Laparoscopic colorectal resection: short-term outcomes after 60 procedures – A single center initial experience

Miljan S. Ćeranić; Stojan M. Latinčić; Ognjan M. Skrobić; Dragan D. Gunjić; Jovica V. Vasiljević; Maja J. Pavlov

doi:10.2298/VSP180309077C

Miljan S. Ćeranić University of Belgrade, Faculty of Medicine, Belgrade, Serbia
Stojan M. Latinčić Clinical Center of Serbia, First Surgical Clinic, Department for Colorectal and Pelvic Surgery, Belgrade, Serbia
Ognjan M. Skrobić University of Belgrade, Faculty of Medicine, Belgrade, Serbia
Dragan D. Gunjić Clinical Center of Serbia, First Surgical Clinic, Department for Minimally Invasive Upper Digestive Surgery, Belgrade, Serbia
Jovica V. Vasiljević Clinical Center of Serbia, First Surgical Clinic, Department for Colorectal and Pelvic Surgery, Belgrade, Serbia
Maja J. Pavlov University of Belgrade, Faculty of Medicine, Belgrade, Serbia

DOI: https://doi.org/10.2298/VSP180309077C

Keywords: colonic neoplasms, digestive system surgical procedures, laparoscopy, postoperative complications, rectal neoplasms

Abstract

Background/Aim. Laparoscopic colorectal surgery is now widely accepted surgical method in the treatment of malignant and benign colorectal diseases. It is getting constantly more supporters due to its positive effects on enhanced patient recovery. The aim of this study was to determine the safety of minimally invasive approach as well as perioperative data, oncologic results and postoperative data. Methods. Prospective observational cohort clinical study was carried out at the Department for Colorectal and Pelvic Oncologic Surgery, First Surgical University Hospital, Clinical Center of Serbia, Belgrade. We analyzed demographics records concerning the type of surgery, clinicopathological features and oncological data for all operated patients. Records on early postoperative follow-up were also evaluated. Results. Laparoscopic colorectal resection was performed in 60 patients. Mean age of patients was 65 (29–87) years. Majority of patients were man, 37 (62%) of them. The most common indication was colorectal cancer (43 patients, 71.6%); 12 (20%) patients were operated due to the colorectal polyps unfitted for colonoscopic resection and 5 (8.3%) were operated due to Crohn’s disease. Average number of lymph node harvested in patients with colorectal carcinoma was 22.5 (6–52). We achieved negative resection margins in all patients operated due to carcinoma. Mean duration of hospital stay was 5 (4–12) days. Postoperative complications were encountered in 5 (8.3%) patients. Overall mortality rate was 1.7% (1 patient died due to thromboembolism). Conclusion. This study showed that initiation of laparoscopic colorectal resection is feasible and safe with short hospital stay, adequate oncologic resection and number of lymph node harvested.

References

Jacobs M, Verdeja JC, Goldstein HS. Minimally invasive colon resection (laparoscopic colectomy). Surg Laparosc Endosc. 1991; 1(3): 144–50.

Watanabe M, Ohgami M, Teramoto T, Kitajima M. Laparoscopic local excision of the cecum for cecal creeping tumor. Surg Laparosc Endosc 1997; 7(2): 144–7.

Kobayashi H, Miyata H, Gotoh M, Baba H, Kimura W, Kitagawa Y, et al. Risk model for right hemicolectomy based on 19,070 Japanese patients in the National Clinical Database. J Gastro-enterol 2014; 49(6): 1047–55.

Matsubara N, Miyata H, Gotoh M, Tomita N, Baba H, Kimura W, et al. Mortality after common rectal surgery in Japan: a study on low anterior resection from a newly established nationwide large-scale clinical database. Dis Colon Rectum 2014; 57(9): 1075–81.

The English national training programme for laparoscopic col-orectal surgery. http://lapco.nhs.uk [accessed 2015 January27]

Ohtani H, Tamamori Y, Arimoto Y, Nishiguchi Y, Maeda K, Hirakawa K. A meta-analysis of the short- and long-term re-sults of randomized controlled trials that compared laparosco-py-assisted and conventional open surgery for colorectal can-cer. J Cancer 2011; 2: 425–34.

Di B, Li Y, Wei K, Xiao X, Shi J, Zhang Y, et al. Laparoscopic versus open surgery for colon cancer: a meta-analysis of 5-year follow-up outcomes. Surg Oncol 2013; 22(3): e39–43.

Fleshman J, Sargent DJ, Green E, Anvari M, Stryker SJ, Beart RW Jr, et al. Clinical Outcomes of Surgical Therapy Study Group. Laparoscopic colectomy for cancer is not inferior to open surgery based on 5-year data from the COST Study Group trial. Ann Surg 2007; 246(4): 655–62; discussion 662–4.

Vallribera Valls F, Landi F, Espín Basany E, Sánchez García JL, Jiménez Gómez LM, Martí Gallostra M, et al. Laparoscopy-assisted versus open colectomy for treatment of colon cancer in the elderly: morbidity and mortality outcomes in 545 pa-tients. Surg Endosc 2014; 28(12): 3373–8.

Amin MB, Edge S, Greene F, Byrd DR, Brookland RK, Washing-ton MK, et al. AJCC Cancer Staging Manual. 8th ed. New York: Springer; 2017.

National Cancer Institute. Common Terminology Criteria for Adverse Events v.4.0 (CTCAE). Available from: http://ctep.cancer.gov/protocolDevelopment/electronic_applications/ctc.htm. [Accessed 2012June 20].

Melotti G, Tamborrino E, Lazzaretti MG, Bonilauri S, Mecheri F, Piccoli M. Laparoscopic surgery for colorectal cancer. Semin Surg Oncol 1999; 16: 332–6.

Stocchi L, Nelson H. Laparoscopic colectomy for colon cancer trial update. J Surg Oncol 1998; 68(4): 255–67.

Hasegawa H, Kabeshima Y, Watanabe M, Yamamoto S, Kitajima M. Randomized controlled trial of laparoscopic versus open colectomy for advanced colorectal cancer. Surg Endosc 2003; 17(4): 636–40.

Yang T, Wei M, He Y, Deng X, Wang Z. Impact of visceral obesity on outcomes of laparoscopic colorectal surgery: a me-ta-analysis. ANZ J Surg 2015; 85(7–8): 507–13.

Wang CL, Qu G, Xu HW. The short- and long-term outcomes of laparoscopic versus open surgery for colorectal cancer: a meta-analysis. Int J Colorectal Dis 2014; 29(3): 309–20.

Steele SR, Brown TA, Rush RM, Martin MJ. Laparoscopic vs open colectomy for colon cancer: results from a large nation-wide population-based analysis. J Gastrointest Surg 2008; 12(3): 583–91.

Juo YY, Hyder O, Haider AH, Camp M, Lidor A, Ahuja N. Is minimally invasive colon resection better than traditional ap-proaches?: First comprehensive national examination with propensity score matching. JAMA Surg 2014; 149(2): 177–84.

Kang CY, Chaudhry OO, Halabi WJ, Nguyen V, Carmichael JC, Stamos MJ, et al. Outcomes of laparoscopic colorectal surgery: data from the Nationwide Inpatient Sample 2009. Am J Surg 2012; 204(6): 952–7.

Owen RM, Perez SD, Lytle N, Patel A, Davis SS, Lin E, et al. Impact of operative duration on postoperative pulmonary complications in laparoscopic versus open colectomy. Surg Endosc 2013; 27(10): 3555–63.

Wilson MZ, Hollenbeak CS, Stewart DB. Laparoscopic colecto-my is associated with a lower incidence of postoperative com-plications than open colectomy: a propensity scorematched cohort analysis. Colorectal Dis 2014; 16(5): 382–9.

Chen K, Zhang Z, Zuo Y, Ren S. Comparison of the clinical out-comes of laparoscopic assisted versus open surgery for colorec-tal cancer. Oncol Lett 2014; 7(4): 1213–8.

Prakash K, Varma D, Rajan M, Kamlesh NP, Zacharias P, Ganesh Narayanan R, et al. Laparoscopic colonic resection for rectosigmoid colonic tumours: a retrospective analysis and comparison with open resection. Indian J Surg 2010; 72(4): 318–22.

Kiran RP, Kirat HT, Ozturk E, Geisler DP, Remzi FH. Does the learning curve during laparoscopic colectomy adversely affect costs? Surg Endosc 2010; 24(11): 2718–22.

McDonald JR, Renehan AG, O’Dwyer ST, Haboubi NY. Lymph node harvest in colon and rectal cancer: Current considera-tions. World J Gastrointest Surg 2012; 4(1): 9–19.