TY - JOUR
T1 - Colonoscopic-Assisted Laparoscopic Wedge Resection for Colonic Lesions
T2 - A Prospective Multicenter Cohort Study (LIMERIC-Study)
AU - Leicher, Laura W
AU - Huisman, Jelle F
AU - van Grevenstein, Wilhelmina M U
AU - Didden, Paul
AU - Backes, Yara
AU - Offerhaus, G Johan A
AU - Laclé, Miangela M
AU - Moll, Freek C P
AU - Geesing, Joost M J
AU - Smakman, Niels
AU - Droste, Jochim S Terhaar Sive
AU - Verdaasdonk, Emiel G G
AU - Ter Borg, Frank
AU - Talsma, A Koen
AU - Erkelens, G Willemien
AU - van der Zaag, Edwin S
AU - Schrauwen, Ruud W M
AU - van Wely, Bob J
AU - Schot, Ingrid
AU - Vermaas, Maarten
AU - van Bergeijk, Jeroen D
AU - Sietses, Colin
AU - Hazen, Wouter L
AU - Wasowicz, Dareczka K
AU - Ramsoekh, Dewkoemar
AU - Tuynman, Jurriaan B
AU - Alderlieste, Yasser A
AU - Renger, Rutger-Jan
AU - Oort, Frank A
AU - Bilgen, Ernst Jan Spillenaar
AU - Vleggaar, Frank P
AU - Vasen, Hans F A
AU - Cappel, Wouter H de Vos Tot Nederveen
AU - Moons, Leon M G
AU - van Westreenen, Henderik L
N1 - 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.
PY - 2022/5/1
Y1 - 2022/5/1
N2 - 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 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.
AB - 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 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.
KW - Adenoma
KW - Aged
KW - Carcinoma/surgery
KW - Colonic Neoplasms/pathology
KW - Colonic Polyps/pathology
KW - Colonoscopy/methods
KW - Female
KW - Humans
KW - Laparoscopy/methods
KW - Male
KW - Margins of Excision
KW - Prospective Studies
KW - Retrospective Studies
KW - colonoscopic-assisted laparoscopic wedge resection
KW - organ preserving surgery
KW - colonic polyps
KW - endoscopically-unresectable
UR - http://www.scopus.com/inward/record.url?scp=85129999689&partnerID=8YFLogxK
U2 - 10.1097/SLA.0000000000005417
DO - 10.1097/SLA.0000000000005417
M3 - Article
C2 - 35185125
SN - 0003-4932
VL - 275
SP - 933
EP - 939
JO - Annals of surgery
JF - Annals of surgery
IS - 5
ER -