1. EBM: LAPAROSCOPIC COLON SURGERY - results and data + a single center experience (120 patients ) Zdravko Perko University Department of Surgery, Clinical Hospital Split and Split Medical School, Croatia

2. Split 2006 role of laparoscopic colon resection accepted as a first choice of treatment for benign diseases for palliative treatment in advanced malignant diseases laparoscopic curable treatment of malignant colorectal diseases

3. Split 2006 laparoscopic curable treatment of malignant colorectal diseases Lacy, AM, García-Valdecasas, JC, Delgado, S, Castells, A, Taurá, P, Piqué, JM, Visa, J (2002) "Laparoscopy-assisted colectomy versus open colectomy for treatment of non- metastatic colon cancer: a randomised trial" Lancet 29: 2224-2229 Franklin, ME, Kazantsev, GB, Abrego, D, Diaz-E, JA, Balli, J, Glass, JL (2000) "Laparoscopic surgery for stage III colon cancer: long-term follow-up" Surg Endosc 14: 612-616 Lezoche, E, Feliciotti, F, Paganini, AM, Guearrei, M, Sanctis, A, Minervini, S, Campagnacci, R (2002) "Laparoscopic vs open hemicolectomy for colon cancer" Surg Endosc 16: 596-602......

4. Split 2006 Level of evidence 1b – individual RCT

5. Split 2006

6. Level of evidence 1b – individual RCT

7. Split 2006

9. The most important data COLOR The COlon cancer Laparoscopic or Open study group 1248 pts (29 European Hospitals) MRC CLASICC Conventional vs LAparoscopic Assisted Surgery in Colorectal Cancer (UK + USA) EAES consensus, Lisabon SAGES statement

10. Split 2006 Level of evidence 2b – individual cohort study

11. Split 2006

12. The prognostic effect of the stage in patients with R0 resected carcinoma of the right colon (operated in current intent) Figure 5. Percentage of mortality-free patients decreased slower in patients with lower tumour stage (1, 2 and 3) than in patients with tumour stage 4 (the “survival” curves were obtained by Kaplan-Meier method and compared by Gehan's – Wilcoxon test). Patients with stages II and III of the disease have almost the same survival.

13. Split 2006 current results and published data laparoscopic (assisted) colon resection for cancer acceptable mortality and morbidity surviving and recurence rate do not appear to differ adversely from those after open resection

14. Split 2006 Lap colon – KB Split The first lap colon - December 12 th 2002 December 12 th 2002 – September 15 th 2006 120 operations benign and malignant diseases

15. Split 2006 indications Polyps, diverticular disease, cecal necrosis, rectum perforation.... Colon carcinoma Suitability for lap procedure

16. Split 2006 RESULTS – 100 resections

17. Split 2006 procedures Sigmoidectomy Right and left hemicolectomy Anterior resections Transversum resections Hartman procedures Rectum amputation Colostomies Colon reconstructions after Hartman procedure Subtotal colectomy Proctocolectomy + IPAA

18. Split 2006 Preoperative management Open procedures Fast track surgery Peroral feeding No NGT One shoot ABT LMH Colonoscopy Barium enema MSCT...

19. Split 2006 technique Reusable and disposable trocars and instruments UC, LS Endostaplers Circular stapler NO TRANSFUSION

20. Split 2006 Patients data Sex ratio males 54.7% females 45.3% Age: average 64,8 ±12.94 (range 24 - 87) years Mean follow up average 12,58 ± 8,28 (range 1 - 44) months

21. Split 2006 Pathology – carcinoma!

22. Split 2006 results Average duration of procedures 152,1 ± 53,902 min Range 80 – 270 min Procedures: Resectio rectosygmoidei sec. Dixon 32%; 169,28±37,92 min 2) Resectio sygmae 20%; 133,92±43,86, 3) Hemicolectomia lat. dex. 18%; 156,42±52,12 amputatio recti anterior sec. Milles, resectio recti sec. Hartman, hemicolectomia lat. sin., subtotal/total colectomy..

23. Split 2006 conversions 17 conversions the main reason bulky tumor locally advanced malignant disease infiltration of surrounding organs urether injury

24. Split 2006 complications six major complications minor anastomotic dehiscence x3 2 urether transection peritonitis after small bowel injury No mortality wound infection, bowel paresis,.....

25. Split 2006 OVERALL PRICE lap10077,31OVERALL PRICE open 10171,98 Cost comparison sygma / rectum resection Perko Z, Kraljević D, Družijanić N, Juričić J, Tomić I, Baković A, Mimica Ž, Petričević A, Baća I, Krnić D, Bilan K. Laparoskopska kirurgija kolona. Acta Chir Croat 2004; 1: 23-31. The cost of our laparoscopic colon resection is comparable with open colon surgery.

26. Split 2006 conclusions Considering our short experience (high volume hospital / surgeon) during learning curve and literature data laparoscopic colon resection comparable with open colon resection including malignant disease treatment

27. Split 2006