Abstract
Hand-assisted laparoscopic surgery combines the benefit of minimal access and open surgery. It is an important tool in the armamentarium of a colorectal surgeon and may be of great clinical utility in the resection of left-sided colorectal malignancies. The study aimed to assess the short-term postoperative outcomes following hand-assisted laparoscopic surgery for left-sided colorectal malignancies. This a retrospective study that included 580 patients undergoing hand-assisted laparoscopic resections for left-sided colorectal malignancies from March 2010 to March 2020. Preoperative, intraoperative, and postoperative data of the patients was obtained from carefully maintained patient records. Factors contributing to postoperative complications and length of stay were studied using univariate and multivariate analysis using a logistic regression model. Secondary outcomes studied included conversion rates, operative time, and blood loss. The majority of patients were men with a mean age of 61 ± 14 years. Of these, 210 patients underwent descending colon and sigmoid resections, while 370 underwent rectal resections. The conversion rate was 1.6%. The mean operative time was 120 ± 42 min. The mean length of hospital stay was 7.4 ± 3 days. The most common postoperative complication was surgical site infection (13%), followed by ileus (6.6%). Major complications occurred in 6 patients. Diabetes, hypertension, obesity, non-negotiable tumors, and long operative times were associated with the development of postoperative complications. The development of complications and inability to tolerate oral diet by day 4 was associated with increased length of stay. A negative circumferential resection margin was obtained in 98.9% cases and a negative distal resection margin in 99.6%. The average lymph node yield was 12.6 ± 7. The hand-assisted laparoscopic approach for oncological colorectal resections maintains the advantage of laparoscopy and helps in reducing conversion rates and margin positivity rates.
Similar content being viewed by others
References
Jacobs M, Verdeja JC, Goldstein HS (1991) Minimally invasive colon resection (laparoscopic colectomy). Surg Laparosc Endosc 1(3):144–150
Senagore AJ, Luchtefeld MA, Mackeigan JM, Mazier WP (1993) Open colectomy versus laparoscopic colectomy: are there differences? Am Surg 59(8):549–553 discussion 553-554
Phillips EH, Franklin M, Carroll BJ, Fallas MJ, Ramos R, Rosenthal D (1992) Laparoscopie colectomy. Ann Surg 216(6):703–710. https://doi.org/10.1097/00000658-199212000-00015
Sammour T, Kahokehr A, Srinivasa S, Bissett IP, Hill AG (2011) Laparoscopic colorectal surgery is associated with a higher intraoperative complication rate than open surgery. Ann Surg 253(1):35–43. https://doi.org/10.1097/SLA.0b013e318204a8b4
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(1):83–91. https://doi.org/10.1097/01.sla.0000167857.14690.68
Meijer DW, Bannenberg JJG, Jakimowicz JJ (2000) Hand-assisted laparoscopic surgery: an overview. Surg Endosc 14(10):891–895. https://doi.org/10.1007/s004640020019
Arulampalam T, Austin R, Motson R (2005) MRC CLASICC trial. Lancet 366(9487):712. https://doi.org/10.1016/S0140-6736(05)67168-1
Kiran RP, El-Gazzaz GH, Vogel JD, Remzi FH (2010) Laparoscopic approach significantly reduces surgical site infections after colorectal surgery: data from National Surgical Quality Improvement Program. J Am Coll Surg 211(2):232–238. https://doi.org/10.1016/j.jamcollsurg.2010.03.028
Davis CH, Shirkey BA, Moore LW, Gaglani T, du XL, Bailey HR, Cusick MV (2018) Trends in laparoscopic colorectal surgery over time from 2005-2014 using the NSQIP database. J Surg Res 223:16–21. https://doi.org/10.1016/j.jss.2017.09.046
Campos FG, Bertoncini AB, Martinez CAR, Bustamante-Lopez LA, Morais PGM (2019) Adoption rates of laparoscopic techniques for colorectal resections among Brazilian surgeons: limiting factors affecting incorporation into daily practice. J Coloproctol 39(1):27–32. https://doi.org/10.1016/j.jcol.2018.10.002
Romanelli JR, Kelly JJ, Litwin DE (2001) Hand-assisted laparoscopic surgery in the United States: an overview. Semin Laparosc Surg 8(2):96–103
Clavien PA, Barkun J, de Oliveira ML, Vauthey JN, Dindo D, Schulick RD, de Santibañes E, Pekolj J, Slankamenac K, Bassi C, Graf R, Vonlanthen R, Padbury R, Cameron JL, Makuuchi M (2009) The Clavien-Dindo classification of surgical complications: five-year experience. Ann Surg 250(2):187–196. https://doi.org/10.1097/SLA.0b013e3181b13ca2
Berríos-Torres SI, Umscheid CA, Bratzler DW, Leas B, Stone EC, Kelz RR, Reinke CE, Morgan S, Solomkin JS, Mazuski JE, Dellinger EP, Itani KMF, Berbari EF, Segreti J, Parvizi J, Blanchard J, Allen G, Kluytmans JAJW, Donlan R, Schecter WP, for the Healthcare Infection Control Practices Advisory Committee (2017) Centers for disease control and prevention guideline for the prevention of surgical site infection, 2017. JAMA Surg 152(8):784–791. https://doi.org/10.1001/jamasurg.2017.0904
Bragg D, El-Sharkawy AM, Psaltis E, Maxwell-Armstrong CA, Lobo DN (2015) Postoperative ileus: recent developments in pathophysiology and management. Clin Nutr 34(3):367–376. https://doi.org/10.1016/j.clnu.2015.01.016
Yasuda K, Kawai K, Ishihara S, Murono K, Otani K, Nishikawa T, Tanaka T, Kiyomatsu T, Hata K, Nozawa H, Yamaguchi H, Aoki S, Mishima H, Maruyama T, Sako A, Watanabe T (2016) Level of arterial ligation in sigmoid colon and rectal cancer surgery. World J Surg Oncol 14(1). https://doi.org/10.1186/s12957-016-0819-3
Zeng J, Su G (2018) High ligation of the inferior mesenteric artery during sigmoid colon and rectal cancer surgery increases the risk of anastomotic leakage: a meta-analysis. World J Surg Oncol 16(1):157. https://doi.org/10.1186/s12957-018-1458-7
Heald RJ, Ryall RDH (1986) Recurrence and survival after total mesorectal excision for rectal cancer. Lancet 327(8496):1479–1482. https://doi.org/10.1016/S0140-6736(86)91510-2
von Elm E, Altman DG, Egger M, Pocock SJ, Gøtzsche PC, Vandenbroucke JP (2007) The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement: guidelines for reporting observational studies. Lancet 370(9596):1453–1457. https://doi.org/10.1016/S0140-6736(07)61602-X
van der Pas MH, Haglind E, Cuesta MA, Fürst A, Lacy AM, Hop WC, Bonjer HJ, COlorectal cancer Laparoscopic or Open Resection II (COLOR II) Study Group (2013) Laparoscopic versus open surgery for rectal cancer (COLOR II): short-term outcomes of a randomised, phase 3 trial. Lancet Oncol 14(3):210–218. https://doi.org/10.1016/S1470-2045(13)70016-0
Kang CY, Chaudhry OO, Halabi WJ, Nguyen V, Carmichael JC, Stamos MJ, Mills S (2012) Outcomes of laparoscopic colorectal surgery: data from the Nationwide Inpatient Sample 2009. Am J Surg 204(6):952–957. https://doi.org/10.1016/j.amjsurg.2012.07.031
Wu B, Wang W, Hao G, Song G (2018) Effect of cancer characteristics and oncological outcomes associated with laparoscopic colorectal resection converted to open surgery: a meta-analysis. Medicine 97(50):e13317. https://doi.org/10.1097/MD.0000000000013317
Fleshman J, Branda M, Sargent DJ, Boller AM, George V, Abbas M, Peters WR Jr, Maun D, Chang G, Herline A, Fichera A, Mutch M, Wexner S, Whiteford M, Marks J, Birnbaum E, Margolin D, Larson D, Marcello P, Posner M, Read T, Monson J, Wren SM, Pisters PWT, Nelson H (2015) Effect of laparoscopic-assisted resection vs open resection of stage II or III rectal cancer on pathologic outcomes: the ACOSOG Z6051 randomized clinical trial. JAMA 314(13):1346–1355. https://doi.org/10.1001/jama.2015.10529
Cima RR, Pattana-arun J, Larson DW, Dozois EJ, Wolff BG, Pemberton JH (2008) Experience with 969 minimal access colectomies: the role of hand-assisted laparoscopy in expanding minimally invasive surgery for complex colectomies. J Am Coll Surg 206(5):946–950. https://doi.org/10.1016/j.jamcollsurg.2007.12.021
Moloo H, Haggar F, Coyle D, et al (2010) Hand assisted laparoscopic surgery versus conventional laparoscopy for colorectal surgery. Cochrane Colorectal Cancer Group, ed. Cochrane Database of Systematic Reviews doi:https://doi.org/10.1002/14651858.CD006585.pub2
Zhang X, Wu Q, Gu C, Hu T, Bi L, Wang Z (2017) Hand-assisted laparoscopic surgery versus conventional open surgery in intraoperative and postoperative outcomes for colorectal cancer: an updated systematic review and meta-analysis. Medicine 96(33):e7794. https://doi.org/10.1097/MD.0000000000007794
Aalbers AGJ, Biere SSAY, van Berge Henegouwen MI, Bemelman WA (2008) Hand-assisted or laparoscopic-assisted approach in colorectal surgery: a systematic review and meta-analysis. Surg Endosc 22(8):1769–1780. https://doi.org/10.1007/s00464-008-9857-4
Zhang X, Wu Q, Hu T, Gu C, Bi L, Wang Z (2017) Hand-assisted laparoscopic surgery versus conventional laparoscopic surgery for colorectal cancer: a systematic review and meta-analysis. J Laparoendoscop Adv Surg Techniq 27(12):1251–1262. https://doi.org/10.1089/lap.2017.0210
Stevenson ARL, Solomon MJ, Lumley JW, Hewett P, Clouston AD, Gebski VJ, Davies L, Wilson K, Hague W, Simes J, ALaCaRT Investigators (2015) Effect of laparoscopic-assisted resection vs open resection on pathological outcomes in rectal cancer: the ALaCaRT randomized clinical trial. JAMA 314(13):1356–1363. https://doi.org/10.1001/jama.2015.12009
Acknowledgements
We are grateful to Dr. Sudarshan Chaugale for the diagrammatic representation of the hand port technique.
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
We the authors, Amanjeet Singh, Deeksha Kapoor, Saurabh Dubey, Azhar Perwaiz, and Adarsh Chaudhary, have obeyed and complied with ethical standards.
Conflict of Interest
The authors declare no competing interests.
Disclaimer
This is a retrospective study assessing the results of hand-assisted laparoscopic surgery in the management of left-sided colorectal malignancies, at our institute. This paper represents the opinions of the authors and is the product of professional research.
Additional information
Publisher’s Note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Rights and permissions
About this article
Cite this article
Singh, A., Kapoor, D., Dubey, S. et al. Short-Term Outcomes Following Hand-Assisted Laparoscopy for Left-Sided Colon and Rectal Malignancies: Single-Center Experience of 580 Cases. Indian J Surg 84, 326–334 (2022). https://doi.org/10.1007/s12262-021-02868-1
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s12262-021-02868-1