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EBM: LAPAROSCOPIC COLON SURGERY - results and data + a single center experience ( 120 patients )

EBM: LAPAROSCOPIC COLON SURGERY - results and data + a single center experience ( 120 patients ). Z dravko Perko University Department of Surgery, Clinical Hospital Split and Split Medical School, Croatia. role of laparoscopic colon resection.

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EBM: LAPAROSCOPIC COLON SURGERY - results and data + a single center experience ( 120 patients )

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  1. EBM: LAPAROSCOPIC COLON SURGERY - results and data+a single center experience(120 patients) Zdravko PerkoUniversity Department of Surgery, Clinical Hospital Split and Split Medical School, Croatia

  2. role of laparoscopic colon resection • accepted as a first choice of treatment for benign diseases • for palliative treatment in advanced malignant diseases • laparoscopic curable treatment of malignant colorectal diseases

  3. laparoscopic curable treatment of malignant colorectal diseases • Lacy, AM, García-Valdecasas, JC, Delgado, S, Castells, A, Taurá, P, Piqué, JM, Visa, J (2002) "Laparoscopy-assisted colectomy versus open colectomy for treatment of non-metastatic colon cancer: a randomised trial" Lancet 29: 2224-2229 • Franklin, ME, Kazantsev, GB, Abrego, D, Diaz-E, JA, Balli, J, Glass, JL (2000) "Laparoscopic surgery for stage III colon cancer: long-term follow-up" Surg Endosc 14: 612-616 • Lezoche, E, Feliciotti, F, Paganini, AM, Guearrei, M, Sanctis, A, Minervini, S, Campagnacci, R (2002) "Laparoscopic vs open hemicolectomy for colon cancer" Surg Endosc 16: 596-602 • ......

  4. Level of evidence 1b – individual RCT

  5. Level of evidence 1b – individual RCT

  6. The most important data • COLOR • The COlon cancer Laparoscopic or Open study group • 1248 pts (29 European Hospitals) • MRC CLASICC • Conventional vs LAparoscopic Assisted Surgery in Colorectal Cancer (UK + USA) • EAES consensus, Lisabon • SAGES statement

  7. Level of evidence 2b – individual cohort study

  8. The prognostic effect of the stagein patients with R0 resected carcinoma of the right colon (operated in current intent) Figure 5. Percentage of mortality-free patients decreased slower in patients with lower tumour stage (1, 2 and 3) than in patients with tumour stage 4 (the “survival” curves were obtained by Kaplan-Meier method and compared by Gehan's – Wilcoxon test). Patients with stages II and III of the disease have almost the same survival.

  9. current results and published data • laparoscopic (assisted) colon resection for cancer • acceptable mortality and morbidity • surviving and recurence rate do not appear to differ adversely from those after open resection

  10. Lap colon – KB Split • The first lap colon -December 12th 2002 • December 12th 2002 – September 15th 2006 • 120 operations • benign and malignant diseases

  11. indications • Polyps, diverticular disease, cecal necrosis, rectum perforation.... • Colon carcinoma • Suitability for lap procedure

  12. RESULTS – 100 resections

  13. Sigmoidectomy Right and left hemicolectomy Anterior resections Transversum resections Hartman procedures Rectum amputation Colostomies Colon reconstructions after Hartman procedure Subtotal colectomy Proctocolectomy + IPAA procedures

  14. Preoperative management • Open procedures • Fast track surgery • Peroral feeding • No NGT • One shoot ABT • LMH • Colonoscopy • Barium enema • MSCT ...

  15. technique • Reusable and disposable trocars and instruments • UC, LS • Endostaplers • Circular stapler • NO TRANSFUSION

  16. Sex ratio males 54.7% females 45.3% Age: average 64,8 ±12.94 (range 24 - 87) years Mean follow up average 12,58 ±8,28 (range1 - 44) months Patients data

  17. Pathology – carcinoma!

  18. Average duration of procedures 152,1 ±53,902 min Range 80– 270 min Procedures: Resectio rectosygmoidei sec. Dixon 32%; 169,28±37,92 min 2) Resectio sygmae 20%; 133,92±43,86, 3) Hemicolectomia lat. dex. 18%; 156,42±52,12 amputatio recti anterior sec. Milles, resectio recti sec. Hartman, hemicolectomia lat. sin., subtotal/total colectomy.. results

  19. conversions • 17 conversions • the main reason • bulky tumor • locally advanced malignant disease • infiltration of surrounding organs • urether injury

  20. complications • six major complications • minor anastomotic dehiscence x3 • 2 urether transection • peritonitis after small bowel injury • No mortality • wound infection, bowel paresis, .....

  21. OVERALL PRICE lap OVERALL PRICEopen 10171,98 10077,31 Cost comparisonsygma / rectum resection • The cost of our laparoscopic colon resection is comparable with open colon surgery. Perko Z, Kraljević D, Družijanić N, Juričić J, Tomić I, Baković A, Mimica Ž, Petričević A, Baća I, Krnić D, Bilan K. Laparoskopska kirurgija kolona. Acta Chir Croat 2004; 1: 23-31.

  22. conclusions • Considering our short experience (high volume hospital / surgeon) • during learning curve and literature data • laparoscopic colon resection • comparable with open colon resection • including malignant disease treatment

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