2005 SAGES Abstracts

POSTER ABSTRACTS
One patient had undergone a previous non-diverted transanal
repair, which failed. All four patients were doing well after
their initial laparoscopic prostatectomy until one week postop
whereby pneumoturia and fecaluria occurred. The injury
occurred during dissection at the initial laparoscopic procedure.
This is most likely a result of heat transfer which lead to
the fistulas to open a week later.
Conclusion: RUF is rare, but since the etiology is associated
with therapy for a very common disease, they will continue to
be encountered. Despite performing the prostatectomy laparoscopically,
there is still a risk of rectourethral injury. The perineal
approach with gracilis muscle interposition is a reliable
although relatively complex method of RUF repair which
results in healthy, well vascularized tissue between the rectum
and urethra, while at the same time affording optimal opportunity
for urethral mobilization and repair.
P117–Colorectal/Intestinal Surgery
LAPAROSCOPIC VS OPEN COLO-RECTAL RESECTION FOR
CANCER: LONG TERM RESULTS ELEVEN YEARS ON,
Emanuele Lezoche MD, Mario Guerrieri MD,Angelo De Sanctis
MD,Roberto Campagnacci MD,Alessandro Maria Paganini
MD,Ylenia Sarnari MD,Maddalena Baldarelli MD,Giovanni
Lezoche MD, 1 ?Paride Stefanini? Department of Surgery, 2nd
Surgical Institute, ?La Sapienza? University, Rome, Italy 2
Department of Laparoscopy and Minimally-invasive Surgery,
University of Ancona, ?Umberto I? Hospital, Ancona, Italy
Aims of this clinical study were to compare the long-term outcome
with a minimum follow-up of 12 months between
laparoscopic and open approach for the treatment of colo-rectal
cancer.
Between 1992 and 2003, of 397 patients (pts) with colonic cancer,
274 underwent Laparoscopic Resection (LR), whereas 123
were treated by Open Resection OR. Three hundred two pts
were included in this study (207 LR, 95 OR); we excluded pts
who underwent a palliative resection (39 LR, 20 OR), perioperative
mortality (3 LR, 1 OR), conversion to open surgery (8),
pts lost to follow-up (4 LR, 2 OR) and pts died from causes not
related to cancer (13 LR, 5 OR). Mean follow-up was 53.6
months during which time we observed 1 case of port-site
metastases (0.5%) in Dukes? stage C. No Statistically
Significant Difference (SSD) was observed in the Local
Recurrences rate (3.4% after LR and 7.3% after OR) (p=0.24)
and in the incidence of Distant Metastases (11.6% after LR and
10.5% after OR) (p=0.96). At 84 months of follow-up cumulative
survival probability in LR was 0.927 as compared to 0.842
after OR (p=0.65). One hundred-seventy-two pts in the laparoscopic
group (83.1%) and 78 in the open group (82.1%) are disease
free.
Between 1992 and 2003, of 156 pts with rectal cancer, 110
underwent LR and 46 OR. One hundred-twenty-four pts were
included in this study (85 LR, 39 OR); we excluded pts who
underwent a palliative resection (10 LR, 6 OR), conversion to
open surgery (12), pts lost to follow-up (1 LR) and pts died
from causes not related to cancer (2 LR, 1 OR). Mean follow-up
was 51.8 months. No SSD was observed in the Local
Recurrences rate (11.7% after LR and 15.3% after OR) (p=0.84)
and in the incidence of Distant Metastases (11.7% after LR and
17.9% after OR) (p=0.60). At 84 months of follow-up cumulative
survival probability in LR was 0.823 as compared to 0.666
after OR (p=0.57). Sixty-five pts (76.5%) in the laparoscopic
group and 26 in the open group (66.6%) are disease free. The
higher local recurrences rate in our pts with rectal cancer is
related to the had little or no response to neoadjuvant therapy
(?oncologically unfavourable patient group?); a selected group
of pts who had demonstrated a better response to neoadjuvant
therapy was underwent Transanal Endoscopic
Microsurgery (TEM) where the local recurrence rate was 1,5%.
We conclude that laparoscopic surgery could guarantee an
oncological radicality.
P118–Colorectal/Intestinal Surgery
LONG TERM RESULTS OF LAPAROSCOPIC VS OPEN COLO-
RECTAL RESECTIONS FOR CANCER IN 235 PATIENTS WITH A
MINIMUM FOLLOW-UP OF 5 YEARS, Emanuele Lezoche MD,
Mario Guerrieri MD,Angelo De Sanctis MD,Roberto
Campagnacci MD,Alessandro Maria Paganini MD,Ylenia
Sarnari MD,Maddalena Baldarelli MD,Giovanni Lezoche MD, 1
?Paride Stefanini? Department of Surgery, 2nd Surgical
Institute, ?La Sapienza? University, Rome, Italy 2 Department
of Laparoscopy and Minimally-invasive Surgery, University of
Ancona, ?Umberto I? Hospital, Ancona, Italy
This study aimed to compare the long-term outcome with a
minimum follow-up of 5 years between laparoscopic or open
approach for the treatment of colo-rectal cancer.
Between 1992 and 1999, 312 patients (pts) were operated: 192
underwent laparoscopic colo-rectal resection (LR) whereas 120
were treated by open surgery (OR).
Of 207 pts with colonic cancer, 125 underwent LR, whereas 82
were treated by OR. One hundred fourty nine pts have been
studied (85 LR, 64 OR); we excluded pts who underwent a palliative
resection (16 LR, 11 OR), perioperative mortality (3 LR, 1
OR), conversion to open surgery (4), pts lost to follow-up (4
LR, 2 OR) and pts died from causes not related to cancer (13
LR, 4 OR). Mean follow-up was 62.8 months. No Statistically
Significant Difference (SSD) was observed in the Local
Recurrences rate (3.5% after LR and 6.2% after OR) (p=0.726)
and in the incidence of Distant Metastases (10.5% after LR and
10.9% after OR) (p=0.838). At 84 months of follow-up cumulative
survival probability in LR was 0.882 as compared to 0.859
after OR (p=0.990). Seventy-two pts in the laparoscopic group
(84.7%) and 53 in the open group (82.8%) are disease free.
Of 105 pts with rectal cancer, 67 underwent LR and 38 OR.
Eighty six pts were included in this study (52 LR, 34 OR); we
excluded pts who underwent a palliative resection (4 LR, 3
OR), conversion to open surgery (8), pts lost to follow-up (1
LR) and pts died from causes not related to cancer (2 LR, 1
OR). Mean follow-up was 58.7 months. No SSD was observed
in the Local Recurrences rate (19.2% after LR and 17.6% after
OR) (p=0.900) and in the incidence of Distant Metastases
(15.3% after LR and 20.5% after OR) (p=0.815). At 84 months of
follow-up cumulative survival probability in LR was 0.711 as
compared to 0.617 after OR (p=0.819). Thirty six pts (69.2%) in
the laparoscopic group and 21 in the open group (61.7%) are
disease free. Regard the higher incidence of local recurrences
in the present series of pts with rectal cancer we must take
into account that the majority of this pts represent an oncologically
?unfavourable? patient group because they had little or
no response to neoadjuvant therapy; a selected group of pts
who had demonstrated a better response to neoadjuvant therapy
was underwent Transanal Endoscopic Microsurgery (TEM)
where the local recurrence rate was 1,5%.
We conclude that no adverse long-term oncologic outcomes of
laparoscopic resections for colorectal cancer were observed.
P119–Colorectal/Intestinal Surgery
SURGEON-INITIATED SCREENING COLONOSCOPY PROGRAM
BASED ON SAGES AND ASCRC RECOMMENDATIONS IN A
GENERAL SURGERY PRACTICE, Edward Lin DO, Leena
Khaitan MD,Dianne Williams RN,C. Daniel Smith MD, Emory
University School of Medicine and Emory Crawford Long
Hospital
PURPOSE:To determine the utility of a screening colonoscopy
program initiated by general surgeons in an academic center.
METHODS: New patients who meet screening colonoscopy
indications presenting to three general surgeons were asked if
they have had colorectal cancer (CRC) screening. Patients who
did not have CRC screening were offered screening colonoscopies
or referred to their gastroenterologists. RESULTS: In
the first 9-month period of the program, 200 patients who met
the SAGES/ASCRC indications for CRC screening were asked if
they have had screenings, but only 46% (92) had any prior
appropriate screenings. Of the patients who elected CRC
screening by the surgeons, 55 patients underwent full-colonoscopies
(2 concurrently with hemorrhoidectomies) and 2
patients had flexible sigmoidoscopies. Ten patients (18%)
required treatment as a result of screening; 7 patients had
polypectomies, 2 patients required partial colectomies, and 1
patient with indication for surgery deferred treatment. CON-
CLUSIONS: The majority of patients presenting to the general
surgeon likely have not had CRC screening and diligence in
making appropriate recommendations should be routine.
Colonoscopic findings requiring intervention is not insignificant.
http://www.sages.org/
SAGES 2005
155