Prospective randomized study of laparoscopic <i>versus</i>
 open colonic resection for adenocarcinoma

Stage, Jan; Schulze, Svend; Møller, P.; H, Overgaard; Andersen, Marit Helen; Rebsdorf-Pedersen, V. B.; Nielseni, H. J.

doi:10.1046/j.1365-2168.1997.02516.x

Cited by 139 publications

(267 citation statements)

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“…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).…”

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

et al. 2006

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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.

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

et al. 2006

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“…Pneumoperitoneum, for contributing to a phenomenon called aerosolization, is the most questioned factor for this fact 39,66,70,73,74,78,81,94 . However, the relation between pneumoperitoneum and the forms of tumor cell dissemination and tumor implantation is not clear 4,11,33,41,43,45,49,54,68 .…”

Section: Discussionmentioning

confidence: 99%

“…Although the incidence of tumor implantation in surgical incision is real, after the laparoscopic resection of a carcinoma, it is not definitively establis hed 4,11,33,41,43,45,49,54,68 , estimated to be within the range of 0 to 21% 67,71,76 . However, recent studies report values of 0.6 to 0.7 of incisional tumor recurrence after laparotomy 43,52,57,59 .…”

Section: Vol 32 Nºmentioning

confidence: 99%

“…Local, locoregional, parietal or diffuse recurrences have been similar in both surgical techniques. However, data are not yet conclusive, due to short follow-up period and reduced number of patients analyzed 4,11,33,41,43,49,54,58 . The literature shows great controversy regarding parietal tumor implantation, which would be greater at sites of surgical trocar introduction, due to the presence of pneumoperitoneum, when compared to rates of implantation from incisions in conventional laparotomy, with CO 2 possibly causing some impact on the immunological function 19,23,24,31,[37][38][39]42,43,50, .…”

Section: Introductionmentioning

confidence: 99%

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Influence of pneumoperitoneum on tumor implantation in parietal incision: a comparative study of trocar incision and laparotomy in rats

Kagohara¹,

Costa²

2012

J. Coloproctol. (Rio J.)

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Kagohara OH, Costa SL. Influence of pneumoperitoneum on tumor implantation in parietal incision: a comparative study of trocar incision and laparotomy in rats. J Coloproctol, 2012;32(3): 214-222. ABSTRACT:Videolaparoscopic surgery has enabled great progress in surgical procedures. However, the literature shows great controversy concerning its indication in oncological surgery for possibly increasing the implantation of metastases. This experimental study was carried out to help solve this controversy and analyze the influence of pneumoperitoneum as a cause of this implantation. A comparative study between incisions of trocars of videolaparoscopy and conventional laparotomy was conducted. For this analysis, 30 Wistar rats were divided into two equal groups: laparotomic group (A), that underwent a 5 cm laparotomy, which was left exposed for 15 minutes; and another (B), in which a 3 mmHg pneumoperitoneum was created with CO 2 and two more trocars were inserted, maintaining the insufflation for the same period. In both groups, the tumor, Walker 256 carcinosarcoma, was inoculated in the surgical procedure. The evaluation was performed within the fifth and the seventh postoperative days. The result of the macroscopic evaluation indicated that the tumor invasion in group A reached 93.33% and the implantation in the laparoscopy incision reached 73.33%. Nevertheless, the histopathological exam showed tumor implantation in all incisions of both groups (100%). The study concluded that parietal tumor implantation is not influenced by pneumoperitoneum in incisions of trocars when compared with conventional laparotomy in rats.Keywords: laparoscopy; laparotomy; neoplasm metastasis; implantation; carcinosarcoma. RESUMO:A cirurgia videolaparoscópica proporcionou grande avanço nas técnicas cirúrgicas. No entanto, há controvérsia na literatura sobre sua indicação na cirurgia oncológica por possivelmente aumentar a implantação tumoral de metástases. No intuito de contribuir para esclarecer essa controvérsia, realizou-se este estudo experimental visando analisar a influência do pneumoperitônio como causa dessa implantação. Realizou-se um estudo comparativo entre incisões dos trocartes da videolaparoscopia e da laparotomia convencional. Para isso, foram utilizados 30 ratos Wistar divididos em dois grupos iguais: um laparotômico (A), que foi submetido à laparotomia com 5 cm de extensão, a qual ficou exposta por 15 minutos; e outro (B), no qual se efetuou pneumoperitônio de 3 mmHg com CO 2 e colocaram-se mais dois trocartes, mantendo-se insuflado pelo mesmo período. Em ambos os grupos, inoculou-se o tumor no ato operatório, o carcinossarcoma 256 de Walker. A avaliação deu-se entre o quinto e sétimo dia de pós-operatório. Como resultado na avaliação macroscópica, há invasão tumoral no grupo A de 93,33% e implantação na incisão laparoscópica de 73,33%. No exame histopatológico, porém, revelou-se implantação tumoral em todas as incisões de ambos os grupos (100%). Conclui-se que a implantação tumoral não sofre influência do pneumoperitônio...

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“…The complication rate in laparoscopic colorectal surgery is not higher than in open surgery (14)(15)(16). In previous studies, the complication rates were found to be between 1.5-36% (17)(18)(19).…”

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confidence: 99%

Laparoscopic resection for colorectal diseases: short-term outcomes of a single center

Attaallah

Babayev

Yardimci

et al. 2016

UCD

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Laparoscopic resection for colorectal diseases: short-term outcomes of a single center INTRODUCTIONLaparoscopic colorectal surgery provides less postoperative pain, better cosmesis, shorter hospital stay and earlier patient mobilization (1, 2). Jacobs et al. (3) performed the first laparoscopic colon resection in 1991 (3). However, it took time to be adopted due to its technical difficulties, lack of clinical evidence, the learning curve and fear of tumor seeding (4, 5). The recently published case series proved that there was no significant difference between open and laparoscopic colorectal surgery in terms of tumor recurrence, distant metastasis rates and disease free survival (6-8). Although laparoscopy is still not the gold standard in colorectal surgery, its advantages in experienced hands are acknowledged (9). In our study, we presented 33 cases who underwent laparoscopic colorectal resection for benign or malignant diseases. MATERIAL AND METHODSThirty-three patients underwent laparoscopic colorectal surgery between January 2013-September 2014. An ethics committee approval was obtained from Marmara University. Our prospective database consisted of information on patient demographics, pathology reports (TNM stage, number of dissected lymph nodes), operation type, complications and length of hospital stay.All the patients were evaluated for presence of locoregional disease and distant metastasis with colonoscopy, computed thoracic and abdominal tomography and/or pelvic magnetic resonance imaging. Patients were informed on laparoscopic surgery and their consents were obtained. Locally advanced rectal cancers were treated with neoadjuvant chemotherapy and radiation therapy. Preoperative bowel preparation was achieved by sodium phosphate containing purgatives, and the antibiotic prophylaxis consisted of 2 gr Cefazolin and 500 mg Metronidazole. A second antibiotic dose was administered in operations lasting longer than 4 hours. Low molecular weight heparins were applied for thrombo-emboli prophylaxis with a dose adjusted for body weight 12 hours before the operation.Under general anesthesia, a 1 cm supra-umbilical skin incision was done followed by Veress needle insertion for carbon dioxide insufflation up to 10-12 millimeter mercury (mmHg). Mesocolic excision was performed for colon tumors and total mesorectal excision was performed for rectal cancers. To avoid seeding and surgical site infection, a wound protector was used in all operations (Alexis® O™ Retrac- 199Objective: Even though, laparoscopy is not accepted as the current gold standard in colorectal surgery, it can be performed as safely as open surgery. It is also widely accepted that the technique has many advantages. In this study, we evaluated the results of 33 patients with laparoscopic colorectal resection. Material and Methods:Thirty-three patients who underwent laparoscopic colon surgery between January 2013 and September 2014 in the General Surgery Clinic at Marmara University Hospital were included in the study. Patients were evaluated in te...

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Prospective randomized study of laparoscopic versus open colonic resection for adenocarcinoma

Abstract: Laparoscopic colonic resection is an acceptable and safe alternative to open procedures; the differences between the two techniques are not marked.

Cited by 139 publications

References 40 publications

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

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

Influence of pneumoperitoneum on tumor implantation in parietal incision: a comparative study of trocar incision and laparotomy in rats

Laparoscopic resection for colorectal diseases: short-term outcomes of a single center

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