Purpose: To evaluate short term clinical and oncologic outcomes of hand-assisted laparoscopic (HAL) colectomy for cancer compared with case matched open colectomies.
Methods: All 168 HAL colorectal procedures performed at out institution between August 2002 and August 2006 were review. Rectal procedures and colectomies performed for benign disease were excluded. Thirty-seven colon cancers remained for analysis. These procedures were case matched with 37 open colectomies performed between February 1998 and August 2006. Case matching was performed by; stage, location, age, sex, and ASA score. The groups were compared for; operative time, estimated blood loss, length of hospital stay, lymph node harvest, intra-operative and 30 day post operative complication rates. Overall and cancer specific survival were evaluated. One-hundred percent follow up was achieved using chart review, telephone contact and Social Security Death Index.
Results: Demographics were similar between groups. The HAL group included 21 right, 13 left and sigmoid, 2 transverse and 1 subtotal colectomies. The Open group; 18 right, 16 left, 2 transverse and 1 subtotal colectomies. In the HAL group there were twelve Stage I, thirteen Stage II, nine Stage III and three Stage IV patients. In the open group there were, eleven Stage I, fifteen Stage II, seven stage III and four Stage IV. There was one conversion two open in the HAL group, overall percent of 2.7%. Operative time, 184 vs.176 min (p=0.52) and lymph node harvest, 13.58 vs. 14.79 (p=0.42) were not statistically different between groups. Estimated blood loss, 85 vs. 165ml (p=0.005), and length of stay 4.5 vs. 7.9 days (p=0.0025) were significantly less for HAL group. Intra-operative and 30 day post-op complications were similar at 0.5 vs. 0.5% and 42.vs. 45% respectively. In the follow up period there were a total of 6 deaths in the open group all cancer related. There were total of 3 deaths in the HAL group 2 cardio-pulmonary, one cancer related.
Conclusion: HAL colectomy appears to be equivalent to open colectomy in terms of safety and early oncologic outcomes, while maintaining the benefits of minimally invasive surgery. Larger studies with longer duration of follow up are warranted for the comparision of survival.
Program Number: P122