Preoperatif radyoterapi uygulanmasının ve acil cerrahinin laparoskopik kolorektal cerrahide açığa geçiş üzerine etkisi: Retrospektif kohort çalışma
Abstract
Amaç: Laparoskopik kolorektal kanserlerde açığa geçiş üzerinde neoadjuvan radyoterapi uygulanmasının ve acil şartlarda operasyon yapılmasının etkisi açık değildir. Bu nedenle Neoadjuvan radyoterapi alınması ve acil cerrahinin preoperatif açık cerrahiye geçiş üzerine etkilerini değerlendirmek amaçlandı.
Yöntemler: Ekim 2016 – Ocak 2018 tarihleri arasında aynı cerrahi ekip tarafından ailesel polipozis koli, kolon malign neoplazisi ve rektum malign neoplazisi nedeniyle aynı cerrahi ekip tarafından opere edilen 67 hastanın dosyaları retrospektif olarak incelendi. Laparoskopik tamamlanan veya laparoskopik başlanıp açık cerrahiye geçilen 55 hasta çalışmaya dahil edildi. Çalışmadan çıkarılma kriterleri; direk açık cerrahi uygulanmak, benign veya malign sebeplerle daha önce kolorektal cerrahi uygulanmış olmak, morbid obezite (vücut kitle indeksi >40 kg/m2) ve verilere ulaşılamamaktır. Hastalar demografik özellikleri (yaş, cinsiyet), tümör lokalizasyonu, cerrahinin acil ya da elektif olarak yapılması, preoperatif kemoterapi ve radyoterapi uygulanması, açığa geçiş nedenleri açısından değerlendirildi.
Bulgular: Çalışmaya dahil edilen 55 hastanın 35’i erkek (%63,6), 20’si kadın (%36,4) hastaydı. Hastaların yaş ortalaması 58,4 (13,4) (22 – 80) yaştı. Açığa geçilen hastaların yaş ortalaması 62,86 (8,91) (53 – 73) ve laparoskopik tamamlanan hastaların yaş ortalaması 57,71 (13,84) (22 – 80) yaştı (P=0,216). Hastaların operasyon nedenleri; 3 sağ kolon kanseri (%5,5), 6 sol kolon kanseri (%10.9), 37 rektum kanseri (%67,3), 5 rektosigmoid bölge tümörü (%9,1) ve 4 familiyal polipozis koli sendromu zemininde gelişen adenokarsinomdu (%7,3). 7 hastada cerrahiye laparoskopik başlandı ancak açık cerrahiye geçilmek zorunda kalındı (%12,7). 47 hasta elektif şartlarda (%85,5) opere edilirken 8 hasta acil şartlarda (%14,5) opere edildi. Açığa geçilen 7 hastanın 5’i acil şartlarda opere olurken 2 hasta elektif şartlarda opere edildi (P<0,001). 38 hasta (%69,1) neoadjuvan radyoterapi almamışken (3’ü sadece kemoterapi, 35’i hiçbir neoadjuvan tedavi almadı), 17 hastaya (%39,1) neoadjuvan kemoterapi ve radyoterapi kombinasyonu verilmişti. Açığa geçilen 7 hastadan 1’inde neoadjuvan radyoterapi uygulanmışken, 6’sı neoadjuvan radyoterapi almamıştı (P=0,308).
Sonuç: Laparoskopik kolorektal cerrahi, elektif şartlarda konvansiyonel açık cerrahi kadar başarı ile uygulanabilen bir cerrahidir. Preoperatif radyoterapi alınması ile açığa geçiş arasında ilişki yoktur.
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Thanks
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References
- 1. Kelli M, Dunn B, Rothenberger AD. Colon, Rectum, and Anus. In Schwartz’s Principles of Surgery, Tenth Edition (Edts; FC Brunicardi, DK Andersen, TR Billiar, DL Dunn, JG Hunter, JB Matthews, RE Pollock): Columbus, Ohio/USA, McGraw-Hill Education, 2015
- 2. Emir S, Sözen S, Kanat BH, Özkan Z, Yazar FM, Kavlakoğlu B, et al. Mekanik Bağırsak Tıkanıklığına Neden Olan Kolorektal Kanserlerde Morbidite ve Mortaliteye Etki Eden Faktörler. Int J Basic Clin Med. 2014;2(1):18-23.
- 3. Özkan E, Yıldız MK, Odabaşı HM, Eriş C, Abuoğlu HH, Günay E, et al. The Association of Lymph Node Number with Prognosis/Prognostic Factors in Colorectal Cancer. Turk J Colorectal Dis. 2013;23:178-85.
- 4. Kılıç D, Demircioğlu F. The Comparison of Short or Long Term Radiotherapy at Neoadjuvant Treatment of Rectal Cancer. Turk J Colorectal Dis. 2014;24:1-13.
- 5. Zhou HT, Wang P, Liang JW, Su H, Zhou ZX. Short-term outcomes of overlapped delta-shaped anastomosis, an innovative intracorporeal anastomosis technique, in totally laparascopic colectomy for colon cancer. World J Gastroenterol. 2017;23(36):6726-32.
- 6. Zhao B, Lv W, Mei D, Luo R, Bao S, Huang B, LinJ. Comparison of short-term surgical outcome between 3D and 2D laparoscopy surgery for gastrointestinal cancer: a systematic review and meta-analysis. Langenbecks Arch Surg. 2020;405(1):1-12. doi: 10.1007/s00423-020-01853-8.
- 7. Sawazaki S, Numata M, Morita J, Maezawa Y, Amano S, Aoyama T, et al. Safety of Laparoscopic Surgery for Colorectal Cancer in Patients with Severe Comorbidities. Anticancer Res. 2018;38(6):3767-72. doi: 10.21873/anticanres.12659.
- 8. Okkabaz N, Yılmaz M, Civil O, Haksal M, Oncel M. Outcomes of conversion from laparoscopy to open surgery in geriatric patients with colorectal cancer: a case-control study. J BUON. 2019;24(5):1809-16.
- 9. Jacobs M, Verdeja JC, Goldstein HS. Minimally invasive colon resection (laparoscopic colectomy). Surg Laparosc Endosc. 1991;1:144–50.
- 10. Abraham NS, Young JM, Solomon MJ. Meta-analysis of short-term outcomes after laparoscopic resection for colorectal cancer. Br J Surg. 2004;91:1111–24.
- 11. Aziz O, Constantinides V, Tekkis PP, Athanasiou T, Purkayastha S, Paraskeva P, et al. Laparoscopic versus open surgery for rectal cancer: a meta-analysis. Ann Surg Oncol. 2006;13:413-24.
- 12. Lin Z, Jiang ZL, Chen DY, Chen MF, Chen LH, Zhou P, et al. Short- and long-term outcomes of laparoscopic versus open surgery for rectal cancer: A systematic review and meta-analysis of randomized controlled trials. Medicine. 2018;97(50):e13704. doi: 10.1097/MD.0000000000013704.
- 13. Erdoğdu UE, Çaycı HM. The Effect of Resection Methods on Outcomes in Colorectal Cancers: Does Conversion Matter? Turk J Colorectal Dis. 2017;27:134-41.
- 14. Hussain A, Mahmood F, Torrance AW, Tsiamis A. Impact of medial-to-lateral vs lateral-to-medial approach on short-term and cancer-related outcomes in laparascopic colorectal surgery: A retrospective cohort study. Ann Med Surg. 2017;26:19-23.
- 15. Mahmoud AMA, Moneer MM. Toward standardization of laparascopic resection for colorectal cancer in developing countries: A step by step module. J Egypt Natl Canc Inst. 2017;29:135-140.
- 16. Gervaz P, Pikarsky A, Utech M, Secic M, Efron J, Belin B, et al. Converted laparoscopic colorectal surgery. Surg Endosc. 2001;15:827–32.
- 17. Marusch F, Gastinger I, Schneider C, Scheidbach H, Konradt J, Bruch HP, et al. Importance of conversion for results obtained with laparoscopic colorectal surgery. Dis Colon Rectum. 2001;44:207–14.
- 18. Pikarsky AJ, Saida Y, Yamaguchi T, Martinez S, Chen W, Weiss EG, et al. Is obesity a high-risk factor for laparoscopic colorectal surgery? Surg Endosc. 2002;16:855–8.
- 19. Pandya S, Murray JJ, Coller JA, Rusin LC. Laparoscopic colectomy: indications for conversion to laparotomy. Arch Surg. 1999;134:471–5.
- 20. Yong L, Deane M, Monson JR, Darzi A. Systematic review of laparoscopic surgery for colorectal malignancy. Surg Endosc. 2001;15:1431–9.
- 21. van de Velde CJ, Boelens PG, Tanis PJ, Espin E, Mroczkowski P, Naredi P, et al. Experts reviews of the multidisciplinary consensus conference colon and rectal cancer 2012: science, opinions and experiences from the experts of surgery. Eur J Surg Oncol. 2014 Apr;40(4):454-68. doi: 10.1016/j.ejso.2013.10.013.
- 22. Young-Fadok TM. Laparoscopic Resection for Carcinoma of the Colon . In; Mastery of Endoscopic and Laparascopic Surgery Fourth Edition, (Edts: LL Swanström, NJ Soper): Philadelphia, PA 19103 USA, Wolters Kluwer I Lippincott Williams & Wilkins, 2014
- 23. Skóra T, Nowak-Sadzikowska J, Martynów D, Wszołek M, Sas-Korczyńska B. Preoperative short-course radiotherapy in rectal cancer patients: results and prognostic factors. J Radiat Oncol. 2018;7(1):77-84.
- 24. Feeney G, Sehgal R, Sheehan M, Hogan A, Regan M, Joyce M, Kerin M. Neoadjuvant radiotherapy for rectal cancer management. World J Gastroenterol 2019;25(33):4850-69
- 25. Kuipers EJ, Grady WM, Lieberman D, Seufferlein T, Sung JJ, Boelens PG, et al. Colorectal cancer. Nat Rev Dis Primers. 2015;1:15065. doi: 10.1038/nrdp.2015.65.
- 26. Huang MY, Lee HH, Tsai HL, Huang CW, Yeh YS, Ma CJ, et al. Comparison of efficacy and safety of preoperative Chemoradiotherapy in locally advanced upper and middle/lower rectal cancer. Radiat Oncol. 2018;13(1):53. Published 2018 Mar 27. doi:10.1186/s13014-018-0987-0
- 27. Rezvani M, Franko J, Fassler SA, Harper SG, Nejman JH, Zebley DM. Outcomes in patients treated by laparoscopic resection of rectal carcinoma after neoadjuvant therapy for rectal cancer. JSLS. 2007;11(2):204-7.
Effect of preoperative radiotherapy and emergent surgery on conversion in laparoscopic colorectal surgery: A retrospective cohort study
Abstract
Aim: The effects of preoperative radiotherapy and emergent surgery on conversion in laparoscopic colorectal surgery is not clear. We therefore aimed to determine the effects of neoadjuvant radiotherapy and emergent surgery on conversion.
Methods: The data of 67 patients, who were operated for familial adenomatosis polyposis coli, colon, and rectum malignant neoplasms by the same surgical team between October 2016 and January 2018 were evaluated retrospectively. Among them, fifty-five laparoscopically finished or converted to open surgery cases were included in the study. The exclusion criteria included cases which began as open surgery, history of previous colorectal surgery for benign or malignant diseases, morbid obesity (body mass index >40 kg/m2) and missing data. Demographic values (age, gender), localization of tumor, whether it was an emergent or elective surgery, history of preoperative chemotherapy and radiotherapy, and causes of conversion were evaluated.
Results: Among 55 patients, 35 were male (63.6%) and 20 were female 20 (36.4%), with a mean age of 58.4 (13.4) (22 – 80) years. Mean ages of conversion and laparoscopically finished cases were 62.86 (8.91) (53 – 73) and 57.71 (13.84) (22 – 80) years, respectively (P=0,216). The reason for operation was right colon cancer in three patients (5.5%), left colon cancer in six (10.9%), rectum cancer in thirty-seven (67.3%), rectosigmoid junction cancer in five (9.1%) and adenocancer due to familial adenomatous polyposis coli in four patients (7.3%). In seven patients (12.7%), the need for conversion to open surgery arose. Among 55 patients, 47 patients were operated electively (85.5%) and 8 were operated under emergent conditions (14.5%). Of the 7 conversion patients, 5 were operated under emergent conditions and 2 were operated electively (P<0,001). This result showed that conversion rates were higher in emergent surgery patients. Neoadjuvant radiotherapy wasn’t administered to 38 patients (69.1%) (chemotherapy was administered alone to 3 of the patients and 35 patients were not treated with any neoadjuvant therapy), and neoadjuvant chemoradiotherapy combination was administered to 17 patients (39.1%). Among 7 conversion patients, 1 had been administered neoadjuvant radiotherapy while 6 had not (P=0.308). This result showed no statistical differences between patients to whom preoperative radiotherapy were and were not administered.
Conclusion: Laparoscopic colorectal surgery can be performed as successfully as conventional open surgery under elective conditions. Preoperative radiotherapy is not related to conversion.
Keywords
Colorectal cancer Laparascopic colorectal surgery Rectum cancer Radiotherapy Emergent surgery
Project Number
Yok
References
- 1. Kelli M, Dunn B, Rothenberger AD. Colon, Rectum, and Anus. In Schwartz’s Principles of Surgery, Tenth Edition (Edts; FC Brunicardi, DK Andersen, TR Billiar, DL Dunn, JG Hunter, JB Matthews, RE Pollock): Columbus, Ohio/USA, McGraw-Hill Education, 2015
- 2. Emir S, Sözen S, Kanat BH, Özkan Z, Yazar FM, Kavlakoğlu B, et al. Mekanik Bağırsak Tıkanıklığına Neden Olan Kolorektal Kanserlerde Morbidite ve Mortaliteye Etki Eden Faktörler. Int J Basic Clin Med. 2014;2(1):18-23.
- 3. Özkan E, Yıldız MK, Odabaşı HM, Eriş C, Abuoğlu HH, Günay E, et al. The Association of Lymph Node Number with Prognosis/Prognostic Factors in Colorectal Cancer. Turk J Colorectal Dis. 2013;23:178-85.
- 4. Kılıç D, Demircioğlu F. The Comparison of Short or Long Term Radiotherapy at Neoadjuvant Treatment of Rectal Cancer. Turk J Colorectal Dis. 2014;24:1-13.
- 5. Zhou HT, Wang P, Liang JW, Su H, Zhou ZX. Short-term outcomes of overlapped delta-shaped anastomosis, an innovative intracorporeal anastomosis technique, in totally laparascopic colectomy for colon cancer. World J Gastroenterol. 2017;23(36):6726-32.
- 6. Zhao B, Lv W, Mei D, Luo R, Bao S, Huang B, LinJ. Comparison of short-term surgical outcome between 3D and 2D laparoscopy surgery for gastrointestinal cancer: a systematic review and meta-analysis. Langenbecks Arch Surg. 2020;405(1):1-12. doi: 10.1007/s00423-020-01853-8.
- 7. Sawazaki S, Numata M, Morita J, Maezawa Y, Amano S, Aoyama T, et al. Safety of Laparoscopic Surgery for Colorectal Cancer in Patients with Severe Comorbidities. Anticancer Res. 2018;38(6):3767-72. doi: 10.21873/anticanres.12659.
- 8. Okkabaz N, Yılmaz M, Civil O, Haksal M, Oncel M. Outcomes of conversion from laparoscopy to open surgery in geriatric patients with colorectal cancer: a case-control study. J BUON. 2019;24(5):1809-16.
- 9. Jacobs M, Verdeja JC, Goldstein HS. Minimally invasive colon resection (laparoscopic colectomy). Surg Laparosc Endosc. 1991;1:144–50.
- 10. Abraham NS, Young JM, Solomon MJ. Meta-analysis of short-term outcomes after laparoscopic resection for colorectal cancer. Br J Surg. 2004;91:1111–24.
- 11. Aziz O, Constantinides V, Tekkis PP, Athanasiou T, Purkayastha S, Paraskeva P, et al. Laparoscopic versus open surgery for rectal cancer: a meta-analysis. Ann Surg Oncol. 2006;13:413-24.
- 12. Lin Z, Jiang ZL, Chen DY, Chen MF, Chen LH, Zhou P, et al. Short- and long-term outcomes of laparoscopic versus open surgery for rectal cancer: A systematic review and meta-analysis of randomized controlled trials. Medicine. 2018;97(50):e13704. doi: 10.1097/MD.0000000000013704.
- 13. Erdoğdu UE, Çaycı HM. The Effect of Resection Methods on Outcomes in Colorectal Cancers: Does Conversion Matter? Turk J Colorectal Dis. 2017;27:134-41.
- 14. Hussain A, Mahmood F, Torrance AW, Tsiamis A. Impact of medial-to-lateral vs lateral-to-medial approach on short-term and cancer-related outcomes in laparascopic colorectal surgery: A retrospective cohort study. Ann Med Surg. 2017;26:19-23.
- 15. Mahmoud AMA, Moneer MM. Toward standardization of laparascopic resection for colorectal cancer in developing countries: A step by step module. J Egypt Natl Canc Inst. 2017;29:135-140.
- 16. Gervaz P, Pikarsky A, Utech M, Secic M, Efron J, Belin B, et al. Converted laparoscopic colorectal surgery. Surg Endosc. 2001;15:827–32.
- 17. Marusch F, Gastinger I, Schneider C, Scheidbach H, Konradt J, Bruch HP, et al. Importance of conversion for results obtained with laparoscopic colorectal surgery. Dis Colon Rectum. 2001;44:207–14.
- 18. Pikarsky AJ, Saida Y, Yamaguchi T, Martinez S, Chen W, Weiss EG, et al. Is obesity a high-risk factor for laparoscopic colorectal surgery? Surg Endosc. 2002;16:855–8.
- 19. Pandya S, Murray JJ, Coller JA, Rusin LC. Laparoscopic colectomy: indications for conversion to laparotomy. Arch Surg. 1999;134:471–5.
- 20. Yong L, Deane M, Monson JR, Darzi A. Systematic review of laparoscopic surgery for colorectal malignancy. Surg Endosc. 2001;15:1431–9.
- 21. van de Velde CJ, Boelens PG, Tanis PJ, Espin E, Mroczkowski P, Naredi P, et al. Experts reviews of the multidisciplinary consensus conference colon and rectal cancer 2012: science, opinions and experiences from the experts of surgery. Eur J Surg Oncol. 2014 Apr;40(4):454-68. doi: 10.1016/j.ejso.2013.10.013.
- 22. Young-Fadok TM. Laparoscopic Resection for Carcinoma of the Colon . In; Mastery of Endoscopic and Laparascopic Surgery Fourth Edition, (Edts: LL Swanström, NJ Soper): Philadelphia, PA 19103 USA, Wolters Kluwer I Lippincott Williams & Wilkins, 2014
- 23. Skóra T, Nowak-Sadzikowska J, Martynów D, Wszołek M, Sas-Korczyńska B. Preoperative short-course radiotherapy in rectal cancer patients: results and prognostic factors. J Radiat Oncol. 2018;7(1):77-84.
- 24. Feeney G, Sehgal R, Sheehan M, Hogan A, Regan M, Joyce M, Kerin M. Neoadjuvant radiotherapy for rectal cancer management. World J Gastroenterol 2019;25(33):4850-69
- 25. Kuipers EJ, Grady WM, Lieberman D, Seufferlein T, Sung JJ, Boelens PG, et al. Colorectal cancer. Nat Rev Dis Primers. 2015;1:15065. doi: 10.1038/nrdp.2015.65.
- 26. Huang MY, Lee HH, Tsai HL, Huang CW, Yeh YS, Ma CJ, et al. Comparison of efficacy and safety of preoperative Chemoradiotherapy in locally advanced upper and middle/lower rectal cancer. Radiat Oncol. 2018;13(1):53. Published 2018 Mar 27. doi:10.1186/s13014-018-0987-0
- 27. Rezvani M, Franko J, Fassler SA, Harper SG, Nejman JH, Zebley DM. Outcomes in patients treated by laparoscopic resection of rectal carcinoma after neoadjuvant therapy for rectal cancer. JSLS. 2007;11(2):204-7.
Details
| Primary Language | English |
|---|---|
| Subjects | Surgery |
| Journal Section | Research article |
| Authors | |
| Project Number | Yok |
| Publication Date | May 1, 2020 |
| Published in Issue | Year 2020 Volume: 4 Issue: 5 |
