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2006 Abstracts: Laparoscopic Colorectal Resections: A Single Center Experience
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Laparoscopic Colorectal Resections: A Single Center Experience
silvana perretta2, Roberto Campagnacci1, Mario Guerrieri1, Angelo De Sanctis1, Maddalena Baldarelli1, Giovanni Lezoche2, Emanuele Lezoche2; 1Clinica di Chirurgia Generale e Metodologia Chirurgica, University of Ancona, Ancona, Italy; 2Department of Surgery,Paride Stefanini, Universita La Sapienza, Roma, Italy

Background:Since our first minimally invasive colon resection 13 years ago, laparoscopic colorectal resection has been implemented as techniques have evolved.This study aims to evaluate the surgical outcomes, and the present role of laparoscopic surgery for benign and malignant colorectal diseases. Methods:From 1992 to 2005, 758 patients(pts) underwent laparoscopic colorectal resection by the same surgical team; 572 (75.4%)pts(mean age 65,6 years)underwent laparoscopic colon resections (359 left and 213 right hemicolectomies)and 186 (24.6%)pts (mean age 63.8)rectal resections.Data collection included preoperative,operative, postoperative and oncologic results with long-term follow-up.Results: Overall mean operative time was 180.5min for the right, 289 for the left hemicolectomies and 255 min for rectal resection.In the last five years the op.time shortened to 135 min for the right(R),240 for the left(L) hemicolectomies and 217min for rectal resections.Fourteen conversions(2.4%)occurred, 1 in the R and 13 in the L- hemicolectomies.Ten out of 14 conversions occurred in the first 134 cases.In the rectal group there were 12 conversions(6.5%),9 in the first 94 and 3 in the last 92 pts. Mortality was 1.4% in the R-hemicolectomy group and zero for left colon and rectal resections.There were 16 (5.6%)major complications in the colon group: 5 in the R and 11 in the L-hemicolectomies.In the rectal group 14 major complications occurred (8.4%).The mean number of lymph nodes removed was 15, 10, and 11 in the R and L-hemicolectomies and rectal resections respectively. Mean overall p.o. stay for hemicolectomies was 7.9 days range 5-76).In the rectal resections, mean p.o. stay was 8.6 days (6-52).At a minimum follow-up of 5 years there were 3 (3.5%) local recurrences,1 carcinomatosis (1.1%) and 9(10.5%) metachronous metastases in pts who underwent colectomies whereas in those who underwent rectal resection 10 (19.2%)local recurrences,1(1.8%)carcinomatosis and 8(15.3%) metachronous metastases occurred.The cumulative survival probability according to TNM stage was 0.88 and 0.71 for Stage I to III,0.76 and 0.58 for Stage III in the colon and rectal pts respectively. Conclusions: Laparoscopic colorectal resection is a safe and feasible procedure for benign and malignant colorectal diseases although it requires a long and steep learning curve. While survival after laparoscopic colorectal resection for cancer appears to be at least equal to survival after open resection, in our experience a higher complication rate occured when operating for malignancy.


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