Search Results (37)

Background and Objectives: Laparoscopic procedures have become a routine approach in colorectal surgery. We aimed to evaluate intraoperative, postoperative and pathological outcomes of laparoscopic right hemicolectomy in comparison with open right hemicolectomy. Materials and Methods: We reviewed our database for colorectal surgery and collected data regarding right hemicolectomies performed over a period of 10 years regarding patient characteristics, operative outcomes and postoperative outcomes. We compared laparoscopic with open right hemicolectomies. All the anastomoses in the laparoscopic group were performed intracorporeally. Results: We included 384 cases, 74 (19.3%) laparoscopic and 310 (80.7%) open right hemicolectomies. Baseline characteristics were comparable between the two groups. Conversion rate was low (2.7%). A drain was placed more often in the open colectomies (p < 0.001). Laparoscopic colectomies lasted longer by 25 min on average in the entire cohort (p = 0.002) and by 30 min in cancer-only cases without concomitant procedures (p < 0.001). Laparoscopic procedures yielded more lymph nodes (p = 0.007), as well as longer distal resection margins (p < 0.001) and total specimen (p < 0.001). There was no difference between the two approaches concerning intraoperative complications (p = 0.36) or need for transfusion (p = 0.708). There was also no difference regarding overall (p = 0.361) or major complications (p = 1), as well as anastomotic leak (p = 0.475), surgical site infections (p = 0.275) or readmission rates (p = 1). Hospitalisation duration was shorter by 3 days after laparoscopic surgery in the entire cohort (p < 0.001), as well as when cancer-only cases without concomitant procedures were considered (p < 0.001). Conclusions: Laparoscopic right hemicolectomy with intracorporeal anastomosis provides perioperative safety and pathology outcomes comparable to open surgery, while significantly reducing hospital stay. Full article

Intracorporeal anastomosis (IA) has gained increasing acceptance in minimally invasive colorectal surgery, primarily owing to its demonstrated association with improved perioperative outcomes compared with extracorporeal techniques. Nevertheless, the specific role of intracorporeal handsewn anastomosis remains insufficiently explored within the context of laparoscopic colorectal procedures. The present study describes a standardized technique for performing a side-to-side isoperistaltic handsewn intracorporeal ileocolic anastomosis following laparoscopic right colectomy and evaluates its safety and feasibility through a review of the relevant literature and institutional experience. The procedure is executed employing a medial-to-lateral dissection approach, and a single-layer isoperistaltic handsewn anastomosis is constructed entirely intracorporeally. Over a three-year period, 68 laparoscopic right colectomies were completed using this technique, predominantly for malignant disease, all performed by a single surgeon. Notably, no anastomotic leaks or anastomosis-related complications, including bleeding, stenosis, or hematoma formation, were observed. Available evidence supports the advantages of intracorporeal anastomosis, including reduced surgical trauma, lower incidence of wound-related complications, faster recovery of bowel function, and comparable oncological outcomes. Furthermore, emerging data from robotic-assisted colorectal surgery suggest potential benefits of handsewn techniques with respect to hemostasis and anastomotic quality. In conclusion, intracorporeal handsewn ileocolic anastomosis following laparoscopic right colectomy appears to represent a safe and reproducible technique when performed by experienced surgeons, thereby warranting further prospective, comparative and multicenter studies to delineate its broader applicability and long-term outcomes. Full article

Background: Right hemicolectomy remains the standard surgical treatment for right colon diseases. This study evaluates robotic versus laparoscopic approaches to determine optimal, minimally invasive strategies, balancing technical efficacy with healthcare economics. Materials and Methods: This retrospective study evaluates robotic versus laparoscopic approaches using data from 46 studies (2003–2025) involving 36,868 patients (6,312 robotic, 30,547 laparoscopic). Primary outcomes assessed were lymph node yield, operative time, and hospital stay; secondary outcomes included blood loss, conversion rates, infections, readmissions, and costs. Results: Concerning robotic surgery, lymph node harvest was higher (MD 1.34 for CME; MD 1.27 for non-CME). Laparoscopy showed shorter operative times (MD 25.73 for CME; MD 42.45 for non-CME). Hospital stays showed no significant difference. Robotics demonstrated lower blood loss in non-CME cases (MD -0.38). Conversion rates favored robotics (1% vs. 10% for CME; 4% vs. 8% for non-CME). No significant differences were found in wound infections or non-CME readmissions, though robotics showed lower CME readmission costs (MD 5.34). There were several study-acknowledged limitations, including surgeon preference bias, protocol variability, learning curves, and evolving techniques over the 22-year period. Cost analyses considered both direct surgical expenses and postoperative care. Conclusions: While robotics offers advantages in oncological resection and procedural stability, laparoscopy maintains efficiency benefits. These findings contribute to ongoing discussions about optimal, minimally invasive approaches for right colon pathologies, balancing technical efficacy with healthcare economics. By comparing surgical techniques, surgeon expertise, patient characteristics, and healthcare costs across multiple institutions, this study seeks to provide meaningful insights for surgical decision-making and further standardization. Full article

Background: Liver cirrhosis increases perioperative risk in colorectal cancer surgery, yet data on long-term outcomes remain limited. In this study, we evaluated postoperative morbidity, mortality, and survival in cirrhotic patients. Methods: In this single-center retrospective cohort, 53 cirrhotic patients undergoing elective colectomy or proctectomy (2011–2022) were propensity score-matched 1:1 with non-cirrhotic controls. Perioperative variables, complications, and survival were analyzed. Subgroup analyses were performed for right hemicolectomy and non-right hemicolectomy procedures. Kaplan–Meier and logistic regression analyses were implemented to assess outcomes and risk factors. Results: Cirrhotic patients had higher preoperative MELD-Na scores and lower albumin and hemoglobin levels. They experienced greater blood loss, longer operative times, more ICU admissions, and higher rates of major complications (18.9% vs. 3.8%, p = 0.01). Mortality was higher at in-hospital (7.5% vs. 0%), 3-month (9.4% vs. 0%), and 60-month (66% vs. 28.3%) intervals, and these patients’ overall survival was shorter (70.7 vs. 116.8 months, p < 0.001). The subgroup analysis showed that the adverse impact of cirrhosis persisted for both right hemicolectomy and non-right hemicolectomy procedures, with significantly worse long-term survival in cirrhotic patients. Postoperative complications after right hemicolectomy did not differ significantly between groups. Among cirrhotic patients, Child–Turcotte–Pugh class B predicted worse survival than class A (40.1 vs. 84.8 months, p = 0.006). Preoperative hypoalbuminemia (<3.5 g/dL) independently predicted long-term mortality (HR = 3.93). Conclusions: Elective colorectal surgery in patients with cirrhosis is associated with increased perioperative complications and significantly reduced long-term survival. However, postoperative outcomes after right hemicolectomy in cirrhotic patients were comparable to those of non-cirrhotic patients, despite their persistently poorer long-term survival. Optimization of nutritional status and careful preoperative assessment of hepatic reserve are essential to improving outcomes in this high-risk population. Full article

Background: Robotic surgery represents the most advanced evolution of minimally invasive colorectal procedures. The Hugo™ Robotic-Assisted Surgery (RAS) platform by Medtronic, introduced in 2021, is a novel modular system designed to enhance accessibility and flexibility. Evidence on its application in colorectal procedures remains limited. This study aimed to evaluate the perioperative outcomes of major colorectal resections performed using the Hugo™ RAS system. Methods: A retrospective, consecutive, single-center case series was conducted on all adult patients who underwent major colorectal surgery using the Hugo™ RAS platform between May 2024 and March 2025. Primary endpoints included operative time, docking time, conversions, and intraoperative complications. Secondary endpoints included postoperative complications (classified using Clavien–Dindo), length of stay, time to bowel function recovery, postoperative pain, and readmission. All perioperative variables were standardized with defined measurement criteria, and complication severity was systematically graded. Results: Forty-four patients were included. All surgeries were completed robotically without conversion or intraoperative complications. The median docking time was 11 min, the median console time was 179 min, and the median operative time was 300 min. Four patients (9.1%) developed major complications (Clavien–Dindo III). Right colectomy anastomoses were intracorporeal, performed with a laparoscopic linear stapler through the assistant port due to absence of a robotic stapler. Conclusions: Major colorectal resections performed with the Hugo™ RAS platform were feasible and safe, with satisfactory perioperative outcomes and no conversions. These findings confirm the reproducibility of this novel robotic system in colorectal surgery. Larger prospective multicenter studies with extended follow-up are warranted to further assess long-term and oncological outcomes. Full article

Introduction: Appendiceal neuroendocrine neoplasms (aNENs) are the most common malignant appendiceal neoplasms. Localized aNENs are typically managed with an appendectomy; however, right colectomy may be necessary in patients with a high risk of nodal disease. However, the role of right hemicolectomy and the optimal surveillance strategy, particularly for tumors between 1 and 2 cm, remains controversial. Material and Methods: This retrospective, observational study evaluated patients diagnosed with aNENs between January 1995 and July 2015 at two tertiary centers in Ireland and Italy. Data were extracted from a prospectively maintained registry and included clinical, pathological, and therapeutic variables, as well as follow-up outcomes. Results: Forty-three patients (41.8% male; median age 27.5 years) were included, with a median follow-up of 49 months. The median tumor size was 6.4 mm (range: 0.6–40 mm). The majority were G1 tumors (58%), and staging distribution was predominantly Stage I (60%). While no significant differences in demographics or tumor features were observed between centers, completion right hemicolectomies were more frequent in the Irish cohort (p = 0.04). Follow-up practices varied, with more intensive imaging and biochemical monitoring observed in the Italian cohort. Overall prognosis was excellent, with a single case of recurrence during the study period. Conclusions: Most aNENs are effectively managed with appendectomy alone, and routine follow-up may be unnecessary in the absence of adverse pathological features. Accurate risk stratification, driven by comprehensive histopathological assessment, is critical for optimizing management and surveillance strategies. Full article

Background/Objectives: We aim to provide pooled data on the safety and efficacy of Transvaginal Natural Orifice Transluminal Endoscopic (vNOTES) right colectomy. Methods: This systematic review was conducted according to the Cochrane Handbook and the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. The primary endpoint was the overall complication rate. Quality assessment was based on the NHLBI quality assessment tools. Results: Overall, six studies were included in this review. Overall morbidity rate was 21.9% (95% CI: 10.7–33.2%, p < 0.001), while intraoperative adverse events were noted in 19.9% (p < 0.001) of cases. Mean operation duration was 176.42 (p < 0.001) minutes. Overall hospital stay was 8.68 days (p = 0.002). Conclusions: Our analyses confirm the safety and efficacy of the approach. Given several study limitations, further large-scale and high-quality trials are required. Full article

Background: Postoperative ventral hernia (POVH) remains a significant complication following laparoscopic colectomy despite minimally invasive approaches. Extraction site selection may influence POVH incidence, yet optimal location remains controversial. Methods: This retrospective cohort study analyzed 550 patients undergoing elective laparoscopic right colectomy (2009–2024) at a single center. After exclusions for anastomotic leak and loss to follow-up, 266 patients were propensity-matched 1:1 comparing paramedian (n = 133) versus midline (n = 133) extraction sites. The primary outcome was POVH incidence at 36 months. Secondary outcomes included risk factor identification using multivariate logistic regression and Firth penalized methods. Results: POVH occurred in 3/133 (2.3%) paramedian versus 15/133 (11.3%) midline patients (p = 0.007). Multivariate analysis identified midline extraction (aOR 30.3, 95% CI: 3.34–969, p < 0.001), chronic cough (aOR 25.6, 95% CI: 3.56–287, p = 0.001), and constipation (aOR 10.1, 95% CI: 1.60–70.7, p = 0.015) as independent POVH predictors. Patient comorbidities showed stronger associations than surgical factors in univariate analysis. The number needed to treat with paramedian extraction to prevent one POVH was 11.1. Conclusions: Paramedian extraction sites significantly reduce POVH incidence compared to midline approaches in laparoscopic right colectomy. The identification of modifiable physiological risk factors, particularly conditions causing increased intra-abdominal pressure (chronic cough, constipation), suggests that comprehensive perioperative optimization targeting these specific factors may further reduce POVH risk. Full article

(1) Minimally invasive techniques are standard in colorectal surgery, though complete mesocolic excision (CME) with central lymphadenectomy remains technically demanding. Robotic systems may address these challenges. While the DaVinci system is well established, the modular Dexter system allows rapid switching between laparoscopy and robotics. (2) This prospective single-surgeon study compared right hemicolectomy with CME and intracorporeal anastomosis using Dexter, DaVinci, and conventional laparoscopy in 75 patients (25 per group) at a German high-volume center. Outcomes assessed included operative time, complications, lymph node yield, and CME quality. (3) Mean operative time was longest with DaVinci (190.5 min) versus Dexter (164.8 min) and laparoscopy (152.6 min). Intracorporeal anastomosis was more frequent in robotic groups. No significant differences were found in lymph node yield, CME quality, postoperative complications, length of stay, or survival. (4) The ability to convert briefly to laparoscopy during Dexter procedures helped manage challenging steps, especially during the learning curve. The results suggest that Dexter is a safe, feasible alternative to established robotic and laparoscopic techniques, with the added benefits of flexibility and integration into existing workflows. Full article

Background and Objectives: The technique of complete mesocolic excision (CME) for colonic cancer is being advocated to improve the local control of the disease and increase the long-term survival. However, even with an open approach, CME is a complex technique and has not yet been adopted as standard care. Laparoscopy has been proven to bring significant advantages to colorectal surgery but performing a laparoscopic CME (Lap-CME) for colonic cancer is even more technically demanding than CME in open surgery. The purpose of this study is to evaluate whether Lap-CME can be offered as a standard procedure for patients with colonic cancer and to compare the results with those obtained after a conventional, open technique. Materials and methods: This study included 100 consecutive patients with colonic cancer, who were operated on by the same surgical team using a standardized medial-to-lateral open or laparoscopic complete mesocolic excision technique. The perioperative data was prospectively recorded in a database and retrospectively analyzed with the aim of identifying the proportion of patients that received Lap-CME, to evaluate the success rate of the procedure and to identify whether there are differences in the oncological quality of CME between the laparoscopic and open surgery groups. Results: Most of the patients enrolled in this study were in the advanced stages of the disease, with the incidence of pT3 tumors being 67% and the mean tumor size averaging 4.5 cm. Laparoscopic CME was performed in 39% of cases overall, with 41.4% being right colectomies, 42.5% being left colectomies and 16.1% being transverse colectomies. All of the parameters relevant to the oncological quality of resection, namely total lymph node count, resection margins, or the completeness of resection, were similar between the open and laparoscopic groups both when analyzed for the entire cohort or when analyzed for specific subgroups according to the tumor location (right, transverse, or left colon) or stage of the disease (pT3 or stage III). Conclusions: Laparoscopic complete mesocolic excision for colonic cancer can be offered as a standard procedure by experienced surgical teams in carefully selected patients and provides oncological results similar to those obtained with open surgery. Full article

Background/Objectives: Colon cancer is one of the main causes of cancer-related mortality worldwide. Among its histopathological subtypes, mucinous adenocarcinoma (MAC) is characterized by a more aggressive behavior than non-mucinous adenocarcinoma (non-MAC). This study aimed to compare the clinical outcomes and postoperative recovery between MAC and non-MAC cases in order to better understand the treatment implications and optimize therapeutic strategies. Methods: A retrospective cohort study was conducted on patients diagnosed and treated at the Bihor County Emergency Hospital between January 2019 and December 2022. Data were collected from the medical records. Patients were divided into two groups, based on the histopathological results: mucinous adenocarcinoma and non-mucinous adenocarcinoma. Statistical analysis included descriptive statistics, t-tests, Chi-square tests, and ANOVA where appropriate. Results: A total of 191 patients were enrolled in this study, grouped in 36 cases of MAC and 155 cases of non-MAC. No significant statistical differences were found regarding hematological parameters. However, MAC was associated with higher rates of local invasion and a predominant right-sided colonic location, necessitating more frequent right colectomies. The overall mortality rate was significantly higher for MAC, indicating its aggressive nature. Conclusions: MAC presents higher local invasion rates and overall mortality. The aggressiveness of MAC underscores the need for tailored treatment approaches to optimize patient outcomes. Future large-scale studies are recommended to validate these findings and refine the therapeutic strategies. Full article

Background and Objective: Colorectal cancer (CRC) is the third most common cancer worldwide, with colon cancer accounting for approximately 60% of all CRC cases. Surgery remains the primary and most effective treatment. Robotic-assisted surgery (RAS) has emerged as a promising approach for colon cancer resection. This retrospective study compares RAS and laparoscopic-assisted surgery (LSS) for stage I–III colon cancer resections at a single medical center in East Asia. Methods: Between 1 January 2018, and 29 February 2024, patients undergoing colectomy were classified into right-side and left-side colectomies. Propensity score matching was conducted based on age group, gender, ASA score, and BMI to ensure comparability between groups. After matching, there were 50 RAS and 200 LSS cases for right colectomy (RC), and 129 RAS and 258 LSS cases for left colectomy (LC). Perioperative outcomes were compared between the two surgical approaches. The primary outcomes were recovery milestones, while secondary outcomes included complications and postoperative pain scores. Results: RAS demonstrated faster recovery milestones compared to LSS (hospital stay: 6.5 vs. 10.2 days, p = 0.005 for RC; 5.5 vs. 8.2 days, p < 0.001 for LC). RAS also resulted in lower rates of ileus (14% vs. 26%, p = 0.064 for RC; 6.2% vs. 15.9%, p = 0.007 for LC) and higher lymph node yields (31.4 vs. 26.8, p = 0.028 for RC; 25.8 vs. 23.9, p = 0.066 for LC). Major complication rates showed no significant difference between RAS and LSS (4.0% vs. 7.0%, p = 0.746 for RC; 4.7% vs. 3.1%, p = 0.563 for LC). Patients in the RAS group experienced earlier diuretic phases and reported significantly lower postoperative pain scores (3.0 vs. 4.1, p = 0.011 for RC; 2.9 vs. 4.1, p < 0.001 for LC). Conclusions: Robotic-assisted surgery is associated with faster recovery, lower rates of ileus (LC), higher lymph node yield (RC) and reduced postoperative pain compared to laparoscopic-assisted surgery for colon cancer resection. Full article

Background and Clinical Significance: Neuroendocrine expressing goblet cell adenocarcinomas (GCAs) are uncommon clinically aggressive tumours of the digestive system, originating almost exclusively in the ileocecal appendix. GCA’s singularity comes from its amphicrine nature, expressing both neuroendocrine and exocrine characteristics. The case report’s objective is to raise awareness of this neoplasia’s possible extra-appendiceal localisation by showcasing a GCA involving the cecum with no detectable appendiceal tumour. Case Presentation: The authors present a case of GCA with neuroendocrine expression in an 82-year-old male patient with severe anaemia and comorbidities who underwent a right colectomy and had no histopathological evidence of appendiceal tumour involvement. Immunohistochemical testing was performed using synaptophysin, chromogranin A, neuronal specific enolase, CD56, CDX-2, CK20, CEA, MUC2 and Ki67, thus establishing the final diagnosis of high-grade extra-appendiceal goblet-cell adenocarcinoma of the cecum, G3. The patient died on postoperative day 26 due to pneumonia and acute renal failure in a chronic renal disease context. Conclusions: Extremely few cases of extra-appendiceal GCA have been reported. Appendiceal evaluation with the exclusion of this possible origin should be mandatory in such cases for a correct classification. These tumours do not benefit from any official management protocols concerning clinical evaluation, and their treatment is commonly based on the tumour’s stage, as in classical adenocarcinoma. Full article

Background: The effect of gender dimorphism and marital status on colorectal cancer mortality have been previously documented, but the relationship between these factors and DNA mismatch repair protein (MMRP) expression status is unknown. Methods: Colectomy specimens were reviewed retrospectively for patients between 2018 and 2023, with demographics including race/ethnicity, gender, marital status, faith, body mass index, pathologic staging, and MMRP expression status. Statistical analyses were performed by using baseline characteristics tables and various programs in the R package. Results: A total 1018 colectomies were reviewed, and the tumor stages were significantly higher in the right colon (stage 3 and 4) than in the left colon and rectosigmoid colon (p < 0.01). Marital status was significantly associated with patients’ gender, age, tumor size, and tumor stages (all p < 0.01). MMRP status was available in 775 cases, with 139 (17.9%) MMRP-deficient and 636 (82%) MMRP-proficient. MMRP deficiency was significantly associated with older female patients, larger tumor sizes, higher tumor stages, higher histologic grades, and was more common in the right colon (all p < 0.01). In addition, MMRP deficiency was statistically associated with a higher percentage of divorced and widowed patients (p < 0.01). Multivariate linear regression analysis revealed a persistent association of MMRP deficiency with tumor size, tumor grade, tumor stage, and nodal metastasis, but the associations with gender and marital status no longer existed. Conclusions: The differences in prevalence of CRC by gender and marital status and tumor MMRP status illustrate the importance of these factors on tumor stages and nodal metastasis but these associations are more complex with other confounding factors. Full article

Retroperitoneal tumors are uncommon and may reach a large size prior to causing symptoms or being noticed by the patient or physician. A middle-aged female consulted us for care during her “terminal” illness. She had already undergone four previous retroperitoneal resection surgical procedures. She presented with a large recurrent protruding mass from the right side of the abdomen and related a history of a previous cholecystectomy, right nephrectomy, right colectomy, and repeated resection of a recurrent retroperitoneal liposarcoma. She thus came to us for consultation and terminal care in order to be away from her friends during treatment for this terminal condition. After our consultation, she elected to have repeated surgical excisions of the tumor. The surgical excisions yielded a giant recurrent tumor mass, which overflowed and covered all margins of the 21-inch-wide surgical scrub basin. Over the next eleven years, she had multiple surgical resection procedures involving both the right and left retroperitoneum (a splenectomy, a left colectomy, and a colostomy). Recovery from each of these resection procedures (the final combined resection weight was 120 pounds) was without complications. However, the tumor finally encased the pancreas and the left kidney. If the tumor encasement were to be palliated and resected, she would require hemodialysis. At this time, the patient elected to have no further resection surgeries, no dialysis, nor any palliative chemoradiation treatment. Over a period of sixteen years from her first resection and twelve years from our first resection, the patient had continued to work at her medical administrative and leadership position and led a functional life after our consultation, except for her surgical period. The patient was not cured but benefited from repeated palliative surgeries, prolonging her life and improving her job performance. Full article