Laparoscopy may decrease morbidity and length of stay after elective colon cancer resection, especially in frail patients: results from an observational real-life study

Santacruz, Carlos Cerdán; Frasson, Matteo; Flor-Lorente, Blas; Rodríguez, José Luis Ramos; Anoro, Marta Trallero; Scheiding, Mónica Millán; Díaz, Olga Maseda; Lindenbaum, Paula Dujovne; Abad, Andrés Monzón; Ximénez, Eduardo García-Granero

doi:10.1007/s00464-017-5548-3

Cited by 26 publications

(15 citation statements)

References 60 publications

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“…CCI scores, a marker of baseline comorbid severity, only differed in terms of range; the median CCI score was the same in both patient cohorts. Finally, though laparoscopy has been clearly shown to reduce SSI [31][32][33][34] and there were more minimally invasive procedures in the post-intervention cohort compared to preintervention (7.3% versus 2.6%, respectively), the proportions were small. Subgroup analysis based on smoking history and wound closure confirmed the post-intervention reduction in SSIs (data not shown).…”

Section: Discussionmentioning

confidence: 89%

A perioperative multidisciplinary care bundle reduces surgical site infections in patients undergoing synchronous colorectal and liver resection

Tufts

Jarnagin

Flynn

et al. 2019

HPB

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In combined colorectal/liver resection patients, implementation of a multidisciplinary care bundle was associated with a 61% reduction in SSIs, with the greatest impact on superficial/deep SSI, and modest reduction in LOS. The absence of trends within each time period indicated that the intervention was likely responsible for SSI reduction. Future efforts should target further reduction in organ space SSI.

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Section: Discussionmentioning

confidence: 89%

A perioperative multidisciplinary care bundle reduces surgical site infections in patients undergoing synchronous colorectal and liver resection

Tufts

Jarnagin

Flynn

et al. 2019

HPB

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“…Resource-consuming events in inpatient care was the main contributor to the difference in mean cost. In previous studies, bowel obstruction and incisional hernia [37] and wound infection [37,38] have been reported to be more prevalent after open than after laparoscopic surgery. Many observations on preoperative clinical T and, to some extent, N-stage were missing in open surgery group.…”

Section: Discussionmentioning

confidence: 93%

Cost-effectiveness analysis of laparoscopic and open surgery in routine Swedish care for colorectal cancer

et al. 2019

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Background Laparoscopic surgery for colorectal cancer has been shown in clinical trials to be effective regarding short-term outcomes and oncologically safe. Health economic analyses have been performed early in the learning curve when adoption of laparoscopic surgery was not extensive. This cost-effectiveness analysis evaluates laparoscopic versus open colorectal cancer surgery in Swedish routine care. Methods In this national retrospective cohort study, data were retrieved from the Swedish ColoRectal Cancer Registry. Clinical effectiveness, resource use and unit costs were derived from this and other sources with nationwide coverage. The study period was 2013 and 2014 with 1 year follow-up. Exclusion criterion comprised cT4-tumors. Clinical effectiveness was estimated in a composite endpoint of all-cause resource-consuming events in inpatient care, readmissions and deaths up to 90 days postoperatively. Up to 1 year, events predefined as related to the primary surgery were included. Costs included resource-consuming events, readmissions and sick leave and were estimated for both the society and healthcare. Multivariable regression analyses were used to adjust for differences in baseline characteristics between the groups. Results After exclusion of cT4 tumors, the cohort included 7707 patients who underwent colorectal cancer surgery: 6060 patients in the open surgery group and 1647 patients in the laparoscopic group. The mean adjusted difference in clinical effectiveness between laparoscopic and open colorectal cancer surgery was 0.23 events (95% CI 0.12 to 0.33). Mean adjusted differences in costs (open minus laparoscopic surgery) were $4504 (95% CI 2257 to 6799) and $4480 (95% CI 2739 to 6203) for the societal and the healthcare perspective respectively. In both categories, resource consuming events in inpatient care were the main driver of the results. Conclusion In a national cohort, laparoscopic colorectal cancer surgery was associated with both superior outcomes for clinical effectiveness and cost versus open surgery. Keywords Cost-effectiveness analysis • Laparoscopic surgery • Colorectal cancer Colorectal cancer is the second most common form of cancer in men and third most common cancer in women [1].

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“…Due to the thin proper muscle layer of appendix compared to that of the colon and rectum, and the abundant lymphatics surrounding the ileocecal area, lymph node metastasis of appendical adenocarcinoma is often identified 3) . Because of the reduced postoperative complications associated with laparoscopic colon resection 4,5) , we believe that laparoscopic resection of the ileocecal area and regional lymph nodes should be considered when malignant change is clinically suspected.…”

Section: Discussionmentioning

confidence: 99%

“…2B). The distal part of the appendix had fluid retention ( , Haruka Maehara 2) , Tsutomu Namikawa 3) , Satoru Tamura 4) , Makoto Hiroi 5) , Kazuhiro Hanazaki 3) , Michiya Kobayashi 1) phy (PET)-CT showed strong accumulation of FDG in the tumor of the appendix (Fig. 2D), although no other abnormal accumulation, including in regional lymph nodes, was identified.…”

Section: Clinical Datamentioning

confidence: 99%

Laparoscopic resection of villous adenoma of the appendix

Maeda

Maehara²,

Namikawa

et al. 2017

Ann. Cancer Res. Therap.

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Villous adenoma accounts for only 1% of adenomas arising from the large intestine. Malignant changes are more common for villous adenoma than for tubular and tubulovillous adenomas. However, preoperative diagnosis of villous adenoma is rare and treatment remains contentious.A 77-year-old woman was referred to Kochi Medical School (KMS) Hospital for treatment of villous adenoma of the appendix. Preoperative abdominal computed tomography (CT) revealed that the tumor was 3 cm in diameter and accompanied by a cystic structure on the distal side. Strong accumulation of fluorodeoxyglucose (FDG) on FDG-positron emission tomography-CT and elevated serum carcinoembryonic antigen concentrations suggested malignant change. Consequently, laparoscopic ileocecal resection with regional lymph node dissection was performed. Pathologically, atypical cells with enlarged nucleus were arranged in the villous structure.Until the minimum surgical intervention is proven safe, when malignant change is likely, surgical resection with lymph node dissection should be considered.

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Laparoscopy may decrease morbidity and length of stay after elective colon cancer resection, especially in frail patients: results from an observational real-life study

Abstract: In a real-life setting, laparoscopy decreases wound infection rate, post-operative complications, and length of stay, especially in ASA III-IV patients.

Cited by 26 publications

References 60 publications

A perioperative multidisciplinary care bundle reduces surgical site infections in patients undergoing synchronous colorectal and liver resection

A perioperative multidisciplinary care bundle reduces surgical site infections in patients undergoing synchronous colorectal and liver resection

Cost-effectiveness analysis of laparoscopic and open surgery in routine Swedish care for colorectal cancer

Laparoscopic resection of villous adenoma of the appendix

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