Single-port Resection for Colorectal Cancer J Hornsby, B Carrick, DK Garg, TS Gill University Hospital of North Tees Colorectal NSSG Education & Audit Day 17/05/2013

Evolution of Laparoscopic Surgery 1806 Bozzini’s “Lichtleiter“1 1st laparoscopy 1936 Lap. tubal ligation Lap.Cholecystectomy2 2000s Laparoscopic colorectal surgery, Robotic surgery, Single port access, natural orifice transluminal endoscopic surgery 1Bush RB (1974). Urology 3(1): 119-123. 2Reynolds W (2001): “The first laparoscopic cholecystectomy”. JSLS 5(1): 89-94.

Laparoscopic Colorectal Cancer Surgery Reduced blood loss Less pain Faster recovery Shorter length of stay Comparable morbidity & mortality1 Oncologically safe2 Better cosmetic results Gold standard BJS 97(11) 211 1Reza MM (2006): BJS 93(8): 921-928. 2Jayne DG (2010): BJS 97(11): 1638-1645.

SPA laparoscopic surgery Better cosmesis than conventional laparoscopy Technically challenging Learning curve Comparative outcomes with conventional laparoscopic in audit of all colorectal cases1 1. Kanakala et al. Techniques in coloproctology. 2012

Single Port Laparoscopic Resections for Colon Cancer at North Tees Single port resections for colorectal cancer since November 2009 Experience of > 100 benign cases Retrospective audit of all single port resections for colorectal cancer Data from notes, Theatreman, pathology system Conventional laparoscopic surgery is gold standard, increasing experience with single port in cancer patients, we’d like to present the results that we have to date

Outcomes Patient profile Operative time Length of stay Morbidity and mortality Dukes stage Lymph node yield

Cases DG 10 cases TG 21 cases 2009 2010 2011 2012 2013 R Hemicolectomy   2009 2010 2011 2012 2013 R Hemicolectomy 1 5 7 3 L Hemicolectomy 2 Anterior resection 16 right, 6 left, 8 rectal.

Age Mean 67.9 Median 67 Range 34 - 94 No significant change in age range over time

BMI: Mean 24 (17.9-32.8), Median 24.8 4 patients had documented previous abdominal surgery

Gender ASA Higher number of males as expected in CRC

Operative time Mean 140 mins (85-210) R hemi 135 mins (85-210) L hemi/AR 156 mins (104-170) Data from theatreman also includes set up/clean up times, R hemicolectomy operating time probably skewed by early experience; one patient had no operating time data

Length of Stay Mean 5.8 days Median 4 Range 3 – 25 Only 2 patients stayed over 9 days

Morbidity & Mortality No 30 day mortality, no leaks 2 (6.5%) wound infections 1 (3.2%) collection requiring US guided drainage 2 extended hospital stays

Dukes stage

Lymph node yield Mean 21.5, median 17, range 5-92 6 (19.4%) less than 12

Conclusion Initial results indicate that this technique appears to be safe without excessive operating times and recovery time Further audits required with longer follow up and comparison with conventional laparoscopic resections Backgroud of experience of benign disease

Dukes Stage B C1 C2 D 11 9 3 1