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Safety and feasibility of repeat laparoscopic colorectal resection: a matched case–control study

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Abstract

Background

Perioperative outcomes of repeat laparoscopic colorectal resection (LCRR) have not been extensively reported.

Methods

Patients who underwent LCRR from 2010 to 2018 in an expert center were retrieved from a prospectively collected database and compared to 2:1 matched sample. Matching was based on demographics, surgical indication [colorectal cancer (CRC) or benign condition], and type of resection (right-sided resection or left-sided resection or proctectomy).

Results

Twenty-three patients underwent repeat LCRR with a median time of 36 months between the primary and the repeat LCRR. They were 12 (52%) men with a mean age of 64.9 years (31–87) and a median BMI of 21.4 kg/m2 (17.7–34). Indication for repeat LCRR was CRC, dysplasia, anastomotic stricture, and inflammatory bowel disease in 11 (48%), 5 (22%), 4 (17%), and 3 (13%) patients, respectively. A right-sided resection, a left-sided resection, and proctectomy were reported in 11 (48%), 8 (35%), and 4 (17%) patients, respectively. Median blood loss reached 211 mL (range 0–2000 mL). Thirteen (57%) patients required conversion to laparotomy including 12 for intense adhesions. The median length of hospital stay was 7.5 days (5–20). Two (9%) major complications (Clavien–Dindo ≥ 3) were reported: 1 (4%) anastomotic fistula and 1 (4%) postoperative hemorrhage, without mortality. Among patients who underwent repeat LCRR for CRC, histopathological examination showed R0 resection in all patients, with at least 12 lymph nodes harvested in ten (91%) patients. After matched case–control analysis that compared to primary LCRR, conversion rate (p = 0.03), operative time (p = 0.03), and intraoperative blood loss (p = 0.0016) were significantly increased in repeat LCRR, without impact on postoperative outcomes.

Conclusions

Repeat LCRR seems to be feasible and safe in expert hands without compromising the oncologic outcomes. Intense postoperative adhesions and misidentification of blood supply might lead to conversion to laparotomy. Real benefits of laparoscopic approach for repeat LCRR should be assessed in further studies.

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Abbreviations

LCRR:

Laparoscopic colorectal resection

CRC:

Colorectal cancer

AS:

Anastomotic stricture

BMI:

Body mass index

IBD:

Inflammatory bowel disease

ERAS:

Enhanced recovery after surgery

CT:

Computed tomography

References

  1. Freischlag K, Adam M, Turner M, Watson J, Ezekian B, Schroder PM, Mantyh C, Migaly J (2018) With widespread adoption of MIS colectomy for colon cancer, does hospital type matter? Surg Endosc. https://doi.org/10.1007/s00464-018-6289-7

    Article  PubMed  Google Scholar 

  2. Balvardi S, Pecorelli N, Castelino T, Niculiseanu P, Liberman AS, Charlebois P, Stein B, Carli F, Mayo NE, Feldman LS, Fiore JF Jr (2018) Measuring in-hospital recovery after colorectal surgery within a well- established enhanced recovery pathway: a Comparison between hospital length of stay and time to readiness for discharge. Dis Colon Rectum 61:854–860

    Article  Google Scholar 

  3. Ballian N, Weisensel N, Rajamanickam V, Foley EF, Heise CP, Harms BA, Kennedy GD (2012) Comparable postoperative morbidity and mortality after laparoscopic and open emergent restorative colectomy: outcomes from the ACS NSQIP. World J Surg 36:2488–2496. https://doi.org/10.1007/s00268-012-1694-x

    Article  PubMed  Google Scholar 

  4. Aarts MA, Rotstein OD, Pearsall EA, Victor JC, Okrainec A, McKenzie M, McCluskey SA, Conn LG, McLeod RS, iERAS group (2018) Postoperative ERAS Interventions have the greatest impact on optimal recovery: experience with implementation of ERAS across multiple hospitals. Ann Surg 267:992–997

    Article  Google Scholar 

  5. Kothari P, Congiusta DV, Merchant AM (2018) Laparoscopic versus open colectomy: the impact of frailty on outcomes. Updates Surg. https://doi.org/10.1007/s13304-018-0531-7

    Article  PubMed  Google Scholar 

  6. Kannan U, Reddy VS, Mukerji AN, Parithivel VS, Shah AK, Gilchrist BF, Farkas DT (2015) Laparoscopic vs open partial colectomy in elderly patients: insights from the American College of Surgeons—National Surgical Quality Improvement Program database. World J Gastroenterol 21:12843–12850. https://doi.org/10.3748/wjg.v21.i45.12843

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  7. Cunningham D, Atkin W, Lenz HJ, Lynch HT, Minsky B, Nordlinger B, Starling N (2010) Colorectal cancer. Lancet 375:1030–1047. https://doi.org/10.1016/S0140-6736(10)60353-4

    Article  PubMed  Google Scholar 

  8. Gallo G, Kotze PG, Spinelli A (2018) Best Pract Res Clin Gastroenterol 32–33:71–78. https://doi.org/10.1016/j.bpg.2018.05.017

    Article  PubMed  Google Scholar 

  9. Mege D, Garrett K, Milsom J, Sonoda T, Michelassi F (2018) Changing trends in surgery for abdominal Crohn’s disease. Colorectal Dis. https://doi.org/10.1111/codi.14450

    Article  PubMed  Google Scholar 

  10. Klarenbeek BR, Samuels M, van der Wal MA, van der Peet DL, Meijerink WJ, Cuesta MA (2010) Indications for elective sigmoid resection in diverticular disease. Ann Surg 251:670–674. https://doi.org/10.1097/SLA.0b013e3181d3447d

    Article  PubMed  Google Scholar 

  11. Lefevre JH, Bretagnol F, Maggiori L, Ferron M, Alves A, Panis Y (2011) Redo surgery for failed colorectal or coloanal anastomosis: a valuable surgical challenge. Surgery 149:65–71. https://doi.org/10.1016/j.surg.2010.03.017

    Article  PubMed  Google Scholar 

  12. Genser L, Manceau G, Karoui M, Breton S, Brevart C, Rousseau G, Vaillant JC, Hannoun L (2013) Postoperative and long-term outcomes after redo surgery for failed colorectal or coloanal anastomosis: retrospective analysis of 50 patients and review of the literature. Dis Colon Rectum 56:747–755. https://doi.org/10.1097/DCR.0b013e3182853c44

    Article  PubMed  Google Scholar 

  13. Maggiori L, Blanche J, Harnoy Y, Ferron M, Panis Y (2015) Redo-surgery by transanal colonic pull-through for failed anastomosis associated with chronic pelvic sepsis or rectovaginal fistula. Int J Colorectal Dis 30:543–548. https://doi.org/10.1007/s00384-014-2119-0

    Article  PubMed  Google Scholar 

  14. Brouquet A, Bretagnol F, Soprani A, Valleur P, Bouhnik Y, Panis Y (2010) A laparoscopic approach to iterative ileocolonic resection for the recurrence of Crohn’s disease. Surg Endosc 24:879–887. https://doi.org/10.1007/s00464-009-0682-1

    Article  PubMed  Google Scholar 

  15. Zarzavadjian Le Bian A, Denet C, Tabchouri N, Levard H, Besson R, Perniceni T, Costi R, Wind P, Fuks D, Gayet B (2018) The effect of metabolic syndrome on postoperative outcomes following laparoscopic colectomy. Tech Coloproctol 22:215–221. https://doi.org/10.1007/s10151-018-1772-7

    Article  CAS  PubMed  Google Scholar 

  16. Dindo D, Demartines N, Clavien PA (2004) Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg 240:205–213

    Article  Google Scholar 

  17. Søndenaa K, Quirke P, Hohenberger W, Sugihara K, Kobayashi H, Kessler H, Brown G, Tudyka V, D’Hoore A, Kennedy RH, West NP, Kim SH, Heald R, Storli KE, Nesbakken A, Moran B (2014) The rationale behind complete mesocolic excision (CME) and a central vascular ligation for colon cancer in open and laparoscopic surgery: proceedings of a consensus conference. Int J Colorectal Dis 29(4):419–428. https://doi.org/10.1007/s00384-013-1818-2

    Article  PubMed  Google Scholar 

  18. Yamamoto M, Okuda J, Tanaka K, Kondo K, Asai K, Kayano H, Masubuchi S, Uchiyama K (2013) Effect of previous abdominal surgery on outcomes following laparoscopic colorectal surgery. Dis Colon Rectum 56:336–342. https://doi.org/10.1097/DCR.0b013e31827ba103

    Article  PubMed  Google Scholar 

  19. Lee SY, Kim CH, Kim YJ, Kim HR (2016) Laparoscopic surgery for colorectal cancer patients who underwent previous abdominal surgery. Surg Endosc 30:5472–5480

    Article  Google Scholar 

  20. Park S, Kang J, Park EJ, Baik SH, Lee KY (2017) laparoscopic and robotic surgeries for patients with colorectal cancer who have had a previous abdominal surgery. Ann Coloproctol 33:184–191

    Article  CAS  Google Scholar 

  21. Boni L, David G, Dionigi G, Rausei S, Cassinotti E, Fingerhut A (2016) Indocyanine green-enhanced fluorescence to assess bowel perfusion during laparoscopic colorectal resection. Surg Endosc 30:2736–2742

    Article  Google Scholar 

  22. Ome Y, Hashida K, Yokota M, Nagahisa Y, Yamaguchi K, Okabe M, Kawamoto K (2018) The feasibility and efficacy of pure laparoscopic repeat hepatectomy. Surg Endosc 32:3474–3479. https://doi.org/10.1007/s00464-018-6066-7

    Article  PubMed  Google Scholar 

  23. Noda T, Eguchi H, Wada H, Iwagami Y, Yamada D, Asaoka T, Gotoh K, Kawamoto K, Takeda Y, Tanemura M, Umeshita K, Doki Y, Mori M (2018) Short- term surgical outcomes of minimally invasive repeat hepatectomy for recurrent liver cancer. Surg Endosc 32:46–52

    Article  Google Scholar 

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Authors and Affiliations

  1. Department of Digestive Surgery and Surgical Oncology – Hôpital Avicenne, Assistance Publique – Hôpitaux de Paris, Université Paris XIII, 125 rue de Stalingrad, 93000, Bobigny, France

    Alban Zarzavadjian le Bian, Laurent Genser & Philippe Wind

  2. Department of Digestive Surgery, Surgical Oncoloy and Metabolic Surgery – Institut Mutualiste Montsouris, 42 Boulevard Jourdan, 75014, Paris, France

    Christine Denet, Carlotta Ferretti, Anais Laforest, Jean-Marc Ferraz, Candice Tubbax, Brice Gayet & David Fuks

  3. Université Paris Descartes, 15 rue de l’Ecole de Médecine, 75006, Paris, France

    Brice Gayet & David Fuks

Authors
  1. Alban Zarzavadjian le Bian
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  2. Laurent Genser
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  3. Christine Denet
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  4. Carlotta Ferretti
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  8. Philippe Wind
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Contributions

Conception of the work: AZLB, LG, CD, CF, AL, JMF, CT, PW, BG, and DF. Acquisition, analysis, and interpretation of data: AZLB, LG, CD, CF, AL, BG, and DF. Drafting the work or revising it critically for important intellectual content: AZLB, LG, PW, BG, and DF. Final Approval: AZLB, LG, CD, CF, AL, JMF, CT, PW, BG, and DF.

Corresponding author

Correspondence to Alban Zarzavadjian le Bian.

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Disclosures

Alban Zarzavadjian Le Bian, Laurent Genser, Christine Denet, Carlotta Ferretti, Anais Laforest, Jean-Marc Ferraz, Candice Tubbax, Philippe Wind, Brice Gayet, and David Fuks have no conflicts of interest or financial ties to disclose.

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Zarzavadjian le Bian, A., Genser, L., Denet, C. et al. Safety and feasibility of repeat laparoscopic colorectal resection: a matched case–control study. Surg Endosc 34, 2120–2126 (2020). https://doi.org/10.1007/s00464-019-06995-5

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