Sandeep K Jha, MBBS, MSGen, Surg, Neeraj Chaudhary, Neeraj Dhamija, Abhideep Chaudhary, B B Agarwal, Saumitra Rawat. Sir Ganga Ram Hospital
Introduction: Laparoscopic approach is increasingly being applied to colorectal cancer surgery following results from large, multi-centre trials proving its non-inferiority to open approach. While immediate post-operative advantages are apparent, oncological clearance and long-term outcome is still under debate and whether comparable results can be attained at smaller centres. Our objective was to study the short-term outcomes and oncological clearance in laparoscopic colorectal cancer surgery.
Methods: This study analyses the prospectively collected data of all patients undergoing laparoscopic colorectal cancer surgery between June 2013 to August 2014. All procedures were performed completely by senior laparoscopic surgeon himself or by resident trainees under his supervision. Morbidity and mortality associated with this procedure was analysed along with peri-operative parameters and final histo-pathological diagnosis.
Results: During the study period a total of 29 patients were planned for laparoscopic colorectal surgery and 24 of these patients had a diagnosis of colorectal cancer. Of the remaining, two had ulcerative colitis, one each had FAP, Tubercular ileal stricture and polyp with high grade dysplasia. Of the 24 patients, 21 successfully underwent a laparoscopic or lap-assisted procedure. Two patients were converted to ensure adequate tumor clearance and one procedure was abandoned due to non-obstructive metastatic disease found at diagnostic laparoscopy. Mean age was 61 years with two-thirds being men. Four patients were found to have metastatic disease and colectomy with palliative intent was done. Rectal carcinomas comprised 5/21(23%) of the cases and 3/5(60%) underwent a laparoscopic APR. Primary anastomosis was achieved in 11/21(52%) patients however diversion ileostomy was required in 4/11(36%) subject to surgeon’s assessment. Mean operative time was 228 min and may be attributed to the learning curve of resident trainees who performed a substantial proportion of the procedures. The mean post-op hospital stay was 8 days. There were no anastomotic leaks, re-operations or peri-operative mortality. Adhesive sub-acute obstruction (2/21; 9.5%) and surgical site infection (2/21; 9.5%) were the most common complications. R0 resection was achieved in 20/21(95%) and in one patient lympho-vascular involvement at margin was seen. Majority of carcinomas were moderately differentiated (16/2; 76%) and 4/21(19%) were poorly differentiated. Mean lymph node yield was 20 (13-40) and lymph node involvement was seen in 11/21 (52%). Lymph node positivity ratio ranged from 3%-100%. Lympho-vascular involvement was seen in 11/21(52%) whereas perineural involvement was seen in 1/21 (~5%).Stage I disease was found in 4/21(19%) Stage IIa in 6/21(29%), Stage IIIb in 3/21 (14.2%), Stage IIIc in 4/21(19%) and Stage IVb disease was found in 4/21(19%).
Conclusions: Laparoscopic colorectal surgery is a viable and efficient treatment modality that can be safely offered with markedly improved post-operative recovery and adequate oncological clearance. Majority of our patients were T3 or with nodal disease and laparoscopic resection was achieved with oncological safety and minimal peri-operative morbidity.