Laparoscopic Colon Resection by a Single General Surgeon in a Community Hospital: A Review of 200 Consecutive Cases

Fiscon, Valentino; Frigo, Flavio; Migliorini, Giovanni; Portale, Giuseppe; Lazzarini, Elvio

doi:10.1089/lap.2008.0103

Cited by 7 publications

(4 citation statements)

References 14 publications

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“…Official scientific literature has fully answered all these questions thus wholeheartedly favouring the laparoscopic technique [3][4][5][6][7][8][9][10].…”

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confidence: 99%

Early results and complications of colorectal laparoscopic surgery and analysis of risk factors in 492 operated cases

Santoro

Carboni²,

Ettorre

et al. 2010

Updates Surg

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This study aimed to evaluate the early results of colorectal laparoscopic surgery with special attention to surgical and medical complications. The risk factors of such surgery are also investigated on the basis of a large series of operated cases: the preoperative knowledge of such factors could guide the operative program and the postoperative treatment with reduction of complications and improvement of the outcome. Between 1998 and 2008, 492 patients had been submitted to colorectal laparoscopic surgery by the same team: 387 for cancer and 105 for benign disease. All colorectal surgical operations are included in the series. No selection of the patients was made: laparoscopy was performed in all cases accepting the procedure. Several risk factors have been analysed in cases of fistula (age, pathology sex, type of the operation, cancer stages, preoperative radiochemotherapy, stool diversion and team experience) and in cases of medical complications (age, pathology, cancer stages and type of operation). The overall results in this series of laparoscopic colorectal operated cases are similar to other results published at present by the main surgical Department all over the world; no mortality and low number of medical (2.4%) and surgical complications (9.3%), with no differences also with the best open surgery series. Complete or partial conversion to open surgery was required in few cases (1.2%) and same others (1.4%) were operated again for bleeding or sudden anastomotic leakage. Regarding the risk factors in such surgery, a good correlation has been discovered between anastomotic leakage and the team experience, the age over 70 of the patients, the rectal tumour site in man, the advanced tumour stages, the previous radiochemotherapy, while medical complications seem to depend on advanced patients age and advanced cancer stages. Laparoscopic colorectal surgery at present is going to be considered the gold standard in the large majority of colorectal diseases including all cancer stages in the preoperative balance and in the early postoperative follow-up a special attention is required to same risk factors like the advanced patients age, the extended cancers, the low positioned rectal tumours. Complications are more frequent at the beginning of the experience of the surgical team and if more than one risk factors coexist, but it do not represent contraindication to laparoscopic surgery.

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“…Official scientific literature has fully answered all these questions thus wholeheartedly favouring the laparoscopic technique [3][4][5][6][7][8][9][10].…”

mentioning

confidence: 99%

Early results and complications of colorectal laparoscopic surgery and analysis of risk factors in 492 operated cases

Santoro

Carboni²,

Ettorre

et al. 2010

Updates Surg

View full text Add to dashboard Cite

show abstract

“…Over the last decade, because of the safety and efficacy reported in several studies and clinical trials, [1][2][3][4][5][6][7][8][9][10][11] laparoscopic colorectal surgery has rapidly become an important tool for surgeons. Until now, most of the studies related to laparoscopic colorectal surgery have been descriptive reports of its potential advantages, such as less pain, better cosmesis, increased patient satisfaction, shorter length of stay, faster return to work, less bleeding, less pain, and fewer wound infections.…”

Section: Discussionmentioning

confidence: 99%

“…T HE ADVANTAGES OF LAPAROSCOPIC surgery have been consistently reported in a number of large prospective randomized studies and case series, for a variety of colorectal diseases. [1][2][3][4][5][6][7][8][9][10][11] Laparoscopic surgery has gained widespread acceptance due to its major benefits, including less pain, cosmesis, fewer wound issues, shorter ileus, patient satisfaction, fewer adhesions and shorter length of stay. Laparoscopic surgery is less invasive than conventional procedures, but postoperative complications still occur at a steady rate, and some may require reoperation.…”

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confidence: 99%

Laparoscopic Colectomy: Complications Causing Reoperation or Emergency Room/Hospital Readmissions

Abarca

Saclarides

Brand

2011

The American Surgeon™

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The purpose of this study was to determine the incidence of complications causing reoperation or emergency room(ER)/hospital readmission after laparoscopic colectomy (LC). We retrospectively reviewed a prospectively managed database of 358 patients undergoing LC. Nonhand assisted LC was jointly performed by two surgeons assisted by a general surgery resident. Trochar site fascial wounds larger than 5 millimeters were not closed for the first 283 cases, mesenteric defects were not closed. Forty-one patients (11%) required reoperation. Of the 19 hernias (17 incisional, 2 mesenteric), seven caused early postoperative obstructions either within the first week of surgery or within 4 days after discharge. Twelve hernias presented in a delayed fashion and were repaired months later. Eight hernias occurred at trochar sites, nine at specimen extraction sites, and two were in the mesenteric defect. There were eight adhesive small bowel obstructions, five were treated with early reoperation. Other causes included perforations in six cases (2%), anastomotic leak in seven cases (2%) and bleeding in two cases (0.5%). Fifty-nine (16%) separate patients required evaluation in the ER. Fifty-three patients had one ER visit, six patients had two. Causes included nausea and vomiting in 19 cases (5%), wound infection in 16 cases (4%), pain in 13 cases (4%), fever in five cases (1%), thrombosis in four cases (1%); 46 were admitted to the hospital, 70 per cent were discharged within 4 days. Eleven per cent of patients required reoperation after LC, usually for hernias or adhesive small bowel obstruction. Fifty-three per cent of the hernias could have been avoided by routine closure of the fascia. An additional 16 per cent of patients required ER evaluation for complications. Of these, 78 per cent were admitted, 70 per cent were discharged within 4 days. LC is not without potential complications and is not necessarily a less morbid operation.

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“…Reports on community surgeon experience with laparoscopic colon surgery are emerging in the literature. 19,20 The techniques developed during these early trials have been standardized in definable steps, which are now used to teach residents, fellows, and fully trained practicing surgeons to perform a safe, oncologically sound colectomy for cancer. Hand-Assisted Laparoscopy The use of a hand-assist device during laparoscopic colon surgery mitigates some of the technical challenges of the procedure.…”

Section: Upcoming Trialsmentioning

confidence: 99%

Laparoscopy for Colon and Rectal Cancer

Nandakumar

Fleshman²

2010

Clinics in Colon and Rectal Surgery

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Laparoscopy has emerged as a useful tool in the surgical treatment of diseases of the colon and rectum. Specifically, in the application of colon cancer, a laparoscopicassisted approach offers short-term benefits to patients while maintaining a long-term oncologic outcome. Hand-assisted laparoscopic surgery may help decrease operative times while preserving the benefits of laparoscopy. The literature on the use of laparoscopy for rectal cancer is still in its early stages. Limited data suggest short-term benefits without compromising oncologic outcome; however, data from large multicenter trials will clarify the role of laparoscopy in the treatment of rectal cancer. Robotic proctectomy is a novel technique that may offer considerable advantage and overcome some limitations laparoscopy creates while working in the confines of the pelvis. The improved magnification and visualization offered with the robot may also assist in preserving bladder and sexual function. Transanal endoscopic microsurgery (TEM) for the treatment of T1 rectal cancers with low-risk features appears to be safe. However, TEM has a significantly higher recurrence rate when used to treat invasive cancer. Endoluminal techniques and equipment are under development and could offer more minimally invasive approaches to the treatment of colon and rectal cancer. Credentialing and training of surgeons and teams involved in the use of laparoscopy is important prior to making these techniques ubiquitous. KEYWORDS: Colon cancer, rectal cancer, laparoscopyObjectives: On completion of this article, the readers should be able to summarize the current evidence supporting the use of laparoscopy for colon cancer and the use of laparoscopy, robotics, and transanal techniques for the treatment of rectal cancer.Following the success and wide implementation of laparoscopic cholecystectomy, reports on the use of laparoscopy for colon resections soon appeared. 1 Unfortunately, due to initial concerns regarding the oncologic quality of the operation and reports of port site implants, there was hesitance in the application of laparoscopy to colon and rectal cancer. Between 1994 and 2004 there were multiple randomized control trials conducted to study the use of laparoscopy for the treatment of colon cancer. 2 The data on colon cancer has since matured suggesting that laparoscopy offers short-term benefits with no compromise on the oncologic outcome. Evidence on the use of laparoscopy for rectal cancer is limited and we await the results of large multicenter randomized control trials to define the role of laparoscopy. This review aims to provide the current evidence for the minimally invasive management of colon and rectal cancer. We also highlight some of the upcoming technologies related to the application of robotic proctectomy, transanal

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Laparoscopic Colon Resection by a Single General Surgeon in a Community Hospital: A Review of 200 Consecutive Cases

Abstract: The outcomes of LCR surgery performed by a well-trained laparoscopic surgeon working in a community hospital are comparable with results from academic health science centers.

Cited by 7 publications

References 14 publications

Early results and complications of colorectal laparoscopic surgery and analysis of risk factors in 492 operated cases

Early results and complications of colorectal laparoscopic surgery and analysis of risk factors in 492 operated cases

Laparoscopic Colectomy: Complications Causing Reoperation or Emergency Room/Hospital Readmissions

Laparoscopy for Colon and Rectal Cancer

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