Short-Term Outcomes Following Hand-Assisted Laparoscopy for Left-Sided Colon and Rectal Malignancies: Single-Center Experience of 580 Cases

Hand-assisted laparoscopic surgery combines the benefit of minimal access and open surgery. It is an important tool in the armamentarium of a colorectal surgeon and may be of great clinical utility in the resection of left-sided colorectal malignancies. The study aimed to assess the short-term postoperative outcomes following hand-assisted laparoscopic surgery for left-sided colorectal malignancies. This a retrospective study that included 580 patients undergoing hand-assisted laparoscopic resections for left-sided colorectal malignancies from March 2010 to March 2020. Preoperative, intraoperative, and postoperative data of the patients was obtained from carefully maintained patient records. Factors contributing to postoperative complications and length of stay were studied using univariate and multivariate analysis using a logistic regression model. Secondary outcomes studied included conversion rates, operative time, and blood loss. The majority of patients were men with a mean age of 61 ± 14 years. Of these, 210 patients underwent descending colon and sigmoid resections, while 370 underwent rectal resections. The conversion rate was 1.6%. The mean operative time was 120 ± 42 min. The mean length of hospital stay was 7.4 ± 3 days. The most common postoperative complication was surgical site infection (13%), followed by ileus (6.6%). Major complications occurred in 6 patients. Diabetes, hypertension, obesity, non-negotiable tumors, and long operative times were associated with the development of postoperative complications. The development of complications and inability to tolerate oral diet by day 4 was associated with increased length of stay. A negative circumferential resection margin was obtained in 98.9% cases and a negative distal resection margin in 99.6%. The average lymph node yield was 12.6 ± 7. The hand-assisted laparoscopic approach for oncological colorectal resections maintains the advantage of laparoscopy and helps in reducing conversion rates and margin positivity rates.