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Robotic technology: Optimizing the outcomes in rectal cancer?

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World Journal of clinical Oncology 2015年第3期6卷 22-24页

作者： Nicolas C Buchs clinic for Visceral and Transplantation Surgery Department of SurgeryUniversity Hospital of Geneva

Minimally invasive rectal resection remains a challenging procedure, even in experienced hands. Technical limitations explain at least in part the reasons of a relatively poor adoption of laparoscopy for rectal resection, in particular for low tumors in a deep and narrow pelvis.Robotics is intended to overcome these limitations.Potentially better short-term outcomes have beenpublished: reduced conversion rates, better functional outcomes, shorter learning curve, reduction of positive margins, better specimen… However, robotic surgery has not yet taken over as the gold standard approach for low anterior resection. Several drawbacks might indeed discourage the most fervent surgeon: the size of the robot, the lack of tactile feedback, the risk and difficulties during multiquadrant surgery, and, of course, costs. Whilst new systems might overcome most of these drawbacks, it seems obvious that the development of robotic surgery is underway. Robotics is not just another interesting technical tool, but more a new concept, which should play a role in the future.

关键词： Robot Laparoscopy Total mesorectal excision Transanal total mesorectal excision Transanal endoscopic microsurgery Outcomes Rectal cancer

Transanal total mesorectal excision:a valid option for rectal cancer?

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World Journal of Gastroenterology 2015年第41期21卷 11700-11708页

作者： Nicolas C Buchs Gary A Nicholson Frederic Ris Neil J Mortensen Roel Hompes Department of colorectal Surgery Churchill Hospital Oxford University Hospitals Division of Visceral Surgery Department of Surgery University Hospitals of Geneva Nuffield Department of Surgical Science University of Oxford John Radcliffe Hospital

Low anterior resection can be a challenging operation, especially in obese male patients and in particular after radiotherapy. Transanal total mesorectal excision(Ta TME) might offer technical advantages over laparoscopic or open approaches particularly for tumors in the distal third of the rectum. The aim of this article is to review the current experience with Ta TME. The limits and future developments are also explored. Although the experience with Ta TME is still limited, it might be a promising alternative to laparoscopic TME, especially for difficult cases where laparoscopy is too demanding. The preliminary data on complications and short-term oncological outcomes are good, but also emphasize the importance of careful patient selection. Finally, there is a need for large-scale trials focusing on long-term outcomes and oncological safety before widespread adoption can be recommended.

关键词： Transanal Bottom up Transanal minimally invasive s

Vascular invasion in pancreatic cancer:Imaging modalities,preoperative diagnosis and surgical management

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World Journal of Gastroenterology 2010年第7期16卷 818-831页

作者： Nicolas C Buchs Michael chilcott Pierre-Alexandre Poletti Leo H Buhler Philippe Morel clinic for Visceral and Transplantation Surgery Department of SurgeryUniversity Hospitals of GenevaGeneva1211Switzerland Department of Radiology University Hospitals of GenevaGeneva1211Switzerland

Pancreatic cancer is associated with a poor prognosis,and surgical resection remains the only chance for curative therapy.In the absence of metastatic disease,which would preclude resection,assessment of vascular invasion is an important parameter for determining resectability of pancreatic cancer.A frequent error is to misdiagnose an involved major vessel.Obviously,surgical exploration with pathological examination remains the"gold standard"in terms of evaluation of resectability,especially from the point of view of vascular involvement.However,current imaging modalities have improved and allow detection of vascular invasion with more accuracy.A venous resection in pancreatic cancer is a feasible technique and relatively reliable.Nevertheless,a survival benefit is not achieved by curative resection in patients with pancreatic cancer and vascular invasion.Although the discovery of an arterial invasion during the operation might require an aggressive management,discovery before the operation should be considered as a contraindication.Detection of vascular invasion remains one of the most important challenges in pancreatic surgery.The aim of this article is to provide a complete review of the different imaging modalities in the detection of vascular invasion in pancreatic cancer.

关键词： Vascular invasion cancer Pancreas Management

Natural history of uncomplicated sigmoid diverticulitis

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World Journal of Gastrointestinal Surgery 2015年第11期7卷 313-318页

作者： Nicolas C Buchs Neil J Mortensen Frederic Ris Philippe Morel Pascal Gervaz Department of colorectal Surgery Oxford University Hospitals Division of Visceral and Transplantation Surgery Department of Surgery Faculty of Medicine University Hospitals of Geneva

While diverticular disease is extremely common, the natural history(NH) of its most frequent presentation(i.e., sigmoid diverticulitis) is poorly investigated. Relevant information is mostly restricted to populationbased or retrospective studies. This comprehensive review aimed to evaluate the NH of simple sigmoid diverticulitis. While there is a clear lack of uniformity in terminology, which results in difficulties interpreting and comparing findings between studies, this review demonstrates the benign nature of simple sigmoid diverticulitis. The overall recurrence rate is relatively low, ranging from 13% to 47%, depending on the definition used by the authors. Among different risk factors for recurrence, patients with c-reactive protein > 240 mg/L are three times more likely to recur. Other risk factors include: Young age, a history of several episodes of acute diverticulitis, medical vs surgical management, male patients, radiological signs of complicated first episode, higher comorbidity index, family history of diverticulitis, and length of involved colon > 5 cm. The risk of developing a complicated second episode(and its corollary to require an emergency operation) is less than 2%-5%. In fact, the old rationale for elective surgery as a preventive treatment, based mainly on concerns that recurrence would result in a progressively increased risk of sepsis or the need for a colostomy, is not upheld by the current evidence.

关键词： Diverticulitis colon cohort Recurrence Natural his

Risk of colorectal cancer in patients with diverticular disease

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World Journal of clinical Oncology 2018年第6期9卷 119-122页

作者： Jeremy Meyer nicolas christian buchs Frédéric Ris Division of Digestive Surgery University Hospitals of Geneva

colorectal cancer constitutes an important burden on the healthcare system. Screening at-risk populations to reduce colorectal cancer-related morbidity and mortality has become part of good clinical practice. However, recommendations regarding subgroups of patients with diverticular disease are subject to controversy. Herein, we review the most recent literature regarding the prevalence of colorectal cancer in patients with diverticular disease, diverticulitis and uncomplicated diverticulitis. The recent literature does not identify diverticular disease as a long-term risk factor for colorectal cancer. However, the risk of colorectal cancer is increased in the short-term period after hospitalization related to diverticular disease. According to a recent systematic review and meta-analysis, the prevalence of colorectal cancer is 1.6% in patients with acute diverticulitis who underwent colonoscopy. The risk of having colorectal cancer after an episode of acute diverticulitis is 44-fold higher than that of an age-and gender-adjusted reference population. Despite lower among patients with uncomplicated episode, the risk of colorectal cancer remains 40-fold higher in that subpopulation than that in the reference population. To conclude, the recent literature describes an increased risk of colorectal cancer among patients with acute diverticulitis compared to the reference population. colonoscopy is therefore recommended in patients with diverticulitis to exclude colorectal cancer.

关键词： Diverticulosis Diverticulitis colonoscopy Screening Tumor Risk factor

Lateral lymph node dissection for low rectal cancer: Is it necessary?

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World Journal of Gastroenterology 2019年第31期25卷 4294-4299页

作者： Niki christou Jeremy Meyer christian Toso Frédéric Ris nicolas christian buchs Service de chirurgie Digestive Endocrinienne et GénéraleCHU de LimogesLimoges Cedex 87042France Division of Digestive Surgery University Hospitals of GenevaGenève 1211Switzerland Unit of Surgical Research University of GenevaGenève 1206Switzerland

Rectal cancer constitutes a major public health issue.Total mesorectal excision has remained the gold standard treatment for mid and low rectal tumors since its introduction in the late 1980s.Removal of all lymph nodes located in the mesorectum has indeed improved pathological and oncological outcomes.However,when cancer spreads to the lateral lymph nodes(located along the iliac and obturator arteries)Western and Japanese practices differ.Where the Western guidelines consider this condition as an advanced form of the disease and use neoadjuvant radiochemotherapy liberally,the Japanese guidelines define it as a local disease and proceed to lateral lymph node dissection with or without neoadjuvant treatment.Herein,we review the current literature regarding both therapeutic strategies,with the aim of contributing to potential improvements in treatment and outcome for patients with low and mid rectal cancer.

关键词： Total mesorectum excision Mesorectal resection Lateral node metastasis Extended lymphadenectomy

Reducing anastomotic leak in colorectal surgery: The old dogmas and the new challenges

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World Journal of Gastroenterology 2019年第34期25卷 5017-5025页

作者： Jeremy Meyer Surennaidoo Naiken Niki christou Emilie Liot christian Toso nicolas christian buchs Frédéric Ris Division of Digestive Surgery University Hospitals of Geneva

Anastomotic leak(AL)constitutes a significant issue in colorectal surgery,and its incidence has remained stable over the last years.The use of intra-abdominal drain or the use of mechanical bowel preparation alone have been proven to be useless in preventing AL and should be abandoned.The role or oral antibiotics preparation regimens should be clarified and compared to other routes of administration,such as the intravenous route or enema.In parallel,preoperative antibiotherapy should aim at targeting collagenase-inducing pathogens,as identified by the microbiome analysis.AL can be further reduced by fluorescence angiography,which leads to significant intraoperative changes in surgical strategies.Implementation of fluorescence angiography should be encouraged.Progress made in AL comprehension and prevention might probably allow reducing the rate of diverting stoma and conduct to a revision of its indications.

关键词： Anastomotic leakage Rectal surgery colic surgery Prevention Surgical site infection Anastomosis complication

Biological mesh reconstruction of the pelvic floor following abdominoperineal excision for cancer:A review

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World Journal of clinical Oncology 2017年第3期8卷 249-254页

作者： Boris Schiltz nicolas christian buchs Marta Penna cosimo Riccardo Scarpa Emilie Liot Philippe Morel Frederic Ris Division of Visceral Surgery Department of SurgeryUniversity Hospitals of Geneva Department of colorectal Surgery Churchill HospitalOxford University Hospitals

Extralevator abdominoperineal excision and pelvic exenteration are mutilating operations that leave wide perineal wounds.Such large wounds are prone to infection and perineal herniation,and their closure is a major concern to most surgeons.Different approaches to the perineal repair exist,varying from primary or mesh closure to myocutaneous flaps.Each technique has its own associated advantages and potential complications and the ideal approach is still debated.In the present study,we reviewed the current literature and our own local data regarding the use of biological mesh for perineal wound closure.current evidence suggests that the use of biological mesh carries an acceptable risk of wound complications compared to primary closure and is similar to flap reconstruction.In addition,the rate of perineal hernia is lower in early follow-up,while long-term hernia occurrence appears to be similar between the different techniques.Finally,it is an easy and quick reconstruction method.Although more expensive than primary closure,the cost associated with the use of a biological mesh is at least equal,if not less,than flap reconstruction.

关键词： Biological mesh Rectal cancer Pelvic exenteration Abdominoperineal resection Primary perineal wound closure Perineal wound infection Perineal hernia

Segmental duodenectomy for gastrointestinal stromal tumor of the duodenum

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World Journal of Gastroenterology 2010年第22期16卷 2788-2792页

作者： nicolas christian buchs Pascal Bucher Pascal Gervaz Sandrine Ostermann Franois Pugin Philippe Morel Department of Surgery University Hospital Geneva

AIM: To evaluate the results of segmental duodenectomy (SD) and pancreaticoduodenectomy (PD) for duodenal gastrointestinal stromal tumor (GIST) and help clinicians with surgical management. METHODS: All patients who underwent surgery for non-metastatic GIST of the duodenum in a single institution since 2000 were prospectively followed up. Seven patients (median age 51 years, range: 41-73 years) were enrolled: five underwent SD and two underwent PD. RESULTS: All the patients had a complete resection (R0), with no postoperative morbidity and mortality. Among the SD group, GIST was classified as low risk in two patients, intermediate risk in two, and high risk in one, according to the Fletcher scale, (vs two high risk patients in the PD group). With a median followup of 41 (18-85) mo, disease-free survival (DFS) rateswere 100% after SD and 0% after PD (P cONcLUSION: Whenever associated with clear surgical margins, SD is a reliable and curative option for most duodenal GISTs, and is compatible with longterm DFS.

关键词： Gastrointestinal stromal tumor Duodenal neoplasms Segmental duodenectomy Pancreaticoduodenectomy