LAPAROSCOPIC COLORECTAL SURGERY: ANALYSIS OF THE FIRST OPERATIONS

Abstract

SUMMARY. The aim – to analyze the initial experience of the introduction of laparoscopic technologies in the surgical treatment of patients with colorectal cancer (CRC).

Material and Methods. Our experience in performing laparoscopic operations includes 5 patients (2 men and 3 women) on CRC who underwent laparoscopic operations in the Ternopil Regional Clinical Hospital from December 2021 to May 2022. The mean age of patients was 62±7.84 (range 59–74). All patients underwent preoperative 3D-CT angiography and vascular anatomy of the mesentery. 3 patients had previously undergone surgery and had a connective tissue laparoscopic viscerolysis. In 2 patients, the tumor grew into the lateral abdominal wall, pelvic lateral wall and loop of the small intestine, respectively, combined operations were performed.

Results. The average blood loss was 120±77.3 ml (range 50–250 ml). Intraoperative time was 235±46.18 minutes (interval 180–300 minutes). The average number of removed lymph nodes was 13±2.34 (range 12–17). According to the TNM classification, stage T1 was detected in 1 patient, T2 – 1, T3 – 3, T4a – 1, T4b – 1. Three patients were diagnosed with a high (G1) degree of adenocarcinoma differentiation, while a low (G3) degree was diagnosed in 2 patients. Metastasis to regional lymph nodes were detected in 2 patients. In 3 cases the specimen was removed through a 4 cm Pphanenstil incision, in 1 case through a 5 cm incision above the navel and in 1 case through access in the left mesogastric region, where a sigmostoma was subsequently formed. A protective sleeve was used during the extraction of the specimen. We did not observe any cases of anastomosis leakage or 30-day mortality. In 1 patient the postoperative period was complicated by the development of pseudomembranous colitis. R0 resection was achieved in all patients.