الفهرس 
AIM OF THE WORKOnly 14 pages are availabe for public view
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Abstract
Laparoscopic colectomy has been widely used clinically due to its minimally invasive advantages, and many studies have also demonstrated its safety and efficacy. However, the efficacy of laparoscopic left hemicolectomy remains unclear due to the differences in pathogenesis and surgical details between left and right colon cancers.
This prospective study was conducted on 40 patients with colon cancer at Menoufia University hospital and Damanhur Medical National Institute to evaluate the safety and efficacy of laparoscopic left hemicolectomy versus open left hemicolectomy for patients with left colon cancer.
Patients were divided into two groups:
group I: included ”20 patients” comprised those who had left-sided colonic carcinoma planned for laparoscopic intervention. group II: included ”20 patients” comprised those who had left-sided colonic carcinoma planned for open surgical intervention.
All patients were subjected to the following:
History taking and clinical examination: Age, sex, comorbidities, American Society of Anesthesiologists group (ASA classification), tumor stage and previous abdominal surgery.
Anthropometric data: weight, height, and BMI.
Preoperative preparation: laboratory an radiological evaluation
group I: laparoscopic intervention and group II: open surgical intervention.
Postoperative care and follow up.
Regarding baseline characteristics of the studied groups, the mean age of group I was 48.2 ± 8.55 years and the mean age of group II was 49.4 ± 8.36 years. In group II, There were 12 males (60%) and 8 females (40%) while in group I there were 10 males (50%) and 10 females (50%). The mean BMI was 28.65 ± 1.24 kg/m 2 in group I and 28.59 ± 1.2 kg/m 2 in group II. The mean MAP was 94.7 ± 5.89 mmHg in group I and 95.7 ± 5.48 mmHg in group II. Hypertension was the common comorbidity in both group. There was no statistically significant difference between the two studied groups regarding their age, BMI, MAP, gender distribution, comorbidities, and smoking status.
Concerning Intraoperative data in studied groups, there was no statistical significant difference between both groups in terms of blood transfusion need, splenic, intestinal, and ureteric injury. Noteworthy, no patients in either group experienced trocar site bleeding (in group I) or died during operation.
There was statistical significant difference between study groups regarding operative time, Patients subjected to laparoscopic intervention took significantly longer operative time (with a mean time of 4.48 ± 0.44 vs 2.58 ± 0.37 hours, P<0.001).
As regard postoperative outcome of the studied groups, both groups were comparable regarding the incidence of postoperative pulmonary embolism, abdominal collection, burst abdomen, incisional hernia, intestinal fistula, and ICU need. No patients in either group developed post-operative bleeding or leak or died after 30 days. Patients subjected to laparoscopic intervention took significantly shorter time to resume liquid diet (after a mean time of 2.35 ± 0.49 vs 4.45 ± 3.63 days, P=0.019) and pass first flatus (2.35 ± 0.49 vs 3.45 ± 0.69, P<0.001) than those subjected to surgical intervention, with significantly shorter hospital stay (4.1 ± 0.31 vs 8.75 ± 2.15, P<0.001). regarding incisional hernia, there was one patient in group I and two patients in group II with no significant statistically difference, As regards the number of lymph nodes harvested, it was significantly higher in group I than group II (13 ± 1.08 vs 11.85 ± 0.75, P<0.001).
In multiple regression analysis, method of intervention was associated with the length of hospital stay as patients subjected to laparoscopic colectomy had significantly shorter stay than those subjected to open colectomy, regarding length of hospital stay in patients with open colectomy (mean = 8.7 ± 2.1, median = 8 & IQR = 8 - 8) when compared with patients with laparoscopic colectomy (mean = 4.1 ± 0.3, median = 4 & IQR = 4 - 4), highly statistical significance were found (p-value < 0.001).