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Robotic and laparoscopic pelvic lymph node dissection for rectal cancer
Sung Uk Bae,Avanish P. Saklani,Hyuk Hur,Byung Soh Min,Seung Hyuk Baik,Kang Young Lee,Nam Kyu Kim 대한외과학회 2014 Annals of Surgical Treatment and Research(ASRT) Vol.86 No.2
Purpose: The aim of this study is to describe our initial experience and assess the feasibility and safety of robotic and laparoscopic lateral pelvic node dissection (LPND) in advanced rectal cancer. Methods: Between November 2007 and November 2012, extended minimally invasive surgery for LPND was performed in 21 selected patients with advanced rectal cancer, including 11 patients who underwent robotic LPND and 10 who underwent laparoscopic LPND. Extended lymphadenectomy was performed when LPN metastasis was suspected on preoperative magnetic resonance imaging even after chemoradiation. Results: All 21 procedures were technically successful without the need for conversion to open surgery. The median operation time was 396 minutes (range, 170?581 minutes) and estimated blood loss was 200 mL (range, 50?700 mL). The median length of stay was 10 days (range, 5?24 days) and time to removal of the urinary catheter was 3 days (range, 1?21 days). The median total number of lymph nodes harvested was 24 (range, 8?43), and total number of lateral pelvic lymph nodes was 7 (range, 2?23). Six patients (28.6%) developed postoperative complications; three with an anastomotic leakages, two with ileus and one patient with chyle leakage. Two patients (9.5%) developed urinary incontinence. There was no mortality within 30 days. During a median follow-up of 14 months, two patients developed lung metastasis and there was no local recurrence. Conclusion: Robotic and laparoscopic LPND is technically feasible and safe. Minimally invasive techniques for LPND in selected patients can be an acceptable alternative to an open LPND.
Mufaddal Kazi,Shraddha Patkar,Avanish Saklani 대한내시경로봇외과학회 2023 Journal of Minimally Invasive Surgery Vol.26 No.4
Neuroendocrine tumors (NET) are relatively uncommon rectal neoplasms, and the liver is the most common site of distant metastasis. Simultaneous liver and colorectal resections by minimally invasive surgery and natural orifice specimen extraction are gaining popularity, reducing morbidity. We describe a case of rectal NET with liver metastasis operated simultaneously by laparoscopy with both specimens extracted via the anal canal. Transanal or transvaginal natural orifice specimen extraction surgery for suitable cases is underutilized and only isolated case reports for simultaneous resections exist.
Minimally invasive surgery for maximally invasive tumors: pelvic exenterations for rectal cancers
Mufaddal Kazi,Ashwin Desouza,Chaitali Nashikkar,Avanish Saklani 대한내시경로봇외과학회 2022 Journal of Minimally Invasive Surgery Vol.25 No.4
Purpose: Trials comparing minimally invasive rectal surgery have uniformly excluded T4 tumors. The present study aimed to determine the safety of minimally invasive surgery (MIS) for locally-advanced rectal cancers requiring pelvic exenterations based on benchmarked outcomes from the international PelvEx database. Methods: Consecutive patients of T4 rectal cancers with urogenital organ invasion that underwent MIS exenterations between November 2015 and June 2022 were analyzed from a single center. A safety threshold was set at 20% for R1 resections and 40% for major complications (≥grade IIIA) for the upper limit of the 95% confidence interval (CI). Results: The study included 124 MIS exenterations. A majority had a total pelvic exenteration (74 patients, 59.7%). Laparoscopic surgery was performed in 95 (76.6%) and 29 (23.4%) had the robotic operation. Major complications were observed in 35 patients (28.2%; 95% CI, 20.5%–37.0%). R1 resections were found pathologically in nine patients (7.3%; 95% CI, 3.4%–13.4%). The set safety thresholds were not crossed. At a median follow-up of 15 months, 44 patients (35.5%) recurred with 8.1% local recurrence rate. The 2-year overall and disease-free survivals were 85.2% and 53.7%, respectively. Conclusion: MIS exenterations for locally-advanced rectal cancers demonstrated acceptable morbidity and safety in term of R0 resections at experienced centers. Longer follow-up is required to demonstrate cancer survival outcomes.
Mufaddal Kazi,Shraddha Patkar,Prerak Patel,Aditya Kunte,Ashwin Desouza,Avanish Saklani,Mahesh Goel 한국간담췌외과학회 2023 Annals of hepato-biliary-pancreatic surgery Vol.27 No.1
Backgrounds/Aims: Timing of resection for synchronous colorectal liver metastasis (CRLM) has been debated for decades. The aim of the present study was to assess the feasibility of simultaneous resection of CRLM in terms of major complications and develop a prediction model for safe resections. Methods: A retrospective single-center study of synchronous, resectable CRLM, operated between 2013 and 2021 was conducted. Upper limit of 95% confidence interval (CI) of major complications (≥ grade IIIA) was set at 40% as the safety threshold. Logistic regression was used to determine predictors of morbidity. Prediction model was internally validated by bootstrap estimates, Harrell’s C-index, and correlation of predicted and observed estimates. Results: Ninety-two patients were operated. Of them, 41.3% had rectal cancers. Major hepatectomy (≥ 4 segments) was performed for 25 patients (27.2%). Major complications occurred in 20 patients (21.7%, 95% CI: 13.8%–31.5%). Predictors of complications were the presence of comorbidities and major hepatectomy (area under the ROC curve: 0.692). Unacceptable level of morbidity (≥ 40%) was encountered in patients with comorbidities who underwent major hepatectomy. Conclusions: Simultaneous bowel and CRLM resection appear to be safe. However, caution should be exercised when combining major liver resections with bowel resection in patients with comorbid conditions.