Skip to main content

Advertisement

SpringerLink
Log in

Totally laparoscopic versus laparoscopic-assisted left colectomy for cancer: a retrospective review

  • Published:
Surgical Endoscopy Aims and scope Submit manuscript

Abstract

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 anastomosis (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 were collected: gender, age, body mass index, American Society of Anesthesiologists risk class, operation duration, conversion to laparotomy, intraoperative complications, postoperative complications, postoperative course (duration of stay, time to first flatus), number of excised lymph nodes, readmission, and reoperation rates. Data were 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 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.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. The COLOR Study Group (2000) A randomized clinical trial comparing laparoscopic and open resection for colon cancer. Dig Surg 17:617–622

    Google Scholar 

  2. Lacy AM, Garcia-Valdecasas JC, Delgado S, Castells A, Taura P, Pique JM, Visa J (2002) Laparoscopy-assisted colectomy versus open colectomy for treatment of non-metastatic colon cancer: a randomized trial. Lancet 359:2224–2229

    Article  PubMed  Google Scholar 

  3. Clinical Outcomes of Surgical Therapy Study Group (2004) A comparison of laparoscopically assisted and open colectomy for colon cancer. N Engl J Med 350:2050–2059

    Article  Google Scholar 

  4. Bonjer HJ, Hop WC, Nelson H, Sargent DJ, Lacy AM, Castells A, Guillou PJ, Thorpe H, Brown J, Delgado S, Kuhrij E, Haglind E, Påhlman L, Transatlantic Laparoscopically Assisted vs Open Colectomy Trials Study Group (2007) Laparoscopically assisted vs open colectomy for colon cancer: a meta-analysis. Arch Surg 142:298–303

    Article  PubMed  Google Scholar 

  5. Buunen M, Veldkamp R, Hop WC, Kuhry E, Jeekel J, Haglind E, Påhlman L, Cuesta MA, Msika S, Morino M, Lacy A, Bonjer HJ, Colon Cancer Laparoscopic or Open Resection Study Group (2009) Survival after laparoscopic surgery versus open surgery for colon cancer: long-term outcome of a randomized clinical trial. Lancet Oncol 10:44–52

    Article  PubMed  Google Scholar 

  6. Guller U, Jain N, Hervey S, Purves H, Pietrobon R (2003) Laparoscopic vs open colectomy. Arch Surg 138:1179–1186

    Article  PubMed  Google Scholar 

  7. Veldkamp R, Gholghesaei M, Bonjer HJ, Meijer DW, Buunen M, Jeekel J, Anderberg B, Cuesta MA, Cuschierl A, Fingerhut A, Fleshman JW, Guillou PJ, Haglind E, Himpens J, Jacobi CA, Jakimowicz JJ, Koeckerling F, Lacy AM, Lezoche E, Monson JR, Morino M, Neugebauer E, Wexner SD, Whelan RL (2004) Laparoscopic resection of colon cancer: consensus of the European association of endoscopic surgery (EAES). Surg Endosc 18:1163–1185

    Article  CAS  PubMed  Google Scholar 

  8. Lacy AM, Delgado S, Castells A, Prins HA, Arroyo V, Ibarzabal A, Pique JM (2008) The long-term results of a randomized clinical trial of laparoscopy-assisted versus open surgery for colon cancer. Ann Surg 248:1–7

    Article  PubMed  Google Scholar 

  9. Bilimoria KY, Bentrem DJ, Nelson H, Stryker SJ, Stewart AK, Soper NJ, Russell TR, Ko CY (2008) Use and outcomes of laparoscopic-assisted colectomy for cancer in the United States. Arch Surg 143:832–839

    Article  PubMed  Google Scholar 

  10. Poon JT, Law WL, Wong IW, Ching PT, Wong LW, Fan JK, Lo OS (2009) Impact of laparoscopic colorectal resection on surgical site infection. Ann Surg 249:77–81

    Article  PubMed  Google Scholar 

  11. Zheng MH, Feng B, Lu AG, Li JW, Wang ML, Mao ZH, Hu YY, Dong F, Hu WG, Li DH, Zang L, Peng YF, Yu BM (2005) Laparoscopic versus open right colectomy with curative intent for colon carcinoma. World J Gastroenterol 11:323–326

    Article  PubMed  PubMed Central  Google Scholar 

  12. Senagore AJ, Delaney CP, Brady KM, Fazio VW (2004) Standardized approach to LRC: outcomes in 70 consecutive cases. J Am Coll Surg 199:675–679

    Article  PubMed  Google Scholar 

  13. Franklin ME Jr, Gonzalez JJ Jr, Miter DB, Mansur JH, Trevino JM, Glass JL, Mancilla G, Abrego-Medina D (2004) Laparoscopic right colectomy for cancer: 11-year experience. Rev Gastroenterol Mex 69:65–72

    PubMed  Google Scholar 

  14. Tekkis PP, Senagore AJ, Delaney CP, Fazio VW (2005) Evaluation of the learning curve in laparoscopic colorectal surgery: comparison of right-sided and left-sided resections. Ann Surg 242:83–91

    Article  PubMed  PubMed Central  Google Scholar 

  15. Anania G, Santini M, Scagliarini L, Marzetti A, Vedana L, Marino S, Gregorio C, Resta G, Cavallesco G (2012) A totally mini-invasive approach for colorectal laparoscopic surgery. World J Gastroenterol 18:3869–3874

    Article  PubMed  PubMed Central  Google Scholar 

  16. Roscio F, Bertoglio C, De Luca A, Frattini P, Scandroglio I (2012) Totally laparoscopic versus laparoscopic assisted right colectomy for cancer. Int J Surg 10:290–295

    Article  PubMed  Google Scholar 

  17. Chaves JA, Idoate CP, Fons JB, Oliver MB, Rodríguez NP, Delgado AB, Lizoain JL (2011) A case-control study of extracorporeal versus intracorporeal anastomosis in patients subjected to right laparoscopic colectomy. Cir Esp 89:24–30

    Article  PubMed  Google Scholar 

  18. Scatizzi M, Kroning KC, Borrelli A, Andan G, Lenzi E, Feroci F (2010) Extracorporeal versus intracorporeal anastomosis after LRC for cancer: a case-control study. World J Surg 34:2902–2908

    Article  PubMed  Google Scholar 

  19. Fabozzi M, Allieta R, Contul RB, Grivon M, Millo P, Lale-Murix E, Nardi M Jr (2010) Comparison of short- and medium-term results between laparoscopically assisted and totally LRC: a case-control study. Surg Endosc 24:2085–2091

    Article  PubMed  Google Scholar 

  20. Hellan M, Anderson C, Pigazzi A (2009) Extracorporeal versus intracorporeal anastomosis for LRC. JSLS 13:312–317

    PubMed  PubMed Central  Google Scholar 

  21. Magistro C, Di Lernia S, Ferrari G, Zullino A, Mazzola M, De Martini P, De Carli S, Forgione A, Bertoglio CL, Pugliese R (2013) Totally laparoscopic versus laparoscopic-assisted right colectomy for colon cancer: is there any advantage in short-term outcomes? A prospective comparative assessment in our center. Surg Endosc 27:2613–2618

    Article  PubMed  Google Scholar 

  22. Carnuccio P, Jimeno J, Pare´s D (2014) LRC: a systematic review and meta-analysis of observational studies comparing two types of anastomosis. Tech Coloproctol 18:5–12

    Article  CAS  PubMed  Google Scholar 

  23. Milone M, Elmore U, Di Salvo E, Delrio P, Bucci L, Ferulano GP, Napolitano C, Angiolini MR, Bracale U, Clemente M, D’ambra M, Luglio G, Musella M, Pace U, Rosati R, Milone F (2014) Intracorporeal versus extracorporeal anastomosis. Results from a multicentre comparative study on 512 right-sided colorectal cancers. Surg Endosc 29:2314–2320

    Article  PubMed  Google Scholar 

  24. Iorio Tara, Blumberg David (2014) A case-control study examining the benefits of laparoscopic colectomy using a totally intracorporeal technique for left-sided colon tumors. Surg Laparosc Endosc Percutan Tech 24:381–384

    Article  PubMed  Google Scholar 

  25. Raftopoulos I, Courcoulas AP, Blumberg D (2006) Should completely intracorporeal anastomosis be considered in obese patients who undergo laparoscopic colectomy for benign or malignant disease of the colon? Surgery 140:675–682

    Article  PubMed  Google Scholar 

  26. Blumberg D (2009) Laparoscopic colectomy performed using a completely intracorporeal technique is associated with similar outcome in obese and thin patients. Surg Laparosc Endosc Percutan Tech 19:57–61

    Article  PubMed  Google Scholar 

  27. Li JC, Lee JF, Ng SS, Yiu RY, Hon SS, Leung WW, Leung KL (2010) Conversion in laparoscopic assisted colectomy for right colon cancer: risk factors and clinical outcomes. Int J Colorectal Dis 25:983–988

    Article  PubMed  Google Scholar 

  28. Baker RP, Titu LV, Hartley JE, Lee PW, Monson JR (2004) A case-control study of laparoscopic right colectomy vs open right colectomy. Dis Colon Rectum 47:1675–1679

    Article  PubMed  Google Scholar 

  29. Schwenk W, Haase O, Neudecker J, Muller JM (2005) Short term benefits for laparoscopic colorectal resection. Cochrane Database Syst Rev 20:CD003145. doi:10.1002/14651858

    Google Scholar 

  30. Marchesi F, Pinna F, Percalli L, Cecchini S, Riccó M, Costi R, Pattonieri V, Roncoroni L (2013) Totally LRC: theoretical and practical advantages over the laparo-assisted approach. J Laparoendosc Adv Surg Tech A 23:418–424

    Article  PubMed  Google Scholar 

  31. DeSouza A, Domajnko B, Park J, Marecik S, Prasad L, Abcarian H (2011) Incisional hernia, midline versus low transverse incision: what is the ideal incision for specimen extraction and hand-assisted laparoscopy? Surg Endosc 25:1031–1036

    Article  PubMed  Google Scholar 

  32. Kisielinski K, Conze J, Murken AH, Lenzen NN, Klinge U, Schumpelick V (2004) The Pfannenstiel or so called ‘‘bikini cut’’: still effective more than 100 years after first description. Hernia 8:177–181

    Article  CAS  PubMed  Google Scholar 

  33. Orcutt ST, Balentine CJ, Marshall CL, Robinson CN, Anaya DA, Artinyan A, Awad SS, Berger DH, Albo D (2012) Use of a Pfannenstiel incision in minimally invasive colorectal cancer surgery is associated with a lower risk of wound complications. Tech Coloproctol 16:127–132

    Article  CAS  PubMed  Google Scholar 

  34. Winslow ER, Fleshman JW, Birnbaum EH, Brunt LM (2002) Wound complications of laparoscopic vs open colectomy. Surg Endosc 16:1420–1425

    Article  CAS  PubMed  Google Scholar 

  35. Singh R, Omiccioli A, Hegge S, McKinley C (2008) Does the extraction site location in laparoscopic colorectal surgery have an impact on incisional hernia rates? Surg Endosc 22:2596–2600

    Article  PubMed  Google Scholar 

  36. Nelson H, Petrelli N, Carlin A, Couture J, Fleshman J, Guillem J, Miedema B, Ota D, Sargent D, National Cancer Institute Expert Panel (2001) Guidelines 2000 for colon and rectal cancer surgery. J Natl Cancer Inst 93:583–596

    Article  CAS  PubMed  Google Scholar 

  37. Zerey M, Hawver LM, Awad Z, Stefanidis D, Richardson W, Fanelli RD, Members of the SAGES Guidelines Committee (2013) SAGES evidence-based guidelines for the laparoscopic resection of curable colon and rectal cancer. Surg Endosc 27:1–10

    Article  PubMed  Google Scholar 

  38. Young-Fadok TM, Fanelli RD, Price RR, Earle DB (2007) Laparoscopic resection of curable colon and rectal cancer: an evidence-based review. Surg Endosc 21:1063–1068

    Article  CAS  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. General Surgery Department, Bnai-Zion Medical Center, Affiliated to Rappoport Medical School, Technion, Haifa, Golomb 47, 31048, Haifa, Israel

    Forat Swaid, Gideon Sroka, Hussam Madi, Dan Shteinberg & Ibrahim Matter

  2. Anesthesiology Department, Bnai-Zion Medical Center, Haifa, Israel

    Mustafa Somri

Authors
  1. Forat Swaid
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Gideon Sroka
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Hussam Madi
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Dan Shteinberg
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Mustafa Somri
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Ibrahim Matter
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Forat Swaid.

Ethics declarations

Disclosures

Drs. Swaid, Sroka, Madi, Shteinberg, Somri, and Matter have no conflicts of interest or financial ties to disclose.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Swaid, F., Sroka, G., Madi, H. et al. Totally laparoscopic versus laparoscopic-assisted left colectomy for cancer: a retrospective review. Surg Endosc 30, 2481–2488 (2016). https://doi.org/10.1007/s00464-015-4502-5

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00464-015-4502-5

Keywords

Search

Navigation