Laparoscopic-assisted vs. open surgery for colorectal cancer

Hewitt, Peter; Ip, Siu‐Po; Kwok, S.P.Y.; Somers, Shaw; Li, Karen; Leung, Ka Lau; Lau, Wan Yee; Li, Arthur K.C.

doi:10.1007/bf02235376

Cited by 154 publications

(134 citation statements)

References 40 publications

Supporting

Mentioning

117

Contrasting

Unclassified

Order By: Relevance

“…15). A c 2 test for heterogeneity was calculated and the I 2 statistic determined to estimate the proportion of variation between study results attributable to heterogeneity rather than chance (16). Heterogeneity was considered high if I 2 statistic was above 50% (17).…”

Section: Discussionmentioning

confidence: 99%

PTGS2 (Cyclooxygenase-2) Expression and Survival among Colorectal Cancer Patients: A Systematic Review

Kunzmann¹,

Murray

Cardwell

et al. 2013

Cancer Epidemiology, Biomarkers &Amp; Prevention

View full text Add to dashboard Cite

Background: Studies have examined whether tumor expression of PTGS2 (also known as COX-2), an enzyme inhibited by nonsteroidal anti-inflammatory drugs such as aspirin, is associated with prognosis in patients with colorectal cancer. However, results to date have been mixed.Methods: Using terms for PTGS2 and colorectal cancer, the Medline, Embase, and Web of Science databases were systematically searched for studies published, in any language, until December 2011. Random effects meta-analyses were used to calculate pooled HRs [95% confidence intervals (CI)] for the association between PTGS2 expression and tumor recurrence, colorectal cancer-specific survival, and overall survival.Results: In total, 29 studies, which had prognostic data on 5,648 patients, met the inclusion criteria. PTGS2-positive patients were at an increased risk of tumor recurrence (n ¼ 9 studies; HR, 2.79; 95% CI, 1.76-4.41; P < 0.001) and had poorer colorectal cancer-specific survival (n ¼ 7; HR, 1.36; 95% CI, 1.02-1.82; P ¼ 0.04). However, there was funnel plot asymmetry, possibly due to publication bias, for the association with cancerspecific survival but less so for recurrence. PTGS2 expression was not associated with overall survival [(n ¼ 16; pooled unadjusted HR, 1.30; 95% CI, 0.94-1.79; P ¼ 0.11) and (n ¼ 9; pooled adjusted HR, 1.02; 95% CI, 0.72-1.45;Conclusions: PTGS2 expression was associated with an increased risk of tumor recurrence and poorer colorectal cancer-specific survival but not overall survival among patients with colorectal cancer. However, confounding by tumor characteristics such as tumor stage seems likely.Impact: There is insufficient evidence to recommend PTGS2 expression as a prognostic marker in patients with colorectal cancer. Furthermore, studies providing adjusted results are required. Cancer Epidemiol Biomarkers Prev; 22(9); 1490-7. Ó2013 AACR.

show abstract

Section: Discussionmentioning

confidence: 99%

PTGS2 (Cyclooxygenase-2) Expression and Survival among Colorectal Cancer Patients: A Systematic Review

Kunzmann¹,

Murray

Cardwell

et al. 2013

Cancer Epidemiology, Biomarkers &Amp; Prevention

View full text Add to dashboard Cite

show abstract

“…However, some authors have reported no evidence of improved immunity after laparoscopy. [8][9][10][11] In addition, port site metastases (PSM) and local recurrences, although occasionally observed, remain a disputable problem with laparoscopic surgery for cancer. 12,13 With respect to renal cell carcinoma (RCC), laparoscopy related studies on the host immunity are insufficient and incomplete.…”

Section: Introductionmentioning

confidence: 99%

Early immune outcome of retroperitoneal laparoscopic radical nephrectomy for localized renal cell carcinoma: a prospective, randomized study

Yang

Fan

Wei

et al. 2012

CUAJ

View full text Add to dashboard Cite

Objectives: We evaluated differences in cytokine responses and T-lymphocyte subsets following retroperitoneal laparoscopic and conventional open radical nephrectomies for localized renal cell carcinoma (RCC). Methods: A total of 62 patients with T 1 N 0 M 0 staged RCC were randomized to either retro-laparoscopic (n = 31) or open (n = 31) radical nephrectomy. Plasma levels of interleukin-1β (IL-1β), IL-6, and tumour necrosis factor-alpha (TNF-α) were measured separately by enzyme linked immunosorbent assay (ELISA) preoperatively and on postoperative days 1 and 5. Levels + in the open group, returned to about preoperative levels (p < 0.05). Follow-up ranged from 4 to 14 months postoperatively in all 62 patients with a 100% cancerspecific survival rate in both groups. Conclusions: Retroperitoneal laparoscopic radical nephrectomy is associated with the milder cytokine responses caused by trauma and inflammation and the better preserved distribution of T-lymphocytes. IntroductionSince Clayman and colleagues in 1991 1 reported the first laparoscopic radical nephrectomy (LRN) for a tumour-bearing kidney, this technique has become increasingly popular because of milder postoperative pain, decreased hospital stay and shortened convalescence compared to the conventional open radical nephrectomy (ORN). During the last 20 years, with advances in instrumentation and surgeon experience, LRN has emerged as an equally effective and minimally morbid surgical alternative to ORN for selected kidney neoplasms. 2,3Surgical trauma provokes a variety of physiologic and immunologic changes in the host. The host's acute phase response to injury includes a complicated interaction among the metabolic, neuroendocrine and immune systems. This response is deemed to be proportional to the extent of the initial injury and is presumably directed toward the host defense. 4 Due to this altered immune response in the postoperative period, surgical trauma can cause an increased production of pro-inflammatory cytokines and an inhibition of cellular responses.5 A wealth of studies with intermediate to long-term follow-up results indicate that laparoscopic radical malignance resections offer equivalent safety and oncologic efficacy as compared to open surgical approaches.6,7 This is partially because of the reduced inflammatory response and minimal extent of immunosuppression. However, some authors have reported no evidence of improved immunity after laparoscopy. [8][9][10][11] In addition, port site metastases (PSM) and local recurrences, although occasionally observed, remain a disputable problem with laparoscopic surgery for cancer. 12,13 With respect to renal cell carcinoma (RCC), laparoscopy related studies on the host immunity are insufficient and incomplete. Whether and how the laparoscopy under CO 2 pneumoperitoneum could exert some negative influences on the RCC patients is still unclear.

show abstract

“…Conversely, issues have arisen with regard to the high proportion of patients who require a conversion to an open procedure, and the generally longer theatre time required with costs associated with them. However, despite advocates of this technique, few have been subjected to randomised controlled clinical trials of therapy (Stage et al, 1997;Hewett et al, 1998;Lacy et al, 2002). Nonrandomised studies have examined cost, some of which have indicated lower costs with laparoscopic surgery (Bokey et al, 1996;Philipson et al, 1997), while others have found the results to be equivocal (Falk et al, 1993;Bergamaschi and Arnaud, 1997;Joo et al, 1998;Khalili et al, 1998;Young-Fadok et al, 2001).…”

mentioning

confidence: 99%

Short-term costs of conventional vs laparoscopic assisted surgery in patients with colorectal cancer (MRC CLASICC trial)

et al. 2006

View full text Add to dashboard Cite

The short-term clinical results of the CLASICC trial indicated that clinical outcomes were similar between laparoscopic and open approaches. This study presents the short-term (3 month) cost analysis undertaken on a subset of patients entered into the CLASICC trial (682 of 794 patients). As expected the costs associated with the operation were higher in the 452 patients randomised to laparoscopic surgery (lap) compared with the 230 randomised to open procedure (open), d1703 vs d1386. This was partially offset by the other hospital (nontheatre) costs, which were lower in the lap group (d2930 vs d3176). The average cost to individuals for reoperations was higher in the lap group (d762 vs d553). Overall costs were slightly higher in the lap group (d6899 vs d6631), with mean difference of d268 (95%CI À689 to 1457). Sensitivity analysis made little difference to these results. The cost of rectal surgery was higher than for colon, for lap (d8259 vs d5586) and open procedures (d7820 vs d5503). The short-term cost analysis for the CLASICC trial indicates that the costs of either laparoscopic or open procedure were similar, lap surgery costing marginally more on average than open surgery.

show abstract

Laparoscopic-assisted vs. open surgery for colorectal cancer

Abstract: Both laparoscopic-assisted resection and open surgery affect the immune response. It would appear that laparoscopic-assisted resection does not have an immunologic advantage over open surgery in patients with colorectal cancer.

Cited by 154 publications

References 40 publications

PTGS2 (Cyclooxygenase-2) Expression and Survival among Colorectal Cancer Patients: A Systematic Review

PTGS2 (Cyclooxygenase-2) Expression and Survival among Colorectal Cancer Patients: A Systematic Review

Early immune outcome of retroperitoneal laparoscopic radical nephrectomy for localized renal cell carcinoma: a prospective, randomized study

Short-term costs of conventional vs laparoscopic assisted surgery in patients with colorectal cancer (MRC CLASICC trial)

Contact Info

Product

Resources

About