T. Bartley Pickron

Single-Incision Laparoscopic Colectomy for Cancer: Short-Term Outcomes and Comparative Analysis

Introduction. Single-incision laparoscopic colectomy (SILC) is a viable and safe technique; however, there are no single-institution studies comparing outcomes of SILC for colon cancer with well-established minimally invasive techniques. We evaluated the short-term outcomes following SILC for cancer compared to a group of well-established minimally invasive techniques. Methods. Fifty consecutive patients who underwent SILC for colon cancer were compared to a control group composed of 50 cases of minimally invasive colectomies performed with either conventional multiport or hand-assisted laparoscopic technique. The groups were paired based on the type of procedure. Demographics, intraoperative, and postoperative outcomes were assessed. Results. With the exception of BMI, demographics were similar between both groups. Most of the procedures were right colectomies (n = 33) and anterior resections (n = 12). There were no significant differences in operative time (127.9 versus 126.7 min), conversions (0 versus 1), complications (14% versus 8%), length of stay (4.5 versus 4.0 days), readmissions (2% versus 2%), and reoperations (2% versus 2%). Oncological outcomes were also similar between groups. Conclusions. SILC is an oncologically sound alternative for the management of colon cancer and results in similar short-term outcomes as compared with well-established minimally invasive techniques.

Minimally Invasive Approaches for the Management of “Difficult” Colonic Polyps

Traditionally, patients with colonic polyps not amenable to endoscopic removal require open colectomy for management. We evaluated our experience with minimally invasive approaches including endoscopic mucosal resection (EMR), laparoscopic-assisted endoscopic polypectomy (LAEP), and laparoscopic-assisted colectomy (LAC). Patients referred for surgery for colonic polyps were selected for one of three minimally invasive modalities. A total of 123 patients were referred for resection of “difficult” polyps. Thirty underwent EMR, 25 underwent LAEP, and 68 underwent LAC. Of those selected to undergo EMR or LAEP, 76.4% were successfully managed without colon resection. The remaining 23.6% underwent LAC. Nine complications were encountered, including two requiring reoperative intervention. Of the 123 patients, three were found to have malignant disease on final pathology. Surgical resection can be avoided in a significant number of patients with “difficult” polyps referred for surgery by performing EMR and LAEP. In those who require surgery, minimally invasive resection can be achieved.

Laparoscopic Primary Colorrhaphy for Acute Iatrogenic Perforations during Colonoscopy

Purpose. We present our experience with laparoscopic colorrhaphy as definitive surgical modality for the management of colonoscopic perforations. Methods. Over a 17-month period, we assessed the outcomes of consecutive patients presenting with acute colonoscopic perforations. Patient characteristics and perioperative parameters were tabulated. Postoperative outcomes were evaluated within 30 days following discharge. Results. Five female patients with a mean age of 71.4 ± 9.7 years (range: 58–83), mean BMI of 26.4 ± 3.4 kg/m2 (range: 21.3–30.9), and median ASA score of 2 (range: 2-3) presented with acute colonoscopic perforations. All perforations were successfully managed through laparoscopic colorrhaphy within 24 hours of development. The perforations were secondary to direct trauma (n = 3) or thermal injury (n = 2) and were localized to the sigmoid (n = 4) or cecum (n = 1). None of the patients required surgical resection, diversion, or conversion to an open procedure. No intra- or postoperative complications were encountered. The mean length of hospital stay was 3.8 ± 0.8 days (range: 3–5). There were no readmissions or reoperations. Conclusion. Acute colonoscopic perforations can be safely managed via laparoscopic primary repair without requiring resection or diversion. Early recognition and intervention are essential for successful outcomes.

Mo1624 Comparative Analysis of Single Incision Colorectal Surgery in Obese and Non-Obese Patients: A Case-Matched Study

S A T A b st ra ct s therapy to treat LRRC remains controversial. Therefore, we retrospectively analyzed patients who underwent surgical treatment for LRRC, to evaluate the perioperative outcome and the prognosis. Methods: Forty-five patients (male-female ratio, 25:20), who underwent surgical treatment for LRRC in a single institution between 1990 and 2014, were clinicopathologically analyzed. Results: The mean age at surgical treatment for LRRC was 60 years old (range 36-87). Thirty-four patients (76%) were diagnosed as LRRC within three years after surgery for the primary tumor. Total pelvic exenteration, abdominoperineal resection or low anterior resection, and simple tumor excision were performed in 7, 27, and 11 patients, respectively. The median operative time, blood loss and hospital stay were 530 min, 2213 ml and 53 days, respectively. Out of 45 patients, 32 patients (71%) had curative (R0) resection and 13 patients (29%) had non-curative resection. The complications, such as intrapelvic abscess, urinary tract dysfunction, wound infection, and intestinal obstruction, were observed in 35 patients (75%) after surgical treatment for LRRC. There was no surgery-related death. Threeyear survival rate of all 45 patients and 35 patients with R0 resection were 53% and 73%, respectively. No three-year survivors were observed in the patients with non-curative resection. Conclusions: Although surgical treatment for LRRC is highly invasive, curative (R0) resection improves the outcome of the patients with LRRC.