Laparoscopic Colorectal Surgery:A Five-Year Experience

Abstract

Objective: The aim of this study was to assess the feasibility and outcome of 300 laparoscopic colorectal procedures performed within 5 years for both benign and malignant disorders. The specific purpose was to identify the impact of the learning curve on reducing morbidity and on improving the outcome of laparoscopic colorectal surgery. Patients and Methods: All cases were divided into 3 groups: the first 100, the second 100 and the third 100 procedures were analyzed. Statistical analysis was performed by Student’s t test and χ² test. Results: The laparoscopic procedure had to be converted to open surgery in 22 cases (mean conversion rate 7.3%). Thus, a total of 278 procedures could be performed laparoscopically. The mean major complication rate was 8.6%, minor complications occurred in 9.7%. The overall morbidity rate was 18.3%. In 44 cases, laparoscopic resections were performed for the cure of colorectal malignancy. The mean lymph node harvest was 12.8 nodes, no port-site recurrence was documented at a mean follow-up of 22 months. Analyzing our 5-year experience, the incidence of conversion showed a decline from 8.0% (1st and 2nd 100) to 6.0% in the last 100 procedures (p > 0.05). The major complication rate was significantly decreased from 15 to 6.0% (1st vs. 2nd 100) and was 5.0% in the 3rd group. The minor complication rate, overall morbidity rate and laparotomy rate have also been reduced (p > 0.05). The duration of surgery was shortened from 251.4 to 213.5 min (1st vs. 2nd 100, p < 0.05) and was 196.9 min in the last 100 procedures. Postoperative hospital stay was decreased from 16.3 to 14.3 days (1st 100 vs. 2nd 100, p > 0.05) and could be shortened to 11.2 days (2nd vs. 3rd 100, p < 0.05). Conclusion: With increasing experience, laparoscopic colorectal surgery can be performed with reduced morbidity and improved outcome. To evaluate the role of laparoscopic colorectal procedures, particularly for the cure of malignancy, prospective randomized trials are necessary.

Evaluation of Laparoscopic Versus Open Surgery for Colorectal Malignancy: A Single Institute Study

“…The rate of conversion to open surgery is low when strict eligibility criteria are applied and the surgical team is well trained. 16 The highest conversion rates were reported in series resulting from early experiences. [17][18] Data from our study indicate that extent of resection including proximal, distal and CRM margins and lymph node examination were similar in both rectal resection groups.…”

Laparoscopic colorectal surgery: what to expect from an initial experience

“…When dividing the groups of two most frequent surgical procedures into subgroups with the first half of surgeries (subgroup 1) and the second half of surgeries (subgroup 2), we observed reduced mean duration of surgery and reduced rate of conversions. In the study conducted by Bruch et al 15 , the learning curve in laparoscopic colorectal surgery was analyzed by dividing 300 patients into 3 groups of 100, for the period of 5 years. Conversion was observed in 22 cases (7.3%).…”

The Implications of Subspecialisation on the Management and Outcome of Surgery for Rectal Carcinoma

“…Indeed, Pricolo and Potenti [17]in their review concluded that the mainstay of treatment remains surgical despite use of adjuvant therapy. In addition, other authors have shown good results for colorectal cancer operated laparoscopically without pre-operative adjuvant therapy [18]. …”