چکیده (انگلیسی):

Background/purpose: Trials have shown laparoscopic colorectal surgery to be
safe. We aim to analyze the long-term results from a single national training center for laparoscopic
surgery, especially in patients with high predicted mortality scores as well as in octogenarians.
We also aim to explore the trend in the length of the learning curve among
consultants and colorectal trainees, and determine whether or not laparoscopic colorectal surgery
is amenable to surgical training.
Methods: All patients between July 2003 and July 2011 having laparoscopic colorectal surgery
were included in a prospectively maintained database and analyzed retrospectively. We
collected operative data (operation time, conversion), postoperative 30-day morbidity/mortality,
cancer survival (including local/distant recurrences), postoperative incisional/port site
hernia rates, and rates of reoperation.
Results: A total of 508 patients (258 males and 250 females) were enrolled in the study. The
mean age of patients was 65.5 years and median body mass index (BMI) 27 kg/m2
; 70% of cases
were malignant. Conversion rate was 15%, mean operation time was 175 minutes, and mean
blood loss was 220 mL. The mean postoperative length of stay was 5.8 days, 30-day morbidity
23% (leak rate 1.38%), and 30-day mortality 1.57%. Operating time and conversion rates were
significantly lower in right-sided resections compared to left-sided and rectal resections, and
lymph node retrieval was significantly higher. Readmission and reoperation rates were 4.9% and 2.8%, respectively. The overall mean follow-up period was 1.8 years, rate of incisional/
port site/parastomal hernia was 5.7% (n Z 30), and readmission secondary to adhesions was
<1% (n Z 4). Readmission rates and 30-day surgical morbidity were significantly higher in patients
with non-neoplastic disease compared to those with benign or malignant lesions. The
mean follow-up period for cancer patients was 2.3 years. Local and distant recurrence rates
were 4.2% and 13.2%, respectively. Overall death from cancer was 10.4%. Among the study participants,
74 were octogenarians and 23 had a predicted mortality of >5% (P-Possum tool). No
statistically significant increases were observed in conversion, morbidity, or mortality rates in
these groups (p > 0.05), but length of stay was statistically longerd7 days for octogenarians
and 8 days for patients with >5% predicted mortality (p < 0.05). In 2003, two consultants operated
on all cases; currently, twice as many procedures are performed by supervised trainees
instead of consultants, with no change in outcome. Operating time was significantly higher
in the consultant-led cases, but no other differences were noted in short- or long-term outcomes
between consultant- and junior/senior trainee-led cases.
Conclusion: We conclude that laparoscopic colorectal surgery should be the standard treatment
option offered to all patients regardless of age and comorbidities and it is amenable
to training.