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01-11-2010

Factors affecting difficulty of laparoscopic surgery for left-sided colon cancer

Authors: Takashi Akiyoshi, Hiroya Kuroyanagi, Masatoshi Oya, Masashi Ueno, Yoshiya Fujimoto, Tsuyoshi Konishi, Toshiharu Yamaguchi

Published in: Surgical Endoscopy | Issue 11/2010

Abstract

Background

Laparoscopic colon resection for left-sided colon cancer is being performed with increasing frequency worldwide. The purpose of this study is to evaluate the influence of patient- and procedure-related factors on difficulty of laparoscopic surgery for left-sided colon cancer.

Methods

Two hundred sixty consecutive patients underwent laparoscopic surgery for left-sided colon cancer from July 2005 to December 2008. Gender, body mass index (BMI), tumor location, tumor size, previous abdominal surgery, tumor depth, tumor stage, splenic flexure mobilization, type of anastomosis, and site of arterial division were analyzed as potential variables that affect difficulty of laparoscopic surgery. Dependent variables were operative time, intraoperative blood loss, intra- and postoperative complications, and proximal and distal tumor margin. Univariate and multivariate analyses were performed to determine predictive significance of variables.

Results

Multivariate analysis showed that male gender (P = 0.0183) and splenic flexure mobilization (P < 0.0001) were independently predictive of longer operative time. Splenic flexure mobilization was related to greater intraoperative blood loss (P = 0.0006), intraoperative complications (P = 0.0111, odds ratio: 7.22), and wider distal tumor margin (P = 0.0048).

Conclusions

Male gender and splenic flexure mobilization were independent predictors of difficulty of laparoscopic surgery for left-sided colon cancer. In contrast, our findings also showed that BMI, tumor location, previous abdominal surgery, tumor stage, type of anastomosis, and site of arterial division did not have an adverse impact on difficulty of laparoscopic surgery for left-sided colon cancer in our clinical setting. Our data support the safety of performing laparoscopic surgery for left-sided colon cancer in well-selected patients by well-experienced surgical teams.

Guillou PJ, Quirke P, Thorpe H, Walker J, Jayne DG, Smith AM, Heath RM, Brown JM (2005) Short-term endpoints of conventional versus laparoscopic-assisted surgery in patients with colorectal cancer (MRC CLASICC trial): multicentre, randomised controlled trial. Lancet 365:1718–1726CrossRefPubMed

Lacy AM, Garcia-Valdecasas JC, Delgado S, Castells A, Taura P, Pique JM, Visa J (2002) Laparoscopy-assisted colectomy versus open colectomy for treatment of non-metastatic colon cancer: a randomised trial. Lancet 359:2224–2229CrossRefPubMed

Clinical Outcomes of Surgical Therapy Study Group (2004) A comparison of laparoscopically assisted and open colectomy for colon cancer. N Engl J Med 350:2050–2059CrossRef

Hewett PJ, Allardyce RA, Bagshaw PF, Frampton CM, Frizelle FA, Rieger NA, Smith JS, Solomon MJ, Stephens JH, Stevenson AR (2008) Short-term outcomes of the Australasian randomized clinical study comparing laparoscopic and conventional open surgical treatments for colon cancer: the ALCCaS trial. Ann Surg 248:728–738CrossRefPubMed

Thorpe H, Jayne DG, Guillou PJ, Quirke P, Copeland J, Brown JM (2008) Patient factors influencing conversion from laparoscopically assisted to open surgery for colorectal cancer. Br J Surg 95:199–205CrossRefPubMed

Tsujinaka S, Konishi F, Kawamura YJ, Saito M, Tajima N, Tanaka O, Lefor AT (2008) Visceral obesity predicts surgical outcomes after laparoscopic colectomy for sigmoid colon cancer. Dis Colon Rectum 51:1757–1765 (discussion 1765–1767)CrossRefPubMed

Kennedy GD, Heise C, Rajamanickam V, Harms B, Foley EF (2009) Laparoscopy decreases postoperative complication rates after abdominal colectomy: results from the national surgical quality improvement program. Ann Surg 249:596–601CrossRefPubMed

Steering Committee of the Western Pacific Region of the World Health Organization, the International Association for the Study of Obesity, and the International Obesity Task Force (2000) The Asia-Pacific perspective: redefining obesity and its treatment. Health Communications Australia Pty Ltd, Melbourne, Australia

The Examination Committee of Criteria for ‘Obesity Disease’ in Japan, Japan Society for the Study of Obesity (2002) New criteria for ‘obesity disease’ in Japan. Circ J 66:987–992CrossRef

10.

Kuroyanagi H, Oya M, Ueno M, Fujimoto Y, Yamaguchi T, Muto T (2008) Standardized technique of laparoscopic intracorporeal rectal transection and anastomosis for low anterior resection. Surg Endosc 22:557–561CrossRefPubMed

11.

Akiyoshi T, Kuroyanagi H, Oya M, Konishi T, Fukuda M, Fujimoto Y, Ueno M, Yamaguchi T, Muto T (2009) Safety of laparoscopic total mesorectal excision for low rectal cancer with preoperative chemoradiation therapy. J Gastrointest Surg 13:521–525CrossRefPubMed

12.

Tekkis PP, Senagore AJ, Delaney CP, Fazio VW (2005) Evaluation of the learning curve in laparoscopic colorectal surgery: comparison of right-sided and left-sided resections. Ann Surg 242:83–91CrossRefPubMed

13.

Targarona EM, Balague C, Pernas JC, Martinez C, Berindoague R, Gich I, Trias M (2008) Can we predict immediate outcome after laparoscopic rectal surgery? Multivariate analysis of clinical, anatomic, and pathologic features after 3-dimensional reconstruction of the pelvic anatomy. Ann Surg 247:642–649CrossRefPubMed

14.

Veenhof AA, Engel AF, van der Peet DL, Sietses C, Meijerink WJ, de Lange-de Klerk ES, Cuesta MA (2008) Technical difficulty grade score for the laparoscopic approach of rectal cancer: a single institution pilot study. Int J Colorectal Dis 23:469–475CrossRefPubMed

15.

Jamali FR, Soweid AM, Dimassi H, Bailey C, Leroy J, Marescaux J (2008) Evaluating the degree of difficulty of laparoscopic colorectal surgery. Arch Surg 143:762–767 (discussion 768)CrossRefPubMed

16.

Anuurad E, Shiwaku K, Nogi A, Kitajima K, Enkhmaa B, Shimono K, Yamane Y (2003) The new BMI criteria for asians by the regional office for the western Pacific region of WHO are suitable for screening of overweight to prevent metabolic syndrome in elder Japanese workers. J Occup Health 45:335–343CrossRefPubMed

17.

Leroy J, Ananian P, Rubino F, Claudon B, Mutter D, Marescaux J (2005) The impact of obesity on technical feasibility and postoperative outcomes of laparoscopic left colectomy. Ann Surg 241:69–76PubMed

18.

Deurenberg P, Deurenberg-Yap M, Guricci S (2002) Asians are different from Caucasians and from each other in their body mass index/body fat per cent relationship. Obes Rev 3:141–146CrossRefPubMed

19.

Park JS, Kang SB, Kim DW, Lee KH, Kim YH (2009) Laparoscopic versus open resection without splenic flexure mobilization for the treatment of rectum and sigmoid cancer: a study from a single institution that selectively used splenic flexure mobilization. Surg Laparosc Endosc Percutan Tech 19:62–68CrossRefPubMed

20.

Brennan DJ, Moynagh M, Brannigan AE, Gleeson F, Rowland M, O’Connell PR (2007) Routine mobilization of the splenic flexure is not necessary during anterior resection for rectal cancer. Dis Colon Rectum 50:302–307 (discussion 307)CrossRefPubMed

Title: Factors affecting difficulty of laparoscopic surgery for left-sided colon cancer
Authors: Takashi Akiyoshi
Hiroya Kuroyanagi
Masatoshi Oya
Masashi Ueno
Yoshiya Fujimoto
Tsuyoshi Konishi
Toshiharu Yamaguchi
Publication date: 01-11-2010
Publisher: Springer-Verlag
Published in: Surgical Endoscopy / Issue 11/2010
Print ISSN: 0930-2794
Electronic ISSN: 1432-2218
DOI: https://doi.org/10.1007/s00464-010-1039-5

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Factors affecting difficulty of laparoscopic surgery for left-sided colon cancer

Abstract

Background

Methods

Results

Conclusions

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Background

Methods

Results

Conclusions

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