Laparoscopic colorectal surgery: A five-year experience

Objective: The aim of this study was to assess the feasibility and outcome of 300 laparoscopic colorectal procedures performed within 5 years for both benign and malignant disorders. The specific purpose was to identify the impact of the learning curve on reducing morbidity and on improving the outcome of laparoscopic colorectal surgery. Patients and Methods: All cases were divided into 3 groups: the first 100, the second 100 and the third 100 procedures were analyzed. Statistical analysis was performed by Student's t test and chi(2) test. Results: The laparoscopic procedure had to be converted to open surgery in 22 cases (mean conversion rate 7.3%). Thus, a total of 278 procedures could be performed laparoscopically. The mean major complication rate was 8.6%, minor complications occurred in 9.7%. The overall morbidity rate was 18.3%. In 44 cases, laparoscopic resections were performed for the cure of colorectal malignancy. The mean lymph node harvest was 12.8 nodes, no port-site recurrence was documented at a mean follow-up of 22 months. Analyzing our 5-year experience, the incidence of conversion showed a decline from 8.0% (1st and 2nd 100) to 6.0% in the last 100 procedures (p > 0.05). The major complication rate was significantly decreased from 15 to 6.0% (Ist vs. 2nd 100) and was 5.0% in the 3rd group. The minor complication rate, overall morbidity rate and laparotomy rate have also been reduced (p > 0.05). The duration of surgery was shortened from 251.4 to 213.5 min (Ist vs. 2nd 100, p < 0.05) and was 196.9 min in the last 100 procedures. Postoperative hospital stay was decreased from 16.3 to 14.3 days (Ist 100 vs. 2nd 100, p > 0.05) and could be shortened to 11.2 days (2nd vs. 3rd 100, p < 0.05). Conclusion: With increasing experience, laparoscopic colorectal surgery can be performed with reduced morbidity and improved outcome. To evaluate the role of laparoscopic colorectal procedures, particularly for the cure of malignancy, prospective randomized trials are necessary.