Evolving application of minimally invasive cancer operations at a tertiary cancer center

Abstract

Background Patients and providers are increasingly interested in the utilization, safety, and efficacy of minimally invasive surgery (MIS). We reviewed eleven years of MIS resections (laparoscopic and robotic) for intra-abdominal malignancies. Methods Patients who underwent gastrectomy, distal pancreatectomy, hepatic resection, and colorectal resection between 2004 and 2014 were identified. Cases were categorized as open, laparoscopic, and robotic based on the initial operation approach. Diagnostic laparoscopies were excluded. Results Of the 10,039 patients who underwent the above procedures, between 2004 and 2014, 2,832 (28%) were MIS. In 2004 12% (100/826) of all resections were performed with MIS approaches, rising to 23% (192/821) of all resections by 2009 and 44% (484/1,092) in 2014. The number of open resections has remained largely stable: 726 (88% of all resections) in 2004 and 608 (56% of all resections) in 2014. Initially, laparoscopy experienced incremental adoption. Robotic surgery was implemented in 2009 and is currently the dominant MIS approach, accounting for 76% (368/484) of all MIS resections in 2014. Overall mortality has remained less than 1%. Conclusions While maintaining patient safety, utilization of MIS techniques has increased substantially since 2004, particularly for gastric and colorectal resections. Since 2009 robotic surgery is the predominant MIS approach.

Minimally Invasive Surgery in Pediatric Surgical Oncology

“…Currently, the characteristic tumor amenable to a minimally invasive resection appears most commonly to be a neuroblastic tumor without IDRF and with a tumor volume less than 100 mL. It is expected that the range of tumors considered to be amenable to MIS will broaden with increasing surgeon comfort using this approach, as is evident from the adult literature [1]. Continued improvement in neoadjuvant therapies and screening protocols of children genetically predisposed to develop an embryonal tumor may render more cases amenable to MIS resection.…”

“…Adult colon cancer represents the first application of minimally invasive surgery (MIS) for definitive resection of malignant disease. The use of MIS for definitive resection of adult cancers has expanded rapidly over the past 15 years, and increasing types and numbers of intrabdominal malignancies are being treated with MIS, including the complexities of pancreatic adenocarcinoma [1,2]. For any operative approach, an oncologic resection that includes complete removal of tumor with negative margins, adequate lymphadenectomy, and preservation of adjacent organs when possible is the primary goal.…”

Association between surgical approach and survival following resection of abdominopelvic malignancies

“…Following the first reported laparoscopic surgical procedures in the late 1980s and early 1990s, there has been a rapid adoption of minimally invasive surgery (MIS) throughout many surgical specialties 1,2 . This diffusion has substantially impacted the approach to surgical management of abdominopelvic malignancies, with minimally invasive techniques (including both traditional laparoscopic and robotically‐assisted approaches) comprising a large and increasing share of the surgical volume for many cancer types 3–7 …”

“…1,2 This diffusion has substantially impacted the approach to surgical management of abdominopelvic malignancies, with minimally invasive techniques (including both traditional laparoscopic and robotically-assisted approaches) comprising a large and increasing share of the surgical volume for many cancer types. [3][4][5][6][7] Despite the expansion of MIS techniques, concerns persist regarding the level of evidence justifying their use for oncologic indications. There are relatively few prospective randomized comparisons of surgical approach and most of those studies were carried out at pioneering centers early in the MIS era.…”

Fast and accurate vision‐based stereo reconstruction and motion estimation for image‐guided liver surgery

“…Notably, while much research effort focuses strictly on laparoscopic surgeries, most liver resections are performed as open resections due to the extent and location of disease. In our centre, roughly 75% of liver resections are performed in an open environment [32]. Moreover, laparoscopic approaches are only suitable for certain cases where there is oncologic equivalency between open and laparoscopic [32].…”