الفهرس 
Introduction & Aim of workOnly 14 pages are availabe for public view
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Abstract
Recently, colorectal cancer has been a significant leading cause of death from malignancies worldwide. Conventional open surgery is associated with significant morbidity and long convalescence. Laparoscopic surgery has been widely used as a minimally invasive surgery to treat diverse benign diseases such as benign gall bladder disease. Jacobs et al. first reported the technical feasibility of laparoscopic colectomy in 1991.
Since then, laparoscopic surgery has been widely operated for various benign colorectal conditions such as polyps, rectal prolapsed and now colorectal cancer increasingly. The benefits of laparoscopic surgery in comparison with open surgery have been suggested with respect to decreased morbidity, decreased pain, faster recovery, shorter hospital stay and possibly reduced immunosuppression. Laparoscopic colorectal surgery is technically complex as it involves laparoscopic mobilization of colon over a wide area, intracorporeal division of major vessels, extraction of specimen and a bowel anastomosis. There is a steep learning curve to achieve advanced laparoscopic skills , and specialized equipment is required. There are concerns with oncological outcome and safety of the laparoscopic procedure in colorectal cancer. There are also controversies with portential port site recurrence after curative resection of tumour, hospital cost and lack of data on longterm oncological outcome.
Laparoscopic colorectal surgery is the most significant technical development in colo-rectal surgery over the last decade. Several issues were raised against the use of laparoscopy in cases of malignancy. One of these issues was the adequacy of the obtained specimens especially in those cases that are candidate for radical resection. Taking the number of lymph nodes as an indicator for the radicality of the surgery done with the number of 12 lymph nodes being the target value as proposed by recent studies, we found that laparoscopic resection in cases of malignancy yields adequate samples that are comparable to those obtained by open surgery, if not better owing to the magnifying power given by laparoscopy.
However, adopting laparoscopic surgical techniques for malignant cases is a highly demanding task from all the members of the team i.e. the surgeon, the assistants, the nurses, the technician and the pathologist; each member has a task with certain requirements that should be met for the maximum benefit to be obtained from laparoscopy for the sake of the patient and the community on both the short and long run. Detailed anatomy of the colon and pelvis is a must for a safe laparoscopic procedure. Also, understanding the physiological response of the body to pneumoperitonium is essential for a smooth intra-operative and post-operative management of patients. It was also very clear that a successful management of a patient with colo-rectal cancer, and in the same manner any surgical patient, is a result of collaboration between different specialties adding another call for the importance of establishing multi-disciplinary teams where every member co-operates with others to take a decision putting the patient on the right track to reach the utmost benefit for the patient in comparison to the old concept of person`s own experience and preference. Indeed, surgeon`s old experience is very important, but, alone, the mission cannot be completed satisfactorily.
This prospective study was conducted on 30 patients presented with colonic cancer presented to the outpatient clinic Minia University Hospitals .
In our study 5 patients had sigmoid mass (16.7%), 9 patients had caecal mass (30%) , 9 patients had left colonic mass (30%) , 4 patients had right hepatic flexure mass (13.3%), one case in the ascending colon (3.3%) and 2 cases with transverse colonic mass (6.7%). Five morbidities (16.6%) occurred in our thesis. 2 cases port site hernias, one case intra operative ureteric injury in which repair was done over ureteric stent without conversion , one case port site infection and one case of anastomotic leakage which occurred in a case of left hemicolectomy that needed surgical exploration and managed by loop ileostomy . We have one case that converted to open due to bleeding the case was obese patient (BMI 37 kg\m2). In our study, shot term and early long-term oncological safety was assessed by examining postoperative results, such as the resection margin and the number of harvested lymph nodes , port site recurrence as well as the recurrence and the survival rates of patients who were available for long-term follow up. The average number of harvested lymph nodes was 13.1 ± 2.7 , rang 8 – 18 . Histological examination revealed that proximal and distal margins were free of tumor cells in all surgical specimens in both groups. The proximal and distal margins for colonic resections were > 5 cm in all specimens. In our study, median follow up was 30.45 months ranging from 24 to 40 months. no preioperative death , no local or distant recurrence or port site recurrence .
According to our experience, laparoscopic colorectal surgery is safe and feasible, with better short-term outcomes and oncological adequacy comparable to open approach. Despite of those data, open surgery is still frequently performed, so we believe that it is important to share own experiences and results on laparoscopic colorectal surgery. Several studies demonstrate that laparoscopic procedure is convenient and less invasive and could be the first surgical approach in colorectal cancers. In our hospital daily management, laparoscopic mean operating time represents a disadvantage; however, we think that this might be improved. Nodal metastatic disease plays a key role through cancer care, consequent management and therapy and its study needs to be improved with a multidisciplinary approach integrating pathologist and surgical competences.