Does the laparoscopic colorectal surgery learning curve adversely affect the results of colorectal cancer resection? A 3-year prospective study in a district general hospital.
BACKGROUND
Laparoscopic colorectal surgery is slowly being adopted across the UK. We present a 3-year prospective study of laparoscopic colorectal cancer resections in a district general hospital.


METHODS
Data relating to premorbid, operative and postoperative parameters were recorded for all patients undergoing laparoscopic, open, planned converted (laparoscopic assisted) and unplanned converted resections prospectively from April 2003 to April 2006.


RESULTS
A total of 238 colorectal resections were performed, 153 of which were for cancer. Of these 44 (29%) were open, 77 (50%) were laparoscopic and 32 (21%) were converted [26 (17%) planned and six (4%) unplanned]. Blood loss was less in the laparoscopic group compared with the open group (P = 0.02) as was intra-operative fluid replacement (P = 0.01). Time to requiring oral analgesia alone was shorter (P = 0.001) and bowel function returned earlier (P = 0.001) in the laparoscopic group. This is reflected in a trend towards a shorter hospital stay for the laparoscopic group compared with the open group (P = 0.049). The operating time of the laparoscopic group was not significantly longer (P = 0.38). The complication rate was similar between groups (P = 0.31) and the mortality in the laparoscopic group was 1.3%.


CONCLUSIONS
Changing from open to laparoscopic dissection for colorectal cancer is safe even during the initial learning curve. There are clear potential short-term benefits for patients and the technique can be introduced without penalties in terms of reduced surgical throughput.
Lordan
J T
JT
Department of Colorectal Surgery, Frimley Park Hospital NHS Foundation Trust, Frimley, Surrey, UK. dr_lordan@yahoo.co.uk
Tilney
H S
HS
Shirol
S
S
Jourdan
I
I
Gudgeon
A M
AM
D002983:Clinical Competence; D015179:Colorectal Neoplasms / Q000601:surgery*; D003107:Colorectal Surgery / Q000193:education; D013505:Digestive System Surgical Procedures / Q000009:adverse effects / Q000379:methods*; D006767:Hospitals, District; D006801:Humans; D010535:Laparoscopy / Q000009:adverse effects / Q000379:methods*; D007902:Length of Stay; D011183:Postoperative Complications; D011446:Prospective Studies; D006113:United Kingdom