[Laparoscopic colorectal resections -- experience based on 393 cases]. / Laparoscopos colorectalis resectiók -- 393 eset tapasztalatai.

Laparoscopic (LAP) colorectal surgery has become increasingly popular worldwide. Large comparative studies demonstrate the benefit of the method, but data about routine application are relatively moderate. This study presents the results of laparoscopic colorectal linterventions in a non-selected patient population, who were admitted to the 1st Department of Surgery, Semmelweis University between January 2004 and December 2011. 393 patients underwent LAP surgery. In 333 cases the malignant tumor indicated surgery. T3 tumor rate was 62.7%. Synchronous liver metastases were detected in 17 cases, three of them were single and operable, but 14 cases were multiplex and inoperable. Bowel was successfully resected in all cases. Complication rate was 9.9 percent. In-hospital mortality was 2.0%. Length of hospital stay of non-complicated cases was 6.7 days. In 9 cases single incision intervention was performed, with an average length of hospital stay of four days. Rate of sphincter preserving rectal resections were 87.2%. 59 (15.0%) patients underwent conversion from LAP to open surgery. Operating time decreased by time, but both OP time and conversion rate were tipically determinded by the surgeon's skill. LAP surgery was found to be useful for all kind colorectal diseases requiring elective resection. Application of LAP method requires organized training programs.

Evaluation and comparison of the clinical, surgical and pathological TNM staging of colorectal cancer.

BACKGROUND/AIMS: The aim of our study was to compare the results of clinical, surgical and pathological staging of colorectal cancer. METHODOLOGY: 660 patients with colorectal carcinoma were included in the study. The results of the clinical, surgical and pathological staging were compared. RESULTS: Clinical T values were identical with the surgical in 75.15%, and with the pathological in 74.54% respectively. Surgical T values were identical with the clinical in 78.48%. In 67.27% of the cases the clinical evaluation of N value was identical with the surgical one. Clinical evaluation was identical with the pathological result in 60.60% of the cases. Surgical diagnosis of the lymph node metastasis matched the pathological finding in 76.66%. Regarding the M value, the coincidence of the diagnoses was as follows: clinical versus pathological 72.72%, surgical versus pathological 90.90%. Clinical and surgical TNM stages were by 79.09% in accordance. By decision of total TNM stage the clinical-pathological staging showed worse (76.06%), while surgical-pathological showed significantly better (88.48%) matching. CONCLUSIONS: Based on our results we can state that in a quarter of all colorectal cancer cases the extent of the primary tumor could not have been established correctly. The lymph node involvement was well defined in just over half of the cases only. The M values were accurately stated in about three quarters of the cases. High grade of conformity of clinical, surgical and pathological staging can result in better treatment-planning, short- and long-term survival, and higher quality of life.