Laparoscopic Resection of Colorectal Cancer in a Regional Hospital

Background: Laparoscopic colectomy is a safe and effective alternative to open colectomy for colorectal cancer. It is not widely adopted because of its complex procedures and estimated higher morbidity and mortality in the early period of the learning curve. In this paper, we report on the short-term results of our first 14 consecutive laparoscopic colectomies performed in 2006. Methods: Laparoscopic colectomy was offered as an alternative to elective open colectomy for colorectal cancer, except for T4 tumors. Fourteen patients underwent laparoscopic resection of colorectal cancer in 2006. In this paper the characteristics of patients and tumors are reported as well as the short-term outcomes, including the length of operation time, conversion rate, recovery course, morbidity and mortality. Data were prospectively recorded. Results: Laparoscopic procedures were completed in 13 of the 14 patients. The average operation time was 238 minutes and the average postoperative hospital stay was 17.8 days. The postoperative staging was stage I in 2 patients, stage IIA in 2, stage IIIB in 4, and stage IV in 6, according to the American Joint Committee on Cancer (AJCC). One of the 14 patients experienced ureter injury and conversion of the procedure to open colectomy. Postoperative complications occurred in 3 patients, including respiratory failure in one, anastomosis leak in another one, and wound infection with dehiscence in the remaining one. The only patient whose body-mass index (BMI) was ＞30 kg/m^2 experienced conversion due to intraoperative ureter injury and died of postoperative respiratory failure. The patient with anastomosis leak had severe intraperitoneal adhesion due to 3 previous major intraabdominal operations. No positive margin was detected in the specimens and the average number of harvested lymph nodes was 16. These results closely follow the guidelines of colorectal cancer surgery in Taiwan. Conclusion: Our report indicates that laparoscopic colectomy for colorectal cancer can be developed safely by surgeons with adequate experience in other laparoscopic procedures in a regional hospital. Proper selection of patients, by avoiding cases with a BMI ＞30 kg/m^2 or previous major abdominal surgery, for example, is highly recommended to prevent conversion, and to reduce morbidity and mortality in the early period of the learning curve.