Laparoscopic colorectal cancer surgery by a colon lifting-up technique that decreases the number of access ports: comparison by propensity scoring of short-term and long-term outcomes with standard multiport laparoscopic surgery.
BACKGROUND
Laparoscopic colectomy for colorectal cancer has become established as a minimally invasive surgical approach. However, many disposable instruments are required, and there is an associated disadvantage of cost. We have developed a new technique, which uses a suture string to lift up the colon. This method is expected to reduce the number of access ports required without compromising the radical cure.


METHODS
A suture string piercing the abdominal wall is passed through the mesocolon. The colon is retracted anteriorly and is fixed at the abdominal wall. The main mesenteric vessels are under tension, and lymph node dissection is performed easily by a medial approach. The working space is more stable because the colon is fixed to the abdominal wall.


METHODS
This study examined the short-term and long-term surgical outcomes of laparoscopic resection for colorectal cancer using our colon lifting-up technique (CLT), compared with the standard multiport technique. The study design was a case-matched control by propensity scoring. Analyzed variables were sex, age, American Society of Anesthesiologists score, cancer in a different organ, multiple colorectal cancer, operator, operative year, tumor location, operative procedure, adjuvant chemotherapy, and International Union Against Cancer TNM stage.


RESULTS
From 2000 to 2010, 301 patients underwent CLT and 436 standard multiport technique, 148 patients were matched by propensity score and analyzed. Regarding short-term outcomes, there was no difference between the 2 groups. The mean number of ports needed was 3.37±0.48 for CLT (93 with 3 ports, 55 with 4). There were no differences in recurrence-free survival and overall survival in long-term follow-up results for each stage. There were neither recurrences nor complications due to CLT.


CONCLUSIONS
The CLT facilitated laparoscopic colectomy without compromising cure rates. It is a useful method to keep a stable view and to conserve medical resources.
Department of Surgery, Gastroenterological Center, Graduate School of Medicine, Yokohama City University, Minami-ku, Yokohama, Japan. u0970047@urahp.yokohama-cu.ac.jp
Shoichi
S
Fujii
Kazuteru
K
Watanabe
Mitsuyoshi
M
Ota
Jun
J
Watanabe
Yasushi
Y
Ichikawa
Shigeru
S
Yamagishi
Kenji
K
Tatsumi
Hirokazu
H
Suwa
Chikara
C
Kunisaki
Masataka
M
Taguri
Satoshi
S
Morita
Itaru
I
Endo
D000368:Aged; D016063:Blood Loss, Surgical; D016022:Case-Control Studies; D003082:Colectomy / Q000379:methods*; D003106:Colon; D003110:Colonic Neoplasms / Q000601:surgery*; D005260:Female; D006801:Humans; D010535:Laparoscopy / Q000379:methods*; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D057216:Propensity Score; D012004:Rectal Neoplasms / Q000601:surgery*; D013536:Suture Techniques; D016896:Treatment Outcome