{"paper_id":"27e3ea58-a30e-4e96-ada9-cb679d30edbe","body_text":"An Observational Study of Oncological and Short-Term Outcomes in Laparoscopic Colon Surgery | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article An Observational Study of Oncological and Short-Term Outcomes in Laparoscopic Colon Surgery Marcelo Viola Malet, Alexandra Duffau, Marcelo Laurini, Alejandro Soumastre, and 4 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-4325937/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Objective: The advancement of colorectal surgery through laparoscopic approach has represented one of the greatest challenges for digestive surgeons in the modern era. The questioning of this approach oncological quality and radical nature was for many years the cause of the delay in its implementation in colonic pathology, mainly malignant. Our objective is to share the results and analysis of the oncological quality of work we do in the Coloproctology Section of Médica Uruguaya (MUCAM). Methods: This is a descriptive, retrospective, observational study on a prospective database of patients over 15 years of age undergoing consecutive laparoscopic colon surgery. Scheduled between December 2008 and December 2022 at MUCAM. 432 patients were operated on (377 cancer patients). Demographical population carachteristics, hospital stay, suture leakage, reinterventions, 90 days mortality, nodal harvest, overall survival, cancer-related survival, disease-free survival. Results: Our series including 53% women and 47% men, with an average age of 62.6 years (15-90 years). The average hospital stay was 4 days. We reported 5.5% suture leakage, 11.3% reinterventions and 3.2% mortality at 90 days. The average nodal harvest was 16. Overall survival was 77.7% and 65.5% at 5 and 10 years, and cancer-related survival was 82.7% and 79.2% at 5 and 10 years. Median survival was 136.6 months. The 5-year survival for Stage 0 is 96.6%, EI 91.7%, IBD 92.8%, EIII 80.3%, EIV 35.2 Our study has the limitation of being a retrospective study of a case series in a single health institution. Conclusions: The above results show that laparoscopic colon surgery is feasible and safe in our environment, and are comparable with large prospective, randomized, multicenter studies. Colon cancer Laparoscopic surgery Oncological outcomes Introduction The advancement of colorectal surgery through laparoscopic approach has undoubtedly represented one of the greatest challenges for digestive surgeons in the modern era. Despite the obvious advantages of this approach compared to conventional surgery, its implementation should have been faster and more effective, but several factors contributed to a slower development compared to laparoscopic cholecystectomy or esophageal hiatus surgery. Laparoscopic colorectal surgery involves working in multiple quadrants, performing intestinal anastomoses, using sutures, and controlling large-caliber blood vessels. 1 In the early years of its development, laparoscopic colorectal cancer surgery was marred by the description of tumor implants in trocar scars, sometimes in large numbers, which raised doubts about its possible application in oncological surgery. 2,3,4 It was Moises Jacobs 5 in the United States who first published reports on minimally invasive surgery in the treatment of colorectal pathology. A few years later Lacy 6 , in a randomized study with more than 200 patients, showed similar results and even better survival in patients with stage III, by laparoscopy. The authors attribute this situation to a likely better immune response with this approach. Since then, multiple studies have shown that there are no differences in terms of survival associated with this approach compared to conventional surgery in patients with colon cancer. The COST 7 COLOR 8 , and CLASICC 9 studies were among the first randomized controlled trials that changed the course of laparoscopic colorectal surgery. They demonstrated the safety and effectiveness of this approach in malignant pathology. The perioperative and oncological results were similar to those found in open surgery, with all the known postoperative benefits of laparoscopy. These results were confirmed years later in long-term analyzes of some of the aforementioned studies populations. 10 , 11 However, not all patients are candidates for this approach, and the technique election depends on several factors, such as the surgical team experience, complexity of the surgery and patient's condition, so the decision must be individualized and adapted to each patient. Quality in colorectal surgery can be measured through the use of different indices such as: suture failure, harvest and lymph node index, reinterventions, readmissions and operative mortality, beyond purely oncological ones. The analysis of these indices allows us to know our reality and be able to compare results with international centers, daily seeking excellence in care through high-quality procedures and the best results for our patients. 12 , 13, 14 Nowadays there are different strategies that allow optimizing recovery of patients undergoing colorectal surgery. These are multimodal rehabilitation programs which include a set of perioperative care aimed at reducing the physiological response to surgical stress and improving postoperative recovery through a multidisciplinary team. From the first Fast Track programs to the current ERASÒ (Enhanced recovery after Surgery) 15 , 16, 17, 18 programs, they have allowed a decrease in morbidity and mortality, mainly due to a substantial improvement in anesthetic management. In Anglo-Saxon and Asian literature, there is scarcely any evidence generated from developing countries, especially from Latin America, regarding experiences in laparoscopic colon surgery. The results generated by our group reveal that working in multidisciplinary teams, with methodology and systematization, can achieve levels of excellence even in developing countries. Objective- The aim of this study is to share the work we do daily in the Coloproctology Section of Médica Uruguaya (MUCAM) since the beginning of use of laparoscopic surgery in our Institution as a standard approach for colon pathology. Furthermore, to report our results in the period from December 2008 to 2022, in terms of demographics, duration of hospital stays, readmission, removal rate and lymph nodes, suture leakage, reinterventions, disease-free survival, overall survival, cancer-related survival and survival by stage. Material and method An observational study was carried out through retrospective analysis of a prospective database in a Microsoft ExcelÒ for Mac spreadsheet version 16.66. and medical records. The IRB of Médica Uruguaya endorsed the conduct of this study based on a prospectively and consecutively filled database of all patients who underwent elective colon surgery at our institution. All patients included in the study signed the informed consent for surgery and participation. As inclusion criteria for the study, we utilized all patients aged 16 years and above who underwent elective consecutive colon surgeries at our institution. Patients younger than this age and emergency surgeries were excluded. We highlight the inclusion of intraperitoneal rectal surgery as colon surgery, due to its similarity in technical aspects, as well as its oncological behavior. 432 patients over 15 years of age operated electively by laparoscopic approach for colonic pathology were included consecutively between December 2008 and 2022 in MUCAM. For the oncological result analysis, colectomies for adenocarcinoma (360 patients) were considered. Emergency surgeries were excluded from this analysis. We have defined the term suture failure as encompassing all patients who required surgery or another percutaneous intervention to address a disruption in the continuity of the anastomosis we performed. This includes patients with peritonitis in its various presentations, as well as abscesses and perianastomotic collections. As of June 2017, all patients in the series followed the standard of care of the ERASÒ programs. ERASÒ is a new way of understanding perioperative care, which is based on 3 fundamental pillars. Firstly, a multidisciplinary work team including anesthesiologists, nurses, nutritionists, ostomatherapists and surgeons interacting with all the necessary specialists to guarantee the best quality of care, centering the patient in their work. A second pillar is a paradigm shift in the care of patients undergoing colon surgery through evidence-based practices: adopting pre, intra and postoperative measures aimed at reducing the response to surgical stress, modulating physiological factors, and thus trying to reduce the most frequent complications of this surgery. The third pillar is the audit through software provided by the program, which allows us to control our processes and results permanently and in real time. These clinical management protocols go hand in hand with a fundamental premise in any strategic plan to improve the quality of care, which says: what we cannot measure we cannot control, what we cannot control we cannot manage, and if we cannot manage, we cannot improve. Continuous variables are expressed as mean with standard deviation (SD) or median and range. Categorical variables are expressed as N and/or percentages. \"P\" value was considered significant when it was <0.05; Actuarial survival was analyzed using the Kaplan-Meier test. Statistical analysis was performed using IBM SPSS W statictics software version 26.0 Results 377 of the 432 patients who underwent surgery were due to oncological pathology and 55 were non-oncological. Of the first, 360 corresponded to adenocarcinoma. Distribution by sex was similar including 53% women and 47% men and the average age was 62.6 years (15 - 90 years). (Table 1). Compliance of the measures proposed in the ERASÒ protocol by our team is currently at 77%. Today our Institution is certified as an ERAS Center of Excellence and the colorectal surgery team is also certified as trainers of the ERAS implementation program (EIP). 217 were right colectomies, 45 left colectomies, 11 sigmoidectomies, 153 anterior intra-abdominal rectal resections and 17 total abdominal colectomies. (Table 2) All the previously mentioned surgeries were performed interchangeably by two senior surgeons from the colorectal surgery team at our institution throughout the study period. At the beginning of the experience, few laparoscopic colon surgeries were performed due to the overlap with surgeons performing laparotomy colectomies. Nowadays, the unit performs over 100 scheduled laparoscopic colorectal surgeries annually. The average operative time was 127 minutes and the median hospital stay was 4 days (2-35 days). There was 5.5% (24 patients) of suture leakage, 49 reinterventions (11.3%) and 3.2% (14 patients) of mortality at 90 days. Twelve patients (2.8%) were readmitted. (Table 2) Within adenocarcinomas, cancer stages were distributed as Stage0 2 patients, Stage I 74, Satge II 124, Stage III 111 and Stage IV 24. (Table 3) The average lymph node harvest was 16 (5-87), with 72% of cases having more than 12 nodes resected. Lymph nodes were positive in 125 patients (34.7%) and lymph node ratio was 0.34 when more than 12 nodes were resected and 0.36 if there were fewer than 12, which had no statistical difference (p>0.05). Of the 377 oncologic patients, 10 had local relapses and 47 had systemic relapses. (Table 4) The overall survival of the series was 77.7% and 65.5% at 5 and 10 years, with a mean survival of 120.15 months (95% CI 111.99 - 128.32). (Graph 1) Cancer-related survival in our series was 82.7% and 79.2% at 5 and 10 years, with a median survival of 134.09 months (95% CI 126.78 - 141.40). (Graph 2). Local and/or systemic disease-free time was 136.6 months (95% CI 129.7 - 143.5) (Graph 3). Discriminating by stage, 5-year survival rate for Stage 0 was 96.6%, for Stage I 91.7%, for Stage II 91.1%, for Stage III 78.8% and finally for Stage IV. 39.1% (Graph 4) Discussion Benefits of laparoscopic colorectal surgery in terms of less surgical trauma, less bleeding, less postoperative ileus, less pain and shorter hospital stay are widely recognized. Since COST vii , COLOR viii and CLASICC ix studies, which demonstrated the oncological safety and efficacy of laparoscopic procedures in the treatment of malignant diseases of the colon, there has been an exponential increase in the use of the minimally invasive approach worldwide. In addition, better short-term results have been observed in certain population groups such as elderly patients, being a less invasive alternative with less blood loss and shorter hospital stay than conventional surgery. 19 Despite all the benefits reported by laparoscopic colon surgery, one of our group concerns from the beginning of the experience was to permanently audit our results, and evaluate whether they are comparable with experiences published in other media. Fourteen years after its onset, with an average follow-up of 52.5 months and 71% of patients with more than 2 years, we present our oncological and short-term results. As there are multiple quality indicators in colon surgery 20, , we decided to consider the following in order to meet our objectives: anastomotic leak rate, operative mortality, duration of hospital stay, readmission, reinterventions, harvest and lymph node index, oncological follow-up, overall and cancer-related survival, and disease-free time. Our average incidence of anastomotic leak is 5.5%, 5% for intracorporeal suture, 9% for extracorporeal suture. We have not reported any ileocolic suture failure in the last 28 months, highlighting that we have been performing these exclusively side to side isoperistaltic intracorporeal sutures with a 45mm violet reload stapler for 6 years. 4.5% was reported in colorectal anastomosis, which is within the range reported in international studies. 21, 22 Murray 23 reviews 23,568 patients from the American College of Surgeons (ACS-NSQIP) database and observes lower rates of anastomotic leak with laparoscopic surgery compared to conventional surgery, 2.8% vs. 4.5% respectively. The ANACO 24 reference study, a Spanish prospective multicenter study, shows a median anastomotic leak of 8.5%, with the 25th and 75th percentiles at 6.1% and 12.4%. The European Society of Coloproctology collaborating group 25 reports an overall incidence of 8.3% for ileocolic anastomosis. The highest incidence of leak in ileocolic anastomosis stands out in our series. During the first 8 years of experience, we performed extracorporeal \"Barcelona\" type sutures, with leak rates close to 9%, so we began to perform intracorporeal sutures. Colorectal anastomosis was always performed in the same way from the beginning of the experience, with double stapler technique. Although intracorporeal anastomosis is technically more demanding its benefits are recognized, especially in obese patients where traction and tearing of the mesos is avoided, which can occur when the piece is removed to perform extracorporeal anastomosis. On the other hand, it gives us the possibility of extracting it through a Pfannenstiel incision, which is less intrusive than a median supraumbilical incision, the one we usually use to perform the extracorporeal anastomosis. The median hospital stay is 4 days, with a low readmission rate of 2.8%, 14 patients. There is a clear downward trend in the length of stay in recent years, with a large number of patients with 2 and 3 days of hospitalization, which correlates with the incorporation of the ERASÒ protocol since 2015, and formally accredited by the ERASÒ Society, since 2017. Results are comparable to those published by Shah 26 , who shows a median hospitalization of 4 days with a high readmission rate of 12%, although he identifies the ileostomy as the main guilty in the multivariate analysis. Shah included patients who are not considered in our study series, since we decided to exclude lower rectal cancer as we considered it a different pathology. The implementation of the ERAS® Program allows us a continuous audit of our results through the use of online software, which links our experience to more than 180,000 patients around the world. This working modality not only allows us to control our results, but also to compare them with worldwide centers, improving them based on scientific evidence information. References from ANACO study xxiv show a median hospital stay of 10.28 days and a reintervention rate of 12%, which a priori may seem somewhat high. A prospective, observational, multicenter, Norwegian analysis 27 shows a reintervention rate of 8.7%, slightly lower than that of our series. When we analyze our reinterventions causes, we have a total of 49 (11.3%), 8 of which were non-therapeutic laparoscopies, reducing therapeutic reinterventions to 9.49%. Our strategy to improve results when there are complications is to act vigorously through early relaparoscopy, in the same way as when there is unexpected clinical evolution or an ascending PCR and procalcitonin curve. This strategy has allowed us to reduce the need for scheduled reinterventions, morbidity and mortality and, ultimately, healthcare spending. The operative mortality at 90 days is 3.2% (14 patients), slightly higher than that reported by the ANACO study xxiv , which was 2% (0.6-4.7%). If we analyze the mortality of our series in the last 3 years, it is 3 patients (2.3%). Another quality indicator in colon cancer surgery is lymph node extraction, since it constitutes one of the main independent prognostic factors in this pathology, having a great impact on overall and disease-free survival, in addition to determining the indication for adjuvant treatment. 28 , 29, 30 Currently, a minimum of 12 nodes is suggested to classify a surgical colon resection as oncologically sufficient. However, this is an arbitrary, debatable figure that depends on multiple factors. These include the resection quality, the thoroughness of the pathologist's search for the nodes, tumor stage of the disease as well as anatomical and biological factors of each patient. Our series shows a node count greater than 12 nodes in 72% (n=260). Regardless of whether the nodal harvest is greater or less than 12, nodal ratio does not show significant differences (0.34 vs. 0.36), which does not affect oncological radicality. We have also not observed a correlation with a higher incidence of locoregional recurrence. Following the same line of audit, regarding the resection quality we decided to review photographic documentation of low lymph node count patients’ pieces, finding no evidence of poor quality in the extent of the surgery performed. This was carried out by a group external auditor, an anatomopathologist with special dedication to coloproctology. Sometimes a low lymph node count is questioned or interpreted as an insufficient surgically treated patient, which could lead to underdiagnosis and sometimes to overtreatment given the possibility of indicating adjuvant treatment in such an eventuality. Hence the importance of discussing these patients in multidisciplinary groups to interact and define possible treatments with oncologists, pathologists, imaging specialists and surgeons. When analyzing our series, overall survival was 77.7% and 65.5% at 5 and 10 years with a mean survival of 120.15 months (95% CI 111.99 - 128.32). These figures are higher than those reported in the COST study xiv of 66.8% at 5 years for the laparoscopic group, and are similar to those reported in the CLASICC study xvi , where overall survival was 85.1% in both conventional and laparoscopic groups. Conclusion Our study has some limitations regarding the number of patients analyzed over such a long period of time, but it is an undeniable reality in developing countries with small populations, where establishing high-volume centers is very complex. Additionally, over the years, through the unification and centralization of surgeries, we have managed to perform just over 100 laparoscopic colorectal surgeries per year in our unit. Another limitation is the difficulty in patient follow-up; however, we managed to achieve it in over 90% of our patients through telephone interviews or in-person consultations. Our series includes a large number of patients, considering the reality of our country, as well as many others in Latin America and other developing countries. Additionally, this is the largest series with long-term follow-up in Uruguay. Results presented through the analysis of different quality indicators in our series show that laparoscopic colon surgery is feasible and safe in our environment, with oncological and short-term results comparable with large multicenter prospective randomized studies. As it is a technically demanding surgery with a long learning curve, we recommend performing it in the context of multidisciplinary teams with exclusive dedication, where perioperative procedures and processes are systematized, especially within multimodal rehabilitation programs. Declarations Author Contribution The authors state that they have taken part in conception and design, or acquisition of data, or analysis and interpretation of data; drafting the article or revising it critically for important intellectual content; final approval of the version to be published, and are responsible for its contents. Data Availability The data that support the findings of this study are not openly available due to reasons of privacy and are available from the corresponding author upon reasonable request. References E. Balén, J. Suárez, I. Ariceta, B. Oronoz, J. Herrera, J. M. Lera An Sist Sanit Navar 2005; 28(S3): 67-80 Wexner SD, Cohen SM. 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Existe un número mínimo de ganglios linfáticos que se debe analizar en la cirugía del cáncer colorrectal? Cir Esp 2008; 83(3): 108-117 NCCN Clinical Practice Guidelines in oncology. Colon Cancer. Version 4.2018- October 19, 2018 www.nccn.org Wong J, et al Number of nodes examined and staging accuracy in colorrectal carcinoma. Journal of Oncol 1999; 17(9): 2896-2900 Tables Tables 1 to 4 are available in the Supplementary Files section. Graphs Graphs 1 to 4 are available in the Supplementary Files section. Additional Declarations No competing interests reported. Supplementary Files Graph1.jpg Graph2.jpg Graph3.jpg Graph4.jpg Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {\"props\":{\"pageProps\":{\"initialData\":{\"identity\":\"rs-4325937\",\"acceptedTermsAndConditions\":true,\"allowDirectSubmit\":true,\"archivedVersions\":[],\"articleType\":\"Research Article\",\"associatedPublications\":[],\"authors\":[{\"id\":295755631,\"identity\":\"17df056e-1270-4898-acbe-a3790229411a\",\"order_by\":0,\"name\":\"Marcelo Viola 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16:39:32\",\"extension\":\"jpg\",\"order_by\":8,\"title\":\"\",\"display\":\"\",\"copyAsset\":false,\"role\":\"supplement\",\"size\":203729,\"visible\":true,\"origin\":\"\",\"legend\":\"\",\"description\":\"\",\"filename\":\"Graph4.jpg\",\"url\":\"https://assets-eu.researchsquare.com/files/rs-4325937/v1/ebbc0967a0e5efa5f306fbca.jpg\"}],\"financialInterests\":\"No competing interests reported.\",\"formattedTitle\":\"\\u003cp\\u003eAn Observational Study of Oncological and Short-Term Outcomes in Laparoscopic Colon Surgery\\u003c/p\\u003e\",\"fulltext\":[{\"header\":\"Introduction\",\"content\":\"\\u003cp\\u003eThe advancement of colorectal surgery through laparoscopic approach has undoubtedly represented one of the greatest challenges for digestive surgeons in the modern era. Despite the obvious advantages of this approach compared to conventional surgery, its implementation should have been faster and more effective, but several factors contributed to a slower development compared to laparoscopic cholecystectomy or esophageal hiatus surgery.\\u0026nbsp;\\u003c/p\\u003e\\n\\u003cp\\u003eLaparoscopic colorectal surgery involves working in multiple quadrants, performing intestinal anastomoses, using sutures, and controlling large-caliber blood vessels.\\u003csup\\u003e1\\u003c/sup\\u003e\\u003c/p\\u003e\\n\\u003cp\\u003eIn the early years of its development, laparoscopic colorectal cancer surgery was marred by the description of tumor implants in trocar scars, sometimes in large numbers, which raised doubts about its possible application in oncological surgery.\\u003csup\\u003e\\u0026nbsp;2,3,4\\u003c/sup\\u003e \\u0026nbsp;\\u003c/p\\u003e\\n\\u003cp\\u003eIt was Moises Jacobs\\u003csup\\u003e5\\u003c/sup\\u003e in the United States who first published reports on minimally invasive surgery in the treatment of colorectal pathology.\\u003c/p\\u003e\\n\\u003cp\\u003eA few years later Lacy \\u003csup\\u003e6\\u003c/sup\\u003e, in a randomized study with more than 200 patients, showed similar results and even better survival in patients with stage III, by laparoscopy. The authors attribute this situation to a likely better immune response with this approach.\\u003c/p\\u003e\\n\\u003cp\\u003eSince then, multiple studies have shown that there are no differences in terms of survival associated with this approach compared to conventional surgery in patients with colon cancer.\\u003c/p\\u003e\\n\\u003cp\\u003eThe COST \\u003csup\\u003e7\\u003c/sup\\u003e COLOR \\u003csup\\u003e8\\u003c/sup\\u003e, and CLASICC \\u003csup\\u003e9\\u003c/sup\\u003e studies were among the first randomized controlled trials that changed the course of laparoscopic colorectal surgery. They demonstrated the safety and effectiveness of this approach in malignant pathology. The perioperative and oncological results were similar to those found in open surgery, with all the known postoperative benefits of laparoscopy. These results were confirmed years later in long-term analyzes of some of the aforementioned studies populations. \\u003csup\\u003e10\\u003c/sup\\u003e\\u003csup\\u003e, 11\\u003c/sup\\u003e\\u003c/p\\u003e\\n\\u003cp\\u003eHowever, not all patients are candidates for this approach, and the technique election depends on several factors, such as the surgical team experience, complexity of the surgery and patient\\u0026apos;s condition, so the decision must be individualized and adapted to each patient.\\u003c/p\\u003e\\n\\u003cp\\u003eQuality in colorectal surgery can be measured through the use of different indices such as: suture failure, harvest and lymph node index, reinterventions, readmissions and operative mortality, beyond purely oncological ones. The analysis of these indices allows us to know our reality and be able to compare results with international centers, daily seeking excellence in care through high-quality procedures and the best results for our patients. \\u003csup\\u003e12\\u003c/sup\\u003e\\u003csup\\u003e, 13, 14\\u003c/sup\\u003e\\u003c/p\\u003e\\n\\u003cp\\u003eNowadays there are different strategies that allow optimizing recovery of patients undergoing colorectal surgery. These are multimodal rehabilitation programs which include a set of perioperative care aimed at reducing the physiological response to surgical stress and improving postoperative recovery through a multidisciplinary team. From the first Fast Track programs to the current ERAS\\u0026Ograve;\\u0026nbsp;(Enhanced recovery after Surgery) \\u003csup\\u003e15\\u003c/sup\\u003e\\u003csup\\u003e, 16, 17, 18\\u003c/sup\\u003e programs, they have allowed a decrease in morbidity and mortality, mainly due to a substantial improvement in anesthetic management.\\u003c/p\\u003e\\n\\u003cp\\u003eIn Anglo-Saxon and Asian literature, there is scarcely any evidence generated from developing countries, especially from Latin America, regarding experiences in laparoscopic colon surgery. The results generated by our group reveal that working in multidisciplinary teams, with methodology and systematization, can achieve levels of excellence even in developing countries.\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003eObjective-\\u003c/strong\\u003e\\u003c/p\\u003e\\n\\u003cp\\u003eThe aim of this study is to share the work we do daily in the Coloproctology Section of M\\u0026eacute;dica Uruguaya (MUCAM) since the beginning of use of laparoscopic surgery in our Institution as a standard approach for colon pathology.\\u003c/p\\u003e\\n\\u003cp\\u003eFurthermore, to report our results in the period from December 2008 to 2022, in terms of demographics, duration of hospital stays, readmission, removal rate and lymph nodes, suture leakage, reinterventions, disease-free survival, overall survival, cancer-related survival and survival by stage.\\u0026nbsp;\\u003c/p\\u003e\"},{\"header\":\"Material and method\",\"content\":\"\\u003cp\\u003eAn observational study was carried out through retrospective analysis of a prospective database in a Microsoft Excel\\u0026Ograve;\\u0026nbsp;for Mac spreadsheet version 16.66. and medical records.\\u003c/p\\u003e\\n\\u003cp\\u003eThe IRB of M\\u0026eacute;dica Uruguaya endorsed the conduct of this study based on a prospectively and consecutively filled database of all patients who underwent elective colon surgery at our institution. All patients included in the study signed the informed consent for surgery and participation.\\u0026nbsp;\\u003c/p\\u003e\\n\\u003cp\\u003eAs inclusion criteria for the study, we utilized all patients aged 16 years and above who underwent elective consecutive colon surgeries at our institution. Patients younger than this age and emergency surgeries were excluded. We highlight the inclusion of intraperitoneal rectal surgery as colon surgery, due to its similarity in technical aspects, as well as its oncological behavior.\\u0026nbsp;\\u003c/p\\u003e\\n\\u003cp\\u003e432 patients over 15 years of age operated electively by laparoscopic approach for colonic pathology were included consecutively between December 2008 and 2022 in MUCAM. For the oncological result analysis, colectomies for adenocarcinoma (360 patients) were considered. Emergency surgeries were excluded from this analysis.\\u003c/p\\u003e\\n\\u003cp\\u003eWe have defined the term suture failure as encompassing all patients who required surgery or another percutaneous intervention to address a disruption in the continuity of the anastomosis we performed. This includes patients with peritonitis in its various presentations, as well as abscesses and perianastomotic collections.\\u003c/p\\u003e\\n\\u003cp\\u003eAs of June 2017, all patients in the series followed the standard of care of the ERAS\\u0026Ograve;\\u0026nbsp;programs. ERAS\\u0026Ograve;\\u0026nbsp;is a new way of understanding perioperative care, which is based on 3 fundamental pillars. Firstly, a multidisciplinary work team including anesthesiologists, nurses, nutritionists, ostomatherapists and surgeons interacting with all the necessary specialists to guarantee the best quality of care, centering the patient in their work.\\u003c/p\\u003e\\n\\u003cp\\u003eA second pillar is a paradigm shift in the care of patients undergoing colon surgery through evidence-based practices: adopting pre, intra and postoperative measures aimed at reducing the response to surgical stress, modulating physiological factors, and thus trying to reduce the most frequent complications of this surgery.\\u003c/p\\u003e\\n\\u003cp\\u003eThe third pillar is the audit through software provided by the program, which allows us to control our processes and results permanently and in real time. These clinical management protocols go hand in hand with a fundamental premise in any strategic plan to improve the quality of care, which says: what we cannot measure we cannot control, what we cannot control we cannot manage, and if we cannot manage, we cannot improve.\\u0026nbsp;\\u003c/p\\u003e\\n\\u003cp\\u003eContinuous variables are expressed as mean with standard deviation (SD) or median and range. Categorical variables are expressed as N and/or percentages. \\u0026quot;P\\u0026quot; value was considered significant when it was \\u0026lt;0.05; Actuarial survival was analyzed using the Kaplan-Meier test. Statistical analysis was performed using IBM SPSS W statictics software version 26.0\\u003c/p\\u003e\"},{\"header\":\"Results\",\"content\":\"\\u003cp\\u003e377 of the 432 patients who underwent surgery were due to oncological pathology and 55 were non-oncological. Of the first, 360 corresponded to adenocarcinoma. Distribution by sex was similar including 53% women and 47% men and the average age was 62.6 years (15 - 90 years). (Table 1).\\u0026nbsp;\\u003c/p\\u003e\\n\\u003cp\\u003eCompliance of the measures proposed in the ERAS\\u0026Ograve;\\u0026nbsp;protocol by our team is currently at 77%. Today our Institution is certified as an ERAS Center of Excellence and the colorectal surgery team is also certified as trainers of the ERAS implementation program (EIP).\\u003c/p\\u003e\\n\\u003cp\\u003e217 were right colectomies, 45 left colectomies, 11 sigmoidectomies, 153 anterior intra-abdominal rectal resections and 17 total abdominal colectomies. (Table 2) All the previously mentioned surgeries were performed interchangeably by two senior surgeons from the colorectal surgery team at our institution throughout the study period. At the beginning of the experience, few laparoscopic colon surgeries were performed due to the overlap with surgeons performing laparotomy colectomies. Nowadays, the unit performs over 100 scheduled laparoscopic colorectal surgeries annually.\\u0026nbsp;\\u003c/p\\u003e\\n\\u003cp\\u003eThe average operative time was 127 minutes and the median hospital stay was 4 days (2-35 days). There was 5.5% (24 patients) of suture leakage, \\u0026nbsp;49 reinterventions (11.3%) and 3.2% (14 patients) of mortality at 90 days. Twelve patients (2.8%) were readmitted. (Table 2)\\u003c/p\\u003e\\n\\u003cp\\u003eWithin adenocarcinomas, cancer stages were distributed as Stage0 2 patients, Stage I 74, Satge II 124, Stage III 111 and Stage IV 24. (Table 3) The average lymph node harvest was 16 (5-87), with 72% of cases having more than 12 nodes resected. Lymph nodes were positive in 125 patients (34.7%) and lymph node ratio was 0.34 when more than 12 nodes were resected and 0.36 if there were fewer than 12, which had no statistical difference (p\\u0026gt;0.05). Of the 377 oncologic patients, 10 had local relapses and 47 had systemic relapses. (Table 4)\\u003c/p\\u003e\\n\\u003cp\\u003eThe overall survival of the series was 77.7% and 65.5% at 5 and 10 years, with a mean survival of 120.15 months (95% CI 111.99 - 128.32). (Graph 1) Cancer-related survival in our series was 82.7% and 79.2% at 5 and 10 years, with a median survival of 134.09 months (95% CI 126.78 - 141.40). (Graph 2). Local and/or systemic disease-free time was 136.6 months (95% CI 129.7 - 143.5) (Graph 3). Discriminating by stage, 5-year survival rate for Stage 0 was 96.6%, for Stage I 91.7%, for Stage II 91.1%, for Stage III 78.8% and finally for Stage IV. 39.1% (Graph 4)\\u003c/p\\u003e\"},{\"header\":\"Discussion\",\"content\":\"\\u003cp\\u003eBenefits of laparoscopic colorectal surgery in terms of less surgical trauma, less bleeding, less postoperative ileus, less pain and shorter hospital stay are widely recognized.\\u0026nbsp;\\u003c/p\\u003e\\n\\u003cp\\u003eSince COST\\u003csup\\u003e\\u0026nbsp;vii\\u003c/sup\\u003e, COLOR \\u003csup\\u003eviii\\u003c/sup\\u003e and CLASICC\\u003csup\\u003e\\u0026nbsp;ix\\u003c/sup\\u003e studies, which demonstrated the oncological safety and efficacy of laparoscopic procedures in the treatment of malignant diseases of the colon, there has been an exponential increase in the use of the minimally invasive approach worldwide. In addition, better short-term results have been observed in certain population groups such as elderly patients, being a less invasive alternative with less blood loss and shorter hospital stay than conventional surgery.\\u003csup\\u003e\\u0026nbsp;19\\u003c/sup\\u003e\\u003c/p\\u003e\\n\\u003cp\\u003eDespite all the benefits reported by laparoscopic colon surgery, one of our group concerns from the beginning of the experience was to permanently audit our results, and evaluate whether they are comparable with experiences published in other media. Fourteen years after its onset, with an average follow-up of 52.5 months and 71% of patients with more than 2 years, we present our oncological and short-term results.\\u0026nbsp;\\u003c/p\\u003e\\n\\u003cp\\u003eAs there are multiple quality indicators in colon surgery\\u003csup\\u003e\\u0026nbsp;20,\\u003c/sup\\u003e, we decided to consider the following in order to meet our objectives: anastomotic leak rate, operative mortality, duration of hospital stay, readmission, reinterventions, harvest and lymph node index, oncological follow-up, overall and cancer-related survival, and disease-free time.\\u003c/p\\u003e\\n\\u003cp\\u003eOur average incidence of anastomotic leak is 5.5%, 5% for intracorporeal suture, 9% for extracorporeal suture. \\u0026nbsp;We have not reported any ileocolic suture failure in the last 28 months, highlighting that we have been performing these exclusively side to side isoperistaltic intracorporeal sutures with a 45mm violet reload stapler for 6 years. 4.5% was reported in colorectal anastomosis, which is within the range reported in international studies.\\u003csup\\u003e\\u0026nbsp;21, 22\\u003c/sup\\u003e\\u0026nbsp;\\u003c/p\\u003e\\n\\u003cp\\u003eMurray \\u003csup\\u003e23\\u003c/sup\\u003e reviews 23,568 patients from the American College of Surgeons (ACS-NSQIP) database and observes lower rates of anastomotic leak with laparoscopic surgery compared to conventional surgery, 2.8% vs. 4.5% respectively.\\u003c/p\\u003e\\n\\u003cp\\u003eThe ANACO \\u003csup\\u003e24\\u003c/sup\\u003e reference study, a Spanish prospective multicenter study, shows a median anastomotic leak of 8.5%, with the 25th and 75th percentiles at 6.1% and 12.4%.\\u003c/p\\u003e\\n\\u003cp\\u003eThe European Society of Coloproctology collaborating group \\u003csup\\u003e25\\u003c/sup\\u003e reports an overall incidence of 8.3% for ileocolic anastomosis.\\u003c/p\\u003e\\n\\u003cp\\u003eThe highest incidence of leak in ileocolic anastomosis stands out in our series. During the first 8 years of experience, we performed extracorporeal \\u0026quot;Barcelona\\u0026quot; type sutures, with leak rates close to 9%, so we began to perform intracorporeal sutures. Colorectal anastomosis was always performed in the same way from the beginning of the experience, with double stapler technique. Although intracorporeal anastomosis is technically more demanding its benefits are recognized, especially in obese patients where traction and tearing of the mesos is avoided, which can occur when the piece is removed to perform extracorporeal anastomosis. On the other hand, it gives us the possibility of extracting it through a Pfannenstiel incision, which is less intrusive than a median supraumbilical incision, the one we usually use to perform the extracorporeal anastomosis.\\u003c/p\\u003e\\n\\u003cp\\u003eThe median hospital stay is 4 days, with a low readmission rate of 2.8%, 14 patients. There is a clear downward trend in the length of stay in recent years, with a large number of patients with 2 and 3 days of hospitalization, which correlates with the incorporation of the ERAS\\u0026Ograve;\\u0026nbsp;protocol since 2015, and formally accredited by the ERAS\\u0026Ograve;\\u0026nbsp;Society, since 2017.\\u003c/p\\u003e\\n\\u003cp\\u003eResults are comparable to those published by Shah \\u003csup\\u003e26\\u003c/sup\\u003e, who shows a median hospitalization of 4 days with a high readmission rate of 12%, although he identifies the ileostomy as the main guilty in the multivariate analysis. Shah included patients who are not considered in our study series, since we decided to exclude lower rectal cancer as we considered it a different pathology. The implementation of the ERAS\\u0026reg; Program allows us a continuous audit of our results through the use of online software, which links our experience to more than 180,000 patients around the world. This working modality not only allows us to control our results, but also to compare them with worldwide centers, improving them based on scientific evidence information.\\u003c/p\\u003e\\n\\u003cp\\u003eReferences from ANACO study\\u003csup\\u003e\\u0026nbsp;xxiv\\u003c/sup\\u003e show a median hospital stay of 10.28 days and a reintervention rate of 12%, which a priori may seem somewhat high.\\u003c/p\\u003e\\n\\u003cp\\u003eA prospective, observational, multicenter, Norwegian analysis \\u003csup\\u003e27\\u003c/sup\\u003e shows a reintervention rate of 8.7%, slightly lower than that of our series. When we analyze our reinterventions causes, we have a total of 49 (11.3%), 8 of which were non-therapeutic laparoscopies, reducing therapeutic reinterventions to 9.49%. Our strategy to improve results when there are complications is to act vigorously through early relaparoscopy, in the same way as when there is unexpected clinical evolution or an ascending PCR and procalcitonin curve. This strategy has allowed us to reduce the need for scheduled reinterventions, morbidity and mortality and, ultimately, healthcare spending.\\u003c/p\\u003e\\n\\u003cp\\u003eThe operative mortality at 90 days is 3.2% (14 patients), slightly higher than that reported by the ANACO study\\u0026nbsp;\\u003csup\\u003exxiv\\u003c/sup\\u003e, which was 2% (0.6-4.7%). If we analyze the mortality of our series in the last 3 years, it is 3 patients (2.3%).\\u003c/p\\u003e\\n\\u003cp\\u003eAnother quality indicator in colon cancer surgery is lymph node extraction, since it constitutes one of the main independent prognostic factors in this pathology, having a great impact on overall and disease-free survival, in addition to determining the indication for adjuvant treatment. \\u003csup\\u003e28\\u003c/sup\\u003e\\u003csup\\u003e, 29, 30\\u003c/sup\\u003e\\u0026nbsp;\\u003c/p\\u003e\\n\\u003cp\\u003eCurrently, a minimum of 12 nodes is suggested to classify a surgical colon resection as oncologically sufficient. However, this is an arbitrary, debatable figure that depends on multiple factors. These include the resection quality, the thoroughness of the pathologist\\u0026apos;s search for the nodes, tumor stage of the disease as well as anatomical and biological factors of each patient.\\u003c/p\\u003e\\n\\u003cp\\u003eOur series shows a node count greater than 12 nodes in 72% (n=260). Regardless of whether the nodal harvest is greater or less than 12, nodal ratio does not show significant differences (0.34 vs. 0.36), which does not affect oncological radicality. We have also not observed a correlation with a higher incidence of locoregional recurrence.\\u003c/p\\u003e\\n\\u003cp\\u003eFollowing the same line of audit, regarding the resection quality we decided to review photographic documentation of low lymph node count patients\\u0026rsquo; pieces, finding no evidence of poor quality in the extent of the surgery performed. This was carried out by a group external auditor, an anatomopathologist with special dedication to coloproctology.\\u003c/p\\u003e\\n\\u003cp\\u003eSometimes a low lymph node count is questioned or interpreted as an insufficient surgically treated patient, which could lead to underdiagnosis and sometimes to overtreatment given the possibility of indicating adjuvant treatment in such an eventuality. Hence the importance of discussing these patients in multidisciplinary groups to interact and define possible treatments with oncologists, pathologists, imaging specialists and surgeons.\\u003c/p\\u003e\\n\\u003cp\\u003eWhen analyzing our series, overall survival was 77.7% and 65.5% at 5 and 10 years with a mean survival of 120.15 months (95% CI 111.99 - 128.32). These figures are higher than those reported in the COST study\\u0026nbsp;\\u003csup\\u003exiv\\u003c/sup\\u003e of 66.8% at 5 years for the laparoscopic group, and are similar to those reported in the CLASICC study\\u0026nbsp;\\u003csup\\u003exvi\\u003c/sup\\u003e, where overall survival was 85.1% in both conventional and laparoscopic groups.\\u003c/p\\u003e\"},{\"header\":\"Conclusion\",\"content\":\"\\u003cp\\u003eOur study has some limitations regarding the number of patients analyzed over such a long period of time, but it is an undeniable reality in developing countries with small populations, where establishing high-volume centers is very complex. Additionally, over the years, through the unification and centralization of surgeries, we have managed to perform just over 100 laparoscopic colorectal surgeries per year in our unit. Another limitation is the difficulty in patient follow-up; however, we managed to achieve it in over 90% of our patients through telephone interviews or in-person consultations.\\u003c/p\\u003e\\n\\u003cp\\u003eOur series includes a large number of patients, considering the reality of our country, as well as many others in Latin America and other developing countries. Additionally, this is the largest series with long-term follow-up in Uruguay.\\u003c/p\\u003e\\n\\u003cp\\u003eResults presented through the analysis of different quality indicators in our series show that laparoscopic colon surgery is feasible and safe in our environment, with oncological and short-term results comparable with large multicenter prospective randomized studies.\\u003c/p\\u003e\\n\\u003cp\\u003eAs it is a technically demanding surgery with a long learning curve, we recommend performing it in the context of multidisciplinary teams with exclusive dedication, where perioperative procedures and processes are systematized, especially within multimodal rehabilitation programs.\\u003c/p\\u003e \"},{\"header\":\"Declarations\",\"content\":\"\\u003ch2\\u003eAuthor Contribution\\u003c/h2\\u003e\\u003cp\\u003eThe authors state that they have taken part in conception and design, or acquisition of data, or analysis and interpretation of data; drafting the article or revising it critically for important intellectual content; final approval of the version to be published, and are responsible for its contents.\\u003c/p\\u003e\\u003ch2\\u003eData Availability\\u003c/h2\\u003e\\u003cp\\u003eThe data that support the findings of this study are not openly available due to reasons of privacy and are available from the corresponding author upon reasonable request.\\u003c/p\\u003e\"},{\"header\":\"References\",\"content\":\"\\u003col\\u003e\\n\\u003cli\\u003eE. Bal\\u0026eacute;n, J. Su\\u0026aacute;rez, I. Ariceta, B. Oronoz, J. Herrera, J. M. Lera An Sist Sanit Navar 2005; 28(S3): 67-80\\u003c/li\\u003e\\n\\u003cli\\u003eWexner SD, Cohen SM. Port site metastases after laparoscopic colorectal surgery for cure of malignancy. Br J Surg 1995; 82: 295-298\\u003c/li\\u003e\\n\\u003cli\\u003eReilly WT, Nelson H, Schroeder G, Wieand HS, Bolton J, O Conell MJ. Wound recurrence following conventional treatment of colorectal cancer: a rare, but perhaps underestimated problem. Dis Colon Rectum 1996; 39: 200-207\\u003c/li\\u003e\\n\\u003cli\\u003eWhelan RL, Youg-Fadok TM. Should carcinoma of the colon be treated laparoscopically? Surg Endosc 2004; 18: 857-862\\u003c/li\\u003e\\n\\u003cli\\u003eJacobs M, Verdeja JC, Goldstein HS. Minimally invasive colon resection (laparoscopic colectomy). Surg Laparosc Endosc 1991; 1: 144-50\\u003c/li\\u003e\\n\\u003cli\\u003eLacy A, Garc\\u0026iacute;a-Valdecasas J, Delgado S, Castells A, Taur\\u0026aacute; P, Piqu\\u0026eacute; J, et al. Laparoscopy-assisted colectomy versus open colectomy for treatment of non-metastatic colon cancer: a radomised trial. Lancet 2002; 359: 2224-2229\\u003c/li\\u003e\\n\\u003cli\\u003eNelson H, Sargent D, Wieand S, Fleshman J, Anvari M, Stryker J, et al. A comparison of laparoscopically assisted and open colectomy for colon c\\u0026aacute;ncer. The Clinical Outcomes of Surgical Therapy Study Group (COST) N Engl J Med 2004; 350: 2050-2059.\\u003c/li\\u003e\\n\\u003cli\\u003eBuunen M, Veldkamp R, Hop W, Kuhry E, Jeekel J, Haglind E, et al. Colon Cancer Laparoscopic or Open Resection Study Group. Survival after laparoscopic surgery versus open surgery for colon cancer: long term outcome of a randomised clinical trial. Lancet Oncol 2009; 10: 44-52\\u003c/li\\u003e\\n\\u003cli\\u003eGreen B, Marshall H, Collinson F, Quirke P Guillou D, Jayne D, Long- term follow-up of the Medical Research Council CLASICC trial of conventional versus laparoscopically assisted resection in colorectal c\\u0026aacute;ncer. Br J Surg 2013; 100: 75-82\\u003c/li\\u003e\\n\\u003cli\\u003eDeijen CL, Vasmel JE, de Lange-de Klerk ESM, Cuesta MA, Coene PLO, Lange JF, Meijerink WJHJ, Jakimowicz JJ, Jeekel J, Kazemier G, Janssen IMC, P\\u0026aring;hlman L, Haglind E, Bonjer HJ; COLOR (COlon cancer Laparoscopic or Open Resection) study group. Ten-year outcomes of a randomised trial of laparoscopic versus open surgery for colon cancer. Surg Endosc. 2017 Jun;31(6):2607-2615. doi: 10.1007/s00464-016-5270-6. Epub 2016 Oct 12. PMID: 27734203; PMCID: PMC5443846.\\u003c/li\\u003e\\n\\u003cli\\u003eBingener J, Sloan JA, Novotny PJ, Pockaj BA, Nelson H. Perioperative patient- reported outcomes predict serious postoperative complications: a secondary analysis of the COST trial. J Gastrointest Surg. 2015 Jan;19(1):65-71; discussion 71. doi: c. Epub 2014 Aug 5. PMID: 25091846; PMCID: PMC4289078.\\u003c/li\\u003e\\n\\u003cli\\u003eCastro A, Liz A, Soumastre A, Lavega A, Fag\\u0026uacute;ndez N, Viola M. Seguridad y calidad oncol\\u0026oacute;gica de la cirug\\u0026iacute;a por c\\u0026aacute;ncer colorrectal en un centro docente universitario. Rev Argent Coloproct. (2022) 33,3: 18-24. DOI: https://doi.org/10.46768/racp.v0i0.197\\u003c/li\\u003e\\n\\u003cli\\u003eBannura C. Guillermo. Estándares De Calidad En Cirugía Colorrectal. Servicio Y Departamento De Cirugía. Hospital Clínico San Borja Arriarán (Hcsba). Facultad De Medicina Universidad De Chile. Rev Chil Cir. Vol 66 - No 1, Febrero 2014; Pág. 86-91 Santiago, Chile.\\u003c/li\\u003e\\n\\u003cli\\u003eDe La Portilla F, Et Al. An\\u0026aacute;lisis De Los Indicadores De Calidad En La Cirug\\u0026iacute;a De C\\u0026aacute;ncer Colorrectal De Unidades Acreditadas Por La Asociaci\\u0026oacute;n Espa\\u0026ntilde;ola De Coloproctolog\\u0026iacute;a. Cir Esp. 2018. Https://Doi.Org/10.1016/J.Ciresp.2018.02.008 \\u003c/li\\u003e\\n\\u003cli\\u003eGustafsson UO, Scott MJ, Schwenk W, Demartines N, Roulin D, Francis N, McNaught CE, Macfie J, Liberman AS, Soop M, Hill A, Kennedy RH, Lobo DN, Fearon K, Ljungqvist O; Enhanced Recovery After Surgery (ERAS) Society, for Perioperative Care; European Society for Clinical Nutrition and Metabolism (ESPEN); International Association for Surgical Metabolism and Nutrition (IASMEN). Guidelines for perioperative care in elective colonic surgery: Enhanced Recovery After Surgery (ERAS(\\u0026reg;)) Society recommendations. World J Surg. 2013 Feb;37(2):259-84. doi: 10.1007/s00268-012-1772-0. PMID: 23052794. \\u003c/li\\u003e\\n\\u003cli\\u003eLjungqvist O, Scott M, Fearon KC. Enhanced Recovery After Surgery: A Review. JAMA Surg. 2017 Mar 1;152(3):292-298. doi: 10.1001/jamasurg.2016.4952. PMID: 28097305.\\u003c/li\\u003e\\n\\u003cli\\u003eGustafsson UO, Scott MJ, Hubner M, Nygren J, Demartines N, Francis N, Rockall TA, Young-Fadok TM, Hill AG, Soop M, de Boer HD, Urman RD, Chang GJ, Fichera A, Kessler H, Grass F, Whang EE, Fawcett WJ, Carli F, Lobo DN, Rollins KE, Balfour A, Baldini G, Riedel B, Ljungqvist O. Guidelines for Perioperative Care in Elective Colorectal Surgery: Enhanced Recovery After Surgery (ERAS\\u0026reg;) Society Recommendations: 2018. World J Surg. 2019 Mar;43(3):659-695. doi: 10.1007/s00268-018-4844-y. PMID: 30426190.\\u003c/li\\u003e\\n\\u003cli\\u003eGreer NL, Gunnar WP, Dahm P, Lee AE, MacDonald R, Shaukat A, Sultan S, Wilt TJ. Enhanced Recovery Protocols for Adults Undergoing Colorectal Surgery: A Systematic Review and Meta-analysis. Dis Colon Rectum. 2018 Sep;61(9):1108-1118. doi: 10.1097/DCR.0000000000001160. PMID: 30086061.\\u003c/li\\u003e\\n\\u003cli\\u003eNishikawa T, Ishihara S, Hata K, Murono K, Yasuda K, Otani K et al. Short-term outcomes of open versus laparoscopic surgery in elderly patients with colorectal c\\u0026aacute;ncer. Surg Endosc 2016; 30(12): 5550-5557\\u003c/li\\u003e\\n\\u003cli\\u003eVergara-Fernandez O, Swallow C, Victor J, O\\u0026acute;Connor B, Gryphe R, MacRae H, et al. Assessing outcomes following surgery for colorectal cancer using quality of care indicators. Can J Surg 2010; 53: 232-240\\u003c/li\\u003e\\n\\u003cli\\u003eKube R, Mroczkowski P, Steinert R, Sahm M, Schmidt U, Gastinger I, et al. Anastomotic leakage following bowel resections for colon c\\u0026aacute;ncer: Multivariate analysis of risk factors. Chirurg 2009; 80: 1153-1159 \\u003c/li\\u003e\\n\\u003cli\\u003eBaker IS, Grossmann I, Henneman D, Havenga K, Wiggers T. Risk factors for anastomotic leakage and leak-related mortalitity after colonic c\\u0026aacute;ncer surgery in a nationwide audit. Br J Surg 2014; 101:424-432\\u003c/li\\u003e\\n\\u003cli\\u003eMurray AC, Chuzan C, Kiran RP Risk of anastomotic leak after laparoscopic versus open colectomy Surg Endosc 2016; 30(12): 5275-5282\\u003c/li\\u003e\\n\\u003cli\\u003eJS Muriel, M Frasson, D Herv\\u0026aacute;s, B Flor-Lorente, JL Ramos, M Romero, et al. Resultados quir\\u0026uacute;rgicos est\\u0026aacute;ndar tras resecci\\u0026oacute;n oncol\\u0026oacute;gica de colon. Creaci\\u0026oacute;n de un nomograma de autoevaluaci\\u0026oacute;n. Cir Esp 2017; 95(1): 30-37.\\u003c/li\\u003e\\n\\u003cli\\u003eEuropean Society of Coloproctology Collaborating Group Glasbey J, Nepogodiev D, Battersby N, Bhangu A, El-Hussuna A, Frasson M, Singh B, et al. The impact of stapling technique and surgeon specialism on anastomotic failure after right-sided colorectal resection: and international multicentre, prospective audit. Colorectal Dis 2018; 20(11): 1028-1040\\u003c/li\\u003e\\n\\u003cli\\u003eShah P, Johnston L, Saosiek B, Harrigan A, Friel C, Thiele R, et al. Reducing readmissions while shortening length of stay: The positive impact of an enhanced recovery protocol in colorectal surgery. Dis Colon Rectum 2017; 60(2): 219-227\\u003c/li\\u003e\\n\\u003cli\\u003eNymo L, Norderval S, Eriksen M, Wasmuth H, Korner H, Bjornbeth, et al. Short-term outcomes after elective colon cancer surgery: an observational study from the Norwegian registry for gastrointestinal and HPB surgery, NoRGast. Surg Endosc 2018 Nov 9. Doi: 10.1007/s00464-018-6575-4. Epub ahead of print\\u003c/li\\u003e\\n\\u003cli\\u003eMartinez D, et al. Existe un n\\u0026uacute;mero m\\u0026iacute;nimo de ganglios linf\\u0026aacute;ticos que se debe analizar en la cirug\\u0026iacute;a del c\\u0026aacute;ncer colorrectal? Cir Esp 2008; 83(3): 108-117\\u003c/li\\u003e\\n\\u003cli\\u003eNCCN Clinical Practice Guidelines in oncology. Colon Cancer. Version 4.2018- October 19, 2018 www.nccn.org\\u003c/li\\u003e\\n\\u003cli\\u003eWong J, et al Number of nodes examined and staging accuracy in colorrectal carcinoma. Journal of Oncol 1999; 17(9): 2896-2900\\u003c/li\\u003e\\n\\u003c/ol\\u003e\"},{\"header\":\"Tables\",\"content\":\"\\u003cp\\u003eTables 1 to 4 are available in the Supplementary Files section.\\u003c/p\\u003e\"},{\"header\":\"Graphs\",\"content\":\"\\u003cp\\u003eGraphs 1 to 4 are available in the Supplementary Files section.\\u003c/p\\u003e\"}],\"fulltextSource\":\"\",\"fullText\":\"\",\"funders\":[],\"hasAdminPriorityOnWorkflow\":false,\"hasManuscriptDocX\":true,\"hasOptedInToPreprint\":true,\"hasPassedJournalQc\":\"\",\"hasAnyPriority\":false,\"hideJournal\":true,\"highlight\":\"\",\"institution\":\"\",\"isAcceptedByJournal\":false,\"isAuthorSuppliedPdf\":false,\"isDeskRejected\":\"\",\"isHiddenFromSearch\":false,\"isInQc\":false,\"isInWorkflow\":false,\"isPdf\":false,\"isPdfUpToDate\":true,\"isWithdrawnOrRetracted\":false,\"journal\":{\"display\":true,\"email\":\"info@researchsquare.com\",\"identity\":\"researchsquare\",\"isNatureJournal\":false,\"hasQc\":true,\"allowDirectSubmit\":true,\"externalIdentity\":\"\",\"sideBox\":\"\",\"snPcode\":\"\",\"submissionUrl\":\"/submission\",\"title\":\"Research Square\",\"twitterHandle\":\"researchsquare\",\"acdcEnabled\":true,\"dfaEnabled\":false,\"editorialSystem\":\"\",\"reportingPortfolio\":\"\",\"inReviewEnabled\":false,\"inReviewRevisionsEnabled\":true},\"keywords\":\"Colon cancer, Laparoscopic surgery, Oncological outcomes\",\"lastPublishedDoi\":\"10.21203/rs.3.rs-4325937/v1\",\"lastPublishedDoiUrl\":\"https://doi.org/10.21203/rs.3.rs-4325937/v1\",\"license\":{\"name\":\"CC BY 4.0\",\"url\":\"https://creativecommons.org/licenses/by/4.0/\"},\"manuscriptAbstract\":\"\\u003cp\\u003e\\u003cstrong\\u003eObjective:\\u003c/strong\\u003e The advancement of colorectal surgery through laparoscopic approach has represented one of the greatest challenges for digestive surgeons in the modern era.\\u003c/p\\u003e\\n\\u003cp\\u003eThe questioning of this approach oncological quality and radical nature was for many years the cause of the delay in its implementation in colonic pathology, mainly malignant.\\u003c/p\\u003e\\n\\u003cp\\u003eOur objective is to share the results and analysis of the oncological quality of work we do in the Coloproctology Section of Médica Uruguaya (MUCAM).\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003eMethods:\\u003c/strong\\u003e This is a descriptive, retrospective, observational study on a prospective database of patients over 15 years of age undergoing consecutive laparoscopic colon surgery. Scheduled between December 2008 and December 2022 at MUCAM. 432 patients were operated on (377 cancer patients).\\u003c/p\\u003e\\n\\u003cp\\u003eDemographical population carachteristics, hospital stay, suture leakage, reinterventions, 90 days mortality, nodal harvest, overall survival, cancer-related survival, disease-free survival.\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003eResults:\\u003c/strong\\u003e Our series including 53% women and 47% men, with an average age of 62.6 years (15-90 years). The average hospital stay was 4 days. We reported 5.5% suture leakage, 11.3% reinterventions and 3.2% mortality at 90 days. The average nodal harvest was 16. Overall survival was 77.7% and 65.5% at 5 and 10 years, and cancer-related survival was 82.7% and 79.2% at 5 and 10 years. Median survival was 136.6 months. The 5-year survival for Stage 0 is 96.6%, EI 91.7%, IBD 92.8%, EIII 80.3%, EIV 35.2\\u003c/p\\u003e\\n\\u003cp\\u003eOur study has the limitation of being a retrospective study of a case series in a single health institution.\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003eConclusions:\\u003c/strong\\u003e The above results show that laparoscopic colon surgery is feasible and safe in our environment, and are comparable with large prospective, randomized, multicenter studies.\\u003c/p\\u003e\",\"manuscriptTitle\":\"An Observational Study of Oncological and Short-Term Outcomes in Laparoscopic Colon Surgery\",\"msid\":\"\",\"msnumber\":\"\",\"nonDraftVersions\":[{\"code\":1,\"date\":\"2024-05-02 16:31:26\",\"doi\":\"10.21203/rs.3.rs-4325937/v1\",\"editorialEvents\":[{\"type\":\"communityComments\",\"content\":0}],\"status\":\"published\",\"journal\":{\"display\":true,\"email\":\"info@researchsquare.com\",\"identity\":\"researchsquare\",\"isNatureJournal\":false,\"hasQc\":true,\"allowDirectSubmit\":true,\"externalIdentity\":\"\",\"sideBox\":\"\",\"snPcode\":\"\",\"submissionUrl\":\"/submission\",\"title\":\"Research Square\",\"twitterHandle\":\"researchsquare\",\"acdcEnabled\":true,\"dfaEnabled\":false,\"editorialSystem\":\"\",\"reportingPortfolio\":\"\",\"inReviewEnabled\":false,\"inReviewRevisionsEnabled\":true}}],\"origin\":\"\",\"ownerIdentity\":\"b6671882-c2b7-4723-91a9-e2802cbfa0df\",\"owner\":[],\"postedDate\":\"May 2nd, 2024\",\"published\":true,\"recentEditorialEvents\":[],\"rejectedJournal\":[],\"revision\":\"\",\"amendment\":\"\",\"status\":\"posted\",\"subjectAreas\":[],\"tags\":[],\"updatedAt\":\"2024-06-19T07:44:10+00:00\",\"versionOfRecord\":[],\"versionCreatedAt\":\"2024-05-02 16:31:26\",\"video\":\"\",\"vorDoi\":\"\",\"vorDoiUrl\":\"\",\"workflowStages\":[]},\"version\":\"v1\",\"identity\":\"rs-4325937\",\"journalConfig\":\"researchsquare\"},\"__N_SSP\":true},\"page\":\"/article/[identity]/[[...version]]\",\"query\":{\"redirect\":\"/article/rs-4325937\",\"identity\":\"rs-4325937\",\"version\":[\"v1\"]},\"buildId\":\"qtupq5eGEP_6zYnWcrvyt\",\"isFallback\":false,\"isExperimentalCompile\":false,\"dynamicIds\":[84888],\"gssp\":true,\"scriptLoader\":[]}","source_license":"CC-BY-4.0","license_restricted":false}