Minimally Invasive Cancer Management (eBook)

Foreword to the Second Edition 5
Foreword to the First Edition 7
Preface to the Second Edition 8
Preface to the First Edition 9
Contents 10
Contributors 15
Part I Introductory Issues 18
1 Indications and General Oncologic Principles 19
Oncologic Principles 19
Indications for Diagnostic Laparoscopy 20
Immunologic Consequences of the Surgical Approach 22
Specific Organ Sites 23
Pancreatic Malignancy 23
Gastric Cancer 24
Esophageal Cancer 24
Gallbladder Cancer 24
References 25
2 Cancer Biology Relating to Minimal Access Management 27
Systemic Effects of Minimally Invasive Surgery 28
Effects of Minimally Invasive Surgery on Systemic Cytokines 29
Effects of Minimally Invasive Surgery on Systemic Immunity 30
B Cells and Neutrophils 30
T Cells 31
Monocytes/Macrophages and Dendritic Cells 31
Natural Killer Cells 31
Intraperitoneal Oncologic Effects 32
Tumor Cell Shedding from the Primary Tumor 32
Tumor Cell Dissemination Within the Peritoneal Cavity 33
Local Surgical Factors in Port Site Recurrence 34
Effect of Pneumoperitoneum on Intraperitoneal Tumor Growth 34
Effect of Pneumoperitoneum on Peritoneal Mesothelial Cells 34
Effect of Pneumoperitoneum on Peritoneal Immune Cells 35
Conclusion 37
References 37
3 Pneumoperitoneum: Metabolicand Mechanical Effects 44
Historical Concepts 44
Current Concepts 45
Environmental Effects 46
Intravascular Effects 47
Immunologic Alterations 48
Mechanical Effects 48
Conclusion 48
References 49
4 Energy Sources in Laparoscopy 50
Introduction 50
Electrosurgery 50
Electrosurgery Defined 51
Applications of Electrosurgery 51
Therapeutic Applications of Electrosurgery 52
Argon Beam Coagulation 53
Complications 53
Pacemakers and Electrosurgery 54
Ultrasonic Energy 54
Harmonic 54
LigaSure 55
EnSeal 57
Radiofrequency Energy 57
Conclusion 58
References 58
5 Biopsy and Staging: Technical Issues 60
Rationale 60
Operating Room Setup 61
Technical Issues 62
Biopsy Techniques Following Standard Staging Laparoscopy 65
Peritoneal Lavage for Cytological Analysis 65
Fine Needle Aspiration Cytology (FNAC) 65
Pinch Biopsy/Scrape Biopsy 65
Cup Biopsy 65
Core Biopsy and Laparoscopic Ultrasound Guidance 66
Incisional Biopsy 66
Excisional Biopsy 66
Lymph Node Biopsy 67
Sentinel Node Biopsy 67
References 68
6 Ultrasound Techniques in Minimally Invasive Oncologic Surgery 69
Introduction 69
Basic Equipment and Operating Room Setup for Laparoscopic Ultrasound 70
Basic Techniques of Laparoscopic Ultrasound Examination 70
Laparoscopic Ultrasound for Hepatobiliary Neoplasms 71
Techniques for Laparoscopic Ultrasound Exam of the Biliary Tree 71
Techniques for Laparoscopic Ultrasound Exam of the Liver 72
Specific Applications and Results of Laparoscopic Ultrasound for Hepatobiliary Tumors 73
Staging of Primary and Secondary Liver Tumors 73
Ultrasound Guidance of Liver Biopsy, Ablation, and Resection 74
Techniques for Laparoscopic Ultrasound of the Pancreas 76
Specific Applications and Results of Laparoscopic Ultrasound for Pancreatic Neoplasms 77
Staging of Pancreatic Adenocarcinoma 77
Localization and Resection of Pancreatic Neuroendocrine Tumors 78
Evaluation and Resection of Cystic Neoplasms of the Pancreas 78
Laparoscopic Ultrasound for Other Neoplasms 79
Techniques for Laparoscopic Ultrasound Examination of Lymph Nodes 79
Specific Applications of Laparoscopic Ultrasound to Other Neoplasms 79
Esophagus and Stomach 79
Adrenal Gland and Kidney 80
Future of Ultrasound in Minimally Invasive Surgery 80
References 80
Part II Management of Foregut Cancer 82
7 Endoscopic Ablation of Barrett's Esophagus and Early Esophageal Cancer 83
Introduction 83
Risk of Progression to Dysplasia and Esophageal Adenocarcinoma 83
Rationale for Endoscopic Ablation of Barretts Epithelium 84
Ablation Technology and Outcomes 85
Circumferential Balloon-Based Radiofrequency Ablation (RFA) 85
Photodynamic Therapy (PDT) 88
Cryotherapy 91
Endoscopic Resection (ER) 92
References 95
8 Management of Esophageal Cancer 98
Initial Evaluation and Clinical Staging 99
Endoscopic Mucosal Resection 100
Minimally Invasive Esophagectomy 100
Laparoscopic Inversion Esophagectomy 101
Patient Positioning and Port Placement 101
Hiatal Dissection and Division of the Left Gastric Vessels 101
Gastric Mobilization 101
Creation of the Gastric Conduit and Distal Esophageal Mobilization 102
Cervical Esophageal Exposure 102
Esophageal Inversion 102
Esophageal Reconstruction 104
Thoracoscopic--Laparoscopic Esophagectomy 104
Thoracoscopy 104
Laparoscopy 105
Choice of Approach 105
Palliation of Dysphagia 105
Esophageal Dilation 106
Esophageal Stenting 106
Nd:YAG Laser 106
Photodynamic Therapy 106
Palliative Chemotherapy and Radiation 106
References 106
9 Laparoscopic Resection of Gastrointestinal Stromal Tumors 109
Preoperative Preparation 110
Local Excision Techniques by Location 111
Anterior Gastric Wall 111
Posterior Gastric Wall 112
Greater and Lesser Curvatures 113
Distal Stomach/Pylorus 113
Gastroesophageal Junction 113
Gastrectomy 114
Partial Gastrectomy 114
Total Gastrectomy 115
Results 116
Discussion 117
Conclusion 119
References 120
10 Laparoscopic Approaches to Gastric Cancer 122
Introduction 122
Present Status of Laparoscopic Gastrectomy in Japan 123
Indications for LADG in Japan 123
Techniques of LADG with D1+ß Lymph Node Dissection 124
Patient Positioning and Port Placement 124
Dissection of the Greater Omentum (No. 4d Ln Dissection) and the Left Gastroepiploic Vessels (No. 4sb Ln Dissection) 124
Dissection of the Right Gastroepiploic Vessels (No. 6 LN Dissection) 124
Dissection of the Lesser Omentum (No. 3 LN Dissection) and Division of the Right Gastric Vessels (No. 5 LN Dissection) 125
Transection of the Duodenum 125
DissectionofLymphNodesAlongthe Common Hepatic Artery and Celiac Artery (Nos. 8, 9 LN Dissections) 126
Division of the Left Gastric Vessels (No. 7 LN Dissection) 126
Dissection of the Left Cardiac and Superior Gastric Lymph Nodes (Nos. 1, 3 LN Dissection) 126
Mini-Laparotomy and Roux-en-Y Reconstruction 126
Irrigation and Drainage 127
Evaluations of LADG for Early Gastric Cancer (EGC) 127
Technical Feasibility 128
Oncologic Feasibility 128
Advantages of LADG vs. ODG for EGC 129
Extension of Indications for LADG 129
LADG for Obese Patients and Elderly Patients 129
LADG for Advanced Cancer 129
Development of Laparoscopic Gastrectomy 130
Laparoscopic Total Gastrectomy (LTG) and Proximal Gastrectomy (LPG) 130
Totally Laparoscopic Distal Gastrectomy 130
Conclusion 130
References 133
Part III Management of Hepatopancreaticobiliary Cancer 135
11 Minimal Access Management of Pancreatic Cancer 136
Laparoscopic Staging of Pancreatic Cancer 137
Technique 138
Laparoscopic Distal Pancreatectomy 139
Technique 139
Pancreatic Leak 140
Splenectomy 141
Laparoscopic Pancreaticoduodenectomy 142
Technique 142
Laparoscopic Palliation of Pancreatic Adenocarcinoma 144
Endoscopic Biliary and Duodenal Stenting 145
Endoscopic Biliary Stents Versus Surgical Bypass 145
Endoscopic Duodenal Stenting Versus Surgical Bypass 146
Laparoscopic Palliation 146
Double Bypass 146
Technique for Minimally Invasive Biliary Bypass 147
Technique for Minimally Invasive Gastrojejunostomy 147
Cholecystojejunostomy Versus Choledochojejunostomy 147
Prophylactic Palliation of Duodenal Obstruction 148
Splanchnicectomy 148
Conclusion 148
References 148
12 Laparoscopic Approaches to PancreaticEndocrine Tumors 152
Overview 152
Pathology 152
Epidemiology and Natural History 153
Diagnosis and Treatment 154
Lesions Located in the Head and Uncinate Process 155
Lesions in the Neck, Body, and Tail 156
Techniques 157
Patient Positioning and Setup 157
Hand-Assisted Laparoscopic Techniques 158
Laparoscopic Distal Pancreatectomy and Splenectomy 158
Laparoscopic Distal Pancreatectomy with Spleen Preservation 161
Robotics 162
Conclusion 163
References 163
13 Laparoscopic Approaches to Hepatobiliary Cancer 165
General Considerations 167
Laparoscopy and Immune Function 168
Laparoscopic Staging and Determination of Resectability 168
Laparoscopic Staging Techniques for Hepatobiliary Cancer 171
Minilaparoscopy 172
Laparoscopic Ultrasound 172
Biopsy Techniques 174
Procedure Completion 175
Results 175
Indications for Laparoscopic Surgery in Patients with Hepatobiliary Cancers 176
Indications for Minimally Invasive Palliation 177
Regional Chemotherapy 177
Debulking 177
Biliary Drainage 177
Enteric Bypass 178
Pain Management 178
Indications for Laparoscopic Curative Surgery 178
Liver Cancer 178
Gallbladder Cancer 179
Minimally Invasive Surgical Techniques 179
Totally Laparoscopic Liver Resection 179
Hand-Assisted Laparoscopic Resection 181
Laparoscopy-Assisted Open Resection 181
Technique for Ablation 182
Hepatic Artery Infusion Pumps 183
Biliary Bypass 184
Cholecystojejunostomy 184
Choledochojejunostomy 184
Segment Three Bypass 185
Enteric Bypass 186
Conclusion 186
References 187
14 Laparoscopic Approaches to ColonicMalignancy 191
Techniques 191
Resection of the Right Colon 192
Resection of the Left Colon 193
Resection of the Sigmoid Colon 194
Results 194
Contraindications 195
Complications 195
Learning Curve 197
Conversion 198
Cancer Issues 198
Extent of Resection 198
Tumor Staging 199
Wound Recurrences 200
Results of Randomized Trials and Meta-Analyses 200
Credentialing 201
Outlook 201
Conclusion 202
References 202
15 Laparoscopic Resection of Rectal Cancer 205
Current Issues and Concerns 205
Diagnosis and Staging 206
Oncologic Principles and Operative Strategy 206
Indications and Contraindications 207
Preoperative Preparation 207
Perioperative Preparation 207
Instruments 207
Positioning 208
Port Placement 208
Procedure 209
Assessment and Tumor Localization 209
Liver Evaluation 209
Direct Inspection 209
Overview of Laparoscopic Proctectomy 210
Mobilization of the Left Colon and Splenic Flexure 210
Pelvic Dissection 212
Mesenteric Transection 214
Specimen Exteriorization 215
Anastomosis 216
Creation of Ileostomy 216
Closure 217
Specific Considerations and Problems 217
Mesorectal Excision with Autonomic Nerve Preservation 217
Hemorrhage 217
Conversion to Open Procedure 217
Prevention of Port-Site Recurrence 218
Postoperative Care and Complications 218
Contraindications 218
Results 218
Multicenter Prospective Randomized Trial 219
Surgical Education 219
Conclusion 220
References 220
16 Transanal Endoscopic Microsurgery (TEM) 222
Introduction 222
Development 223
Instrumentation 223
Evaluation and Patient Selection 225
Procedure 227
Postoperative Care 230
Results 230
References 231
17 Laparoscopic Ablation of Liver Tumors 233
Introduction 233
Spectrum of Disease 234
Liver Metastases from Colorectal Cancer 234
Hepatocellular Carcinoma 235
Physics of Thermal Ablation 236
Surgical Technique for Laparoscopic Ablation 237
Outcomes for Ablation 239
Conclusion 241
References 241
Part IV Laparoscopic Management of Other Solid Organs 242
18 Laparoscopic Splenectomy for Malignant Diseases 243
Indications 244
Lymphoproliferative Disease 244
Hodgkin's Disease 244
Non-Hodgkin's Lymphoma (NHL) 245
Hairy Cell Leukemia 246
Myeloproliferative Disease 247
Selection Criteria 247
Preoperative Preparation 248
Operative Technique 249
Outcomes 251
Conclusion 253
References 253
19 Laparoscopic Management of Renal Cell Carcinoma 256
Introduction 256
Laparoscopic Radical Nephrectomy 256
Clinical Outcomes and Oncologic Safety 256
Preoperative Evaluation and Imaging 257
Technical Considerations for Laparoscopic Radical Nephrectomy 258
Operative Strategy: Hand-Assisted Laparoscopic Radical Nephrectomy 259
Instrumentation, Patient Positioning, Port Placement, and Procedural Steps 259
Hand-Assisted Laparoscopic Left Radical Nephrectomy 260
Hand-Assisted Laparoscopic Right Radical Nephrectomy 263
Operative Strategy: Purely Laparoscopic Radical Nephrectomy 264
Laparoscopic Partial Nephrectomy: Indications and Literature Review 264
Preoperative Evaluation and Selection Criteria for Partial Nephrectomy 265
Operative Strategy: Hand-Assisted Laparoscopic Partial Nephrectomy (HALPN) 266
Instrumentation, Patient Positioning, Port Placement, and Operative Steps 266
Outcomes for Hand-assisted Partial Nephrectomy 268
Conclusion 269
References 269
20 Laparoscopic Adrenalectomy for Metastatic Cancer 271
Introduction 271
Adrenalectomy for Metastatic Disease: Literature Review and Oncologic Outcomes 271
Preoperative Evaluation 273
Operative Technique 274
Laparoscopic Trans-abdominal Left Adrenalectomy 274
Patient Position, Port Strategy, and Establishment of Pneumoperitoneum 274
Operative Steps 274
Laparoscopic Trans-abdominal Right Adrenalectomy 277
Patient Position and Port Strategy 277
Operative Steps 278
Hand-Assisted Laparoscopic Adrenalectomy 281
Conclusions 282
References 283
21 Minimally Invasive Approaches to Lung Cancer 284
Background 284
Diagnosis and Staging 285
Diagnosis 285
Staging 285
Pulmonary Resection 285
Sublobar Resection 285
Lobectomy 286
Definition of VATS Lobectomy 286
Preoperative Evaluation 286
Techniques 287
Right Upper Lobectomy 290
Right Middle Lobectomy 292
Right Lower Lobectomy 293
Left Upper Lobectomy 293
Left Lower Lobectomy 293
Indications for Open Conversion 293
Palliation 294
Conclusions 294
References 294
22 Laparoscopy in Gynecologic Malignancies 297
Introduction 297
Surgical Approaches to Gynecologic Disease 298
Restaging 298
Uterine Cancer 299
Ovarian Tumors 301
Benign Masses 301
Risk of Rupture 302
Low Malignant Potential (Atypically Proliferating) Tumors of the Ovary 303
Staging in Early Ovarian Cancer 304
Advanced Ovarian Cancer 304
Second Look Surgery in Ovarian Cancer 305
Secondary Resection of Ovarian Cancer 305
Cervical Cancer 305
Laparoscopic Sentinel Nodes 306
Radical Trachelectomy 307
Laparoscopic Radical Parametrectomy 307
Pelvic Exenteration 308
Fistula Management 308
References 308
Part V Special Issues in Cancer Management 313
23 Minimally Invasive Surgery in Pediatric Oncology 314
Introduction 314
Equipment and Technical Considerations 315
Patient Position and Port Placement 315
Access 315
Insufflation 315
Instruments 316
Thoracic Lesions 316
Mediastinal Masses 318
Abdominal and Retroperitoneal Lesions 319
Biopsy 319
Excision 320
Pelvic Tumors 322
MIS Applications in Treating Morbidities of Chemotherapy 323
Advantages and Disadvantages of Pediatric MIS 324
Conclusion 324
References 325
24 Endoscopic Diagnosis and Treatment of Breast Diseases 327
Mammary Ductoscopy (MD) 328
Indications for Mammary Ductoscopy 328
Pathologic Nipple Discharge (PND) 328
Margin Assessment During Lumpectomy 328
Intraductal Breast Biopsy 328
Ductoscopy-Directed Duct Excision 328
Ductoscopy Equipment 328
Procedure 328
Patient Analgesia 328
Nipple Block 328
Ductoscope Preparation 329
Identification and Cannulation of the Correct Duct 329
Irrigation and Visualization 329
Intraductal Breast Biopsy (IDBB) 329
Ductoscopy-Directed Duct Excision 329
Cannulating the High-Risk or Cancer Patient 331
Pathology Considerations 332
Limitations 332
Advantages 332
Pitfalls and Management 332
Future Directions 332
Endoscopic Axillary Procedures 332
Indications 332
Sentinel Lymph Node Biopsy 333
Axillary Lymph Node Dissection 333
Equipment 333
Procedure 333
Positioning of the Patient 333
Establishment of Gas Space in the Axilla 333
Control of Gas Pressure in Axillary Space 334
Placement of Trocars 334
Procedure for Lymph Node Dissection 334
Advantages of Endoscopic Sentinel Lymph Node and Axillary Dissection 335
Limitations 335
Challenges for Endoscopic Axillary Dissection 335
Endoscopic-Assisted Subcutaneous Mastectomy with Immediate Mammary Prosthesis Reconstruction for Early Breast Cancer 335
Indications 335
Equipment 335
Procedure 335
Advantages 336
Limitations 336
References 336
25 The Applications of Sentinel Lymph Node to Cancer 338
Introduction 338
Melanoma 339
SLN Mapping Technique 339
Surgical Management 339
Other Skin Cancers 340
Breast Cancer 341
SLN Technique 341
Surgical Management 341
Colorectal Cancer 342
SLN Technique 342
Surgical Management 343
Gastric Cancer 345
Sentinel Node Technique 346
Surgical Management 346
Esophageal Cancer 347
Technique 347
Surgical Management 347
Head and Neck Tumors 347
Surgical Technique 347
Surgical Management 348
Lung Cancer 348
Conclusions 349
References 349
26 Future Prospects 354
References 356
Index 357