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  • Title: Evolution of laparoscopic colorectal surgery in Brazil: results of 4744 patients from the national registry.
    Author: Campos FG, Valarini R.
    Journal: Surg Laparosc Endosc Percutan Tech; 2009 Jun; 19(3):249-54. PubMed ID: 19542856.
    Abstract:
    BACKGROUND: Since its introduction, laparoscopic colorectal surgery has raised intense debate and controversies regarding its safety and effectiveness. METHODS: This multicentric registry reports the experience of 28 Brazilian surgical teams specializing in laparoscopic colorectal surgery. RESULTS: Between 1992 and 2007, 4744 patients (1994 men--42% and 2750 women--58%) were operated upon, with ages ranging from 13 to 94 years (average 57.5 y). Benign diseases were diagnosed in 2356 patients (49.6%). Most diseases were located in 50.7% of the left and sigmoid colon, 28.2% in the rectum and anal canal, 8.0% in the right colon, and diffuse 7.0%. There were 181 (3.8%) intraoperative complications (from 0% to 14%). There were 261 (5.5%) reported conversions to laparotomy (from 0% to 16.5%), mainly during the early experience (n=119 -59.8%). Postoperative complications were registered in 683 (14.5%) patients (from 5.0% to 50%). Mortality occurred in 43 patients (0.8%). Surgeons who performed less than 50 cases reported similar rates of intraoperative (4.2% vs. 3.8%; P=0.7), postoperative complications (20.8% vs. 14.3%; P=0.07), and mortality (1.0% vs. 0.9%; P=0.5), but the conversion rate was higher (10.4% vs. 5.4%; P=0.04). Two thousand three hundred and eighty-nine (50.4%) malignant tumors were operated upon, and histologic classification showed 2347 (98%) adenocarcinomas, 30 (0.6%) spinocelular carcinomas, and 12 (0.2%) other histologic types. Tumor recurrence rate was 16.3% among patients followed more than 1 year. After an average follow-up of 52 months, 19 (0.8%) parietal recurrences were reported, 18 of which were in port sites and 1 in a patient with disseminated disease. There was no incisional recurrence in the ports used to withdraw the pathologic specimen. Compared with other registries, there was a 75% increase in the number of groups performing laparoscopic colorectal surgery and a decrease in conversions (from 10.5% to 5.5%) and mortality (from 1.5% to 0.9%) rates. CONCLUSIONS: (1) The number of patients operated upon increased expressively during the last years; (2) operative indications for benign and malignant diseases were similar, and diverticular disease of the colon comprised 40% of the benign ones; (3) conversion and mortality rates decreased over time; (4) surgeon's experience did not influence the complication rates, but was associated with a lower conversion; and (5) oncologic outcome expressed by recurrence rates showed results similar to those reported in conventional surgery.
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