Individualized laparoscopic and related technique in rectal cancer surgery

[Extract from Preface] The main studies listed in each chapter were carefully selected as to reflect the critical knowledge essential in each of the important steps to overcome the main challenges toward the success in achieving the best possible outcomes in rectal cancer patient care. However, the main original contribution of the thesis was demonstrated clearly in "Chapter 3: Laparoscopic surgery for rectal cancer" where the proposed laparoscopic pull-through with coloanal anastomosis was highlighted. The chapter showed a prospective comparative study comparing all aspects of the two techniques; laparoscopic ultralow anterior resection versus laparoscopic pull-through with coloanal anastomosis for rectal cancers. All the published studies involved in each chapter of the thesis were carefully illustrated in their original format with my great respect to the international peer-review. Nevertheless, each chapter contained the overview aiming to state the connectivity of the ideas for each specific detail contained in each chapter. Despite the fact that the majority of the studies were conducted in high-volume, specialized centers, it was a real challenge to organize prospective studies for highly specific research questions over the limited time of my doctorate degree study. Chapter Overview. Chapter 1: Introduction. This chapter described the context of this research; why rectal cancer treatment is challenging; impact of multidisciplinary treatment on the outcomes. Chapter 2: Overview in colorectal cancer treatment. To review of role of various treatment modalities and variations to optimise both short-term and long-term outcomes; Hiranyakas A, Yik Hong H. Surgical Treatment of Colorectal Cancer – a Review. Int Surg. 2011; 96(2):120-6. Chapter 3: Laparoscopic surgery for rectal cancer. To discuss and propose appropriate laparoscopic techniques / approaches in the challenging surgical conditions to achieve the best possible outcomes; Hiranyakas A, Yik Hong H. Laparoscopic Ultralow Anterior Resection Versus Laparoscopic Pull-through with Coloanal Anastomosis for Rectal Cancers – a Comparative Study. Am J Surg. 2011; 202(3):291-7. Chapter 4: Factors influencing rectal cancer treatment outcomes. To discuss and propose the factors influencing the optimal outcomes for rectal cancer treatment; Hiranyakas A, Yik-Hong H, da Silva, GM, Wexner SD, Allende D, Berho M. Factors Influencing Circumferential Resection Margin in Rectal Cancer. Colorectal Dis. 2013 ;15(3):298-303. Chapter 5: Technique to avoid postsurgical complication. To discuss and propose surgical techniques essential in avoiding serious postsurgical consequences; Hiranyakas A, da Silva GM, Denoya P, Shawki S, Wexner SD. Colorectal Anastomotic Stricture: Is it associated with inadequate Colonic Mobilization? Tech Coloproctol. 2013 ;17(4):371-5. Chapter 6: Protocols for rapid recovery. To discuss in depth for the appropriate immediate postsurgical-care protocols to achieve the smooth and rapid recovery (among the most common diseased population); Hiranyakas A, Bashankaev B, Seo CJ, Khaikin M, Wexner SD. Epidemiology, Pathophysiology and Medical Management of Postoperative Ileus in the Elderly. Drugs Aging. 2011; 28(2):107- 18. Chapter 7: Closure of the ileostomy. To discuss and propose the necessity of certain surgical procedures to enhance optimal immediate postsurgical outcomes in low rectal cancer patients; Hiranyakas A, Rather A, da Sliva GM, Wexner SD, Weiss EG. Loop ileostomy Closure after Laparoscopic vs. Open Surgery: Is There a Difference? Surg Endosc. 2013 ;27(1):90-4. Chapter 8: Treatment of common stomal complication. To discuss and propose minimally invasive surgical approaches in the treatment of the common stomal consequence; Hiranyakas A, Yik Hong H. Laparoscopic Parastoma Hernia Repair, Multi-media Article. Dis Colon Rectum 2010; 53(9):1334-6. Chapter 9: Conclusion, outcomes and future research directions. This chapter gives the conclusions from the studies and proposes future research directions

Laparoscopic ultralow anterior resection versus laparoscopic pull-through with coloanal anastomosis for rectal cancers: a comparative study

Background: \ud Ultralow anterior resection for mid and distal rectal cancers has been reported routinely performed using either a laparoscopic ultralow anterior resection (LAR) or laparoscopic pull-through with coloanal anastomosis (LPT). This study evaluated the postoperative and functional outcomes.\ud \ud Methods: \ud Between January 2007 and December 2008, 40 consecutive patients had laparoscopic surgery for rectal cancers. The data were prospectively collected.\ud \ud Results: \ud There were 21 patients (21 men; mean age 61.2 ± 3.2 years standard error of the mean [SEM]) in the LAR group and 19 (16 men; mean age 61.4 ± 2.4 years SEM) in the LPT group. Tumor characteristics, adjuvant therapy given, mean follow-up (overall 33.5 ± 1.4 months SEM), intraoperative time, blood loss, mesorectum quality, conversion rate (LAR n = 2, LPT n = 1), pain score, time for ileostomy to function, subsequent incontinence scores, and complication rates (LAR n = 7, LPT n = 9) were not different between groups, but benign anastomotic strictures were higher after LPT (n = 4, LAR n = 0, P = .042). The latter was associated with chemoradiotherapy (P = .015). There were 2 systemic cancer recurrences both in the LPT group but no local recurrences to date.\ud \ud Conclusions: \ud The LAR technique may have less risk of anastomotic strictures, particularly with adjuvant therapy. LPT may be considered selectively for a bulky distal rectal tumor in a small pelvis with comparable functional results

Surgical treatment for colorectal cancer

The rapid in development of surgical technology has had a major effect in surgical treatment of colorectal cancer. Laparoscopic colon cancer surgery has been proven to provide better short-term clinical and oncologic outcomes. However this quickly accepted surgical approach is still performed by a minority of colorectal surgeons. The more technically challenging procedure of laparoscopic rectal cancer surgery is also on its way to demonstrating perhaps similar short-term benefits. This article reviews current evidences of both short-term and long-term outcomes of laparoscopic colorectal cancer surgery, including the overall costs comparison between laparoscopic surgery and conventional open surgery. In addition, different surgical techniques for laparoscopic colon and rectal cancer are compared. Also the relevant future challenge of colorectal cancer robotic surgery is reviewed

Outcomes predictor for the patients with stage II and III rectal cancer

Satisfactory outcomes are always the primary goal for rectal cancer treatment. Obesity is an important modifiable factor directly related to both short and long term outcomes. This retrospective study aimed to identify the most reliable method to predict the outcomes in patient with rectal cancer

Preoperative weight loss reduces the risk of abdominoperineal resection in obese patients

Obesity is associated with rectal cancer carcinogenesis,\ud as well as poorer outcomes due to metabolic syndrome. The aim is to find the relationship between BMl alterations and treatment outcomes in rectal cancer patients