Colonoscopic-Assisted Laparoscopic Wedge Resection for Colonic Lesions: A Prospective Multicenter Cohort Study (LIMERIC-Study)
Leicher, Laura W; Huisman, Jelle F; van Grevenstein, Wilhelmina M U; Didden, Paul; Backes, Yara; Offerhaus, G Johan A; Laclé, Miangela M; Moll, Freek C P; Geesing, Joost M J; Smakman, Niels; Droste, Jochim S Terhaar Sive; Verdaasdonk, Emiel G G; Ter Borg, Frank; Talsma, A Koen; Erkelens, G Willemien; van der Zaag, Edwin S; Schrauwen, Ruud W M; van Wely, Bob J; Schot, Ingrid; Vermaas, Maarten; van Bergeijk, Jeroen D; Sietses, Colin; Hazen, Wouter L; Wasowicz, Dareczka K; Ramsoekh, Dewkoemar; Tuynman, Jurriaan B; Alderlieste, Yasser A; Renger, Rutger-Jan; Oort, Frank A; Bilgen, Ernst Jan Spillenaar; Vleggaar, Frank P; Vasen, Hans F A; Cappel, Wouter H de Vos Tot Nederveen; Moons, Leon M G; van Westreenen, Henderik L
(2022) Annals of surgery, volume 275, issue 5, pp. 933 - 939
(Article)
Abstract
OBJECTIVE: The aim of this study was to evaluate the safety and efficacy of a modified CAL-WR. SUMMARY BACKGROUND DATA: The use of segmental colectomy in patients with endoscopically unresectable colonic lesions results in significant morbidity and mortality. CAL-WR is an alternative procedure that may reduce morbidity. METHODS: This prospective
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multicenter study was performed in 13 Dutch hospitals between January 2017 and December 2019. Inclusion criteria were (1) colonic lesions inaccessible using current endoscopic resection techniques (judged by an expert panel), (2) non-lifting residual/recurrent adenomatous tissue after previous polypectomy or (3) an undetermined resection margin after endoscopic removal of a low-risk pathological T1 (pT1) colon carcinoma. Thirty-day morbidity, technical success rate and radicality were evaluated. RESULTS: Of the 118 patients included (56% male, mean age 66 years, standard deviation ± 8 years), 66 (56%) had complex lesions unsuitable for endoscopic removal, 34 (29%) had non-lifting residual/recurrent adenoma after previous polypectomy and 18 (15%) had uncertain resection margins after polypectomy of a pT1 colon carcinoma. CAL-WR was technically successful in 93% and R0 resection was achieved in 91% of patients. Minor complications (Clavien-Dindo i-ii) were noted in 7 patients (6%) and an additional oncologic segmental resection was performed in 12 cases (11%). Residual tissue at the scar was observed in 5% of patients during endoscopic follow-up. CONCLUSIONS: CAL-WR is an effective, organ-preserving approach that results in minor complications and circumvents the need for major surgery. CAL-WR, therefore, deserves consideration when endoscopic excision of circumscribed lesions is impossible or incomplete.
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Keywords: Adenoma, Aged, Carcinoma/surgery, Colonic Neoplasms/pathology, Colonic Polyps/pathology, Colonoscopy/methods, Female, Humans, Laparoscopy/methods, Male, Margins of Excision, Prospective Studies, Retrospective Studies, colonoscopic-assisted laparoscopic wedge resection, organ preserving surgery, colonic polyps, endoscopically-unresectable, Surgery, Multicenter Study, Journal Article
ISSN: 0003-4932
Publisher: Lippincott Williams and Wilkins
Note: Funding Information: We received funding for the study from Department of Innovation and Research of the Isala Clinics, the grant number was €80.000. Publisher Copyright: © 2022 Lippincott Williams and Wilkins. All rights reserved.
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