title: Hand-assisted laparoscopic colon and rectal cancer surgery: feasibility, short-term, and oncological outcomes.
abstract: BACKGROUND
  Hand-assisted laparoscopic surgery (HALS) is an established alternative to laparoscopic-assisted surgery, but limited data exist regarding its applicability for colorectal cancer (CRC). We report short-term outcomes in a large series of CRC patients who underwent HALS between 2004 and 2009.
  
  
  METHODS
  A prospectively maintained database was used to identify all CRC patients. Patients with colon cancer (CC) and rectal cancer (RC) were considered separately. Three patients with synchronous CC and RC were excluded. Data are frequency (%) or median (interquartile range).
  
  
  RESULTS
  Between 2004 and 2009, 323 CRC patients underwent a HALS procedure. Median age was 65 (53-73) years, 39% were women, and the median BMI was 27 (24-31) kg/m(2). Diagnoses included 194 colon cancers (CC, 56.7% stage I/II), 129 rectal cancers (RC, 62.7% stage I/II). Operative time was less for CC than RC (157 vs 204 min; P < .0001). Conversion to laparotomy occurred in similar proportions of CC and RC cases (14% vs 10%; P = .38); lymph nodes retrieval was also similar (18 vs 18; P = .45). Overall duration of stay was 5 (4-7) days. At 30 days, postoperative complications occurred in similar proportions of CC and RC patients (28% vs 30%; P = .72). There was 1 mortality (0.5%). For the subgroup with 3 year follow-up, (73 CC and 45 RC patients), the overall survival was 80% and 88% (CC and RC, respectively), and disease free survival 79% and 85%, respectively.
  
  
  CONCLUSIONS
  Colon and rectal cancer can be resected safely using HALS techniques. Conversion rates are low, complication rates expected, durations of hospital stay shorter, and the number of lymph nodes retrieved is high.
authors.affiliation: Department of Colon and Rectal Surgery, Mayo Clinic, Rochester, MN, USA.
authors.forename: Rajesh
authors.initials: R
authors.lastname: Pendlimari
authors.forename: Stefan D
authors.initials: SD
authors.lastname: Holubar
authors.forename: Jirawat
authors.initials: J
authors.lastname: Pattan-Arun
authors.forename: David W
authors.initials: DW
authors.lastname: Larson
authors.forename: Eric J
authors.initials: EJ
authors.lastname: Dozois
authors.forename: John H
authors.initials: JH
authors.lastname: Pemberton
authors.forename: Robert R
authors.initials: RR
authors.lastname: Cima
mesh_terms: D000368:Aged; D003110:Colonic Neoplasms / Q000473:pathology / Q000601:surgery*; D013505:Digestive System Surgical Procedures / Q000009:adverse effects / Q000379:methods*; D005260:Female; D006225:Hand; D006801:Humans; D053208:Kaplan-Meier Estimate; D010535:Laparoscopy / Q000009:adverse effects / Q000379:methods*; D008297:Male; D008875:Middle Aged; D019060:Minimally Invasive Surgical Procedures / Q000009:adverse effects / Q000379:methods; D011183:Postoperative Complications / Q000209:etiology; D011446:Prospective Studies; D012004:Rectal Neoplasms / Q000473:pathology / Q000601:surgery*; D012449:Safety; D016896:Treatment Outcome