Brief Article
Copyright ©2013 Baishideng Publishing Group Co., Limited. All rights reserved.
World Journal of Gastrointestinal Surgery. Nov 27, 2013; 5(11): 294-299
Published online Nov 27, 2013. doi: 10.4240/wjgs.v5.i11.294
Comparative analysis of open and laparoscopic colectomy for malignancy in a developing country
Pierre-Anthony Leake, Kristen Pitzul, Patrick O Roberts, Joseph M Plummer
Pierre-Anthony Leake, Patrick O Roberts, Joseph M Plummer, Department of Surgery, Radiology, Anaesthesia and Intensive Care, Faculty of Medical Sciences, University of the West Indies, Kingston 7, Jamaica
Kristen Pitzul, Institute of Health Policy Management and Evaluation, University of Toronto, Toronto, Ontario M5T 3M6, Canada
Author contributions: Leake PA designed the study and wrote the manuscript; Pitzul K performed the statistical analysis and was involved in editing the manuscript; Roberts PO assisted in data collection and editing the manuscript; Plummer JM assisted in study design and was involved in editing the manuscript.
Correspondence to: Dr. Pierre-Anthony Leake, Department of Surgery, Radiology, Anaesthesia and Intensive Care, University of the West Indies, Mona, Kingston 7, Jamaica. paeleake@yahoo.com
Telephone: +1-876-9271270 Fax: +1-876-9788603
Received: July 28, 2013
Revised: October 1, 2013
Accepted: October 17, 2013
Published online: November 27, 2013
Processing time: 138 Days and 6.4 Hours
Abstract

AIM: To compare the short-term, including oncologic, outcomes of open vs laparoscopic colectomy for cancer in a developing country.

METHODS: The records of patients who underwent elective open and laparoscopic colectomies for cancer at the University Hospital of the West Indies between January 2005 and December 2010 were retrospectively reviewed. Demographic (age, gender, Charlson comorbidity index score), peri-operative, post-operative and oncologic data were collected for each patient. Specific oncologic variables included lymph node yield, pathologic stage, grade, proximal, distal and circumferential margin involvement. Fisher’s exact, Mann-Whitney, and binary logistic regression tests were used for analysis. Significance level was set at P < 0.05.

RESULTS: There were 87 cases for open colectomy (OC) and 17 cases for laparoscopic colectomy (LC). Demographics did not significantly differ between OC and LC groups. Intra-operative blood loss and post-operative analgesic requirements did not significantly differ between groups. There was a trend towards longer operating times in OC group and shorter hospital stay in the LC group. Lymph node yield (14 vs 14, P = 0.619), proximal (10 cm vs 7 cm, P = 0.353) and distal (8 cm vs 8 cm, P = 0.57) resection margin distance and circumferential margin involvement (9 vs 0, P = 0.348) did not significantly differ between groups. Thirty-day morbidity was equivalent between groups (22 vs 6, P = 0.774). There were 6 deaths within 30 d of initial procedure, all in the OC group (6.9%).

CONCLUSION: Laparoscopic colectomy in a developing country is oncologically safe and represents a option for colonic malignancies in these regions. Such data encourage the continued laparoscopic development.

Keywords: Laparoscopy; Colectomy; Cancer; Developing country; Colorectal; Oncology; Short-term; Outcomes

Core tip: The development of laparoscopic colectomy in developing countries has been slow despite strong evidence to support its benefit. The demonstration that laparoscopic procedures can be performed safely in these environments supports and encourages further incorporation of laparoscopy in these environments. Notwithstanding proven feasibility of laparoscopic colectomy for cancer in developing countries, there is the need to demonstrate equivalent oncologic outcomes to open surgery in order to establish safety. This study shows that laparoscopic colectomy for cancer in a developing country is not only feasible but is oncologically safe.