2005 SAGES Abstracts

POSTER ABSTRACTS
SAGES 2005
AIM: Controversial issues surrounding the use of laparoscopic
surgery (LAP) for colorectal cancer include high
conversion¡Bhigh complication rate¡Bport site recurrence and
poor outcome than open surgery (OPEN) previously reported.
The purpose of this single center, prospective study was to
assess the oncological outcomes achieved after curative LAP
for cancer.
MATERIALS & METHODS: We enrolled 514 consecutive
patients with colorectal cancer undergoing LAP between July
1998 and May 2004. The data were including patient
profile¡Boperative complication ¡Bpathology and oncological
outcome. We compared the oncologic outcomes achieved
using LAP and OPEN during period from July 1998 to June
2001. Patient follow-up ranged from 36 to 72 months. The follow-up
rate was 95%. We recorded the final status of all cancer
patients as of June 30, 2004.
RESULTS: We attempted to perform LAP in 514 patients and
14 patients (2.7%) needed conversion to open surgery. The
LAP was successfully in 500 patients with 308 males and 192
females, age from 26 to 96 years, av. 64.2 years. Of the 500
LAP patients, 85 (17.0%) experienced complications & 42
(8.4%) patients had major complications that required further
surgery. Major complication of LAP for rectal cancer was higher
than colon cancer: 11.4% (34/298) vs. 4.0% (8/202). There
were three (0.6%) operative mortality due to sepsis, CVA and
hepatic failure. We examined the oncologic results achieved in
185 patients who had curative LAP between July 1998 and
June 2001. The 3Y-DFS between LAP and OPEN were no difference
in stage I (94.2% vs. 93.9%), stage II (79.7% vs. 73.4%),
stage III (57.2% vs. 56.7%) and over-all (75.8% vs. 70.3%).
There were two (0.4%) port site recurrence found in LAP
patients.
Conclusion: The LAP for cancer was feasible for the acceptable
morbidity rate & operation time. The oncological results are
encouraging and equal to OPEN.
P143–Colorectal/Intestinal Surgery
LAPAROSCOPIC COLORECTAL SURGERY: EARLY AND LATER
EXPERIENCE, David A Vivas MD,Seong-Yeop You MD,Dan Ruiz
MD,Jonathan Efron MD,Eric Weiss MD,Juan J Nogeras
MD,Dana Sands MD,Anthony Vernava MD, Steven Wexner
MD, Department of Colorectal Surgery, Cleveland Clinic
Florida, Weston ,FL
Background: The aim of this study was to compare early and
more recent results of laparoscopic colorectal surgery to
assess any differences in indications or procedures and any
changes in results. Methods: After IRB approval, the medical
records of all patients who underwent elective laparoscopic
colorectal surgery between August 1991 and April 2004 were
reviewed. Group I included patients operated upon between
August 1991 and December 1995 (53 months), Group II included
patients who were operated between January 1996 to
September 1999 (45 months) and Group III included patients
who underwent laparoscopic colorectal surgery between
October 1999 and April 2004 (55 months). Results: 644
patients underwent elective laparoscopic colorectal surgery
during this period, including 175 patients in Group I, 199
patients in Group II and 270 patients in Group III. While there
were no differences among Group I, Group II and Group III relative
to gender (p=NS), patients in Group II were significantly
older than those of Group I [50.2 (range 15-88) versus 58.3
(range 15-89); (p = 0.05)]; there was no difference between
Group II and Group III (p=NS) respect to age. Significantly
more patients underwent sigmoid colectomy in Group III than
in Groups I and II (24% versus 13.7% and 15.6%, respectively;
p = 0.05). Interventions for diverticular disease increased significantly
during this period from 10.9% in Group I, to 14.1% in
Group II to 24.8% in Group III (p= 0.05). Right hemicolectomy
was one of the most common procedures performed, representing
24.6%, 39.7% and 22.2% for Groups I, II and III, respectivelyç
11 procedures in Group III were ileocolic resections for
Crohn’s disease. Intraoperative complications decreased significantly
from Group I to Group II (16.0% versus 4.5%, respectively;
p = 0.05) but remained unchanged between Group II
and Group III (4.5% versus 6.66%, respectively; NS). Although
the operative time decreased significantly between Group I
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and II (180.5 min versus 146.0 min, respectively; p = 0.05), it
increased between Group II and Group III (146.0 min versus
170.02 min, respectively; p = 0.05).
Conclusion: Increasing experience in laparoscopic colorectal
surgery may lead to better results as attested to by the
decrease in morbidity. However, the selection of more challenging
cases like sigmoid diverticulitis and ileal Crohn’s disease
may be the reason for the increase in operative time.
P144–Colorectal/Intestinal Surgery
SHORT TIME RESULTS OF LAPAROSCOPIC COLORECTAL
RESECTION BY DIFFERENT SURGEONS, Shigeki Yamaguchi
PhD, Ota Mitsuyoshi MD,Masayuki Ishii MD,Hirofumi Morita
MD, Shizuoka Cancer Center
Purpose: The purpose of this study is to assess short term
results of laparoscopic colorectal cancer resection and to clarify
the difference between surgeons.
Patients: One hundred thirteen colorectal cancer resection
were included since 2002 September to 2004 April by surgeons.
Surgeon A was tutor, B had some experience, and C, D
were beginner. When B, C, D did operator, A assisted them in
80% cases. Number of patients was A: 59, B: 20, C: 22, D: 12,
respectively.
Results: Each tumor location was as right colon/ left colon/ rectum,
A: 11/ 29/ 19, B: 7/ 9/ 4, C: 7/ 12/ 3, D: 5/ 4/ 3. Lymph node
dissection was as D1/ D2/ D3, A: 2/ 16/ 41, B: 2/ 5/ 13, C: 0/ 9/
13, D: 2/ 4/ 6. Mean BMI was A: 23.1, B: 23.6, C: 23.2, D: 22.6.
Mean operating time was A: 238 minutes(128?`459), B:
227(135?`485), C: 209(136?`300), D: 204(136?`279). Each operating
time of the first half and second half were A: 240?¨234 min.
B: 273?¨180, C: 240?¨179, D: 234?¨174. B, C, D had shortened
operating time except A. Mean blood loss count was A: 65??,
B: 74, C: 45, D: 29, and no patient received blood transfusion.
Three patients in group A were converted to open surgery
because of blood supply insufficiency, mesorectal inflammation,
and obesity. Median postoperative hospital stay was 8.0
in all groups. Postoperative complications were 1) anastomotic
leakage A: 3, B: 0, C: 0, D: 0, 2) ileus A: 2, B: 1, C: 0, D:1, 3)
wound infection A: 1, B: 1, C: 1, D:0.
Conclusion: Because of making operating team and assisting
beginner surgeon, operating time and blood loss were no difference
between all surgeons.
P145–Colorectal/Intestinal Surgery
LAPAROSCOPIC APPROACH TO A JEJUNAL STROMAL
TUMOR., Nihat Yavuz MD, Abdullah As MD,Fatih Aydogan
MD,Sabri Erguney MD,Osman Tortum MD, Istanbul
University,Cerrahpasa Medical School,General Surgery
Department
Introduction:
Small bowel tumors are rarely seen and are difficult to diagnose.As
other small bowell tumors,they lead to either obstruction
or haemorrhage.In recent years with the introduction of
capsule endoscopy procedure,their preoperative recognation
has become possible.
Materyal-Method:
We report here a 61 years old woman with a jejunal tumor
which led to an acute lower gastrointestinal haemorrhage. She
had two more episodes of bleeding in the last year. All investigations
including upper and lower gastrointestinal endoscopies,
abdominal CT scan and enteroclysis performed in this
period could not detect any source of bleeding. Following the
last haemorrhage a capsule endoscopy was realized,which evidenced
a 3 cm ulcerated polypoid mass in the proximal
jejunum. In
laparoscopic exploration,the tumor was seen in the jejunum,20
cm distal to Treitz ligament. Laparoscopic assisted segmentary
jejunal resection was performed. The corresponding mesentary
was dissected with the use of LigaSure Vessel Sealing
System(LVSS) intracorporally,the specimen was exteriorized
through a small insicion of 4 cm length and the jejunal anastomosis
was performed extracorporally.
Results:
The operation time was 120 minutes.The oral intake was
begun on the 3th postoperative day and patient was discharged
the day after.No any postoperative complication was
seen.Histopathological exam revealed a malignant stromal