Hand-assisted laparoscopic vs open colectomy in a rural healthcare center

Abstract

14587 Background: Complete surgical resection is a key component of curative therapy for colon cancer. Accurate pathologic staging requires examination of a sufficient number of lymph nodes in the resection specimen. Open colectomy (OC) is the traditional surgical technique, newer minimally-invasive laparoscopic techniques allow equivalent-quality cancer resection while reducing post-operative morbidity, but require longer operating time. Hand-assisted laparoscopic colectomy (HALC) may yield the benefits of laparoscopic colectomy while reducing operating time. The benefits of laparoscopic surgery reported in tertiary healthcare centers may not be achievable in non-tertiary care centers. We compared the operative experience of patients undergoing HALC to those who had OC at a rural veterans Hospital. Methods: Study design: Retrospective case-control study of consecutive patients undergoing HALC for colon cancer from April 2000 to September 2004 compared to patients who had OC. Patients with rectal and stage IV colon cancer were excluded. Reported variables were compared by the non-parametric Mann-Whitney U-test, all p-values are two-tailed. Results: Data is reported as HALC vs. OC. N= 39 in HALC cohort vs. 55 in OC. Median age: 72.1 vs 70.3 yrs (p 0.46). Location of tumors: right colon 62% vs 56%, left colon 2.5 vs 11%, sigmoid colon 36% vs 33. Stage: 0, 23% vs 11%; I 23% vs 23%; II 31% vs 36%; III 23% vs 31%. Median operating room time was 139 vs 137 minutes (p 0.94). 4 of 39 (10%) HALC procedures were converted to OC. Number of lymph nodes in resection specimen 12 vs 9 (p=0.043). Duration of hospitalization: 6 days vs 10 days (p=0.007). 5% of HALC patients were transfused vs 13% of OC patients. There were 3 cases of serious post-operative infection in the HALC group vs 9 in the OC cohort, 0 cases of wound dehiscence vs 3, 0 perioperative deaths vs 3. Overall, 8% of HALC patients developed severe post-operative surgical complications vs 22% of OC patients (p<0.05). Conclusions: HALC is technically feasible in the non-tertiary care setting, with equivalent duration of surgery to OC, but significantly shorter duration of hospitalization. The quality of surgical resection, pathologic staging and rates of peri-operative morbidity and mortality are similar or slightly better with HALC. No significant financial relationships to disclose.