Does laparoscopic vs. Conventional surgery increase exfoliated cancer cells in the peritoneal cavity during resection of colorectal cancer?

Kim, Seon Hahn; Milsom, Jeffrey W.; Gramlich, Terry L.; Toddy, Sean M.; Shore, Gregg; Okuda, Jun; Fazio, Victor W.

doi:10.1007/bf02237382

Cited by 76 publications

(47 citation statements)

References 18 publications

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“…Of note, at least eight publications contained duplicated information [6][7][8][9][10][11][12][13] and were not analyzed further. Several other publications were deemed unfit for analysis because of absence of clinical data [14] , faulty randomization [15] and three other trials because they involved different anastomotic techniques during laparoscopic sigmoidectomy [16] or compared hand-assisted laparoscopy to laparoscopy [17] and differences between gasless laparoscopy and pneumoperitoneum during laparoscopic colectomy [18] .…”

Section: Introductionmentioning

confidence: 99%

Laparoscopic Approach to Colonic Cancer: Critical Appraisal of the Literature

Fingerhut

Ata²,

Chouillard³

et al. 2007

Dig Dis

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Background/Aims: As laparoscopic colectomy finds its place in the surgical armamentarium, the literature concerning the safety, efficacy, and oncological rational for treatment of colonic cancer is also enriched. A review and critical appraisal of the literature on this subject was the aim of this paper. Methods: A systematic research and a hand search were conducted to gain access to all controlled studies involving laparoscopic colectomy using the Medline, Embase, HealthSTAR, Cumulative Index for Nursing and Allied Health Literature, CancerLit data bases and the Cochrane Central Register of Controlled Trials for the years 1991–2006. Results: Over 40 controlled randomized trials and ten systematic reviews and/or meta-analyses were found. Several of the completed controlled randomized trials have published either short- or long-term results; only partial and short-term results are available in rectal cancer. The principal conclusions are that the laparoscopic approach affords better short-term outcomes including surgical site morbidity, but with increased operative times and direct costs. Among the proven long-term outcomes, cancer recurrence and survival do not seem to be worse. Whether conversion, a source of increased operative time and costs, is responsible for poorer outcomes or whether specific settings associated with poorer outcomes are among the causes of conversion remains to be shown. However, there are still concerns as regards specific laparoscopic-related complications. Conclusion: There seems to no real safety problems in performing laparoscopic colectomy for cancer; improvement in operative times, conversion rates, and complications should make laparoscopy the best cost-effective approach to colectomy.

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Section: Introductionmentioning

confidence: 99%

Laparoscopic Approach to Colonic Cancer: Critical Appraisal of the Literature

Fingerhut

Ata²,

Chouillard³

et al. 2007

Dig Dis

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“…Issues regarding the pneumoperitoneum and peritoneal implants have already been addressed and refuted by studies on colorectal cancer. 34 Fear remains that these results would not apply to the different biological behaviour of gastric cancer. In a large retrospective cohort study of 1417 patients treated with LAG for gastric cancer, Song and colleagues 10 reported a 13.4% recurrence for advanced gastric cancer and observed a pattern and timing of recurrence similar to that described after open surgery.…”

Section: Discussionmentioning

confidence: 98%

Laparoscopic bariatric surgery can be performed safely in secondary health care centres with a dedicated service corridor to an affiliated tertiary health care centre

Christou

2013

cjs

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Background:The Eastern experience has reported the safety of laparoscopic assisted gastrectomy (LAG) for gastric cancer. Its use in Western countries is still debated owing to concerns about its oncologic equivalence to open gastrectomy (OG). We sought to review and compare their operative outcomes and oncologic specimen quality (number of harvested lymph nodes and surgical margins) for gastric adenocarcinoma (GA). Methods:We reviewed the charts of all patients undergoing LAG (2007( ) and OG (2000 for GA in a single institution. Several surgeons performed the OGs, whereas 1 fellowship-trained laparoscopic surgeon performed LAGs. The primary outcome was quality of the surgical specimen, assessed by the number of harvested lymph nodes (LNs) and margin status. Secondary outcomes were perioperative events. Data were analyzed as intention to treat. Results:We retrieved 60 cases (47 OGs, 13 LAGs). The conversion rate was 23%. Conclusion:Laparoscopic assisted gastrectomy is a challenging but safe and feasible procedure in experienced hands. It offers the same radical resection as OG regarding negative margins and LN retrieval. Long-term follow-up is warranted.Contexte : La gastrectomie assistée par laparoscopie (GAL) a été démontrée dans des études orientales comme sécuritaire dans le traitement de l'adénocarcinome gastrique (AG). En occident, l'équivalence oncologique de la GAL avec la gastrectomie ouverte (GO) demeure cependant controversée. Cette étude vise à comparer le devenir postopératoire et la qualité des spécimens oncologiques de ces interventions, dans le traitement de l'AG. (2007)(2008)(2009)(2010) ou GO (2000GO ( -2010 pour AG dans un seul centre hospitalier ont été revus. Différents chirurgiens ont réalisé les GO. Toutes les GAL ont été réalisées par un seul chirurgien sur-spécialisé en chirurgie laparoscopique. Le critère d'évaluation principal était la qualité du spécimen chirurgical évaluée par le nombre de ganglions lymphatiques (GL) prélevés et le statut des marges de résection. Le critère d'évaluation secondaire était la morbidité postopératoire. Les données ont été analysées en fonction de l'intention de traiter. Méthodes : Tous les dossiers de patients opérés par GALRésultats : Soixante cas ont été inclus (47 GO, 13 GAL). Le taux de conversion s'est établi à 23 %. Le temps opératoire moyen était plus long de 115 minutes, et les pertes sanguines moyennes moindres de 425 mL (p < 0,001 dans les 2 cas) pour la GAL que pour la GO. Une moyenne de 14,4 (écart-type [ET] 9,8) et 11,2 (ET 8,2) GL ont été prélevés respectivement pour la GO et la GAL (p = 0.29). On a obtenu des marges négatives pour tous les patients. La durée moyenne du séjour ne différait pas (GAL 19 j c. GO 18,9 j; p = 0,91). Les complications majeures (12,7 % c. 23,1 %; p = 0,39) et la mortalité post-opératoires (2,1 % c. 7,7 %; p = 0,32) étaient similaires. Conclusion :La gastrectomie assistée par laparoscopie est une intervention complexe, mais peut être réalisée de manière sécuritaire en des mains expertes. Elle offre un spécimen onc...

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“…Several in vivo studies have also shown that laparoscopy with carbon dioxide insufflations seems to stimulate the growth of dormant tumor cells into overt liver metastases (Gutt et al, 2001;Kim et al, 2002). However, some studies in colon and gallbladder cancer refuted this risk (Kim et al, 1998;Goetze and Paolucci, 2006). Regard to these results, the possibility of peritoneal or port site seeding of malignant cells remains unknown.…”

Section: Discussionmentioning

confidence: 99%

Systematic review of laparoscopy-assisted versus open gastrectomy for advanced gastric cancer

Liu

et al. 2013

J. Zhejiang Univ. Sci. B

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Abstract:Objective: The study compared laparoscopy-assisted gastrectomy (LAG) with open gastrectomy (OG) in the management of advanced gastric cancer (AGC). Methods: Literature search was performed in the Medline, Embase, and Cochrane Library databases to identify control studies that compared LAG and OG for AGC. A meta-analysis was conducted to examine the surgical safety and oncologic adequacy, using the random-effect model. Results: Seven eligible studies including 815 patients were analyzed. LAG was associated with less blood loss, less use of analgesics, shorter time of flatus and periods of hospital stay, but longer time of operation. The incidence of most complications was similar between the two groups. However, LAG was associated with a lower rate of pulmonary infection (odds ratio (OR) 0.19; 95% confidence interval (CI) 0.05 to 0.68; P<0.05). No significant differences were noted in terms of the number of harvested lymph nodes (weighted mean difference (WMD) 1.165; 95% CI −2.000 to 4.311; P>0.05), overall mortality (OR 0.65; 95% CI 0.39 to 1.10; P>0.05), cancer-related mortality (OR 0.64; 95% CI 0.32 to 1.25; P>0.05), or recurrence (OR 0.62; 95% CI 0.33 to 1.16; P>0.05). Conclusions: LAG could be performed safely for AGC with adequate lymphadenectomy and has several short-term advantages compared with conventional OG. No differences were found in long-term outcomes. However, these results should be validated in large randomized controlled studies (RCTs) with sufficient follow-up.

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Does laparoscopic vs. Conventional surgery increase exfoliated cancer cells in the peritoneal cavity during resection of colorectal cancer?

Cited by 76 publications

References 18 publications

Laparoscopic Approach to Colonic Cancer: Critical Appraisal of the Literature

Laparoscopic Approach to Colonic Cancer: Critical Appraisal of the Literature

Laparoscopic bariatric surgery can be performed safely in secondary health care centres with a dedicated service corridor to an affiliated tertiary health care centre

Systematic review of laparoscopy-assisted versus open gastrectomy for advanced gastric cancer

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