Surgical Outcomes Of Laparoscopic Surgery Research Articles

Laparoscopic versus open surgical management in elderly patients with rectal cancer aged 70 and older.

This retrospective study aimed to compare the short- and long-term surgical outcomes of laparoscopic surgery versus open surgery in elderly patients with rectal cancer. Elderly patients (≥70 years old) with rectal cancer who received radical surgery were retrospectively analysed. Patients were matched (1:1 ratio) using propensity score matching (PSM), with age, sex, body mass index, American Society of Anesthesiologists score and tumour-node-metastasis staging included as covariates. Baseline characteristics, post-operative complications, short- and long-term surgical outcomes and overall survival (OS) were compared between the two matched groups. Sixty-one pairs were selected after PSM. Patients with laparoscopic surgery had a longer duration of operation time, lower estimated blood loss, shorter duration of post-operative analgesics administered, time to first flatus, time to first oral diet and post-operative hospitalisation stay than those observed in patients with open surgery (All P < 0.05). The incidence of post-operative complications in the open surgery group was numerically higher than that occurred in the laparoscopic surgery group (30.6% vs. 17.7%). Median OS was 67.0 months (95% confidence interval [CI], 62.2-71.8) in the laparoscopic surgery group and 65.0 months (95% CI, 59.9-70.1) in the open surgery group, however, Kaplan-Meier curves indicated that no significant differences in OS (Log-rank test, P = 0.535) were noted between the two matched groups. Compared with the open surgery, laparoscopic surgery had the advantages of less trauma and faster recovery, and provided similar long-term prognostic outcome in elderly patients with rectal cancer.

Comparison of short-term surgical outcome between 3D and 2D laparoscopy surgery for gastrointestinal cancer: a systematic review and meta-analysis

Three-dimensional (3D) laparoscopic surgery is becoming more popular with the development of laparoscopic devices. The objective of this study was to explore whether the 3D imaging system could improve surgical outcomes of laparoscopic surgery for gastrointestinal cancer compared with the 2D imaging system. Systematic literature search was performed using PubMed and Embase databases and relevant data were extracted. Surgical quality, postoperative complications, and postoperative recovery between 3D and 2D laparoscopic surgery groups were compared using a fixed or random effect model. A total of 12 studies involving 1456 patients (3D group 683 patients and 2D group 773 patients) were included in this meta-analysis. The results indicated that mean operation time was significantly shorter in 3D group than in 2D group (WMD, - 9.08; 95% CI, - 14.77, - 3.40; P = 0.002; I2= 70.3%), especially for gastric cancer patients (WMD, - 14.61; 95% CI, - 26.00, - 3.23, P = 0.012; I2= 74.1%). In addition, 3D laparoscopic surgery for gastric cancer had an advantage than 2D group in reducing the amount of intraoperative blood loss (WMD, - 13.60, 95% CI, - 21.48, - 5.72; P = 0.001; I2= 0%). The number of retrieved lymph nodes in 3D group was not significantly different from that in 2D group, regardless of laparoscopic gastrectomy (WMD, 1.10; 95% CI, - 0.67, 2.88; P = 0.222; I2= 18.8%) and laparoscopic colorectal surgery (WMD, 0.55, 95% CI; - 1.99, 3.09; P = 0.671; I2= 76.9%). In addition, there was no significant difference between 3D and 2D laparoscopic surgery for postoperative complications and postoperative recovery. Main advantages of 3D laparoscopic gastrectomy for gastric cancer were that it could shorten the operation time and reduce the amount of intraoperative blood loss. However, 3D laparoscopic surgery had no obvious advantage over 2D laparoscopic surgery for colorectal cancer patients.

Comparison of Laparoscopic and Open Surgery for Patients With Borderline Ovarian Tumors

The aim of this study was to compare surgical and oncologic outcomes of open and laparoscopic surgery in patients with borderline ovarian tumors (BOTs). This study included patients with BOTs who underwent open (n = 433) or laparoscopic (n = 210) surgery between 1990 and 2015. Surgical outcomes, perioperative morbidity, and disease-free survival and overall survival were compared. There was no significant difference in age, histologic type of tumor, and laterality of tumor. However, body mass index was slightly higher for the open surgery group (P = 0.046). The open surgery group had a higher serum cancer antigen 125 level (P < 0.001), larger tumor size (P < 0.001), more frequent radical surgery (P = 0.001), higher stage (P = 0.034), and higher incidence of invasive implants (P = 0.035). The operative time (P < 0.001), time interval to return of bowel movement (P < 0.001), and length of postoperative hospital stay (P < 0.001) were significantly shorter and estimated blood loss was significantly less (P < 0.001) in the laparoscopic group. Perioperative complications were documented in 5 (2.4%) patients in the laparoscopic surgery group and 17 (3.9%) in the open surgery group (P = 0.064). Twenty-three (5.3%) patients in the open surgery group and 9 (4.3%) in the laparoscopic surgery group had recurrence (P = 0.902) at a median follow-up of 57 months. The 10-year disease-free survival was 96% and 97% for the open and laparoscopic groups, respectively (P = 0.851), with no significant difference between the groups after adjusting for independent factors (odds ratio, 1.0; 95% confidence interval, 0.4-2.4; P = 0.999). The 10-year overall survival was 99% for both groups, respectively (P = 0.441). Laparoscopic surgery and open surgery showed similar survival outcomes in BOTs. The surgical outcomes of laparoscopic surgery were more favorable.

Should We Manage Large Ovarian Cysts Laparoscopically?

Abstract Objective: The aim of this research was to evaluate the feasibility and surgical outcomes of laparoscopic surgery for large ovarian cysts in women <40 years of age. Materials and Methods: This was a retrospective evaluation (Canadian Task Force classification 11-2 design) of 55 women (ages <40) with large ovarian cysts (≥10 cm) with features suggestive of benign disease managed laparoscopically at Paul's Hospital, in Cochin, Kerala, from July 2006 to April 2013. All patients were followed-up for a minimum of 1 year. Patients who were diagnosed as having borderline ovarian tumors were evaluated for their present clinical status at the end of study. Results: Laparoscopic surgery was performed successfully for all patients. The mean operative time, estimated blood loss, and hospital stay were, respectively, 109.6 minutes (range: 40–255), 304.6 mL (range: 100–650), and 1.1 days (range: 1–3). Conversion to laparotomy was performed in none of the patients. Five cases of borderline malignancy were detec...

Long-term and surgical outcomes of laparoscopic surgery for gastric gastrointestinal stromal tumors

Gastrointestinal stromal tumors (GISTs) are the most common mesenchymal neoplasms of the gastrointestinal tract. Surgical resection with a free margin is the gold standard treatment for these lesions. The aim of this study was to evaluate the feasibility of performing laparoscopic resection for gastric GIST from the viewpoint of operative and long-term oncological outcomes. Between 2005 and 2011, a total of 78 consecutive patients undergoing laparoscopic resection of gastric GISTs were enrolled in a retrospective single-center study. Patient and tumor characteristics, surgical procedures, risk classification, postoperative complications, mortality, recurrence, and survival time were collected from a database, and the descriptive statistics were estimated. Patients (N = 78; 32 males and 46 females) with a median age of 63 years (range 31-82) were evaluated. The tumors were located at the cardia (10.3%), upper stomach (59.0%), middle stomach (23.1), and lower stomach (7.7%). The mean size of the tumors was 34.7 ± 12.1 mm. The laparoscopic procedures included wedge resection (92.3%), such as laparoscopy and endoscopy cooperative surgery (51.3%), and gastrectomy (7.7%). All cases exhibited a pathologically negative margin. The mean operative time was 147.5 ± 63.8 min, and the mean estimated amount of blood loss was 17.8 ± 47.9 ml. The mean length of hospitalization was 9.4 ± 12.8 days. The incidence of perioperative complications higher than grade III was 2.6%, including two cases of anastomotic leakage. Regarding risk classification, low, intermediate and high were observed in 61, 6, and 11 cases, respectively. During a mean follow-up period of 45.3 ± 18.5 months, one patient experienced local recurrence in the omentum. Meanwhile, four patients died due to other diseases; all other patients survived. Adequate oncologic resection was achieved in all cases. Laparoscopic surgery is a feasible option for gastric GISTs <5 cm.

The impact of visceral obesity on surgical outcomes of laparoscopic surgery for colon cancer

Although obesity is considered as a risk factor for postoperative morbidity in abdominal surgery, its effect on the outcomes of laparoscopic-assisted colectomy (LAC) is still unclear. The technical difficulty and risk factor for postoperative complication in LAC are thought to be influenced by visceral obesity. The aim of this prospective study was to evaluate the impact of visceral fat on the surgical outcomes of LAC. Between April 2005 and December 2010, consecutive patients with preoperatively diagnosed colon cancer, excluding medium and low rectal cancer, who underwent LAC, were enrolled. Their visceral fat area (VFA) and body mass index (BMI) were prospectively collected. The VFA was assessed by Fat Scan software. The patients were classified into two groups as follows: VFA nonobese with VFA <100 cm(2) (VNO) and VFA obese with VFA ≧100 cm(2) (VO). The predictive factors for surgical complications of LAC were evaluated by univariate and logistic regression analyses. A total of 338 consecutive patients were enrolled in this study. Of the 338 patients, 194 (57.4 %) and 138 (42.6 %) were classified into the VNO and VO groups, respectively. Logistic regression analysis showed that high BMI (≧25 kg/m(2)) and VO independently predicted the incidence of overall postoperative complications (p = 0.040 and 0.007, respectively). VO was more highly related to the incidence of overall postoperative complications, anastomotic leakage (p = 0.021), and surgical site infection (SSI) (p = 0.013) than high BMI. VFA is a more useful parameter than BMI in predicting surgical outcomes after LAC.

Robotic Surgical System: A Possible Solution for Treating Severe Adhesion during Gynecological Surgeries

Pelvic adhesion is considered as contraindication to laparoscopic surgeries. In this study, we evaluated the surgical outcomes of laparoscopic surgery versus robotic surgery in patients receiving total hysterectomy under severe adhesion conditions. The objective of this study is to establish the idea that robotic approach is a superior tool to manage severe pelvic adhesion during gynecological surgeries.

Comparison of laparoscopic versus conventional open surgical staging procedure for endometrial cancer.

The aim of this study was to compare the surgical outcomes of laparoscopic surgery and conventional laparotomy for endometrial cancer. A total of 104 consecutive patients were non-randomly assigned to either laparoscopic surgery or laparotomy. All patients underwent comprehensive surgical staging procedures including total hysterectomy, bilateral salpingo-oophorectomy, and pelvic/para-aortic lymphadenectomy. The safety, morbidity, and survival rates of the two groups were compared, and the data was retrospectively analyzed. Thirty-four patients received laparoscopic surgery and 70 underwent laparotomy. Operation time for the laparoscopic procedure was 227.0+/-28.8 minutes, which showed significant difference from the 208.1+/-46.4 minutes (p=0.032) of the laparotomy group. The estimated blood loss of patients undergoing laparoscopic surgery was 230.3+/-92.4 mL. This was significantly less than that of the laparotomy group (301.9+/-156.3 mL, p=0.015). The laparoscopic group had an average of 20.8 pelvic and 9.1 para-aortic nodes retrieved, as compared to 17.2 pelvic and 8.5 para-aortic nodes retrieved in the laparotomy group. There was no significant difference (p=0.062, p=0.554). The mean hospitalization duration was significantly greater in the laparotomy group than the laparoscopic group (23.3 and 16.4 days, p<0.001). The incidence of postoperative complications was 15.7% and 11.8% in the laparotomy and laparoscopic groups respectively. No statistically significant difference was found between the two groups in the survival rate. Laparoscopic surgical staging operation is a safe and effective therapeutic procedure for management of endometrial cancer with an acceptable morbidity compared to the laparotomic approach, and is characterized by far less blood loss and shorter postoperative hospitalization.

Short- and midterm outcomes of laparoscopic surgery compared for 131 patients with rectal and rectosigmoid cancer

This study aimed to clarify and compare the short- and midterm surgical outcomes of laparoscopic surgery for rectal and rectosigmoid cancer. Between June 1992 and December 2004, 131 selected patients with cancer of the rectum (n = 60) and rectosigmoid (n = 71) underwent laparoscopic surgery. The indications for laparoscopy included a preoperative diagnosis of T1/T2 tumor in the rectum and T1-T3 tumors in the rectosigmoid. The mean follow-up period was 42 months. The procedures included anterior resection for 117 patients, abdominoperineal resection for 11 patients, Hartmann's procedure for 1 patient, and restorative proctocolectomy for 1 patient. Conversion to an open procedure occurred for four patients (3.1%). Postoperative complications developed in 29 patients (22.1%), including anastomotic leakage in 14 patients (11.8%). The length of hospital stay for the rectal cases was significantly longer than for the rectosigmoid cases (10 vs 7 days; p = 0.0049). The tumor node metastasis (TNM) stages included 0 (n = 14), I (n = 72), II (n = 15), III (n = 29), and IV (n = 1). Recurrences were experienced by 13 patients, including local recurrence (n = 7) and recurrences involving the liver ((n = 2), lung (n = 3), and distant lymph nodes (n = 1). The 5-year disease-free and overall survival rates were, respectively 91.7% and 97.9% for stage I, 86.7% and 90.9% for stage II, and 77.1% and 90.0% for stage III. Laparoscopic surgery is feasible and safe for selected patients with rectal or rectosigmoid cancer. The selected patients in this study experienced favorable short- and midterm outcomes.

Short-term surgical outcomes of laparoscopic colonic surgery in octogenarians: a matched case-control study.

This study was undertaken to evaluate the short-term surgical outcomes of laparoscopic surgery for colonic carcinoma in octogenarians and compare them with those for a younger group of patients who underwent the same surgical procedures. This matched case-control study involved 17 octogenarian patients with colonic carcinoma who underwent laparoscopic surgery between 1996 and 2001. The results were compared with those for 34 matched patients aged 60 years or less who underwent the same surgical procedures during the same period. Both groups were well matched for clinical characteristics. However, the American Society of Anesthesiology status was significantly higher in the octogenarian group (P = 0.001). There were no significant differences between the two groups in terms of the incidence of complications, the interval before resumption of liquid or solid food intake, or length of hospitalization. There were no deaths in either group. Advanced age should not be regarded as a contraindication for laparoscopic colonic surgery.