Minimally invasive colorectal cancer procedures in patients with obesity: an interdisciplinary approach

Alyaqout, Khaled; Lairy, Ali; Efthymiou, Evgenia; Khwaja, Haris A.; Warren, Oliver; Mills, Sarah; Tekkis, Paris; Kontovounisios, Christos

doi:10.1007/s10151-019-02027-5

Cited by 3 publications

(2 citation statements)

References 8 publications

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“…Bariatric-length trocars and bariatric-length laparoscopic instruments should be available in the operating theatre and should be used if required. Additional 5 mm ports should be considered to allow for more effective assistant retraction and handling of the heavy mesentery [ 22 ].…”

Section: Discussionmentioning

confidence: 99%

Colorectal Cancer and the Obese Patient: A Call for Guidelines

Petrou

Rafique

Tekkis

et al. 2022

Cancers

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The link between obesity and colorectal cancer has been well established. The worldwide rise in obesity rates in the past 40 years means that we are dealing with increasing numbers of obese patients with colorectal cancer. We aimed to review the existing guidelines and make recommendations specific to this group of patients. Upon comparing the current NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines ®), the guidelines from the European Society of Medical Oncology (ESMO) and the guidelines of the Japanese Society for Cancer of the Colon and Rectum (JSCCR), we observed that these did not take into consideration the needs of obese patients. We proceeded to make specific recommendations with regards to the diagnostic work-up, surgical pathways, minimally invasive technique, perioperative treatment, post-operative surveillance, and management of metastatic disease in this group of patients. Our review highlights the need for modification of the existing guidelines to account for the needs of this patient cohort. A multidisciplinary approach, including principles used by bariatric surgeons, should be the way forward to reach consensus in the management of this group of patients.

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Section: Discussionmentioning

confidence: 99%

Colorectal Cancer and the Obese Patient: A Call for Guidelines

Petrou

Rafique

Tekkis

et al. 2022

Cancers

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“…Indeed, the opposite can be quite true, and many patients with obesity demonstrate protein calorie malnutrition and sarcopenia, as demonstrated by low albumin and prealbumin levels as well as muscle wasting on cross-sectional imaging [59,60]. Methods to reduce visceral and systemic adiposity while improving protein stores preoperatively are imperative to improve operative and postoperative outcomes [61]. Options include very low calorie diets, pharmacotherapy, or metabolic surgery.…”

Section: Obesitymentioning

confidence: 99%

Preoperative Evaluation in Colorectal Patients

Landmann

Francone

2021

The ASCRS Textbook of Colon and Rectal Surgery

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Patients undergoing elective abdominal colorectal operations are in the "intermediate" risk group for perioperative morbidity and mortality. • Recognition and optimization of concomitant patient pathophysiology are paramount in minimizing sepsis (anastomotic leak, surgical site infection), complications, and overall morbidity. • These include cardiopulmonary, renal, metabolic, and endocrine physiology and other pathophysiologic risk factors and derangements (such as frailty and immunosuppression). • Implementation of ACC/AHA guidelines and evidencebased medical management leads to improved efficiencies with minimization of extraneous testing and delays, while preserving low complication rates. • Corticosteroids and immunosuppression remain significant determinants of morbidity in patients undergoing intestinal colorectal surgery. • Prehabilitation of the frail and elderly patient is critical in optimizing patients for surgery while attempting to mitigate perioperative morbidity and mortality. Evaluation of the Routine Colorectal Patients In Office by SurgeonA detailed history and physical examination are paramount to the evaluation and optimal management of a preoperative patient. A thorough review of the patient's chief complaint as well as associated signs and symptoms and confounding issues or factors is necessary to synthesize an appropriate diagnosis and perioperative plan. Careful attention to the patient's medical comorbidities and past surgical history, as well as review and reconciliation of the patient's medications, is relevant to help coordinate perioperative management and operative planning. In patients who require multidisciplinary care such as inflammatory bowel disease and rectal cancer, it is imperative to ascertain the other specialists' contact information for optimal coordination of care. Similarly, specialist communication should be coordinated for patients who have significant cardiopulmonary disease or other major medical comorbidities. Personal review of source documentation for pertinent pathology, endoscopy, and radiological findings is critical in establishing a diagnosis and individualized plan of care. In many cases, the above may require coordination among more than one physician and more than one healthcare organization to achieve optimal perioperative care and outcomes, while minimizing morbidity.

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A Case of Laparoscopic Left Hemicolectomy for Transverse Colon Cancer With Severe Obesity Performed Safely by Multidisciplinary Perioperative Management

Matsumi,

Kikuchi,

Shoji

et al. 2024

Cureus

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A minimally invasive approach using laparoscopy or robotics has become the standard procedure in surgery for colorectal cancer. However, obesity is considered to be associated with a poor prognosis in laparoscopic colorectal surgery. Perioperative management, as well as the surgical procedure, is particularly important in severely obese patients. A case of colon cancer with severe obesity that underwent laparoscopic colectomy and was managed safely by multidisciplinary perioperative management in collaboration with a bariatric and metabolic surgery (BMS) team is presented. The patient was severely obese, with a body mass index (BMI) of 50.4 kg/m 2 . After one month of preoperative weight loss intervention by the BMS team, the patient’s weight was successfully decreased by approximately 15 kg (BMI: 46 kg/m 2 ), and the patient underwent laparoscopic colectomy for transverse colon cancer in collaboration with the BMS team. In the laparoscopic surgery, a small incision for specimen removal was made above the umbilicus to insert the first trocar safely, and five additional trocars, whose placement was determined based on the target vessels of the dissected lymph nodes in reference to preoperative computed tomography (CT), were also inserted above the umbilicus. Gastrointestinal reconstruction was performed intracorporeally by an overlap technique using an endoscopic linear stapler to perform the procedure safely with minimal invasiveness. The patient was discharged on postoperative day eight without any postoperative complications, following early postoperative rehabilitation with intervention by the BMS team. The proportion of colorectal cancer patients with obesity is expected to increase in the future, and the establishment of multidisciplinary perioperative management and surgical techniques will be useful to improve the surgical outcomes and prognosis of colorectal cancer patients with severe obesity.

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Minimally invasive colorectal cancer procedures in patients with obesity: an interdisciplinary approach

Cited by 3 publications

References 8 publications

Colorectal Cancer and the Obese Patient: A Call for Guidelines

Colorectal Cancer and the Obese Patient: A Call for Guidelines

Preoperative Evaluation in Colorectal Patients

A Case of Laparoscopic Left Hemicolectomy for Transverse Colon Cancer With Severe Obesity Performed Safely by Multidisciplinary Perioperative Management

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