Safety of laparoscopic colorectal surgery in a low-volume setting: review of early and late outcome.

Robert C Gandy,Christophe R Berney

doi:10.1155/2014/581523

Robert C Gandy, Christophe R Berney

Open Access

https://doi.org/10.1155/2014/581523

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Abstract

Background. There is increasing evidence suggesting that the laparoscopic technique is the treatment of choice for large bowel resection, including for malignancy. The purpose of the study was to assess whether general surgeons, with particular skills in advanced laparoscopy, can adequately provide safe laparoscopic colorectal resections in a low-volume setting. Methods. A retrospective review of prospectively collected case series of all laparoscopic colorectal resections performed under the care of a single general surgeon is presented. The primary endpoint was postoperative clinical outcome in terms of morbidity and mortality. Secondary endpoints were adequacy of surgical margins and number of lymph nodes harvested for colorectal cancer cases. Results. Seventy-three patients underwent 75 laparoscopic resections between March, 2003, and May, 2011. There was no elective mortality and the overall 30-day postoperative morbidity was 9.3%. Conversion and anastomotic leakage rates were both 1.3%, respectively. None of the malignant cases had positive margins and the median number of lymph nodes retrieved was 17. Conclusions. Our results support the view that general surgeons with advanced skills in minimally invasive surgery may safely perform laparoscopic colorectal resection in a low-volume setting in carefully selected patient cases.

Highlights

Since the first published series on large bowel resection using a minimally invasive approach in 1991 by Jacobs et al [1], there has been convincing evidence in the literature to suggest that a laparoscopic approach should be the method of choice for colorectal resection
The assertion is relevant to low rectal cancers, its significance is independent of the method used to achieve tumour clearance and is unrelated to the laparoscopic technique per se but more to the surgeon’s familiarity with surgical anatomy and experience
The aim of this study is to retrospectively review the data of all patients who underwent laparoscopic colorectal resection under the care of a single general surgeon with broad experience in minimally invasive surgery but who performs less than 10 laparoscopic colorectal resections per year

Summary

Introduction

Since the first published series on large bowel resection using a minimally invasive approach in 1991 by Jacobs et al [1], there has been convincing evidence in the literature to suggest that a laparoscopic approach should be the method of choice for colorectal resection. It is widely accepted that open colorectal surgeries can be safely completed by generally trained surgeons with almost identical short- and long-term outcomes, bearing in mind that a large number of these cases are performed acutely for large bowel obstruction [5]. The purpose of the study was to assess whether general surgeons, with particular skills in advanced laparoscopy, can adequately provide safe laparoscopic colorectal resections in a low-volume setting. Our results support the view that general surgeons with advanced skills in minimally invasive surgery may safely perform laparoscopic colorectal resection in a low-volume setting in carefully selected patient cases

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Conclusion