Introduction: The learning curve for laparoscopic colectomy (LAC) is considered long and difficult. The presence of a preceptor may shorten the learning curve of LAC and ensure adequate oncologic and short term results. City of Hope implemented a full time LAC preceptorship between September 2004 and March 2006 with one experienced surgeon assisting 6 other staff surgeons. We review our outcomes with laparoscopic colon resection for colon adenocarcinoma after implementation of this preceptorship.
Methods and Procedures: All cases of laparoscopic colon resection for adenocarcinoma performed until April 2009 were retrospectively reviewed. Clinical characteristics evaluated included sex, age, body mass index (BMI), ASA level and history of previous abdominal surgery. Post-operative variables evaluated included type of operation, conversion to open surgery, estimated blood loss (EBL), operation time, stage, number of harvested lymph nodes, time to liquid diet, post-operative stay, complications, and 30-day mortality rate. Kaplan-Meier survival curves were constructed based on disease-free survival (DFS) and overall survival (OS).
Results: One hundred-eighteen patients were identified who underwent LAC for cancer during the study period. Mean age was 66.5 years with a mean BMI of 27.9 (kg/m2). Fifty percent of patients had prior abdominal surgery. There was a 14.4% conversion rate . Most patients (77.1%) underwent lap right hemicolectomy or sigmoid colectomy. There was a near-even distribution of Stage I-III disease among patients (Stage I 35.6%; II 28.8%; III 28%). The average number of lymph nodes removed was 18.6. No 30-day mortalities were observed. The 3-year DFS was 95.1% with mean follow-up of 22.9 months and 3-year OS was 89.6% with mean follow-up of 20.5 months.
Conclusions: Implementation of a full-time preceptorship program can hep institutions overcome the challenges of laparoscopic colectomy and achieve acceptable postoperative and oncologic ourcomes.
Program Number: P158