Laparoscopic Colectomy
Laparoscopic colectomy for colorectal cancer is increasingly the standard treatment. The objective of our work is to show that the short-term results and oncological safety provided by the laparoscopic route are at least equivalent to those of laparotomy in the treatment of non-metastatic colonic adenocarcinoma. We also propose to study the impact of the learning curve on the results of laparoscopy in these cancers.
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Methods
This is a retrospective study including all patients operated on for resectable colonic adenocarcinoma over a period of 6 years. The study population divided into 2 groups, depending on the approach initially used. The “OC” group included 35 patients operated by midline laparotomy and the “LAC” group included 30 patients operated by laparoscopy. All information were examined using SPSS version 19.0 software.
We conducted a retrospective, single-center study. This study collected 65 patients operated on for resectable and non-metastatic colonic ADK. The work carried out over a period of 6 years from January 2006 to December 2011. The inclusion criteria were histological criteria. Only patients with colonic ADK proven by pathological examination of biopsy fragments. The operating room. The seat of the tumour. Located between the valve of Bauhin and the rectosigmoid hinge. Subjects of both sexes whose age and condition allowed curative treatment. Colonic ADK classified from T1 to T4a and non-metastatic according to the 2009 TNM classification of the International Union Against Cancer.
The non-inclusion criteria were: colonic ADKs with multiple locations; Complicated forms of occlusion, suppuration, fistulization or hemorrhage; Colonic ADKs in the context of proven familial adenomatous polyposis or hereditary nonpolyposis colorectal cancer syndrome or Lynch syndrome; History of colonic surgery; The existence of severe or morbid obesity with a body mass index = 35 kg/m 2 .
Exclusion Criteria
Locally advanced and/or metastatic tumors discovered intraoperatively; Pneumoperitoneum intolerance. The population of our study divided into 2 groups according to the approach initially used. The first group operated by laparotomy called the “Open Colectomy” group. The 2ndthe group operated by laparoscopy called the “Laparoscopic-Assisted Colectomy” group. The choice of approach left to the surgeon.
The variables studied were epidemiological data, morphological and histological characteristics of tumors, biological, radiological and endoscopic examinations, approach, duration of intervention and surgical procedures. The main judgment criteria were the short-term and long-term results as well as oncological safety defined by the limits of resection and the number of lymph nodes removed. . The comparisons of 2 means on independent series were carried out by means of Student's t test for independent series.
The comparisons of percentages on independent series carried out by the Pearson chi-square test, and in the event of significance with the chi-square test and of invalidity of this test and comparison of 2 percentages, by the bilateral exact test of Fisher. The survival data studied by establishing survival curves according to the Kaplan Meier method. The significance level was set at 0.05. All information were analyzed using SPSS version 19.0 software.
Results
Our study did not show any significant difference in the short-term results between the two groups, namely intraoperative morbidity, hospital stay, intensive care unit stay and postoperative morbidity and mortality. Regarding the long-term results, there was also no significant difference in terms of late complications, type of recurrence, overall survival and recurrence-free survival.
Conclusion
Oncological safety, attested by the limits of resections and the number of nodes removed, was not significantly different between the two groups. Operative time was significantly longer in laparoscopy. The conversion rate was 33%. It went from 67% in the first 2 years of the study to 13% in the last 2 years.
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