Toward standardization of laparoscopic resection for colorectal cancer in developing countries: A step by step module

Abstract

Background: Despite the proven benefits, laparoscopic colorectal surgery is still underutilized among surgeons especially in developing countries. Also a steep learning is one of the causes of its limited adoption. Objective: To explore the learning curve of single surgeon experience in laparoscopic colectomy and feasibility of implementing a well standardized step by step operative technique to overcome the beginning technical obstacles. Patients and methods: This prospective study included 50 patients with carcinoma of the left colon and rectum recruited from the department of surgical oncology at National Cancer Institute, Cairo University in the period 2012–2016. All the procedures were performed through laparoscopic approach. Intra and post-operative data were recorded and analyzed. Results: The mean age was 49.7 ± 10.6 years (range: 33–74 years). They were 29 males and 21 females. The mean operation time was 180 min (range 100–370 min), and the mean blood loss was 350 ml (60–600 ml). Six patients (12%) were converted to a laparotomy. The median lymph nodes harvest was 12 (range 7–25). The mean time of passing flatus after surgery was 2 days (1–4 days) and the mean time of passing stools was 3.3 days (2–5) days. The median hospitalization period after surgery was 4 days (3–12). 5 patients (10%) had postoperative morbidity, major morbidity occurred in one patient. Conclusion: Laparoscopic colorectal surgery for colorectal cancer is safe and oncologically sound, standardized well-structured laparoscopic technique masters the procedure even in early learning curve setting.

Keywords

• Colon cancer
• Laparoscopic resection
• Learning curve