Short-term Oncologic Outcomes Research Articles

Transanal total mesorectal excision (TaTME): current status and future perspectives.

Total mesorectal excision (TME) is the gold standard surgical treatment for mid- and low rectal cancer; however, it is associated with specific technical hurdles. Transanal TME (TaTME) is a new procedure developed to overcome these difficulties, through an enhanced visualization of the dissection plane. This potentially could result in a more accurate distal dissection with a lower rate of positive circumferential resection margins, increasing the rate of sphincter-saving procedures. The indications for TaTME are currently expanding, despite not being yet standardized, and structured training programs are ongoing to help overcome the steep learning curve related to the technique. The procedure is feasible and safe with similar intraoperative complications and readmission rates when compared with conventional open or laparoscopic TME. Favorable short-term oncologic results have been reported: in particular, TaTME is associated with mesorectal specimen of a better quality and a longer distal resection margin that is established at the beginning of the procedure under direct view. Robotics, when available, will probably overcome the steep learning curve related to the complexity of TaTME. Long-term follow-up and ongoing RCT trials data are awaited regarding functional results, local recurrence and survival, and to facilitate the comparison with standard laparoscopic or robotic rectal resections. The present review is focused on critically analyzing the theoretical benefits and risks of the procedure, its indications, short- and long-term results and future direction in the application of TaTME.

Robotic assisted 3 stage Esophagectomy for Carcinoma esophagus: A prospective single centre study

Background: Addition of robotic technique to minimally invasive esophagectomy is relatively new and is gaining acceptance worldwide.This study was done to analyse the safety, technical feasibility and short term oncological outcomes of robotic esophagectomy in Indian setup.

Effect of prostate gland weight on the surgical and oncological outcomes of extraperitoneal robot-assisted radical prostatectomy

BackgroundRobot-assisted radical prostatectomy (RARP) is performed by urologists as one of the surgical procedures for treating prostate cancer. Numerous studies have been published with regard to the impact of prostate weight on performing RARP but were limited by the insufficient number of patients and use of the transperitoneal approach. This study aimed to determine the effect of prostate gland weight on the surgical and short-term oncological outcomes of RARP using the extraperitoneal approach.MethodsIn total, 1168 patients who underwent extraperitoneal RARP (EP-RARP) performed by a single surgeon at Yonsei University Severance Hospital between May 2009 and May 2016 were included in the study. The patients were divided into 4 groups according to the prostate weight measured by transrectal ultrasonography preoperatively. Intraoperative and postoperative outcomes were analyzed retrospectively. One-way analysis of variance and the chi-square test were used in the statistical analyses.ResultsAge, the Gleason score, clinical stage, and pathological stage were significantly different. Patients with a larger prostate size had a longer console time and higher estimated blood loss (P < 0.05). There were no significant differences between the 4 groups in length of hospital stay, duration of catheterization, blood transfusion, body mass index, prostate-specific antigen (PSA) level, history of abdominal surgery, intraoperative complications, positive surgical margin, incidence of lymphocele, and PSA recurrence after 1 year.ConclusionsThe console time and estimated blood loss were significantly increased with a larger prostate size. However, there were no significant differences in the oncologic outcome and intraoperative complications, suggesting that EP-RARP requires meticulous bleeding control in patients with a prostate weighing > 75 g, and if appropriate management is implemented for blood loss intraoperatively, EP-RARP can be performed regardless of the prostate size.

Open versus laparoscopic liver resection for colorectal metastases located in the posterosuperior segments

Background: Laparoscopic liver resection of tumors located in the posterosuperior segments is considered to be technically challenging.This study aimed to compare the perioperative outcomes for laparoscopic versus open resection of colorectal liver metastases (CRLM) located in the posterosuperior segments. Methods: This is a sub-study of the Oslo-CoMet trial. In this trial, 280 patients were randomly assigned to open or laparoscopic parenchyma sparing liver resections of CLRM. Inclusion was from February 2012 to February 2016. Patients with CRLM in posterosuperior segments were identified, and perioperative and short-term oncological outcomes were collected from the prospective trial database. The Accordion system and the Comprehensive Complication Index were used for grading of postoperative complication. Results: 62 patients underwent laparoscopic and 78 patients open liver resections. Postoperative complications developed in 22 cases (28.2%) in open group and 16 cases (25.4%) in laparoscopic group (p=0.71). The median postoperative hospital stay was 2 days in the laparoscopic and 4 days in the open group (p<0.001). Further perioperative outcomes will be presented at the congress. Conclusion: We found similar postoperative complications rate and decreased hospital stay, following laparoscopic resection of posterosuperior segments in patients with CRLM.

Single-Port Laparoscopic and Robotic Cholecystectomy in Obesity (&gt;25 kg/m2)

Background and Objectives:Single-port cholecystectomy has emerged as an alternative technique to reduce the number of ports and improve cosmesis. Few previous studies have assessed obesity-related surgical outcomes following single-port cholecystectomy. In this study, technical feasibility and surgical outcomes of single-port laparoscopic cholecystectomy (SPLC) and robotic single-site cholecystectomy (RSSC) in obese patients were investigated.Methods:We conducted a two-center collaborative study and retrospectively reviewed initial experiences of RSSC and SPLC in patients whose body mass index was over 25 kg/m2. Medical records of patients were reviewed. Clinical characteristics and short-term oncologic outcomes were considered and compared between SPLC and RSSC groups.Results:RSSC and SPLC were performed in 39 and 78 patients, respectively. In comparative analysis, the total operative time was longer in the RSSC group (109.92 minutes vs. 60.99 minutes; P < .001).However, requiring additional port for completion of surgical procedure was less frequent in the RSSC group (0% vs. 12.8%; P = .029). Immediate postoperative pain score was not significantly different between the two groups (4.95 vs. 5.00; P = .882). However, pain score was significantly lower in the RSSC group at the time of discharge (1.79 vs. 2.38; P = .010). Conversion to conventional multiport cholecystectomy, intraoperative bile spillage, or complication rate was not significantly different between the two groups (P > .05).Conclusions:SPLC and RSSC could be safely performed in selected patients with high body mass index, showing no significant clinical differences.

Analyzing the current practice patterns and views among urologists regarding focal therapy for prostate cancer

Introduction and objectiveFocal therapy (FT) for localized prostate cancer (CaP) has been shown to have encouraging short-term oncological outcomes, excellent preservation of functional outcomes and is increasing in popularity in urologic community. We aim to evaluate the preferences and practice trends among urologists regarding this treatment strategy. MethodsA 20 item online questionnaire was designed to collect information on urologists' views and use of FT. The survey was sent to the members of the Endourological Society and the American Urological Association. Multivariate logistic regression analysis was done to determine predictors for utilization of FT. ResultsA total of 425 responses were received [American Urological Association: 319, Endourological Society: 106]. Mean age of respondents was 53(SD: 11.3) years. Although half of the respondents (50.8%) believed FT to be moderate to extremely beneficial in the treatment of CaP, only 24.2% (103) of the respondents currently utilize FT in their practice. Respondents who were fellowship trained in urologic oncology were more likely to consider FT to be at least moderately beneficial (P < 0.001). Surgeon's experience (greater than 15 years in urology practice) (P = 0.025) and seeing more than 10 patients with new CaP diagnosis per month (P = 0.002) were independent predictors of FT utilization for localized CaP. While the most common setting for utilization of FT was in patients with unilateral intermediate-risk (72.8%) CaP, a small percentage of respondents also used FT for patients with unilateral high-risk CaP and bilateral intermediate risk (21.4% and 10.7%, respectively). Most common reasons for not using FT were the lack of belief in 'index lesion theory' (63.2%), lack of experience (41.3%), lack of belief in FT’s efficacy (41.1%), lack of infrastructure (35.8%), difficult salvage treatment in cases of recurrence (22.7%) and high cost (21.8%). About 57.6% would use FT more often in an office or outpatient setting if they had access to reliable and cost-effective options. ConclusionsOnly a quarter of our respondents utilize FT in their practice with surgeon's experience being the important independent predictor for using FT. Majority of respondents though consider FT to be beneficial in CaP management, would use it more often if provided more reliable and cost-effective options. Over time, experience and accessibility to reliable methods to perform FT may lead to further utilization of this novel treatment strategy.

Natural Orifice Transluminal Endoscopic Surgery for Colorectal Cancer

AbstractLaparoscopic colorectal resection is used increasingly in colon and rectal cancer treatment. In our study, two NOTES techniques were assessed; laparoscopic colorectal resection with Natural Orifice Specimen Extraction (NOSE) in 16 cases and transanal Total Mesorectal Excision (taTME) in 18 cases. Feasibility, short term oncologic outcome, as well as, com-paring both techniques are displayed. Finally, although patients in our study were not randomly assigned to either arm, we could demonstrate better quality of mesorectal excision in the transanal dissection group in comparison to conventional laparoscopy with NOSE technique.

Transanal total mesorectal excision (TaTME) versus laparoscopic TME for MRI-defined low rectal cancer: a propensity score-matched analysis of oncological outcomes

BackgroundWhile a shift to minimally invasive techniques in rectal cancer surgery has occurred, non-inferiority of laparoscopy in terms of oncological outcomes has not been definitely demonstrated. Transanal total mesorectal excision (TaTME) has been pioneered to potentially overcome difficulties experienced when operating with a pure abdominal approach deep down in the pelvis. This study aimed to compare short-term oncological results of TaTME versus laparoscopic TME (lapTME), based on a strict anatomical definition for low rectal cancer on MRI.MethodsFrom June 2013, all consecutive TaTME cases were included and compared to lapTME in a single institution. Propensity score-matching was performed for nine relevant factors. Primary outcome was resection margin involvement (R1), secondary outcomes included intra- and post-operative outcomes.ResultsAfter matching, forty-one patients were included in each group; no significant differences were observed in patient and tumor characteristics. The resection margin was involved in 5 cases (12.2%) in the laparoscopic group, versus 2 (4.9%) TaTME cases (P = 0.432). The TME specimen quality was complete in 84.0% of the laparoscopic cases and in 92.7% of the TaTME cases (P = 0.266). Median distance to the circumferential resection margin (CRM) was 5 mm in lapTME and 10 mm in TaTME (P = 0.065). Significantly more conversions took place in the laparoscopic group, 9 (22.0%) compared to none in the TaTME group (P < 0.001). Other clinical outcomes did not show any significant differences between the two groups.ConclusionThis is the first study to compare results of TaTME with lapTME in a highly selected patient group with MRI-defined low rectal tumors. A significant decrease in R1 rate could not be demonstrated, although conversion rate was significantly lower in this TaTME cohort.

Robot assisted minimally invasive esophagectomy (RAMIE) for esophageal cancer

Worldwide, the standard treatment for locally advanced esophageal cancer with curative intent is perioperative chemotherapy or preoperative chemoradiotherapy followed by open transthoracic esophagectomy (OTE) with gastric conduit reconstruction. Minimally invasive esophagectomy (MIE) was developed to improve the postoperative outcome by reducing the surgical trauma, with comparable short-term oncologic results. However, MIE is a highly complex procedure associated with a long learning curve.In 2003, robot-assisted minimally invasive thoraco-laparoscopic esophagectomy (RAMIE) was developed to overcome the technical limitations of MIE. Robotic surgery benefits from a stable 3-dimensional, magnified view and articulated instruments enabling precise dissection with 7 degrees of freedom of movement.In this review, the development of RAMIE within our hospital is described using a 5-stage development process for the assessment of surgical innovation (IDEAL).

Open or laparoscopic resection: does approach matter?

In colon cancer surgery, laparoscopic resection is a safer and more feasible method than open resection; however, despite its increasing popularity in recent years, laparoscopic approaches for the treatment of rectal cancer have not become a standard therapy option, due to the technical difficulties in gaining access to the deep and narrow pelvis and the steep learning curve. Multiple randomized trials found that short-term oncological outcomes and perioperative mortality and morbidity were comparable between laparoscopic and open rectal surgery, whereas comparative data between the two approaches. Comparative data between the two approaches on long-term oncological outcomes remain limited. In this review, we summarize the current status of laparoscopic surgery in rectal cancer in the light of recent studies.

Comparison of short-term oncologic outcome of robotic thyroid surgery using dynamic risk stratification: A propensity score–matched comparison study

The long-term oncologic outcome of robotic surgery for thyroid cancer is not well established. The aim of this study was to predict the long-term oncologic outcome of robotic surgery by using dynamic risk stratification in classic papillary thyroid carcinoma. A total of 444 propensity score-matched pairs of patients with papillary thyroid carcinoma treated with robotic surgery and conventional open surgery were classified into 4 response-to-therapy categories. The results were compared between the robotic surgery and open surgery groups. The median follow-up duration was 60 months. After propensity score matching, the robotic surgery group showed less extensive thyroid surgery and lymph node dissection and a higher proportion of patients who underwent radioactive iodine remnant ablation than the open surgery group; however, the dynamic risk stratification did not differ between the 2 groups (P = .086). The long-term oncologic outcome of robotic surgery is expected to be comparable with that of open surgery based on the dynamic risk stratification.

Controversies in Surgical Oncology: Does the Minimally Invasive Approach for Rectal Cancer Provide Equivalent Oncologic Outcomes Compared with the Open Approach?

Compared with open surgery, minimally invasive surgery for colon cancer has been shown to improve short-term outcomes and yield equivalent long-term oncologic results. It remains to be seen if oncologic outcomes for the minimally invasive approach for rectal cancer are equivalent to traditional open rectal resection. We conducted a systematic review of Medline, SCOPUS, and Cochrane databases. Relevant studies were selected using Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Five key questions comparing minimally invasive and open oncologic outcomes for rectal cancer were specifically analyzed. A meta-analysis was not done due to heterogeneity of studies. Forty-five studies met inclusion criteria, including six randomized controlled trials. The laparoscopic approach to rectal resection was not more likely than the traditional open approach to have clear circumferential and distal margins, a complete total mesorectal excision grade, ≥ 12 lymph nodes in the resected specimen, reduced local recurrence rates, or reduced overall survival rates. Two randomized trials revealed that successful laparoscopic resection was not noninferior to open. Caution should be exercised when choosing surgical options for rectal cancer. Results of randomized trials could not prove that short-term oncologic outcomes of laparoscopic surgery were equivalent to those after open surgery even when performed by surgeons with laparoscopic expertise. However, reported long-term data have not shown a difference in outcomes between laparoscopic and open surgery. Future advances in minimally invasive technology may improve oncologic margins but these will require careful study and scrutiny.

Introduction of minimally invasive surgery for distal and total gastrectomy: a population-based study

BackgroundMinimally invasive gastrectomy has been introduced in Western populations during the last decade. As minimally invasive distal gastrectomy (MIDG) versus total gastrectomy (MITG) are procedures with a different complexity, outcomes may differ. The aim of this population-based cohort study was to evaluate the safety of MIDG and MITG. Materials and methodsAll patients who underwent potentially curative gastrectomy for gastric adenocarcinoma were included from the Dutch Upper GI Cancer Audit (2011–2016). Propensity score matching was applied to create comparable groups of patients receiving open distal gastrectomy (ODG) versus MIDG and open total gastrectomy (OTG) versus MITG, using patient and tumor characteristics. Postoperative outcomes and short-term oncological outcomes were appraised. ResultsOf the 1970 eligible patients, 1138 underwent distal gastrectomy and 832 underwent total gastrectomy. For distal gastrectomy, 390 ODG were matched to 288 MIDG patients. Although overall postoperative morbidity and mortality were similar, patients who underwent MIDG encountered less intra-abdominal abscesses (4% vs. 1%, p = 0.039) and wound complications (6% vs. 2%, p = 0.021). The median hospital stay was shorter after MIDGs (9 vs. 7 days, p < 0.001). For total gastrectomy, 323 OTG patients were matched to 258 MITG patients. Overall postoperative morbidity, mortality and hospital stay were similar, whereas the anastomotic leakage rate was higher after MITGs (11% vs. 17%, p = 0.030). Short-term oncological outcomes between both groups were equal for distal and total gastrectomy. ConclusionBenefits of MIG during the early introduction were demonstrated for distal gastrectomy but not for total gastrectomy. An increased anastomotic leakage rate was encountered for MITG.

PS01.147: BODY MASS INDEX AND PERIOPERATIVE OUTCOMES AFTER ESOPHAGECTOMY: THORACOABDOMINAL APPROACH HAS EQUIVALENT RESULTS AS MINIMALLY INVASIVE ESOPHAGECTOMY

Abstract Background A thoracoabdominal approach to esophagectomy provides excellent exposure to the lower esophagus and gastroesophageal junction, particularly in obese patients and in patients with prior chest or abdominal surgery. However, thoracoabdominal esophagectomy (TE) has been associated with higher rates of perioperative complications and limits to the extent of resection, which may have oncologic consequences. Selectively approaching most obese or re-operative patients with esophageal cancer following neoadjuvant therapy through an open thoracoabdominal incision, the aim of this study was to compare perioperative complications and short-term oncologic outcomes of TE with minimally invasive Ivor-Lewis esophagectomy (MIE). Methods All esophageal cancer patients who underwent neoadjuvant treatment followed by MIE or TE with curative intent at a tertiary referral center between 2008 and 2017 were identified using a prospectively maintained database. Primary outcomes were oncological adequacy, including extent of lymph node resection and R0 resection rates, and perioperative complications including pneumonia, anastomotic leakage and chylothorax. Secondary outcomes included length of stay and readmission rates. Results A total of 171 patients were included, of whom 139 patients underwent MIE and 32 patients TE. Patients who underwent TE had a significantly higher body mass index (BMI) (mean 30.6 vs 26.5, P = 0.001) and were more likely to have relevant surgical history (56% vs 1%, P = 0.001). R0 resection rates were the same regardless of operative approach. Pathologic N-stage was the same between groups, though total lymph node yield was higher with MIE (mean 15 vs 20, P = 0.006). The rate of postoperative complications was not increased with TE. Median length of stay was one day longer in the TE group (P = 0.007). Conclusion In patients with esophageal cancer, resection is often more challenging in the setting of obesity or prior surgery, particularly in patients treated with neoadjuvant therapy. By selectively employing a thoracoabdominal approach in these difficult cases equivalent oncologic outcomes can be achieved, with no significant increase in postoperative complications, as compared with MIE. This study demonstrates that patient-specific selection in surgical approach can lead to comparable postoperative results. Further studies are warranted to evaluate effects on long-term outcomes. Disclosure All authors have declared no conflicts of interest.

Outcomes of Elderly Patients Undergoing Curative Resection for Retroperitoneal Sarcomas: Analysis From the US Sarcoma Collaborative

BackgroundThe postoperative outcomes of elderly patients undergoing resection of retroperitoneal sarcomas (RPS) have not been widely studied. MethodsPatients undergoing surgical resection for primary or recurrent RPS between 2000 and 2015 at participating US Sarcoma Collaborative institutions were identified. Patient demographics, perioperative morbidity, mortality, length of stay, discharge to home, disease-specific survival, and disease-free survival were compared between elderly (≥70 y, n = 171) and nonelderly (<70 y, n = 494) patients. ResultsThere was no difference in perioperative morbidity (total and major complications elderly versus nonelderly: 39% versus 35%; P = 0.401 and 18% versus 17%; P = 0.646, respectively) or mortality between elderly and nonelderly patients with each group experiencing a 1% 30-d mortality rate. Length of stay and 30-d readmission rates were similar (elderly versus nonelderly; 7 d interquartile range [IQR: 5-9] versus 6 d [IQR: 4-9], P = 0.528 and 11% versus 12%, P = 0.667). Elderly patients were more likely to be discharged to a skilled nursing or rehabilitation facility (elderly versus nonelderly; 19% versus 7%, P < 0.001). There was no difference in 3-y disease-free survival between the elderly and nonelderly patients (41% versus 43%, P = 0.65); however, elderly patients had a lower 3-y disease-specific survival (60% versus 76%, P < 0.001). In elderly patients, the presence of multiple comorbidities and high-grade tumors were most predictive of outcomes. ConclusionsAdvanced age was not associated with an increased risk of perioperative morbidity and mortality following resection of RPS in this multi-institutional review. Although short-term oncologic outcomes were similar in both groups, the risk of death after sarcoma recurrence was higher in elderly patients and may be related to comorbidity burden and tumor histology.

Magnetic resonance guided focused high frequency ultrasound ablation for focal therapy in prostate cancer - phase 1 trial.

To evaluate the feasibility and safety of focal therapy for low-intermediate risk prostate cancer (PCa) with magnetic resonance-guided high frequency focused ultrasound (MRgFUS) METHODS: This IRB-approved phase 1 prospective study enrolled eight patients with prostate specific antigen (PSA) ≤ 10 ng/ml, ≤ cT2a and Gleason score ≤ 7 (4 + 3) disease following informed consent. Under MRI guidance, focused high frequency ultrasound energy was delivered to ablate the target tissue. Treatment-related adverse events were recorded. Oncologic outcomes were evaluated with multiparametric MRI, PSA and TRUS biopsy at 6 months following treatment. Ten target lesions [six Gleason 6 lesions, two Gleason 7 (3 + 4) and two Gleason 7 (4 + 3)] were treated in eight men (prostate volume range, 25-50 cc; mean MRI time, 248 min per patient; mean sonication duration, 65 min). Mean target volume was 2.7 cc and mean post-treatment non-perfused volume was 4.3 cc. Quality of life parameters were similar between baseline and 6 months in 6/8 patients. All treated regions were negative on MRI; 4/8 patients and 6/10 target lesions (60%) were clear of disease on biopsy. One patient with 2-mm Gleason 8 disease in one of five cores from treatment site (4 + 3 disease at baseline) subsequently underwent prostatectomy with negative surgical margins. Three patients with low volume (5-15%) Gleason 6 residual disease were offered active surveillance. Mean PSA decreased from 5.06 at baseline to 3.4 ng/ml at 6 months. MRgFUS is a feasible and safe method of noninvasively ablating low-intermediate risk PCa with acceptable short-term oncologic outcomes. • Focal therapy selectively ablates locally confined, clinically significant index lesion with a margin while sparing rest of gland and adjacent vital structures. • Magnetic resonance-guided focused high frequency ultrasound surgery (MRgFUS) combines MRI with HIFU. • MRgFUS provides ability to monitor treatments in real time and allows a targeted approach for focal ablation. • MRgFUS is a feasible, safe method of noninvasively ablating low-intermediate risk PCa. • MRgFUS providesacceptable oncologic outcomes at 6 months.

Comparison of Short-Term Functional, Oncological, and Perioperative Outcomes Between Laparoscopic and Robotic Partial Nephrectomy Beyond the Learning Curve

To compare the short-term outcomes of robot-assisted partial nephrectomy (RPN) and laparoscopic partial nephrectomy (LPN) when performed by highly experienced surgeons. A prospective multicenter study was conducted, including the 50 last patients having undergone LPN and RPN for T1-T2 renal tumors in two institutions between 2013 and 2016, performed by two different surgeons with an experience of over 200 procedures each in LPN and RPN, respectively, at the beginning of the study. Perioperative parameters and functional and oncological outcomes were collected and compared between the LPN and RPN groups. The laparoscopic approach was associated with a longer warm ischemia time (15.7 versus 23 minutes; P < .001) and hospital stay (3.6 versus 4.6 days; P = .01). Conversely, estimated blood loss was significantly higher in the RPN group (381 mL versus 215 mL; P < .001), but transfusion rates were similar between the two groups (8% versus 6%; P = .33). In the RPN group, three patients (6%) required conversion to open partial nephrectomy and three patients (6%) required a conversion to radical nephrectomy (RN), while no conversion was needed in the LPN group. There were no differences in terms of perioperative complications, and change in renal function was comparable in the two groups postoperatively. Positive surgical margin rates were similar in the RPN and LPN groups (2% versus 6%; P = .36). After a median follow-up of 19 and 14 months in the RPN and LPN groups, respectively (P = .38), recurrence-free survivals did not differ significantly (P = .94). In this series, perioperative and short-term oncological and functional outcomes appeared broadly comparable between RPN and LPN when performed by highly experienced surgeons.

A Retrospective Study Comparing Surgical and Early Oncological Outcomes between Intracorporeal and Extracorporeal Ileal Conduit after Laparoscopic Radical Cystectomy from a Single Center.

Background:Robot-assisted/laparoscopic intracorporeal ileal conduit (ICIC) has been reported in many experienced centers. Whether laparoscopic ICIC is superior to extracorporeal ileal conduit (ECIC) and whether laparoscopic ICIC should be promoted is still controversial. The aim of the study was to compare surgical and early oncological outcomes between patients undergoing laparoscopic radical cystectomy (LRC) with ICIC and ECIC.Methods:From January 2011 to June 2016, a total of 45 patients with bladder cancer underwent LRC with ileal conduit at our department, of whom 20 patients underwent LRC with ECIC and 25 patients underwent LRC with ICIC. Data of each patient's characteristics, surgical outcomes, and short-term oncological outcomes were collected and analyzed.Results:LRC with ileal conduit was performed successfully on all 45 patients. There were no significant differences in patients’ characteristics, mean total operative time, and mean estimated blood loss between the ICIC and ECIC groups. Median time of flatus and oral intake was shorter in the ICIC group compared with the ECIC group (3 vs. 5 days, P = 0.035; 4 vs. 5 days, P = 0.002). The complications rates did not show significant difference between the two groups within the first 90 days postoperatively (P = 0.538). Cancer staging showed 45% of patients in the ECIC group and 36% in the ICIC group had a pathologic stage of T3 or T4, and 50% of patients in the ECIC group and 44% in the ICIC group had a pathologic stage of N1 or N1+. Kaplan–Meier analysis showed no significant difference in overall survival at 24 months (60% vs. 62%, P = 0.857) between the ECIC and ICIC groups.Conclusions:ICIC after LRC may be successful with the benefits of faster recovery time. No significant difference was found in complications and oncological outcomes between ICIC and ECIC. However, larger series with longer follow-up are needed to validate this procedure.

Single-Incision Laparoscopic Colectomy for Colon Cancer: Experiences with 308 Consecutive Cases

Single-incision laparoscopic surgery (SILS) has been developed with the aim to further reduce the invasiveness of conventional laparoscopy. Our experiences with more than 300 consecutive patients with SILS for colon cancer are reviewed, and its outcomes are evaluated to determine the midterm clinical and oncologic safety of SILS for colon cancer in a community hospital. A single surgeon's consecutive experience of SILS for colon cancer is presented. Three hundred and eight patients were treated with the SILS procedure for colon cancer between December 2010 and March 2015. Data were analyzed according to intention to treat. Of these 308 patients, 19 (6.2%) were converted to laparotomy. Intraoperative injury occurred in five patients. Postoperative complications occurred in 19 patients (6.2%). The 2-year relapse-free survival rates of patients with Stage I, Stage II, and Stage III were 97.8, 92.2, and 80.4 per cent, respectively, and the 2-year overall survival rates of patients with Stage I, Stage II, Stage III, and Stage IV were 100, 95.7, 93.0, and 74.4 per cent, respectively. Our initial experiences showed that SILS colectomy for cancer can be performed safely and with good short-term oncologic outcomes by a skilled surgeon.

Oncological and functional outcomes of 244 laparoscopic urological procedures: Cumhuriyet University experience

Objective: Presenting short-term oncological and functional outcomes of laparoscopic procedures performed in the past two years in the Urology Department of Cumhuriyet University Health Services Training and Research Hospital. Method: Clinical data of a total of 244 patients, including 13 pediatric patients, who underwent laparoscopic surgery between May 2015 and February 2018 were evaluated retrospectively. Results: Of the patients who underwent laparoscopic surgery, 139 (57%) were male and 105 (43%) were female, 13 (5%) were pediatric and the mean age of the patients was 52.6 ± 17.6 (1-83). Radical nephrectomy was performed in 47 patients, radical prostatectomy was performed in 46 patients, simple nephrectomy was performed in 37 patients, renal cyst excision was performed in 35 patients, partial nephrectomy was performed in 26 patients, dismembered pyeloplasty was performed in 25 patients 13 of whom were pediatric, adrenalectomy was performed in 15 patients, ureterolithotomy was performed in 8 patients, pyelolithotomy was performed in 2 patients, sacrocolpopexy was performed in 2 patients, and due to undescended testicle diagnosis, laparoscopy was performed in 1 patient. The mean duration of operation was 101.9 ± 62.7 (20-270) minutes and the mean amount of bleeding was found as 154.3 ± 138.7 (5-800) ml. Transperitoneal approach was preferred in all other cases except extraperitoneal radical prostatectomy. Blood transfusion was required in twenty-six cases, fourteen of which were laparoscopic radical prostatectomy in perioperative and / or postoperative periods. There was no need for initiating intraoperative open surgery except one case. In one case, laparotomy was required due to bleeding on the 4th postoperative day. In six cases, superficial wound site infection developed. The mean duration of postoperative hospitalization was 3.8 ± 2.7 days (1-8 days). The mean follow-up period of our patients was 16.5 (0-33) months. Conclusions: Laparoscopic urological surgeries are frequently preferred as minimally invasive procedures being technically well-defined, with good oncological and functional outcomes, as well as with short hospitalization periods and cosmetic advantages.