Colonoscopic-Assisted Laparoscopic Wedge Resection for Colonic Lesions

Abstract

The aim of this study was to evaluate the safety and efficacy of a modified CAL-WR. Summary Background Data: The use of segmental colectomy in patients with endoscopically unresectable colonic lesions results in significant morbidity and mortality. CAL-WR is an alternative procedure that may reduce morbidity. Methods: This prospective multicenter study was performed in 13 Dutch hospitals between January 2017 and December 2019. Inclusion criteria were (1) colonic lesions inaccessible using current endoscopic resection techniques (judged by an expert panel), (2) non-lifting residual/recurrent adenomatous tissue after previous polypectomy or (3) an undetermined resection margin after endoscopic removal of a low-risk pathological T1 (pT1) colon carcinoma. Thirty-day morbidity, technical success rate and radicality were evaluated. Results: Of the 118 patients included (56% male, mean age 66 years, standard deviation AE 8 years), 66 (56%) had complex lesions unsuitable for endoscopic removal, 34 (29%) had non-lifting residual/recurrent adenoma after previous polypectomy and 18 (15%) had uncertain resection margins after polypectomy of a pT1 colon carcinoma. CAL-WR was technically successful in 93% and R 0 resection was achieved in 91% of patients. Minor complications (Clavien-Dindo i-ii) were noted in 7 patients (6%) and an additional oncologic segmental resection was performed in 12 cases (11%). Residual tissue at the scar was observed in 5% of patients during endoscopic follow-up. Conclusions: CAL-WR is an effective, organ-preserving approach that results in minor complications and circumvents the need for major surgery. CAL-WR, therefore, deserves consideration when endoscopic excision of circumscribed lesions is impossible or incomplete.

Hybrid laparoendoscopic technologies in treatment of large colon polyps

“…Осложнения I-II степени (по Clavien-Dindo) были отмечены лишь у 7 (6 %) пациентов. Авторы пришли к выводу, что гибридная лапароэндоскопическая клиновидная резекция кишки (CAL-WR) -эффективный, органосохраняющий метод лечения трудных и эндоскопически нерезектабельных полипов с минимальными рисками послеоперационных осложнений [16].…”

Colonoscopic‐assisted laparoscopic wedge resection versus segmental colon resection for benign colonic polyps: a comparative cost analysis

“…In this retrospective cohort, CAL‐WR was considered curative in 40 of 57 patients, and an SCR was therefore prevented in 70% of the patients. In contrast to SCR, CAL‐WR is associated with negligible morbidity and no mortality [18, 28].…”

“…Written informed consent was obtained from each patient. For details on the procedure and technical aspects of CAL-WR, we refer to previous reports by Leicher et al [18,19].…”

“…Since the implementation of the national bowel cancer screening programme, the number of surgical referrals for benign polyps has tripled [11], whilst at the same time colorectal cancer is more frequently detected at an earlier stage and also the armamentarium of advanced endoscopic (combined with laparoscopic) techniques has expanded, both resulting in a shift to a more common use of local resection techniques [12][13][14]. Combined endoscopic laparoscopic surgery techniques, such as the colonoscopic-assisted laparoscopic wedge resection (CAL-WR), can be used to treat patients with endoscopic unresectable benign colonic polyps [15][16][17][18][19].…”

“…Recently, CAL-WR has been proven as an effective and safe technique to remove endoscopic unresectable complex colonic polyps, yielding a technical success rate of 95% and an overall R0 resection rate of 91% in a national prospective multicentre study (LIMERIC study) [18]. In this study all polyps that were judged to be endoscopically unresectable were reviewed by an expert panel before inclusion.…”