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1. Predictors of surgical outcomes of minimally invasive right colectomy: the MERCY study

Author

de’Angelis, Nicola, Pattacini, Gianmaria Casoni, Winter, Des C., Aisoni, Filippo, Bianchi, Giorgio, Carcoforo, Paolo, Celentano, Valerio, Coccolini, Federico, Di Saverio, Salomone, Frontali, Alice, Denet, Christine, Fuks, David, Genova, Pietro, Guerrieri, Mario, Kraft, Miquel, Lakkis, Zaher, Antonot, Céphise, Vertier, Jeanne, Le Roy, Bertrand, Lupinacci, Renato Micelli, Martínez-Perez, Aleix, De Palma, Giovanni Domenico, Milone, Marco, Orci, Lorenzo, Bartoletti, Sebastiano, O’Connell, Lauren, Ortenzi, Monica, Paquet, Jean-Christophe, Perrotto, Ornella, Petri, Roberto, Santangelo, Antonio, Scabini, Stefano, De Rosa, Raffaele, Tonini, Valeria, Valverde, Alain, Andolfi, Enrico, Pecchini, Francesca, Pellino, Gianluca, Urbani, Alessia, Vidal, Laura, Restivo, Angelo, Deidda, Simona, Zorcolo, Luigi, Ris, Frederic, Espin, Eloy, Piccoli, Micaela, de’Angelis, Nicola, Pattacini, Gianmaria Casoni, Winter, Des C., Aisoni, Filippo, Bianchi, Giorgio, Carcoforo, Paolo, Celentano, Valerio, Coccolini, Federico, Di Saverio, Salomone, Frontali, Alice, Denet, Christine, Fuks, David, Genova, Pietro, Guerrieri, Mario, Kraft, Miquel, Lakkis, Zaher, Antonot, Céphise, Vertier, Jeanne, Le Roy, Bertrand, Lupinacci, Renato Micelli, Martínez-Perez, Aleix, De Palma, Giovanni Domenico, Milone, Marco, Orci, Lorenzo, Bartoletti, Sebastiano, O’Connell, Lauren, Ortenzi, Monica, Paquet, Jean-Christophe, Perrotto, Ornella, Petri, Roberto, Santangelo, Antonio, Scabini, Stefano, De Rosa, Raffaele, Tonini, Valeria, Valverde, Alain, Andolfi, Enrico, Pecchini, Francesca, Pellino, Gianluca, Urbani, Alessia, Vidal, Laura, Restivo, Angelo, Deidda, Simona, Zorcolo, Luigi, Ris, Frederic, Espin, Eloy, Piccoli, Micaela, De'Angelis, N., Pattacini, G. C., Winter, D. C., Aisoni, F., Bianchi, G., Carcoforo, P., Celentano, V., Coccolini, F., Di Saverio, S., Frontali, A., Denet, C., Fuks, D., Genova, P., Guerrieri, M., Kraft, M., Lakkis, Z., Antonot, C., Vertier, J., Le Roy, B., Lupinacci, R. M., Martinez-Perez, A., De Palma, G. D., Milone, M., Orci, L., Bartoletti, S., O'Connell, L., Ortenzi, M., Paquet, J. -C., Perrotto, O., Petri, R., Santangelo, A., Scabini, S., De Rosa, R., Tonini, V., Valverde, A., Andolfi, E., Pecchini, F., Pellino, G., Urbani, A., Vidal, L., Restivo, A., Deidda, S., Zorcolo, L., Ris, F., Espin, E., and Piccoli, M.

Subjects
Colonic Neoplasm, Anastomosis, Anastomosis, Surgical, Operative Time, Gastroenterology, Right colectomy, Intracorporeal anastomosis, Robotic surgery, Intracorporeal anastomosi, Colon cancer, Cohort Studies, Treatment Outcome, Robotic Surgical Procedures, Retrospective Studie, Minimally invasive surgery, Surgical, Colonic Neoplasms, Laparoscopy, Colectomy, Humans, Retrospective Studies, Cohort Studie, Human
Abstract

PURPOSE: The optimal approach for minimally invasive (MIS) right colectomy remains under debate. This study aimed to describe surgical trends in the treatment of nonmetastatic right colon cancer and to identify predictors of short-term surgical outcomes. METHODS: A retrospective multicenter cohort study of Minimally-invasivE surgery for oncologic Right ColectomY (MERCY) was conducted on patients who underwent laparoscopic or robotic right colectomy between 2014 and 2020. Classification tree approach was used to describe the extracorporeal (EA) or intracorporeal (IA) anastomosis choice. Mixed-model regressions were used to identify patient- and surgery-related factors predictive of postoperative outcomes. A questionnaire was used to evaluate the surgeons' perspectives. RESULTS: The MERCY database comprised 1870 patients; 87.2% underwent laparoscopy, and 68.1% received an EA. A clear surgical trend was noted, with an increasing rate of IA and robotic procedures after 2017. EA represented 41% of anastomoses in centers equipped with a robotic surgical system. Mixed-model regressions (on 1088 patients) showed that age, sex, BMI, comorbidity, robotics, IA, and conversion to open surgery were predictors of surgical outcomes. In particular, IA was a predictor of a shorter time to regular diet and fewer surgical site infections. Based on the questionnaire, IA was the preferred over EA by 72% of surgeons. CONCLUSION: MIS continues to evolve, with an increasing number of IA being performed in the recent years and when using a robotic surgical system. Understanding the role of predictors of surgical outcomes may help surgeons personalize decision-making among the different MIS options to manage right colon cancer.

Published
2022

2. Impact of operation duration on postoperative outcomes of minimally-invasive right colectomy

Author

de'Angelis, Nicola, Schena, Carlo Alberto, Piccoli, Micaela, Casoni Pattacini, Gianmaria, Pecchini, Francesca, Winter, Des C, O'Connell, Lauren, Carcoforo, Paolo, Urbani, Alessia, Aisoni, Filippo, Martínez-Pérez, Aleix, Celentano, Valerio, Chiarugi, Massimo, Tartaglia, Dario, Coccolini, Federico, Arces, Francesco, Di Saverio, Salomone, Frontali, Alice, Fuks, David, Denet, Christine, Genova, Pietro, Guerrieri, Mario, Ortenzi, Monica, Kraft, Miquel, Pellino, Gianluca, Vidal, Laura, Lakkis, Zaher, Antonot, Céphise, Perrotto, Ornella, Vertier, Jeanne, Le Roy, Bertrand, Micelli Lupinacci, Renato, Milone, Marco, De Palma, Giovanni Domenico, Petri, Roberto, Santangelo, Antonio, Scabini, Stefano, De Rosa, Raffaele, Tonini, Valeria, Valverde, Alain, Bianchi, Giorgio, Carra, Maria Clotilde, Zorcolo, Luigi, Deidda, Simona, Restivo, Angelo, Andolfi, Enrico, Paquet, Jean-Christophe, Bartoletti, Sebastiano, Orci, Lorenzo, Ris, Frederic, Espin, Eloy, De'Angelis, Nicola, Schena, Carlo Alberto, Piccoli, Micaela, Casoni Pattacini, Gianmaria, Pecchini, Francesca, Winter, Des C, O'Connell, Lauren, Carcoforo, Paolo, Urbani, Alessia, Aisoni, Filippo, Martínez-Pérez, Aleix, Celentano, Valerio, Chiarugi, Massimo, Tartaglia, Dario, Coccolini, Federico, Arces, Francesco, Di Saverio, Salomone, Frontali, Alice, Fuks, David, Denet, Christine, Genova, Pietro, Guerrieri, Mario, Ortenzi, Monica, Kraft, Miquel, Pellino, Gianluca, Vidal, Laura, Lakkis, Zaher, Antonot, Céphise, Perrotto, Ornella, Vertier, Jeanne, Le Roy, Bertrand, Micelli Lupinacci, Renato, Milone, Marco, De Palma, Giovanni Domenico, Petri, Roberto, Santangelo, Antonio, Scabini, Stefano, De Rosa, Raffaele, Tonini, Valeria, Valverde, Alain, Bianchi, Giorgio, Carra, Maria Clotilde, Zorcolo, Luigi, Deidda, Simona, Restivo, Angelo, Andolfi, Enrico, Paquet, Jean-Christophe, Bartoletti, Sebastiano, Orci, Lorenzo, Ris, Frederic, Espin, Eloy, and de'Angelis, Nicola

Subjects
right colectomy, Gastroenterology, laparoscopy, robotic right colectomy, operating time, minimally-invasive surgery
Abstract

Aim: Operation time (OT) is a key operational factor influencing surgical outcomes. The present study aimed to analyse whether OT impacts on short-term outcomes of minimally-invasive right colectomies by assessing the role of surgical approach (robotic [RRC] or laparoscopic right colectomy [LRC]), and type of ileocolic anastomosis (i.e., intracorporal [IA] or extra-corporal anastomosis [EA]). Methods: This was a retrospective analysis of the Minimally-invasivE surgery for oncological Right ColectomY (MERCY) Study Group database, which included adult patients with nonmetastatic right colon adenocarcinoma operated on by oncological RRC or LRC between January 2014 and December 2020. Univariate and multivariate analyses were used. Results: The study sample was composed of 1549 patients who were divided into three groups according to the OT quartiles: (1) First quartile

Published
2022

3. Predictors of surgical outcomes of minimally invasive right colectomy: the MERCY study.

Author

The MERCY Study Collaborating Group, de'Angelis, Nicola, Pattacini, Gianmaria Casoni, Winter, Des C., Aisoni, Filippo, Bianchi, Giorgio, Carcoforo, Paolo, Celentano, Valerio, Coccolini, Federico, Di Saverio, Salomone, Frontali, Alice, Denet, Christine, Fuks, David, Genova, Pietro, Guerrieri, Mario, Kraft, Miquel, Lakkis, Zaher, Antonot, Céphise, Vertier, Jeanne, and Le Roy, Bertrand

Subjects
COLECTOMY, SURGICAL site infections, MERCY, MINIMALLY invasive procedures, COLON cancer, ONCOLOGIC surgery
Abstract

Purpose: The optimal approach for minimally invasive (MIS) right colectomy remains under debate. This study aimed to describe surgical trends in the treatment of nonmetastatic right colon cancer and to identify predictors of short-term surgical outcomes. Methods: A retrospective multicenter cohort study of Minimally-invasivE surgery for oncologic Right ColectomY (MERCY) was conducted on patients who underwent laparoscopic or robotic right colectomy between 2014 and 2020. Classification tree approach was used to describe the extracorporeal (EA) or intracorporeal (IA) anastomosis choice. Mixed-model regressions were used to identify patient- and surgery-related factors predictive of postoperative outcomes. A questionnaire was used to evaluate the surgeons' perspectives. Results: The MERCY database comprised 1870 patients; 87.2% underwent laparoscopy, and 68.1% received an EA. A clear surgical trend was noted, with an increasing rate of IA and robotic procedures after 2017. EA represented 41% of anastomoses in centers equipped with a robotic surgical system. Mixed-model regressions (on 1088 patients) showed that age, sex, BMI, comorbidity, robotics, IA, and conversion to open surgery were predictors of surgical outcomes. In particular, IA was a predictor of a shorter time to regular diet and fewer surgical site infections. Based on the questionnaire, IA was the preferred over EA by 72% of surgeons. Conclusion: MIS continues to evolve, with an increasing number of IA being performed in the recent years and when using a robotic surgical system. Understanding the role of predictors of surgical outcomes may help surgeons personalize decision-making among the different MIS options to manage right colon cancer. [ABSTRACT FROM AUTHOR]

Published
2022
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4. Conversion to Open Surgery During Minimally Invasive Right Colectomy for Cancer: Results from a Large Multinational European Study

Author

Martínez-Pérez, Aleix, Piccoli, Micaela, Casoni Pattacini, Gianmaria, Winter, Des C, Carcoforo, Paolo, Celentano, Valerio, Chiarugi, Massimo, Di Saverio, Salomone, Bianchi, Giorgio, Frontali, Alice, Fuks, David, Genova, Pietro, Guerrieri, Mario, Kraft, Miquel, Lakkis, Zaher, Le Roy, Bertrand, Micelli Lupinacci, Renato, Milone, Marco, Petri, Roberto, Scabini, Stefano, Tonini, Valeria, Valverde, Alain, Zorcolo, Luigi, Ris, Frederic, Espin, Eloy, de'Angelis, Nicola, Carlo Schena, Francesca Pecchini, Lauren O'Connell, Filippo Aisoni, Alessia Urbani, Dario Tartaglia, Federico Coccolini, Francesco Arces, Christine Denet, Monica Ortenzi, Laura Vidal, Gianluca Pellino, Céphise Antonot, Jeanne Vertier, Ornella Perrotto, Giovanni Domenico De Palma, Antonio Santangelo, Raffaele De Rosa, Angelo Restivo, Simona Deidda, Lorenzo Orci, Sebastiano Bartoletti, Jean-Christophe Paquet, Enrico Andolfi, Martínez-Pérez, Aleix, Piccoli, Micaela, Casoni Pattacini, Gianmaria, Winter, Des C, Carcoforo, Paolo, Celentano, Valerio, Chiarugi, Massimo, Di Saverio, Salomone, Bianchi, Giorgio, Frontali, Alice, Fuks, David, Genova, Pietro, Guerrieri, Mario, Kraft, Miquel, Lakkis, Zaher, Le Roy, Bertrand, Micelli Lupinacci, Renato, Milone, Marco, Petri, Roberto, Scabini, Stefano, Tonini, Valeria, Valverde, Alain, Zorcolo, Luigi, Ris, Frederic, Espin, Eloy, de'Angelis, Nicola, Aleix, Martínez-Pérez, Micaela, Piccoli, Gianmaria, Casoni Pattacini, Des C, Winter, Paolo, Carcoforo, Valerio, Celentano, Massimo, Chiarugi, Salomone, Di Saverio, Giorgio, Bianchi, Alice, Frontali, David, Fuk, Pietro, Genova, Mario, Guerrieri, Miquel, Kraft, Zaher, Lakki, Bertrand, Le Roy, Renato, Micelli Lupinacci, Marco, Milone, Roberto, Petri, Stefano, Scabini, Valeria, Tonini, Alain, Valverde, Luigi, Zorcolo, Frederic, Ri, Eloy, Espin, Nicola, De'Angeli, Schena, Carlo, Pecchini, Francesca, O'Connell, Lauren, Aisoni, Filippo, Urbani, Alessia, Tartaglia, Dario, Coccolini, Federico, Arces, Francesco, Denet, Christine, Ortenzi, Monica, Vidal, Laura, Pellino, Gianluca, Antonot, Céphise, Vertier, Jeanne, Perrotto, Ornella, Domenico De Palma, Giovanni, Santangelo, Antonio, De Rosa, Raffaele, Restivo, Angelo, Deidda, Simona, Orci, Lorenzo, Bartoletti, Sebastiano, Paquet, Jean-Christophe, and Andolfi, Enrico

Subjects
Minimally InvasivE surgery, colon cancer, right colectomy, robotic surgery, laparoscopy, Surgery, conversion
Abstract

Background: The risk of conversion to open surgery is inevitably present during any minimally invasive colorectal surgical procedure. Conversions have been associated with adverse postoperative and oncologic outcomes. No previous study has evaluated the specific causes and consequences of conversion during a minimally invasive right colectomy (MIS-RC). Materials and Methods: We analyzed the Minimally invasivE surgery for oncologic Right ColectomY (MERCY) study database including patients who underwent laparoscopic or robotic RC because of colon cancer between 2014 and 2020. Descriptive analyses were performed to determine the different reasons for conversion. Uni- and multivariate logistic regressions were run to identify potential variables associated with this outcome. Cox regression analyses were used to evaluate the impact of conversion on tumor recurrence. Results: Over a total of 1574 MIS-RC, 120 (7.6%) were converted to open surgery. The main reasons for conversion were procedural difficulties related to adherences from previous abdominal surgical procedures (39.2%), or owing to large tumor size or infiltration of adjacent structures (26.7%). Only 16.7% of the conversions were caused by intraoperative medical or surgical complications. Converted patients required longer operative times and developed more postoperative complications, both overall (39.2% versus 27.5%; P = .006) and severe ones (13.3% versus 8.3%; P = .061). Male gender (odds ratio [OR] = 1.89 [95% confidence interval: 1.31-2.71]), obesity (OR = 1.99 [1.4-2.83]), prior abdominal surgery (OR = 1.68 [1.19-2.37]), and pT4 cancers (OR = 4.04 [2.86-5.69]) were independently associated with conversion. Conversion to open surgery was not significantly associated with tumor recurrence (hazard ratios = 1.395 [0.724-2.687]). Conclusions: Although conversion to open surgery during MIS-RC for cancer is associated with worsened postoperative outcomes, it seems not to impact on the oncologic prognosis.

Published
2023

5. Impact of operation duration on postoperative outcomes of minimally-invasive right colectomy.

Author

de'Angelis N, Schena CA, Piccoli M, Casoni Pattacini G, Pecchini F, Winter DC, O'Connell L, Carcoforo P, Urbani A, Aisoni F, Martínez-Pérez A, Celentano V, Chiarugi M, Tartaglia D, Coccolini F, Arces F, Di Saverio S, Frontali A, Fuks D, Denet C, Genova P, Guerrieri M, Ortenzi M, Kraft M, Pellino G, Vidal L, Lakkis Z, Antonot C, Perrotto O, Vertier J, Le Roy B, Micelli Lupinacci R, Milone M, De Palma GD, Petri R, Santangelo A, Scabini S, De Rosa R, Tonini V, Valverde A, Bianchi G, Carra MC, Zorcolo L, Deidda S, Restivo A, Andolfi E, Paquet JC, Bartoletti S, Orci L, Ris F, and Espin E

Subjects
Adult, Humans, Male, Retrospective Studies, Colectomy adverse effects, Anastomosis, Surgical adverse effects, Postoperative Complications epidemiology, Postoperative Complications etiology, Postoperative Complications surgery, Treatment Outcome, Operative Time, Colonic Neoplasms surgery, Colonic Neoplasms etiology, Adenocarcinoma surgery, Adenocarcinoma etiology, Robotic Surgical Procedures, Laparoscopy adverse effects
Abstract

Aim: Operation time (OT) is a key operational factor influencing surgical outcomes. The present study aimed to analyse whether OT impacts on short-term outcomes of minimally-invasive right colectomies by assessing the role of surgical approach (robotic [RRC] or laparoscopic right colectomy [LRC]), and type of ileocolic anastomosis (i.e., intracorporal [IA] or extra-corporal anastomosis [EA])., Methods: This was a retrospective analysis of the Minimally-invasivE surgery for oncological Right ColectomY (MERCY) Study Group database, which included adult patients with nonmetastatic right colon adenocarcinoma operated on by oncological RRC or LRC between January 2014 and December 2020. Univariate and multivariate analyses were used., Results: The study sample was composed of 1549 patients who were divided into three groups according to the OT quartiles: (1) First quartile, <135 min (n = 386); (2) Second and third quartiles, 135-199 min (n = 731); and (3) Fourth quartile ≥200 min (n = 432). The majority (62.7%) were LRC-EA, followed by LRC-IA (24.3%), RRC-IA (11.1%), and RRC-EA (1.9%). Independent predictors of an OT ≥ 200 min included male gender, age, obesity, diabetes, use of indocyanine green fluorescence, and IA confection. An OT ≥ 200 min was significantly associated with an increased risk of postoperative noninfective complications (AOR: 1.56; 95% CI: 1.15-2.13; p = 0.004), whereas the surgical approach and the type of anastomosis had no impact on postoperative morbidity., Conclusion: Prolonged OT is independently associated with increased odds of postoperative noninfective complications in oncological minimally-invasive right colectomy., (© 2022 Association of Coloproctology of Great Britain and Ireland.)

Published
2022
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