Impact of the Standardized Medial-to-Lateral Approach on Outcome of Laparoscopic Colorectal Resection
Background Beginning in 2004, a standardized medial-to-lateral approach was adopted in laparoscopic colorectal resection (LapCR) in our institution. The present study aimed to compare the outcomes of patients operated on by this approach with those who were operated on prior to the adoption of this...
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Published in | World journal of surgery Vol. 33; no. 10; pp. 2177 - 2182 |
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Main Authors | , , , |
Format | Journal Article |
Language | English |
Published |
New York
Springer-Verlag
01.10.2009
Springer‐Verlag Springer Springer Nature B.V |
Subjects | |
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Abstract | Background
Beginning in 2004, a standardized medial-to-lateral approach was adopted in laparoscopic colorectal resection (LapCR) in our institution. The present study aimed to compare the outcomes of patients operated on by this approach with those who were operated on prior to the adoption of this technique.
Methods
Data were retrieved from a prospectively collected database on LapCR. The control group included 196 patients operated on from January 2002 to December 2003 and the medial approach group included 224 patients who underwent operations from January 2005 to December 2007. The patient characteristics, operative details, pathology, and surgical outcomes of the two groups were compared.
Results
The patient demographics, types of operation and pathology did not show any statistically significant difference. The medial approach group was associated with significantly less median blood loss [100 (interquartile range [IQR]: 50–174) ml versus 150 (IQR:100–300) ml;
p
< 0.001], shorter hospital stay [4 (IQR: (4–7) versus 7 (5–9) days;
p
< 0.001], and more lymph nodes harvested [12 (7–17.5) versus 10 (6–15);
p
= 0.001]. Significantly earlier bowel function recovery was observed in the medial approach group. The mortality and complications did not show any difference.
Conclusions
A standardized medial-to-lateral approach for LapCR is associated with less blood loss, earlier return of bowel function, shorter hospital stay, and increased number of lymph nodes harvested. This should be the preferred approach in LapCR. |
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AbstractList | Background
Beginning in 2004, a standardized medial‐to‐lateral approach was adopted in laparoscopic colorectal resection (LapCR) in our institution. The present study aimed to compare the outcomes of patients operated on by this approach with those who were operated on prior to the adoption of this technique.
Methods
Data were retrieved from a prospectively collected database on LapCR. The control group included 196 patients operated on from January 2002 to December 2003 and the medial approach group included 224 patients who underwent operations from January 2005 to December 2007. The patient characteristics, operative details, pathology, and surgical outcomes of the two groups were compared.
Results
The patient demographics, types of operation and pathology did not show any statistically significant difference. The medial approach group was associated with significantly less median blood loss [100 (interquartile range [IQR]: 50–174) ml versus 150 (IQR:100–300) ml; p < 0.001], shorter hospital stay [4 (IQR: (4–7) versus 7 (5–9) days; p < 0.001], and more lymph nodes harvested [12 (7–17.5) versus 10 (6–15); p = 0.001]. Significantly earlier bowel function recovery was observed in the medial approach group. The mortality and complications did not show any difference.
Conclusions
A standardized medial‐to‐lateral approach for LapCR is associated with less blood loss, earlier return of bowel function, shorter hospital stay, and increased number of lymph nodes harvested. This should be the preferred approach in LapCR. BACKGROUNDBeginning in 2004, a standardized medial-to-lateral approach was adopted in laparoscopic colorectal resection (LapCR) in our institution. The present study aimed to compare the outcomes of patients operated on by this approach with those who were operated on prior to the adoption of this technique. METHODSData were retrieved from a prospectively collected database on LapCR. The control group included 196 patients operated on from January 2002 to December 2003 and the medial approach group included 224 patients who underwent operations from January 2005 to December 2007. The patient characteristics, operative details, pathology, and surgical outcomes of the two groups were compared. RESULTSThe patient demographics, types of operation and pathology did not show any statistically significant difference. The medial approach group was associated with significantly less median blood loss [100 (interquartile range [IQR]: 50-174) ml versus 150 (IQR:100-300) ml; p < 0.001], shorter hospital stay [4 (IQR: (4-7) versus 7 (5-9) days; p < 0.001], and more lymph nodes harvested [12 (7-17.5) versus 10 (6-15); p = 0.001]. Significantly earlier bowel function recovery was observed in the medial approach group. The mortality and complications did not show any difference. CONCLUSIONSA standardized medial-to-lateral approach for LapCR is associated with less blood loss, earlier return of bowel function, shorter hospital stay, and increased number of lymph nodes harvested. This should be the preferred approach in LapCR. Background Beginning in 2004, a standardized medial-to-lateral approach was adopted in laparoscopic colorectal resection (LapCR) in our institution. The present study aimed to compare the outcomes of patients operated on by this approach with those who were operated on prior to the adoption of this technique. Methods Data were retrieved from a prospectively collected database on LapCR. The control group included 196 patients operated on from January 2002 to December 2003 and the medial approach group included 224 patients who underwent operations from January 2005 to December 2007. The patient characteristics, operative details, pathology, and surgical outcomes of the two groups were compared. Results The patient demographics, types of operation and pathology did not show any statistically significant difference. The medial approach group was associated with significantly less median blood loss [100 (interquartile range [IQR]: 50–174) ml versus 150 (IQR:100–300) ml; p < 0.001], shorter hospital stay [4 (IQR: (4–7) versus 7 (5–9) days; p < 0.001], and more lymph nodes harvested [12 (7–17.5) versus 10 (6–15); p = 0.001]. Significantly earlier bowel function recovery was observed in the medial approach group. The mortality and complications did not show any difference. Conclusions A standardized medial-to-lateral approach for LapCR is associated with less blood loss, earlier return of bowel function, shorter hospital stay, and increased number of lymph nodes harvested. This should be the preferred approach in LapCR. Abstract Background Beginning in 2004, a standardized medial‐to‐lateral approach was adopted in laparoscopic colorectal resection (LapCR) in our institution. The present study aimed to compare the outcomes of patients operated on by this approach with those who were operated on prior to the adoption of this technique. Methods Data were retrieved from a prospectively collected database on LapCR. The control group included 196 patients operated on from January 2002 to December 2003 and the medial approach group included 224 patients who underwent operations from January 2005 to December 2007. The patient characteristics, operative details, pathology, and surgical outcomes of the two groups were compared. Results The patient demographics, types of operation and pathology did not show any statistically significant difference. The medial approach group was associated with significantly less median blood loss [100 (interquartile range [IQR]: 50–174) ml versus 150 (IQR:100–300) ml; p < 0.001], shorter hospital stay [4 (IQR: (4–7) versus 7 (5–9) days; p < 0.001], and more lymph nodes harvested [12 (7–17.5) versus 10 (6–15); p = 0.001]. Significantly earlier bowel function recovery was observed in the medial approach group. The mortality and complications did not show any difference. Conclusions A standardized medial‐to‐lateral approach for LapCR is associated with less blood loss, earlier return of bowel function, shorter hospital stay, and increased number of lymph nodes harvested. This should be the preferred approach in LapCR. Beginning in 2004, a standardized medial-to-lateral approach was adopted in laparoscopic colorectal resection (LapCR) in our institution. The present study aimed to compare the outcomes of patients operated on by this approach with those who were operated on prior to the adoption of this technique. Data were retrieved from a prospectively collected database on LapCR. The control group included 196 patients operated on from January 2002 to December 2003 and the medial approach group included 224 patients who underwent operations from January 2005 to December 2007. The patient characteristics, operative details, pathology, and surgical outcomes of the two groups were compared. The patient demographics, types of operation and pathology did not show any statistically significant difference. The medial approach group was associated with significantly less median blood loss [100 (interquartile range [IQR]: 50-174) ml versus 150 (IQR:100-300) ml; p < 0.001], shorter hospital stay [4 (IQR: (4-7) versus 7 (5-9) days; p < 0.001], and more lymph nodes harvested [12 (7-17.5) versus 10 (6-15); p = 0.001]. Significantly earlier bowel function recovery was observed in the medial approach group. The mortality and complications did not show any difference. A standardized medial-to-lateral approach for LapCR is associated with less blood loss, earlier return of bowel function, shorter hospital stay, and increased number of lymph nodes harvested. This should be the preferred approach in LapCR. Beginning in 2004, a standardized medial-to-lateral approach was adopted in laparoscopic colorectal resection (LapCR) in our institution. The present study aimed to compare the outcomes of patients operated on by this approach with those who were operated on prior to the adoption of this technique. Data were retrieved from a prospectively collected database on LapCR. The control group included 196 patients operated on from January 2002 to December 2003 and the medial approach group included 224 patients who underwent operations from January 2005 to December 2007. The patient characteristics, operative details, pathology, and surgical outcomes of the two groups were compared. The patient demographics, types of operation and pathology did not show any statistically significant difference. The medial approach group was associated with significantly less median blood loss [100 (interquartile range [IQR]: 50-174) ml versus 150 (IQR:100-300) ml; p < 0.001], shorter hospital stay [4 (IQR: (4-7) versus 7 (5-9) days; p < 0.001], and more lymph nodes harvested [12 (7-17.5) versus 10 (6-15); p = 0.001]. Significantly earlier bowel function recovery was observed in the medial approach group. The mortality and complications did not show any difference. A standardized medial-to-lateral approach for LapCR is associated with less blood loss, earlier return of bowel function, shorter hospital stay, and increased number of lymph nodes harvested. This should be the preferred approach in LapCR. |
Author | Fan, Joe K. M. Law, Wai-Lun Poon, Jensen T. C. Lo, Oswen S. H. |
Author_xml | – sequence: 1 givenname: Jensen T. C. surname: Poon fullname: Poon, Jensen T. C. organization: Department of Surgery, University of Hong Kong Medical Centre, Queen Mary Hospital – sequence: 2 givenname: Wai-Lun surname: Law fullname: Law, Wai-Lun email: lawwl@hkucc.hku.hk, lawwl@hku.hk organization: Department of Surgery, University of Hong Kong Medical Centre, Queen Mary Hospital – sequence: 3 givenname: Joe K. M. surname: Fan fullname: Fan, Joe K. M. organization: Department of Surgery, University of Hong Kong Medical Centre, Queen Mary Hospital – sequence: 4 givenname: Oswen S. H. surname: Lo fullname: Lo, Oswen S. H. organization: Department of Surgery, University of Hong Kong Medical Centre, Queen Mary Hospital |
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Keywords | Bowel Function Approach Group Ureter Injury Medial Approach Vascular Pedicle Medicine Endoscopic surgery Prognosis Treatment Digestive system Gut Rectum Evolution Colon Malignant tumor Cancer |
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References_xml | – volume: 179 start-page: 92 year: 2000 end-page: 96 ident: CR10 article-title: Risk factors for anastomotic leakage after low anterior resection with total mesorectal excision publication-title: Am J Surg doi: 10.1016/S0002-9610(00)00252-X contributor: fullname: Ho – volume: 21 start-page: 1657 year: 2007 ident: CR13 article-title: Medially approached radical lymph node dissection along the surgical trunk for advanced right-sided colon cancers publication-title: Surg Endosc doi: 10.1007/s00464-007-9305-x contributor: fullname: Nagayama – volume: 359 start-page: 2224 year: 2002 end-page: 2229 ident: CR1 article-title: Laparoscopy-assisted colectomy versus open colectomy for treatment of non-metastatic colon cancer: a randomised trial publication-title: Lancet doi: 10.1016/S0140-6736(02)09290-5 contributor: fullname: Delgado – volume: 8 start-page: 1117 year: 1994 end-page: 1123 ident: CR4 article-title: Laparoscopic oncologic proctosigmoidectomy with low colorectal anastomosis in a cadaver model publication-title: Surg Endosc doi: 10.1007/BF00705735 contributor: fullname: Decanini – volume: 27 start-page: 190 year: 2003 end-page: 196 ident: CR6 article-title: Comparison of medial-to-lateral versus traditional lateral-to-medial laparoscopic dissection sequences for resection of rectosigmoid cancers: randomized controlled clinical trial publication-title: World J Surg doi: 10.1007/s00268-003-1029-z contributor: fullname: Huang – year: 2006 ident: CR9 publication-title: Laparoscopic colorectal surgery contributor: fullname: Nakajima – volume: 350 start-page: 2050 year: 2004 end-page: 2059 ident: CR3 article-title: A comparison of laparoscopically assisted and open colectomy for colon cancer publication-title: N Engl J Med doi: 10.1056/NEJMoa032651 – volume: 17 start-page: 51 year: 1993 end-page: 56 ident: CR7 article-title: Laparoscopic colonic procedures publication-title: World J Surg doi: 10.1007/BF01655705 contributor: fullname: Rosenthal – volume: 21 start-page: 1503 year: 2007 end-page: 1507 ident: CR16 article-title: Medial-to-lateral laparoscopic colon resection: a view beyond the learning curve publication-title: Surg Endosc doi: 10.1007/s00464-006-9085-8 contributor: fullname: Bowne – volume: 1 start-page: 144 year: 1991 end-page: 150 ident: CR8 article-title: Minimally invasive colon resection (laparoscopic colectomy) publication-title: Surg Laparosc Endosc contributor: fullname: Goldstein – volume: 219 start-page: 732 year: 1994 end-page: 740 ident: CR12 article-title: Laparoscopic-assisted colectomy. 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Laparoscopic resection of colon cancer: consensus of the European Association of Endoscopic Surgery (EAES) publication-title: Surg Endosc – volume: 359 start-page: 2224 year: 2002 end-page: 2229 article-title: Laparoscopy‐assisted colectomy versus open colectomy for treatment of non‐metastatic colon cancer: a randomised trial publication-title: Lancet – volume: 6 start-page: 477 year: 2005 end-page: 484 article-title: COlon cancer Laparoscopic or Open Resection Study Group (COLOR). Laparoscopic surgery versus open surgery for colon cancer: short‐term outcomes of a randomised trial publication-title: Lancet Oncol – volume: 23 start-page: 463 year: 1999 end-page: 467 article-title: Prospective evaluation of selective defunctioning stoma for low anterior resection with total mesorectal excision publication-title: World J Surg – volume: 219 start-page: 732 year: 1994 end-page: 740 article-title: Laparoscopic‐assisted colectomy. Initial experience publication-title: Ann Surg – ident: e_1_2_5_3_2 doi: 10.1016/S1470‐2045(05)70221‐7 – ident: e_1_2_5_18_2 doi: 10.1007/s10350‐004‐6590‐5 – ident: e_1_2_5_5_2 doi: 10.1007/BF00705735 – ident: e_1_2_5_13_2 doi: 10.1097/00000658‐199406000‐00018 – ident: e_1_2_5_15_2 doi: 10.1245/s10434‐006‐9153‐2 – ident: e_1_2_5_7_2 doi: 10.1007/s00268‐003‐1029‐z – ident: e_1_2_5_6_2 doi: 10.1007/s00464‐003‐8253‐3 – ident: e_1_2_5_16_2 doi: 10.1007/s11605‐007‐0120‐4 – ident: e_1_2_5_17_2 doi: 10.1007/s00464‐006‐9085‐8 – ident: e_1_2_5_2_2 doi: 10.1016/S0140‐6736(02)09290‐5 – ident: e_1_2_5_11_2 doi: 10.1016/S0002‐9610(00)00252‐X – ident: e_1_2_5_8_2 doi: 10.1007/BF01655705 – ident: e_1_2_5_10_2 doi: 10.1007/0-387-33863-2 – ident: e_1_2_5_4_2 doi: 10.1056/NEJMoa032651 – ident: e_1_2_5_14_2 doi: 10.1007/s00464‐007‐9305‐x – volume: 1 start-page: 144 year: 1991 ident: e_1_2_5_9_2 article-title: Minimally invasive colon resection (laparoscopic colectomy) publication-title: Surg Laparosc Endosc contributor: fullname: Jacobs M – ident: e_1_2_5_12_2 doi: 10.1007/PL00012331 |
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Beginning in 2004, a standardized medial-to-lateral approach was adopted in laparoscopic colorectal resection (LapCR) in our institution. The... Background Beginning in 2004, a standardized medial‐to‐lateral approach was adopted in laparoscopic colorectal resection (LapCR) in our institution. The... Beginning in 2004, a standardized medial-to-lateral approach was adopted in laparoscopic colorectal resection (LapCR) in our institution. The present study... Abstract Background Beginning in 2004, a standardized medial‐to‐lateral approach was adopted in laparoscopic colorectal resection (LapCR) in our institution.... BACKGROUNDBeginning in 2004, a standardized medial-to-lateral approach was adopted in laparoscopic colorectal resection (LapCR) in our institution. The present... |
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Title | Impact of the Standardized Medial-to-Lateral Approach on Outcome of Laparoscopic Colorectal Resection |
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