Laparoscopic colorectal surgery in the irradiated pelvis

BACKGROUND: Heightened interest in minimally invasive surgery and the expanding use of radiation therapy presents surgeons with new challenges. While conventional surgery in the irradiated pelvis represents a significant technical obstacle, indications for laparoscopic colorectal surgery are currently being defined. The purpose of this study is to examine the efficacy of laparoscopic surgery in the irradiated field. METHODS: Forty-two patients underwent laparoscopic colorectal surgery after preoperative radiation therapy, mean dose of 5,644 cGy. All patients were assessed according to intraoperative issues and perioperative events. RESULTS: Eleven patients underwent diverting stoma formation whereas 31 patients underwent resections. The overall conversion rate was 7% (n = 3). Average blood loss was 378 mL. There were no perioperative deaths. Overall morbidity was 19% (n = 8). 78% of patients tolerated clear liquids by postoperative day 2, and 73% tolerated a house diet by postoperative day 4. Average length of stay was 5.5 days. CONCLUSIONS: With proper patient selection and laparoscopic experience, laparoscopic colorectal surgery can be performed in the irradiated pelvis without undue morbidity and mortality.