초기 학습 단계에서 복강경 저위전방절제술의 안정성 및 실행 가능성에 대한 고찰

Abstract

Purpose: After the final report of Clinical Outcomes of Surgical Therapy (COST) study group, the application of laparoscopic surgery in colon cancer a spread widely. However, laparoscopic surgery in the rectum is still regarded as a complicated procedure to start due to technical difficulties and a steep learning curve. The aim of this study was to show the safety and technical feasibility of a laparoscopic low anterior resection at an early time on the learning curve in comparison with open low anterior resection.

Methods: The learning curves of one colorectal surgeon in open and laparoscopic low anterior resections were retrospectively compared. The compared factors were clinicopathologic characteristics, operation time, and the factors associated with postoperative recovery, morbidity and mortality.

Results: There were no significant differences in age or sex between two groups. The operation time was significantly longer in the laparoscopy group (P＜0.001) In the view point of postoperative recovery, the laparoscopy group showed significant advantages in hospital stay (P＜0.001), the passage of flatus (P＜0.001), the number of analgesics used (P=0.03), and the removal of foley catheter (P=0.001). There were no conversions in the laparoscopy group, and the complication rate was lower in the laparoscopy group (10.7% vs. 17.6%). There was no postoperative mortality in either group.

Conclusions: Even though the operation time was significantly longer in the laparoscopy group, a laparoscopic low an terior resection appears to have some benefits in postoperative recovery and morbidity. In terms of surgical outcomes, a laparoscopic low anterior resection can be performed safely even in early times on the learning curve.