LAPAROSCOPIC COLORECTAL SURGERY: ANALYSIS OF THE FIRST OPERATIONS
The aim of the research: to analyze the initial experience of the introduction of laparoscopic technologies in the surgical treatment of patients with colorectal cancer (CRC).
Materials and Methods. Our experience in performing laparoscopic operations includes 7 patients (3 men and 4 women) on CRC who underwent laparoscopic operations in the Ternopil Regional Clinical Hospital from December 2021 to July 2022. The mean age of patients was 64,42 ± 10,87 (range 46-75). All patients underwent preoperative 3D-CT angiography and vascular anatomy of the mesentery. 4 patients had previously undergone surgery and had a connective tissue laparoscopic viscerolysis. In 2 patients, the tumor grew into the lateral abdominal wall, pelvic lateral wall and loop of the small intestine, respectively, combined operations were performed. D3 lymphadenectomy was performed in 2 cases and D2 lymphadenectomy was performed in 5 cases. Stapler intracorporeal anastomosis was applied to 3 patients, manual extracorporeal anastomosis was applied to 3 patients. 3 patients receive adjuvant chemotherapy. Statistical analysis was performed using Statistica 64 software. Ordinal data were calculated using the median.
Results. The average blood loss was 120±73,7 ml (range 40-250 ml). Intraoperative time was 242,86±45,44 minutes (interval 180-300 minutes). The average number of removed lymph nodes was 16,57 ± 8, (range 12-35). According to the TNM classification, stage T1 was detected in 1 patient, T2 -2, T3 - 3, T4a - 2, T4b – 1. Three patients were diagnosed with a high (G1) degree of adenocarcinoma differentiation, 2 patients were diagnosed with a moderate (G2) degree, while a low (G3) degree was diagnosed in 2 patients. Metastasis to regional lymph nodes were detected in 3 patients. In 3 cases, the macrodrug was removed through a 4-cm Pfanenstiel incision, in 2 cases through a 5-cm incision above the umbilicus, in 1 case through access in the left mesogastric area, where a sigmoid was later formed, and in 1 case through the perineum. We did not observe any cases of anastomosis leakage or 30-day mortality. In 1 patient the postoperative period was complicated by the development of pseudomembranous colitis. R0 resection was achieved in all patients. During the laparoscopic resection of the sigmoid colon in a patient with a T1 tumor, there were difficulties in locating the tumor, the situation was resolved by intraoperative colonoscopy. In the future, we plan to use the technique of endoscopic marking with the help of special stewed paints. The treatment of 3 patients at the pre- and postoperative stages was carried out according to the fast-track protocol, respectively, the patients were discharged from the hospital 3-4 days after the operation
Conclusions. Laparoscopic surgery is safe and feasible for colorectal cancer and has resulted in improved short-term outcomes and equivalent oncological outcomes compared with open surgery, even in the setting of colon obstruction. Good selection of patients, preoperative 3D CT-angiography and management of patients according to the program of accelerated rehabilitation are the keys to reducing postoperative complications and faster recovery of patients.
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