Resection For Left-sided Colon Cancer Research Articles

Predictive Factors of Anastomotic Leakage after Resection of Left Colon Cancer: A Single Center Experience

Purpose: To evaluate the incidence and the different potential risk factors for the development of anastomotic leakage (AL) after resection of left-sided colon cancer. Also, to evaluate the AL impact on long-term survival outcomes.

Comparison of clinical efficacy between bursa omentalis approach and medial-to-lateral approach in laparoscopic left hemicolectomy: a propensity score matching analysis

Objective: Splenic flexure mobilization is technically difficult during the resection of left hemicolon cancer. This study aims to compare the safety and effectiveness between the bursa omentalis approach (BOA) and medial-to-lateral approach (MTLA) in laparoscopic radical resection of left-sided colon cancer. Methods: A retrospective cohort study was conducted. Inclusion criteria: (1) patients underwent radical resection of left hemicolon cancer; (2) the postoperative pathological result was adenocarcinoma; (3) patients aged 18-80 years old; (4) no liver, peritoneal or other distant metastasis. Exclusion criteria: (1) poor physical condition with serious heart, brain, lung, liver, kidney and hematopoietic system diseases; (2) unable to tolerate laparoscopic surgery; (3) history of other malignancies simultaneously, or multisource tumors; (4) emergency operation due to bleeding, obstruction, perforation, etc. Clinical data of 189 patients who underwent laparoscopic left hemicolectomy in the Guangdong Provincial Hospital of Chinese Medicine from 2014 to 2020 were retrospectively analyzed. According to surgical approaches, patients were divided into the BOA group (52 cases) and MTLA group (137 cases). The whole group of patients were matched by propensity score matching (PSM) according to the nearest neighbor matching method. The caliper value was 0.01. The matching variables included gender, age, American Society of Anesthesiologists (ASA) score, body mass index, tumor location and tumor stage. After PSM, 47 patients were included in the BOA group and MTLA group, respectively. There were no significant differences in baseline data between the two groups after PSM (all P>0.05). Paired t-test, paired rank sum test and paired Chi-square test were used to compare intraoperative and postoperative paramether between the two groups. Kaplan-Meier method was used to draw the survival curve, and log rank test was used for inter group comparison. When the two survival curves intersect, the two-stage method and restricted mean survival time (RMST) were further performed. Results: Both groups of patients successfully completed the operation without conversion to laparotomy or intraoperative death. No combined splenectomy or pancreatectomy were performed in the two groups. There were also no significant differences in intraoperative blood loss, number of harvested lymph nodes, time to the first flatus and the length of hospital stay between the two groups (all P>0.05). However, the median laparoscopic dissection time in the BOA group was shorter than that in the MTLA group, and the difference was statistically significant (median: 56 minutes vs. 65 minutes, P=0.032). No entry to posterior pancreatic space was recorded in the BOA group but wrong entry to posterior pancreatic space happened to 6.4% (3/47) of patients (body mass index >25 kg/m(2)) when dissecting left Toldt's fascia in the MTLA group. The 3-year disease-free survival rate in BOA group and MTLA group was 90.2% and 86.1%, respectively (P=0.909) and the 3-year overall survival rate was 85.6% and 94.4%, respectively (P=0.532). Conclusions: BOA is safe and feasible in laparoscopic left hemicolectomy, especially for inexperienced surgeons. For obese patients, BOA facilitates the entrance into the correct anatomical level and avoid entering the retropancreatic space.

Comparison and short-term outcomes between hand-assisted laparoscopic surgery and conventional laparoscopic surgery for anterior resections of left-sided colon cancer

Hand-assisted laparoscopic surgery has been introduced as an alternative to conventional laparoscopic surgery. This study compared the efficacies and short-term clinical outcomes between hand-assisted laparoscopic anterior resection (HAL-AR) and conventional laparoscopic anterior resection (CL-AR) for treating left-sided colon cancer. We retrospectively analyzed 248 patients who underwent anterior resection for colon cancer (118 HAL-AR and 128 CL-AR) between May 2000 and December 2006. The collected data included the perioperative and short-term oncologic outcomes. There were no significant differences between the HAL-AR and CL-AR groups, except for the operation time and the size of the primary tumor. The operation time of the HAL-AR group was significantly shorter than that of the CL-AR group (p = 0.004), and the size of the primary tumor in the HAL-AR group was significantly larger than that of the CL-AR group (p = 0.019). The operating time of the HAL-AR group reached an earlier mean plateau than did that of the CL-AR group. Before and after reaching the plateau, there were no differences in the perioperative results between the two groups. The operating time for the HAL-AR group was significantly shorter than that of the CL-AR group after reaching a plateau (p = 0.012). The short-term outcomes for both groups were similar in terms of survival and recurrence (p = 0.996 and p = 0.476, respectively). Hand-assisted laparoscopic anterior resection has a shorter operative time than does CL-AR and is more successful than CL-AR for resecting larger tumors, while both procedures result in similar short-term oncologic outcomes. Hand-assisted laparoscopic anterior resection is thought be a comparable operative technique for anterior resection of left-sided colon cancer.

Factors affecting difficulty of laparoscopic surgery for left-sided colon cancer

Laparoscopic colon resection for left-sided colon cancer is being performed with increasing frequency worldwide. The purpose of this study is to evaluate the influence of patient- and procedure-related factors on difficulty of laparoscopic surgery for left-sided colon cancer. Two hundred sixty consecutive patients underwent laparoscopic surgery for left-sided colon cancer from July 2005 to December 2008. Gender, body mass index (BMI), tumor location, tumor size, previous abdominal surgery, tumor depth, tumor stage, splenic flexure mobilization, type of anastomosis, and site of arterial division were analyzed as potential variables that affect difficulty of laparoscopic surgery. Dependent variables were operative time, intraoperative blood loss, intra- and postoperative complications, and proximal and distal tumor margin. Univariate and multivariate analyses were performed to determine predictive significance of variables. Multivariate analysis showed that male gender (P = 0.0183) and splenic flexure mobilization (P < 0.0001) were independently predictive of longer operative time. Splenic flexure mobilization was related to greater intraoperative blood loss (P = 0.0006), intraoperative complications (P = 0.0111, odds ratio: 7.22), and wider distal tumor margin (P = 0.0048). Male gender and splenic flexure mobilization were independent predictors of difficulty of laparoscopic surgery for left-sided colon cancer. In contrast, our findings also showed that BMI, tumor location, previous abdominal surgery, tumor stage, type of anastomosis, and site of arterial division did not have an adverse impact on difficulty of laparoscopic surgery for left-sided colon cancer in our clinical setting. Our data support the safety of performing laparoscopic surgery for left-sided colon cancer in well-selected patients by well-experienced surgical teams.