Transcript Jednostavan i ekonomičan način laparoskopske intraoperacijske

EBM: LAPAROSCOPIC COLON SURGERY results and data + a single center experience
(120 patients )
Zdravko Perko
University Department of Surgery, Clinical Hospital Split and Split Medical School,
Croatia
role of laparoscopic colon resection
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accepted as a first choice of treatment for
benign diseases
for palliative treatment in advanced malignant
diseases
laparoscopic curable treatment of malignant
colorectal diseases
laparoscopic curable treatment of
malignant colorectal diseases
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Lacy, AM, García-Valdecasas, JC, Delgado, S, Castells, A, Taurá, P, Piqué, JM, Visa, J
(2002) "Laparoscopy-assisted colectomy versus open colectomy for treatment of nonmetastatic colon cancer: a randomised trial" Lancet 29: 2224-2229
Franklin, ME, Kazantsev, GB, Abrego, D, Diaz-E, JA, Balli, J, Glass, JL (2000)
"Laparoscopic surgery for stage III colon cancer: long-term follow-up" Surg Endosc 14:
612-616
Lezoche, E, Feliciotti, F, Paganini, AM, Guearrei, M, Sanctis, A, Minervini, S,
Campagnacci, R (2002) "Laparoscopic vs open hemicolectomy for colon cancer" Surg
Endosc 16: 596-602
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Level of evidence 1b – individual RCT
Split 2006
Split 2006
Level of evidence 1b – individual RCT
Split 2006
Split 2006
Split 2006
The most important data
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COLOR
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MRC CLASICC
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The COlon cancer Laparoscopic or Open study group
1248 pts (29 European Hospitals)
Conventional vs LAparoscopic Assisted Surgery in
Colorectal Cancer (UK + USA)
EAES consensus, Lisabon
SAGES statement
Level of evidence 2b – individual cohort study
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The prognostic effect of the stage in patients with R0
resected carcinoma of the right colon (operated in
current intent)
Cumulative Proportion Surviving
1,0
S tage 1 (n =16)
Figure 5. Percentage of
mortality-free patients decreased
slower in patients with lower
tumour stage (1, 2 and 3) than in
patients with tumour stage 4 (the
“survival” curves were obtained
by Kaplan-Meier method and
compared by Gehan's –
Wilcoxon test). Patients with
stages II and III of the disease
have almost the same survival.
0,8
S tage 2 (n =18)
S tage 3 (n =14)
0,6
p<0.001
0,4
S tage 4 (n =7)
0,2
0,0
0
1
2
3
4
5
6
7
Years after surgery
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8
9
10
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current results and published data
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laparoscopic (assisted) colon resection for
cancer
acceptable mortality and morbidity
surviving and recurence rate do not appear
to differ adversely from those after open
resection
Lap colon – KB Split
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The first lap colon - December 12th 2002
December 12th 2002 – September 15th 2006
120 operations
benign and malignant diseases
indications
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Polyps, diverticular disease, cecal necrosis,
rectum perforation....
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Colon carcinoma
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Suitability for lap procedure
RESULTS – 100 resections
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procedures
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Sigmoidectomy
Right and left hemicolectomy
Anterior resections
Transversum resections
Hartman procedures
Rectum amputation
Colostomies
Colon reconstructions after
Hartman procedure
Subtotal colectomy
Proctocolectomy + IPAA
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Preoperative management
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Open procedures
Fast track surgery
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Peroral feeding
No NGT
One shoot ABT
LMH
Colonoscopy
Barium enema
MSCT ...
technique
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Reusable and disposable trocars
and instruments
UC, LS
Endostaplers
Circular stapler
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NO TRANSFUSION
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Patients data
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Sex ratio
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Age:
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average 64,8 ±12.94
(range 24 - 87) years
Mean follow up
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males 54.7%
females 45.3%
average 12,58 ± 8,28
(range 1 - 44) months
Pathology – carcinoma!
%
Adenocarcinoma
DUKES-A
Adenocarcinoma
DUKES-B
Adenocarcinoma
DUKES-C
Adenocarcinoma
DUKES-D
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11,3
49,8
18,7
20,2
results
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Average duration of procedures
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152,1 ± 53,902 min
Range 80 – 270 min
Procedures:
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Resectio rectosygmoidei sec.
Dixon
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2) Resectio sygmae
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20%; 133,92±43,86,
3) Hemicolectomia lat. dex.
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32%; 169,28±37,92 min
18%; 156,42±52,12
amputatio recti anterior sec.
Milles, resectio recti sec.
Hartman, hemicolectomia lat.
sin., subtotal/total colectomy..
conversions
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17 conversions
the main reason
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bulky tumor
locally advanced
malignant disease
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infiltration of
surrounding organs
urether injury
complications
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six major complications
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minor anastomotic
dehiscence x3
2 urether transection
peritonitis after small
bowel injury
No mortality
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wound infection, bowel
paresis, .....
Cost comparison
sygma / rectum resection
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The cost of our laparoscopic colon resection is
comparable with open colon surgery.
OVERALL PRICE lap
OVERALL PRICE open
10077,31
10171,98
Perko Z, Kraljević D, Družijanić N, Juričić J, Tomić I, Baković A, Mimica Ž, Petričević A, Baća I, Krnić D, Bilan K.
Laparoskopska kirurgija kolona. Acta Chir Croat 2004; 1: 23-31.
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conclusions
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Considering our short experience
(high volume hospital / surgeon)
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laparoscopic colon resection
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during learning curve and literature data
comparable with open colon resection
including malignant disease treatment
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Split 2006