Sector Hospital

Objective: To assess feasibility, advantages, oncological safety, cost effectiveness and long term results of laparoscopic surgery for rectal cancer in a government sector hospital. Method: From January 2005 to May 2007, 20 patients of operable cancer rectum were subjected to laparoscopic curative resection. Surgical technique, postoperative morbidity and clinical results were reviewed in close follow-up for median period of 20 months (12 wks to 30 months). Results: Fourteen patients underwent LAPR and 6 patients LAR. Median age was 39 years. Median operating time for Lap APR was 296 minutes, initial 7 cases taking an average of 368 minutes, while subsequent 7 cases average operating time was 232.5 minutes. In Lap AR, average duration of surgery was 356 minutes, first 4 cases taking 400 minutes while for last 2 cases, and mean operating time was 300 min. There was no intraoperative complication in either group. All patients mobilized on POD: (1) Incidence of PONV was significantly less. Oral feeds were routinely started on POD, (2) Incidence of wound infection was also reduced (2/20). Hospital stay on an average was 11 days as ours being a government sector hospital, patients were discharged only after drain removal and thus stay was slightly prolonged. Of the 20 patients, 17 were diagnosed to be Adenocarcinoma, 2 with Malignant Melanoma and 1 with GIST. Two patients of malignant melanoma developed locoregional recurrence and 2 patients developed distant metastasis after approximately 1 year. No incidence of port metastasis in any patient. Conclusion: Laparoscopic colorectal surgery is safe, feasible and meets oncologic requirements of radicality. Pattern of local recurrence and distant metastasis is similar to open surgery. Lap surgery has a steeper learning curve. Cost of treatment decreased by use of Ligaclips for intracorporeal vascular control and extracorporeal division of gut whenever possible