logging in or signing up Laparoscopic Colorectal Surgery johnact Download Post to : URL : Related Presentations : Share Add to Flag Embed Email Send to Blogs and Networks Add to Channel Uploaded from authorPOINT lite Insert YouTube videos in PowerPont slides with aS Desktop Copy embed code: (To copy code, click on the text box) Embed: URL: Thumbnail: WordPress Embed Customize Embed The presentation is successfully added In Your Favorites. Views: 380 Category: Education License: All Rights Reserved Like it (1) Dislike it (0) Added: February 21, 2011 This Presentation is Public Favorites: 1 Presentation Description Dr John Thanakumar Senior Surgeon, Minimal Access, Bariatric and GI Surgery, Global Hospital, Chennai On Laparoscopic Colorectal Surgery Comments Posting comment... By: johnact (9 month(s) ago) Thank you Saving..... Post Reply Close Saving..... Edit Comment Close By: rpnaik (9 month(s) ago) good work Saving..... Post Reply Close Saving..... Edit Comment Close Premium member Presentation Transcript Laparoscopic Colorectal Surgery: Laparoscopic Colorectal Surgery Dr John AC Thanakumar Senior Consultant Minimal Access, Bariatric and GI Surgery Global Hospital, ChennaiEvidence in literature: Evidence in literature Short term benefits Return of Bowel Functions Quality of life -pain Stay in Hospital Cost of Hospitalization Long term benefits Recurrence of malignancy Survival of patientLevels of Evidence: Levels of Evidence Level I: At least one properly designed RCT. Level II-1:Well-designed controlled trials without radomization. Level II-2: Well-designed cohort or case- c ontrol analy tic studies, preferably from more than one center or research group. Level II-3:Multiple time series with or without the intervention. Level III: Opinions of respected authorities, clinical experience, descriptive studiesCategories of Recommendation: Categories of Recommendation Level A: Clinicians should discuss the service with eligible patients. Level B: Clinicians should discuss the service with eligible patients. Level C: Clinicians need not offer it unless there are individual considerations. Level D: Clinicians should not routinely offer the service to asymptomatic patients. Level I: Clinicians should help patients understand the uncertainty surrounding the clinical service.Laparoscopy: Colorectal cancer Bowel Function Recovery: Laparoscopy: Colorectal cancer Bowel Function Recovery Author Year N of patients Bowel function (mean/median n of days) Lap Open Lap Open Milsom 1998 54 53 3 4 Curet 2000 18 18 2.7 4.4 Lacy 2002 111 108 1.5 2.3 Hasegawa 2003 29 30 2 3.3 p<0.05 RandomizedLaparoscopy: Colorectal cancer Bowel Function Recovery: Laparoscopy: Colorectal cancer Bowel Function Recovery The evidence that laparoscopy offers faster bowel function recovery than the traditional open approach may be considered high (Level I)Laparoscopy: Colorectal cancer Quality of life: Laparoscopy: Colorectal cancer Quality of life Randomized trial (COST trial) 449 patients 228 Laparoscopy (Lap) , 221Open Pain, hospital stay Quality of life (2 days, 2 weeks, 2 months) Symptom distress scale Quality of life index Global rating scale (1-100)Results: Results Lap n = 228 Open n = 221 p value Oral analgesics 1.9 2.2 0.03 IV narcotics/analgesics 3.2 4.0 <0.001 Hospital stay 5.6 6.4 <0.001 Weeks, JAMA 2002 Patients in the Lap group had only greater mean global rate scores at 2 weeks after surgery (76.9 vs. 74.4; p=.0009) No other differences in quality of life Values are meansLaparoscopy: Colorectal cancer: Laparoscopy: Colorectal cancer The superiority of laparoscopy in reducing pain during the same length of the postoperative period seems evident (Level I) Other aspects of quality of life warrant further investigationLaparoscopy: Colorectal cancer Hospital Stay: Laparoscopy: Colorectal cancer Hospital Stay Randomized Author Year N of patients Hospital Stay (mean n of days) Lap Open Lap Open Stage 1997 15 14 5 8 Schwenk 1998 30 30 10.1 11.6 Milsom 1998 54 53 6 7 Curet 2000 18 18 5.2 7.3 Lacy 2002 111 108 5.2 7.9 Weeks 2002 168 221 5.6 6.4 Hasegawa 2003 29 30 7.1 12.7 p<0.05Laparoscopy: Colorectal cancer Hospital stay: Laparoscopy: Colorectal cancer Hospital stay There is high evidence (Level I) that laparoscopy for malignancy is associated with an earlier discharge compared to laparotomyLaparoscopy: Colorectal cancer Costs: Laparoscopy: Colorectal cancer Costs Retrospective study Psaila, Br J Surg 1998 Lap n = 29 Open n = 25 p Disposable equipment (lb) 140 (200) 400 (220) 0.05 Total cost (lb) 3300 (1700) 2900 (1500) NS Values are mean (s.d)Laparoscopy: Colorectal cancer Costs: Laparoscopy: Colorectal cancer Costs The data available does not provide adequate evidence on whether total costs differ between laparoscopy and laparotomy in the treatment of malignancySlide 14: Laparoscopic resection of colorectal malignancies a systematic review English language Randomized controlled trials Controlled clinical trials Case series/reports Laparoscopic Colectomy: Cancer Chapman et al. Ann Surg 2001Slide 15: Laparoscopic Colectomy : Cancer Advantages vs. Open Colectomy Improved cosmesis Quicker hospital discharge Less narcotic use, though possibly larger benefits for certain types of colectomy (low colonic) Possibly less pain at rest, at least for patients who have uncovered procedures Possibly earlier return of bowel function and resumption of normal diet Chapman et al. Ann Surg 2001Laparoscopic Colectomy : Prospective, Randomized, Controlled: Laparoscopic Colectomy : Prospective, Randomized, Controlled 48 institutions, 872 patients Prospective, randomized Follow-up 4.4 years Conversion 21% Endpoint was time to tumor recurrence Nelson, NEJM 2004Prospective, Randomized, Controlled: Conclusions: Prospective, Randomized, Controlled: Conclusions No difference between: Time to recurrence Disease-free survival Overall survival Oncologic outcome of laparoscopic resection is similar to that of open resection Laparoscopic Approach is associated with less pain and a shorter hospital stay than conventional surgery Nelson, NEJM 2004Laparoscopy: Colorectal cancer Conclusion: Laparoscopy: Colorectal cancer Conclusion Laparoscopy for colorectal cancer has shown to be potentially superior to laparotomy in regard to short-term benefits and equivalent with regard to long term benefits Available data appear to support that laparoscopic colectomy and conventional open colectomy have either similar or superior long-term outcomes (Level 1 evidence)Steps of Anterior resection Patient position and trochars: Steps of Anterior resection Patient position and trocharsSlide 20: ExposureSlide 21: Vascular ApproachSlide 22: Colon and Upper Rectum mobilizationSlide 23: ExtractionSlide 24: AnastamosisSlide 25: The medial approach involves division of the vascular pedicle first, followed by mobilization of the mesentery toward the abdominal wall, and finally freeing of the colon along the white line of Toldt. This approach allows immediate identification of the plane between the mesocolon and the retroperitoneum and renders the dissection fast and safe. Laparoscopic medial-to-lateral colon dissection: how and why. Pigazzi A , Hellan M , Ewing D R , Paz BI , Ballant yne GH . J Gastro intest S urg. 2007 Jun ;11(6):778-82.Laparoscopic Right Hemicolectomy: Laparoscopic Right HemicolectomyTrochars and Exposure: Trochars and ExposureVascular Dissection: Vascular DissectionMobilization of Tr Colon: Mobilization of Tr ColonMobilize Rt Colon: Mobilize Rt ColonExtraction and Anastamosis: Extraction and AnastamosisFIAGES Chennai 21-24 April,2011: FIAGES Chennai 21-24 April,2011 END You do not have the permission to view this presentation. In order to view it, please contact the author of the presentation.
Laparoscopic Colorectal Surgery johnact Download Post to : URL : Related Presentations : Share Add to Flag Embed Email Send to Blogs and Networks Add to Channel Uploaded from authorPOINT lite Insert YouTube videos in PowerPont slides with aS Desktop Copy embed code: (To copy code, click on the text box) Embed: URL: Thumbnail: WordPress Embed Customize Embed The presentation is successfully added In Your Favorites. Views: 380 Category: Education License: All Rights Reserved Like it (1) Dislike it (0) Added: February 21, 2011 This Presentation is Public Favorites: 1 Presentation Description Dr John Thanakumar Senior Surgeon, Minimal Access, Bariatric and GI Surgery, Global Hospital, Chennai On Laparoscopic Colorectal Surgery Comments Posting comment... By: johnact (9 month(s) ago) Thank you Saving..... Post Reply Close Saving..... Edit Comment Close By: rpnaik (9 month(s) ago) good work Saving..... Post Reply Close Saving..... Edit Comment Close Premium member Presentation Transcript Laparoscopic Colorectal Surgery: Laparoscopic Colorectal Surgery Dr John AC Thanakumar Senior Consultant Minimal Access, Bariatric and GI Surgery Global Hospital, ChennaiEvidence in literature: Evidence in literature Short term benefits Return of Bowel Functions Quality of life -pain Stay in Hospital Cost of Hospitalization Long term benefits Recurrence of malignancy Survival of patientLevels of Evidence: Levels of Evidence Level I: At least one properly designed RCT. Level II-1:Well-designed controlled trials without radomization. Level II-2: Well-designed cohort or case- c ontrol analy tic studies, preferably from more than one center or research group. Level II-3:Multiple time series with or without the intervention. Level III: Opinions of respected authorities, clinical experience, descriptive studiesCategories of Recommendation: Categories of Recommendation Level A: Clinicians should discuss the service with eligible patients. Level B: Clinicians should discuss the service with eligible patients. Level C: Clinicians need not offer it unless there are individual considerations. Level D: Clinicians should not routinely offer the service to asymptomatic patients. Level I: Clinicians should help patients understand the uncertainty surrounding the clinical service.Laparoscopy: Colorectal cancer Bowel Function Recovery: Laparoscopy: Colorectal cancer Bowel Function Recovery Author Year N of patients Bowel function (mean/median n of days) Lap Open Lap Open Milsom 1998 54 53 3 4 Curet 2000 18 18 2.7 4.4 Lacy 2002 111 108 1.5 2.3 Hasegawa 2003 29 30 2 3.3 p<0.05 RandomizedLaparoscopy: Colorectal cancer Bowel Function Recovery: Laparoscopy: Colorectal cancer Bowel Function Recovery The evidence that laparoscopy offers faster bowel function recovery than the traditional open approach may be considered high (Level I)Laparoscopy: Colorectal cancer Quality of life: Laparoscopy: Colorectal cancer Quality of life Randomized trial (COST trial) 449 patients 228 Laparoscopy (Lap) , 221Open Pain, hospital stay Quality of life (2 days, 2 weeks, 2 months) Symptom distress scale Quality of life index Global rating scale (1-100)Results: Results Lap n = 228 Open n = 221 p value Oral analgesics 1.9 2.2 0.03 IV narcotics/analgesics 3.2 4.0 <0.001 Hospital stay 5.6 6.4 <0.001 Weeks, JAMA 2002 Patients in the Lap group had only greater mean global rate scores at 2 weeks after surgery (76.9 vs. 74.4; p=.0009) No other differences in quality of life Values are meansLaparoscopy: Colorectal cancer: Laparoscopy: Colorectal cancer The superiority of laparoscopy in reducing pain during the same length of the postoperative period seems evident (Level I) Other aspects of quality of life warrant further investigationLaparoscopy: Colorectal cancer Hospital Stay: Laparoscopy: Colorectal cancer Hospital Stay Randomized Author Year N of patients Hospital Stay (mean n of days) Lap Open Lap Open Stage 1997 15 14 5 8 Schwenk 1998 30 30 10.1 11.6 Milsom 1998 54 53 6 7 Curet 2000 18 18 5.2 7.3 Lacy 2002 111 108 5.2 7.9 Weeks 2002 168 221 5.6 6.4 Hasegawa 2003 29 30 7.1 12.7 p<0.05Laparoscopy: Colorectal cancer Hospital stay: Laparoscopy: Colorectal cancer Hospital stay There is high evidence (Level I) that laparoscopy for malignancy is associated with an earlier discharge compared to laparotomyLaparoscopy: Colorectal cancer Costs: Laparoscopy: Colorectal cancer Costs Retrospective study Psaila, Br J Surg 1998 Lap n = 29 Open n = 25 p Disposable equipment (lb) 140 (200) 400 (220) 0.05 Total cost (lb) 3300 (1700) 2900 (1500) NS Values are mean (s.d)Laparoscopy: Colorectal cancer Costs: Laparoscopy: Colorectal cancer Costs The data available does not provide adequate evidence on whether total costs differ between laparoscopy and laparotomy in the treatment of malignancySlide 14: Laparoscopic resection of colorectal malignancies a systematic review English language Randomized controlled trials Controlled clinical trials Case series/reports Laparoscopic Colectomy: Cancer Chapman et al. Ann Surg 2001Slide 15: Laparoscopic Colectomy : Cancer Advantages vs. Open Colectomy Improved cosmesis Quicker hospital discharge Less narcotic use, though possibly larger benefits for certain types of colectomy (low colonic) Possibly less pain at rest, at least for patients who have uncovered procedures Possibly earlier return of bowel function and resumption of normal diet Chapman et al. Ann Surg 2001Laparoscopic Colectomy : Prospective, Randomized, Controlled: Laparoscopic Colectomy : Prospective, Randomized, Controlled 48 institutions, 872 patients Prospective, randomized Follow-up 4.4 years Conversion 21% Endpoint was time to tumor recurrence Nelson, NEJM 2004Prospective, Randomized, Controlled: Conclusions: Prospective, Randomized, Controlled: Conclusions No difference between: Time to recurrence Disease-free survival Overall survival Oncologic outcome of laparoscopic resection is similar to that of open resection Laparoscopic Approach is associated with less pain and a shorter hospital stay than conventional surgery Nelson, NEJM 2004Laparoscopy: Colorectal cancer Conclusion: Laparoscopy: Colorectal cancer Conclusion Laparoscopy for colorectal cancer has shown to be potentially superior to laparotomy in regard to short-term benefits and equivalent with regard to long term benefits Available data appear to support that laparoscopic colectomy and conventional open colectomy have either similar or superior long-term outcomes (Level 1 evidence)Steps of Anterior resection Patient position and trochars: Steps of Anterior resection Patient position and trocharsSlide 20: ExposureSlide 21: Vascular ApproachSlide 22: Colon and Upper Rectum mobilizationSlide 23: ExtractionSlide 24: AnastamosisSlide 25: The medial approach involves division of the vascular pedicle first, followed by mobilization of the mesentery toward the abdominal wall, and finally freeing of the colon along the white line of Toldt. This approach allows immediate identification of the plane between the mesocolon and the retroperitoneum and renders the dissection fast and safe. Laparoscopic medial-to-lateral colon dissection: how and why. Pigazzi A , Hellan M , Ewing D R , Paz BI , Ballant yne GH . J Gastro intest S urg. 2007 Jun ;11(6):778-82.Laparoscopic Right Hemicolectomy: Laparoscopic Right HemicolectomyTrochars and Exposure: Trochars and ExposureVascular Dissection: Vascular DissectionMobilization of Tr Colon: Mobilization of Tr ColonMobilize Rt Colon: Mobilize Rt ColonExtraction and Anastamosis: Extraction and AnastamosisFIAGES Chennai 21-24 April,2011: FIAGES Chennai 21-24 April,2011 END