Background. Reduced port surgery (RPS) is becoming increasingly popular for some surgeries. However, the application of RPS to the field of colectomy is still underdeveloped. Patients and Methods. In this series, we evaluated the outcome of laparoscopic colorectal resection using 3 ports technique (10?mm umbilical port plus another two ports of either 5 or 10?mm) for twenty-four cases of colorectal cancer as a step for refining of RPS. Results. The mean estimated blood loss was 70?mL (40–90?mL). No major intraoperative complications have been encountered. The mean time for passing flatus after surgery was 36 hours (12–48?hrs). The mean time for oral fluid intake was 36 hours and for semisolid food was 48 hours. The mean hospital stay was 5 days (4–7 days). The perioperative period passed without events. All cases had free surgical margins. The mean number of retrieved lymph nodes was 14 lymph nodes (5–23). Conclusion. Three ports laparoscopy assisted colorectal surgeries looks to be safe, effective and has cosmetic advantages. The procedure could maintain the oncologic principles of cancer surgery. It’s a step on the way of refining of reduced port surgery. 1. Introduction Laparoscopy has emerged as a useful tool in the surgical treatment of the colon and rectal diseases. Specifically for colon cancer, a laparoscopic approach offers short-term benefits to patients while it looks to maintain long-term oncologic outcomes. Favorable postoperative results in terms of less pain, less consumption of analgesia, early return of bowel function, and short hospital stay in patients who underwent laparoscopic colorectal surgery have been persistently reported, both in series with benign and malignant colorectal diseases [1–4]. Published randomized trials comparing laparoscopic and open colorectal resection did not show inferior oncologic results in patients who underwent laparoscopic surgery [5–9]. The added advantages of improved morbidity and cosmesis after laparoscopic surgery make reduction of ports number or even single incision laparoscopic colectomy a viable alternative to the conventional multiports laparoscopic colectomy. However, reduced ports surgery (RPS) as well as single incision laparoscopic colectomy (SILC) are challenging and highly demanding techniques. In this series, we have evaluated the outcome of our newly developed technique of laparoscopic resection of colorectal cancer, only using three ports as a step on refining of reduced port surgery. 2. Patients and Methods Twenty-four patients (13 males and 11 females) have been enrolled for this
References
[1]
H. Hasegawa, Y. Kabeshima, M. Watanabe, S. Yamamoto, and M. Kitajima, “Randomized controlled trial of laparoscopic versus open colectomy for advanced colorectal cancer,” Surgical Endoscopy and Other Interventional Techniques, vol. 17, no. 4, pp. 636–640, 2003.
[2]
T. M. Khalili, P. R. Fleshner, J. R. Hiatt et al., “Colorectal cancer: comparison of laparoscopic with open approaches,” Diseases of the Colon and Rectum, vol. 41, no. 7, pp. 832–838, 1998.
[3]
S. A. Lord, S. W. Larach, A. Ferrara, P. R. Williamson, C. P. Lago, and M. W. Lube, “Laparoscopic resections for colorectal carcinoma: a three-year experience,” Diseases of the Colon and Rectum, vol. 39, no. 2, pp. 148–154, 1996.
[4]
T. M. Young-Fadok, E. Radice, H. Nelson, and W. Scott Harmsen, “Benefits of laparoscopic-assisted colectomy for colon polyps: a case-matched series,” Mayo Clinic Proceedings, vol. 75, no. 4, pp. 344–348, 2000.
[5]
“A comparison of laparoscopically assisted and open colectomy for colon cancer,” The New England Journal of Medicine, vol. 350, pp. 2050–2059, 2004.
[6]
A. M. Lacy, J. C. García-Valdecasas, S. Delgado et al., “Laparoscopy-assisted colectomy versus open colectomy for treatment of non-metastatic colon cancer: a randomised trial,” The Lancet, vol. 359, no. 9325, pp. 2224–2229, 2002.
[7]
K. L. Leung, S. P. Y. Kwok, S. C. W. Lam et al., “Laparoscopic resection of rectosigmoid carcinoma: prospective randomised trial,” The Lancet, vol. 363, no. 9416, pp. 1187–1192, 2004.
[8]
W. L. Law, Y. M. Lee, H. K. Choi, C. L. Seto, and J. W. C. Ho, “Impact of laparoscopic resection for colorectal cancer on operative outcomes and survival,” Annals of Surgery, vol. 245, no. 1, pp. 1–7, 2007.
[9]
G. Anania, M. Santini, C. Gregorio et al., “Laparoscopic colorectal resection performed over a seven-year period in a single Italian centre,” Il Giornale di Chirurgia, vol. 33, no. 8-9, pp. 259–262, 2012.
[10]
T. Makino, J. W. Milson, and S.W. Lee, “Single incision laparoscopic surgeries for colorectal diseases: early experiences of a novel surgical method,” Minimally Invasive Surgery, vol. 2012, Article ID 783074, 16 pages, 2012.
[11]
M. H. Chew, M. T. C. Wong, B. Y. K. Lim, K. H. Ng, and K. W. Eu, “Evaluation of current devices in single-incision laparoscopic colorectal surgery: a preliminary experience in 32 consecutive cases,” World Journal of Surgery, vol. 35, no. 4, pp. 873–880, 2011.
[12]
F. Lopez-Kostner, I. C. Lavery, G. R. Hool, L. A. Rybicki, and V. W. Fazio, “Total mesorectal excision is not necessary for cancers of the upper rectum,” Surgery, vol. 124, no. 4, pp. 612–618, 1998.
[13]
J. Canedo, R. A. Pinto, S. Regadas, F. S. P. Regadas, L. Rosen, and S. D. Wexner, “Laparoscopic surgery for inflammatory bowel disease: does weight matter?” Surgical Endoscopy and Other Interventional Techniques, vol. 24, no. 6, pp. 1274–1279, 2010.
[14]
W. Khoury, R. P. Kiran, T. Jessie, D. Geisler, and F. H. Remzi, “Is the laparoscopic approach to colectomy safe for the morbidly obese?” Surgical Endoscopy and Other Interventional Techniques, vol. 24, no. 6, pp. 1336–1340, 2010.
[15]
R. Veldkamp, E. Kuhry, W. C. Hop et al., “Colon cancer Laparoscopic or Open Resection Study Group (COLOR). Laparoscopic surgery versus open surgery for colon cancer: short-term outcomes of a randomized trial,” Lancet Oncology, vol. 6, no. 7, pp. 477–484, 2005.
[16]
P. J. Guillou, P. Quirke, H. Thorpe et al., “Short-term endpoints of conventional versus laparoscopic-assisted surgery in patients with colorectal cancer (MRC CLASICC trial): multicentre, randomised controlled trial,” The Lancet, vol. 365, no. 9472, pp. 1718–1726, 2005.
[17]
“Laparoscopically assisted colectomy is as safe and effective as open colectomy in people with colon cancer Abstracted from: Nelson H, Sargent D, Wieand HS, et al; for the Clinical Outcomes of Surgical Therapy Study Group. A comparison of laparoscopically assisted and open colectomy for colon cancer. N Engl J Med 2004; 350: 2050-2059,” Cancer Treatment Reviews, vol. 30, no. 8, pp. 707–709, 2004.
[18]
J. C. Weeks, H. Nelson, S. Gelber, D. Sargent, and G. Schroeder, “Short-term quality-of-life outcomes following laparoscopic- assisted colectomy vs open colectomy for colon cancer: a randomized trial,” Journal of the American Medical Association, vol. 287, no. 3, pp. 321–328, 2002.
[19]
Clinical Outcomes of Surgical Therapy Study Group, “A comparison of laparoscopically assisted and open colectomy for colon cancer,” The New England Journal of Medicine, vol. 350, no. 20, pp. 2050–2059, 2004.
[20]
T. D. Jackson, G. G. Kaplan, G. Arena, J. H. Page, and S. O. Rogers Jr., “Laparoscopic versus open resection for colorectal cancer: a metaanalysis of oncologic outcomes,” Journal of the American College of Surgeons, vol. 204, no. 3, pp. 439–446, 2007.
[21]
J. J. Tjandra and M. K. Y. Chan, “Systematic review on the short-term outcome of laparoscopic resection for colon and rectosigmoid cancer,” Colorectal Disease, vol. 8, no. 5, pp. 375–388, 2006.
[22]
J. Fleshman, D. J. Sargent, E. Green et al., “Laparoscopic colectomy for cancer is not inferior to open surgery based on 5-year data from the COST Study Group trial,” Annals of Surgery, vol. 246, no. 4, pp. 655–662, 2007.