2005 SAGES Abstracts

POSTER ABSTRACTS
SAGES 2005
OLAR showed 2 cases of anastomotic leakage, 2 wound infection,
2 paralytic ileus and one atelectasis . In long-term results
of LLAR, there were one lung metastasis, one lymph metastasis
and one death from the other disease . We showed a recurrence
in 5 cases in OLAR, and including one peritoneal and
peritoneal metastasis and 4 liver metastases. In LLAR, the
number of removed lymph node was greater than OLAR, and
mean blood loss was less than OLAR. There was no difference
to operation time and days of hospitalization in both groups.
[conclusion s] LLAR showed better curability and safeness of
treatment for advanced rectal cancer by its good long term
prognosis , little quantity of operative haemorrhage and complications.
However, from a complication such as transient urination
disorder, the hospitalization was equal with OLAR. By
further improvement of operative procedure such as nerve
preservation utilizing magnifying view under laparoscopy,
LLAR could become the standard therapy for advanced rectal
cancer.
P127–Colorectal/Intestinal Surgery
LAPAROSCOPIC-ASSISTED ABDOMINO-PERINEAL RESEC-
TION FOR RECTAL CANCER BY 4 PORTS METHOD, Minoru
Naito MD, Hideo Ino MD,Masakazu Murakami MD,Nobuyoshi
Shimizu MD, Department of Cancer and Throcic Surgery
,Okayama University Graduate School of Medicine and
Dentistry,Okayama,Japan
We have performed 5 cases laparoscopic-assisted
abdominoperineal resection for patients with rectal cancer
between May 1999 and August 2004. All cases were successfully
performed laparoscopically without intraoperative complication.
The patient was placed in the lithotomic position
with Trendelenburg position.We used four ports,initial port for
a laparoscope was inserted just right side of the
umbilicus,then CO2 pneumoperitoneum was created.After
pneumoperitoneum was initiated,three ports were
placed(suprapubic and bilateral pararectal). We used a medial
approach for colorectal mobilization and had performed all
cases with autonomic nerve preservation.Finally a 3cm circular
incision was made over the port site in the left lower quadrant
and the stapled bowel end was pulled through extraperitoneal
for colectomy. Results:The mean age was 78years .The male to
female ratios were 1:1.5.The mean operative time was 360minutes
.The mean hospital stay was 12days . Conversion to open
surgery was none?DNo operative mortality, no portsite metastasis
and morbidity.All patients are alive without recurrence.
Laparoscopy affords improved visualization of the rectum in
the confined space of the pelvis. Laparoscopic-assisted
abdominoperineal resection for patients with rectal cancer is a
feasible and safe operation . Recurrence rate or long term
functional outcome needs longer follow up.
P128–Colorectal/Intestinal Surgery
CLINICAL OUTCOME OF LAPAROSCOPIC COLORECTAL CAN-
CER SURGERY, Takeshi Naitoh MD, Takashi Tsuchiya
MD,Satoshi Akaishi MD,Hiroshi Honda MD,Masao Kobari MD,
Department of Surgery, Sendai City Medical Center
[Backgrounds] Laparoscopic colorectal cancer surgery has
been widely accepted because of less pain, faster recovery and
good cosmetic results. Although several authors presented
results of prospective studies which support advantages of
laparoscopic colorectal cancer surgery, an oncological validity
of this surgery is not well analyzed yet. The aim of this study
is to assess the clinical outcome of the laparoscopic colorectal
cancer surgery in our hospital. [Patients and Methods] During
June 1999 and Aug. 2004, we operated more than 700 cases of
colorectal cancer patients. Of those 205 patients underwent
laparoscopic colorectal surgery. We assessed an operative
time, estimated blood loss, postoperative complications, duration
of hospitalization, and clinical outcome, retrospectively.
[Results] Male female ratio was 118:87, and mean age of these
patients was 64.6 year-old. Among these cases, 71 tumors
were located in the cecum or ascending colon, 20 in the transverse
colon, 7 in the descending colon, 55 in the sigmoid
colon, and 52 in the rectum. Among 52 cases of rectal cancer,
17 cases were localized in Rs, which is rectosigmoid region, 30
in Ra, which is rectum above the peritoneal reflection, and 5 in
158 http://www.sages.org/
Rb, which is rectum below the peritoneal reflection according
to the Japanese classification of colorectal cancer. Histological
T numbers of the tumor according to the UICC classification
were as follows; 113 cases of T1, 43 cases of T2, 33 of T3, and
11 of T4. Forty nine cases (23.9%) of them were node-positive.
Mean operative time was 178 min., and mean estimated blood
loss was 62 ml. Twelve cases (5.9%) were converted to conventional
surgery because of the severe adhesion.
Postoperative complications were identified in 16 cases (7.8%),
of those 6 cases represented an anastomotic leakage, and 5 of
them required further operation. Two cases were complicated
with postoperative hemorrhage which required reoperation.
No operative mortality was observed in these patients. Mean
postoperative hospitalization was 16 days. Mean follow-up
time was 23 months. Five patients have tumor recurrence; 1
case with local recurrence, 2 with liver metastasis, 1 with lung
metastasis, and 1 with peritoneal carcinomatosis. Only one
patient with local recurrence died of cancer 2 years after initial
surgery, so far. [Conclusion] Although further evaluation is
mandatory, laparoscopic colorectal cancer surgery is safe and
would be oncologically adequate procedure.
P129–Colorectal/Intestinal Surgery
LAPAROSCOPIC SURGERY FOR DIVERTICULAR DISEASE
COMPLICATED BY ENTERIC FISTULAS, Scott Q Nguyen MD,
Celia M Divino MD,Anthony Vine MD,Mark Reiner MD,Lester B
Katz MD,Barry Salky MD, Mount Sinai Medical Center
Introduction. Enteric fistulas complicate diverticular disease in
up to 20% of cases. Elective laparoscopic surgery for uncomplicated
diverticular disease is considered safe and effective,
however little data exists for disease complicated by fistulas.
This study describes a series of patients who underwent
laparoscopic assisted sigmoid resection for diverticulitis complicated
by fistulas.
Methods. A retrospective chart review was performed of
patients who underwent laparoscopic treatment of enteric fistulas
complicating diverticular disease by four surgeons specializing
in minimally invasive surgery at the Mount Sinai
Medical Center.
Results. During a 10-year period (1994-2004), 14 patients
underwent elective laparosopically assisted sigmoid resections
for diverticular disease complicated by enteric fistulas. The
average age was 62 and the male/female ratio was 10:4.
Twenty nine percent of patients had previous abdominal surgery
and 21% had multiple fistulas. There were 8 colovesical, 5
enterocolic, 2 colovaginal, 1 colosalpingal, and 1 colocutaneous
fistulas. 100% patients successfully underwent sigmoid
resection and 2/14 (14%) required additional bowel resections.
No cases were proximally diverted. Thirty-six percent of cases
were converted to open, all due to dense adhesions and
severe inflammation resulting in difficult dissection. The mean
operative time was 209 minutes and the mean blood loss was
326 ml. There were two (14%) postoperative complications,
including one self-limiting anastamotic bleed and one prolonged
ileus. No anastamotic leaks occurred and there were
no mortalities. The mean postoperative stay was six days.
Conclusions. Laparoscopic management of diverticular disease
complicated by fistulas can be performed effectively and safely
with minimal morbidity and mortality. The conversion rate is
higher than in uncomplicated cases of diverticulitis and is
associated with severe adhesions and inflammation interfering
with safe laparoscopic dissection.
P130–Colorectal/Intestinal Surgery
LESS INVASIVE SURGERY ON THE PATIENTS WITH SEVERE
CONSTIPATION, Hirotsugu Ohara MD, Yasuhiko Masuda
MD,Toshiyuki Hirai MD, Department of surgery , Fujieda Heisei
Memorial Hospital , Fujieda , Sizuoka , Japan
INTRODUCTION : Until now, operation for severe constipation
have seldom been performed, because severe constipation
was most common in the elderly or the institutionalized
patients, and in patients with a variety neurologic disorders.
Recently, we have been able to perform less invasive surgery
on the the patients with severe constipation. In all cases we
achieved good results by our own unique method. This
method, including the indication to operate, will be discussed.
METHODS AND PROCEDURES : At first, these diseases are