LAPAROSCOPICALLY ASSISTED COLON RESECTIONS COMPARE FAVORABLY WITH OPEN TECHNIQUE

To date, 14 patients have undergone laparoscopic or laparoscopically a ssisted colon resections for malignant disease. Margins of resection a nd lymph nodes (LNs) recovered were compared with those of 20 consecut ive controls treated over the preceding 6-month period at the same ins titution. Of these 14 procedures, one was completed entirely via lapar oscopy, 13 were laparoscopically assisted (a small transverse incision was used to deliver the colon and lesion after laparoscopic mobilizat ion). One other patient required conversion to open colectomy. An aver age of 10.5 LNs (range 0-32) were recovered via the laparoscopic techn ique per case; 0.4 LNs showed positive signs of metastatic disease (ra nge 0-4). Average margins of resection were 11.1 cm proximally and 10. 0 cm distally (range 3-34 cm proximally, 2-23 cm distally). In no case did the margins contain tumor. These results compare favorably with t hose for the 20 concurrent controls, among whom an average of 7.6 LNs were recovered per case, 0.5 LNs with positive signs of metastatic dis ease (range 2-19 LNs total, 0-4 positive). Similarly, proximal margins averaged 7.4 cm, and distal margins averaged 14.2 cm (range 1.5-20 cm and 2-30 cm, respectively). Only one postoperative complication was d irectly related to the surgical procedure-a herniation of small bowel into a trocar site. One anastomotic stricture occurred 6 weeks after s urgery, and one partial small-bowel obstruction was noted at 4 weeks. Both were treated nonoperatively. The procedure took only 10 min longe r than the conventional open technique, hospitalization was shorter, r esumption of regular diet took place significantly sooner(p = 0.01), a nd postoperative analgesic requirements were significantly lessened (p = 0.002). These preliminary results suggest that in experienced hands , laparoscopically assisted colon resections yield adequate surgical s pecimens and may be preferable to an open technique in terms of comfor t and recovery.