ABSTRACT
BACKGROUND: This study was undertaken to compare the technical success and outcomes of laparoscopic colectomy performed by resident surgeons (RS) and attending surgeons (AS). METHODS: A review of 451 consecutive laparoscopic colectomies performed by 2 surgeons either with or without a general surgery resident. Data reviewed included demographics, diagnoses, operative data, and outcomes. Comparison was made between patients operated on by RS under attending surgeon supervision, and patients operated on by AS alone. RESULTS: Of 451 patients, 324 were operated on by RS and 127 by AS. The mean age and preoperative diagnoses were similar between groups. Operative time was significantly longer in the RS group (155 minutes vs. 128 minutes, P < .05). Blood loss was slightly higher in RS groups but was not statistically significant (191 mL vs. 174 mL, P = .31). The incidence of conversion to an open procedure, postoperative complications, and length of stay were similar between groups. CONCLUSIONS: Supervised RS can safely perform laparoscopic colectomy with results similar to AS. RS take longer to perform the procedure than AS.
Subject(s)
Colectomy/methods , Internship and Residency , Laparoscopy , Medical Staff, Hospital , Outcome Assessment, Health Care , Adult , Aged , Aged, 80 and over , Clinical Competence , Colonic Diseases/surgery , Female , Hospitals, Community , Humans , Male , Middle Aged , Pennsylvania , Postoperative Complications , Retrospective Studies , Time FactorsABSTRACT
BACKGROUND: Endometrial cancer is the fourth most common malignancy among women. Metastases typically involve the lungs, peritoneal surfaces of the abdominal cavity, and lymph nodes outside the pelvis. CASE: We report an unusually difficult complication of metastatic endometrial cancer occurring in a 57 year-old woman with paraaortic nodal recurrence: refractory occult gastrointestinal bleeding. Repeated upper endoscopic evaluation revealed an extrinsic mass eroding into the third portion of the duodenum. Segmental duodenal resection was performed, and the GI tract was reconstructed with a side-to-side duodenojejunostomy. The postoperative course was uneventful, and the patient experienced durable relief from continued bleeding and impending obstruction. CONCLUSION: We review the role of palliative surgery for bleeding complications of advanced cancer and the alternatives for treating invasive extrinsic lesions of the duodenum.
