1. 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

2. 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):
2Reynolds W (2001): “The first laparoscopic cholecystectomy”. JSLS 5(1):

3. 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):
2Jayne DG (2010): BJS 97(11):

4. 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

5. 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

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

7. 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.

8. Age
Mean 67.9
Median 67
Range
No significant change in age range over time

9. BMI: Mean 24 ( ), Median 24.8
4 patients had documented previous abdominal surgery

10. Gender
ASA
Higher number of males as expected in CRC

11. Operative time Mean 140 mins (85-210) R hemi 135 mins (85-210)
L hemi/AR 156 mins ( )
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

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

13. 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

14. Dukes stage

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

16. 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

19. Dukes Stage B C1 C2 D 11 9 3 1