Evaluating the predictive factors for anastomotic leakage after total laparoscopic resection with transrectal natural orifice specimen extraction for colorectal cancer

Zhou, Sicheng; Pei, Wei; Li, Zijin; Zhou, Haitao; Liang, Jianwei; Liu, Qian; Zhou, Zhixiang; Wang, Xishan

doi:10.1111/ajco.13372

Cited by 6 publications

(5 citation statements)

References 19 publications

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“…The robotic technique enhances the accuracy, flexibility, and precision of the NOSES procedure. Zhou et al (15) reported that 21 (10.1%) patients developed anastomotic leakage (AL) following laparoscopic resection with transrectal NOSE. The narrow pelvic cavity increased the complexity of the transrectal NOSE, such as intracorporeal This study showed that T4 stage cases accounted for 34.3% in the CRR group and 20.5% in the NOSES group, which is inconsistent with the recommendations of the International consensus on natural orifice specimen extraction surgery (NOSES) for colorectal cancer (10).…”

Section: Discussionmentioning

confidence: 99%

Robotic natural orifice specimen extraction surgery versus conventional robotic resection for patients with colorectal neoplasms

Liu

et al. 2023

Front. Oncol.

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BackgroundLaparoscopic natural orifice specimen extraction surgery (NOSES) has been widely used in colorectal neoplasms. However, only a few studies have focused on robotic NOSES. This study compared the short-term clinical outcomes and long-term survival outcomes between robotic NOSES and conventional robotic resection (CRR) groups.MethodsFrom March 2016 to October 2018, a consecutive of 143 patients who underwent robotic sigmoid and rectal resection at the Department of Gastrointestinal Surgery, The Second Xiangya Hospital, Central South University, were considered for inclusion in this study. Propensity-score matching (PSM) was conducted to account for differences in the baseline characteristics. After PSM, 39 patients were included in the robotic NOSES group, and 39 patients in the CRR group. The baseline characteristics between the two groups were all balanced and comparable.ResultsPatients in the NOSES group experienced less intraoperative blood loss (p=0.001), lower requirements for additional analgesia (p=0.020), shorter time to first flatus (p=0.010), and a shorter time to first liquid diet (p=0.003) than the CRR group. The 3-year overall survival rates (NOSES: 92.3% vs. CRR: 89.7% p=1.000) and 3-year disease-free survival rates (NOSES: 82.1% vs. CRR: 84.6% p=0.761) between the two groups were comparable.ConclusionRobotic natural orifice specimen extraction surgery is a safe and feasible surgery for patients with colorectal neoplasms. Robotic NOSES is associated with better short-term clinical outcomes and similar long-term survival outcomes to conventional robotic resection.

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Section: Discussionmentioning

confidence: 99%

Robotic natural orifice specimen extraction surgery versus conventional robotic resection for patients with colorectal neoplasms

Liu

et al. 2023

Front. Oncol.

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“…Both domestically and internationally, there is consensus on the impact of tumor location on AL following low anterior resection of rectal cancer; that is, the closer the tumor is to the anal margin, the higher the risk of AL[ 24 - 26 ]. The same conclusion was reached in the present study.…”

Section: Discussionmentioning

confidence: 99%

Establishment and application of three predictive models of anastomotic leakage after rectal cancer sphincter-preserving surgery

Li,

Zhou,

Wang

et al. 2023

World J Gastrointest Surg

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Postcholecystectomy bile duct injury (BDI) remains a devastating iatrogenic complication that adversely impacts the quality of life with high healthcare costs. Despite a decrease in the incidence of laparoscopic cholecystectomy-related BDI, the absolute number remains high as cholecystectomy is a commonly performed surgical procedure. Open Roux-en-Y hepaticojejunostomy with meticulous surgical technique remains the gold standard surgical procedure with excellent long-term results in most patients. As with many hepatobiliary disorders, a minimally invasive approach has been recently explored to minimize access-related complications and improve postoperative recovery. Since patients with gallstone disease are often admitted for a minimally invasive cholecystectomy, laparoscopic and robotic approaches for repairing postcholecystectomy biliary stricture are attractive. While recent series have shown the feasibility and safety of minimally invasive post-cholecystectomy biliary stricture management, most are retrospective analyses with small sample sizes. Also, long-term follow-up is available only in a limited number of studies. The principles and technique of minimally invasive repair resemble open repair except for the extent of adhesiolysis and the suturing technique with continuous sutures commonly used in minimally invasive approaches. The robotic approach overcomes key limitations of laparoscopic surgery and has the potential to become the preferred minimally invasive approach for the repair of postcholecystectomy biliary stricture. Despite increasing use, lack of prospective studies and selection bias with available evidence precludes definitive conclusions regarding minimally invasive surgery for managing postcholecystectomy biliary stricture. High-volume prospective studies are required to confirm the initial promising outcomes with minimally invasive surgery.

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“…We also created the nomogram as a reference for clinicians and surgeons to help in clinical decision-making. Previous reports have described many potential risk factors for AL after colorectal cancer [ 17 , 18 , 20 , 34 ]. These risk factors include a wide range of factors in the perioperative period, and those predictive of preoperative factors alone have not yet been reported.…”

Section: Discussionmentioning

confidence: 99%

“…We searched the PubMed, Embase, and Web of Science databases without language or time restrictions to retrieve relevant studies. In some retrospective cohort studies and published reviews, based on the results of these articles, we selected some predictor variables that were assessable early at hospital admission [ 11 , 17 – 20 ], and these variables were combined with other preoperative factors added to the subsequent statistical analysis.…”

Section: Methodsmentioning

confidence: 99%

A preoperative prediction model based on Lymphocyte-C-reactive protein ratio predicts postoperative anastomotic leakage in patients with colorectal carcinoma: a retrospective study

Zhong

Lin

et al. 2022

BMC Surg

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Background & Aims Lymphocyte-C-reactive Protein Ratio (LCR) has been demonstrated as a promising new marker for predicting surgical and oncological outcomes in colorectal carcinoma (CRC). However, anastomotic leakage (AL) is also likely related to this inflammatory marker. Herein, we aimed to identify preoperative predictors of AL and build and develop a novel model able to identify patients at risk of developing AL. Methods We collected 858 patients with CRC undergoing elective radical operation between 2007 and 2018 at a single center were retrospectively reviewed. We performed univariable and multivariable analyses and built a multivariable model that predicts AL based on preoperative factors. Propensity adjustment was used to correct the bias introduced by non-random matching of the LCR. The model's performance was evaluated by using the area under the receiver operator characteristic curves (AUROCs), decision curve analysis (DCA), Brier scores, D statistics, and R2 values. Results Age, nutrition risk screening 2002 (NRS2002) score, tumor location and LCR, together with hemoglobin < 90 g/l, were independent predictors of AL. The models built on these variables showed good performance (internal validation: c-statistic = 0.851 (95%CI 0.803–0.965), Brier score = 0.049; temporal validation: c-statistic = 0.777 (95%CI 0.823–0.979), Brier score = 0.096). A regression equation to predict the AL was also established by multiple linear regression analysis: [Age(≥ 60 year) × 1.281] + [NRS2002(≥ 3) × 1.341] + [Tumor location(pt.) × 1.348]-[LCR(≤ 6000) × 1.593]-[Hemoglobin(< 90 g/L) × 1.589]-6.12. Conclusion Preoperative LCR is an independent predictive factor for AL. A novel model combining LCR values, age, tumor location, and NRS2002 provided an excellent preoperative prediction of AL in patients with CRC. The nomogram can help clinical decision-making and support future research.

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Evaluating the predictive factors for anastomotic leakage after total laparoscopic resection with transrectal natural orifice specimen extraction for colorectal cancer

Cited by 6 publications

References 19 publications

Robotic natural orifice specimen extraction surgery versus conventional robotic resection for patients with colorectal neoplasms

Robotic natural orifice specimen extraction surgery versus conventional robotic resection for patients with colorectal neoplasms

Establishment and application of three predictive models of anastomotic leakage after rectal cancer sphincter-preserving surgery

A preoperative prediction model based on Lymphocyte-C-reactive protein ratio predicts postoperative anastomotic leakage in patients with colorectal carcinoma: a retrospective study

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