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Chirurgie 6. Mai 2015

Functional and clinical outcomes of hand-assisted laparoscopic colorectal surgery: a single-institution experience in 255 patients

Hand-assisted laparoscopic surgery: single-center experience

Background: Hand-assisted laparoscopic colectomy is an alternative technique to laparoscopy: it is technically easier, learning curve and operative time is shorter. We aimed to describe the characteristics of patients admitted due to colorectal cancer for hand-assisted laparoscopic surgery (HALS), intra- and postoperative clinical and functional outcomes.

Methods: A prospectively maintained database was used to identify all patients who underwent HALS for colorectal cancer at the National Cancer Institute from April 2006 to November 1 2014. Data are presented as frequency (proportion) or median (interquartile range).

Results: A total of 255 HALS colorectal resections were performed. The mean HALS time was 105 min (50–270). The conversion rate was 1.96 % (5/255). The average number of lymph nodes harvested was 15 (2–54). The average time to first flatus was 1.92 days (1.5–4.5), to tolerance of solid food was 2.85 (1.4–3.4), and to first bowel movements was 3.64 (2.6–4.3). The median length of hospital stay was 6.8 days (3–31). Postoperative complication rate was 9.8 %. Three patients (1.17 %) demanded explorative laparotomy. Postoperative mortality rate was 0.39 % (one patient). There was 3.2 % of local recurrence in the colon and 5.8 % in the rectum and no port site metastasis during 36.3 (1–108) months of surveillance. The 3-year survival rates were 100 % for stage I, 97 % for stage II, 84 % for stage III, and 50 % for stage IV colorectal cancer.

Conclusions: Hand-assisted laparoscopic colorectal resection preserves nearly all the benefits of laparoscopic colectomy reported in the literature. With experience, it is associated with improved clinical outcomes.

A. Dulskas, Prof. N.E. Samalavicius, R.K. Gupta, A. Kilius, K. Petrulis, R.S. Samalavicius, R. Tikuisis, European Surgery 2/2015

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