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Improved Short-term Outcomes of Laparoscopic Versus Open Resection for Colon and Rectal Cancer in an Area Health Service: A Multicenter Study

McKay, Gary D. B.Med., F.R.A.C.S.1; Morgan, Matthew J. F.R.A.C.S.1,2; Wong, Siu-Kin C. F.R.A.C.S.1,6; Gatenby, Andrew H. F.R.A.C.S.3; Fulham, Stephen B. F.R.A.C.S.4; Ahmed, Khalid W. M.B.Ch.B.3; Toh, James W. T. M.B., F.R.C.S.I.2,4; Hanna, Mina M.B.B.S., B.Sc.(Med.)Hons.1; Hitos, Kerry B.Sc., Ph.D.5the South Western Sydney Colorectal Tumor Group

Diseases of the Colon & Rectum: January 2012 - Volume 55 - Issue 1 - p 42–50
doi: 10.1097/DCR.0b013e318239341f
Original Contributions

BACKGROUND: Evidence demonstrates short-term benefits of laparoscopic surgery for colon cancer. The situation for rectal cancer is less clear.

OBJECTIVES: This review assessed the use and short-term outcomes of elective open and laparoscopic colon and rectal cancer resections within an area health service.

DESIGN: This was a multicenter, retrospective review of a prospective database.

SETTINGS: All elective colon and rectal cancer resections in the western zone of Sydney South West Area Health Service from 2001 until 2008 were included.

PATIENTS: Included were 1721 patients who underwent either a laparoscopic colon (n = 434) or rectal (n = 157) resection or an open colon (n = 742) or rectal (n = 388) resection.

MAIN OUTCOME MEASURES: Outcome measures included operating time, blood loss, adequacy of resection, conversion rate, intensive care unit admission, length of stay, and 26 acute postoperative complications.

RESULTS: Patients were matched for age, sex, ASA, BMI, and tumor stage. Laparoscopic surgery increased in frequency. Fewer patients experienced a complication in both the laparoscopic colon (28.8 vs 54.4%; p < 0.0001) and rectal (41.4 vs 60.3%; p < 0.0001) group irrespective of age. Laparoscopic operating time for colon and rectal cancer was 24.1 minutes (p < 0.0001) and 25.8 minutes (p < 0.0001) longer, with a low conversion-to-open rate (6.5% and 8.3%; p = 0.44). Laparoscopic surgery resulted in fewer transfusions (0.4 vs 0.7units; p = 0.0028) and length of stay (7 vs 10 days; p = 0.0011) for colon cancers, and reduced intraoperative hemoglobin drop (20.5 vs 24.8; p = 0.029) and intensive care unit admissions (26.8 vs 36.3%; p = 0.032) for rectal cancers.

LIMITATIONS: This was a nonrandomized study with rectal cancers more often resected with the open technique (71.2 vs 28.8%; p < 0.001).

CONCLUSIONS: Within an area health service, elective laparoscopic resection for colon and rectal cancer had improved short-term outcomes in comparison with open surgery.

1 Division of Surgery, Bankstown Hospital, Bankstown, NSW, Australia

2 Division of Surgery, Fairfield Hospital, Prairiewood, NSW, Australia

3 Division of Surgery, Campbelltown Hospital, Campbelltown, NSW, Australia

4 Division of Surgery, Liverpool Hospital, Liverpool, NSW, Australia

5 Faculty of Surgery, University of Sydney, NSW, Australia

6 Clinical Cancer Registry, Sydney South West Area Health Service, Liverpool, Sydney, NSW, Australia

Financial Disclosures: None reported.

Presented at the Cairns Tripartite Colorectal meeting, Cairns, NSW, Australia, July 4 to 7, 2011.

Correspondence: Gary McKay, B.Med., F.R.A.C.S., Department of Surgery, Bankstown Hospital, NSW, 2200, Australia. E-mail: garymckay@optusnet.com.au

© The ASCRS 2012