LAPAROSCOPY WITHIN MULTIMODAL OPTIMIZATION PROGRAMM IN PATIENTS WITH COLORECTAL CANCER

Abstract

AIM to assess the efficacy of combination of laparoscopy and protocol of enhanced recovery in patients with colorectal cancer. MATERIALS AND METHODS. Between 2008-2016 466 patients were randomly allocated into 3 groups. Of them 266 of received perioperative treatment according to enhanced recovery protocol, 191 had routibne open procedure (group 2) and, 75 had laparoscopic operation (group 1). Patients underwent the following procedures: right hemicolectomy (n=53), left hemicolectomy (n=32), sigmoidectomy (n=55), abdomeno-perineal excision (n=67) and low anterior resection of rectum(n=201), other operation - 58. The following variables were analized: operating time, intraoperative blood loss, time of first flatus and defecation, morbidity (wound infections, anastomotic leakage, peritonitis, postoperative ileus, urinary disorders, thrombosis, cardiopulmonary complications). RESULTS. Groups were comparable in gender, comorbidities, body mass index, types of operations. Operating time did not differ significantly between 3 groups. Intraoperative blood loss was higher in conventional group. The time offirstflatus and defecation were better in group 1 and 2. Mortality rate was similar. Morbidity was lower in group 1 and 2 compared with conventional group: wound infections 1,3%, 3,1% vs 9%, anastomotic leakage 4%, 5,5% vs 9%, ileus 1,2 vs 5,4%, peritonitis 2,6%, 1,5% and 3,5%, bowel obstruction caused by the adhesions 0%, 6,8% vs 5,5%. Reoperation rate was 4%, 4,7% vs 5,5%, consequemntly. CONCLUSION. Combination of laparoscopic surgery withenhanced recovery program provides better results of treatment.