Skip to main content
Top
Published in: Indian Journal of Surgery 3/2015

01-12-2015 | Original Article

A Study of 101 Laparoscopic Colorectal Surgeries: a Single Surgeon Experience. How Important Is the Learning Curve?

Authors: Anil Heroor, Ghanishkumar Panjwani, Rahul Chaskar

Published in: Indian Journal of Surgery | Special Issue 3/2015

Login to get access

Abstract

This study aims to document demographic and intraoperative variables and short-term postoperative outcomes in patients being operated by laparoscopy-assisted colorectal surgeries and assessing the magnitude of impact of the learning curve on surgical results. This study included 101 patients with colonic or rectal pathology getting operated for laparoscopy-assisted colorectal surgeries carried out by the same surgeon over 5 years (2008 to 2013). The patient data was retrospectively analyzed for pre-decided variables. Also, comparison was made between the surgeries performed during the learning curve of initial 30 cases with subsequent operations. Laparoscopic colorectal surgeries give satisfactory results in terms of intraoperative parameters like surgical duration, blood loss, and clinico-pathologic parameters like lymph nodal resection and distal and circumferential margins. Patients undergoing laparoscopic colorectal surgeries fare better in short-term postoperative period while early long-term outcomes appear similar as compared to the standard open colorectal surgeries. The surgical outcomes, both intraoperative and early postoperative, improve significantly once the learning curve is negotiated. Laparoscopic Surgery can be safely used as an alternative to conventional open colorectal surgeries without compromising on oncological principles.
Literature
1.
go back to reference Nelson H, Sargent DJ, Wieand HS, for the Clinical Outcomes of Surgical Therapy (COST) Study Group et al (2004) A comparison of laparoscopically assisted and open colectomy for colon cancer. N Engl J Med 350:2050–2059CrossRef Nelson H, Sargent DJ, Wieand HS, for the Clinical Outcomes of Surgical Therapy (COST) Study Group et al (2004) A comparison of laparoscopically assisted and open colectomy for colon cancer. N Engl J Med 350:2050–2059CrossRef
2.
go back to reference Simons AJ, Anthone GJ, Ortega AE et al (1995) Laparoscopic-assisted colectomy learning curve. Dis Colon Rectum 38:600–603CrossRefPubMed Simons AJ, Anthone GJ, Ortega AE et al (1995) Laparoscopic-assisted colectomy learning curve. Dis Colon Rectum 38:600–603CrossRefPubMed
3.
go back to reference Dincler S, Koller MT, Steurer J, Bachmann LM, Christen D, Buchmann P (2003) Multidimensional analysis of learning curves in laparoscopic sigmoid resection: eight-year results. Dis Colon Rectum 46:1371–1379CrossRefPubMed Dincler S, Koller MT, Steurer J, Bachmann LM, Christen D, Buchmann P (2003) Multidimensional analysis of learning curves in laparoscopic sigmoid resection: eight-year results. Dis Colon Rectum 46:1371–1379CrossRefPubMed
4.
go back to reference Kang SB, Park JW, Jeong SY et al (2010) Open versus laparoscopic surgery for mid or low rectal cancer after neoadjuvant chemoradiotherapy (COREAN trial): short-term outcomes of an open-label randomised controlled trial. Lancet Oncol 11:637–645CrossRefPubMed Kang SB, Park JW, Jeong SY et al (2010) Open versus laparoscopic surgery for mid or low rectal cancer after neoadjuvant chemoradiotherapy (COREAN trial): short-term outcomes of an open-label randomised controlled trial. Lancet Oncol 11:637–645CrossRefPubMed
5.
go back to reference 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):210–8. doi:10.1016/S1470-2045(13)70016-0 CrossRefPubMed 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):210–8. doi:10.​1016/​S1470-2045(13)70016-0 CrossRefPubMed
6.
go back to reference Lacy AM, Garcia-Valdecasas JC, Delgado S et al (2002) Laparoscopy-assisted colectomy versus open colectomy for treatment of non-metastatic colon cancer: a randomised trial. Lancet 359:2224–2229CrossRefPubMed Lacy AM, Garcia-Valdecasas JC, Delgado S et al (2002) Laparoscopy-assisted colectomy versus open colectomy for treatment of non-metastatic colon cancer: a randomised trial. Lancet 359:2224–2229CrossRefPubMed
7.
go back to reference Koh DC, Wong KS, Sim R, Ng YP, Hu ZQ, Cheong DM, Foo A (2005) Laparoscopic-assisted colon and rectal surgery—lessons learnt from early experience. Ann Acad Med Singap 34(3):223–228PubMed Koh DC, Wong KS, Sim R, Ng YP, Hu ZQ, Cheong DM, Foo A (2005) Laparoscopic-assisted colon and rectal surgery—lessons learnt from early experience. Ann Acad Med Singap 34(3):223–228PubMed
10.
go back to reference Kim HJ, Lee IK, Lee YS, Kang WK, Park JK, Oh ST (2009) A comparative study on the short-term clinicopathologic outcomes of laparoscopic surgery versus conventional open surgery for transverse colon cancer. Surg Endosc 23(8):1812–1817. doi:10.1007/s00464-009-0348-z CrossRefPubMed Kim HJ, Lee IK, Lee YS, Kang WK, Park JK, Oh ST (2009) A comparative study on the short-term clinicopathologic outcomes of laparoscopic surgery versus conventional open surgery for transverse colon cancer. Surg Endosc 23(8):1812–1817. doi:10.​1007/​s00464-009-0348-z CrossRefPubMed
11.
go back to reference Ivanov P, Vasilev K, Kotashev G, Grigorov G, Kiossev V, Hristova V (2013) Laparoscopic vs open resection for rectal carcinoma—a prospective analysis. Khirurgiia (Sofiia) (1):23–29. Ivanov P, Vasilev K, Kotashev G, Grigorov G, Kiossev V, Hristova V (2013) Laparoscopic vs open resection for rectal carcinoma—a prospective analysis. Khirurgiia (Sofiia) (1):23–29.
13.
go back to reference Lujan J, Valero G, Hernandez Q, Sanchez A, Frutos MD, Parrilla P (2009) Randomized clinical trial comparing laparoscopic and open surgery in patients with rectal cancer. Br J Surg 96:982–989. doi:10.1002/bjs.6662 CrossRefPubMed Lujan J, Valero G, Hernandez Q, Sanchez A, Frutos MD, Parrilla P (2009) Randomized clinical trial comparing laparoscopic and open surgery in patients with rectal cancer. Br J Surg 96:982–989. doi:10.​1002/​bjs.​6662 CrossRefPubMed
14.
go back to reference Zhou ZG, Hu M, Li Y, Lei WZ, Yu YY, Cheng Z, Li L, Shu Y, Wang TC (2004) Laparoscopic versus open total mesorectal excision with anal sphincter preservation for low rectal cancer. Surg Endosc 18:1211–1215CrossRefPubMed Zhou ZG, Hu M, Li Y, Lei WZ, Yu YY, Cheng Z, Li L, Shu Y, Wang TC (2004) Laparoscopic versus open total mesorectal excision with anal sphincter preservation for low rectal cancer. Surg Endosc 18:1211–1215CrossRefPubMed
15.
go back to reference Jayne DG, Guillou PJ, Thorpe H, UK MRC CLASICC Trial Group et al (2007) Randomized trial of laparoscopic-assisted resection of colorectal carcinoma: 3-year results of the UK MRC CLASICC Trial Group. J Clin Oncol 25:3061–3068CrossRefPubMed Jayne DG, Guillou PJ, Thorpe H, UK MRC CLASICC Trial Group et al (2007) Randomized trial of laparoscopic-assisted resection of colorectal carcinoma: 3-year results of the UK MRC CLASICC Trial Group. J Clin Oncol 25:3061–3068CrossRefPubMed
16.
go back to reference Morino M, Parini U, Giraudo G (2003) Laparoscopic total mesorectal: a consecutive series of 100 patients. Ann Surg 237:335–342PubMedPubMedCentral Morino M, Parini U, Giraudo G (2003) Laparoscopic total mesorectal: a consecutive series of 100 patients. Ann Surg 237:335–342PubMedPubMedCentral
17.
go back to reference Silecchia G, Perrotta N, Giraudo G, for the Italian Registry of Laparoscopic Colorectal Surgery et al (2002) Abdominal wall recurrences after colorectal resection for cancer: results of the Italian registry of laparoscopic colorectal surgery. Dis Colon Rectum 45(9):1172–1177CrossRefPubMed Silecchia G, Perrotta N, Giraudo G, for the Italian Registry of Laparoscopic Colorectal Surgery et al (2002) Abdominal wall recurrences after colorectal resection for cancer: results of the Italian registry of laparoscopic colorectal surgery. Dis Colon Rectum 45(9):1172–1177CrossRefPubMed
18.
go back to reference Janson M, Björholt I, Carlsson P et al (2004) Randomized clinical trial of the costs of open and laparoscopic surgery for colonic cancer. Br J Surg 91:409–417CrossRefPubMed Janson M, Björholt I, Carlsson P et al (2004) Randomized clinical trial of the costs of open and laparoscopic surgery for colonic cancer. Br J Surg 91:409–417CrossRefPubMed
19.
go back to reference Yang L, Yu YY, Zhou ZG, Li Y, Xu B, Song JM, Liu HY, Jiang X (2007) Quality of life outcomes following laparoscopic total mesorectal excision for low rectal cancers: a clinical control study. Eur J Surg Oncol 33:575–579CrossRefPubMed Yang L, Yu YY, Zhou ZG, Li Y, Xu B, Song JM, Liu HY, Jiang X (2007) Quality of life outcomes following laparoscopic total mesorectal excision for low rectal cancers: a clinical control study. Eur J Surg Oncol 33:575–579CrossRefPubMed
20.
21.
go back to reference Braga M, Frasson M, Vignali A, Zuliani W, Capretti G, Di Carlo V (2007) Laparoscopic resection in rectal cancer patients: outcome and cost-benefit analysis. Dis Colon Rectum 50:464–471CrossRefPubMed Braga M, Frasson M, Vignali A, Zuliani W, Capretti G, Di Carlo V (2007) Laparoscopic resection in rectal cancer patients: outcome and cost-benefit analysis. Dis Colon Rectum 50:464–471CrossRefPubMed
22.
go back to reference Kuhry E, Schwenk WF, Gaupset R, Romild U, Bonjer HJ (2008) Long-term results of laparoscopic colorectal cancer resection. Cochrane database Syst Rev [Internet]. [cited 2014 Oct 23];(2):CD003432 Kuhry E, Schwenk WF, Gaupset R, Romild U, Bonjer HJ (2008) Long-term results of laparoscopic colorectal cancer resection. Cochrane database Syst Rev [Internet]. [cited 2014 Oct 23];(2):CD003432
Metadata
Title
A Study of 101 Laparoscopic Colorectal Surgeries: a Single Surgeon Experience. How Important Is the Learning Curve?
Authors
Anil Heroor
Ghanishkumar Panjwani
Rahul Chaskar
Publication date
01-12-2015
Publisher
Springer India
Published in
Indian Journal of Surgery / Issue Special Issue 3/2015
Print ISSN: 0972-2068
Electronic ISSN: 0973-9793
DOI
https://doi.org/10.1007/s12262-015-1274-z

Other articles of this Special Issue 3/2015

Indian Journal of Surgery 3/2015 Go to the issue