SHORT-TERM OUTCOMES OF LAPAROSCOPIC COLORECTAL RESECTIONS FOR CANCER: A FIVE-YEAR SINGLE-CENTRE EXPERIENCE FROM SERBIA

Boško  Milev; Saša Dragović; Mihailo  Bezmarević; Miodrag  Jocić; Jovana  Stevanović; Ivan  Pantić; Miroslav  Mitrović; Srđan  Petković; Darko  Mirković; Irfan Ćorović; Haris  Plojović; Filip; Milan  Jovanović

doi:10.5937/mckg59-61537

Boško Milev Clinic for General Surgery, Military Medical Academy, University of Defense, Belgrade, Serbia
Saša Dragović 1Clinic for General Surgery, Military Medical Academy, University of Defense, Belgrade, Serbia
Mihailo Bezmarević 1Clinic for General Surgery, Military Medical Academy, University of Defense, Belgrade, Serbia
Miodrag Jocić Institute for Transfusiology and Haemobiology, Military Medical Academy, Belgrade, Serbia
Jovana Stevanović Institute of Neonatology, Belgrade, Serbia
Ivan Pantić Clinic for General Surgery, Military Medical Academy, University of Defense, Belgrade, Serbia
Miroslav Mitrović Clinic for General Surgery, Military Medical Academy, University of Defense, Belgrade, Serbia
Srđan Petković Department of Surgery, Military Hospital Novi Sad, Serbia
Darko Mirković Clinic for General Surgery, Military Medical Academy, University of Defense, Belgrade, Serbia
Irfan Ćorović General Hospital of Novi Pazar, Department of Internal Medicine, Novi Pazar, Serbia
Haris Plojović General Hospital of Novi Pazar, Department of Surgery, Novi Pazar, Serbia
Filip University of Kragujevac, Serbia, Faculty of Medical Sciences, Department of Pharmacy
Milan Jovanović Clinic for General Surgery, Military Medical Academy, University of Defense, Belgrade, Serbia

DOI: https://doi.org/10.5937/mckg59-61537

Keywords: Keywords: colorectal cancer, laparoscopy, postoperative complications, anastomotic leak, lymph-node yield.

Abstract

Objective: To evaluate the short-term outcomes of laparoscopic colorectal resections for colorectal cancer in a single Serbian tertiary centre.

Methods: A retrospective cohort study included 97 patients who underwent elective laparoscopic colorectal resections between January 2018 and March 2023. Demographic, perioperative, and oncologic data were analyzed. Primary outcomes were 30-day morbidity and mortality; secondary outcomes included operative time, conversion, re-intervention, length of stay, and lymph-node yield. Logistic regression identified independent predictors of complications.

Results: The cohort comprised 59 men (60.8%) and 38 women (39.2%), with a median age of 71 years. Conversion to open surgery occurred in 6 patients (6.1%), while re-intervention was required in 3 (3.1%). The median operative time was 120 minutes for colonic and 175 minutes for rectal resections. Median lymph-node yield was 15, with all achieving R0 resection. The overall 30-day morbidity rate was 17.5%, with no perioperative deaths. General complications occurred in 12.4% and surgery-specific complications in 11.3%, with partial overlap. Median length of stay was 9 days, significantly longer in men and diabetic patients. Logistic regression confirmed cardiomyopathy as an independent predictor of postoperative complications (OR 7.5, p = 0.008).

Conclusion: Laparoscopic colorectal resections in this series were associated with acceptable morbidity, no mortality, low conversion, and adequate oncologic quality. Cardiomyopathy was identified as a major perioperative risk factor, highlighting the need for tailored perioperative management.

References

References:
1. Roshandel G, Ghasemi-Kebria F, Malekzadeh R. Colorectal cancer: Epidemiology, risk factors, and prevention. Cancers (Basel) 2024; 16: 1530.

2. Lee SW. Laparoscopic procedures for colon and rectal cancer surgery. Clin Colon Rectal Surg 2009; 22: 218-24.

3. Jayne DG, Guillou PJ, Thorpe H, Quirke P, Copeland J, Smith AM, et al. Randomized trial of laparoscopic-assisted resection of colorectal carcinoma: 3-year results of the UK MRC CLASICC Trial Group. J Clin Oncol 2007; 25: 3061-8.

4. Colon Cancer Laparoscopic or Open Resection Study Group, Buunen M, Veldkamp R, Hop WC, Kuhry E, Jeekel J, et al. Survival after laparoscopic surgery versus open surgery for colon cancer: long-term outcome of a randomised clinical trial. Lancet Oncol 2009; 10: 44-52.

5. Lacy AM, Delgado S, Castells A, Prins HA, Arroyo V, Ibarzabal A, et al. The long-term results of a randomized clinical trial of laparoscopy-assisted versus open surgery for colon cancer. Ann Surg 2008; 248: 1-7.

6. Bonjer HJ, Deijen CL, Abis GA, Cuesta MA, van der Pas MH, de Lange-de Klerk ES, et al; COLOR II Study Group. A randomized trial of laparoscopic versus open surgery for rectal cancer. N Engl J Med 2015; 372: 1324-32.

7. Troller R, Bawa J, Baker O, Ashcroft J. First experience in laparoscopic surgery in low and middle income countries: A systematic review. World J Gastrointest Surg 2024; 16: 546-53.

8. Yoo J. Laparoscopic colorectal surgery. Perm J 2008; 12: 27-31.

9. Schwenk W, Haase O, Neudecker J, Müller JM. Short term benefits for laparoscopic colorectal resection. Cochrane Database Syst Rev 2005; 2: CD003145.

10. Veldkamp R, Kuhry E, Hop WC, et al; Colon Cancer Laparoscopic or Open Resection Study Group (COLOR). Laparoscopic surgery versus open surgery for colon cancer: short-term outcomes of a randomized trial. Lancet Oncol 2005; 6: 477-84.

11. Petersson J, Matthiessen P, Jadid KD, Bock D, Angenete E. Short term results in a population based study indicate advantage for laparoscopic colon cancer surgery versus open. Sci Rep 2023; 13: 4335.

12. The Clinical Outcomes of Surgical Therapy Study Group. A comparison of laparoscopically assisted and open colectomy for colon cancer. N Engl J Med 2004; 350: 2050-9.

13. Janson M, Bjorholt I, Carlsson P, Haglind E. Randomized clinical trial of the costs of open and laparoscopic surgery for colonic cancer. Br J Surg 2004; 91: 409-17.

14. Law WL, Lee YM, Choi HK, Seto CL, Ho JW. Impact of laparoscopic resection for colorectal cancer on operative outcomes and survival. Ann Surg 2007; 245: 1-7.

15. Steele SR, Brown TA, Rush RM, Martin MJ. Laparoscopic vs open colectomy for colon cancer: results from a large nationwide population-based analysis. J Gastrointest Surg 2008; 12: 583-91.

16. Chiulli LC, Stephen AH, Heffernan DS, Miner TJ. Association of medical comorbidities, surgical outcomes, and failure to rescue: An analysis of the Rhode Island Hospital NSQIP Database. J Am Coll Surg 2015; 221: 1050-6.

17. Hall CM, Jupiter DC, Regner JL. Newly diagnosed and decompensated congestive heart failure is associated with increased rates of pneumonia, reintubation, and death following laparoscopic cholecystectomy: A NSQIP database review of 143,761 patients. Int J Surg 2016; 35: 209-13.

18. Juo YY, Hyder O, Haider AH, Camp M, Lidor A, Ahuja N. Is minimally invasive colon resection better than traditional approaches? First comprehensive national examination with propensity score matching. JAMA Surg 2014; 149: 177-84.

19. Foo CC, Ku C, Wei R, Yip J, Tsang J, Chan TY, et al. How does lymph node yield affect survival outcomes of stage I and II colon cancer? World J Surg Oncol 2020; 18: 22.

20. Ibáñez N, Abrisqueta J, Luján J, Sánchez P, Soriano MT, Arevalo-Pérez J, et al. Reoperation after laparoscopic colorectal surgery: Does the laparoscopic approach have any advantages? Cir Esp (Engl Ed) 2018; 96: 109-16.

21. Leung KL, Kwok SP, Lam SC, Lee JF, Yiu RY, Ng SS, et al. Laparoscopic resection of rectosigmoid carcinoma: prospective randomised trial. Lancet 2004; 363: 1187-92.