Early Experiences with Laparoscopic- assisted Colectomy: Retrospective Comparison with Open Colectomy (Case-control Study)

Park, Ki Jae; Lee, Mi Ri; Choi, Hong Jo

Abstract

Purpose
The aim of this study was to review our experience with laparoscopic-assisted colectomy (LACs), and to evaluate its feasibility and safety for surgical treatment of colorectal diseases, including cancer. Methods: Between September 2002 and September 2005, a LAC was performed in 58 patients. Of these, 6 cases of conversion to open colectomy were excluded from the analysis. Fifty conventional open colectomy (OCs) with clinicopathologic characteristics comparable to those of the LACs were selected and matched as a control group for comparative analysis regarding short-term oncologic and perioperative outcomes. The mean follow-up period was 13.8 (2~37) months. Results: Thirteen complications, involving 11 patients, occurred. The mean operative time of the LAC was longer than that of the OC (215 min vs. 179 min; P<0.0001). However, earlier restoration of bowel function was achieved in the LAC as measured by postoperative first flatus (2.8 days vs. 3.8 days) and intake of a clear liquid diet (4.7 days vs. 5.8 days). There was no significant difference in hospital stay (LAC vs. OC, 10.2 days vs. 11.8 days). In patients with malignancy, the proximal resection margin in the LAC was significantly shorter than that in the OC (9.2 cm vs. 13.3 cm; P<0.0001). However, there were no significant differences in the mean numbers of harvested lymph nodes (LAC vs. OC, 16.6 vs. 19.3; P=0.4330) and the mean distal resection margins (LAC vs. OC, 6.9 cm vs. 6.0 cm; P=0.1359). There were 3 distant metastases and one local recurrence during follow-up in the LAC group, but no port-site recurrence. Conclusions: In this study, we could not receive an advantage of shorter hospital stay due to the relatively high complication rate for a LAC, which may reflect a learning curve. Earlier postoperative recovery of bowel function and equal pathologic extent of resection in the LAC suggest that the LAC is an acceptable alternative procedure in the treatment of colorectal diseases, including malignancy. More experience with the LAC is necessary to overcome the learning curve. Affirmative long-term oncologic outcomes of are expected for the LAC.