Lymph Node Retrieval in Colorectal Cancer in the Era of Minimally Invasive Surgery: Are We Following Oncologic Principles?

Laila Rashidi, MD, Mike L Kueht, MS, Aakash H Gajjar, MD. University of Texas Medical Branch, Galveston, Texas, USA

 

Introduction:

Hand-assisted laparoscopic surgery (HALS) and single incision laparoscopic surgery (SILS) are minimally invasive surgical techniques that have been slowly adopted by general and colorectal surgeons. Conventional laparoscopic surgery is associated with shorter hospital stay, decreased postoperative pain, earlier return to gastrointestinal function, and fewer postoperative wound and pulmonary complications. According to National Institute of Health (NIH) and American Joint Committee of Cancer (AJCC) at least 12 lymph nodes are required for accurate colon cancer staging. Our study compared lymph node harvesting in laparoscopic (including HALS and SILS) versus open colorectal cancer surgery.

Methods and Procedure:

This study is a retrospective single-center chart review series. We searched records for all colon and rectal related surgeries from 2005 to 2011 and excluded surgeries for causes other than malignancy. Patients were divided into four major groups based on the type of surgery: open surgery (OS), straight laparoscopy (LAP), hand assisted laparoscopy (HALS), and single incision laparoscopy (SILS). Patients in all groups were further divided based on the technique of surgery (right, left, transverse, sigmoid colectomy, and lower anterior resection). The mean procedure time, length of stay, and number of lymph nodes resected with each surgical technique were compared using 2-tailed student T test.

Results:

A total of 222 colectomies for colorectal malignancy were considered. There were a total of 112 LAP procedures and 96 OS procedures. 7 HALS and 7 SILS were performed. The average age of all patients was 62.5 + 13 years. There were 104 (47%) female and 118 (53%) male participants. Patients were 67% Caucasian, 20% African American, and 13% Hispanic. The average number of lymph nodes resected per patient by LAP, HALS, and SILS (19.6) was lower than that of OS (23.1) (p= 0.019), however, the HALS and SILS group had greater node retrieval (20.5) compared to LAP group (16.3) (p=0.151). OS average OR time (195 min) was longer than both the LAP (168 min) and HALS group (193 min), however, the time for the SILS group was longer (245 min). The average hospital stay was 1.9 times longer for OS (12.8 days) when compared to the combined LAP, HALS, and SILS group (6.8 days) (p=0.005). The average hospital stay for HALS and SILS (3.7 days) was less compared to LAP (6.9 days). (p=0.002).

Conclusion:

HALS and SILS surgery allow for higher lymph node retrieval compared to conventional LAP, however, is less, but not statistically significant compared to OS. These techniques do not compromise oncologic principles recommended by NIH and AJCC. HALS and SILS allow for less time in the hospital compared to LAP and OS, however, SILS was associated with longer operative times possibly attributed by innovation and its learning curve. Our study was limited by the number of HALS and SILS performed. More procedures are required to evaluate the practicality of HALS and SILS.

 


Session Number: SS20 – Colorectal
Program Number: S113

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