Yoon-Suk Lee

Multidimensional analysis of the learning curve for laparoscopic rectal cancer surgery.

BACKGROUNDnThe need for an initial learning experience in laparoscopic colorectal cancer surgery has been well established. However, the inherent differences in the complexity and results of laparoscopic rectal cancer surgery, as compared to colon surgery, warrant a study to analyze the learning curve exclusively for rectal cancer resections.nnnMATERIALS AND METHODSnfour hundred thirty-one patients operated on between April 1994 and March 2006 were analyzed retrospectively for changes in surgical outcomes according to case sequence. A multidimensional analysis was done, based on the following parameters: conversion to laparotomy, intraoperative complications, postoperative complications, reoperations, operative time, and transfusion volumes. Multiple statistical methods were used for evaluation of the learning curve, which included the cumulative sum (CUSUM) method, risk-adjusted CUSUM, moving average method, and analysis of variance (ANOVA).nnnRESULTSnThe risk factors for conversion were prior abdominal surgery (hazard ratio, 2.52; 95% CI, 1.04-6.10; P = 0.04) and tumor size > or =3.5 cm (hazard ratio, 5.05; 95% CI, 1.95-13.08; P = 0.001). Risk-adjusted CUSUM analysis showed that case 61 was the peak change point for conversion. Postoperative complications occurred in 56 patients (13.0%), and the rate was associated significantly with case sequence (P < 0.001). The turning point in the CUSUM model occurred at case 79, and the complication rates decreased thereafter. Operative time and intraoperative transfusion volumes stabilized over cases 61-75 and declined thereafter.nnnCONCLUSIONSnMultidimensional analysis considering various surgical outcomes is necessary to evaluate the learning curve for laparoscopic rectal cancer surgery. The effective surgical learning curve was approximately 60-80 procedures in this series.

Simultaneous Laparoscopic Resection of Primary Colorectal Cancer and Metastatic Liver Tumor: Initial Experience of Single Institute

BACKGROUNDnApproximately 20%-25% of patients with colorectal cancer have synchronous liver metastasis at the time of diagnosis. Simultaneous resection of primary colorectal cancer and metastatic liver tumor is the treatment option in colorectal cancer with liver metastasis. The aim of this study was to report our initial experiences of simultaneous laparoscopic resection of colorectal cancer and liver metastasis.nnnMETHODSnA single-center, retrospective study of 10 cases of laparoscopic simultaneous resection of colorectal cancer and liver metastasis was carried out.nnnRESULTSnThe patients average age was 63.7 years (range, 48-75 years) and average body mass index was 23.5 kg/m2(range, 20-27.4 kg/m2). The primary cancer was right-sided colon cancer in 4 cases, left-sided colon cancer in 3 cases, and rectal cancer in 3 cases. Single-lesion liver metastasis was found in 6 cases and two or more lesion liver metastasis was found in 4 cases. The mean operating time was 401 minutes (range, 230-620 minutes) and blood loss was 500 mL (range, 60-1000 mL). The mean hospital stay was 10 days (range, 7-15 days). One case was converted to open surgery and anastomotic leakage was encountered in the converted case.nnnCONCLUSIONSnThis study shows that simultaneous laparoscopic resection of primary colorectal cancer and liver metastasis is safe and technically feasible in selected patients.

Impact of laparoscopic surgery on the long-term outcomes for patients with rectal cancer

Background:u2002 This 20‐year retrospective study compared the results of laparoscopic surgery with open surgery for patients with rectal cancer to evaluate the impact of laparoscopic surgery on long‐term oncological outcomes for rectal cancer.

Initial experience of a surgical fellow in laparoscopic colorectal cancer surgery under training protocol and supervision: comparison of short-term results for 70 early cases (under supervision) and 73 late cases (without supervision)

PurposeLaparoscopic colorectal surgery is a technically challenging procedure for beginners, such as surgical fellows. The purpose of this study was to assess the safety, feasibility, and short-term surgical outcomes of laparoscopic colorectal cancer surgery by a single surgical fellow.MethodsThe study analyzed the data from 143 consecutive patients who underwent laparoscopic colorectal resection by a single surgical fellow between August 2009 and October 2010. The patients were divided into two groups: the early group—the first 70 patients (under supervision of experienced surgeon), and the late group—the last 73 patients (without supervision). The short-term surgical results were compared between two groups.ResultsThe operations were 24 right colon resections, two transverse colectomies, six left colectomies, 36 anterior resections, 57 low anterior resections, 12 intersphincteric resections, two abdominoperineal resections, three Hartmann’s operations, and 1 total colectomy. The mean operating time, mean amounts of blood loss, and conversion rate were similar between the two groups. The morbidity rate, anastomosis leak rate, and mortality rate within 30xa0days of surgery did not differ significantly. The mean number of lymph nodes was larger in the late group (23.8 vs. 31.7, Pxa0=xa00.017). In terms of low anterior resection, the mean number of endo-linear staplers used was smaller in the late group (2.46xa0±xa00.81 vs. 1.97xa0±xa00.83, Pxa0=xa00.028). The anastomosis leakage rate in rectal cancer surgery was not significantly different between the two groups.ConclusionsThis study demonstrates that laparoscopic colorectal resections can be independently performed safely after a period of supervision and training by an experienced surgeon.