Takeshi Naitoh, MD, FACS, Shinobu Ohnuma, MD, PhD, Tomoya Abe, MD, PhD, Munenori Nagao, MD, PhD, Hiroyuki Sasaki, MD, PhD, Kazuhiro Watanabe, MD, PhD, Hideaki Karasawa, MD, PhD, Hiroaki Musha, MD, PhD, Naoki Tanaka, MD, PhD, Katsuyoshi Kudo, MD, PhD, Fumie Ikezawa, MD, PhD, Kei Nakagawa, MD, PhD, Takanori Morikawa, MD, PhD, Hiroshi Yoshida, MD, PhD, Fuyuhiko Motoi, MD, PhD, Yu Katayose, MD, PhD, Michiaki Unno, MD, PhD. Department of Surgery, Tohoku University Graduate School of Medicine
[Backgrounds] A history of previous abdominal surgery often has some influences on performability of laparoscopic procedures. Severe adhesion of bowels to the operative scar or adhesion between bowels would be a problem and surgeons could not often help converting to the conventional procedures. On the other hand, the recent progress of laparoscopic equipment makes several complicated procedures feasible to perform without conversion to open surgeries. The high-definition image system, for example, helps to recognize detail anatomies that lead to precise dissection. Some energy devices are useful to perform precise dissection, as well. In this study, we aimed to assess if previous abdominal surgery history had influence on the performability of laparoscopic colon cancer surgery in a retrospective way.
[Patients & Methods] Since July 2008 to June 2013, ninety-nine cases of colon cancer were operated laparoscopically. Forty-four cases had history of previous abdominal surgery. Of those we assessed operative outcome such as operative time, estimated blood loss, and perioperative morbidity compared to patients who do not have previous abdominal surgery.
[Results] Distribution of tumor localization is as follows: 14 in cecum, 25 in ascending colon, 16 in transverse colon, 5 in descending colon, and 39 in sigmoid colon. Median age of patients was 69 year-old, and male female ratio was 55:44. Of those 44 cases had previous abdominal surgery. Multiple procedures were done in 12 cases, and 4 cases had three times history of abdominal surgery prior to colon cancer surgery. Types of previous abdominal surgery were as follows: 33 appendectomy, 13 gynecological procedures, 4 cholecystectomy, 4 gastrectomy, 1 colectomy, 1 nephrectomy, 1 abdominal aortic replacement, 1 liver resection, and 2 miscellaneous procedures. Six of those procedures were done by laparoscopic technique. One cases of no-previous-surgery (NPS) group was converted to open surgery, while no conversion was seen in previous-surgery (PS) group. Operative time was 205 min. in NPS group while 209 min. in PS group. Estimated blood loss was 47 ml and 59 ml, respectively. No difference was seen in both operative time and blood loss. Postoperative hospital stay was not prolonged, as well: 11.0 days vs. 11.8 days. Postoperative complication was seen in 7 cases: 4 surgical site infections, 2 pneumonia, and 1 ileus. Of those, 6 cases were of NPS group. No anastomotic leakage was seen in both groups. In cases of right side colon cancer, difference of operative time and blood loss between groups was minimum (215 min. in NPS group vs. 206 min. in PS group, 73 ml in NPS group and 60 ml in PS group). However, in cases of left side colon, these differences were slightly enhanced though it is not significant (189 min. in NPS group and 205 min. in PS group, 24 ml in NPS group and 42 ml in PS group).
[Conclusion] In these series, previous abdominal surgery, on the whole, does not affect to the operative outcome. However, in left colon cancer cases, operative time and blood loss might be influenced by previous abdominal surgery history.