Significance of the localization of small tumors at laparoscopic large bowel resections

Abstract

Introduction: The premalignant and malignant diseases of the colon could be identified earlier owing to the colonoscopic screening. Although large part of these small lesions could be removed by the new intraluminal techniques (endoscopic submucosal dissection), the other tumors needs minimal invasive surgical (laparoscopic large bowel resection) procedure. To find these small, T1-T2 tumors during the operation is usually very difficult, or impossible owing to the nature of the laparoscopic technique. The correct anatomical localization with the preoperative colonoscopy is false in about 15–20% of the cases, and the intraoperative colonoscopy is not considered to be an ideal solution for various reasons. Patients and method: 158 laparoscopic large bowel resections were performed because of malignant and benignant lesions of the colon between 1 Jan. 2005 and 31 Dec. 2008. The average age of the patients was 68,3 years. The size of the tumors was less than 3cm at 56 cases, and the histology detected lesions which not reached the serosa at 45 patients. Results: At 29/158 (18,4%) cases pre- or intraoperativ techniques had to be used for the localization. Preoperative endoscopic clip placement has been used at 5 cases. Intraoperative colonoscopy was performed at 4 cases owing to the difficulties of intraoperative localization, rectoscopy at 3 cases and rectal digital examination at 15 cases. Re-resection had to be made because of the missed blind resection at 2 cases. The average operation time of these small lesions was not shorter significantly to the large (T3-T4) tumors (168min. vs. 145min.). Conclusions: There is increasing claim for the preoperative (if it is possible at the time of the detection of the lesion) marking with the development of the laparoscopic large bowel surgery. The definition of the exact criteria's (when, where, how) needs consensus between gastroenterologists and surgeons. The present endoscopic tattooing did not live up to expectations, therefore development of such new inks is necessary, which could be detected easily during laparoscopic procedures.