Duchalais, Émilie

Few series have reported on the impact of robotic right colectomy compared with conventional laparoscopy. Even fewer have reported on the outcomes of intracorporeal anastomoses. The aim of our study was to determine the impact of robotic surgery on short-term operative outcomes in patients undergoing right colectomy with intracorporeal anastomosis. One hundred and fourteen consecutive patients who underwent a right colectomy by two colorectal surgeons between 2012 and 2017 were included. Patients were separated into two groups: laparoscopic technique with extracorporeal anastomosis (n = 87) and robotic technique with intracorporeal anastomosis (n = 27). Univariate analysis was performed to determine differences in outcomes. Differences between cohorts were only identified with regard to gender (62 vs 37%, P = 0.022) and year of surgery. In comparison with laparoscopy, robotic colectomy resulted in a shorter time of GI recovery (1.3 ± 0.6 vs 3 ± 1.1, P < 0.0001), lower rates of postoperative ileus (4 vs 28%, P = 0.007), lower overall morbidity (26 vs 52%, P = 0.019), less blood loss ( P = 0.001), 50 per cent lower narcotic use, and longer operative time (255 ± 66 vs 139 ± 49, P < 0.001). Despite longer operative time, robotic surgery improved GI recovery, significantly lowered oral morphine equivalent usage, and decreased short-term complications.

BACKGROUND: Anastomotic leak remains a critical complication after restorative rectal cancer surgery and is associated with significant morbidity and mortality rates, whereas reported rates range from 4% to 29%. Whether the occurrence of leak may have an impact on long-term oncological outcomes is under debate. OBJECTIVE: This study aimed to describe the oncological impact of anastomotic leak on patients undergoing sphincter-preserving surgery for rectal adenocarcinoma. DESIGN: This is a retrospective review of a prospectively maintained database. SETTINGS: The study was conducted at a high-volume colorectal center. PATIENTS: Data on patients who underwent restorative surgery for rectal adenocarcinoma from January 2000 until December 2013 were retrospectively analyzed. MAIN OUTCOME MEASURES: The primary outcome measured was the impact of anastomotic leak, defined according to the classification proposed by the International Study Group of Rectal Cancer, on long-term overall survival, disease-free survival, disease-specific survival, and local recurrence. RESULTS: A total of 787 patients undergoing sphincter-preserving surgery for rectal cancer met the inclusion criteria. Forty-two (5.3%) patients presented a symptomatic anastomotic leak. The median follow-up period was 64 months. Fifty-one (6.5%) patients experienced a cancer-related death, 2 of 42 in the anastomotic leak group. Five-year overall survival, disease-specific survival, and disease-free survival were 88%, 94.7%, and 85.3%. Local recurrence rate was 2%. There was no difference in long-term overall survival, disease-specific survival, disease-free survival, and local recurrence rate between groups. On a multivariable analysis, anastomotic leak did not impact oncological outcomes. LIMITATIONS: This study was limited by retrospective analysis. CONCLUSIONS: The occurrence of anastomotic leak after restorative resection for rectal cancer did not impact long-term oncological outcomes in our cohort of patients. See Video Abstract at http://links.lww.com/DCR/B187. RESULTADOS ONCOLÓGICOS A LARGO PLAZO DESPUÉS DE UNA FUGA ANASTOMÓTICA EN CIRUGÍA DE CÁNCER RECTAL ANTECEDENTES: La fuga anastomótica sigue siendo una complicación crítica después de la cirugía restauradora del cáncer rectal y se asocia con tasas significativas de morbilidad y mortalidad, mientras que las tasas reportadas varían del 4% al 29%. Se está debatiendo si la aparición de fugas puede tener un impacto en los resultados oncológicos a largo plazo. OBJETIVO: Describir el impacto oncológico de la fuga anastomótica en pacientes sometidos a cirugía de preservación del esfínter para adenocarcinoma rectal. DISEÑO: Revisión retrospectiva de una base de datos mantenida prospectivamente. MARCO: El estudio se realizó en un centro colorrectal de alto volumen. PACIENTES: Se analizaron retrospectivamente los datos de pacientes que se sometieron a cirugía reparadora por adenocarcinoma rectal desde Enero de 2000 hasta Diciembre de 2013. MEDIDAS PRINCIPALES DE RESULTADOS: Impacto de la fuga anastomótica, definida de acuerdo con la clasificación propuesta por el Grupo de Estudio Internacional del Cáncer Rectal (International Study Group of Rectal Cancer), sobre la supervivencia general a largo plazo, la supervivencia libre de enfermedad, la supervivencia específica de la enfermedad y la recurrencia local. RESULTADOS: Un total de 787 pacientes sometidos a cirugía para preservar el esfínter por cáncer rectal cumplieron con los criterios de inclusión. Cuarenta y dos (5.3%) pacientes presentaron una fuga anastomótica sintomática. El tiempo mediano del período de seguimiento fue de 64 meses. Cincuenta y un (6.5%) pacientes sufrieron muerte relacionada con el cáncer, 2 de 42 en el grupo de fuga anastomótica. La supervivencia global a cinco años, la supervivencia específica de la enfermedad y la supervivencia libre de enfermedad fueron del 88%, 94.7% y 85.3%, respectivamente. La tasa de recurrencia local fue del 2%. No hubo diferencias en la supervivencia global a largo plazo, la supervivencia específica de la enfermedad, la supervivencia libre de enfermedad y la tasa de recurrencia local entre los grupos. En un análisis multivariable, la fuga anastomótica no afectó los resultados oncológicos. LIMITACIONES: Este estudio fue limitado por análisis retrospectivo. CONCLUSIONES: La aparición de fuga anastomótica después de la resección restauradora para el cáncer rectal no afectó los resultados oncológicos a largo plazo en nuestra cohorte de pacientes. Consulte Video Resumen en http://links.lww.com/DCR/B187. (Traducción—Dr. Yesenia Rojas-Kahlil)

BACKGROUND: Revisional and reconstructive surgery for IPAA is rare given the high success of pouch surgery for chronic ulcerative colitis. Limited data exist on both surgical and functional outcomes in patients with chronic ulcerative colitis who undergo IPAA revision or reconstruction. OBJECTIVE: This study aimed to determine the surgical and functional outcome in patients with chronic ulcerative colitis who undergo IPAA revision or reconstruction. DESIGN: A prospectively collected surgical database was accessed for this study. SETTING: This study was conducted at an IBD referral center. PATIENTS: Patients with chronic ulcerative colitis who underwent IPAA revision or reconstruction were selected. MAIN OUTCOME MEASURES: The primary outcomes measured were 30-day postoperative outcomes and long-term pouch function. RESULTS: Eighty-one patients were identified. Original IPAA was performed for chronic ulcerative colitis (n = 71; 88%) and indeterminate colitis (n = 11; 12.%), and the most common configuration was a J-pouch (n = 69; 86%) with handsewn anastomosis (n = 41;68%). No independent predictors of 30-day postoperative complications following reconstructive/revisional surgery were identified. Pelvic abscesses and Crohn’s disease of the pouch were independently associated with ultimate pouch excision. Median follow-up following revision/reconstruction was 40 months (range, 1–292 months) during which 15 patients (23%) had pouch failure. The 5- and 10-year pouch survival rates following revision were 85 ± 5% and 65 ± 9% by Kaplan-Meier estimation; age <30 years was significantly associated with pouch survival. Long-term function (n = 30; 35%) compared with a matched control cohort of primary IPAA was characterized by significantly increased daytime bowel incontinence (p = 0.0119), liquid stool (p = 0.0062), and medication to thicken stools (p = 0.0452). LIMITATIONS: This was a single-center series, and response rate for functional data was 35%. CONCLUSIONS: In properly selected patients with a failing pouch, originally made for chronic ulcerative colitis or indeterminate colitis, revisional and reconstructive surgery is associated with low complication rates, high pouch salvage, and acceptable long-term pouch function. See Video Abstract at http://links.lww.com/DCR/A640.

Abstract Background The prognostic value of pathological lymph node status following neoadjuvant radiotherapy (ypN) remains unclear. This study was designed to determine whether ypN status predicted overall survival. Methods Patients with locally advanced rectal adenocarcinoma who underwent neoadjuvant long-course radiation between 2005 and 2014 were identified from the National Cancer Data Base, and divided into ypN0, ypN1 and ypN2 groups. The primary outcome was overall survival. Univariable and multivariable analyses were used to determine factors associated with overall survival. Results Of 12 271 patients, 3713 (30·3 per cent) were found to have residual nodal positivity. A majority of patients with ypN1 (1663 of 2562) and ypN2 (878 of 1151) disease had suspected lymph node-positive disease before neoadjuvant therapy, compared with 3959 of 8558 with ypN0 tumours (P &lt; 0·001). Moreover, ypN1 and ypN2 were significantly associated with ypT3–4 disease (65·7 and 83·0 per cent respectively versus 39·4 per cent for ypN0; P &lt; 0·001). In unadjusted analyses, survival differed significantly between ypN groups (P &lt; 0·001). Five-year survival rates were 81·6, 71·3 and 55·0 per cent for patients with ypN0, ypN1 and ypN2 disease respectively. After adjustment for confounding variables, ypN1 and ypN2 remained independently associated with overall survival: hazard ratio (HR) 1·61 (95 per cent c.i. 1·46 to 1·77) and 2·63 (2·34 to 2·95) respectively (P &lt; 0·001). Overall survival was significantly longer in patients with ypN1–2 combined with ypT0–2 status than among those with ypT3–4 tumours even with ypN0 status (P = 0·031). Clinical nodal status before neoadjuvant therapy was not significantly associated with overall survival (HR 1·05, 0·97 to 1·13; P = 0·259). Conclusion Both ypT and ypN status is of prognostic significance following neoadjuvant therapy for rectal cancer.