Adaptation of Laparoscopic Surgery for Right Side Colon Cancer – Learn From Open Colectomy Cases

Atsushi Ikeda, title, Atsuko Tsutsui, title, Hirohisa Miura, title, Naoto Ogura, MD, Masanori Naito, MD PhD, Takatoshi Nakamura, MD PhD, Takeo Sato, MD PhD, Masahiko Watanabe, MD PhD. Depertment of Surgery, Kitasato University School of Medicine

 

BACKGROUND:
 Laparoscopic colectomy (LAC) has come to be widespread throughout the world. In our institution, the laparoscopic surgery has been introduced since 1995. The initial deployment was intended for early cancer, and now has been expanded gradually adapt to T4a cases. Secure of the surgical field and understanding of the retroperitoneal layer is very important to perform safe laparoscopic surgery. Furthermore, it is important that we understand blood vessels’ anatomy before surgery especially for laparoscopic operations. Currently, there are no rules in clearly non-adaptive in LAC. Insufficient decompression of the bowel, huge tumor, peritoneal dissemination and poor general conditions are generally considered non-adaptive cases of LAC. But in fact, decision about the surgical procedures is decided in individual cases.
PURPOSE:
 The cases for open colectomy (OC) performed to right-sided colon cancer, a retrospective study reaffirm the difficulty in laparoscopic surgery patients.
OBJECTS:
 From April 2005 to December 2009, all operative patients for colorectal cancer were 730 cases. Surgery for right side colon cancer was performed 141 cases, and 3D-CT was performed among these 119 patients. OC (43 cases) and conversion from LAC to OC (8 cases) a total of 51 cases was included in this study.
EXAMINATIONS:
 Rate of LAC, conversion rate from LAC to OC, non-indication reasons for LAC, reasons for conversion from LAC to OC.
RESULTS:
 The rate of LAC for right side colon cancer was 57.1% (68/119) and conversion rate was 10.5% (8 / 76). Among the 51 patients, 45 patients underwent OC in patient factors (Conversion from LAC – 8 cases). Detailed analysis of patient factors, 12 patients had a previous laparotomy (Upper abdominal operation – 6 cases, Appendectomy – 5 cases, Sigmoidectomy – 1 case), 28 patients had a primary tumor factors (Invasion to other organs – 15 cases, Ileus 5 cases, Bulky tumor – 6 cases, Total circumference of the transverse colon – 5 cases) and 11 cases had a other factors (Other mergers, such as liver metastasis lesions – 6 cases, Poor general condition – 5 cases). The detail reasons of conversion from LAC to OC, 6 of 8 cases were patient factors (Difficulties of adhesive dissection – 2 cases, Multiple organ invasion – 4 cases), and only 2 cases were surgeon factors (Bleeding from gastrocolic trunk of Henle, Torsion of mesenterium).
CONCLUSION:
 Right colon cancer is often found in advanced state with a slow onset of symptoms. Thereby, it is often forced to choose OC. In our cases, the percentage of patients underwent LAC can be low, because it was the most frequent cause of the patients factors (88.2%). Among them, 54.9% was accounted for selection of OC related to the primary tumor factors. We could reduce the conversion rate and surgeon factors by performing adequate preoperative diagnosis and image evaluation using 3D-CT.


Session Number: Poster – Poster Presentations
Program Number: P042
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