The Shift to Laparoscopic Colon Resection: A Single Center Experience

Research Article

Austin J Surg. 2015;2(5): 1070.

The Shift to Laparoscopic Colon Resection: A Single Center Experience

Abdul-Mujib Cadili, Sunita Ghosh and Ali Cadili*

Department of Surgery, University of Saskatchewan, Canada

*Corresponding author: Ali Cadili, Department of Surgery, Saskatoon, Saskatchewan, University of Saskatchewan, Canada

Received: February 09, 2015; Accepted: August 05, 2015; Published: August 12, 2015

Abstract

Introduction: Laparoscopic colon resection has been shown to not compromise oncological outcomes. It also provides superior results with regards to postoperative recovery. Laparoscopic resection, therefore, has become accepted as the standard technique for surgical treatment of colon cancer. We sought to document our experience with transitioning from open to laparoscopic colon resection in a high volume community center.

Methods: A retrospective review of all colon resections at the Sturgeon Community Hospital in St Albert, Alberta over a six year period was carried out. Collected data included patient demographics (age, gender, and medical comorbidities), surgical intervention characteristics (extent of colonic resection, open versus minimally invasive technique) and patient outcomes (mortality, intraoperative and perioperative complications).

Results: 175 colon resections for neoplasia were performed during the study period. 45 Cases were performed laparoscopically, 43 total laparoscopic cases (2 hand assisted). 130 cases were open with midline laparotomy incisions.

Conclusion: Laparoscopic resection resulted in less blood loss, mortality risk, as well as length of hospital stay compared to open surgery. There were no negative outcomes with the adoption of minimally invasive techniques compared to the traditional open approach. This study does support the premise that the shift from laparoscopic surgery for colon neoplasia can be done in a safe and effective manner without compromising outcomes.

Keywords: Laparoscopic resection; ASA class; Minimally invasive technique

Introduction

At its outset, the minimally invasive method of colon resection was met with significant skepticism. Besides the technical complexity anticipated with this procedure, several concerns regarding oncological safety were also voiced. Such concerns included adequate margin and lymph node status, port site metastasis, and CO2 pneumoperitoneum effect on tumor biology [1]. Landmark trials, however, have shown that laparoscopic colon resection does not compromise oncological outcomes and provides superior results with regards to postoperative recovery compared to traditional open surgery [2-4]. In addition, laparoscopic colon surgery has been shown to result in decreased length of hospital stay, use of postoperative analgesics, and wound infections compared to traditional open surgery [5]. Today, laparoscopic colon resection has become accepted as a standard technique for surgical treatment of colon cancer. Studies have shown the safety and efficacy of this technique compared to open surgery. The widespread adoption and uniformity of implementation of this modality, however, remains hindered for a variety of reasons [6,7]. Formal studies have actually documented the variability with which laparoscopic surgery has been adopted in the treatment of colonic disease [8]. A myriad of factors, most important of which are surgeon training, have been identified as being responsible for this hampered implementation. With the ever increasing exposure to laparoscopy in residency training, combined with the popularity of laparoscopic fellowship training programs, the use of laparoscopic surgery as the standard of care is only expected to be further entrenched [9]. For community surgeons not formally trained in laparoscopic surgery through either residency or fellowship training.

The purpose of this study was to document our experience with transitioning from open to laparoscopic colon resection in a high volume community center. Comparison of outcome between the two surgical modalities with regards to efficacy of the surgery, morbidity (both short and long term), and mortality was sought to be determined.

Methods

A retrospective review of all surgeries performed for colon neoplasia (encompassing the spectrum from benign to cancerous) at the Sturgeon Community Hospital in St Albert, Alberta over a six year period (from November 2006 until December 2012) was carried out. Collected data included patient demographics (age, gender, medical comorbidities), surgical intervention characteristics (extent of colonic resection, open versus minimally invasive technique), and patient outcomes (mortality, intraoperative and perioperative complications, tumor characteristics (malignant versus benign on final histology, histologic type, grade, number of lymph nodes harvested and involved in cancer, margin status).Colon resections performed for emergency cases (such as perforated diverticulitis or fulminant colitis) were excluded from this study.

Statistical analysis

Descriptive statistics were reported for the study variables. Mean and standard deviation was used for continuous variables and frequency and percentages were reported for categorical variable. Logistic regression analysis was used to compare the outcome midline vs. minimally invasive group. The following variables average operation time, deceased status (deceased vs. alive), circumferential margin (Involved vs. Uninvolved), reoperation (yes vs. no), surgical complication (yes vs. no), length of hospital stay, number of lymph nodes and blood loss measured in cc were introduced in the univariate model. The variables significant at p<0.10 level in the univariate model were chosen for the multivariate model. The final model was chosen with the significant predictors of midline vs. minimally invasive group. SAS software (SAS Institute Inc. Cary, NC) version 9.3 was used for analysis purpose and a p-value<0.05 was used for statistical significance.

Results

A total of 175 colon resections for neoplasia were performed during the specified study period. 45 cases were done using minimally invasive techniques; 2 hand-assisted cases and 43 total laparoscopic cases. 130 cases were performed using traditional open technique utilizing midline incisions. Table 1 summarizes the baseline patient and tumor characteristics across the two study groups. The two groups were not significantly different in baseline patient characteristics except for histology; more malignant cases tended to be performed by the open rather than minimally invasive method (P value 0.005). No statistically significant difference emerged, however, with regards to age, gender, ASA class, the presence of major medical comorbidities, tumor size, or stage. The site of colon resection, Table 2 lists the differences between the two study groups with regards to the analyzed outcomes. Compared to minimally invasive surgery, open colonic resection exhibited a trend towards greater operative time however this was not statistically significant. Open colon resection cases did, however, result in significantly higher operative blood loss (P value 0.0001) higher 30 day mortality (P value 0.001), and greater length of postoperative hospital stay (P value 0.001). The two study groups also differed according to site of colon resection: right colon, versus left colon, versus transverse colon. There was no significant difference between the two groups, however, with regards to rate or reoperation, rate of postoperative complication development, surgical margin status, and number of lymph nodes resected. Interestingly, a trend towards open surgery in right sided lesions was noted; being contrary to expectations, this trend likely resulted from variability and inexperience early on in selecting patients for the laparoscopic approach.

Citation: Cadili A-M, Ghosh S and Cadili A. The Shift to Laparoscopic Colon Resection: A Single Center Experience. Austin J Surg. 2015;2(5): 1070. ISSN : 2381-9030