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Chirurgie 10. November 2015

Hand-assisted laparoscopic surgery for left sided colorectal cancer: is quality of surgery related with experience?

Introduction: Hand-assisted laparoscopic colectomy (HALC) is an alternative technique to conventional laparoscopic surgery: it is technically easier, learning curve, and operative time is shorter. Our aim was to determine how operative and postoperative results are affected gaining the experience.

Methods: A prospectively maintained database was used to identify all patients who underwent HALC for left-sided colorectal cancer by a single surgeon at the Institute of Oncology, Vilnius University, from April 2006 to December 2013. They were analyzed as two consecutive equal groups: first 100 and next 100 patients. Operative time and quality-related outcomes, including conversions, operative, and postoperative complications, length of hospital stay and reoperations were compared.

Results: A total of 200 HALC were performed. There were no significant differences between the two groups in terms of age, sex, cancer stage, body mass index, operative procedures, comorbidities, prior surgical experience. Conversion rate was similar between the two groups: 3 (2.9 %) versus 3 (2.9 %), p > 0.05. Group 2 showed significantly shorter operative time: 129 ± 49.5 versus 98 ± 35.8 min, p < 0.05; and length of hospital stay: 8.1 ± 4.3 versus 6.5 ± 3.2 days, p < 0.05. The rate of complications was not significantly higher in group 1: 14(14 %) versus 9 (9 %), p > 0.05.

Conclusions: HALC operative time and postoperative hospital stay decreased with surgeon experience. For quality-related outcomes, HALC had no learning curve.

A. Dulskas, Prof. N. E. Samalavicius, R. K. Gupta, V. Zabulis, R. S. Samalavicius, J. Kutkauskiene, R. Escalante, European Surgery 5/2015

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