Laparoscopic Monitored Colonoscopic Polypectomy: Long‐Term Follow‐Up

Franklin, Morris E.; Portillo, Guillermo

doi:10.1007/s00268-009-9967-8

Cited by 63 publications

(54 citation statements)

References 12 publications

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“…Two patients underwent laparoscopic-assisted endoscopic polypectomy. Only two larger studies assessing this technique have been recently published (18,19). Authors concluded that this technique is safe for benign polyps and if malignancy is suspected laparoscopic colectomy can be performed without delay.…”

Section: Discussionmentioning

confidence: 99%

Laparoscopic colorectal surgery for colorectal polyps: experience of ten years

Dulskas

Kuliešius

Samalavičius

2017

AML

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Background. Laparoscopy or its combination with endoscopy is the next step for "difficult" polyps. The purpose of the paper was to review the outcomes of the laparoscopic approach to the management of "difficult" colorectal polyps.Materials and methods. From 2006 to 2016, 58 patients who underwent laparoscopic treatment for "difficult" polyps that could not be treated by endoscopy at the National Cancer Institute, Lithuania, were included. The demographic data, the type of surgery, length of post-operative stay, complications, and final pathology were reviewed prospectively.Results. The mean patient was 65.9 ± 8.9 years of age. Laparoscopic mobilization of the colonic segment and colotomy with removal of the polyp was performed in 15 (25.9%) patients, laparoscopic segmental bowel resection in 41 (70.7%) cases: anterior rectal resection with partial total mesorectal excision in 18 (31.0%), sigmoid resection in nine (15.5%), left hemicolectomy in seven (12.1%), right hemicolectomies in two (3.4%), ileocecal resection in two (3.4%), resection of transverse colon in two (3.4%), and sigmoid resection with transanal retrieval of specimen in one (1.7%). Two patients (3.4%) underwent laparoscopicassisted endoscopic polypectomy. The mean post-operative hospital stay was 5.7 ± 2.4 days. There were four complications (6.9%). All patients recovered after conservative treatment. The mean polyp size was 3.5 ± 1.9 cm. Final histopathology revealed hyperplastic polyps (n = 2), tubular adenoma (n = 9), tubulovillous adenoma (n = 31), carcinoma in situ (n = 12), and invasive cancer (n = 4).Conclusions. For the management of endoscopically unresectable polyps, laparoscopic surgery is currently the technique of choice.

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Section: Discussionmentioning

confidence: 99%

Laparoscopic colorectal surgery for colorectal polyps: experience of ten years

Dulskas

Kuliešius

Samalavičius

2017

AML

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“…Postoperative bleeding was reported in only three studies 15,20,24 or in six patients only (0.8%). Overall postoperative complications are reported in seven of the 11 studies, 15,[18][19][20][21]23,24 ranging between 4.4-25%. Indeed, complications required surgery in only eight patients, as reported in two studies.…”

Section: Discussionmentioning

confidence: 99%

“…This means that the global incidence of second surgical procedures is as high as 10%, which is considerable especially if compared to the 2% of patients who required further surgery after standard laparoscopic colonic resection, as reported above. 26 To be exact, in the largest studies here represented, 19 this second surgical procedure was performed under the same general anaesthesia, as the specimen was examined on frozen sections during surgery. This is a practice achieving some appreciation in the USA, but not at all common in Europe nor in Asia.…”

Section: Discussionmentioning

confidence: 99%

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Efficacy and safety of laparo‐endoscopic resections of colorectal neoplasia: A systematic review

et al. 2015

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Objective: The purpose of this review is to assess the efficacy and safety of laparo-endoscopic local resections for colorectal lesions not suitable for endoscopic resection. Summary background data: The combined laparo-endoscopic approach has been proposed for large colorectal lesions unsuitable for endoscopic resection, in order to reduce morbidity of common laparoscopic resection. However, data on the efficacy and safety of laparo-endoscopic local resections are still controversial. Methods: An Embase search of papers published during the period 1985-2014 was performed. Published studies that evaluated laparo-endoscopic resections for colorectal lesions were assessed using PRISMA (Preferred Reporting Items for Systematic reviews and Meta-Analyses) recommendations by two authors. Forest plots on primary (per-lesion rate of further surgery, including surgery for complications and surgery for oncologic radical treatment) and secondary outcomes were produced based on fixed and random effects models. Heterogeneity was assessed using the I 2 statistic. Risk for within-study bias was ascertained with QUADAS (Quality Assessment of Diagnostic Accuracy Studies) system. Results: A total of 11 studies provided data on 707 lesions treated with a combined laparo-endoscopic approach. A variety of techniques were reported. The overall per-lesion rate of further surgery was 9.5%, while per-lesion rate of further surgery for oncologic treatment was 7.9%, per-lesion rate of further surgery for complications treatment was 3.5%, incidence of adenocarcinoma was 10.5%, incidence of overall complications was 7.9%, incidence of conversion to open surgery 4.3% and incidence of recurrence was 5.4%. Conclusions: Despite laparo-endoscopic approach ensures limited invasiveness, it is affected by a consistent rate of complications and oncologic inadequacy that often requires further surgical treatment.

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“…3 long-term colonoscopic follow up of 209 polypectomies (range: 6-196 months) showed no recurrence. 17 Mild abdominal/trocar pain was the most common complaint.…”

Section: Wood Lord Wheeler Borley Laparo-endoscopic Resection For Extmentioning

confidence: 99%

Laparo-endoscopic resection for extensive and inaccessible colorectal polyps: a feasible and safe procedure

Wood

Lord

Wheeler

et al. 2011

annals

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INTRODUCTION Polypectomy at colonoscopy may be difficult or dangerous. In such instances colonic resection may be indicated. Novel combined laparoscopic-endoscopic procedures have the potential to allow safe extensive extramucosal resection, thus avoiding resection. Laparoscopic colon mobilisation provides a more favourable orientation for endoscopic mucosal resection and facilitates identification of possible perforation sites with immediate laparoscopic repair or resection if necessary. This study aimed to assess the efficacy and safety of laparo-endoscopic resection (LER) of colonic polyps. PATIENTS AND METHODS Data were collected prospectively on consecutive patients undergoing LER. The mode of presentation, referral pattern, lesion site and size, hospital stay, procedural details, complications, histology and further treatment were recorded. RESULTS A total of 13 patients underwent attempted LER (16 polyps in total) and this was completed for 10, with a median hospital stay of 2 days. Five polyps were removed whole and eight piecemeal. Excision was clinically complete in all cases. Three procedures were converted to colonic resection. One lesion appeared malignant, indicating a conversion to laparoscopic right hemicolectomy. Two polyps were not amenable to LER and resection was performed. One patient underwent subsequent colonic resection based on the histological findings. There were no perforations or serious complications. CONCLUSIONS LER is a safe and effective treatment for large and inaccessible colonic polyps that would otherwise be treated by colonic resection.

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Laparoscopic Monitored Colonoscopic Polypectomy: Long‐Term Follow‐Up

Abstract: Long-term follow-up demonstrated that a combined endoscopic-laparoscopic approach is safe and effective. Malignant lesions identified during LMCP can be treated laparoscopically during the same operation, avoiding the need of a second procedure, with good long-term oncologic outcome.

Cited by 63 publications

References 12 publications

Laparoscopic colorectal surgery for colorectal polyps: experience of ten years

Laparoscopic colorectal surgery for colorectal polyps: experience of ten years

Efficacy and safety of laparo‐endoscopic resections of colorectal neoplasia: A systematic review

Laparo-endoscopic resection for extensive and inaccessible colorectal polyps: a feasible and safe procedure

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