Laparoscopic Versus Open Surgery for Colorectal Cancers: Clinical and Pathological Outcomes from a Single Institution in Bahrain.

INTRODUCTION: Colorectal carcinoma is commonly diagnosed and accounts for an important cause of cancerrelated mortality worldwide. Despite that literature has shown the superiority of laparoscopic surgery, with improved short-term clinical benefits and equivalent oncological outcomes compared with open surgery for colorectal cancer, most cases are operated by open approach. The purpose of this study was to compare the clinical and pathological outcomes between laparoscopic and open colorectal cancer surgery at our institution. METHODOLOGY: 126 patients who had operations for colorectal cancers were identified. Patients ' clinical data, surgery type and details, postoperative early clinical outcomes and histology reports were retrieved from the database and retrospectively reviewed. Statistical analysis was used to assess the differences between laparoscopy and open approach in terms of clinical and oncological outcomes. RESULTS: Significant advantages were associated with minimally invasive colorectal surgery, with shorter postoperative hospital stay, less incidence of medical complications and improved survival. There were no statistically significant differences between both groups in pathological parameters, namely, number of retrieved lymph nodes and margins. DISCUSSION: In the hands of skilled trained surgeons, laparoscopic surgery for colorectal cancer is oncologically safe as it showed adequate dissection and appropriate number of resected lymph nodes, and is associated with reduction in postoperative morbidity and mortality. Conversion to open surgery is a risk associated with minimally invasive surgery. However, it is reported that conversion and postoperative complications are decreasing with increased surgical experience. CONCLUSION: In accordance with the current worldwide practice, our study indicates that minimally invasive surgery for colorectal cancer has the benefits of laparoscopy in terms of short-term clinical outcomes but show similar pathological outcomes in comparison to open approach. With increased surgical expertise, laparoscopic surgery is becoming the standard approach to treat colorectal cancer in our centre.

Risk Factors Associated With Sentinel Lymph Node Metastasis in Clinically Node-Negative Breast Cancer.

Objective: Sentinel lymph node biopsy (SLNB) is the standard of care for axillary staging in clinically node negative breast cancer. If predictive factors for sentinel lymph node (SLN) metastasis could be identified, it would allow selection of candidates for SLNB and omit axillary surgery in those with the lowest risk of axillary lymph node involvement. The aim of this study was to determine risk factors associated with SLN metastasis in breast cancer patients in Bahrain. Materials and Methods: Patients with clinically node-negative breast cancer who underwent SLNB at a single institution between 2016 and 2022 were identified from the pathology database. Patients who had failure of localization of SLN, those with bilateral cancers and those treated for a local recurrence were excluded. Results: A total of 160 breast cancer patients were retrospectively analyzed. Of these, 64.4% had a negative SLNB and 21.9% of all cases underwent axillary dissection. The following parameters emerged as predictors of SLN metastasis in univariate analysis: age; tumour grade; ER status; presence of lymphovascular invasion (LVI) and tumor size. On multivariate analysis, age was not independently associated with the incidence of SLN metastasis. Conclusion: This study showed that high tumour grades, presence of LVI and large tumour size were all risk factors related to axillary metastasis after SLNB in breast cancer. In the elderly, the incidence of SLN metastasis appeared to be relatively low, providing an opportunity to de-escalate axillary surgery in these patients. These findings may allow for the development of a nomogram to estimate the risk of SLN metastasis.