Bir bölge hizmet hastanesinde laparoskopik kolorektal kanser cerrahisi: Tek cerrah deneyimi

Öz

AMAÇ: Kanıtlanmış avantajlarına rağmen bölge hizmet hastanelerinde laparoskopik kolorektal cerrahi yeterince kullanılmamaktadır. Türkiye'nin Orta Karadeniz Bölgesi'ndeki bir hizmet hastanesinde bir gastroenteroloji cerrahı tarafından laparoskopik cerrahi ile tedavi edilen kolorektal kanserli hastaların sonuçlarının değerlendirilmesi amaçlanmıştır. GEREÇ ve YÖNTEM: Laparoskopik kolorektal cerrahi uygulanan ardışık her hastanın verileri prospektif olarak kaydedildi ve retrospektif olarak analiz edildi. Kaydedilen parametreler demografik özellikler, teşhis çalışmaları, cerrahi olaylar, ameliyat sonrası morbidite, mortalite ve sonuçları içeriyordu. BULGULAR: Kırk aylık bir süre içinde 75 hastaya kolorektal kanser nedeniyle laparoskopik cerrahi uygulandı. Ortalama yaş 66,4 olup erkeklerin kadınlara oranı 11:4'tür. Rektum kanseri oranı %65,3, kolon kanseri oranı yüzde 34,6 idi. Bir hastada senkron kolorektal kanser tespit edildi. Ortalama ameliyat süresi 276 dakika ve ortalama kanama hacmi 75 ml idi. Açık rezeksiyona geçiş oranı %6,6 idi. Ortalama hastanede kalış günü altı gündü. Ameliyat sonrası komplikasyon oranı (Clavien-Dindo derecesi ≥ III) %8,5 idi. Takip sırasında iki sistemik nüks gözlendi. SONUÇ: Sonuçlarımız ve araştırmada sunulan diğer çalışmalar doğrultusunda, yüksek vaka sayısına sahip eğitimli bir cerrah, gelişmekte olan bir ülkenin bölge hizmet hastanesinde güvenli ve yeterli onkolojik laparoskopik kolorektal prosedürü gerçekleştirebilir. Sağlık politikalarının ve bölgesel koşulların ilimizdeki ve ülkemizdeki cerrahi uygulamalar üzerine olan etkisini göstermesi açısından da sonuçlarımız değerlidir. Özellikle kalabalık hizmet hastanelerinde uzun amaliyat süresi uygulamanın dezavantajıdır. Mevcut şartlarda cerrahların özverisi ve ilgili her türlü destek gereklidir.

Anahtar Kelimeler

• Cerrah
• Hastane
• Kapasite
• Kolorektal kanser
• Minimal invazif cerrahi

Laparoscopic colorectal surgery for cancer in a regional service hospital: single surgeon experience

Öz

Aim: In spite of the demonstrated advantages, laparoscopic colorectal surgery is not adequately utilised in regional service hospitals. Purpose of the research was to document the findings of patients managed by a gastroenterological surgeon for colorectal neoplasms using laparoscopic surgery at a service hospital of the Central Black Sea Region, Turkey. Material and Method: Every sequential patient having laparoscopic colorectal surgery was registered prospectively and analysed retrospectively. Recorded parameters consisted of demographic characteristics, diagnostic work-up, surgical events, post-surgical morbidity, mortality and outcomes. Results: Seventy-five patients each underwent laparoscopic colorectal surgery for colorectal neoplasm within a period of forty months. Average age was 66.4 years and ratio of males to females was 11:4. Rectal cancer rate was 65.3%. Colon cancer rate was 34.6%. One patient had synchronous colorectal cancer. Mean time of surgery was 276 min and mean volume of haemorrhage was 75 ml. Conversion to open resection rate was 6.6%. Median day of hospitalization was six days. Postoperative complication rate (Clavien–Dindo grade ≥ III) was 8.5%. Two systemic recurrences were observed during the surveillance. Conclusion: Based on our results and those of other studies presented here, a trained surgeon with a high caseload can perform safe and adequate oncological laparoscopic colorectal resections in a regional service hospital of a developing country. The longer operative time is the drawback of the procedure, especially in crowded service hospitals. The results are also valuable in terms of showing the effect of health policies and regional conditions on surgical practices in our city and country. Under the current conditions, surgeons’ dedication and all relevant supports are required.

Anahtar Kelimeler

• Colorectal cancer
• Hospital
• Minimally invasive surgery
• Surgeon
• Volume

Kaynakça

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