Laparoscopic colorectal surgery: A five-year experience

Objective: The aim of this study was to assess the feasibility and outcome of 300 laparoscopic colorectal procedures performed within 5 years for both benign and malignant disorders. The specific purpose was to identify the i mpact of the learning curve on reducing morbidity and on improving the outc ome of laparoscopic colorectal surgery. Patients and Methods: All cases wer e divided into 3 groups: the first 100, the second 100 and the third 100 pr ocedures were analyzed. Statistical analysis was performed by Student's t t est and chi(2) test. Results: The laparoscopic procedure had to be converte d to open surgery in 22 cases (mean conversion rate 7.3%). Thus, a total of 278 procedures could be performed laparoscopically. The mean major complic ation rate was 8.6%, minor complications occurred in 9.7%. The overall morb idity rate was 18.3%. In 44 cases, laparoscopic resections were performed f or the cure of colorectal malignancy. The mean lymph node harvest was 12.8 nodes, no port-site recurrence was documented at a mean follow-up of 22 mon ths. Analyzing our 5-year experience, the incidence of conversion showed a decline from 8.0% (1st and 2nd 100) to 6.0% in the last 100 procedures (p > 0.05). The major complication rate was significantly decreased from 15 to 6.0% (Ist vs. 2nd 100) and was 5.0% in the 3rd group. The minor complicatio n rate, overall morbidity rate and laparotomy rate have also been reduced ( p > 0.05). The duration of surgery was shortened from 251.4 to 213.5 min (I st vs. 2nd 100, p < 0.05) and was 196.9 min in the last 100 procedures. Pos toperative hospital stay was decreased from 16.3 to 14.3 days (Ist 100 vs. 2nd 100, p > 0.05) and could be shortened to 11.2 days (2nd vs. 3rd 100, p < 0.05). Conclusion: With increasing experience, laparoscopic colorectal su rgery can be performed with reduced morbidity and improved outcome. To eval uate the role of laparoscopic colorectal procedures, particularly for the c ure of malignancy, prospective randomized trials are necessary.