Short-term outcomes of laparoscopic-assisted colectomy versus open colectomy in patients with colonic carcinoma: a prospective randomized study

Introduction: The second most common cause of cancer-related mortality is colorectal cancer, and laparoscopic-assisted colectomy (LAC) has gained popularity among surgeons as an alternative to the conventional approach, which is open colecrtomy (OC). The differences between LAC and OC in terms of short-term outcomes have not been well documented, and the aim of the present work is to compare the short-term outcomes of both procedures. Materials and Methods: The present prospective study comprised 164 participants submitted to LAC (n = 82) and OC (n = 82) at the Helwan and Zagazig University hospitals between January 2018 and January 2022. We collected and analyzed demographic data, surgical data, and the short-term outcomes. Results: The LAC group had a significantly lower estimated amount of blood loss, shorter hospital stay, lower rates of incisional surgical site infection, and fewer cases of burst abdomen postoperatively, but with a considerably longer operative time (30.3 minutes) than the OC group. Conclusions: Our findings show that LAC is favorable option to OC, with superior outcomes. (AU)

Repeatedly Recurrent Colon Cancer Involving the Appendiceal Orifice after Endoscopic Piecemeal Mucosal Resection: A Case Report / 대한소화기학회지

Local recurrence after endoscopic piecemeal mucosal resection (EPMR) for colorectal tumors is a crucial issue. However, such recurrence is usually detected within one year and cured with additional endoscopic treatment, which makes EPMR acceptable. Herein, we report a rare case of repeatedly recurrent colon cancer involving the appendiceal orifice after EPMR, which was not cured with additional endoscopic treatments. A 67-year-old man was referred to us for endoscopic treatment of a 25 mm cecal tumor spreading to the appendiceal orifice in May 2002. The tumor was resected with EPMR, showing well differentiated intramucosal adenocarcinoma with a positive lateral cut margin of tubular adenoma. Endoscopic surveillance was conducted and the first local recurrence was detected in August 2006. Although we resected it endoscopically, the second local recurrence was found in September 2007 and we removed it with endoscopic resection again. However, the third local recurrence was detected in March 2008. Although endoscopic resection was performed also for the third recurrence, curative resection was not achieved. In February 2009, laparoscopic assisted colectomy was performed and histopathological examination showed well differentiated adenocarcinoma with deep submucosal invasion. This case is important in considering indication for endoscopic resection in colorectal tumors involving the appendiceal orifice.

Early Experiences with Laparoscopic- assisted Colectomy: Retrospective Comparison with Open Colectomy (Case-control Study)

Purpose: The aim of this study was to review our experience with laparoscopic-assisted colectomy (LACs), and to evaluate its feasibility and safety for surgical treatment of colorectal diseases, including cancer. Methods: Between September 2002 and September 2005, a LAC was performed in 58 patients. Of these, 6 cases of conversion to open colectomy were excluded from the analysis. Fifty conventional open colectomy (OCs) with clinicopathologic characteristics comparable to those of the LACs were selected and matched as a control group for comparative analysis regarding short-term oncologic and perioperative outcomes. The mean follow-up period was 13.8 (2~37) months. Results: Thirteen complications, involving 11 patients, occurred. The mean operative time of the LAC was longer than that of the OC (215 min vs. 179 min; P<0.0001). However, earlier restoration of bowel function was achieved in the LAC as measured by postoperative first flatus (2.8 days vs. 3.8 days) and intake of a clear liquid diet (4.7 days vs. 5.8 days). There was no significant difference in hospital stay (LAC vs. OC, 10.2 days vs. 11.8 days). In patients with malignancy, the proximal resection margin in the LAC was significantly shorter than that in the OC (9.2 cm vs. 13.3 cm; P<0.0001). However, there were no significant differences in the mean numbers of harvested lymph nodes (LAC vs. OC, 16.6 vs. 19.3; P=0.4330) and the mean distal resection margins (LAC vs. OC, 6.9 cm vs. 6.0 cm; P=0.1359). There were 3 distant metastases and one local recurrence during follow-up in the LAC group, but no port-site recurrence. Conclusions: In this study, we could not receive an advantage of shorter hospital stay due to the relatively high complication rate for a LAC, which may reflect a learning curve. Earlier postoperative recovery of bowel function and equal pathologic extent of resection in the LAC suggest that the LAC is an acceptable alternative procedure in the treatment of colorectal diseases, including malignancy. More experience with the LAC is necessary to overcome the learning curve. Affirmative long-term oncologic outcomes of are expected for the LAC.