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Impact of frailty on approach to colonic resection: Laparoscopy vs open surgery

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World Journal of Gastroenterology 2016年第43期22卷 9544-9553页

作者： Catalina Mosquera Konstantinos Spaniolas Timothy L Fitzgerald Department of General surgery Division of Surgical Oncology East Carolina University Brody School of Medicine division of bariatric and minimally invasive surgery East Carolina University Brody School of Medicine

AIM To understand the influence of frailty on postoperative outcomes for laparoscopic and open colectomy. METHODS Data were obtained from the National Surgical Quality Improvement Program(2005-2012) for patients undergoing colon resection [open colectomy(OC) and laparoscopic colectomy(LC)]. Patients were classified as non-frail(0 points), low frailty(1 point), moderate frailty(2 points), and severe frailty(≥ 3) using the Modified Frailty Index. 30-d mortality and complications were used as the primary end point and analyzed for the overall population. Complications were grouped into major and minor. Subset analysis was performed for patients undergoing colectomy(total colectomy, partial colectomy and sigmoid colectomy) and separately for patients undergoing rectal surgery(abdominoperineal resection, low anterior resection, and proctocolectomy). We analyzed the data using SAS Platform JMP Pro version 10.0.0(SAS Institute Inc., Cary, NC, United States). RESULTS A total of 94811 patients were identified; the majority underwent OC(58.7%), were white(76.9%), andnon-frail(44.8%). The median age was 61.3 years. Prolonged length of stay(LOS) occurred in 4.7%, and 30-d mortality was 2.28%. Patients undergoing OC were older(61.89 ± 15.31 vs 60.55 ± 14.93) and had a higher ASA score(48.3% ASA3 vs 57.7% ASA2 in the LC group)(P < 0.0001). Most patients were non-frail(42.5% OC vs 48% LC, P < 0.0001). Complications, prolonged LOS, and mortality were significantly more common in patients undergoing OC(P < 0.0001). OC had a higher risk of death and complications compared to LC for all frailty scores(non-frail: OR = 4.7, and OR = 4.67; mildly frail: OR = 2.51, and OR = 2.47; moderately frail: OR = 2.94, and OR = 2.02, severely frail: OR = 2.37, and OR = 2.34, P < 0.05) and an increase in absolute mortality with increasing frailty(non-frail 0.68% OC, mildly frail 1.39%, moderately frail 3.44%, and severely frail 5.83%, P < 0.0001). CONCLUSION LC is associated with improved outcomes. A

关键词： Frailty Outcome Mortality Morbidity Colectomy

Pancreatic cancer: open or minimally invasive surgery?

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World Journal of Gastroenterology 2016年第32期22卷 7301-7310页

作者： Yu-Hua Zhang Cheng-Wu Zhang Zhi-Ming Hu De-Fei Hong division of Hepatobiliary and Pancreatic surgery and minimally invasive surgery Zhejiang Provincial People’s Hospital

Pancreatic duct adenocarcinoma is one of the most fatal malignancies, with R0 resection remaining the most important part of treatment of this malignancy. However, pancreatectomy is believed to be one of the most challenging procedures and R0 resection remains the only chance for patients with pancreatic cancer to have a good prognosis. Some surgeons have tried minimally invasive pancreatic surgery, but the shortand long-term outcomes of pancreatic malignancy remain controversial between open and minimally invasive procedures. We collected comparative data about minimally invasive and open pancreatic surgery. The available evidence suggests that minimally invasive pancreaticoduodenectomy(MIPD) is as safe and feasible as open PD(OPD), and shows some benefit, such as less intraoperative blood loss and shorter postoperative hospital stay. Despite the limited evidence for MIPD in pancreatic cancer, most of the available data show that the short-term oncological adequacy is similar between MIPD and OPD. Some surgical techniques, including superior mesenteric artery-first approach and laparoscopic pancreatoduodenectomy with major vein resection, are believed to improve the rate of R0 resection. Laparoscopic distal pancreatectomy is less technically demanding and is accepted in more pancreatic centers. It is technically safe and feasible and has similar short-term oncological prognosis compared with open distal pancreatectomy.

关键词： Laparoscopic minimally invasive Robotic Pancreaticoduodenectomy Distal pancreatectomy Pancreatic cancer

Robotic-assisted cholecystectomy: stepping stone to expertise or vogue?

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Hepatobiliary surgery and Nutrition 2024年第2期13卷 301-303页

作者： Dimitrios Ntourakis Evangelia Triantafyllou Christiana Roidi Panagiotis Lainas division of surgery School of MedicineEuropean University CyprusNicosiaCyprus minimally invasive surgery Unit Athens Medical Center Palaio Faliro ClinicAthensGreece Department of minimally invasive Digestive&bariatric surgery Metropolitan HospitalHEAL AcademyAthensGreece

We read with great interest the study by Kalata et *** in JAMA surgery comparing the safety of robotic-assisted cholecystectomy(RAC)*** cholecystectomy(LC)(1).This nationwide cohort study from the United States includes more than one million patients who had a cholecystectomy from January 1,2010 to December 31,*** impressive 37-fold increase in the use of RAC is reported during this ***,RAC was found to have a three times higher rate of bile duct injuries requiring surgical repair with choledochojejunostomy or hepaticojejunostomy within one year from surgery when compared to ***,RAC in comparison to LC had a higher incidence of postoperative biliary interventions with endoscopic retrograde cholangiopancreatography and common bile duct exploration[7.4%vs.6.0%;relative risk(RR)=1.25;95%confidence interval(CI):1.16-1.33].In addition,an instrumental variable analysis was undertaken to investigate the causality of this result and found that RAC had two times more bile duct injuries requiring surgical reconstruction when compared to LC(0.4%vs.0.2%;RR=1.88;95%CI:1.14-2.63).

关键词： Robotic surgical procedures laparoscopy intraoperative complications cholecystectomy bile ducts

Post-discharge complications after esophagectomy account for high readmission rates

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World Journal of Gastroenterology 2016年第22期22卷 5246-5253页

作者： Sophia Y Chen Daniela Molena Miloslawa Stem Benedetto Mungo Anne O Lidor Department of surgery Johns Hopkins University School of Medicine Thoracic surgery Service Department of Surgery Memorial Sloan Kettering Cancer Center Section of minimally invasive Foregut and Bariatric Surgery Division of General Surgery University of Wisconsin School of Medicine and Public Health

AIM: To identify rates of post-discharge complications(PDC), associated risk factors, and their influence on early hospital outcomes after ***: We used the 2005-2013 American College of Surgeons National Surgical Quality Improvement Program(ACS-NSQIP) database to identify patients ≥ 18 years of age who underwent an esophagectomy. These procedures were categorized into four operative approaches: transhiatal, Ivor-Lewis, 3-holes, and non-gastric conduit. We selected patient data based on clinical relevance to patients undergoing esophagectomy and compared demographic and clinical characteristics. The primary outcome was PDC, and secondary outcomes were hospital readmission and reoperation. The patients were then divided in 3 groups: no complication(Group 1), only pre-discharge complication(Group 2), and PDC patients(Group 3). A modified Poisson regression analysis was used to identify risk factors associated with developing postdischarge complication, and risk ratios were ***: 4483 total patients were identified, with 8.9% developing PDC within 30-d after esophagectomy. Patients who experienced complications post-discharge had a median initial hospital length of stay(LOS) of 9 d; however, PDC occurred on average 14 d following surgery. Patients with PDC had greater rates of wound infection(41.0% vs 19.3%, P < 0.001), venous thromboembolism(16.3% vs 8.9%, P < 0.001), and organ space surgical site infection(17.1% vs 11.0%, P = 0.001) than patients with pre-discharge complication. The readmission rate in our entire population was 12.8%. PDC patients were overwhelmingly more likely to have a reoperation(39.5% vs 22.4%, P < 0.001) and readmission(66.9% vs 6.6%, P < 0.001). BMI 25-29.9 and BMI ≥ 30 were associated with increased risk of PDC compared to normal BMI(18.5-25).CONCLUSION: PDC after esophagectomy account for significant number of reoperations and readmissions. Efforts should be directed towards optimizing patient's health pre-disch

关键词： Reoperation hospital readmission Post discharge complications esophagectomy Outcomes research

Review of single incision laparoscopic surgery in colorectal surgery

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World Journal of Gastroenterology 2015年第38期21卷 10824-10829页

作者： Nisreen Madhoun Deborah S Keller Eric M Haas Colorectal Surgical Associates division of minimally invasive Colorectal surgery Department of SurgeryUniversity of Texas Medical School at Houston Houston Methodist Hospital

As surgical techniques continue to move towards less invasive techniques,single incision laparoscopic surgery(SILS),a hybrid between traditional multiport laparoscopy and natural orifice transluminal endoscopic surgery,was introduced to further the enhanced outcomes of multiport laparoscopy. The safety and feasibility of SILS for both benign and malignant colorectal disease has been proven. SILS provides the potential for improved cosmesis,postoperative pain,recovery time,and quality of life at the drawback of higher technical skill required. In this article,we review the history,describe the available technology and techniques,and evaluate the benefits and limitations of SILS for colorectal surgery in the published literature.

关键词： Laparoscopic colectomy minimally invasive colorect

The future of robotic liver surgery

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Hepatobiliary surgery and Nutrition 2020年第4期9卷 546-547页

作者： Pier Cristoforo Giulianotti division of General Minimally Invasive and Robotic SurgeryUniversity of Illinois at ChicagoChicagoILUSA

I read with great interest the article published by Melstrom et al.(1)from ***'s team.I found several interesting points worthy of discussion.

关键词： robotic worthy discussion

Robotic-assisted placement of hepatic artery infusion pump for the treatment of colorectal liver metastases:Role of indocyanine green(with video)

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Hepatobiliary & Pancreatic Diseases International 2022年第4期21卷 387-391页

作者： Mario Spaggiari Kiara A Tulla Gabriela Aguiluz Pierpaolo Di Cocco Lola Castro Gil Enrico Benedetti Ivo G Tzvetanov Pier Cristoforo Giulianotti division of Transplantation Department of SurgeryUniversity of Illinois at ChicagoChicagoILUSA division of General Minimally Invasiveand Robotic SurgeryDepartment of SurgeryUniversity of Illinois at ChicagoChicagoILUSA

Surgical resection remains the only definitive treatment for colorectal liver metastasis(CRLM). However, only a minority of cases are deemed resectable at the time of diagnosis. Systemic chemotherapy along with hepatic artery infusion(HAI) is an effective and safe regional chemotherapy modality for the downstaging of patients with isolated unresectable CRLM [1].

关键词： chemotherapy liver artery treatment metastasis

Laparoscopic surgery for colorectal liver metastases:moving forward while keeping feet on the ground

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Hepatobiliary surgery and Nutrition 2021年第1期10卷 107-109页

作者： Mariano Cesare Giglio Roberto Ivan Troisi division of HPB Minimally Invasive and Robotic SurgeryDepartment of Clinical Medicine and SurgeryFederico II University HospitalNaplesItaly

The laparoscopic approach to the surgical treatment of colorectal liver metastases(CRLMs)is supported nowadays by high evidence(1).In the hand of expert surgeons,patients undergoing laparoscopic liver surgery(LLS)for CLRMs benefit from a number of advantages,including a shorter postoperative in-hospital stay,less pain,fewer complications and a faster recovery(1).More importantly,all these profits are achieved while preserving the oncological outcomes,which are not-inferior to those achieved by open procedures(1).Recently published long-term results of randomized trials have shown similar patient survival after laparoscopic and open surgery for CRLM(2).

关键词： surgery colorectal faster

Laparoscopic and robot-assisted gastrectomy for gastric cancer: Current considerations

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World Journal of Gastroenterology 2016年第25期22卷 5694-5717页

作者： Stefano Caruso Alberto Patriti Franco Roviello Lorenzo De Franco Franco Franceschini Andrea Coratti Graziano Ceccarelli Department of General surgery and Surgical Specialties Unit of General Surgery 'Santa Maria Annunziata' Hospital ASL Firenze 50012 Florence Italy Department of surgery General Minimally Invasive and Robotic Surgery 'San Matteo degli Infermi' Hospital 06049 Spoleto (PG) Italy Department of Medical Surgical and Neuroscience/ Unit of General and Minimally Invasive Surgery University of Siena 53100 Siena Italy division of Oncological and Robotic General surgery 'Careggi' University Hospital 50134 Florence Italy Department of Medicine and General surgery Unit of Minimally Invasive and General Surgery ASL8 Arezzo 'San Donato' Hospital 52100 Arezzo Italy

Radical gastrectomy with an adequate lymphadenectomy is the main procedure which makes it possible to cure patients with resectable gastric cancer (GC). A number of randomized controlled trials and meta-analysis provide phase III evidence that laparoscopic gastrectomy is technically safe and that it yields better short-term outcomes than conventional open gastrectomy for early-stage GC. While laparoscopic gastrectomy has become standard therapy for early-stage GC, especially in Asian countries such as Japan and South Korea, the use of minimally invasive techniques is still controversial for the treatment of more advanced tumours, principally due to existing concerns about its oncological adequacy and capacity to carry out an adequately extended lymphadenectomy. Some intrinsic drawbacks of the conventional laparoscopic technique have prevented the worldwide spread of laparoscopic gastrectomy for cancer and, despite technological advances in recent year, it remains a technically challenging procedure. The introduction of robotic surgery over the last ten years has implied a notable mutation of certain minimally invasive procedures, making it possible to overcome some limitations of the traditional laparoscopic technique. Robot-assisted gastric resection with D2 lymph node dissection has been shown to be safe and feasible in prospective and retrospective studies. However, to date there are no high quality comparative studies investigating the advantages of a robotic approach to GC over traditional laparoscopic and open gastrectomy. On the basis of the literature review here presented, robot-assisted surgery seems to fulfill oncologic criteria for D2 dissection and has a comparable oncologic outcome to traditional laparoscopic and open procedure. Robot-assisted gastrectomy was associated with the trend toward a shorter hospital stay with a comparable morbidity of conventional laparoscopic and open gastrectomy, but randomized clinical trials and longer follow-ups are nee

关键词： Gastric cancer Gastric resection minimally invasive surgery Laparoscopic gastrectomy Robot-assisted gastrectomy