Obstructive symptoms are present in 8% of cases at the time of initial diagnosis in cases of colorectal cancer. Emergency surgery has been classically considered the treatment of choice in these patients. However, in ...Obstructive symptoms are present in 8% of cases at the time of initial diagnosis in cases of colorectal cancer. Emergency surgery has been classically considered the treatment of choice in these patients. However, in the majority of studies, emergency colorectal surgery is burdened with higher morbidity and mortality rates than elective surgery, and many patients require temporal colostomy which deteriorates their quality of life and becomes permanent in 10%-40% of cases. The aim of stenting by-pass to surgery is to transform emergency surgery into elective surgery in order to improve surgical results, obtain an accurate tumoral staging and detection of synchronous lesions, stabilization of comorbidities and performance of laparoscopic surgery. Immediate results were more favourable in patients who were stented concerning primary anastomosis, permanent stoma, wound infection and overall morbidity, having the higher surgical risk patients the greater benefit. However, some findings laid out the possible implication of stenting in long-term results of oncologic treatment. Perforation after stenting is related to tumoral recurrence. In studies with perforation rates above 8%, higher recurrences rates in young patients and lower disease free survival have been shown. On the other hand, after stenting the number of removed lymph nodes in the surgical specimen is larger, patients can receive adjuvant chemotherapy earlier and in a greater percentage and the number of patients who can be surgically treated with laparoscopic surgery is larger. Finally, there are no consistent studies able to demonstrate that one strategy is superior to the other in terms of oncologic benefits. At present, it would seem wise to assume a higher initial complication rate in young patients without relevant comorbidities and to accept the risk of local recurrence in old patients(> 70 years) or with high surgical risk(ASA Ⅲ/Ⅳ).展开更多
Background: Carbon filters and expensive evacuation machines are available to evacuate surgical smoke in long-lasting laparoscopic operations and achieve good visibility and patient’s safety. Methods: This study was ...Background: Carbon filters and expensive evacuation machines are available to evacuate surgical smoke in long-lasting laparoscopic operations and achieve good visibility and patient’s safety. Methods: This study was aimed to determine which of two methods for laparoscopic smoke evacuation is most effective getting the best visibility. 20 patients submitted to elective laparoscopic colorectal resections were allocated to be operated using, either a carbon filter (Group A) or a home-made tubing with a continuous suction (Group B) connected through one of the ports to the hospital vacuum system: both methods were regulated with a roller clamp to increase smoke evacuation in order to obtain good visibility. A mono-polar hook and the LigasureV 5-mm vessel-sealing device were used. Groups were comparable for demographic characteristics, surgical techniques, and malignancy. Mann-Whitney and Fisher’s exact test were used for statistics. Results: Morbidity was 10%. There was no mortality, and there was no difference between Group A and B according to complications (p = 1.00), hospital stay (p = 0.23), duration of the operation (p = 0.79) and total consumption of CO2 (p = 0.36). However, the number of times that the clamp had to be released (Group A: 3.4 + 1 vs Group B: 1.5 + 1) (p = 0.006) and that a port had to be opened freely to quickly evacuate dense smoke (Group A: 0.9 + 0.7 vs Group B: 0) (p = 0.002) was very significantly increased in Group A as compared to Group B. Mean follow-up was 60 months and no port site metastases that could be a consequence of “chimney effect” or wound recurrence have been detected. Conclusions: The surgeon’s subjective impression that carbon filters are less effective for smoke evacuation than continuous outflow of gas through a port connected to the hospital vacuum source was confirmed. This simple method is advised for long-lasting laparoscopic procedures to improve visibility throughout the procedure.展开更多
文摘Obstructive symptoms are present in 8% of cases at the time of initial diagnosis in cases of colorectal cancer. Emergency surgery has been classically considered the treatment of choice in these patients. However, in the majority of studies, emergency colorectal surgery is burdened with higher morbidity and mortality rates than elective surgery, and many patients require temporal colostomy which deteriorates their quality of life and becomes permanent in 10%-40% of cases. The aim of stenting by-pass to surgery is to transform emergency surgery into elective surgery in order to improve surgical results, obtain an accurate tumoral staging and detection of synchronous lesions, stabilization of comorbidities and performance of laparoscopic surgery. Immediate results were more favourable in patients who were stented concerning primary anastomosis, permanent stoma, wound infection and overall morbidity, having the higher surgical risk patients the greater benefit. However, some findings laid out the possible implication of stenting in long-term results of oncologic treatment. Perforation after stenting is related to tumoral recurrence. In studies with perforation rates above 8%, higher recurrences rates in young patients and lower disease free survival have been shown. On the other hand, after stenting the number of removed lymph nodes in the surgical specimen is larger, patients can receive adjuvant chemotherapy earlier and in a greater percentage and the number of patients who can be surgically treated with laparoscopic surgery is larger. Finally, there are no consistent studies able to demonstrate that one strategy is superior to the other in terms of oncologic benefits. At present, it would seem wise to assume a higher initial complication rate in young patients without relevant comorbidities and to accept the risk of local recurrence in old patients(> 70 years) or with high surgical risk(ASA Ⅲ/Ⅳ).
文摘Background: Carbon filters and expensive evacuation machines are available to evacuate surgical smoke in long-lasting laparoscopic operations and achieve good visibility and patient’s safety. Methods: This study was aimed to determine which of two methods for laparoscopic smoke evacuation is most effective getting the best visibility. 20 patients submitted to elective laparoscopic colorectal resections were allocated to be operated using, either a carbon filter (Group A) or a home-made tubing with a continuous suction (Group B) connected through one of the ports to the hospital vacuum system: both methods were regulated with a roller clamp to increase smoke evacuation in order to obtain good visibility. A mono-polar hook and the LigasureV 5-mm vessel-sealing device were used. Groups were comparable for demographic characteristics, surgical techniques, and malignancy. Mann-Whitney and Fisher’s exact test were used for statistics. Results: Morbidity was 10%. There was no mortality, and there was no difference between Group A and B according to complications (p = 1.00), hospital stay (p = 0.23), duration of the operation (p = 0.79) and total consumption of CO2 (p = 0.36). However, the number of times that the clamp had to be released (Group A: 3.4 + 1 vs Group B: 1.5 + 1) (p = 0.006) and that a port had to be opened freely to quickly evacuate dense smoke (Group A: 0.9 + 0.7 vs Group B: 0) (p = 0.002) was very significantly increased in Group A as compared to Group B. Mean follow-up was 60 months and no port site metastases that could be a consequence of “chimney effect” or wound recurrence have been detected. Conclusions: The surgeon’s subjective impression that carbon filters are less effective for smoke evacuation than continuous outflow of gas through a port connected to the hospital vacuum source was confirmed. This simple method is advised for long-lasting laparoscopic procedures to improve visibility throughout the procedure.
