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Open Access 01-12-2024 | Minimally Invasive Surgery | Original Article

Safe implementation of minimally invasive surgery in a specialized colorectal cancer unit

Authors: José Azevedo, Anna Kashpor, Laura Fernandez, Ignacio Herrando, Pedro Vieira, Hugo Domingos, Carlos Carvalho, Richard Heald, Amjad Parvaiz

Published in: Techniques in Coloproctology | Issue 1/2024

Abstract

Introduction

In the past 30 years, minimally invasive surgery (MIS) has made remarkable progress and has become the standard of care in colorectal cancer treatment. The implementation of new techniques or platforms is, therefore, a challenge for surgical teams. This study aims to analyze the experience in the implementation of minimally invasive surgery in the colorectal unit in a specialized colorectal cancer center. We will report and compare the clinical outcomes of the patients submitted to the different surgical approaches, reflecting the importance of surgical training in the laparoscopic and robotic field for the reduction of surgical complications and improve short-term outcomes.

Methods

This study involved a retrospective analysis of data collected from a prospectively maintained database at the colorectal unit of Champalimaud Foundation between 2012 and 2023. Data were collected as part of routine clinical documentation and included variables on patient’s demographics, staging, short-term outcomes, and follow-up.

Results

A total of 661 patients treated at the Champalimaud Foundation between 2012 and 2023 were included, of which 389 (59%) had colon and 272 (41%) rectal cancer. Most of the patients underwent elective surgery, with a minimally invasive approach performed in 91% of cases. A complete resection (R0) was achieved in 95.1% (619) of the procedures with a pathology report staging 64.5% (409) of tumors as pT3–4. Eleven percent (70) of patients had complications classified as Clavien-Dindo (CD) ≥ 3.

Conclusion

This study supports the safety of the implementation of minimally invasive surgery in colorectal cancer care, with improvement in postoperative outcomes and surgical quality, supporting the importance of surgical training and specialized teams.

Morneau M, Boulanger J, Charlebois P, Latulippe JF, Lougnarath R, Thibault C, Gervais N (2013) Laparoscopic versus open surgery for the treatment of colorectal cancer: a literature review and recommendations from the Comité de l’évolution des pratiques en oncologie. Can J Surg 56(5):297–310. https://doi.org/10.1503/cjs.005512CrossRefPubMedPubMedCentral

Jacobs M, Verdeja JC, Goldstein HS (1991) Minimally invasive colon resection (laparoscopic colectomy). Surg Laparosc Endosc 1:144–150PubMed

Yamauchi S, Matsuyama T, Tokunaga M, Kinugasa Y (2021) Minimally invasive surgery for colorectal cancer. JMA J 4(1):17–23. https://doi.org/10.31662/jmaj.2020-0089. (Epub 2021 Jan 14. PMID: 33575499; PMCID: PMC7872784)CrossRefPubMedPubMedCentral

Baek SJ, Piozzi GN, Kim SH (2021) Optimizing outcomes of colorectal cancer surgery with robotic platforms. Surg Oncol 37:101559. https://doi.org/10.1016/j.suronc.2021.101559CrossRefPubMed

Melich G, Hong YK, Kim J, Hur H, Baik SH, Kim NK, Sender Liberman A, Min BS (2015) Simultaneous development of laparoscopy and robotics provides acceptable perioperative outcomes and shows robotics to have a faster learning curve and to be overall faster in rectal cancer surgery: analysis of novice MIS surgeon learning curves. Surg Endosc 29(3):558–568. https://doi.org/10.1007/s00464-014-3698-0CrossRefPubMed

de Azevedo JM, Vailati BB, Julião GPS, Fernandez LM, Perez RO (2019) Current surgical strategies in the management of rectal cancer. Curr Colorectal Cancer Rep 15(1):18–27. https://doi.org/10.1007/s11888-019-00428-0CrossRef

Miskovic D, Ahmed J, Bissett-Amess R, Gómez Ruiz M, Luca F, Jayne D, Figueiredo N, Heald RJ, Spinoglio G, Parvaiz A, European Academy for Robotic Colorectal Surgery (EARCS) (2019) European consensus on the standardization of robotic total mesorectal excision for rectal cancer. Colorectal Dis Off J Assoc Coloproctol Great Britain Ireland 21(3):270–276. https://doi.org/10.1111/codi.14502CrossRef

Panteleimonitis S, Popeskou S, Aradaib M, Harper M, Ahmed J, Ahmad M, Qureshi T, Figueiredo N, Parvaiz A (2018) Implementation of robotic rectal surgery training programme: importance of standardisation and structured training. Langenbecks Arch Surg 403(6):749–760. https://doi.org/10.1007/s00423-018-1690-1. (Epub 2018 Jun 20. PMID: 29926187; PMCID: PMC6153605)CrossRefPubMedPubMedCentral

Feng Q, Yuan W, Li T, Tang B, Jia B, Zhou Y, Zhang W, Zhao R, Zhang C, Cheng L, Zhang X, Liang F, He G, Wei Y, Xu J, REAL Study Group (2022) Robotic versus laparoscopic surgery for middle and low rectal cancer (REAL): short-term outcomes of a multicentre randomised controlled trial. Lancet Gastroenterol Hepatol 7(11):991–1004. https://doi.org/10.1016/S2468-1253(22)00248-5CrossRefPubMed

10.

Jayne D, Pigazzi A, Marshall H, Croft J, Corrigan N, Copeland J, Quirke P, West N, Rautio T, Thomassen N, Tilney H, Gudgeon M, Bianchi PP, Edlin R, Hulme C, Brown J (2017) Effect of robotic-assisted vs conventional laparoscopic surgery on risk of conversion to open laparotomy among patients undergoing resection for rectal cancer: the ROLARR randomized clinical trial. JAMA 318(16):1569–1580. https://doi.org/10.1001/jama.2017.7219CrossRefPubMedPubMedCentral

11.

Hemandas A, Flashman KG, Farrow J, O’Leary DP, Parvaiz A (2011) Modular training in laparoscopic colorectal surgery maximizes training opportunities without clinical compromise. World J Surg 35(2):409–414. https://doi.org/10.1007/s00268-010-0837-1. (PMID: 21052997)CrossRefPubMed

12.

Quirke P, Steele R, Monson J, Grieve R, Khanna S, Couture J, O’Callaghan C, Myint AS, Bessell E, Thompson LC, Parmar M, Stephens RJ, Sebag-Montefiore D, MRC CR07/NCIC-CTG CO16 Trial Investigators, NCRI Colorectal Cancer Study Group (2009) Effect of the plane of surgery achieved on local recurrence in patients with operable rectal cancer: a prospective study using data from the MRC CR07 and NCIC-CTG CO16 randomised clinical trial. Lancet (Lond, Engl) 373(9666):821–828. https://doi.org/10.1016/S0140-6736(09)60485-2CrossRef

13.

Fleshman J, Branda M, Sargent DJ, Boller AM, George V, Abbas M, Peters WR Jr, Maun D, Chang G, Herline A, Fichera A, Mutch M, Wexner S, Whiteford M, Marks J, Birnbaum E, Margolin D, Larson D, Marcello P, Posner M, Read T, Monson J, Wren SM, Pisters PW, Nelson H (2015) Effect of laparoscopic-assisted resection vs open resection of stage II or III rectal cancer on pathologic outcomes: the ACOSOG Z6051 randomized clinical trial. JAMA 314(13):1346–1355. https://doi.org/10.1001/jama.2015.10529. (PMID: 26441179; PMCID: PMC5140087)CrossRefPubMedPubMedCentral

14.

Bonjer HJ, Deijen CL, Abis GA, Cuesta MA, van der Pas MH, de Lange-de Klerk ES, Lacy AM, Bemelman WA, Andersson J, Angenete E, Rosenberg J, Fuerst A, Haglind E, COLOR II Study Group (2015) A randomized trial of laparoscopic versus open surgery for rectal cancer. New Engl J Med 372(14):1324–1332. https://doi.org/10.1056/NEJMoa1414882CrossRefPubMed

15.

Kang SB, Park JW, Jeong SY et al (2010) Open versus laparoscopic surgery for mid or low rectal cancer after neoadjuvant chemoradiotherapy (COREAN trial): short-term outcomes of an open-label randomised controlled trial. Lancet Oncol 11(7):637–645CrossRefPubMed

16.

Lacy AM, Garcia-Valdecasas JC, Delgado S et al (2002) Laparoscopy-assisted colectomy versus open colectomy for treatment of non-metastatic colon cancer: a randomized trial. Lancet 359(9325):2224–2229CrossRefPubMed

17.

Weeks JC, Nelson H, Gelber S et al (2002) Clinical Outcomes of Surgical Therapy (COST) Study. Group short-term quality-of- life outcomes following laparoscopic-assisted colectomy vs open colectomy for colon cancer: a randomized trial. JAMA 287(3):321–328CrossRefPubMed

18.

Guillou PJ, Quirke P, Thorpe H et al (2005) MRC CLASICC Trial Group. Short-term endpoints of conventional versus laparoscopic-assisted surgery in patients with colorectal cancer (MRC CLASICC trial): multicentre, randomised controlled trial. Lancet 365(9472):1718–1726CrossRefPubMed

19.

Stevenson AR, Solomon MJ, Lumley JW, Hewett P, Clouston AD, Gebski VJ, Davies L, Wilson K, Hague W, Simes J, ALaCaRT Investigators (2015) Effect of laparoscopic-assisted resection vs open resection on pathological outcomes in rectal cancer: the ALaCaRT randomized clinical trial. JAMA 314(13):1356–1363. https://doi.org/10.1001/jama.2015.12009CrossRefPubMed

20.

Sciuto A, Merola G, De Palma GD, Sodo M, Pirozzi F, Bracale UM, Bracale U (2018) Predictive factors for anastomotic leakage after laparoscopic colorectal surgery. World J Gastroenterol 24(21):2247–2260. https://doi.org/10.3748/wjg.v24.i21.2247CrossRefPubMedPubMedCentral

21.

Yamamoto S, Inomata M, Katayama H, Mizusawa J, Etoh T, Konishi F, Sugihara K, Watanabe M, Moriya Y, Kitano S, Japan Clinical Oncology Group Colorectal Cancer Study Group (2014) Short-term surgical outcomes from a randomized controlled trial to evaluate laparoscopic and open D3 dissection for stage II/III colon cancer: Japan Clinical Oncology Group Study JCOG 0404. Ann Surg 260(1):23–30. https://doi.org/10.1097/SLA.0000000000000499CrossRefPubMed

Title: Safe implementation of minimally invasive surgery in a specialized colorectal cancer unit
Authors: José Azevedo
Anna Kashpor
Laura Fernandez
Ignacio Herrando
Pedro Vieira
Hugo Domingos
Carlos Carvalho
Richard Heald
Amjad Parvaiz
Publication date: 01-12-2024
Publisher: Springer International Publishing
Keywords: Minimally Invasive Surgery
Rectal Cancer
Rectal Cancer
Colorectal Cancer
Colorectal Cancer
Colon Cancer
Colon Cancer
Published in: Techniques in Coloproctology / Issue 1/2024
Print ISSN: 1123-6337
Electronic ISSN: 1128-045X
DOI: https://doi.org/10.1007/s10151-024-03019-w

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