Critical appraisal of laparoscopic<i>vs</i>open rectal cancer surgery

Tan, Winson Jianhong; Dharmawan, Angela Renayanti; Singh, Mukesh Vir; Acharyya, Sanchalika; Loi, Carol; Tang, Choong Leong

doi:10.4240/wjgs.v8.i6.452

Cited by 6 publications

(3 citation statements)

References 36 publications

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“…With increased colorectal cancer incidence, the number of colorectal cancer surgery has also elevated dramatically. Laparoscopic or open colorectal resections, as the main surgical approach for colorectal cancer, may also result in many serious complications like postoperative ileus, nausea, and vomiting, which could lead to significant postoperative morbidity and a prolonged length of hospital stay and place a significant financial burden on health care facilities [ 3 , 4 ]. Therefore, targeting the recovery of intestinal function after colorectal cancer surgery may contribute to promote rehabilitation for the patient.…”

Section: Introductionmentioning

confidence: 99%

Chewing Gum for Intestinal Function Recovery after Colorectal Cancer Surgery: A Systematic Review and Meta-Analysis

Mei

Wang

Cui

et al. 2017

Gastroenterology Research and Practice

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Background This meta-analysis was performed to assess the efficacy and safety of chewing gum in intestinal function recovery after colorectal cancer surgery. Methods A systematic search was conducted in PubMed, Embase, Science Direct, and Cochrane library for relevant randomized controlled trials (RCTs) published until April 2017. Summary risk ratios or weighted mean differences with 95% confidence intervals were used for continuous and dichotomous outcomes, respectively. Results 17 RCTs with a total number of 1845 patients were included. Gum chewing following colorectal cancer surgery significantly reduced the time to first passage of flatus (WMD −0.55; 95% CI −0.94 to −0.16; P = 0.006), first bowel movement (WMD −0.60; 95% CI −0.87 to −0.33; P < 0.0001), start feeding (WMD −1.32; 95% CI −2.18 to −0.46; P = 0.003), and the length of postoperative hospital stay (WMD −0.88; 95% CI −1.59 to −0.17; P = 0.01), but no obvious differences were found in postoperative nausea, vomiting, abdominal distention, pneumonia, and mortality, which were consistent with the findings of intention to treat analysis. Conclusions Chewing gum could accelerate the recovery of intestinal function after colorectal cancer surgery. However, it confers no advantage in postoperative clinical complications. Further large-scale and high-quality RCTs should be conducted to confirm these results.

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Section: Introductionmentioning

confidence: 99%

Chewing Gum for Intestinal Function Recovery after Colorectal Cancer Surgery: A Systematic Review and Meta-Analysis

Mei

Wang

Cui

et al. 2017

Gastroenterology Research and Practice

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“…The most often used definition for CRM involvement was 1 mm, which was used in 37 studies (n ¼ 25,017 patients). 16e21,25e28,31e33,35,37,42,45,47,49,50,53,54,56e59,66e67,70e73,75,76,82, 88,90 Thirty-one studies defined CRM involvement as <1 mm (n ¼ 51,647 patients), 23e24,29e30,34,36, 39e41,43e44,48,51e52,60e62,64,68,69,77e81,83e87,89 and 7 studies used cutoff values of more than 1 mm, such as <1.5 mm or 2 mm (n ¼ 8,384 patients) 22,38,46,55,63,65,74 (Table I). Analyses for CRMþ rates based on the definition of 1 mm was performed for the predefined subgroups (Appendix Table 3).…”

Section: Pooled Proportions Of Crm Involvementmentioning

confidence: 99%

Prognostic importance of circumferential resection margin in the era of evolving surgical and multidisciplinary treatment of rectal cancer: A systematic review and meta-analysis

Detering

Rutgers

Bemelman

et al. 2021

Surgery

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Background: Circumferential resection margin is considered an important prognostic parameter after rectal cancer surgery, but its impact might have changed because of improved surgical quality and tailored multimodality treatment. The aim of this systematic review was to determine the prognostic importance of circumferential resection margin involvement based on the most recent literature. Methods: A systematic literature search of MEDLINE, Embase, and the Cochrane Library was performed for studies published between January 2006 and May 2019. Studies were included if 3-or 5-year oncological outcomes were reported depending on circumferential resection margin status. Outcome parameters were local recurrence, overall survival, disease-free survival, and distant metastasis rate. The Newcastle Ottawa Scale and Jadad score were used for quality assessment of the studies. Meta-analysis was performed using a random effects model and reported as a pooled odds ratio or hazard ratio with 95% confidence interval. Results: Seventy-five studies were included, comprising a total of 85,048 rectal cancer patients. Significant associations between circumferential resection margin involvement and all long-term outcome parameters were uniformly found, with varying odds ratios and hazard ratios depending on circumferential resection margin definition (<1 mm, 1 mm, otherwise), neoadjuvant treatment, study period, and geographical origin of the studies. Conclusion: Circumferential resection margin involvement has remained an independent, poor prognostic factor for local recurrence and survival in most recent literature, indicating that circumferential resection margin status can still be used as a short-term surrogate endpoint.

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“…Surgical trauma causes a decrease in bowel motility through activation of sympathetic activity. Associated with the stress response is release of inflammatory mediators such as vasoactive intestinal peptide, substance P and nitric oxide which contributes to postoperative gastrointestinal dysfunction and ileus [6] Many interventions and strategies, such as prokinetic agents and epidural anesthesia, have been used to manage postoperative ileus. However, these methods have a limited effect, and there is still a relatively high incidence of postoperative ileus.…”

Section: Introductionmentioning

confidence: 99%

Effect of Sham Feeding on Postoperative Clinical Outcomes among Patients Undergoing Elective Abdominal and Gynecological Surgeries

Riad¹,

Masry²,

Elwan³

et al. 2019

AJNR

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Sham feeding has been demonstrated to be one of the methods to increase bowel motility. Gum chewing, as an alternative to sham feeding, provides the benefits of gastrointestinal stimulation without the complications associated with feeding. Aim: to evaluate the effect of sham feeding on postoperative clinical outcomes among patients undergoing elective abdominal and gynecological surgeries. Subjects: A purposive sample including 150 patients who were admitted to the general surgical and gynecological unit for undergoing elective open abdominal surgeries such as cholecystectomy, appendectomy, hysterectomy, myomectomy. Were divided randomly into two equal groups 75 patients in each Study group (I): practice post-operative sham feeding in addition to the usual routine hospital care such as early mobilization and Control group (II): Follow the usual routine hospital care such as early mobilization only. Setting: The study was conducted at the general surgical and gynecological unit of Menoufia University Hospital. Instruments: Three instruments were utilized, I: A structured Interviewing Questionnaire, II: Postoperative Patient's Outcomes Questionnaire and III: Visual Analogue Scale (VAS). Results: Significant statistical differences existed between both groups regarding the time of resumption of gastrointestinal functions, postoperative ileus symptoms, and incidence of nausea, vomiting, pain and length of hospital stay. Conclusion: Patients who practiced chewing gum as alternative for sham feeding experience earlier return of bowel motility in terms of bowel sounds, first flatus and feeling of hunger than those patients who did not practice chewing gum. Furthermore, there was a significant reduction in pain and length of hospital stay among patients who were practice chewing gum than those who were not. Recommendations: the study recommended that: Sham feeding in a form of gum chewing should be added in the protocol of postoperative nursing care and conducting further studies for evaluating the effect of sham feeding on postoperative ileus among patients undergoing abdominal and gynecological surgeries using a larger sample and different geographical areas.

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Critical appraisal of laparoscopicvsopen rectal cancer surgery

Abstract: LRR has equivalent long-term oncologic outcomes when compared to OP. Laparoscopic conversion does not confer a worse prognosis.

Cited by 6 publications

References 36 publications

Chewing Gum for Intestinal Function Recovery after Colorectal Cancer Surgery: A Systematic Review and Meta-Analysis

Chewing Gum for Intestinal Function Recovery after Colorectal Cancer Surgery: A Systematic Review and Meta-Analysis

Prognostic importance of circumferential resection margin in the era of evolving surgical and multidisciplinary treatment of rectal cancer: A systematic review and meta-analysis

Effect of Sham Feeding on Postoperative Clinical Outcomes among Patients Undergoing Elective Abdominal and Gynecological Surgeries

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