INTRODUCTION: Previous studies analyzing the learning curves in laparoscopic colorectal surgery have focused mainly on non-oncologic outcomes or consisted predominantly of patients with colon cancer. The aim of this study was to analyze the learning curve with particular reference to short-term oncologic outcomes for the laparoscopic approach to recto-sigmoid carcinoma (RSC).
MATERIALS AND METHODS: A retrospective review was conducted of patients that underwent laparoscopic resection for RSC and were chronologically divided into two groups. (Group I: 2001-2003 and Group II: 2004-2006). Data relating to short term oncologic parameters was collected from the final histo-pathologic assessment.
RESULTS: From a total of 174 patients, 119 patients with a median age of 66 years (34-87 years) and male/female ratio of 67/33% were included. The mortality and morbidity rates were 1.68% and 10.9% respectively with a conversion rate of 11.8%. The number of patients with adequate lymph nodes (> 12) and proximal and distal margins > 2cms for the entire cohort was 54%, 98% and 61% respectively. In analyzing the impact of accumulating experience over the period of the study, we found no difference in the rate of obtaining adequate nodal harvest (54 vs 54%, p=1) between Groups I and II. Similarly there was a lack of improvement noted in the rate of obtaining a distal margin > 2 cms in Group II when compared to Group I. (67 vs 54%, p= 0.18)
CONCLUSION: The experience required to surmount the short-term oncologic outcomes-related learning curve in laparoscopic surgery for recto-sigmoid carcinoma is greater than anticipated.
Program Number: P098