Hand-assisted laparoscopic colon and rectal cancer surgery: Feasibility, short-term, and oncological outcomes

Rajesh Pendlimari, Stefan D. Holubar, Jirawat Pattan-Arun, David Larson, Eric Dozois, John H. Pemberton, Robert R. Cima

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Abstract

Background: Hand-assisted laparoscopic surgery (HALS) is an established alternative to laparoscopic-assisted surgery, but limited data exist regarding its applicability for colorectal cancer (CRC). We report short-term outcomes in a large series of CRC patients who underwent HALS between 2004 and 2009. Methods: A prospectively maintained database was used to identify all CRC patients. Patients with colon cancer (CC) and rectal cancer (RC) were considered separately. Three patients with synchronous CC and RC were excluded. Data are frequency (%) or median (interquartile range). Results: Between 2004 and 2009, 323 CRC patients underwent a HALS procedure. Median age was 65 (53-73) years, 39% were women, and the median BMI was 27 (24-31) kg/m2. Diagnoses included 194 colon cancers (CC, 56.7% stage I/II), 129 rectal cancers (RC, 62.7% stage I/II). Operative time was less for CC than RC (157 vs 204 min; P < .0001). Conversion to laparotomy occurred in similar proportions of CC and RC cases (14% vs 10%; P = .38); lymph nodes retrieval was also similar (18 vs 18; P = .45). Overall duration of stay was 5 (4-7) days. At 30 days, postoperative complications occurred in similar proportions of CC and RC patients (28% vs 30%; P = .72). There was 1 mortality (0.5%). For the subgroup with 3 year follow-up, (73 CC and 45 RC patients), the overall survival was 80% and 88% (CC and RC, respectively), and disease free survival 79% and 85%, respectively. Conclusion: Colon and rectal cancer can be resected safely using HALS techniques. Conversion rates are low, complication rates expected, durations of hospital stay shorter, and the number of lymph nodes retrieved is high.

Original languageEnglish (US)
Pages (from-to)378-385
Number of pages8
JournalSurgery
Volume148
Issue number2
DOIs
StatePublished - 2010

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Rectal Neoplasms
Colonic Neoplasms
Hand
Hand-Assisted Laparoscopy
Colorectal Neoplasms
Rectal Diseases
Lymph Nodes
Operative Time
Laparoscopy
Laparotomy
Disease-Free Survival
Length of Stay
Databases
Survival
Mortality

ASJC Scopus subject areas

  • Surgery

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Hand-assisted laparoscopic colon and rectal cancer surgery : Feasibility, short-term, and oncological outcomes. / Pendlimari, Rajesh; Holubar, Stefan D.; Pattan-Arun, Jirawat; Larson, David; Dozois, Eric; Pemberton, John H.; Cima, Robert R.

In: Surgery, Vol. 148, No. 2, 2010, p. 378-385.

Research output: Contribution to journalArticle

Pendlimari, Rajesh ; Holubar, Stefan D. ; Pattan-Arun, Jirawat ; Larson, David ; Dozois, Eric ; Pemberton, John H. ; Cima, Robert R. / Hand-assisted laparoscopic colon and rectal cancer surgery : Feasibility, short-term, and oncological outcomes. In: Surgery. 2010 ; Vol. 148, No. 2. pp. 378-385.
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abstract = "Background: Hand-assisted laparoscopic surgery (HALS) is an established alternative to laparoscopic-assisted surgery, but limited data exist regarding its applicability for colorectal cancer (CRC). We report short-term outcomes in a large series of CRC patients who underwent HALS between 2004 and 2009. Methods: A prospectively maintained database was used to identify all CRC patients. Patients with colon cancer (CC) and rectal cancer (RC) were considered separately. Three patients with synchronous CC and RC were excluded. Data are frequency ({\%}) or median (interquartile range). Results: Between 2004 and 2009, 323 CRC patients underwent a HALS procedure. Median age was 65 (53-73) years, 39{\%} were women, and the median BMI was 27 (24-31) kg/m2. Diagnoses included 194 colon cancers (CC, 56.7{\%} stage I/II), 129 rectal cancers (RC, 62.7{\%} stage I/II). Operative time was less for CC than RC (157 vs 204 min; P < .0001). Conversion to laparotomy occurred in similar proportions of CC and RC cases (14{\%} vs 10{\%}; P = .38); lymph nodes retrieval was also similar (18 vs 18; P = .45). Overall duration of stay was 5 (4-7) days. At 30 days, postoperative complications occurred in similar proportions of CC and RC patients (28{\%} vs 30{\%}; P = .72). There was 1 mortality (0.5{\%}). For the subgroup with 3 year follow-up, (73 CC and 45 RC patients), the overall survival was 80{\%} and 88{\%} (CC and RC, respectively), and disease free survival 79{\%} and 85{\%}, respectively. Conclusion: Colon and rectal cancer can be resected safely using HALS techniques. Conversion rates are low, complication rates expected, durations of hospital stay shorter, and the number of lymph nodes retrieved is high.",
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T1 - Hand-assisted laparoscopic colon and rectal cancer surgery

T2 - Feasibility, short-term, and oncological outcomes

AU - Pendlimari, Rajesh

AU - Holubar, Stefan D.

AU - Pattan-Arun, Jirawat

AU - Larson, David

AU - Dozois, Eric

AU - Pemberton, John H.

AU - Cima, Robert R.

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N2 - Background: Hand-assisted laparoscopic surgery (HALS) is an established alternative to laparoscopic-assisted surgery, but limited data exist regarding its applicability for colorectal cancer (CRC). We report short-term outcomes in a large series of CRC patients who underwent HALS between 2004 and 2009. Methods: A prospectively maintained database was used to identify all CRC patients. Patients with colon cancer (CC) and rectal cancer (RC) were considered separately. Three patients with synchronous CC and RC were excluded. Data are frequency (%) or median (interquartile range). Results: Between 2004 and 2009, 323 CRC patients underwent a HALS procedure. Median age was 65 (53-73) years, 39% were women, and the median BMI was 27 (24-31) kg/m2. Diagnoses included 194 colon cancers (CC, 56.7% stage I/II), 129 rectal cancers (RC, 62.7% stage I/II). Operative time was less for CC than RC (157 vs 204 min; P < .0001). Conversion to laparotomy occurred in similar proportions of CC and RC cases (14% vs 10%; P = .38); lymph nodes retrieval was also similar (18 vs 18; P = .45). Overall duration of stay was 5 (4-7) days. At 30 days, postoperative complications occurred in similar proportions of CC and RC patients (28% vs 30%; P = .72). There was 1 mortality (0.5%). For the subgroup with 3 year follow-up, (73 CC and 45 RC patients), the overall survival was 80% and 88% (CC and RC, respectively), and disease free survival 79% and 85%, respectively. Conclusion: Colon and rectal cancer can be resected safely using HALS techniques. Conversion rates are low, complication rates expected, durations of hospital stay shorter, and the number of lymph nodes retrieved is high.

AB - Background: Hand-assisted laparoscopic surgery (HALS) is an established alternative to laparoscopic-assisted surgery, but limited data exist regarding its applicability for colorectal cancer (CRC). We report short-term outcomes in a large series of CRC patients who underwent HALS between 2004 and 2009. Methods: A prospectively maintained database was used to identify all CRC patients. Patients with colon cancer (CC) and rectal cancer (RC) were considered separately. Three patients with synchronous CC and RC were excluded. Data are frequency (%) or median (interquartile range). Results: Between 2004 and 2009, 323 CRC patients underwent a HALS procedure. Median age was 65 (53-73) years, 39% were women, and the median BMI was 27 (24-31) kg/m2. Diagnoses included 194 colon cancers (CC, 56.7% stage I/II), 129 rectal cancers (RC, 62.7% stage I/II). Operative time was less for CC than RC (157 vs 204 min; P < .0001). Conversion to laparotomy occurred in similar proportions of CC and RC cases (14% vs 10%; P = .38); lymph nodes retrieval was also similar (18 vs 18; P = .45). Overall duration of stay was 5 (4-7) days. At 30 days, postoperative complications occurred in similar proportions of CC and RC patients (28% vs 30%; P = .72). There was 1 mortality (0.5%). For the subgroup with 3 year follow-up, (73 CC and 45 RC patients), the overall survival was 80% and 88% (CC and RC, respectively), and disease free survival 79% and 85%, respectively. Conclusion: Colon and rectal cancer can be resected safely using HALS techniques. Conversion rates are low, complication rates expected, durations of hospital stay shorter, and the number of lymph nodes retrieved is high.

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