Laparoscopic and open right‐sided colonic resection in daily routine practice. A prospective multicentre study within an Enhanced Recovery After Surgery (<scp>ERAS</scp>) protocol

Tiefenthal, Marit; Asklid, Daniel; Hjern, Fredrik; Matthiessen, Peter; Gustafsson, Ulf

doi:10.1111/codi.13082

Cited by 25 publications

(15 citation statements)

References 24 publications

(31 reference statements)

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“…Fourthly, out of concern for their safety, conventionally treated patients generally began to ambulate late after the surgery, whereas the ERAS patients were encouraged to move and walk as early as possible. Borborygmus recovery time was obviously shorter in the ERAS group, and early ambulation did not raise the incidence of arrhythmia, which is consistent with the findings of Tiefenthal et al [11] and Kirk et al [12]. Early ambulation can promote recovery of intestinal function, significantly shorten the recovery time of intestinal peristalsis, reduce the occurrence of abdominal distension and constipation, so as to enhance nutrition and improve the body resistance.…”

Section: Discussionsupporting

confidence: 88%

Enhanced Recovery after Surgery for Lung Cancer Patients

Chen

Wang

2020

Open Medicine

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AbstractBackgroundEnhanced recovery after surgery (ERAS) is a perioperative treatment intended to speed up recovery of surgical patients. Pulmonary lobectomy is a high-risk procedure, which ERAS is intended to address.ObjectiveWe evaluated the application of ERAS to patients with lung cancer.Interventions/MethodsOf 337 patients who underwent pulmonary lobectomies for lung cancer at our hospital, 168 received traditional perioperative nursing, and 169 received ERAS. Their complication rates, numerical rating scale of pain (NRS), satisfaction with care, demographics and some inpatient indices before and after surgery were compared.ResultsThe two groups did not significantly differ in general data or NRS score at 6 post-operative hours (P = 0.214) and 1 post-operative day (POD; P = 0.027). The ERAS group had lower incidence of postoperative lung complication (P = 0.008), shorter length of stay (P < 0.001), shorter enterokinesia recovery times (P < 0.001), lower hospitalization costs (P < 0.001), lower NRS scores at POD 2–5 (P < 0.001), higher nursing satisfaction (P < 0.001), and higher postoperative pulmonary function indices of maximal voluntary ventilation (MVV; P < 0.001), forced vital capacity (FVC; P = 0.002), and forced expiratory volume in 1 second (FEV1; P = 0.002) than did the traditional group.ConclusionERAS is applicable to lung surgery patients.Implications for PracticeApplying ERAS to thoracic surgery patients can alleviate their postoperative pain, shorten enterokinesia recovery, lower postoperative complication incidence, reduce hospitalization expenses, and raise nursing satisfaction, thereby expediting recovery.

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Section: Discussionsupporting

confidence: 88%

Enhanced Recovery after Surgery for Lung Cancer Patients

Chen

Wang

2020

Open Medicine

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“…With the laparoscopic approach, no large subcostal incision is needed, making it easier for patients to start mobilizing immediately after surgery. Additionally, laparoscopic abdominal surgery is associated with better pain control [19,22]. This both aids to the significantly shorter hospital stay that was found in the laparoscopic group.…”

Section: Multivariable Regression Analysismentioning

confidence: 98%

Laparoscopic versus open right posterior sectionectomy: an international, multicenter, propensity score-matched evaluation

Heijde

Ratti²,

Aldrighetti³

et al. 2020

Surg Endosc

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Background Although laparoscopic liver resection has become the standard for minor resections, evidence is lacking for more complex resections such as the right posterior sectionectomy (RPS). We aimed to compare surgical outcomes between laparoscopic (LRPS) and open right posterior sectionectomy (ORPS). Methods An international multicenter retrospective study comparing patients undergoing LRPS or ORPS (January 2007—December 2018) was performed. Patients were matched based on propensity scores in a 1:1 ratio. Primary endpoint was major complication rate defined as Accordion ≥ 3 grade. Secondary endpoints included blood loss, length of hospital stay (LOS) and resection status. A sensitivity analysis was done excluding the first 10 LRPS patients of each center to correct for the learning curve. Additionally, possible risk factors were explored for operative time, blood loss and LOS. Results Overall, 399 patients were included from 9 centers from 6 European countries of which 150 LRPS could be matched to 150 ORPS. LRPS was associated with a shorter operative time [235 (195–285) vs. 247 min (195–315) p = 0.004], less blood loss [260 (188–400) vs. 400 mL (280–550) p = 0.009] and a shorter LOS [5 (4–7) vs. 8 days (6–10), p = 0.002]. Major complication rate [n = 8 (5.3%) vs. n = 9 (6.0%) p = 1.00] and R0 resection rate [144 (96.0%) vs. 141 (94.0%), p = 0.607] did not differ between LRPS and ORPS, respectively. The sensitivity analysis showed similar findings in the previous mentioned outcomes. In multivariable regression analysis blood loss was significantly associated with the open approach, higher ASA classification and malignancy as diagnosis. For LOS this was the open approach and a malignancy. Conclusion This international multicenter propensity score-matched study showed an advantage in favor of LRPS in selected patients as compared to ORPS in terms of operative time, blood loss and LOS without differences in major complications and R0 resection rate.

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“…These results are comparable to a study of West et al, which showed an identical CME quality in laparoscopically and open-operated patients, though showing a significantly lower number of resected lymph nodes in the laparoscopic group comparable to patients in whom no central lymph node dissection had been performed [ 20 ]. A number of European studies, comparing the laparoscopic to the open resection of right-sided colon carcinoma, have similarly shown about 20 resected lymph nodes in the laparoscopic group [ 12 , 13 , 21 , 22 ]. A few of these studies also reported 20 resected lymph nodes in the open operated patient group and, thus, reason that laparoscopy and open surgery are equal concerning the oncological outcome and the number of resected lymph nodes.…”

Section: Discussionmentioning

confidence: 99%

“…Up to date, the data regarding the laparoscopic resection of right-sided colon cancer is insufficient. Several studies have compared the laparoscopic resection with historic patient data and were able to show a non-inferiority of the laparoscopic resection [ 12 , 13 ]. However, during the past years, the results for the open right hemicolectomy with CME have improved considerably showing a significantly higher number of resected lymph nodes.…”

Section: Introductionmentioning

confidence: 99%

Laparoscopic right-sided colon resection for colon cancer—has the control group so far been chosen correctly?

et al. 2018

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BackgroundThe treatment strategies for colorectal cancer located in the right side of the colon have changed dramatically during the last decade. Due to the introduction of complete mesocolic excision (CME) with central ligation of the vessels and systematic lymph node dissection, the long-term survival of affected patients has increased significantly. It has also been proposed that right-sided colon resection can be performed laparoscopically with the same extent of resection and equal long-term results.MethodsA retrospective evaluation of a prospectively expanded database on right-sided colorectal cancer or adenoma treated at the University Hospital of Wuerzburg between 2009 and 2016 was performed. All patients underwent CME. This data was analyzed alone and in comparison to the published data describing laparoscopic right-sided colon resection for colon cancer.ResultsThe database contains 279 patients, who underwent right-sided colon resection due to colorectal cancer or colorectal adenoma (255 open; 24 laparoscopic). Operation data (time, length of stay, time on ICU) was equal or superior to laparoscopy, which is comparable to the published results. Surprisingly, the surrogate parameter for correct CME (the number of removed lymph nodes) was significantly higher in the open group. In a subgroup analysis only including patients who were feasible for laparoscopic resection and had been operated with an open procedure by an experienced surgeon, operation time was significantly shorter and the number of removed lymph nodes is significantly higher in the open group.ConclusionSo far, several studies demonstrate that laparoscopic right-sided colon resection is comparable to open resection. Our data suggests that a consequent CME during an open operation leads to significantly more removed lymph nodes than in laparoscopically resected patients and in several so far published data of open control groups from Europe. Further prospective randomized trials comparing the long-term outcome are urgently needed before laparoscopy for right-sided colon resection can be recommended ubiquitously.

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Laparoscopic and open right‐sided colonic resection in daily routine practice. A prospective multicentre study within an Enhanced Recovery After Surgery (ERAS) protocol

Abstract: The use of laparoscopy in routine right-sided colectomy in an ERAS environment, with data on outcome corrected for selection bias, may result in faster recovery compared with open surgery.

Cited by 25 publications

References 24 publications

Enhanced Recovery after Surgery for Lung Cancer Patients

Enhanced Recovery after Surgery for Lung Cancer Patients

Laparoscopic versus open right posterior sectionectomy: an international, multicenter, propensity score-matched evaluation

Laparoscopic right-sided colon resection for colon cancer—has the control group so far been chosen correctly?

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