Laparoscopic Colorectal Surgery

Laparoscopic Colorectal Surgery Giuseppe pp S. Sica Associate Professor of Surgery Tor Vergata g University y of Rome [email protected] sigisica@gmai...
Author: Jerome Flynn
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Laparoscopic Colorectal Surgery Giuseppe pp S. Sica Associate Professor of Surgery Tor Vergata g University y of Rome [email protected] sigisica@gmail com www.chirurgia-miniinvasiva.com www esdd com www.esdd.com

History • 1982 Semm performed first Laparoscopic Appendicectomy • 1987 Mouret performed first Laparoscopic Cholecystectomy • 1990 Italian Society of Surgery

Benefits to the Surgeon • Safe, better visualization, improved dissection, reduced blood loss • Potential benefits for training • Potential to improved quality • Reduced post operative pain • Reduced hospital stay • Improved cosmesis

Benefits to the patient • Less scaring both internal and external • Less pain • Shorter hospital stay • Quicker return to activities

Advantages and disadvantages of the laparoscopic approach • Smaller wounds • Less pain • Faster recovery In general best patient’s satisfaction

• • • • • •

Cost Longer operation Learning curve Oncological safety ‘Off camera’ injury g term outcome Long data

National Institute for Clinical Excellence (NICE, U.K.) NICE guidance id 2000 • “Laparoscopic surgery for colorectal cancer should • Only be undertaken as part of a randomised clinical Trial ” Trial.

NICE Concerns regarding laparoscopic colorectal surgery • Resection less oncologically complete • Port site recurrence

Short-term benefits for laparoscopic colorectal resection (Metanalysis) Copyright © 2005 The Cochrane Collaboration. Published by JohnWiley & Sons, Ltd. • • • • • • •

a laparoscopic approach was found to be associated with increased operating time Less intraoperative blood loss compared to open surgery. Postoperative pain was less, Duration of postoperative ileus shorter shorter, Pulmonary function improved, Morbidity y decreased,, QoL in the first month was better after laparoscopy compared to open surgery

The authors concluded that if long term outcome of laparoscopic and open p procedures p showed equivalent q results,, the laparoscopic p p approach should be preferred in colorectal cancer surgery.

Long-term results of laparoscopic colorectal cancer resection National Center for Advanced Laparoscopic Surgery (NSALK) (NSALK), St Olavs Hospital Hospital, Trondheim, Norway. Department of General Surgery, Medical Faculty of the Humboldt University at Berlin, Charité Campus Mitte Charité, Mitte, Berlin Berlin, Germany. Germany Department of General Surgery, Helse Nord-Trøndelag Health Trust, Namsos Hospital, Namsos, Norway. Department of research and development,HelseNord-Trøndelag development,HelseNord Trøndelag Health Trust, Namsos Hospital, Namsos, Norway. Department of Surgery, Erasmus Medical Center, Rotterdam, Netherlands Editorial group: Cochrane Colorectal Cancer Group. Publication status and date: Edited ((no change g to conclusions), ) published in Issue 5, 2012. Review content assessed as up-to-date: 2 January 2008. Citation: Kuhry E, Schwenk W, Gaupset R, Romild U, Bonjer HJ. Long-term results of laparoscopic colorectal cancer resection. Cochrane Database of Systematic Reviews 2008, Issue 2. Art. No.: CD003432. DOI: 10 1002/14651858 CD003432 b2 10.1002/14651858.CD003432.pub2. Copyright © 2012 The Cochrane Collaboration. Published by JohnWiley & Sons, Ltd.

Cochrane 2012 Long Term Results • Thirty-three Thirty three randomised clinical trials (RCT) comparing laparoscopicallyassisted versus open surgery for colorectal cancer were identified. • Twelve of these trials trials, involving 3346 patients, reported long-term outcome

Cochrane 2012 Long Term Results 5 Years Survival 5-Years • • • • • • •

Lacy 2002

• CLASSIC 2013

COST 2004

• Color II 2015 (rectal cancer)

g 2004 Leung Braga 2005

Laparoscopy: Colorectal cancer Randomized Controlled Trial • • • •

111 Laparoscopy vs. 106 Laparotomy Non metastatic colon cancer Median follow-up time: 43 (27-85) months Postoperative chemotherapy for all suitable su tab e pat patients e ts with t Stage II o or III rectal ecta cancer • Intention-to-treat Intention to treat analysis anal sis • Lacy et al, The lancet 2002

Laparoscopy: Colorectal cancer Recurrence

Laparoscopy: y Colorectal cancer Overall Survival

Laparoscopy: Colorectal cancer Cancer-related Survival

Laparoscopic Colectomy for cancer: COST Study St d Short term Quality-of-Life outcomes g Laparoscopic-Assisted p p Colectomy y following vs Open Colectomy for Colon Cancer AIMS • Are disease free and overall survival equivalent ? • Is laparoscopic approach associated with better QOL ? • Weeks et al. JAMA 2002

Laparoscopic p p Colectomy y COST Study • • • •

Randomized control trial 449 patients Adenocarcinoma of single segment of colon Excluded: Acute presentation presentation, rectal and transverse colon cancers, advanced local disease, those lesions with evidence of metastatic disease, ASA IV or V • Quality of surgery: • All surgeons with > 20 cases; Random audit of cases

Weeks et al. JAMA 2002

Laparoscopic Colectomy COST Study St d Outcomes • Survival pending • QOL at 2days, 2 weeks and 2 months using: • Symptom Distress Scale, Global QOL Scale, QOL index • • • •

Results: Intention to Treat Analysis Shorter use of narcotics Shorter length of stay by 0.8 days (p

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