Totally laparoscopic versus laparoscopic assisted left colectomy for cancer: A retrospective review

Forat Swaid, MD, Gideon Sroka, MD, Hussam Madi, MD, Dan Shteinberg, MD, Mustafa Somri, Prof, Ibrahim Matter. Bnai-Zion Medical Center

Background: Laparoscopic left colectomy (LLC) became the standard of care for treating distal transverse and descending colon cancer in many centers. Most centers use laparoscopic assisted colectomy with extracorporeal anstomosis (LAC/EA). A totally laparoscopic colectomy with intracorporeal anastomosis (TLC/IA) has been proposed. The purpose of our study is to compare these two techniques.

Methods: A series of 52 patients undergoing LLC for left-sided colon cancer was retrospectively evaluated. Thirty three patients underwent TLC/IA, and 19 underwent LAC/EA. The following data was collected: gender, age, body mass index (BMI), American Society of Anesthesiologists risk class (ASA), operation duration, conversion to laparotomy, intra-operative complications, postoperative complications, postoperative course (duration of stay, time to first flatus), number of excised lymph nodes, readmission, and reoperation rates. Data was prospectively recorded in a colorectal cancer database and retrospectively analyzed.

Results: The only demographic parameter that differed significantly between the groups was age (64.2±12.4 years for the TLC/IA group, vs. 72.7±2.1 years for LAC/EA, p=0.0116). The mini-laparotomy incision was significantly shorter in the TLC/IA than in the LAC/EA group (5.8±0.9 cm vs. 8.2±0.9 cm, respectively, p<0.00001).  Hospital stay duration was shorter in the TLC/IA group (4.2 ±1.2 vs. 6.3±1.9, p=0.0001). The average number of harvested lymph nodes did not differ significantly between the groups (12.9±5.7 in TLC/IA vs. 11.2±4.2 in LAC/EA, p=0.2546). No significant differences between the groups were observed in any other perioperative or surgical outcome parameters.

Conclusions: TLC/IA in LLC for the treatment of left colon cancer is technically feasible and can be performed with a low complication rate, favorable cosmetics, and possibly shorter hospital stay, without significantly lengthening operative duration or compromising oncologic radicality principles. Although further prospective randomized studies are needed to determine its role and limitations, we encourage using it as an alternative to LAC/EA in LLC.

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