Evolution of laparoscopic colorectal surgery in Brazil: results of 4744 patients from the national registry.
BACKGROUND
Since its introduction, laparoscopic colorectal surgery has raised intense debate and controversies regarding its safety and effectiveness.


METHODS
This multicentric registry reports the experience of 28 Brazilian surgical teams specializing in laparoscopic colorectal surgery.


RESULTS
Between 1992 and 2007, 4744 patients (1994 men--42% and 2750 women--58%) were operated upon, with ages ranging from 13 to 94 years (average 57.5 y). Benign diseases were diagnosed in 2356 patients (49.6%). Most diseases were located in 50.7% of the left and sigmoid colon, 28.2% in the rectum and anal canal, 8.0% in the right colon, and diffuse 7.0%. There were 181 (3.8%) intraoperative complications (from 0% to 14%). There were 261 (5.5%) reported conversions to laparotomy (from 0% to 16.5%), mainly during the early experience (n=119 -59.8%). Postoperative complications were registered in 683 (14.5%) patients (from 5.0% to 50%). Mortality occurred in 43 patients (0.8%). Surgeons who performed less than 50 cases reported similar rates of intraoperative (4.2% vs. 3.8%; P=0.7), postoperative complications (20.8% vs. 14.3%; P=0.07), and mortality (1.0% vs. 0.9%; P=0.5), but the conversion rate was higher (10.4% vs. 5.4%; P=0.04). Two thousand three hundred and eighty-nine (50.4%) malignant tumors were operated upon, and histologic classification showed 2347 (98%) adenocarcinomas, 30 (0.6%) spinocelular carcinomas, and 12 (0.2%) other histologic types. Tumor recurrence rate was 16.3% among patients followed more than 1 year. After an average follow-up of 52 months, 19 (0.8%) parietal recurrences were reported, 18 of which were in port sites and 1 in a patient with disseminated disease. There was no incisional recurrence in the ports used to withdraw the pathologic specimen. Compared with other registries, there was a 75% increase in the number of groups performing laparoscopic colorectal surgery and a decrease in conversions (from 10.5% to 5.5%) and mortality (from 1.5% to 0.9%) rates.


CONCLUSIONS
(1) The number of patients operated upon increased expressively during the last years; (2) operative indications for benign and malignant diseases were similar, and diverticular disease of the colon comprised 40% of the benign ones; (3) conversion and mortality rates decreased over time; (4) surgeon's experience did not influence the complication rates, but was associated with a lower conversion; and (5) oncologic outcome expressed by recurrence rates showed results similar to those reported in conventional surgery.
Campos
Fabio Guilherme
FG
Department of Gastroenterology, Division of Coloproctology, University of São Paulo, Brazil. fgmcampos@terra.com.br
Valarini
Rubens
R
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001938:Brazil; D003082:Colectomy / Q000379:methods / Q000706:statistics & numerical data*; D003108:Colonic Diseases / Q000601:surgery*; D005260:Female; D006801:Humans; D010535:Laparoscopy / Q000379:methods / Q000706:statistics & numerical data*; D007813:Laparotomy / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D017063:Outcome Assessment, Health Care; D012042:Registries; D012189:Retrospective Studies; D055815:Young Adult