R Singh1, A Omiccioli, S G Hegge, C A McKinley. 1. The Centre for Minimal Access Surgery, North Bay General Hospital, Scollard Avenue, North Bay, ON, Canada, P1B 5A4. singhr13@hotmail.com
Abstract
BACKGROUND: Laparoscopic colorectal surgery (LCS) performed in tertiary care centers has been well studied. It has been shown to provide improved short-term outcomes and comparable long-term outcomes to the conventional open approach. However, LCS performed in a community hospital setting has not been well studied. In a previous paper, we presented the short-term outcomes of 100 LCS performed by two community surgeons with no formal training in LCS. In this follow-up study, we present both short- and longer-term outcomes for 250 patients who underwent LCS. METHODS: This is a prospective study of 250 consecutive patients who underwent LCS at the North Bay District Hospital (a 200-bed community hospital located 350 km away from the nearest tertiary care center). RESULTS: Between October 2000 and October 2006, 250 consecutive patients (130 women and 120 men, mean age of 64.4 +/- 13.7 years) underwent LCS for benign (N = 129) and malignant (N = 121) disease. Median operating time was 215.0 min (58.0-475.0 min) and the conversion rate was 7.2%. The intraoperative complication rate was 2.8%. There were 20 (8.0%) major postoperative complications and 42 (16.8%) minor postoperative complications. There was no intraoperative mortality. There were six 30-day mortalities due to ischemic bowel (1), stroke (1), myocardial infarction (3), and pneumonia (1). The median length of stay was 4.0 days (2.0-55.0 days). Disease-free survival for stages I-IV colorectal cancer (CRC) was 100, 97.2, 71.4, and 10% for a mean follow-up time of 36.9, 29.3, 27.9, and 21.1 months, respectively. The mean number of resected lymph nodes was 11.5 +/- 8.6. CONCLUSION: We note that both our short and longer-term outcomes are similar to tertiary care centers. We therefore conclude that LCS can be performed in a community hospital setting with both short- and longer-term outcomes similar to tertiary care centers.
BACKGROUND: Laparoscopic colorectal surgery (LCS) performed in tertiary care centers has been well studied. It has been shown to provide improved short-term outcomes and comparable long-term outcomes to the conventional open approach. However, LCS performed in a community hospital setting has not been well studied. In a previous paper, we presented the short-term outcomes of 100 LCS performed by two community surgeons with no formal training in LCS. In this follow-up study, we present both short- and longer-term outcomes for 250 patients who underwent LCS. METHODS: This is a prospective study of 250 consecutive patients who underwent LCS at the North Bay District Hospital (a 200-bed community hospital located 350 km away from the nearest tertiary care center). RESULTS: Between October 2000 and October 2006, 250 consecutive patients (130 women and 120 men, mean age of 64.4 +/- 13.7 years) underwent LCS for benign (N = 129) and malignant (N = 121) disease. Median operating time was 215.0 min (58.0-475.0 min) and the conversion rate was 7.2%. The intraoperative complication rate was 2.8%. There were 20 (8.0%) major postoperative complications and 42 (16.8%) minor postoperative complications. There was no intraoperative mortality. There were six 30-day mortalities due to ischemic bowel (1), stroke (1), myocardial infarction (3), and pneumonia (1). The median length of stay was 4.0 days (2.0-55.0 days). Disease-free survival for stages I-IV colorectal cancer (CRC) was 100, 97.2, 71.4, and 10% for a mean follow-up time of 36.9, 29.3, 27.9, and 21.1 months, respectively. The mean number of resected lymph nodes was 11.5 +/- 8.6. CONCLUSION: We note that both our short and longer-term outcomes are similar to tertiary care centers. We therefore conclude that LCS can be performed in a community hospital setting with both short- and longer-term outcomes similar to tertiary care centers.
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