Laura Lorenzon1, Alberto Biondi2, Thomas Carus3, Adam Dziki4, Eloy Espin5, Nuno Figueiredo6, Marcos Gomez Ruiz7, Tamas Mersich8, Isacco Montroni9, Pieter J Tanis10, Stefan Rolf Benz11, Paolo Pietro Bianchi12, Matthias Biebl13, Ivo Broeders14, Raffaele De Luca15, Paolo Delrio16, Mathieu D'Hondt17, Alois Fürst18, Jan Grosek19, Jose Flavio Guimaraes Videira20, Friedrich Herbst21, David Jayne22, György Lázár23, Danilo Miskovic24, Andrea Muratore25, Ole Helmer Sjo26, Tom Scheinin27, Ales Tomazic19, Andreas Türler28, Cornelius Van de Velde29, Steven D Wexner30, Christoph Wullstein31, Wojciech Zegarski32, Domenico D'Ugo2. 1. General Surgery Unit, Fondazione Policlinico Universitario Agostino Gemelli, Catholic University, Rome, Italy. Electronic address: laura.lorenzon@policlinicogemelli.it. 2. General Surgery Unit, Fondazione Policlinico Universitario Agostino Gemelli, Catholic University, Rome, Italy. 3. Department of General, Visceral and Vascular Surgery, Center for Minimally Invasive Surgery, Hamburg, Germany. 4. Department of General and Colorectal Surgery, Medical University of Lodz, Military Medical Academy University Teaching Hospital- Central Veterans' Hospital, Łódź, Poland. 5. Colorectal Surgery Unit, General Surgery Service, Hospital Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain. 6. Colorectal Surgery - Digestive Department, Champalimaud Foundation, Lisbon, Portugal. 7. Colorectal Division, Department of Surgery, Hospital Universitario "Marqués de Valdecilla", IDIVAL, Santander, Spain. 8. Department of Visceral Surgery, Centre of Oncosurgery, National Institute of Oncology, Budapest, Hungary. 9. Colorectal Surgery, General Surgery, AUSL Romagna, Ospedale per gli Infermi-Faenza, Faenza, Italy. 10. Department of Surgery, Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands. 11. Department of Surgery, Sindelfingen-Böblingen Hospital, Böblingen, Germany. 12. Department of Surgery, Misericordia Hospital, Grosseto, Italy. 13. Department of Surgery, Charité University Medicine Berlin, Germany. 14. Department of Surgery, Meander Medisch Centrum Twente University, Amersfoort, The Netherlands. 15. Department of Surgical Oncology, National Cancer Research Centre, Istituto Tumori Giovanni Paolo II, Bari, Italy. 16. Colorectal Surgical Oncology, Istituto Nazionale per lo Studio e la Cura dei Tumori Fondazione Giovanni Pascale IRCCS, Naples, Italy. 17. Department of Digestive and Hepatobiliary/Pancreatic Surgery, Groeninge Hospital, Kortrijk, Belgium. 18. Department of Surgery, Caritas-Clinic St. Josef, Regensburg, Germany. 19. Department of Abdominal Surgery, University Medical Centre, Ljubljana, Slovenia. 20. Department of Surgical Oncology, Instituto Português de Oncologia do Porto, Porto, Portugal. 21. Department of Surgery, St John of God Hospital, Vienna, Austria. 22. Department of Surgery, University of Leeds and Leeds Teaching Hospitals NHS Trust, Leeds, United Kingdom. 23. Department of Surgery, University of Szeged, Szeged, Hungary. 24. St Mark's Hospital, Harrow, London, United Kingdom. 25. General Surgery Unit, Edoardo Agnelli Hospital, Pinerolo, Turin, Italy. 26. Department of Gastrointestinal Surgery, Ullevål Oslo University Hospital, Oslo, Norway. 27. Department of Surgery, Helsinki University Central Hospital, Helsinki, Finland. 28. Department of General and Visceral Surgery, Johanniter Hospital, Bonn, Germany. 29. Department of Surgery, Leiden University Medical Center, Leiden, The Netherlands. 30. Digestive Disease Center, Department of Colorectal Surgery, Cleveland Clinic Florida, Weston, FL, USA. 31. Department of General, Visceral and Minimalinvasive Surgery, Helios Hospital Krefeld, Germany. 32. Department of Surgical Oncology, Nicolaus Copernicus University, Torun, Poland.
Abstract
AIM: To investigate the rate of laparoscopic colectomies for colon cancer using registries and population-based studies. To provide a position paper on mini-invasive (MIS) colon cancer surgery based on the opinion of experts leader in this field. METHODS: A systematic review of the literature was conducted using PRISMA guidelines for the rate of laparoscopy in colon cancer. Moreover, Delphi methodology was used to reach consensus among 35 international experts in four study rounds. Consensus was defined as an agreement ≥75.0%. Domains of interest included nosology, essential technical/oncological requirements, outcomes and MIS training. RESULTS: Forty-four studies from 42 articles were reviewed. Although it is still sub-optimal, the rate of MIS for colon cancer increased over the years and it is currently >50% in Korea, Netherlands, UK and Australia. The remaining European countries are un-investigated and presented lower rates with highest variations, ranging 7-35%. Using Delphi methodology, a laparoscopic colectomy was defined as a "colon resection performed using key-hole surgery independently from the type of anastomosis". The panel defined also the oncological requirements recognized essential for the procedure and agreed that when performed by experienced surgeons, it should be marked as best practice in guidelines, given the principles of oncologic surgery be respected (R0 procedure, vessel ligation and mesocolon integrity). CONCLUSION: The rate of MIS colectomies for cancer in Europe should be further investigated. A panel of leaders in this field defined laparoscopic colectomy as a best practice procedure when performed by an experienced surgeon respecting the standards of surgical oncology.
AIM: To investigate the rate of laparoscopic colectomies for colon cancer using registries and population-based studies. To provide a position paper on mini-invasive (MIS) colon cancer surgery based on the opinion of experts leader in this field. METHODS: A systematic review of the literature was conducted using PRISMA guidelines for the rate of laparoscopy in colon cancer. Moreover, Delphi methodology was used to reach consensus among 35 international experts in four study rounds. Consensus was defined as an agreement ≥75.0%. Domains of interest included nosology, essential technical/oncological requirements, outcomes and MIS training. RESULTS: Forty-four studies from 42 articles were reviewed. Although it is still sub-optimal, the rate of MIS for colon cancer increased over the years and it is currently >50% in Korea, Netherlands, UK and Australia. The remaining European countries are un-investigated and presented lower rates with highest variations, ranging 7-35%. Using Delphi methodology, a laparoscopic colectomy was defined as a "colon resection performed using key-hole surgery independently from the type of anastomosis". The panel defined also the oncological requirements recognized essential for the procedure and agreed that when performed by experienced surgeons, it should be marked as best practice in guidelines, given the principles of oncologic surgery be respected (R0 procedure, vessel ligation and mesocolon integrity). CONCLUSION: The rate of MIS colectomies for cancer in Europe should be further investigated. A panel of leaders in this field defined laparoscopic colectomy as a best practice procedure when performed by an experienced surgeon respecting the standards of surgical oncology.