Laparoscopically Assisted Colectomy

Minimally invasive surgery has been used for gallbladder procedures for a number of years at Abington Memorial Hospital and has significantly shortened morbidity and length of stay as compared to traditional surgery. More recently, minimally invasive surgery has been used for patients with colon cancer, reports Steven A. Fassler, M.D., a colorectal surgeon in the Department of Surgery at Abington Memorial Hospital. A recent study (N Engl J Med 2004; 350: 2050-9) provides a direct comparison of laparoscopically assisted colectomy (LAC) with open colectomy (OC). Participation in the trial was limited to 66 credentialed surgeons at 48 institutions. Each surgeon had performed at least 20 laparoscopically assisted colorectal operations. In this study, 872 patients were randomized between the two procedures. Of the 435 patients assigned to LAC, 90 underwent conversion to open colectomy.

Operating times were 150 minutes with LAC versus 95 minutes with OC. Perioperative recovery was significantly faster in the LAC than OC group with briefer use of parenteral narcotics. There were no significant differences between the groups in the rate of intraoperative complications (2% OC versus 4% LAC). With a median follow-up of 4.4 years, recurrence rates were similar between the two groups (16% LAC and 18% OC). Recurrence at the surgical site was less than 1% in both groups, as well as overall survival for both groups.

These trends and observations have been mirrored in the experiences of Fassler, D. Mark Zebley, M.D., and Robert K. Josloff, M.D. at Abington Memorial Hospital. To date, the experience in LAC numbers at AMH are in excess of 500 patients, reports Zebley of the Department of Surgery. Josloff, a laparoscopic surgeon also from the Department of Surgery at Abington Memorial Hospital, comments that this solid, multi-institutional study demonstrates the equivalent outcomes of LAC and OC in selected patients with colon cancer with less morbidity and shorter hospital stays.

For more information regarding laparoscopically assisted colectomy, contact the Department of Surgery.