Combined endo-laparoscopic surgery for difficult benign colorectal polyps

Liu, Zhonghui; Jiang, Li; Chan, F.H.Y.; Li, Michael Ka-Wah; Fan, Jicong

doi:10.21037/jgo.2019.12.11

Cited by 17 publications

(13 citation statements)

References 48 publications

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“…To date, few studies have described the use of various CELS techniques 16–20 . Reported technical success rates from available literature range from 95% to 100%, 16,18–20 comparable to ourtechnical success rate of 93%.…”

Section: Discussionmentioning

confidence: 72%

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Colonoscopic-Assisted Laparoscopic Wedge Resection for Colonic Lesions

et al. 2022

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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.

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Section: Discussionmentioning

confidence: 72%

“…A recent systematic review of CELS involving 101 patients showed no intra- or post-operative complications 17 . Another recent retrospective cohort study (n = 115 patients) showed Clavien-Dindo grade I-II complications in 13% of patients after CELS 30 .…”

Section: Discussionmentioning

confidence: 99%

Colonoscopic-Assisted Laparoscopic Wedge Resection for Colonic Lesions

et al. 2022

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“…Some smaller, but more recent, studies showed lower complication rates [ 27 , 28 ]. In 2016 [ 29 ] and 2020 [ 30 ] systematic reviews were published with available literature on all combined endoscopic and laparoscopic surgery‐type procedures. All these included studies showed similar numbers of patients and results.…”

Section: Discussionmentioning

confidence: 99%

Laparoscopic wedge resection as an alternative to laparoscopic oncological colon resection for benign endoscopically unresectable colon polyps

et al. 2021

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Aim The aim of this study was to investigate, by comparing clinical and histological outcomes, whether laparoscopic (hybrid) wedge resection (LWR) could be a less invasive and safe alternative to laparoscopic oncological colon resection (OCR) for patients with an endoscopically unresectable, suspected benign, colon polyp. Method All patients with an endoscopically unresectable colon polyp who were referred for surgery between 2009 and 2018 and without biopsy‐proven colon cancer were identified from a prospectively maintained database. Patients with macroscopic features of malignancy during endoscopy were excluded. Clinical and histological results for patients who underwent OCR or LWR were reviewed. Results One hundred‐and‐twenty‐two patients were included. Ninety‐seven patients underwent OCR and 25 LWR. Major complications occurred in 16.7% (n = 16) of the OCR group compared with 4.0% (n = 1) of the LWR group (p = 0.06). In the OCR group the anastomotic leakage rate was 6.3% (n = 6) and the mortality rate 3.1% (n = 3). No anastomotic leakage or deaths occurred in the LWR group. The median length of hospital stay after OCR was 5 days [interquartile range (IQR) 5–9 days)] compared with 2 days (IQR 2–4 days) after LWR (p < 0.0001). Definite pathology showed a malignancy rate of 4.2% (n = 4) in the OCR group and 4.0% (n = 1) (without high‐risk features) in the LWR group. Conclusion This study shows that LWR was associated with significantly lower complication rates and acceptable oncological risks compared with OCR. Therefore we suggest that LWR is a safe alternative treatment, next to other endoscopic options. The treatment that is most suitable for an individual patient should be discussed in a multidisciplinary meeting.

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“…This procedure with little modification is reported by Leicher et al [ 19 ] for “difficult” polyps in terms of location—cecum, hepatic flexure, splenic flexure and sigmoid colon. Polyps of the cecum are considered and described in the literature as “difficult” because of their location and the proximity of the ileocecal valve [ 3 ]. These lesions were usually treated by open surgery, but nowadays, with the introduction of endoscopically assisted laparoscopic procedures, many of these lesions could be resected laparoscopically, as we described here.…”

Section: Discussionmentioning

confidence: 99%

“…This procedure was firstly used for common bile duct stone treatment [ 1 ] but was introduced in other gastrointestinal (GI) areas as well. In GI surgery, this procedure is used for lesions that, for some reason, could not be resected completely endoscopically [ 2 ] or in laparoscopic procedures in which endoscopic navigation is necessary [ 3 ]. Endoscopic navigation is used in this technique for accurately determining the surgical field of work.…”

Section: Introductionmentioning

confidence: 99%

Laparoscopic–Endoscopic “Rendezvous” Procedure in Pediatric Gastrointestinal Surgery—Case Series

et al. 2021

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Laparoscopic–endoscopic “rendezvous” procedures were introduced in surgery for common bile duct stone treatment but are now widely used in other fields of abdominal surgery. An endoscopist navigates a surgeon during the same operative procedure and, thus, enables a better visualization of the location, resection margins, bleeding control, less thermal damage, etc. Here, we present case series of 11 patients that were treated using a “rendezvous” procedure for gastrointestinal lesions on different parts of the gastrointestinal tract such as juvenile polyps on the colon (transversum, ascendens, cecum, sigma), leiomyomatosis of the stomach, Peutz–Jeghers intestinal polyposis, hyperplastic gastric polyp, ectopic pancreatic tissue in the stomach, gastric trichobezoar, and gastric schwannoma. “Rendezvous” procedures are suitable for intestinal lesions that could not be resected endoscopically due to their size, morphology and/or location. In our experience this procedure should be used for endoscopically unresectable lesions as it decreases the time of surgery, possibility of iatrogenic injury, bleeding and technical inability. Furthermore, this procedure has been shown to better navigate the surgeon during laparoscopic surgery, especially in treating polyps in particularly difficult locations such as the duodenum or cecum, and it decreases conversion rates. However, conversion is sometimes necessary, in order to assure all oncological principals are respected, and the best option in some cases.

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Combined endo-laparoscopic surgery for difficult benign colorectal polyps

Cited by 17 publications

References 48 publications

Colonoscopic-Assisted Laparoscopic Wedge Resection for Colonic Lesions

Colonoscopic-Assisted Laparoscopic Wedge Resection for Colonic Lesions

Laparoscopic wedge resection as an alternative to laparoscopic oncological colon resection for benign endoscopically unresectable colon polyps

Laparoscopic–Endoscopic “Rendezvous” Procedure in Pediatric Gastrointestinal Surgery—Case Series

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