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Quality of life after laparoscopic vs open sphincter-preserving resection for rectal cancer

World Journal of Gastroenterology 2013年第29期19卷 4764-4773页

作者： Simon Siu-Man Ng wing-Wa Leung Cherry Yee-Ni Wong Sophie Sok-Fei Hon tony wing-chung mak Dennis KwokYu Ngo Janet Fung-Yee Lee Division for Colorectal Surgery Department of Surgery The Chinese University of Hong Kong Prince of Wales Hospital

AIM: To compare quality of life (QoL) outcomes in Chinese patients after curative laparoscopic vs open surgery for rectal cancer. METHODS: Eligible Chinese patients with rectal cancer undergoing curative laparoscopic or open sphincterpreserving resection between July 2006 and July 2008 were enrolled in this prospective study. The QoL outcomes were assessed longitudinally using the validated Chinese versions of the European Organization for Research and Treatment of Cancer QLQ-C30 and QLQCR38 questionnaires before surgery and at 4, 8, and 12 mo after surgery. The QoL scores at the different time points were compared between the laparoscopic and open groups. A higher score on a functional scale indicated better functioning, whereas a higher score on a symptom scale indicated a higher degree of ***: Seventy-four patients (49 laparoscopic and 25 open) were enrolled. The two groups of patients were comparable in terms of sociodemographic data, types of surgery, tumor staging, and baseline mean QoL scores. There was no significant decrease from baseline in global QoL for the laparoscopic group at different time points, whereas the global QoL was worse compared to baseline beginning at 4 mo but returned to baseline by 12 mo for the open group (P = 0.019, Friedman test). Compared to the open group, the laparoscopic group had significantly better physical (89.9±1.4 vs 79.2±3.7, P = 0.016), role (85.0±3.4 vs 63.3±6.9, P = 0.005), and cognitive (73.5±3.4 vs 50.7±6.2, P = 0.002) functioning at 8 mo, fewer micturition problems at 4-8 mo (4 mo: 32.3±4.7 vs 54.7±7.1, P = 0.011; 8 mo: 22.8±4.0 vs 40.7±6.9, P = 0.020), and fewer male sexual problems from 8 mo onward (20.0±8.5 vs 76.7±14.5, P = 0.013). At 12 mo after surgery, no significant differences were observed in any functional or symptom scale between the two groups, with the exception of male sexual problems, which remained worse in the open group (29.2±11.3 vs 80.0±9.7, P = 0.026). CONCLUSION: Laparoscopic sphin

关键词： Quality of life Rectal cancer Laparoscopic surgery Sphincter-preserving surgery European Organization for Research and Treatment of Cancer QLQ-C30 European Organization for Research and Treatment of Cancer QLQ-CR38

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Robotic surgery for rectal cancer: A systematic review of current practice

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World Journal of Gastrointestinal Oncology 2014年第6期6卷 184-193页

作者： tony wing chung mak Janet Fung Yee Lee Kaori Futaba Sophie Sok Fei Hon Dennis Kwok Yu Ngo Simon Siu Man Ng Division of Colorectal Surgery Department of Surgery The Chinese Uni-versity of Hong Kong Prince of Wales Hospital Department of Colorectal Surgery University Hospital Birmingham NHS Trust

AIM: To give a comprehensive review of current litera-ture on robotic rectal cancer ***: A systematic review of current literature via PubMed and Embase search engines was per-formed to identify relevant articles from january 2007 to november 2013. The keywords used were: "robotic surgery", "surgical robotics", "laparoscopic computer-assisted surgery", "colectomy" and "rectal resection". RESULTS: After the initial screen of 380 articles, 20 pa-pers were selected for review. A total of 1062 patients(male 64.0%) with a mean age of 61.1 years and body mass index of 24.9 kg/m2 were included in the *** of 1062 robotic-assisted operations, 831(78.2%) anterior and low anterior resections, 132(12.4%) in-tersphincteric resection with coloanal anastomosis, 98(9.3%) abdominoperineal resections and 1(0.1%) Hart-mann's operation were included in the review. Robotic rectal surgery was associated with longer operative time but with comparable oncological results and anastomotic leak rate when compared with laparoscopic rectal surgery. CONCLUSION: Robotic colorectal surgery has con-tinued to evolve to its current state with promising re-sults; feasible surgical option with low conversion rate and comparable short-term oncological results. The challenges faced with robotic surgery are for more high quality studies to justify its cost.

关键词： Rectal cancer Robotics Minimal invasive surgery Systematic review Rectal surgery

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Endoscopic submucosal dissection vs laparoscopic colorectal resection for early colorectal epithelial neoplasia

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World Journal of Gastrointestinal Endoscopy 2015年第17期7卷 1243-1249页

作者： Sophie SF Hon Simon SM Ng Tiffany CL Wong Philip WY Chiu tony WC mak WW Leung Janet FY Lee Department of Surgery Prince of Wales HospitalThe Chinese University of Hong Kong

AIM: To compare the short term outcome of endoscopic submucosal dissection(ESD) with that of laparoscopic colorectal resection(LC) for the treatment of early colorectal epithelial neoplasms that are not amenable to conventional endoscopic removal. METHODS: This was a retrospective cohort study. The clinical data of all consecutive patients who underwent ESD for endoscopically assessed benign lesions that were larger than 2 cm in diameter from 2009 to 2013 were collected. These patients were compared with a cohort of controls who underwent LC from 2005 to 2013. Lesions that were proven to be malignant by initial endoscopic biopsies were excluded. Mid and lower rectal lesions were not included because total mesorectal excision, which bears a more complicated postoperative course, is not indicated for lesions without histological proof of malignancy. Both ESD and LC were performed by the same surgical unit with a standardized technique. The patients were managed according to a standard protocol, and they were closely monitored for complications after the procedures. All hospital records were reviewed, and the following data were compared between the ESD and LC groups: patient demographics, size and location of the lesions, procedure time, shortterm clinical outcomes and pathology results. RESULTS: From 2005 to 2013, 65 patients who underwent ESD and 55 patients who underwent LC were included in this study. The two groups were similar in terms of sex(P = 0.41) and American Society of Anesthesiologist class(P = 0.58), although patients in the ESD group were slightly older(68.6 ± 9.4 vs 64.6 ± 9.9, P = 0.03). ESD could be accomplished with a shorter procedure time(113 ± 66 min vs 153 ± 43 min, P < 0.01) for lesions of comparable size(3.0 ± 1.2 cm vs 3.4 ± 1.4 cm, P = 0.22) and location(colon/rectum:59/6 vs colon/rectum: 52/3, P = 0.43). ESD appeared to be associated with a lower short-term complication rate, but the difference did not reach statistical significance(10.8%

关键词： Early colorectal neoplasia Laparoscopic colectomy

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