Laparoscopic Colorectal Surgery: Where Are We Now?

Laparoscopy serves as an increasing component of colon and rectal surgery. Despite early enthusiasm in the 1990s following the widespread acceptance of laparoscopic cholecystectomy, the adoption of advanced laparoscopic techniques in colon and rectal surgery has been measured. This is partially explained by the difficulties inherent in colon surgery, equipment limitations, and the difficulty in mastering these complex laparoscopic procedures.

In this issue of Clinics in Colon and Rectal Surgery we update the experience with laparoscopic colon and rectal surgery and explore several aspects unique to colon and rectal surgery. The use of laparoscopic techniques is expanding into management of curable colon cancer. Some studies have suggested that laparoscopy offers an immunologic advantage over traditional surgery that may translate into an improved outcome following curative resection. Drs. Sang Lee and Richard Whelan from New York Presbyterian Hospital of Columbia and Cornell in New York lead this issue with a review of the latest information on immunologic and oncologic implications of laparoscopic surgery. Their work has pioneered this new frontier, and we will learn where the research has been and where it is headed.

Numerous prospective randomized studies have demonstrated the safety and efficacy of laparoscopic colectomy compared with conventional surgery in the treatment of curable colon cancer. Studies have shown short-term advantages without detriment to oncologic outcomes when performed by experienced surgeons. What is the role of laparoscopic surgery in the treatment of rectal cancer? Dr. Thomas Read from Pittsburgh discusses the current status of laparoscopic proctectomy and the need for randomized trials in laparoscopic rectal cancer surgery.

The role of laparoscopic sigmoid resection for diverticulitis continues to expand. Last year, 45% of all sigmoid resections performed by the residents in colon and rectal surgery fellowship programs were completed laparoscopically. Which patients should have a laparoscopic resection and how should it be performed? Dr. David Vargas, an experienced and overworked colorectal surgeon in Norfolk, Virginia, makes the case for hand-assisted techniques in the management of diverticular disease.

I then discuss how we can push the envelope of laparoscopy in treating inflammatory bowel disease. With the potential advantages of reduced pain, shortened length of stay, and possibly fewer postoperative adhesions, elective laparoscopic ileocolic resection is performed routinely at many centers. For patients with complex Crohn's disease and patients with ulcerative colitis requiring proctocolectomy, the role of laparoscopy remains uncertain. I review how we will advance these frontiers.

As the population continues to age, more patients will require colon surgery. With overall improvement in the medical management of patients, we are seeing today and will continue to see tomorrow an older population of patients with complex medical issues who require colorectal surgery. Where does laparoscopy fit into the equation? When is a patient too old for a laparoscopic procedure? Dr. Matthew Mutch, from Washington University in St. Louis, completes the issue with answers to these questions and more.

As the Guest Editor, I would like to thank all the contributors for their excellent efforts and I hope our readers find it helpful and informative as we continue to advance the field of minimally invasive surgery for the treatment of colorectal disease.