Customized Denonvilliers' Fascia Excision: An Advanced Total Mesorectal Excision Technique for Anteriorly Located Rectal Cancer.

BACKGROUND: The role of Denonvilliers' fascia in achieving a negative circumferential resection margin during anterior total mesorectal excision has been controversial. Opinions on whether to dissect in the anterior or posterior surgical plane varies among researchers. IMPACT OF INNOVATION: We performed total mesorectal excision with selective en bloc resection of Denonvilliers' fascia based on preoperative MRI staging, preoperative clinical tumor stage, and tumor level in selected patients with anterior rectal tumors adherent to Denonvilliers' fascia. TECHNOLOGY MATERIALS AND METHODS: Between March and August 2021, 5 patients who underwent robotic (n = 4) and laparoscopic (n = 1) total mesorectal excision for anteriorly located low rectal adenocarcinomas after neoadjuvant chemoradiotherapy were enrolled in this study. Transabdominal total mesorectal excision dissection is performed by changing to a plane anterior to Denonvilliers' fascia, with partial or total excision tailored to the tumor level and depth of invasion as a further step in circumferential resection margin clearing. Customized excision of Denonvilliers' fascia was performed by dissecting through the extramesorectal plane. This anterior plane permits resection of Denonvilliers' fascia, exposing the prostate and seminal vesicles. PRELIMINARY RESULTS: Two tumors were located at the seminal vesicle level and 3 were found at the prostate level. The mean distance from the anal verge to the distal margin of the tumor was 4.8 ± 0.9 cm. Denonvilliers' fascia was preserved in 1 patient and partially excised in 4. Customized Denonvilliers' fascia excision was performed in 3 robotic ultralow anterior resections with coloanal anastomosis, 1 laparoscopic ultralow anterior resection with coloanal anastomosis, and 1 robot-assisted abdominoperineal resection. The circumferential resection margins in all patients were negative. CONCLUSIONS AND FUTURE DIRECTIONS: Anterior dissection in front of Denonvilliers' fascia can be selectively performed during total mesorectal excision based on preoperative planning, tumor location, and clinical tumor stage. Preoperative MRI and magnified operative views in minimally invasive platforms provide access to more precise surgical planes for clear circumferential resection, achieving optimal functional outcomes and oncological safety.

Nuclear Factor Erythroid 2-Related Factor 2/Kelch-Like ECH-Associated Protein 1 as a Predictor of Prognosis and Radiotherapy Resistance in Patients With Locally Advanced Rectal Cancer: A Prospective Analysis.

BACKGROUND: The nuclear factor erythroid 2-related factor 2/Kelch-like ECH-associated protein 1 (Nrf2/Keap1) signaling pathway is involved in the regulation of cellular responses to oxidative stress. Nrf2 acts as a cell protector from inflammation, cellular damage, and tumorigenesis, whereas Keap1 is a negative regulator of Nrf2. Dysregulation of the Nrf2/Keap1 pathway results in tumorigenesis and the active metabolism of tumor cells, leading to high resistance to radiotherapy. This study aimed to evaluate the predictive role of Nrf2 and Keap1 in the radiosensitivity and prognosis of locally advanced rectal cancer (LARC). METHODS: In total, 90 patients with LARC underwent surgery after preoperative chemoradiotherapy (CRT). Endoscopic biopsies from the tumors were obtained before radiation, and the Nrf2 and Keap1 expressions were assessed by immunohistochemistry. The response to therapy was evaluated after surgery following CRT according to the pathologic tumor regression grade. The disease-free survival (DFS) and overall survival rates were also documented. The association between the Nrf2 and Keap1 immunoreactivity and the clinicopathological parameters was analyzed. RESULTS: The overexpression of the nuclear Nrf2 before CRT showed a significant correlation with better DFS. The cytoplasmic Nrf2 expression was associated with more residual tumors after radiotherapy and a more unfavorable DFS, indicating lower radiosensitivity. CONCLUSION: CRT is an important issue in LARC and is a major aspect of treatment. Thus, the Nrf2/Keap1 expression may be a potential predictor of preoperative therapeutic resistance. The Nrf2-Keap1 modulators that interact with each other may also be effectively applicable to CRT effect in LARC.

Single-port laparoscopic appendectomy for perforated appendicitis using ArtiSential® wristed articulated instrument.

Single-port laparoscopic appendectomy (SPLA) was firstly introduced in 1998 and has been suggested potential advantages including better cosmetic outcome, less post-operative pain and avoidance of possible haemorrhagic complications from injuring epigastric vessels. However, single-port laparoscopic approach using conventional straight instruments may lead to internal and external conflicts and ergonomic discomfort, and new laparoscopic articulating instruments were developed to overcome these limitations of straight instruments. The ArtiSential® (LIVSMED Inc., Republic of Korea) is an 8-mm diameter pistol-handle instrument that has complete articulating function like human wrist and intuitive controllability. We present a technical report of SPLA for perforated appendicitis using ArtiSential® wristed articulated instrument. A 78-year-old female with a body mass index of 23.5 was referred to our emergency room with right lower quadrant abdominal pain. Abdominal computed tomography scan showed a distended tubular structure in the right lower quadrant (1.2 cm in diameter) with periappendiceal fluid collection. The patient's clinical presentation was highly indicative of perforated acute appendicitis. We performed SPLA with ArtiSential® grasper with the left hand, and this instrument helped us to allow greater manoeuvrability and dexterity with double triangulation technique. The total operation time was 40 min, and the patient was discharged without complications on the 1st day after surgery.

Laparoscopic versus open surgery for left flexure colon cancer: A propensity score matched analysis from an international cohort.

AIM: Surgical treatment of splenic flexure cancer (SFC) still presents some debated issues, including the role of laparoscopic surgery. The literature is based on small single-centre series, while randomized controlled studies comparing open and laparoscopic treatment for colon cancer exclude SFC. This study aimed to determine the role of laparoscopic surgery in the treatment of SFC, comparing short- and long-term outcomes with open surgery. METHOD: This was an international multicentre retrospective cohort study that analysed patients from 10 tertiary referral centres. From a cohort of 641 cases, 484 patients with Stage I-III SFC submitted to elective surgery with curative intent were selected. After 1:1 propensity score matching, 130 patients in the laparoscopic group (LapGroup) were compared with 130 patients in the open surgery group (OpenGroup). RESULTS: After propensity score matching, the two groups were comparable for demographic and clinical parameters. OpenGroup presented a higher incidence of overall (P = 0.02) and surgery-related complications (P = 0.05) but a similar rate of severe complications (P = 0.75). Length of stay was notably shorter in the LapGroup (P = 0.001). Overall (P = 0.793) as well as cancer-specific survival (P = 0.63) did not differ between the two groups. CONCLUSIONS: Elective laparoscopic surgery for Stage I-III SFC is feasible and associated with improved short-term postoperative outcomes compared to open surgery. Moreover, laparoscopic surgery appears to provide excellent long-term cancer outcomes.

Single-port laparoscopic appendectomy for acute appendicitis during pregnancy.

AIM OF STUDY: Acute appendicitis is the most common non-obstetric surgical problem in pregnant patients. As minimally invasive surgery has developed, minimising surgical trauma and improving cosmetic outcomes have led to the development of single-port laparoscopic surgery (SPLS). The aim of this study was to assess the feasibility and safety of SPLS for acute appendicitis during pregnancy. PATIENTS AND METHODS: Between September 2014 and May 2016, 12 pregnant patients diagnosed with acute appendicitis and having single-port laparoscopic appendectomy were included in the study. RESULTS: The median gestational age at surgery was 16 weeks (6-30 weeks). All operations were completed safely and without vascular or visceral injury. Four patients (33.3%) required conversion to a reduced-port laparoscopic surgery with 3 patients (25%) having a 5 mm port inserted because of perforated appendicitis with drain placement, and 1 patient (8.3%) having a 2-mm needle instrument insertion. Median operation time was 60 min (32-100 min), and a drainage tube was placed in 5 patients (41.7%). Median total length of incision was 2 cm (1.2-2.5 cm). The median time to soft diet initiation and length of stay in the hospital were 1 day (0-9 days) and 5 days (2-11 days), respectively. Two patients (8.0%) developed post-operative complications: One wound site bleeding and two surgical site infections. One case of abortion (8.3%) was noted on the post-operative day 1 and one case of imperforate hymen was noted after delivery. CONCLUSIONS: SPLS appendectomy is feasible and safe for treating patients with acute appendicitis during pregnancy.

Clinical-Pathologic Characteristics and Long-term Outcomes of Left Flexure Colonic Cancer: A Retrospective Analysis of an International Multicenter Cohort.

BACKGROUND: Colorectal cancer seldom presents at the splenic flexure. Small series on left flexure tumors reported a high occurrence of negative prognostic factors called into question as causes of poor prognosis. However, because of the small number of cases, no definite conclusions can be drawn. OBJECTIVE: The aim of this study was to compare clinical-pathologic characteristics and short- and long-term outcomes of left flexure tumors with other colonic locations. DESIGN: This was a retrospective analysis of consecutive patients who underwent surgery for tumors at the splenic flexure. Each tumor was paired in a 1 to 1 fashion with a right-sided and sigmoid tumor. SETTINGS: The study was conducted in 10 international centers. PATIENTS: A total of 641 patients with left flexure tumors were included in the study. MAIN OUTCOME MEASURES: Overall survival and cancer-specific survival were measured. RESULTS: Left flexure tumors presented more frequently with stenosis (30.5%; p < 0.001), with lesions infiltrating beyond the serosa (21.9%; p = 0.001) and with a high rate of mucinous histology (8.8%; p = 0.001). Looking at long-term prognosis, no differences were observed among the 3 groups, both considering overall and cancer-specific survival. However, left flexure tumors recurred more frequently as peritoneal carcinomatosis (20.6%; p < 0.001). LIMITATIONS: This study was limited because of its retrospective nature. CONCLUSIONS: Although left flexure tumors display several negative prognostic factors, they are not characterized by a worse prognosis compared with other colon cancer locations. See Video Abstract at http://links.lww.com/DCR/B395. CARACTERÍSTICAS CLÍNICO-PATOLÓGICAS Y RESULTADOS A LARGO PLAZO DEL CÁNCER DE COLON DE ÁNGULO IZQUIERDO: UN ANÁLISIS RETROSPECTIVO DE UNA COHORTE MULTICÉNTRICA INTERNACIONAL: El cáncer colorrectal rara vez se presenta en el ángulo esplénico. Pequeñas series sobre tumores de ángulo izquierdo informaron una alta incidencia de factores pronósticos negativos cuestionados como causas de mal pronóstico. Sin embargo, debido al pequeño número de casos, no se pueden sacar conclusiones definitivas.El objetivo de este estudio fue comparar las características clínico-patológicas, los resultados a corto y largo plazo de los tumores de ángulo izquierdo con otras ubicaciones de colon.Análisis retrospectivo de pacientes consecutivos que se sometieron a cirugía por tumores en el ángulo esplénico. Cada tumor se emparejó de forma individual con un tumor del lado derecho y sigmoide.El estudio se realizó en 10 centros internacionales.Se incluyeron en el estudio un total de 641 pacientes con tumores del ángulo izquierdo.Supervivencia general y específica del cáncerLos tumores de ángulo izquierda se presentaron con mayor frecuencia con estenosis (30.5%, p <0.001), con lesiones infiltradas más allá de la serosa (21.9%, p = 0.001), y con una alta tasa de histología mucinosa (8.8%, p = 0.001). En cuanto al pronóstico a largo plazo, no se observaron diferencias entre los tres grupos, considerando la supervivencia general y específica del cáncer. Sin embargo, los tumores de ángulo izquierdo recurrieron con mayor frecuencia como carcinomatosis peritoneal (20,6%; p <0,001).Este estudio fue limitado debido a su naturaleza retrospectiva.Aunque los tumores de ángulo izquierdo muestran varios factores pronósticos negativos, no se caracterizan por un peor pronóstico en comparación con otras ubicaciones de cáncer de colon. Consulte Video Resumen en http://links.lww.com/DCR/B395.

Totally robotic modified complete mesocolic excision and central vascular ligation for right-sided colon cancer: technical feasibility and mid-term oncologic outcomes.

BACKGROUND: Recently, an operative strategy involving complete mesocolic excision (CME) and central vascular ligation (CVL) for colonic cancer has been introduced. We aimed to describe our initial experience and assess the long-term outcomes of robotic modified CME (mCME) and CVL (mCME+CVL) for right-sided colon cancer. METHODS: Of the 677 patients with histologically confirmed, right-sided colon adenocarcinoma who underwent curative mCME+CVL between February 2008 and October 2016, 43 who were treated entirely using the robotic approach were included in this retrospective study. Survival rates were determined using the Kaplan-Meier method, and P values of < 0.05 indicated statistically significant differences. RESULTS: The total operation and docking times were 293 (180-644) min and 5 (3-19) min, respectively, with an estimated blood loss of 50 (10-400) mL. The time to soft diet was 4 (1-16) days and the length of hospitalization was 8 (4-48) days. Based on the Clavien-Dindo classification, grade I, II, IIIa, IIIb, and IV complications were noted in 3 (7.0%), 5 (11.7%), 2 (4.7%), 1 (2.3%), and 0 (0%) patients, respectively. The proximal and distal resection margins were 14 (4-54) and 19 (4-48) cm, respectively, and 29 (6-157) lymph nodes were harvested per patient. The patients were followed-up for a median of 55 (2-109) months, during which the overall survival rate, median disease-free period, disease-free survival rate, and tumor recurrence rate were 93.6%, 38 (2-109) months, 81.1%, and 16.3% (7 patients), respectively. CONCLUSIONS: Robotic mCME and CVL for right-sided colon cancer was feasible and safe. It can be added to the surgeon's toolbox as an optional strategy for the management of colon cancer patients.

Long-term oncologic outcomes of laparoscopic versus open resection following stent insertion for obstructing colon cancer: a multi-center retrospective study.

BACKGROUND: This study compared oncologic outcomes between open and laparoscopic surgery following self-expanding metallic stents insertion for obstructing colon cancer. METHODS: This retrospective study included 50 patients who underwent open surgery and 44 patients who underwent laparoscopic surgery for obstructing left-sided colon cancer at four tertiary referral hospitals between June 2005 and December 2013. RESULTS: The median follow-up periods were 48 months and 47 months in the open and laparoscopic groups, respectively. The median operative time, time to soft diet, and length of stay were comparable between the groups. Four cases converted to open surgery (9.1%) in the laparoscopic group. The morbidity within 30 days after surgery was comparable between the groups (OR 0.931; 95% CI 0.357-2.426; p = 0.884). The proximal and distal resection margins, the histologic grade of tumor, TNM stage, median tumor size, and presence of lymphovascular invasion did not differ significantly between the groups. The 5-year overall survival (OS) rates of the open and laparoscopic groups were 67.1% and 71.7% (HR 1.028, 95% CI 0.491-2.15, p = 0.942) and the 5-year disease-free survival (DFS) rates were 55.8% and 61.5% (HR 0.982; 95% CI 0.522-1.847; p = 0.955), respectively. The recurrence pattern did not differ between the groups. Multivariate analysis showed that sex (p = 0.027), nodal stage (p = 0.043), and the proportion of patients receiving postoperative adjuvant chemotherapy (p = 0.002) were independent prognostic factors for OS. The proportion of patients receiving postoperative adjuvant chemotherapy (p = 0.017) was an independent prognostic factor for DFS. CONCLUSIONS: Laparoscopic resection following stent insertion for obstructing colon cancer can be performed safely, with long-term oncologic outcomes comparable with those of open surgery.

Long-term oncological outcomes of robotic versus laparoscopic total mesorectal excision of mid-low rectal cancer following neoadjuvant chemoradiation therapy.

PROPOSE: The use of robotic surgery and neoadjuvant chemoradiation therapy (CRT) for rectal cancer is increasing steadily worldwide. However, there are insufficient data on long-term outcomes of robotic surgery in this clinical setting. The aim of this study was to compare the 5-year oncological outcomes of laparoscopic vs. robotic total mesorectal excision for mid-low rectal cancer after neoadjuvant CRT. MATERIALS AND METHODS: One hundred thirty-eight patients who underwent robotic (n = 74) or laparoscopic (n = 64) resections between January 2006 and December 2010 for mid and low rectal cancer after neoadjuvant CRT were identified from a prospective database. The long-term oncological outcomes of these patients were analyzed using prospective follow-up data. RESULTS: The median follow-up period was 56.1 ± 16.6 months (range 11-101). The 5-year overall survival (OS) rate of the laparoscopic and robotic groups was 93.3 and 90.0 %, respectively, (p = 0424). The 5-year disease-free survival (DFS) rate was 76.0 % (laparoscopic) vs. 76.8 % (robotic) (p = 0.834). In a subgroup analysis according to the yp-stage (complete pathologic response, yp-stage I, yp-stage II, or yp-stage III), the between-group oncological outcomes were not significantly different. The local recurrence rate was 6.3 % (laparoscopic, n = 4) vs. 2.7 % (robotic, n = 2) (p = 0.308). The systemic recurrence rate was 15.6 % (laparoscopic, n = 10) vs. 18.9 % (robotic, n = 14) (p = 0.644). All recurrences occurred within less than 36 months in both groups. The median period of recurrence was 14.2 months. CONCLUSION: Robotic surgery for rectal cancer after neoadjuvant CRT can be performed safely, with long-term oncological outcomes comparable to those obtained with laparoscopic surgery. More large-scale studies and long-term follow-up data are needed.

Oncologic Outcomes of Colon Cancer Patients with Extraregional Lymph Node Metastasis: Comparison of Isolated Paraaortic Lymph Node Metastasis with Resectable Liver Metastasis.

BACKGROUND: The treatment strategy and benefit of extended lymph node dissection among patients with preoperatively diagnosed paraaortic lymph node metastasis (PALNM) in colon cancer remains highly controversial. In the current study, we analyzed the oncologic outcomes of patients who underwent extraregional lymph node dissection for colon cancer with isolated PALNM. METHODS: From March 2000 to December 2009, the study group included 1082 patients who underwent curative surgery for colonic adenocarcinoma with pathological lymph node metastasis. RESULTS: Of 1082 patients who underwent curative surgery for colonic carcinoma, 953 (88.1 %) patients underwent regional lymphadenectomy, and 129 (11.9 %) patients underwent paraaortic lymph node dissection. Pathologic examination revealed N1 stage disease in 738 (68.2 %), N2 in 295 (27.3 %), and PALNM in 49 (4.5 %). Five-year overall survival (OS) and disease-free survival (DFS) rate were significantly better in the regional LNM group than in the PALNM group (OS 75.1 vs. 33.9 %, p < 0.001; DFS 66.2 vs. 26.5 %, p < 0.001). Five-year OS and DFS were not significantly different between the PALNM and resectable liver metastasis patients who underwent curative resection (OS 33.9 vs. 38.7 %, p = 0.080; DFS 26.5 vs. 27.6 %, p = 0.604). CONCLUSIONS: PALNM in colon cancer is associated with poorer survival than regional lymph node metastasis and showed comparable survival rates with metastasectomy for liver metastasis. Further studies evaluating the net benefit of upfront chemotherapy compared with initial resection for patients with potentially resectable PALNM are needed.

Clinical and oncologic outcomes of totally robotic total mesorectal excision for rectal cancer: initial results in a center for minimally invasive surgery.

PURPOSE: A robotic system was mainly designed to allow precise dissection in deep and narrow spaces. We report the clinical and oncologic outcomes of totally robotic total mesorectal excision for rectal cancer. METHODS: Between July 2009 and January 2012, 60 consecutive patients undergoing robotic surgery for rectal cancer at the Eulji University Hospital were included. RESULTS: The mean total operation time, docking time, and surgeon console time were 466.8 ± 115.6, 7.5 ± 6.7, and 261 ± 87.5 min, respectively. Oral intake of diet was started at 3.3 ± 0.9 days and the mean hospital stay was 8.6 ± 2.4 days. All 60 procedures were technically successful without the need for conversion to open or laparoscopic surgery. Complications included anastomotic leakage, anastomotic stricture, postoperative bleeding, ileus, and perineal wound infection in 3 (5 %), 1 (1.7 %), 2 (3.3 %), 2 (3.3 %), and 1 (1.7 %) patient, respectively. The mean distal resection margin and total number of lymph nodes harvested was 3.1 ± 1.7 cm and 20.1 ± 11.5, respectively. During the mean follow-up period of 48.5 months (range, 7-75), the 4-year overall and disease-free survival rates were 87.7 and 72.8 %, respectively. CONCLUSIONS: A totally robotic approach for rectal cancer operations was a time-consuming procedure, although we already had a lot experience in laparoscopic colorectal surgery. However, the dexterity of the robotic surgery could enable the surgeon to expand the choice of surgical methods according to the condition of the rectal cancer without the need for conversion.

Robotic left colon cancer resection: a dual docking technique that maximizes splenic flexure mobilization.

BACKGROUND: Techniques for robotic resection of the left colon are not well defined and have not been widely adopted due to limited range of motion of the robotic arms. We have developed a dual docking technique for both the splenic flexure and the pelvis. We report our initial experience of robotic left colectomy using this technique for left-sided colon cancer. METHODS: The study group comprised 61 patients who underwent robotic left colon cancer resection using our dual docking technique between July 2008 and January 2013. Operations comprised two stages: colon mobilization (stage 1) followed by pelvic dissection (stage 2). After completion of stage 1, the robot arms were undocked and the operating table was rotated 60° counterclockwise until a 45° angle was created between the patient cart and the operating table. RESULTS: All 61 procedures were technically successful without the need for conversion to laparoscopic or open surgery. Median total operation, 1st docking, and 2nd docking times were 227 min (range, 137-653 min), 4 min (range, 3-8 min), and 3 min (range, 3-9 min), respectively. Estimated blood loss was 20 ml (range, 20-2,000 ml). Median time to soft diet was 2 days (range, 2-12 days) and median length of hospital stay was 7 days (range, 4-20 days). Median total number of lymph nodes harvested was 17 (range, 3-61). According to the Clavien-Dindo classification, the numbers of complications for grades 1, 2, 3a, 3b, and 4 were 10, 2, 3, 3, and 1. There was no mortality within 30 days. CONCLUSIONS: Robotic left colon cancer resection using our dual docking technique is safe and feasible. This procedure can maximize splenic mobilization in robotic colorectal surgery.

Robotic surgery for rectal cancer can overcome difficulties associated with pelvic anatomy.

INTRODUCTION: Total mesorectal excision (TME) for rectal cancer can be challenging to perform in the presence of difficult pelvic anatomy. In our previous studies based on open and laparoscopic TME, we found that pelvic MRI-based pelvimetry could well reflect anatomical difficulty of the pelvis and operative time increased in direct proportion to the difficulty. We explored different outcomes of robotic surgery for TME based on classifications of difficult pelvic anatomies to determine whether this method can overcome these challenges. METHODS: We reviewed data from 182 patients who underwent robotic surgery for rectal cancer between January 2008 and August 2010. Patient demographics, pathologic outcomes, pelvimetric results, and operative and postoperative outcomes were assessed. The data were compared between easy, moderate, and difficult groups classified by MRI-based pelvimetry. RESULTS: Comparing the three groups, there was no difference between the groups in terms of operative and pathologic outcomes, including operation time. High BMI, history of preoperative chemoradiotherapy, and lower tumor levels were significantly associated with longer operation time (p < 0.001, p < 0.001, p = 0.009), but the pelvimetric parameter was not. CONCLUSION: There was no difference between the easy, moderate, and difficult groups in terms of surgical outcomes, such as operation time, for robotic rectal surgery. The robot system can provide more comfort during surgery for the surgeon, and may overcome challenges associated with difficult pelvic anatomy.

Laparoscopic-assisted versus open complete mesocolic excision and central vascular ligation for right-sided colon cancer.

BACKGROUND: A concept of complete mesocolic excision (CME) and central vascular ligation for colonic cancer has been recently introduced. The aim of this study was to evaluate and compare perioperative and oncologic outcomes after laparoscopic-assisted CME (LCME) and open CME (OCME) for right-sided colon cancers. METHODS: The study group included 128 patients who underwent an LCME and 137 patients who underwent an OCME for right-sided colon cancer between June 2006 and December 2008. The propensity scoring matching for sex, body mass index, tumor location, and pathologic T and TNM stage produced 85 matched pairs. RESULTS: The median time to soft diet (LCME 6 days vs. OCME 7 days, p < 0.001) and the possible length of stay (7 vs. 13 days, p < 0.001) were significantly shorter in the laparoscopic group. The median operation time (179 vs. 194 minutes, p = 0.862) and number of harvested lymph nodes (27 vs. 28, p = 0.337) were comparable between groups. The morbidity within 30 days after surgery was comparable between the groups (12.9 vs. 24.7 %, p = 0.050). The 5-year overall survival rates of the OCME and LCME groups were 77.8 and 90.3 % (p = 0.028), and the 5-year disease-free survival rates were 71.8 and 83.3 % (p = 0.578), respectively. CONCLUSIONS: Herein, we demonstrated the feasibility and safety of LCME for right-sided colon cancer, and in terms of better short-term outcomes, LCME was more advantageous than OCME. Although LCME for right-sided colon cancer was associated with better 5-year overall survival, compared with an open approach, the long-term oncologic outcomes between the groups were comparable.

Prognostic impact of preoperative nutritional and immune inflammatory parameters on liver cancer.

The immune response to tissue damage or infection involves inflammation, a multifaceted biological process distinguished by immune cell activation, mediator secretion, and immune cell recruitment to the site of injury. Several blood-based immune-inflammatory biomarkers with prognostic significance in malignancies have been identified. In this issue of the World Journal of Gastrointestinal Surgery, they examined the prognosis of liver cancer radical resection in relation to preoperative systemic immune-inflammation and nutritional risk indices. Comparing older and younger individuals often reveals compromised nutritional and immunological statuses in the former. Therefore, performing preoperative evaluations of the nutritional status and immunity in geriatric patients is critical. In addition to being a primary treatment modality, radical resection is associated with a significant mortality rate following surgery. Insufficient dietary consumption and an elevated metabolic rate within tumor cells contribute to the increased probability of malnutrition associated with the ailment, consequently leading to a substantial deterioration in prognosis. Recent studies, reinforce the importance of nutritional and immune-inflammatory biomarkers. Prior to surgical intervention, geriatric nutritional risk and systemic immune-inflammatory indices should be prioritized, particularly in older patients with malignant diseases.

Effect of preoperative pan-immune-inflammation value on clinical and oncologic outcomes after colorectal cancer surgery: a retrospective study.

Purpose: Surgical resection, the primary treatment for colorectal cancer (CRC), is often linked with postoperative complications that adversely affect the overall survival rates (OS). The pan-immune-inflammation value (PIV), a novel biomarker, is promising in evaluating cancer prognoses. We aimed to explore the impact of preoperative immune inflammation status on postoperative and long-term oncological outcomes in patients with CRC. Methods: A retrospective analysis of 203 patients with CRC who underwent surgery (January 2016-June 2020) was conducted. The preoperative PIV was calculated as [(neutrophil count + platelet count + monocyte count) / lymphocyte counts]. The PIV optimal cutoff value was determined based on the OS using the Contal and O'Quigley methods. Results: A PIV value ≥155.90 was defined as high. Patients were categorized into low-PIV (n = 85) and high-PIV (n = 118) groups. Perioperative clinical outcomes (total operation time, time to gas out, sips of water, soft diet, and hospital stay) were not significantly different between the groups. The high-PIV group exhibited more postoperative complications (P = 0.024), and larger tumor size compared with the low-PIV group. Multivariate analysis identified that American Society of Anesthesiologists grade III (P = 0.046) and high-PIV (P = 0.049) were significantly associated with postoperative complications. The low-PIV group demonstrated higher OS (P = 0.001) and disease-free survival rates (DFS) (P = 0.021) compared with the high-PIV group. Advanced N stage (P = 0.005) and high-PIV levels (P = 0.047) were the identified independent prognostic factors for OS, whereas advanced N stage (P = 0.045) was an independent prognostic factor for DFS. Conclusion: Elevated preoperative PIV was associated with an increased incidence of postoperative complications and served as an independent prognostic factor for OS.