복강경 대장 절제술 경험이 없는 술자에 의하여 시행된 대장암 복강경 절제술: 초기 50예와 후기 51예 단기성적 비교
Initial Experiences with a Laparoscopic Colorectal Resection: a Comparison of Short-term Outcomes for 50 Early Cases and 51 Late Cases
선장원, 주재균, 허정욱, 김형록, 조상혁, 김영진,
소속 상세정보
선장원 ( Seon Jang-Won )
전남대학교 의과대학 화순전남대학교병원 외과
주재균 ( Ju Jae-Kyun )
전남대학교 의과대학 화순전남대학교병원 외과
허정욱 ( Huh Jung-Wook )
전남대학교 의과대학 화순전남대학교병원 외과
김형록 ( Kim Hyeong-Rok )
전남대학교 의과대학 화순전남대학교병원 외과
조상혁 ( Cho Sang-Hyuk )
전남대학교 의과대학 화순전남대학교병원 외과
김영진 ( Kim Young-Jin )
전남대학교 의과대학 화순전남대학교병원 외과
KMID : 0356720090250040252
Abstract
Purpose: The present study aimed to investigate the safety and the feasibility of laparoscopic colorectal surgery performed by a surgeon during a learning period.
Methods: Between April and December 2008, 101 consecutive patients with colorectal cancers underwent laparoscopic surgery by one colorectal surgeon who previously had no experience with laparoscopic colorectal surgery. Standard laparoscopy with a lymphadenectomy using a 5-port technique was performed according to the tumor location. The patients were divided into two chronological groups: 50 cases early in learning period (early cases) and 51 cases later in the learning period (late cases).
Results: The operations were 29 right hemicolectomies, 9 left hemicolectomies, 18 anterior resections, 35 low anterior resections, 6 intersphincteric resections, 2 abdominoperineal resections, and 2 Hartmann’s operation. There were 7 conversions (6.9%). The median operating time was 205 (range, 95-385) min, and the median blood loss was 258 (50-800) mL. The median times to flatus per anus and to feeding of soft diet were 2 (1-5) and 4 (2-13) days, respectively. The median hospital stay was 9 (6-27) days. There were 21 postoperative complications, including 7 anastomotic complications (3 leakages, 3 abscesses, and 1 stenosis). The median number of lymph nodes harvested was 20 (4-65). The operating time, blood loss, and complication rates were significantly decreased in the late group.
Conslusion: Our initial experience with laparoscopic colorectal surgery appears to have acceptable perioperative results and short-term oncologic outcomes, which improved with the experience of the surgeon.
키워드
대장암;복강경 수술;습득 곡선
Colorectal cancer;Laparoscopic surgery;Learning curve
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