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Intraoperative Technical Difficulty During Laparoscopy-Assisted Surgery as a Prognostic Factor for Colorectal Cancer

Kang, Sung-Bum M.D., Ph.D.1; Park, Jun-Seok M.D.2; Kim, Duck-Woo M.D., Ph.D.1; Lee, Taek-Gu M.D.1

doi: 10.1007/DCR.0b013e3181e5e0b1
Original Contribution

BACKGROUND: Laparoscopy-assisted surgery has technical drawbacks compared with open surgery, although laparoscopic surgery has become widely adopted with evidence of oncological safety for colon cancer treatment. The oncological risk of technical difficulties during laparoscopic surgery for colorectal cancer has not been previously reported. We aimed to investigate whether a technical difficulty encountered during laparoscopic surgery can be considered a recurrence-related factor for colorectal cancer.

METHODS: Data from 427 patients who underwent laparoscopic surgery for colorectal cancer between May 2003 and December 2007 were analyzed. An intraoperative technical difficulty was defined as a significant deviation from the ordinary surgical procedure. All conversions to open surgery and iatrogenic bowel perforation during laparoscopic surgery were included as technical difficulties. The Cox proportional-hazards regression model was used to evaluate the recurrence-related factor in the various risk factors including technical difficulty.

RESULTS: Technical difficulties were found in 44 (10.3%) patients, which included 17 (3.9%) conversions to open surgery and 10 (2.4%) with iatrogenic bowel injury. Technical difficulties were encountered more frequently in men compared with women (13.5% vs 6.0%, P = .013), and for cancers located in the mid and low rectum, splenic flexure, and descending colon. The recurrence rates were higher in patients with technical difficulties (local recurrence, 2.6% vs 6.7%, P < .05; systemic recurrence, 6.3% vs 13.6%, P < .05) with a mean follow-up duration of 45.9 months. Multivariate analysis by the Cox proportional-hazards regression model showed that a technical difficulty was an independent factor related to recurrence after laparoscopic surgery (odds ratio, 2.374; 95% CI, 1.006–5.600; P = .048).

CONCLUSIONS: This study has demonstrated that a technical difficulty during laparoscopy-assisted surgery jeopardizes oncological safety. It is suggested that surgeons should be prepared to minimize technical difficulties during laparoscopy-assisted surgery.

1 Department of Surgery, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam-si, Korea

2 Department of Surgery, School of Medicine, Kyungpook National University, Daegu, Korea

Financial Disclosure: None reported.

Correspondence: Sung-Bum Kang, M.D., Ph.D., Department of Surgery, Seoul National University Bundang Hospital, 300 Gumi-dong, Bundang-gu, Seongnam-si, 463-707 Republic of Korea. E-mail:

© The ASCRS 2010