The value of single-incision laparoscopic surgery for colorectal cancer: a systematic literature review.

BACKGROUND/AIMS: Recently, single-incision laparoscopic colectomy (SILC) for colorectal malignancy is rapidly becoming the central issue for explorers of minimally invasive surgery worldwide. The aim of this systematic review was to establish the safety and efficacy of SILC for colorectal malignancy when implemented by experienced surgeons. METHODOLOGY: PubMed, WHO international trial register and Embase were searched for publications concerning SILC and MLC from 2000 to 2013, with the last search on September 10, 2013. Only pure single-incision laparoscopic colonic surgery for malignant disease was included. Primary outcomes were the early postoperative complication profiles of SILC. Secondary outcomes were duration of operation time, blood loss, lymph node yields, conversion rate, distal margin of the resected tumor, and duration of hospital stay. RESULTS: Eight studies involving 547 patients met the inclusion criteria. Compared with multiport laparoscopic colectomy (MLC), SILC has less postoperative complication and bleeding. The conversion, the median lymph node retrieval, proximal margin of the resected tumor and distal margin of the resected tumor for malignant disease achieved with SILC was acceptable. There was no significant reduction in length of hospital stay with SILC. CONCLUSION: SILC is a technically reliable and realistic approach with short-term results similar to those obtained with the MLC procedure.

The prognostic value of HER-2/neu overexpression in colorectal cancer: evidence from 16 studies.

Human epidermal growth factor receptor (HER-2/neu) plays an important role in the progression of several types of cancer. Numerous studies examining the relationship between HER-2 overexpression and prognostic impact in patients with colorectal cancer have yielded inconclusive results. We therefore conducted a meta-analysis to provide a comprehensive evaluation of the prognostic value of HER-2 expression on the survival, which compared the positive and negative expressions of HER-2 in patients of the available studies. Hazard ratios (HRs) and their corresponding 95% confidence intervals (95% CIs) were pooled in terms of disease-specific or overall survival. A detailed search was made in PubMed for relevant original articles published in English. Finally, a total of 18 studies with 16 colorectal cancer patients were involved. Overexpression of HER-2 was negatively related to survival in colorectal cancer patients with the pooled HR of 1.05 (95% CI 0.78-1.31, P = 0.000). In conclusion, the finding from this present meta-analysis suggested that HER-2 overexpression was not related to poor prognostic of colorectal cancer.

Retrospective analysis of protective stoma after low anterior resection for rectal cancer with total mesorectal excision: three-year follow-up results.

BACKGROUND/AIMS: Anastomotic leakage is a complication of low anterior resection (LAR) for rectal cancer with total mesorectal excision (TME). This study evaluated the need for a protective stoma by a three-year follow-up. METHODOLOGY: A retrospective study of 56 LAR patients was conducted. Thirty patients (53.6%) had a protective stoma. C-reactive protein (CRP), interleukin 6 (IL-6) and tumor necrosis factor (TNF) in peripheral blood on the first and third day after surgery were compared, in addition to short-term and later complications, long-term mortality and quality of life (QOL). RESULTS: There was significant difference between patients with and without a stoma in CRP, IL-6 on the third day after surgery (p<0.05). Anastomotic leakage occurred in two patients (6.7%) with a stoma and seven (26.9%) without (p=0.039). The incidence of leaks requiring re-operation was significantly lower with a stoma (p=0.012). After a mean follow-up of three years, there was no difference in long-term mortality, survival or scores on QOL questionnaires. CONCLUSIONS: A protective stoma can reduce the stress reaction, promote recovery of bowel function and reduce anastomotic leakage and re-operation rates in LAR for rectal cancer with TME. No significant difference was observed in long-term mortality or QOL.

Does overexpression of HER-2 correlate with clinicopathological characteristics and prognosis in colorectal cancer? Evidence from a meta-analysis.

BACKGROUND: Previous studies have been inconsistent with respect to the reported associations between human epidermal growth factor receptor (HER-2/neu) overexpression in colorectal cancer. The aims of this meta-analysis are to assess its correlation with clinicopathological characteristics and prognostic significance in colorectal cancer. METHODS: Eligible studies were searched in Pubmed, Embase and Web of Science databases. The inclusion criteria were studies that assessed the relationship between HER-2 expression detected by immunohistochemistry (IHC) and the prognosis or clinicopathological features in patients with colorectal cancer (CRC). Subgroup analysis according to sex, tumor location, TNM stage, grade of differentiation and lymph node metastasis were produced. Odds ratio (OR) or hazard ratio (HR) with 95% confidence interval (CI) were calculated to examine the risk or hazard association, and heterogeneity and publication bias analyses were also performed. RESULTS: A total of 18 studies comprising 2867 colorectal cancer patients were included to assess the association between HER-2 immunohistochemical expression and clinicopathological characteristics and survival. The overall analysis showed that there was no detectable relation between HER-2 expression and prognosis in colorectal cancer patients with the pooled HR of 1.08 (95% CI: 0.96-1.21, P = 0.21). With respect to clinicopathological features, there was also no detectable relation between HER-2 expression and sex (OR = 0.91, 95% CI: 0.72-1.15, P = 0.42), tumor location (OR = 1.21, 95% CI = 0.88-1.65, P = 0.24), grade of differentiation (OR = 1.03, 95% CI = 0.72-1.47, P = 0.86), TNM stages (OR = 0.72, 95% CI = 0.31-1.66, P = 0.44), or lymph node metastasis (OR = 1.90, 95% CI = 0.90-4.02, P = 0.09) in CRC. CONCLUSIONS: The finding from this present meta-analysis suggested that HER-2 overexpression was not related to clinicopathological characteristics and poor prognostic of colorectal cancer patients.

Role of protective stoma in low anterior resection for rectal cancer: a meta-analysis.

AIM: To provide a comprehensive evaluation of the role of a protective stoma in low anterior resection (LAR) for rectal cancer. METHODS: The PubMed, EMBASE, and MEDLINE databases were searched for studies and relevant literature published between 2007 and 2014 regarding the construction of a protective stoma during LAR. A pooled risk ratio (RR) with 95% confidence intervals (CIs) was used to assess the outcomes of the studies, including the rate of postoperative anastomotic leakage and reoperations related to leakage. Funnel plots and Egger's tests were used to evaluate the publication biases of the studies. P values < 0.05 were considered statistically significant. RESULTS: A total of 11 studies were included in the meta-analysis. In total, 5612 patients were examined, 2868 of whom had a protective stoma and 2744 of whom did not. The sample size of the studies varied from 34 to 1912 patients. All studies reported the number of patients who developed an anastomotic leakage and required a reoperation related to leakage. A random effects model was used to calculate the pooled RR with the corresponding 95%CI because obvious heterogeneity was observed among the 11 studies (I (2) = 77%). The results indicated that the creation of a protective stoma during LAR significantly reduces the rate of anastomotic leakage and the number of reoperations related to leakage, with pooled RRs of 0.38 (95%CI: 0.30-0.48, P < 0.00001) and 0.37 (95%CI: 0.29-0.48, P < 0.00001), respectively. The shape of the funnel plot did not reveal any evidence of obvious asymmetry. CONCLUSION: The presence of a protective stoma effectively decreased the incidences of anastomotic leakage and reoperation and is recommended in patients undergoing low rectal anterior resections for rectal cancer.