Is laparoscopic colorectal cancer surgery equal to open surgery? An evidence based perspective

Künzli, Beat; Friess, Helmut; Shrikhande, Shailesh V.

doi:10.4240/wjgs.v2.i4.101

Cited by 17 publications

(9 citation statements)

References 77 publications

(61 reference statements)

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“…The traditional reservations regarding minimally invasive surgery, including the management of intraoperative complications and the maintenance of orthodox oncologic principles remain, and uptake of MIE lags behind the use of minimally invasive techniques in colorectal and liver surgery. 36,37 Furthermore, gastric conduit necrosis has been suggested as a complication specific to MIE. 38 We observed no incidence of gastric tube necrosis in this series in keeping with other large series of MIE-2.…”

Section: Discussionmentioning

confidence: 99%

A prospective comparison of totally minimally invasive versus open Ivor Lewis esophagectomy

et al. 2012

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The majority of esophagectomies in Western parts of the world are performed by a transthoracic approach reflecting the prevalence of adenocarcinoma of the lower esophagus or esophagogastric junction. Minimally invasive esophagectomy (MIE) has been reported in a variety of formats, but there are no series that directly compare totally minimally invasive thoracolaparoscopic 2 stage esophagectomy (MIE-2) with open Ivor Lewis (IVL). A prospective single-center cohort study of patients undergoing elective MIE-2 or IVL between January 2005 and November 2010 was performed. Short-term clinicopathologic outcomes were recorded using validated systems. One hundred and six patients (median age 66, range 36-85, 88 M : 18 F) underwent two-stage esophagectomy (53 MIE-2 and 53 IVL). Patient demographics (age, sex, body mass index, American Society of Anesthesiologists grade, tumor characteristics, neoadjuvant chemotherapy, and TNM stage) were comparable between the two groups. Outcomes for MIE-2 and IVL were comparable for anastomotic leak rates (5 [9%] vs. 2 [4%], P= 0.241), resection margin clearance (R0) (43 [81%] vs. 38 [72%], P= 0.253), median lymph node yield (19 vs. 18, P= 0.584), and median length of stay (12 [range 7-91] vs. 12 [range 7-101] days), respectively. Blood loss was significantly less for MIE-2 compared with IVL (median 300 [range 0-1250] mL vs. 400 [range 0-3000] mL, respectively, P= 0.021). MIE-2 in this series of selected patients supports its efficacy, when performed by an experienced minimally invasive surgical team. A well-designed multicenter trial addressing clinical effectiveness is now required.

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Section: Discussionmentioning

confidence: 99%

A prospective comparison of totally minimally invasive versus open Ivor Lewis esophagectomy

et al. 2012

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“…New, less invasive radiological and treatment strategies are required, but these are already being introduced, such as laparoscopic surgery for colorectal carcinoma [37] and endomucosal resection of oesophageal cancers [38]. Some of the patients undergoing screening are likely to have anxieties related to the outcomes of their yearly tests, but these are arguably balanced by the knowledge that many cancers caught early are in most cases unlikely to be fatal.…”

Section: Discussionmentioning

confidence: 99%

Improved blood tests for cancer screening: general or specific?

Cree

2011

BMC Cancer

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Diagnosis of cancer at an early stage leads to improved survival. However, most current blood tests detect single biomarkers that are of limited suitability for screening, and existing screening programmes look only for cancers of one particular type. A new approach is needed. Recent developments suggest the possibility of blood-based screening for multiple tumour types. It may be feasible to develop a high-sensitivity general screen for cancer using multiple proteins and nucleic acids present in the blood of cancer patients, based on the biological characteristics of cancer. Positive samples in the general screen would be submitted automatically for secondary screening using tests to help define the likelihood of cancer and provide some indication of its type. Only those at high risk would be referred for further clinical assessment to permit early treatment and mitigate potential overdiagnosis. While the assays required for each step exist, they have not been used in this way. Recent experience of screening for breast, cervical and ovarian cancers suggest that there is likely to be widespread acceptance of such a strategy.

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“…On the other hand, laparoscopic techniques for colon cancer resection have been much more widely utilized, as the benefits related to safety, improved short-term outcomes and uncompromised oncologic adequacy have been definitively shown [76][77][78]. Nevertheless, laparoscopic surgery for colon and rectal cancer still requires a relatively large abdominal extraction site and has a lengthy learning curve, with some estimating 40-50 cases necessary to become proficient and decrease operative time [79,80].…”

Section: • • Laparoscopic Techniques and Natural Orifice Specimen Extramentioning

confidence: 99%

Future directions in surgery for colorectal cancer: the evolving role of transanal endoscopic surgery

2014

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The current standard of care for resectable rectal cancers is total mesorectal excision (TME), which is usually performed open or laparoscopically, however, both techniques are associated with high morbidity and mortality.• Transanal endoscopic surgery (TES) is appropriate for benign rectal lesions and low-risk T1 tumors (Sm1; well differentiated; no lymphovascular or perineural invasion, and no tumor budding; <3 cm in size; <30% bowel circumference; and anticipated 3-mm clear margin).• Promising data support the use of neoadjuvant chemoradiation in making more lesions amenable to TES.• TES could potentially become favored over more radical surgery for preoperatively staged T2 tumors after neoadjuvant treatment.• Criteria for 'watch-and-wait' approaches are in flux because TES may have a role as a macrobiopsy for determining postneoadjuvant therapy T-stage, since long-term oncologic outcomes for TES are more related to ypT-stage rather than pretreatment T-stage.• Increasing data support transanal natural orifice translumenal endoscopic surgery (NOTES) TME as an acceptable alternative to open and laparoscopic TME, with regards to oncologic and functional outcomes.• Treatment paradigms including transanal NOTES to perform sentinel-node biopsies may provide more accurate staging, and potentially eliminate the need for TME in some cases.• Transanal NOTES TME should only be performed in carefully selected patients by surgeons with extensive experience with TES, laparoscopic TME and intersphincteric resection.SUMMARY The morbidity associated with radical surgery for rectal cancer has launched a revolution in increasingly less-invasive methods of resection, including a recent resurgence in transanal endoscopic surgical approaches. The next evolution in transanal surgery for rectal cancer is natural orifice translumenal endoscopic surgery (NOTES). To date, 14 series of transanal NOTES total mesorectal excision (TME) for rectal cancer have been published (n = 76).For reprint orders, please contact: reprints@futuremedicine.com

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Is laparoscopic colorectal cancer surgery equal to open surgery? An evidence based perspective

Cited by 17 publications

References 77 publications

A prospective comparison of totally minimally invasive versus open Ivor Lewis esophagectomy

A prospective comparison of totally minimally invasive versus open Ivor Lewis esophagectomy

Improved blood tests for cancer screening: general or specific?

Future directions in surgery for colorectal cancer: the evolving role of transanal endoscopic surgery

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