Colorectal resection by a minilaparotomy approach vs. conventional operation for colon cancer. Results of a prospective randomized trial.
OBJECTIVE
The aim of this study was to evaluate the outcome of patients undergoing colorectal resection for colon cancer using a minilaparotomy approach or conventional surgical procedure.


METHODS
In a prospective randomized trial, twenty consecutive patients undergoing colon resection by minilaparotomy and 26 patients undergoing conventional open colorectal resection were evaluated. Immunologic, metabolic and hemodynamic studies were performed in all patients. Cell surface markers were used to characterize Th1/2 balance, using flow cytometry. Indirect calorimetry to measure energy expenditure, and pulse dye densitometry for a hemodynamic study were performed in patients until 14 POD.


RESULTS
The lengths of laparotomy incisions were 7.5+/-1.5 cm and 20.5+/-2.5 cm in the minilaparotomy and conventional group, respectively. Mean operative time, morbidity and postoperative hospital stay of the two groups was not significantly different. However, mean operative blood loss, days to p.o. liquids and walking, and amount of analgesic usage were significantly less in the minilaparotomy group. The postoperative ratio of Th1/2 in CD4+T cells was decreased in both groups, but no significant difference was seen between the groups. Significant increase of resting energy expenditure and cardiac index was seen until day 3 in the conventional group, whereas those values increased until day 1 in the minilaparotomy group.


CONCLUSIONS
Compared with conventional colorectal resection for colon cancer, colorectal resection by minilaparotomy results in a more rapid return of bowel function, less pain and host response. However, the alternations of the host response for surgical stress between the two groups are similar in the early postoperative stage (days 1-2).
Ishikawa
M
M
Department of Surgery, National Kochi Hospital, Japan. masa1192@tokushima-med.jrc.or.jp
Nishioka
M
M
Hanaki
N
N
Miyauchi
T
T
Kashiwagi
Y
Y
Miki
H
H
D000368:Aged; D000369:Aged, 80 and over; D018791:CD4 Lymphocyte Count; D002153:Calorimetry, Indirect; D003082:Colectomy; D003110:Colonic Neoplasms / Q000503:physiopathology / Q000601:surgery*; D004734:Energy Metabolism; D005260:Female; D005434:Flow Cytometry; D006439:Hemodynamics; D006801:Humans; D007371:Interferon-gamma / Q000032:analysis; D015847:Interleukin-4 / Q000032:analysis; D007813:Laparotomy / Q000379:methods; D008297:Male; D008875:Middle Aged; D019060:Minimally Invasive Surgical Procedures; D011446:Prospective Studies
D015847:Interleukin-4; D007371:Interferon-gamma