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.