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Colon Presentation Revised

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Fadhil Ahmed Mohialdeen
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6 views36 pages

Colon Presentation Revised

ppt

Uploaded by

Fadhil Ahmed Mohialdeen
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
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Download as PPTX, PDF, TXT or read online on Scribd
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Laparoscopic Colon
Resection
Dr. Abdul Mujib Cadili
MBCHB, FRCS(Ed),FRCS(C), FACS
Associate Clinical Professor
University of Alberta
Incidence of Colorectal Cancer in
North America
• Most common malignancy of the gastrointestinal
tract
• 15% of all cancer related deaths in North America
• 50-70 years old, M>F
• Low fiber, high refined carb and fat diet with vitamin
A, C and E deficiency
• 80% arise from the adenoma-carcinoma sequence
• Fewer arise from DNA mismatch repair deficiency
• Also rise from chronic inflammation in the context
of inflammatory bowel disease
Staging: TNM Classification
http://www.drleongmd.com/procedures/laparoscopic-colon-resection-surgery/
http://www.laparoscopykerala.net/gallery.php
Barriers to Laparoscopic Colon
Resection
• Technical difficulty
• Learning curve

• Oncological safety
• Adequate margin and lymph node status
• Port site metastasis
• Effect of CO2 pneumoperitoneum on tumor biology
Advantages of Laparoscopic
Colon Resection

•Decreased
• Length of hospital stay
• Analgesic requirements postoperatively
• Wound infections
• Postoperative hernias and bowel
obstructions?
•Increased exposure to laparoscopic
surgery in training (residency and
fellowships)

•Barriers for community surgeons not


formally trained in advanced
laparoscopic surgery
Purpose of the Study
• Document our experience in transitioning
from open to laparoscopic colon resection in
a high volume community center
• Compare outcomes between open and
laparoscopic colon resection during this
transition
• Efficacy of surgery
• Morbidity (short and long term)
• Mortality
Methods

• Retrospective review of all surgeries done for


colonic neoplasia at the Sturgeon Community
Hospital over a 10 year period (2007 – 2017)
Assessed Variables

• Age • Intraoperative Complications


• Gender • Perioperative Complications
• Medical Comorbidities • Benign vs. Malignant
• Extent of Colonic Resection • Histologic Type & Grade
• Open vs. Minimally invasive • Number and Status of Lymph
• Mortality Nodes
• Margin Status
Exclusion Criteria

• Procedures performed for emergency


indications for non-neoplastic disease
(ex. perforated diverticulitis or
fulminant colitis)
Statistical Analysis
• Logistic regression analysis
• Univariate analysis
• Variables significant at p < 0.1 were included
in multivariate analysis
• P value of < 0.05 was adopted for statistical
significance
Results
• 578 colon resections in study
period
• 369 open; 209 laparoscopic
Table 1
Table 2:
Table 3: Complications; Laparoscopic vs. Open
Table 4: 90 day mortality
Table 5: Outcomes
Results & Conclusions
• Patient outcomes and quality of resection
indicators not different between open and
minimally invasive
• Laparoscopic surgery does not compromise
outcomes, oncologic or otherwise
• Trend toward greater length of operative
time for minimally invasive (not statistically
significant)
• Learning curve
Results & Conclusions
• Less operative blood loss and lower mortality
for minimally invasive cases
• ? Selection bias

• Significantly lower length of postoperative


stay for minimally invasive cases
• Uncontested advantage of laparoscopic over
open surgery
Study Limitations

• Retrospective nature
• Possibility of selection bias
• Inclusion of hand-asssisted cases in the
analysis
• Survival analysis limited to 90 day mortality
• Long term survival not assessed
• Potential long term advantages of laparoscopic
surgery not assessed
Main Conclusion

• No negative outcomes with transitioning to


minimally invasive technique
• The shift to minimally invasive techniques in
colonic resection can be done in an effective
and safe manner without compromising
outcomes

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