1) The document discusses laparoscopic colon resection techniques, including an anterior approach where trocars are placed in the inguinal crease and the sigmoid colon is cut. 2) Studies comparing laparoscopic and open colon resection for cancer show that laparoscopic surgery results in less blood loss, shorter hospital stays, and fewer wound complications with similar long-term survival and recurrence rates. 3) A retrospective study of over 100 patients undergoing laparoscopic colon resection for cancer found 5-year survival rates similar to open surgery and rates reported in the National Cancer Database, suggesting laparoscopic surgery is a safe and effective treatment for colon cancer.

1. LAPAROSCOPIC COLON RESECTION - Anterior Approach Sandeep Malhotra, MD Scott Steinberg, MD George Ferzli, MD, FACS Professor of Surgery, SUNY Downstate Health Science Center, Brooklyn, NY

2. Anterior Approach Patient supine Position hand over sigmoid and rotate in semi-circle to place trocars (3)

3. Trocar Placement : Anterior Position

4. Anterior position 1 2 Trocar in inguinal crease cuts sigmoid

5. Repair - Anterior Position If proximal colon can be brought through inguinal crease trocar incision, tension free repair will be successful

6. Anterior Approach

7. Anterior Approach

8. Laparoscopic Sigmoid Colectomy Ferzli G et al. (2000 – 2001) Unpublished Data 147 (110 – 279) 142 (98 – 216) OR Time 2.4 (2 - 9) 2.2 (2 - 10) Hospital Stay 1 leak (re-op hartman) 1 hematoma flank, 1 re-op for SBO, 1 leak (cut.drainage) Complications 12 5 Carcinoma 6 3 Polyp 20 (4 abscess) 16 (2 abscess) Diverticulitis Indications: 35:3 23:1 Sex, M:F 46 (27 - 86) 48 (32 - 70) Age Anterior (38) Lateral (24) Total (n) = 62 pts

9. Laparoscopic Versus Open Colectomy for Cancer

10. Colorectal Resection Laparoscopic vs. open resection for carcinoma RHC = Right hemicolectomy; Trans = Transverse; AR = Anterior resection; Sig = Sigmoid; LAR = Low anterior resection; APR = Abdominoperineal resection Franklin ME et al, Dis Colon Rectum 1996;39:s35-s46

11. Colorectal Resection Laparoscopic vs. open resection for carcinoma Franklin ME et al, Dis Colon Rectum 1996;39:s35-s46 19.1% 13% Cumulative death and recurrence rates 5 years into the study (Stages I, II, and III) 22% 12.2% Recurrence rates 6% 0.5% Wound complications 450 150 Blood loss, mL 9 5.6 Hospitalization, days Open (n=224) Laparoscopic (n=192)

12. Colorectal Resection Laparoscopic vs. open resection for carcinoma Santoro E et al, Hepato-Gastroenterology 1999; 46:900-904 1 1 Liver+Peritoneum+ Trocar-site or scar 4 4 Liver+ Peritoneum 5 5 Multiple site metastases 1 1 Regional 4 2 Liver 5 3 Single site metastases 10 (23%) 8 (20%) Overall metastases 43 40 No. of cases (n) Open Lap. Follow-up

13. Colorectal Resection Laparoscopic vs. open resection for carcinoma Curet MJ et al, Surg Endosc (2000) 14: 1062-1066 1 6 4 Late death from cancer (mean follow-up 4.9 years) 12 10 11 Number of lymph nodes 32 26 26 Length of specimen (cm) 8, 100% 5, 28% 1, 5% Complications (n, %) 8 7.3 5.2 Length of stay (days) 7 5.8 4.1 Regular diet (days) 5 4.4 2.7 Clear liquids (days) 6 4 3 ICU stay (days) 683 407 284 Blood loss (mL) 242 138 210 Operating room time (min) Converted (n=7) Open (n=18) Lap (n=18) 1 1 0 Recurrence

14. Long-Term Survival After Laparoscopic Colon Resection For Cancer Aim : To evaluate long-term survival after curative, laparoscopic resection for colorectal cancer. Design : Retrospective review of 102 consecutive patients with laparoscopic colon resection between 1991 and 1996 with 5-year follow-up. Comparison made to open colectomy at the same institution and National Cancer Database during similar time period. Lujan HJ et.al. Dis. of Colon and Rectum;45:491-405,April 2002

15. Long-Term Survival After Laparoscopic Colon Resection For Cancer Lap Open

16. Long-Term Survival After Laparoscopic Colon Resection For Cancer Lap Open – Nat. Ca. Database

17. Long-Term Survival After Laparoscopic Colon Resection For Cancer - Conclusions Laparoscopic colectomy for cancer is safe and feasible 5-year survival after laparoscopic colon resection for cancer is similar to survival after conventional surgery Prospective randomized trials currently under way will likely confirm these results Lujan HJ et.al. Dis. of Colon and Rectum;45:491-405,April 2002