Laparoscopic colorectal cancer resection: initial follow-up results.

An observational prospective cohort study was made to evaluate the results of laparoscopic colorectal cancer resection, in terms of recurrence and patient survival. Fifty consecutive patients were analyzed, subjected to abdominoperineal amputations of the rectum (n = 10), anterior rectal resection (n = 13), rectosigmoidectomy (n = 18), and other colectomies (right, left, segmentary) (n = 9). Mean follow-up was 21 months (maximum, 42 months). The tumors corresponded to stage I (TNM classification of the International Union Against Cancer) in 6 cases, stage II in 17, stage III in 18, and stage IV in 9 cases. Survival in stages I-IV was 100, 92, 79, and 18%, respectively, with a disease-free survival rate of 100, 70, and 49% in stages I-III, respectively. Recurrence was pelvic in four cases, with multiple growths, peritoneal carcinomatosis, lung metastases, and implantation in the port scar in one case each. To conclude, survival after a maximum follow-up period of 42 months was found to be acceptable and similar to the percentages reported in the literature for open surgery.

Laparoscopic treatment of esophageal achalasia.

An observational cohort study evaluated the initial results of using laparoscopic-approach cardioesophageal myotomy with Dor-type anterior fundoplicature for esophageal achalasia. The study involved our first 12 patients: five men and seven women whose median age was 51 years. Esophageal motility was vigorous in four patients; the other eight had aperistalsis. Conversion to laparotomy was required in one case. No postoperative mortality occurred. Postoperative complications included one left subdiaphragmatic abscess secondary to perforation of the esophageal mucosa, which was sutured. Median postoperative hospital stay was 5 days (confidence interval, 4.7-6.7 days). Symptom relief (disappearance of dysphagia) was recorded in 10 cases; relief with partial persistence of dysphagia was observed in the remaining two patients, who were treated by postoperative dilatation. As to the postoperative manometric results, the median basal pressure of the lower esophageal sphincter was reduced from 26.3 mm Hg preoperatively to 15.5 mm Hg postoperatively, with a tendency toward statistical significance (p = 0.08); the median esophageal isotopic retention after 15 min decreased from 60% preoperatively to 24.5% after surgery, with a tendency toward statistical significance (p = 0.07). Cardiomyotomy with Dor fundoplicature through a laparoscopic approach seems effective in treating esophageal achalasia.

Injury in laparoscopic surgery.

A prospective study was made to evaluate injury caused by laparoscopic surgery, in terms of physiological response. Two groups of patients were established: Group 1 (laparoscopic surgery, n = 26) and Group 2 (open surgery, n = 18). The groups were homogeneous in terms of age, sex, body mass index (BMI), duration of surgery, and anesthetic technique. Both groups exhibited significant postoperative increases in plasma adrenocorticotropic hormone (ACTH), growth hormone (GH), insulin, and cortisol (p < 0.05), with a significant decrease in follicle-stimulating hormone (FSH) and T3 (p < 0.05). Significant increases were noted in 24-h urine cortisol and catecholamine levels in Group 2 (p < 0.05). No correlation was noted between the duration of surgery and the intensity of neuroendocrine response. Acute-phase postoperative metabolic response was greater in Group 2 and was correlated to the duration of surgery. No postoperative hydrosaline or acid-base alterations were recorded in either group. Injury was graded in terms of neuroendocrine and metabolic response and proved highest in Group 2. Complex laparoscopic surgery (e.g., sigmoid colon and esophageal hiatus) exhibited the least neuroendocrine response, whereas laparoscopic inguinal hernioplasty involved the least metabolic response. To conclude, laparoscopic surgery globally involves less neuroendocrine and metabolic response than does open surgery.