Laparoscopic-assisted colorectal surgery: review of results in 752 patients

I summarize the early results of 652 laparoscopic-assisted colorectal operations published in 16 series and 100 operations done by the author. Operations for colorectal neoplasms accounted for two thirds of the procedures. The average age of patients was 63 years. Operations were performed in men and women with equal frequency. Right hemicolectomies and sigmoid colectomies were the most common operations (65.3%). On average, 77% of attempted procedures were converted to open operations. After the first 20 operations, however, the author maintained approximately a 90% success rate. The average length of operation for 542 successful laparoscopic-assisted operations was 170 minutes (range, 45-540 min). The average number of lymph nodes harvested from 226 laparoscopic specimens was 10.5 (range, 0-35). In 3 institutions, the yield of nodes in 80 laparoscopic specimens was 8.8, and in 88 open specimens, it was 7.5. The need for postoperative parenteral injections was decreased for patients after laparoscopic-assisted colorectal operations compared with open operations. The rate of major complications was 16.7% for 647 attempted laparoscopic-assisted operations, and the rate of mortality was 0.8%. The average length of postoperative stay after 543 successful laparoscopic-assisted colorectal operations was 5.9 days. Among 329 patients treated in private hospitals, the average postoperative length of stay was 4.7 days. The cost of laparoscopic-assisted operations was greater than that of open operations. The total cost of hospitalization for patients undergoing laparoscopic-assisted colorectal operations, however, was less than or approximately equal to that for open colorectal operations. The shortened stay offset the increased cost of operation. These results suggest that following laparoscopic-assisted colorectal operations, patients suffer fewer complications, decreased mortality, less pain, and shortened length of stay than patients after traditional open operations. These data, however, have been compiled from selected patients, and demonstration of these preliminary conclusions will require testing by randomized trials.