Laparoscopic colon resections: A five-year retrospective review

In recent years, laparoscopic surgery has become a matter of growing intere st. It has been shown that laparoscopic colectomy is well tolerated and saf e for benign disease. However, there is some uncertainty about using this m ethod for malignant disease when curative resection is the aim. These uncer tainties mainly consist of spread of cancer to port site, long-term surviva l, and adequacy of resection. The majority of laparoscopic colectomies are technically assisted procedures in which anastomosis is performed outside t he abdomen. However, some surgeons are now performing this surgery totally laparoscopically with the anastomosis performed inside the abdomen. Laparos copic colectomy is currently practiced with great frequency by general surg eons. Its performance requires a steep learning curve and a large number of cases to obtain proficiency. The indications for laparoscopic colectomy ar e different from one institution to another. In some institutions all patie nts with colorectal disease are candidates for laparoscopic colectomy and i n others it may be limited to benign disease only. The purpose of this revi ew is to analyze all laparoscopic colectomies performed at our medical cent er since 1992. We conducted a retrospective chart review of both hospital a nd clinic charts of patients who underwent colectomies at our hospital. A t otal of 338 patient charts were reviewed. In a comparison of both laparosco pic (n = 285) and converted (n = 53) methods, the age and operative time we re about the same. Age average and operating room time average were similar for both groups. With laparoscopy, there was a 3-day drop in length of hos pital stay as well as a 1-day-earlier regaining of bowel function. Hospital cost dropped $5000 average for the laparoscopic colectomy. The conversion rate at our center was 15 per cent. Complication rates were lower in the la paroscopic group. Recurrence of cancer at the port site (0.7%) was no highe r than in the converted group (incisional recurrence, 1.8%). We conclude th at laparoscopic colectomy does show an improvement in return of bowel funct ion, hospital cost, and shorter hospital stay. Long-term follow-up will be necessary to determine the effectiveness of laparoscopic colon resection fo r colorectal cancer.