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


Split 2006
                          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

                ......




Split 2006
             Level of evidence 1b – individual RCT




Split 2006
Split 2006
             Level of evidence 1b – individual RCT



Split 2006
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                          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

Split 2006
             Level of evidence 2b – individual cohort study
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                                                   The prognostic effect of the stage in patients with R0
                                                    resected carcinoma of the right colon (operated in
                                                                      current intent)

                                     1,0
   Cumulative Proportion Surviving




                                                                        Stage 1 (n=16)
                                     0,8                                                                         Figure 5. Percentage of
                                                                        Stage 2 (n=18)                           mortality-free patients decreased
                                                                        Stage 3 (n=14)                           slower in patients with lower
                                     0,6                                                                         tumour stage (1, 2 and 3) than in
                                                                                                                 patients with tumour stage 4 (the
                                                                                                                 “survival” curves were obtained
                                                                                         p<0.001
                                     0,4                                                                         by Kaplan-Meier method and
                                                        Stage 4 (n=7)                                            compared by Gehan's –
                                                                                                                 Wilcoxon test). Patients with
                                     0,2                                                                         stages II and III of the disease
                                                                                                                 have almost the same survival.

                                     0,0
                                           0   1    2        3      4   5     6      7    8        9   10   11

                                                                 Years after surgery
Split 2006
                 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

Split 2006
                       Lap colon – KB Split
                The first lap colon - December 12th 2002
                December 12th 2002 – September 15th 2006

                120 operations
                benign and malignant diseases



Split 2006
                               indications
                Polyps, diverticular disease, cecal necrosis,
                 rectum perforation....

                Colon carcinoma

                Suitability for lap procedure


Split 2006
             RESULTS – 100 resections




Split 2006
                                      procedures
      Sigmoidectomy
      Right and left hemicolectomy
      Anterior resections
      Transversum resections
      Hartman procedures
      Rectum amputation
      Colostomies
      Colon reconstructions after
       Hartman procedure
      Subtotal colectomy
      Proctocolectomy + IPAA


Split 2006
                           Preoperative management
            Open procedures
            Fast track surgery
                Peroral feeding
                No NGT
                One shoot ABT
                LMH


            Colonoscopy
            Barium enema
            MSCT ...
Split 2006
                                          technique
       Reusable and disposable trocars
        and instruments
       UC, LS
       Endostaplers
       Circular stapler




       NO TRANSFUSION



Split 2006
                                         Patients data
            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
                (range 1 - 44) months

Split 2006
                     Pathology – carcinoma!


                     %
    Adenocarcinoma
       DUKES-A       11,3
    Adenocarcinoma
       DUKES-B       49,8
    Adenocarcinoma
       DUKES-C       18,7
    Adenocarcinoma
       DUKES-D       20,2




Split 2006
                                                     results
            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..

Split 2006
                                       conversions

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



Split 2006
                                           complications
     six major complications
            minor anastomotic
             dehiscence x3
            2 urether transection
            peritonitis after small
             bowel injury

            No mortality

                 wound infection, bowel
                  paresis, .....

Split 2006
                            Cost comparison
                          sygma / rectum resection
                The cost of our laparoscopic colon resection is
                 comparable with open colon surgery.

                                             OVERALL PRICE lap                                                         10077,31




                                     OVERALL PRICE open                                                                 10171,98

                             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.




Split 2006
                                  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


Split 2006
Split 2006
Split 2006

				
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posted:1/14/2012
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