Comparative Analysis of Open and Laparoscopic Colectomy for Malignancy in a Developing Country

Pierre-anthony Leake, MD, Kristen B Pitzul, MSc, Patrick O Roberts, MD, Joseph M Plummer, MD. University of the West Indies (Mona Campus), Kingston, Jamaica, West Indies

INTRODUCTION: Despite the various factors limiting the widespread use of laparoscopic colectomy for colorectal cancer in developing countries, short term and oncologic outcomes similar to those noted in large prospective studies can be achieved in these environments. Previous studies have demonstrated laparoscopic colectomy to be a safe and feasible approach to colonic neoplasms in developing countries. Demonstrating outcomes similar to those achieved in the developed world will further support the continued growth of laparoscopy in the developing world. METHODS AND PROCEDURES: The records for patients who underwent elective open and laparoscopic colectomies for cancer at the University Hospital of the West Indies between January 1, 2005 and December 31, 2010 were retrospectively reviewed. One hundred and four charts were grouped according to intention-to-treat for colonic resections. Emergency procedures and rectal resections were excluded. Demographic, peri-operative, post-operative and oncologic data were collected for each patient. Fisher’s exact, Mann-Whitney, and binary logistic regression tests were used for analysis. Significance level was set at P < 0.05. RESULTS: There were 87 cases for open colectomy (OC) and 17 cases for laparoscopic colectomy (LC). Demographics such as gender, age, and Charlson comorbidity index score (CCI) did not significantly differ between OC and LC groups (P_gender= 0.429; P_age < 0.363; P_cci = 0.501). Only 1 laparoscopic case was converted. Intra-operative blood loss and number of post-operative parental narcotic doses did not significantly differ between groups (P_blood < 0.512; P_narcotics < 0.176). There was a trend towards longer operating times in the OC group (P < 0.075). Controlling for potential confounding variables, there was a trend towards shorter length of hospital stay in the LC group (P < 0.083). Lymph node yield (P < 0.619), proximal (P < 0.353) and distal (P < 0.57) resection margin distance and circumferential margin involvement (P = 0.348) did not significantly differ between groups. Thirty-day morbidity was equivalent between groups (P = 0.774). There were 6 deaths within 30 days of initial procedure, all in the OCR group (6.9%). CONCLUSION: Laparoscopic colectomy in the developing world is oncologically safe and represents a viable option for colectomy for cancer in these regions. It provides short-term outcomes at least equivalent to open colectomy. Continued experience with laparoscopy in these settings will serve to more clearly demonstrate the well-established benefits of this operative approach.