound Healing in Open Colorectal Surgery

Perioperative hypothermia may lead to serious complications. This study aims to investigate whether intraoperative insufflation of warmed and humidified carbon dioxide (W-H-CO2) into the open wound during open colorectal surgery influences body core and wound surface temperatures or the incidence of wound healing disorders (WHD). Between 02/2018 and 07/2019, 50 patients intended to undergo open resection for colorectal cancer were recruited and randomised to a control group (n = 25) and an experimental group (n = 25). In the experimental group, a device for insufflation of W-H-CO2 was used. Body core and wound surface temperatures were recorded at the beginning and before finishing the procedure. IL-6 serum levels were determined preoperatively and during the postoperative course. Clinical observation of wound healing was performed until the 30th day post-op. Both groups were homogeneous in terms of risk factors for WHD. In the control group, the median body core temperature (1. quartile/3. quartile) was 36.2 °C (36/36.4 °C) when the operation started and 36.2 °C (35.9/36.45 °C) at the end, while in the experimental group it was initially 36.2 °C (35.7/36.4 °C) and 36.4 °C (36/36.7 °C) at the end. There was no significant difference between the two groups (p = 0.08). The wound temperature in the control group dropped from 32.8 °C (median; 31.85/34.05 °C) to 30.7 °C (median; 29.85/32.15 °C). In the experimental group, we recorded a drop from 31.9 °C (median; 30.25/32.95 °C) to 31.6 °C (median; 30.25/31.85 °C), which was statistically significant (p = 0.000475). The dynamic of the IL-6 serum levels in both groups suggest that there was no significant difference (p = 0.66; p = 0.88; p = 0.88). In the control group, 8 patients experienced superficial WHD, 2 anastomotic leakages (AL), while in the experimental group, superficial WHD were observed in 5 patients and AL in 1 patient. This differences between the groups regarding in WHD were not significant (p = 0.42). The established measures for prevention of perioperative hypothermia in elective procedures are sufficient. However, the local wound surface temperature is not preserved satisfactorily. Deployment of a device for intraoperative insufflation of W-H-CO2 into open wounds may be suitable for maintaining local normothermia. Further studies are needed to determine the influence of warm and humid CO2 on wound healing.

Oncological safety of laparoscopic versus open colorectal cancer surgery in obesity: a systematic review and meta-analysis.

Colorectal cancer resection in the obese (OB) patients can be technically challenging. With the increasing adoption of laparoscopic surgery, the benefits remain uncertain. Hence, the aim of this study is to assess the short- and long-term outcomes of laparoscopic compared to open colorectal cancer resection in the OB patients. A systematic review and meta-analysis was performed according to the PRISMA guidelines. The outcome measures were 5-year disease-free survival, overall survival, circumferential resection margin and local and distant recurrence. A total of 20 studies were included, with a total number of 6779 participants, of whom 1785 (26.3%) were OB and 4994 (73.7%) were non-obese (NOB) participants. The OB patients had higher R1 resection (OB 6.9% versus NOB 3.1%; P = 0.011) and lower mean number of lymph nodes harvested, with standard mean difference of -0.29; P = 0.023, favouring the NOB patients. However, there was no statistical difference for local (OB 2.8% versus NOB 3.4%) or distant recurrence (OB 12.9% versus NOB 15.2%) rate between the two cohorts. There was no difference in 5-year disease-free survival (OB 81% versus NOB 77.4%; odds ratio 1.25, P = 0.215) and overall survival (OB 89.4% versus NOB 87.9%; odds ratio 1.16, P = 0.572). Lastly, the OB group had higher mean total blood loss, total operative time and length of hospital stay when compared to NOB patients. From a pooled non-randomized study, laparoscopic colorectal cancer resection is safe in OB patients with equivalent long-term outcomes compared to NOB patients. However, there is a higher morbidity rate with an increased demand on hospital resources for the OB cohort.

Optimizing Patient Selection for Laparoscopic and Open Colorectal Cancer Resections: A National Surgical Quality Improvement Program–Matched Analysis

The aim of this study was to identify patients undergoing colorectal cancer (CRC) resection who might benefit specifically from either an open or laparoscopic approach. From the NSQIP database (2012-2013), patients who underwent laparoscopic colectomy (LC) or open colectomy (OC) for CRC were identified. The two groups were matched and compared in terms of any, medical, and surgical complications. A wide range of patient characteristics were collected and analyzed. Interaction analysis was performed in a multivariable regression model to identify risk factors that may make LC or OC more beneficial in certain subgroups of patients. Overall, OC (n = 6593) was associated with a significantly higher risk of any [odds ratio (OR) 2.03, 95% confidence interval (CI) 1.87-2.20], surgical (OR 1.98, 95% CI 1.82-2.16), and medical (OR 1.71, 95% CI 1.51-1.94) complications than LC (n = 6593). No subgroup of patients benefited from an open approach. Patients with obesity (BMI > 30) (P = 0.03) and older age (>65 years) (P = 0.01) benefited more than average from a laparoscopic approach. For obese patients, LC was associated with less overall complications (OC vs LC: OR 1.92 obese vs 1.21 nonobese patients). For elderly patients, LC was more preferable regarding the risk of medical complications (OC vs LC OR of 1.91 vs 1.34 for younger patients). No subgroup of CRC patients benefited specifically more from an open colorectal resection. This supports that the laparoscopic technique should be performed whenever feasible. For the obese and elderly patients, the benefits of the laparoscopic approach were more pronounced.

Effect of cancer characteristics and oncological outcomes associated with laparoscopic colorectal resection converted to open surgery: A meta-analysis.

Background:Although laparoscopic colorectal cancer resection is an oncologically safe procedure equivalent to open resection,the effects of conversion of a laparoscopic approach to an open approach remain unclear.This study evaluated the cancer characteristic and oncological outcomes associated with conversion of laparoscopic colorectal resection to open surgery.Method:We conducted searches on PubMed, EMBASE, MEDLINE, and the Cochrane Central Register of Controlled Trials. We included the literature published until 2018 that examined the impact of laparoscopic conversion to open colorectal resection. Only randomized control trials and prospective studies were included. Each study was reviewed and the data were extracted. Fixed-effects methods were used to combine data, and 95% confidence intervals (CIs) were used to evaluate the outcomes.Results:Twelve studies with 5427 patients were included. Of these, 4672 patients underwent complete laparoscopic resection with no conversion (LAP group), whereas 755 underwent conversion to an open resection (CONV group). The meta-analysis showedsignificant differences between the LAP group and converted (CONV) group with respect to neoadjuvant therapy (P = .002), location of the rectal cancer (P = .01), and recurrence (P = .01). However, no difference in local recurrence (P = .17) was noted between both groups.Conclusion:Conversion of laparoscopic to open colorectal cancer resection is influenced by tumor characteristics. Conversion of laparoscopic surgery for colorectal cancer is associated with a worse oncological outcome.

Long term outcomes of simultaneous laparoscopic versus open resection for colorectal cancer with synchronous liver metastases

Because of the advancements in the surgical techniques of liver resection and improvements in anesthesia and postoperative critical care, the simultaneous resection of synchronous colorectal cancer with liver metastasis either by the laparoscopic procedure or by the open resection method has been considered as a safe and acceptable option. However, there is limited information on the comparison of postoperative outcomes between laparoscopic surgery and open surgery. This study investigated the clinical results and postoperative outcomes of laparoscopic simultaneous resection of synchronous colorectal cancer with liver metastasis in comparison with those of open surgery. Patients with synchronous colorectal cancer and liver metastasis who underwent simultaneous resection at Shuang Ho Hospital from 2009 to 2017 were identified. The patient demographics, perioperative morbidity, and survival rates were analyzed. A total of 38 patients underwent simultaneous resection of synchronous colorectal cancer with liver metastasis. Laparoscopic procedure was performed for 16 patients, and the remaining 22 patients underwent open surgery. No significant differences were observed in the patient characteristics between the two groups. There was no perioperative mortality in both groups. The 1- and 3-year disease-free survival rates were 56% and 35% in the laparoscopic group and 70% and 15% in the open surgery group, respectively. The 1- and 3-year overall survival rates were 100% and 84% in the laparoscopic group and 73% and 48% in the open surgery group, respectively. In selected patients, laparoscopic surgery for simultaneous resection of synchronous colorectal cancer with liver metastasis seems to be safe and had a similar outcome to that of open surgery.

Prolonged postoperative ileus after elective colorectal cancer surgery

Background/Aim. Postoperative ileus is a frequent and frustrating occurence for both, patients and surgeons after abdominal surgery. Besides clinical importance of postoperative ileus, its economic aspect is also important. The aim of this prospective study was to analyze development of prolonged postoperative ileus after elective colorectal surgery for cancer and its impact on early postoperative outcome. Methods. This prospective study included all eligible patients, 18 years or older, scheduled for open colorectal resection for cancer from June, 2015 to February, 2016. Patients with metastatic disease, prior hemoirradiation or any resection other then curative were excluded. The study duration was up to 30 days postoperatively. Primary outcome measure was development of prolonged postoperative ileus according to strict definition. The impact of prolonged postoperative ileus on other outcome measures such as postoperative complications, surgical site infections, anastomotic leakage, reoperations, mortality and length of hospital stay were of great interest, too. Results. This prospective study included 103 patients, 64 (37.9%) men and 39 (62.1%) women, mean age 66 years. Prolonged postoperative ileus developed in 12 (11.3%) patients. One third of the patients had some type of surgical site infection, while 47.6% had complications. Ten (9.7%) patients required reoperation. Comparing the group of patients with prolonged postoperative ileus with those without, there were no statistically significant differences in rates of surgical site infection and anastomotic leakage. There was statistically significant difference in terms of complications (_2 = 34.966; p &lt; 0.001), complications grade III (_2 = 23.43; p &lt; 0.001) and reoperations (_2 = 15.724; p &lt;0.001). Patients who developed prolonged postoperative ileus had statistically significant longer postoperative hospital stay (Z = 2.291, p = 0.022) and longer total length of hospital stay (Z = 2.377, p = 0.015). According to regression analyzes prolonged postoperative ileus represents a risk factor for reoperations [odds ratio (OR) = 12.286; p = 0.001]. Conclusion. Prolonged postoperative ileus, although not life-threatening complication effects recovery, increases length of hospital stay and contributes to poor surgical outcome.

Long-term Oncologic Outcome After Laparoscopic Converted or Primary Open Resection for Colorectal Cancer: A Systematic Review of the Literature.

The aim of this study was to critically review the current evidence regarding the oncologic outcomes after laparoscopic converted or open resection for colorectal cancer. A literature search was performed in Pubmed. Study selection and data acquisition were independently performed by 2 reviewers. The search strategy yielded a total of 746 articles, resulting in 7 studies eligible for inclusion. A total of 9190 (57 to 8307) patients were included in the open and 238 (17 to 56) in the converted group. In none of the studies, differences were found in disease stage between both groups. There were no significant differences between both groups with regard to overall survival, local recurrence and distant metastasis rate. There is currently insufficient evidence that patients who had a laparoscopic resection for colorectal cancer converted to open surgery have a worse oncologic outcome than patients who were primarily treated by an open approach.

Introduction of Robotic Surgery into a Community Hospital Setting: A Prospective Comparison of Robotic and Open Colorectal Resection for Cancer

Purpose: The aim of this study was to compare robotic colorectal surgery (RCS) performed by a team having limited expertise in robotic surgery with open colorectal surgery (OCS) performed by experienced colorectal surgeons. Methods: This was a prospective comparative nonrandomized study. Results: Between March 2013 and June 2015, 79 patients with colon and rectal adenocarcinoma were enrolled into the study. Of these, 41 patients underwent OCS and 38 underwent RCS. The groups were comparable in terms of demographics and type of procedure. The RCS took significantly longer in the operating room than the OCS (222 vs. 141 min, p < 0.001). The rate of major complications was similar for both RCS and OCS (5.3 vs. 9.8%, p = 0.454). Wound infections were less frequent in the RCS group (10.5 vs. 29.3%, p = 0.039). The mean hospital stay was 1 day shorter in the RCS group than in the OCS group (5.7 vs. 6.7 days, p = 0.176). The lymph nodes harvested was comparable (14.7 RCS vs. 15.5 OCS, p = 0.596). Conclusions: This study confirmed that the surgical team with limited expertise in minimally invasive surgery can still safely introduce robotic surgery into their colorectal practice. When compared to the open approach, the robotic approach reduces hospital stay, as well as the rate of surgical site infection.

Comparison of the Short-Term Outcomes of Laparoscopic and Open Resections for Colorectal Cancer in Patients with a History of Prior Median Laparotomy.

This study aimed to investigate the short-term outcomes of laparoscopic resection in comparison with those of open resection for colorectal cancer in patients with a history of prior median laparotomy (PML). Eighty-seven consecutive patients (87/1121, 7.8%) with a history of PML who underwent major colorectal cancer resection were enrolled (laparoscopy, n = 40; open, n = 47). The conversion rate to open surgery was 25% (n = 10). The laparoscopy group had a higher proportion of female patients (57.5 vs. 36.2%), a lower rate of American Society of Anesthesiologists (ASA) score for physical status of ≥3 (7.5 vs. 25.5%), and a lower pT4 tumor rate (15 vs. 38.3%) than the open resection group. Regarding the reasons for PML, radical hysterectomy with extended lymphadenectomy for gynecologic cancer was more common (32.5 vs. 4.3%), but gastrointestinal surgeries, such as gastrectomy and colectomy, were less frequent in the laparoscopy group. Regarding intraoperative outcomes, the laparoscopy group showed a similar operative time (197 vs. 204min), intraoperative enterotomy rate (2.5 vs. 2.1%), and bowel resection rate (2.5 vs. 2.1%) with the open resection group. Regarding postoperative outcomes, the laparoscopy group showed a lower complication rate (20 vs. 40.4%), significantly reduced time to soft diet (5 vs. 7days), and shorter hospital stay (12 vs. 18days). Despite the high rate of open conversion, favorable short-term outcomes were observed in the laparoscopic group. Laparoscopy may be chosen as the primary approach in selected patients with a history of non-gastrointestinal PML (prior abdominal surgery for gynecological cancer).

PWE-230 The exaggerated inflammatory response to large incisional hernia and enterocutaneous fistula repair with biological mesh

Introduction Biological meshes are increasingly used in the repair of complex, large incisional hernias, particularly in the context of a contaminated surgical field. In our centre it was noted that patients displayed an exaggerated and prolonged inflammatory response on post-operative blood results in comparison to other similar surgical procedures. This study aims to investigate the post-operative inflammatory response in patients undergoing placement of large biological meshes for the repair of large incisional hernias or enterocutaneous fistulae. Method Post-operative white blood cell count (WCC) and complement reactive protein (CRP) levels were recorded on the first five post-operative days for a consecutive cohort of patients following repair of large ventral or incisional hernias with or without repair of enterocutaneous fistulae. The mesh size and the presence of component separation was also recorded. Post-operative WCC and CRP data was collected for a size-matched contemporaneous, consecutive control group of patients undergoing open colorectal resections for a diagnosis of colorectal cancer. Post-operative inflammatory responses were compared. Results 41 patients underwent a large ventral hernia repair using biologic mesh, of which 16 (39.0%) underwent simultaneous repair of an enterocutaneous fistula. 27 (65.9%) underwent component separation. Post-operative CRP was significantly higher in patients in the hernia group on the third (188 vs. 133) and fourth (188 vs. 117) post-operative days (p < 0.01). There was no significant difference in WCC on either day. The CRP response was not significantly different between groups by the fifth post-operative day. Repair of enterocutaneous fistulae was associated with significantly increased CRP levels on the third and fourth post-operative day when compared to hernia repair alone. There was a positive correlation between mesh area (mean area = 183cm2) and CRP level on the third post-operative day (Pearson’s r = 0.42). Conclusion Patients undergoing large ventral hernia repairs using biological mesh display an exaggerated and prolonged inflammatory response in comparison to open colorectal cancer resections. The inflammatory response is no different between groups by the fifth post-operative day. This data suggests that an exaggerated inflammatory response should be expected in such procedures and that normalisation of inflammatory markers ought to be expected by the fifth post-operative day. Disclosure of interest None Declared.

A meta-analysis to determine the oncological implications of conversion in laparoscopic colorectal cancer surgery.

Laparoscopic colon and rectal cancer surgery is oncologically equivalent to open resection, but the impact of conversion is undetermined. The aim of this study was to assess the oncological outcome and predictive factors associated with conversion. A comprehensive search for published studies examining the associated factors and outcome of conversion from laparoscopic to open colorectal cancer resection was performed adhering to PRISMA (Preferred Reporting Items in Systematic Reviews and Meta-analyses) guidelines. Only randomized control trials and prospective studies were included. Each study was reviewed and the data extracted. Random effects methods were used to combine data. Fifteen studies, including 5293 patients, met the inclusion criteria. Of these 4391 patients had a completed laparoscopic resection and 902 were converted to an open resection. The average conversion rate of the studies was 17.9±10.1%. Meta-analysis showed completed laparoscopic surgery favoured lower 30-day mortality (OR 0.134, 95% CI 0.047-0.385, P<0.0001), lower long-term disease recurrence (OR 0.634, 95% CI 0.421-0.701, P<0.023) and lower overall mortality (OR 0.512, 95% CI 0.417-0.629, P<0.0001). Factors negatively associated with completion of laparoscopic surgery were male gender (P=0.011), rectal tumour (P=0.017), T3/T4 tumour (P=0.009) and node-positive disease (P=0.009). Completed laparoscopic surgery was also associated with a lower body mass index (BMI; mean difference -0.93kg/m(2) , P=0.004). The results suggest that conversion from laparoscopic to open colorectal cancer resection is influenced by patient and tumour characteristics and is associated with an adverse perioperative outcome. Although confounding factors such as advanced tumour stage and elevated BMI are present, unsuccessful laparoscopic surgery appears to be associated with an adverse long-term oncological outcome.

Laparoscopic versus open colorectal resection for cancer and polyps: a cost-effectiveness study.

BackgroundAvailable evidence that compares outcomes from laparoscopic and open surgery for colorectal cancer shows no difference in disease free or survival time, or in health-related quality of life outcomes, but does not capture the short term benefits of laparoscopic methods in the early postoperative period.AimTo explore the cost-effectiveness of laparoscopic colorectal surgery, compared to open methods, using quality of life data gathered in the first 6 weeks after surgery.MethodsParticipants were recruited in 2006–2007 in a district general hospital in the south of England; those with a diagnosis of cancer or polyps were included in the analysis. Quality of life data were collected using EQ-5D, on alternate days after surgery for 4 weeks. Costs per patient, from a National Health Service perspective (in British pounds, 2006) comprised the sum of operative, hospital, and community costs. Missing data were filled using multiple imputation methods. The difference in mean quality adjusted life years and costs between surgery groups were estimated simultaneously using a multivariate regression model applied to 20 imputed datasets. The probability that laparoscopic surgery is cost-effective compared to open surgery for a given societal willingness-to-pay threshold is illustrated using a cost-effectiveness acceptability curve.ResultsThe sample comprised 68 laparoscopic and 27 open surgery patients. At 28 days, the incremental cost per quality adjusted life year gained from laparoscopic surgery was £12,375. At a societal willingness-to-pay of £30,000, the probability that laparoscopic surgery is cost-effective, exceeds 65% (at £20,000 ≈60%). In sensitivity analyses, laparoscopic surgery remained cost-effective compared to open surgery, provided it results in a saving ≥£699 in hospital bed days and takes no more than 8 minutes longer to perform.ConclusionThe study provides formal evidence of the cost-effectiveness of laparoscopic approaches and supports current guidelines that promote use of laparoscopy where suitably trained surgeons are available.

Association between duration of carbon dioxide pneumoperitoneum during laparoscopic abdominal surgery and hepatic injury: a meta-analysis.

BackgroundThe aim of this study is to accurately assess whether the duration of intraoperative carbon dioxide pneumoperitoneum (CDP) is associated with the induction of hepatic injury.MethodsWe conducted a systematic review of PubMed, Embase, and Cochrane Library databases (through February 2014) to identify case-match studies that compared high-pressure CDP with low-pressure CDP or varied the duration of CDP in patients who underwent abdominal surgery. The outcome of interest was postoperative liver function (ALT, AST, TB).ResultsEleven comparative studies involving 2,235 participants were included. Overall, levels of ALT, AST, and TB (on postoperative days 1, 3, and 7) were significantly elevated in the study groups. However, the results of the subanalyses of those who underwent laparoscopic colorectal cancer resection (LCR) versus open colorectal cancer resection (OCR) and those who underwent laparoscopic gastric bypass (LGBP) versus open gastric bypass (OGBP) were inconsistent.ConclusionsThe current evidence suggests that the duration of CDP during laparoscopic abdominal surgery may be associated with hepatic injury. Additional large-scale, randomized, controlled trials are urgently needed to further confirm this.

Quality of Life after Laparoscopic and Open Resection of Colorectal Cancer

Background: The aim of the study was to evaluate quality of life (QOL) outcomes after colorectal surgery for cancer from a 6-month perspective at a single institution. Methods: Cohort study to prospectively assess postoperative QOL in patients who underwent elective colorectal resection at the University Hospital Ostrava. QOL was assessed using the validated Short Form 36 (SF-36v2™) questionnaire at fixed time points. Results: A total of 148 patients were enrolled in the study (83 and 65 patients underwent laparoscopic and open colorectal resection, respectively). Operative time was significantly longer (161 vs. 133 min; p = 0.0073) and length of hospital stay was significantly shorter (10.7 vs. 13.1 days; p = 0.0451) in the laparoscopic group. Overall 30-day morbidity rates were lower in the laparoscopic group, but the difference was not significant (27.7 vs. 33.8%; p = 0.2116). QOL scores were comparable in both study groups before surgery (p ≥ 0.05). QOL was statistically significantly lower 2 days and 1 week after open colorectal surgery compared with laparoscopic surgery. One month and 6 months after surgery, there were no statistically significant differences between groups. Conclusion: The present study suggests a higher postoperative QOL during the first month after laparoscopic colorectal resection could be one of the benefits of laparoscopy.