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A Journal on Surgery
Indexed/Abstracted in: EMBASE, Scopus, Emerging Sources Citation Index
Chirurgia 2000 June;13(3):131-4
Personal experience in the laparoscopic treatment of colorectal neoplasms
Quaglieri M., Quaglieri G., Favoriti M., Angelini P., Altorio F., Scipioni P., Scipioni L.
Background. Videolaparoscopy is undoubtedly a new surgical approach for the treatment of colorectal neoplasms. We have tried to evaluate the extent to which it guarantees and enables compliance with the principles of oncological radicalness laid down by conventional surgery (open cycle).
Methods. A total of 76 patients with colorectal neoplasm were evaluated between 1997 and 1999 (26% right colon adenocarcinoma; 64% left colon adenocarcinoma; 10% rectal adenocarcinoma) and underwent surgery using a videolaparoscopic approach. Rectal neoplasms less than 5 cm from the dentate line were excluded. Patients were selected on the basis of the absence of previous laparotomic surgery, coagulopathies, dilatative heart disease and pulmonary hypertension. A total of 16 right hemicolectomies were performed with side-to-side ileo-transverse extracorporeal anastomosis, 42 left hemicolectomies with end-to-end colorectal anastomosis according to Knight-Griffen and 2 Hartmann. All patients had a minimum follow-up of 6 months and a maximum of 2 years. The following criteria of evaluation were used: tumor markers (CEA- CA 19-9, alpha-feto), colonoscopy, hepatobiliary scan, abdominal CT. The parameters of evaluation were mean hospital stay, re-canalisation, recurrence of local disease and trocar sites, long-term metastases.
Results. Of 76 patients with colorectal neoplasms, the percentage of conversion to laparotomic access was 20%, morbidity was 12% and mortality was 1.5%. The mean hospital stay was 10.4 days with recanalisation within an average of 2.5 days. The lymph nodes removed and examined by the pathologic anatomist were 17. With regard to local recurrence and long-term metastases, the results were comparable with those obtained using laparotomic access, even if the follow-up is not yet adequate.
Conclusions. Videolaparoscopy for colorectal neoplasms represents a valid surgical technique as an alternative to laparotomy, on the condition that adequate training has been carried out. The follow-up is not long enough to provide definitive results in terms of survival and the disease-free interval, but the reduced immunodepression resulting from less surgical stress represents an encouraging start.