LAPAROSCOPIC SURGERY FOR COLORECTAL CANCER PAST PRESENT FUTURE

LAPAROSCOPIC SURGERY FOR COLORECTAL CANCER PAST – PRESENT – FUTURE Phạm Văn Bình MD, Ph. D National Cancer Hospital – Viet Nam ( K Hospital )

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BACKGROUND Incidence and Mortality l WHO 2012 : 1361. 000 new cases, 694. 000 deaths of colorectal cancer worldwide (10% of all cancer ) l AMERICAN 2013 ( ASCRS ): 102. 480 new cases of colon cancer, 40. 340 new cases of rectal cancer, 50. 830 colorectal cancer deaths. l EUROPE: incedence rate of 50/100. 000, 80. 000 colorectal cancer deaths l VIỆT NAM (2008 -2010): incedence rate of 13, 7 - 17, 1/100. 000

COLORECTAL CANCER - GLOBOCAN 2012 Incidence Mortality

MULTIDISCIPLINARY RADIOTHERAPY – SURGERY – CHEMOTHERAPY

SURGERY FOR COLORECTAL CANCER Laparoscopy Laparotomy

HISTORY OF LAPAROSCOPIC SURGERY CELIOSCOPIE CELIO : Ổ BỤNG SCOPIE : SOI , QUAN SÁT LAPAROSCOPY LAPA: Ổ BỤNG SCOPY : SOI , NHÌN VÀO TRONG

HISTORY OF LAPAROSCOPIC SURGERY • HYPPOCRATES: V century B. C: rectal examination, transanal air enema for treatment. • The first idea of minimally Invasive Approaches

Aranzi, the first person use solar lighting for nasal endoscopy Giulio Cesare Aranzi ( 1530– 1589) TROCART – 1706 - England

HISTORY OF LAPAROSCOPIC SURGERY Antoine jean desormeaux 1815 -1894

HISTORY OF LAPAROSCOPIC SURGERY Thomas alva edison 1804 -1869 Incandescent light bulb was invented 10/1879

Georg KELLING 1866 -1945: FIRST EXPERIENTIAL LAPAROSCOPIC SURGERY WITH INSUFFLATION OF GAS 1901

HISTORY OF LAPAROSCOPIC SURGERY Harold Horace Hopkins (1918– 1994): Invented Rigid rod lens system 1953 creating a revolution in image transmission in laparoscopic surgery

HISTORY OF LAPAROSCOPIC SURGERY 1994 - A robotic arm is designed and tested in Silicon Valley. Robot Da Vinci is used in laparoscopic surgery in developed countries

HISTORY OF LAPAROSCOPIC SURGERY Erich Muhe 1985 Philippe Mouret 1987

Lindbergh Operation First transatlantic robot-assisted operation 2003 Strasbourg New York

LAPAROSCOPIC SURGERY FOR COLORECTAL CANCER SURGERY • Possibility of radical resection? • Possibility of radical lymph node dissection? • Laparoscopic surgery spreads cancer cells? • Recurrence rate, survival in comparison with laparotomy surgery?

LAPAROSCOPIC SURGERY FOR COLORECTAL CANCER § 1982 - RJ Heald Deputy chairman of the Association of Royal British Surgeons: Total Mesorectal Excision – TME § The most important change in more than 100 years: locoregional recurrence decrease from 15 -40% to 4%. § Laparoscopic surgery: TME is standard for low and middle rectal cancer. PR HEALD

LAPAROSCOPIC SURGERY FOR COLORECTAL CANCER The first laparoscopic surgery for colon cancer was performed in 1991 in US: first report of 20 cases operated with right hemicolectomy in American Academy Institute Pr JACOBS

LAPAROSCOPIC SURGERY FOR COLORECTAL CANCER JM. SACKIER (USA) 1992 • Laproscopic Abdominoperineal Resection for 63 year old female patient • Published in Lancet Journal in 1993 7

LAPAROSCOPIC SURGERY FOR COLORECTAL CANCER Aziz. 0 (1993 -2004): Medline, Embase, Ovid, Cochrane • Objective: controlled, multicenter comparison between laparoscopic surgery and open surgery on outcome in term of surgery and oncology? • Results: 22 studies with 2071 patients. • The 10 years overall outcome in application of laparoscopic surgery focused on technique: Oncology outcome is not significant. Aziz O. , Constantinides V. , Tekkis P. et al (2006), "Laparoscopic versus open surgery for rectal cancer: a meta-analysis", Ann Surg Oncol, (13), pp. 413 -424. 23

LAPAROSCOPIC SURGERY FOR COLORECTAL CANCER CLASSIC Tria: l Royal Medical Council (UK) (2007): • Objective: controlled, multicenter, prospective comparison between laparoscopic surgery and open surgery • Results: 27 surgery centers with 794 patients • Conclusions: Surgical and Oncology outcome (The number of harvested lymph nodes , CMR, Recurrence rate, Metastasis rate) are equivalent Guillou P. , Quirke P. , Thorpe. H. et al (2005), "Short - term endpoints of conventional versus laparoscopic - assisted surgery in patients with colorectal cancer (MRC CLASICC Trail): multicenter randomized controlled trial", The lancet, (365), pp. 1718 - 1726.

LAPAROSCOPIC SURGERY FOR COLORECTAL CANCER Lourenco - SURG ENDO (2008 ): l Objective: To compare the results of laparoscopic surgery and open surgery for colorectal cancer from 1997 -2005 l Results: 4500 patients in 18 centers. The number of harvested lymph nodes, survival, recurrence, metastasis rate are equivalent, trocart implant rate <1% Lourenco T. , Murray A. , Grant A. et al (2008), "Laparoscopic surgery for colorectal cancer: safe and effective? A systematic review", Surg Endosc, (22), pp. 1146 - 1160.

LAPAROSCOPIC SURGERY FOR COLORECTAL CANCER Pulishing House WILEY ( 2008) : l Objective: controlled, multicenter comparison between laparoscopic surgery and open surgery l Results: From 1998 to 2007: 3346 patients of 33 studies on 46 journals l The number of harvested lymph nodes, survival, recurrence, metastasis rate are equivalent Kuhry E. , Schwenk W. , Gaupset R. (2008), "Long - term results of laparoscopic colorectal cancer resection", The Cochrane collaboration Published by Wiley & Sons, pp. 1 - 63.

LAPAROSCOPIC SURGERY FOR COLORECTAL CANCER l COLOR – EURO (2005) l COST- US ( 2004) l CLASSIC – UK (2007) Surgery outcome: - Operation time: longer than 40 -60 minutes - Blood loss during surgery: less - Conversion to open surgery: 0% - 15% - Complications: anastomotic leakage of 2% -5%, mortality of 0. 5% -1. 5% - Length of hospital stay: shorter. - Nervous urinary genital complications: less - Higher costs

LAPAROSCOPIC SURGERY FOR COLORECTAL CANCER ONGOING STUDIES l. JAPAN: The Japan Clinical Oncology Group Study : 10 year outcome 2004 -2014. l. EURO : 2010 - 2017 The European Colorectal Cancer Laparoscopic or Open Resection II trial: controlled, multicenter comparison: 5 year survival l. USA : The American College of Surgeon Oncology Group III triall 2008 -2013 / 650 patient, Hypothesis: laparoscopic surgery is not inferior to open phase in colorectal cancer stage II-III. 24

LAPAROSCOPIC SURGERY FOR COLORECTAL CANCER FACTORS AFFECTING RESULTS § Disease stage? § Adjuvant treatment? § The expertise of surgeons? § Lymph node dissection? (Independent prognostic factors) Ostadi M. A. , Harnish J. L. , Stegienko S. et al (2007), "Factors affecting the number of lymph nodes retrieved in colorectal cancer specimens", Surg Endosc, (21), pp. 2142 - 2146.

LAPAROSCOPIC SURGERY FOR COLORECTAL CANCER: FUTURE l LAPAROSCOPIC SURGERY SINGLE PORT l NOTE : Natural Orifice Translumenal Endoscopic Surgery l ROBOTIC LAPAROSCOPY

2008 Dr Dan Geisler Single port colectomy Chicago

2008 Dr Dan Geisler Single port colectomy Chicago - USA

NOTES : Natural Orifice Translumenal Endoscopic Surgery 2008

ROBOCTIC LAPAROSCOPY 2000 Robot Da Vinci : Ohio – Cardiothoracic surgery Leonardo Da Vinci 1452 -1519 Mona Lisa

ROBOCTIC LAPAROSCOPY l HISTORY OF ROBOT: 1921 Karel Capek Czech playwright used the term “robot” in the play 'Rossom`s Universal Robots' to describe a tirelessly working machine performing from repetitively simple movements to intelligent movements such as human.

ROBOCTIC LAPAROSCOPY

ROBOTIC COLORECTAL SURGERY Pub. Med and Google Scholar : 2001 -2013 §Objective: To evaluate the results of robot surgery §Results: 69 studies show less blood loss, faster recovery, less conversion to open surgery, and longer operative time §Conclusions: In term of surgery, robotic surgery is superior, regarding to oncology, it is equivalent to traditional surgery. KIM. CW (2 - 2014)“Outcomes of Robotic-Assisted Colorectal Surgery Compared with Laparoscopic and Open Surgery: a Systematic Review” Journal of Gastrointestinal Surgery , 11605014 -2469 -5 Source: Pub. Med

ROBOTIC COLORECTAL SURGERY Pubmed, Web of Science, and Cochrane Library §Objective: To compare robotic surgery with laparoscopic surgery §Results: 110 patients with robotic surgery and 116 patients with laparoscopic surgery. Robotic arm has longer operative time, less blood loss, less conversion to open surgery, fewer complications, faster recovery, the same number of dissected nodes and clear margin. §Conclusion: Oncology research is needed Regulators LIAOG. C (4/2014) “Robotic-assisted versus laparoscopic colorectal surgery: a meta-analysis of four randomized controlled trials”. World Journal of Surgical Oncology Robotic colorectal surgery is a promising tool

ROBOTIC COLORECTAL SURGERY Robot-Assisted Versus Conventional Laparoscopic Surgery for Colorectal Disease, Focusing on Rectal Cancer: A Meta-analysis Ann Surg Oncol. 2012 Nov l. Objective: To compare robotic surgery with laparoscopic surgery for rectal cancer l. Results: 17 studies – robotic surgery has less blood loss during surgery and less conversion rate, and the same complication and cancer outcome in comparison with conventional laparoscopic surgery. l. Conclusion RACLS: Promising tool

ROBOTIC COLORECTAL SURGERY Robotic Surgery for Rectal Cancer: An Update in 2016 Cancer Res Treat. 2016; 48(2): 427 -435 Jung Myun Kwak, MD, Ph. D Seon Hahn Kim, MD, Ph. D l. Objective : ROBOT- LAPAROSCOPY l. Conclusion : more rigorous scientific evaluation in multicenter, randomized clinical trials should be performed to definitely determine the advantages of robotic rectal cancer surgery.

CONCLUSION LAPAROSCOPY LAPAROTOMY

CONCLUSION l Laparoscopic Surgery: superior in surgery outcome l Laparoscopic Surgery: equivalent to open surgery in cancer outcome. l Da Vinci robotic laparoscopic surgery: being studied l Laparotomy : traditional surgery

THANH YOU FOR YOUR ATTENTION 66