Analysis of results for colorectal cancer surgeries performed between 2015 and 2020 in a General Surgery University Hospital
DOI:
https://doi.org/10.29193/RMU.38.1.5Keywords:
COLORECTAL NEOPLASMS, LAPAROSCOPY, MORBIDITY AND MORTALITY, ANALYSIS OF RESULTSAbstract
Introduction: colorectal cancer is frequent condition which evidences growing mortality rates in our country. A dramatic improvement in laparoscopic surgery is evident, and it also applies to colon cancer surgery. Analyzing the impact of this technique on oncologic radicality and survival is of the essence.
Objectives: to determine the clinical characteristics of patients with colorectal cancer in the Surgical Clinic A. To describe our experience in the laparoscopic and conventional approaches to colon cancer surgery. To prove whether quality standards are observed based on: conversion rates, short term results (morbimortality) and oncologic quality.
Method: descriptive, retrospective study in a five-year period (June 1, 2015 to June 1, 2020). Data was collected for all patients who underwent elective colon cancer surgery with curative purposes.
Results: 61 patients were recorded, 32 (52%) of which were men, with an average age of 63 years old. Thirty-two (52%) conventional and 29 (48%) laparoscopic surgeries were performed. The conversion rate was 17%. Morbimortality was 29.5%, being the suture failure rate 12.5%. 30-day mortality rate was 8%. Average surgical time and lymph node count was similar for both approaches.
Conclusions: laparoscopic approach of colorectal cancer is feasible and safe in the mid and long term, and the advantages of a minimally invasive surgery are worth considering. Our results are comparable to international quality standards.
References
1) Comisión Honoraria de Lucha contra el Cáncer. Registro Nacional de Cáncer. Situación epidemiológica del Uruguay en relación al cáncer. Incidencia del cáncer en el quinquenio 2012-2016. Tendencia de la mortalidad por cáncer hasta 2018. Montevideo: CHLCC, 2020. Disponible en: https://www. comisioncancer.org.uy/Ocultas/Situacion-Epidemiologica-del-Uruguay-en-relacion-al-Cancer--Mayo-2020-uc108. [Consulta: 1 marzo 2021].
2) International Agency for Research on Cancer. Global Cancer Observatory. GLOBOCAN 2020. Geneva: WHO, 2021. Disponible en: https://gco.iarc.fr/. [Consulta: 1 marzo 2021].
3) Viola Malet M, Laurini M, Zeballos J, Muniz N, Rodríguez-Goñi P, Castelli F, et al. Cirugía colorrectal videoasistida en Uruguay, luego de 106 casos. AnfaMed 2015; 2(1):43- 52.
4) Chinelli Ramos J, Costa J, Rodríguez Temesio G. Desarrollo de la resección colorrectal mínimamente invasiva en un servicio de cirugía universitario. AnfaMed 2019; 6(1):45-56. doi: 10.25184/anfamed2019v6n1a2.
5) Lacy A, García-Valdecasas J, Delgado S, Castells A, Taurá P, Piqué J, et al. Laparoscopy-assisted colectomy versus open colectomy for treatment of non-metastatic colon cancer: a randomised trial. Lancet 2002; 359(9325):2224-9. doi: 10.1016/S0140-6736(02)09290-5.
6) Fleshman J, Sargent D, Green E, Anvari M, Stryker S, Beart RJr, et al. Laparoscopic colectomy for cancer is not inferior to open surgery based on 5-year data from the COST Study Group trial. Ann Surg 2007; 246(4):655-62. doi: 10.1097/ SLA.0b013e318155a762.
7) Colon Cancer Laparoscopic or Open Resection Study Group. Survival after laparoscopic surgery versus open surgery for colon cancer: long-term outcome of a randomised clinical trial. Lancet Oncol 2009; 10(1):44-52. doi: 10.1016/S1470- 2045(08)70310-3.
8) Jayne D, Guillou P, Thorpe H, Quirke P, Copeland J, Smith A, et al. Randomized trial of laparoscopic-assisted resection of colorectal carcinoma: 3-year results of the UK MRC CLASICC Trial Group. J Clin Oncol 2007; 25(21):3061-8. doi: 10.1200/JCO.2006.09.7758.
9) Dindo D, Demartines N, Clavien P. Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg 2004; 240(2):205-13. doi: 10.1097/01.sla.0000133083.54934.ae.
10) de Neree Tot Babberich M, van Groningen J, Dekker E, Wiggers T, Wouters M, Bemelman W, et al. Laparoscopic con version in colorectal cancer surgery; is there any improvement over time at a population level? Surg Endosc 2018; 32(7):3234-46. doi: 10.1007/s00464-018-6042-2.
11) Surgical Care and Outcomes Assessment Program (SCOAP) Collaborative. Adoption of laparoscopy for elective colorectal resection: a report from the Surgical Care and Outcomes Assessment Program. J Am Coll Surg 2012; 214(6):909-18.e1. doi: 10.1016/j.jamcollsurg.2012.03.010.
12) Wu B, Wang W, Hao G, Song G. Effect of cancer characteristics and oncological outcomes associated with laparoscopic colorectal resection converted to open surgery: a meta-analysis. Medicine (Baltimore) 2018; 97(50):e13317. doi: 10.1097/MD.0000000000013317.
13) Stottmeier S, Harling H, Wille-Jørgensen P, Balleby L, Kehlet H. Postoperative morbidity after fast-track laparoscopic resection of rectal cancer. Colorectal Dis 2012; 14(6):769- 75. doi: 10.1111/j.1463-1318.2011.02767.x.
14) Aoyama T, Oba K, Honda M, Sadahiro S, Hamada C, Mayanagi S, et al. Impact of postoperative complications on the colorectal cancer survival and recurrence: analyses of pooled individual patients’ data from three large phase III randomized trials. Cancer Med 2017; 6(7):1573-80. doi: 10.1002/cam4.1126.
15) Małczak P, Mizera M, Torbicz G, Witowski J, Major P, Pisarska M, et al. Is the laparoscopic approach for rectal cancer superior to open surgery? A systematic review and meta-analysis on short-term surgical outcomes. Wideochir Inne Tech Maloinwazyjne 2018; 13(2):129-40. doi: 10.5114/ wiitm.2018.75845.
16) Ketelaers S, Orsini R, Burger J, Nieuwenhuijzen G, Rutten H. Significant improvement in postoperative and 1-year mortality after colorectal cancer surgery in recent years. Eur J Surg Oncol 2019; 45(11):2052-8. doi: 10.1016/j. ejso.2019.06.017.
17) de Neree Tot Babberich M, Detering R, Dekker J, Elferink M, Tollenaar R, Wouters M, et al. Achievements in colorectal cancer care during 8 years of auditing in The Netherlands. Eur J Surg Oncol 2018; 44(9):1361-70. doi: 10.1016/j. ejso.2018.06.001.
18) Teloken P, Spilsbury K, Platell C. Analysis of mortality in colorectal surgery in the Bi-National Colorectal Cancer Audit. ANZ J Surg 2016; 86(6):454-8. doi: 10.1111/ans.13523.
19) Conticchio M, Papagni V, Notarnicola M, Delvecchio A, Riccelli U, Ammendola M, et al. Laparoscopic vs. open mesorectal excision for rectal cancer: Are these approaches still comparable? A systematic review and meta-analysis. PLoS One 2020; 15(7):e0235887. doi: 10.1371/journal.pone.0235887.
20) Pędziwiatr M, Małczak P, Mizera M, Witowski J, Torbicz G, Major P, et al. There is no difference in outcome between laparoscopic and open surgery for rectal cancer: a systematic review and meta-analysis on short- and long-term oncologic outcomes. Tech Coloproctol 2017; 21(8):595-604. doi: 10.1007/s10151-017-1662-4.
21) Tajima T, Nagata J, Akiyama Y, Torigoe T, Fujimoto K, Sato N, et al. Open colectomy vs. laparoscopic colectomy in Japan: a retrospective study using real-world data from the diagnosis procedure combination database. Surg Today 2020; 50(10):1255-61. doi: 10.1007/s00595-020-02006-6.
2) International Agency for Research on Cancer. Global Cancer Observatory. GLOBOCAN 2020. Geneva: WHO, 2021. Disponible en: https://gco.iarc.fr/. [Consulta: 1 marzo 2021].
3) Viola Malet M, Laurini M, Zeballos J, Muniz N, Rodríguez-Goñi P, Castelli F, et al. Cirugía colorrectal videoasistida en Uruguay, luego de 106 casos. AnfaMed 2015; 2(1):43- 52.
4) Chinelli Ramos J, Costa J, Rodríguez Temesio G. Desarrollo de la resección colorrectal mínimamente invasiva en un servicio de cirugía universitario. AnfaMed 2019; 6(1):45-56. doi: 10.25184/anfamed2019v6n1a2.
5) Lacy A, García-Valdecasas J, Delgado S, Castells A, Taurá P, Piqué J, et al. Laparoscopy-assisted colectomy versus open colectomy for treatment of non-metastatic colon cancer: a randomised trial. Lancet 2002; 359(9325):2224-9. doi: 10.1016/S0140-6736(02)09290-5.
6) Fleshman J, Sargent D, Green E, Anvari M, Stryker S, Beart RJr, et al. Laparoscopic colectomy for cancer is not inferior to open surgery based on 5-year data from the COST Study Group trial. Ann Surg 2007; 246(4):655-62. doi: 10.1097/ SLA.0b013e318155a762.
7) Colon Cancer Laparoscopic or Open Resection Study Group. Survival after laparoscopic surgery versus open surgery for colon cancer: long-term outcome of a randomised clinical trial. Lancet Oncol 2009; 10(1):44-52. doi: 10.1016/S1470- 2045(08)70310-3.
8) Jayne D, Guillou P, Thorpe H, Quirke P, Copeland J, Smith A, et al. Randomized trial of laparoscopic-assisted resection of colorectal carcinoma: 3-year results of the UK MRC CLASICC Trial Group. J Clin Oncol 2007; 25(21):3061-8. doi: 10.1200/JCO.2006.09.7758.
9) Dindo D, Demartines N, Clavien P. Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg 2004; 240(2):205-13. doi: 10.1097/01.sla.0000133083.54934.ae.
10) de Neree Tot Babberich M, van Groningen J, Dekker E, Wiggers T, Wouters M, Bemelman W, et al. Laparoscopic con version in colorectal cancer surgery; is there any improvement over time at a population level? Surg Endosc 2018; 32(7):3234-46. doi: 10.1007/s00464-018-6042-2.
11) Surgical Care and Outcomes Assessment Program (SCOAP) Collaborative. Adoption of laparoscopy for elective colorectal resection: a report from the Surgical Care and Outcomes Assessment Program. J Am Coll Surg 2012; 214(6):909-18.e1. doi: 10.1016/j.jamcollsurg.2012.03.010.
12) Wu B, Wang W, Hao G, Song G. Effect of cancer characteristics and oncological outcomes associated with laparoscopic colorectal resection converted to open surgery: a meta-analysis. Medicine (Baltimore) 2018; 97(50):e13317. doi: 10.1097/MD.0000000000013317.
13) Stottmeier S, Harling H, Wille-Jørgensen P, Balleby L, Kehlet H. Postoperative morbidity after fast-track laparoscopic resection of rectal cancer. Colorectal Dis 2012; 14(6):769- 75. doi: 10.1111/j.1463-1318.2011.02767.x.
14) Aoyama T, Oba K, Honda M, Sadahiro S, Hamada C, Mayanagi S, et al. Impact of postoperative complications on the colorectal cancer survival and recurrence: analyses of pooled individual patients’ data from three large phase III randomized trials. Cancer Med 2017; 6(7):1573-80. doi: 10.1002/cam4.1126.
15) Małczak P, Mizera M, Torbicz G, Witowski J, Major P, Pisarska M, et al. Is the laparoscopic approach for rectal cancer superior to open surgery? A systematic review and meta-analysis on short-term surgical outcomes. Wideochir Inne Tech Maloinwazyjne 2018; 13(2):129-40. doi: 10.5114/ wiitm.2018.75845.
16) Ketelaers S, Orsini R, Burger J, Nieuwenhuijzen G, Rutten H. Significant improvement in postoperative and 1-year mortality after colorectal cancer surgery in recent years. Eur J Surg Oncol 2019; 45(11):2052-8. doi: 10.1016/j. ejso.2019.06.017.
17) de Neree Tot Babberich M, Detering R, Dekker J, Elferink M, Tollenaar R, Wouters M, et al. Achievements in colorectal cancer care during 8 years of auditing in The Netherlands. Eur J Surg Oncol 2018; 44(9):1361-70. doi: 10.1016/j. ejso.2018.06.001.
18) Teloken P, Spilsbury K, Platell C. Analysis of mortality in colorectal surgery in the Bi-National Colorectal Cancer Audit. ANZ J Surg 2016; 86(6):454-8. doi: 10.1111/ans.13523.
19) Conticchio M, Papagni V, Notarnicola M, Delvecchio A, Riccelli U, Ammendola M, et al. Laparoscopic vs. open mesorectal excision for rectal cancer: Are these approaches still comparable? A systematic review and meta-analysis. PLoS One 2020; 15(7):e0235887. doi: 10.1371/journal.pone.0235887.
20) Pędziwiatr M, Małczak P, Mizera M, Witowski J, Torbicz G, Major P, et al. There is no difference in outcome between laparoscopic and open surgery for rectal cancer: a systematic review and meta-analysis on short- and long-term oncologic outcomes. Tech Coloproctol 2017; 21(8):595-604. doi: 10.1007/s10151-017-1662-4.
21) Tajima T, Nagata J, Akiyama Y, Torigoe T, Fujimoto K, Sato N, et al. Open colectomy vs. laparoscopic colectomy in Japan: a retrospective study using real-world data from the diagnosis procedure combination database. Surg Today 2020; 50(10):1255-61. doi: 10.1007/s00595-020-02006-6.
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2022-01-10
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Guastavino A, Delgado E, Ramírez L, Dardanelli S, López P, Barberousse C, et al. Analysis of results for colorectal cancer surgeries performed between 2015 and 2020 in a General Surgery University Hospital. Rev. Méd. Urug. [Internet]. 2022 Jan. 10 [cited 2024 Nov. 23];38(1):e38106. Available from: https://revista.rmu.org.uy/index.php/rmu/article/view/844
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