Laparoscopically Assisted Colon Resections Compare Favorably with Open Technique

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To date, 14 patients have undergone laparoscopic or laparoscopically assisted colon resections for malignant disease. Margins of resection and lymph nodes (LNs) recovered were compared with those of 20 consecutive controls treated over the preceding 6-month period at the same institution. Of these 14 procedures, one was completed entirely via laparoscopy, 13 were laparoscopically assisted (a small transverse incision was used to deliver the colon and lesion after laparoscopic mobilization). One other patient required conversion to open colectomy. An average of 10.5 LNs (range 0–32) were recovered via the laparoscopic technique per case; 0.4 LNs showed positive signs of metastatic disease (range 0–4). Average margins of resection were 11.1 cm proximally and 10.0 cm distally (range 3–34 cm proximally, 2–23 cm distally). In no case did the margins contain tumor. These results compare favorably with those for the 20 concurrent controls, among whom an average of 7.6 LNs were recovered per case, 0.5 LNs with positive signs of metastatic disease (range 2–19 LNs total, 0–4 positive). Similarly, proximal margins averaged 7.4 cm, and distal margins averaged 14.2 cm (range 1.5–20 cm and 2–30 cm, respectively). Only one postoperative complication was directly related to the surgical procedure—a herniation of small bowel into a trocar site. One anastomotic stricture occurred 6 weeks after surgery, and one partial small-bowel obstruction was noted at 4 weeks. Both were treated nonoperatively. The procedure took only 10 min longer than the conventional open technique, hospitalization was shorter, resumption of regular diet took place significantly sooner (p = 0.01), and postoperative analgesic requirements were significantly lessened (p = 0.002). These preliminary results suggest that in experienced hands, laparoscopically assisted colon resections yield adequate surgical specimens and may be preferable to an open technique in terms of comfort and recovery.

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