Experience as a factor influencing the indications for laparoscopic colorectal surgery and the results

Background: The influence of experience on the results of treatment with la paroscopic surgery is indisputable. The establishment of indications and co ntraindications is relative, and varies depending on the experience of the surgeon. Learning curves have been described for a number of laparoscopic i nterventions, in particular laparoscopic cholecystectomy. The current prosp ective multicenter study investigates, among other things, the interrelatio n between experience and the results of treatment using laparoscopic colore ctal surgery. The study makes no pronouncements on the long-term results ac hieved in patients with colorectal carcinoma who underwent an operation wit h curative intent, although relevant data were indeed collected. Results: Between August 1, 1995 and February 1, 1999, a total of 1,658 pati ents were recruited to the prospective multicenter study initiated by the L aparoscopic Colorectal Surgery Study Group. To investigate the influence of surgical experience, two groups were formed. Group A comprised all the ins titutions and surgeons with experience of more than 100 laparoscopic colore ctal operations. Group B contained institutions and surgeons with experienc e of fewer than 100 such interventions. The results of this study clearly s how that in Group A, significantly more procedures involving the rectum wer e performed (26.7% vs 9.5%), and significantly more carcinomas were surgica lly managed (37.3% vs 17.3%). Despite this significantly higher level of te chnically difficult procedures in the patient population of group A, which was comparable in terms of age, gender, height, and weight with the patient in group B, the postoperative mortality and morbidity was, with the except ion of urinary tract infections, identical between the two groups, Conversi on to open surgery was significantly less frequent in group A (4.3% vs 6.9% ), and, finally, the duration of the procedures performed by the more exper ienced surgeons of group A was appreciably shorter than in institutions wit h a smaller frequency of such operations. Conclusions: Laparoscopic colorectal surgery is very demanding, and can be performed with low morbidity and mortality rates only by a surgeon with abo ve-average experience with this type of surgery and a large caseload of lap aroscopic colorectal procedures. The learning curve for such procedures is appreciably longer than for other laparoscopic operations. With increasing experience, technically more demanding operations, including radical oncolo gic rectal laparoscopic procedures, can be performed with appreciably reduc ed operating times and conversion rates, but with no increase in morbidity or mortality.