Re-evaluation of possible vulnerable sites in the lateral pelvic cavity to local recurrence during robot-assisted total mesorectal excision
Background Despite mechanical and technical improvements in laparoscopic and robot-assisted (LAR) rectal cancer procedures, the absence of prognostic disparities among various approaches cannot improve the quality of TME. The present study re-evaluated robot-assisted total mesorectal excision (TME)...
Gespeichert in:
| Veröffentlicht in: | Surgical endoscopy 2021-10, Vol.35 (10), p.5450-5460 |
|---|---|
| Hauptverfasser: | , , , , , , |
| Format: | Artikel |
| Sprache: | eng |
| Schlagworte: | |
| Online-Zugang: | Volltext |
| Tags: |
Tag hinzufügen
Keine Tags, Fügen Sie den ersten Tag hinzu!
|
| container_end_page | 5460 |
|---|---|
| container_issue | 10 |
| container_start_page | 5450 |
| container_title | Surgical endoscopy |
| container_volume | 35 |
| creator | Kim, Jin Cheon Han, Jin Su Lee, Jong Lyul Kim, Chan Wook Yoon, Yong Sik Park, Sung Ho Kim, Jihun |
| description | Background
Despite mechanical and technical improvements in laparoscopic and robot-assisted (LAR) rectal cancer procedures, the absence of prognostic disparities among various approaches cannot improve the quality of TME. The present study re-evaluated robot-assisted total mesorectal excision (TME) procedures to determine whether these procedures may reveal technical faults that may increase the rate of local recurrence (LR).
Methods
This study enrolled 886 consecutive patients with rectal cancer, who underwent curative robot-assisted LAR at Asan Medical Center (Seoul, Korea) between July 2010 and August 2017 (the first vs second period;
n
= 399 vs 487). The quality of TME and lateral pelvic mesorectal excision (LPME) were analyzed, as were LR rates and survival outcomes.
Results
Complete TME and LPME were achieved in 89.2% and 80.1% of these patients, respectively, with ≤ 1% having incomplete TME excluding intramesorectal excision. LR rates were 13.5 and 14.5 times higher in patients with incomplete TME and LPME, respectively, than in patients with complete TME and LPME (14.8% vs 1.1% and 8.7% vs 0.6%;
p
|
| doi_str_mv | 10.1007/s00464-020-08032-2 |
| format | Article |
| fullrecord | <record><control><sourceid>proquest_cross</sourceid><recordid>TN_cdi_proquest_miscellaneous_2445970922</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><sourcerecordid>2445970922</sourcerecordid><originalsourceid>FETCH-LOGICAL-c352t-fd44de32c8e0fe8e84c8aa18b3b2b6edd26a6ae3ec7a9fd933d29425c7c81c2a3</originalsourceid><addsrcrecordid>eNp9kc1q3TAQhUVIoDc_L9CVIJts1Moj-VpalpCmhUChtGshy-NEQddyJfnSPENeOnJuoZBFVnMYvjkzzCHkY8M_NZx3nzPncisZB8644gIYHJFNI1cBjTomG64FZ9Bp-YGc5vzIK6-bdkOefyLDvQ2LLT5ONI50jjn7PiDdL2HCZFeZfcFM_UTLA9JgS20HOmPYe0ed3fvyREukIbraTuiWlHBySIcl-emeptjHwmy1zQWHSpaK7TDHiq4S_zqf6_ZzcjLakPHiXz0jv7_e_Lr-xu5-3H6__nLHnGihsHGQckABTiEfUaGSTlnbqF700G9xGGBrtxYFus7qcdBCDKAltK5zqnFgxRm5OvjOKf5ZMBez89lhCHbCuGQDUra64xqgopdv0Me4pKleZ6DtgHetVLpScKBcqs9LOJo5-Z1NT6bhZs3HHPIxNR_zmo9ZrcVhKM_rlzD9t35n6gXGCJb2</addsrcrecordid><sourcetype>Aggregation Database</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>2572075489</pqid></control><display><type>article</type><title>Re-evaluation of possible vulnerable sites in the lateral pelvic cavity to local recurrence during robot-assisted total mesorectal excision</title><source>SpringerLink Journals - AutoHoldings</source><creator>Kim, Jin Cheon ; Han, Jin Su ; Lee, Jong Lyul ; Kim, Chan Wook ; Yoon, Yong Sik ; Park, Sung Ho ; Kim, Jihun</creator><creatorcontrib>Kim, Jin Cheon ; Han, Jin Su ; Lee, Jong Lyul ; Kim, Chan Wook ; Yoon, Yong Sik ; Park, Sung Ho ; Kim, Jihun</creatorcontrib><description>Background
Despite mechanical and technical improvements in laparoscopic and robot-assisted (LAR) rectal cancer procedures, the absence of prognostic disparities among various approaches cannot improve the quality of TME. The present study re-evaluated robot-assisted total mesorectal excision (TME) procedures to determine whether these procedures may reveal technical faults that may increase the rate of local recurrence (LR).
Methods
This study enrolled 886 consecutive patients with rectal cancer, who underwent curative robot-assisted LAR at Asan Medical Center (Seoul, Korea) between July 2010 and August 2017 (the first vs second period;
n
= 399 vs 487). The quality of TME and lateral pelvic mesorectal excision (LPME) were analyzed, as were LR rates and survival outcomes.
Results
Complete TME and LPME were achieved in 89.2% and 80.1% of these patients, respectively, with ≤ 1% having incomplete TME excluding intramesorectal excision. LR rates were 13.5 and 14.5 times higher in patients with incomplete TME and LPME, respectively, than in patients with complete TME and LPME (14.8% vs 1.1% and 8.7% vs 0.6%;
p
< 0.001 each by univariate analyses). Multivariate analyses showed that defective LPME was independently associated with incomplete TME and vice versa (
p
< 0.001). Cox regression analysis showed that defective LPME was independently correlated with reduced 5-year disease-free survival rate (hazard ratio, 1.563; 95% confidence interval, 1.052–2.323;
p
= 0.027).
Conclusions
LR in rectal cancer patients was largely due to incomplete LPME, which was significantly associated with incomplete TME. Complete LPME may enhance the likelihood of complete TME, reducing LR rates.</description><identifier>ISSN: 0930-2794</identifier><identifier>EISSN: 1432-2218</identifier><identifier>DOI: 10.1007/s00464-020-08032-2</identifier><language>eng</language><publisher>New York: Springer US</publisher><subject>Abdominal Surgery ; Cancer therapies ; Colorectal cancer ; Colorectal surgery ; Dissection ; Endoscopy ; Gastroenterology ; Gynecology ; Hepatology ; Laparoscopy ; Medical prognosis ; Medicine ; Medicine & Public Health ; Proctology ; Rectum ; Surgery</subject><ispartof>Surgical endoscopy, 2021-10, Vol.35 (10), p.5450-5460</ispartof><rights>Springer Science+Business Media, LLC, part of Springer Nature 2020</rights><rights>Springer Science+Business Media, LLC, part of Springer Nature 2020.</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c352t-fd44de32c8e0fe8e84c8aa18b3b2b6edd26a6ae3ec7a9fd933d29425c7c81c2a3</citedby><cites>FETCH-LOGICAL-c352t-fd44de32c8e0fe8e84c8aa18b3b2b6edd26a6ae3ec7a9fd933d29425c7c81c2a3</cites><orcidid>0000-0003-4823-8619</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://link.springer.com/content/pdf/10.1007/s00464-020-08032-2$$EPDF$$P50$$Gspringer$$H</linktopdf><linktohtml>$$Uhttps://link.springer.com/10.1007/s00464-020-08032-2$$EHTML$$P50$$Gspringer$$H</linktohtml><link.rule.ids>314,780,784,27923,27924,41487,42556,51318</link.rule.ids></links><search><creatorcontrib>Kim, Jin Cheon</creatorcontrib><creatorcontrib>Han, Jin Su</creatorcontrib><creatorcontrib>Lee, Jong Lyul</creatorcontrib><creatorcontrib>Kim, Chan Wook</creatorcontrib><creatorcontrib>Yoon, Yong Sik</creatorcontrib><creatorcontrib>Park, Sung Ho</creatorcontrib><creatorcontrib>Kim, Jihun</creatorcontrib><title>Re-evaluation of possible vulnerable sites in the lateral pelvic cavity to local recurrence during robot-assisted total mesorectal excision</title><title>Surgical endoscopy</title><addtitle>Surg Endosc</addtitle><description>Background
Despite mechanical and technical improvements in laparoscopic and robot-assisted (LAR) rectal cancer procedures, the absence of prognostic disparities among various approaches cannot improve the quality of TME. The present study re-evaluated robot-assisted total mesorectal excision (TME) procedures to determine whether these procedures may reveal technical faults that may increase the rate of local recurrence (LR).
Methods
This study enrolled 886 consecutive patients with rectal cancer, who underwent curative robot-assisted LAR at Asan Medical Center (Seoul, Korea) between July 2010 and August 2017 (the first vs second period;
n
= 399 vs 487). The quality of TME and lateral pelvic mesorectal excision (LPME) were analyzed, as were LR rates and survival outcomes.
Results
Complete TME and LPME were achieved in 89.2% and 80.1% of these patients, respectively, with ≤ 1% having incomplete TME excluding intramesorectal excision. LR rates were 13.5 and 14.5 times higher in patients with incomplete TME and LPME, respectively, than in patients with complete TME and LPME (14.8% vs 1.1% and 8.7% vs 0.6%;
p
< 0.001 each by univariate analyses). Multivariate analyses showed that defective LPME was independently associated with incomplete TME and vice versa (
p
< 0.001). Cox regression analysis showed that defective LPME was independently correlated with reduced 5-year disease-free survival rate (hazard ratio, 1.563; 95% confidence interval, 1.052–2.323;
p
= 0.027).
Conclusions
LR in rectal cancer patients was largely due to incomplete LPME, which was significantly associated with incomplete TME. Complete LPME may enhance the likelihood of complete TME, reducing LR rates.</description><subject>Abdominal Surgery</subject><subject>Cancer therapies</subject><subject>Colorectal cancer</subject><subject>Colorectal surgery</subject><subject>Dissection</subject><subject>Endoscopy</subject><subject>Gastroenterology</subject><subject>Gynecology</subject><subject>Hepatology</subject><subject>Laparoscopy</subject><subject>Medical prognosis</subject><subject>Medicine</subject><subject>Medicine & Public Health</subject><subject>Proctology</subject><subject>Rectum</subject><subject>Surgery</subject><issn>0930-2794</issn><issn>1432-2218</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2021</creationdate><recordtype>article</recordtype><sourceid>ABUWG</sourceid><sourceid>AFKRA</sourceid><sourceid>BENPR</sourceid><sourceid>CCPQU</sourceid><recordid>eNp9kc1q3TAQhUVIoDc_L9CVIJts1Moj-VpalpCmhUChtGshy-NEQddyJfnSPENeOnJuoZBFVnMYvjkzzCHkY8M_NZx3nzPncisZB8644gIYHJFNI1cBjTomG64FZ9Bp-YGc5vzIK6-bdkOefyLDvQ2LLT5ONI50jjn7PiDdL2HCZFeZfcFM_UTLA9JgS20HOmPYe0ed3fvyREukIbraTuiWlHBySIcl-emeptjHwmy1zQWHSpaK7TDHiq4S_zqf6_ZzcjLakPHiXz0jv7_e_Lr-xu5-3H6__nLHnGihsHGQckABTiEfUaGSTlnbqF700G9xGGBrtxYFus7qcdBCDKAltK5zqnFgxRm5OvjOKf5ZMBez89lhCHbCuGQDUra64xqgopdv0Me4pKleZ6DtgHetVLpScKBcqs9LOJo5-Z1NT6bhZs3HHPIxNR_zmo9ZrcVhKM_rlzD9t35n6gXGCJb2</recordid><startdate>20211001</startdate><enddate>20211001</enddate><creator>Kim, Jin Cheon</creator><creator>Han, Jin Su</creator><creator>Lee, Jong Lyul</creator><creator>Kim, Chan Wook</creator><creator>Yoon, Yong Sik</creator><creator>Park, Sung Ho</creator><creator>Kim, Jihun</creator><general>Springer US</general><general>Springer Nature B.V</general><scope>AAYXX</scope><scope>CITATION</scope><scope>3V.</scope><scope>7RV</scope><scope>7X7</scope><scope>7XB</scope><scope>88E</scope><scope>8AO</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>BENPR</scope><scope>CCPQU</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>K9.</scope><scope>KB0</scope><scope>M0S</scope><scope>M1P</scope><scope>NAPCQ</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>PRINS</scope><scope>7X8</scope><orcidid>https://orcid.org/0000-0003-4823-8619</orcidid></search><sort><creationdate>20211001</creationdate><title>Re-evaluation of possible vulnerable sites in the lateral pelvic cavity to local recurrence during robot-assisted total mesorectal excision</title><author>Kim, Jin Cheon ; Han, Jin Su ; Lee, Jong Lyul ; Kim, Chan Wook ; Yoon, Yong Sik ; Park, Sung Ho ; Kim, Jihun</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c352t-fd44de32c8e0fe8e84c8aa18b3b2b6edd26a6ae3ec7a9fd933d29425c7c81c2a3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2021</creationdate><topic>Abdominal Surgery</topic><topic>Cancer therapies</topic><topic>Colorectal cancer</topic><topic>Colorectal surgery</topic><topic>Dissection</topic><topic>Endoscopy</topic><topic>Gastroenterology</topic><topic>Gynecology</topic><topic>Hepatology</topic><topic>Laparoscopy</topic><topic>Medical prognosis</topic><topic>Medicine</topic><topic>Medicine & Public Health</topic><topic>Proctology</topic><topic>Rectum</topic><topic>Surgery</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Kim, Jin Cheon</creatorcontrib><creatorcontrib>Han, Jin Su</creatorcontrib><creatorcontrib>Lee, Jong Lyul</creatorcontrib><creatorcontrib>Kim, Chan Wook</creatorcontrib><creatorcontrib>Yoon, Yong Sik</creatorcontrib><creatorcontrib>Park, Sung Ho</creatorcontrib><creatorcontrib>Kim, Jihun</creatorcontrib><collection>CrossRef</collection><collection>ProQuest Central (Corporate)</collection><collection>Nursing & Allied Health Database</collection><collection>Health & Medical Collection</collection><collection>ProQuest Central (purchase pre-March 2016)</collection><collection>Medical Database (Alumni Edition)</collection><collection>ProQuest Pharma Collection</collection><collection>Hospital Premium Collection</collection><collection>Hospital Premium Collection (Alumni Edition)</collection><collection>ProQuest Central (Alumni) (purchase pre-March 2016)</collection><collection>ProQuest Central (Alumni Edition)</collection><collection>ProQuest Central UK/Ireland</collection><collection>ProQuest Central</collection><collection>ProQuest One Community College</collection><collection>Health Research Premium Collection</collection><collection>Health Research Premium Collection (Alumni)</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Nursing & Allied Health Database (Alumni Edition)</collection><collection>Health & Medical Collection (Alumni Edition)</collection><collection>Medical Database</collection><collection>Nursing & Allied Health Premium</collection><collection>ProQuest One Academic Eastern Edition (DO NOT USE)</collection><collection>ProQuest One Academic</collection><collection>ProQuest One Academic UKI Edition</collection><collection>ProQuest Central China</collection><collection>MEDLINE - Academic</collection><jtitle>Surgical endoscopy</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Kim, Jin Cheon</au><au>Han, Jin Su</au><au>Lee, Jong Lyul</au><au>Kim, Chan Wook</au><au>Yoon, Yong Sik</au><au>Park, Sung Ho</au><au>Kim, Jihun</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Re-evaluation of possible vulnerable sites in the lateral pelvic cavity to local recurrence during robot-assisted total mesorectal excision</atitle><jtitle>Surgical endoscopy</jtitle><stitle>Surg Endosc</stitle><date>2021-10-01</date><risdate>2021</risdate><volume>35</volume><issue>10</issue><spage>5450</spage><epage>5460</epage><pages>5450-5460</pages><issn>0930-2794</issn><eissn>1432-2218</eissn><abstract>Background
Despite mechanical and technical improvements in laparoscopic and robot-assisted (LAR) rectal cancer procedures, the absence of prognostic disparities among various approaches cannot improve the quality of TME. The present study re-evaluated robot-assisted total mesorectal excision (TME) procedures to determine whether these procedures may reveal technical faults that may increase the rate of local recurrence (LR).
Methods
This study enrolled 886 consecutive patients with rectal cancer, who underwent curative robot-assisted LAR at Asan Medical Center (Seoul, Korea) between July 2010 and August 2017 (the first vs second period;
n
= 399 vs 487). The quality of TME and lateral pelvic mesorectal excision (LPME) were analyzed, as were LR rates and survival outcomes.
Results
Complete TME and LPME were achieved in 89.2% and 80.1% of these patients, respectively, with ≤ 1% having incomplete TME excluding intramesorectal excision. LR rates were 13.5 and 14.5 times higher in patients with incomplete TME and LPME, respectively, than in patients with complete TME and LPME (14.8% vs 1.1% and 8.7% vs 0.6%;
p
< 0.001 each by univariate analyses). Multivariate analyses showed that defective LPME was independently associated with incomplete TME and vice versa (
p
< 0.001). Cox regression analysis showed that defective LPME was independently correlated with reduced 5-year disease-free survival rate (hazard ratio, 1.563; 95% confidence interval, 1.052–2.323;
p
= 0.027).
Conclusions
LR in rectal cancer patients was largely due to incomplete LPME, which was significantly associated with incomplete TME. Complete LPME may enhance the likelihood of complete TME, reducing LR rates.</abstract><cop>New York</cop><pub>Springer US</pub><doi>10.1007/s00464-020-08032-2</doi><tpages>11</tpages><orcidid>https://orcid.org/0000-0003-4823-8619</orcidid></addata></record> |
| fulltext | fulltext |
| identifier | ISSN: 0930-2794 |
| ispartof | Surgical endoscopy, 2021-10, Vol.35 (10), p.5450-5460 |
| issn | 0930-2794 1432-2218 |
| language | eng |
| recordid | cdi_proquest_miscellaneous_2445970922 |
| source | SpringerLink Journals - AutoHoldings |
| subjects | Abdominal Surgery Cancer therapies Colorectal cancer Colorectal surgery Dissection Endoscopy Gastroenterology Gynecology Hepatology Laparoscopy Medical prognosis Medicine Medicine & Public Health Proctology Rectum Surgery |
| title | Re-evaluation of possible vulnerable sites in the lateral pelvic cavity to local recurrence during robot-assisted total mesorectal excision |
| url | https://sfx.bib-bvb.de/sfx_tum?ctx_ver=Z39.88-2004&ctx_enc=info:ofi/enc:UTF-8&ctx_tim=2025-01-09T02%3A45%3A20IST&url_ver=Z39.88-2004&url_ctx_fmt=infofi/fmt:kev:mtx:ctx&rfr_id=info:sid/primo.exlibrisgroup.com:primo3-Article-proquest_cross&rft_val_fmt=info:ofi/fmt:kev:mtx:journal&rft.genre=article&rft.atitle=Re-evaluation%20of%20possible%20vulnerable%20sites%20in%20the%20lateral%20pelvic%20cavity%20to%20local%20recurrence%20during%20robot-assisted%20total%20mesorectal%20excision&rft.jtitle=Surgical%20endoscopy&rft.au=Kim,%20Jin%20Cheon&rft.date=2021-10-01&rft.volume=35&rft.issue=10&rft.spage=5450&rft.epage=5460&rft.pages=5450-5460&rft.issn=0930-2794&rft.eissn=1432-2218&rft_id=info:doi/10.1007/s00464-020-08032-2&rft_dat=%3Cproquest_cross%3E2445970922%3C/proquest_cross%3E%3Curl%3E%3C/url%3E&disable_directlink=true&sfx.directlink=off&sfx.report_link=0&rft_id=info:oai/&rft_pqid=2572075489&rft_id=info:pmid/&rfr_iscdi=true |