Laparoscopic Colectomy for Colon Cancer: Comparable to Conventional Oncologic Surgery?

ABSTRACT

As a result of the obvious benefits of laparoscopic cholecystectomy, minimally invasive techniques have been applied to more complex gastrointestinal procedures, including colorectal resections. The goal in adapting laparoscopic techniques for colorectal surgery is to offer an operation that results in less pain, shorter hospital stay, more rapid return to normal activities, and improved cosmesis compared with conventional operation. The challenge has been to show that this can be done safely and efficiently and that for cancer patients there is no detrimental oncologic effect. The major issues that have been and continue to be addressed are (1) whether an adequate resection can be performed laparoscopically, (2) whether there is a high rate of wound or port site recurrence following these operations, and (3) whether, by using these techniques, we are trading short-term benefits for a poor long-term oncologic outcome. To answer these fundamental questions, several prospective randomized trials have been conducted and several more are under way. The results of these trials indicate that, in terms of cancer outcome, there is no difference in overall survival, disease-free survival, and wound recurrences in patients treated using laparoscopic techniques compared with conventional operation. In addition, there are short-term benefits associated with the use of these techniques. It can now be said that from an oncologic standpoint, in experienced hands, laparoscopic colectomy for curable colon cancer is equivalent to conventional therapy, and it is superior to conventional operation regarding short-term outcomes. Laparoscopic colectomy for colon cancer should be offered to appropriately selected patients.

Laparoscopy - colon cancer - laparoscopic colectomy

REFERENCES

• 1 Greenlee R T, Murray T, Bolden S et al.. Cancer statistics, 2000.  CA Cancer J Clin. 2000;  50 7-33
• 2 Schlinkert R T. Laparoscopic assisted right hemicolectomy.  Dis Colon Rectum. 1991;  34 1030-1031
• 3 Guillou P J, Darzi A, Monson J R. Experience with laparoscopic colorectal surgery for malignant disease.  Surg Oncol. 1993;  2 43-49
• 4 Falk P M, Beart R W, Wexner S D. Laparoscopic colectomy: a critical appraisal.  Dis Colon Rectum. 1993;  36 28-34
• 5 Peters W R, Bartels T L. Minimally invasive colectomy-are the potential benefits realized?.  Dis Colon Rectum. 1993;  36 751-756
• 6 Nduka C C, Monson J R, Menzies-Gow N, Darzi A. Abdominal wall metastases following laparoscopic surgery.  Br J Surg. 1994;  81 648-652
• 7 Cava A, Roman J, Gonzalez Quintela A, Martin F. Subcutaneous metastasis following laparoscopy in gastric adenocarcinoma.  Eur J Surg Oncol. 1990;  16 63-67
• 8 Lacy A M, Delgado S, Garcia-Valdecasas J C. Port site metastases and recurrence after laparoscopic colectomy. A randomized trial.  Surg Endosc. 1998;  12 1039-1042
• 9 Wexner S D, Cohen S M. Port site metastases after laparoscopic colorectal surgery for cure of malignancy.  Br J Surg. 1995;  82 295-298
• 10 Larach S W, Salomon M C, Williamson P R et al.. Laparoscopic-assisted colectomy: experience during the learning curve.  Coloproctology. 1993;  1 38-41
• 11 Buchman P, Christen D. Pro laparoscopic surgery for colorectal cancer.  Dig Dis. 1995;  12 296-301
• 12 Fowler D L, White S A. Laparoscopy-assisted sigmoid resection.  Surg Laparosc Endosc. 1991;  1 183-188
• 13 Nakajima K, Lee S W, Cocilovo C. Hand assisted laparoscopic colorectal surgery using Gelport.  Surg Endosc. 2003;  18 102-105
• 14 Clinical Outcomes of Surgical Therapy Study Group . Clinical outcomes of surgical therapy study group of the laparoscopic colectomy trial. A comparison of laparoscopically assisted and open colectomy for colon cancer.  N Engl J Med. 2004;  350 2050-2059
• 15 Wittich P H, Kazemier G, Schouten W R et al.. The colon cancer laparoscopic or open resection (COLOR trial).  Ned Tijdsch Geneeskd. 1997;  141 1870-1871
• 16 Milsom J W, Fazio V W. Concerns about laparoscopic colon cancer surgery.  Dis Colon Rectum. 1994;  37 625-626
• 17 Cawthorn S J, Gibbs N M, Marks C G. Clearance technique for the detection of lymph nodes in colorectal cancer.  Br J Surg. 1986;  73 58-60
• 18 Gray D, Lee H, Schlinkert R et al.. Adequacy of lymphadenectomy in laparoscopic-assisted colectomy for colorectal cancer: a preliminary report.  J Surg Oncol. 1994;  57 8-10
• 19 Lacy A M, Garcia-Valdecasas J C, Pique J M et al.. Short term outcome analysis of a randomised study comparing laparoscopic versus open colectomy for colon cancer.  Surg Endosc. 1995;  9 1101-1105
• 20 Papagrigoriadis S. Prospective randomized study of laparoscopic versus open colonic resection for adenocarcinoma.  Br J Surg. 1997;  84 1173-1174
• 21 Moore J W, Bokey E L, Newland R C. Lymphovascular clearance in laparoscopically assisted right hemicolectomy is similar to open surgery.  Aust N Z J Surg. 1996;  66 605-607
• 22 Falk P M, Beart Jr R W, Wexner S D et al.. Laparoscopic colectomy: a critical appraisal.  Dis Colon Rectum. 1993;  36 28-34
• 23 Bokey E L, Moore J W, Chapuis P H. Morbidity and mortality following laparoscopic assisted right hemicolectomy for cancer.  Dis Colon Rectum. 1996;  39 S24-S28
• 24 Lord S A, Larach S W, Ferrera A. Laparoscopic resections for colorectal carcinoma: a 3 year experience.  Dis Colon Rectum. 1996;  39 148-154
• 25 Stone M D, Kane R, Bothe A et al.. Intraoperative ultrasound imaging of the liver at the time of colorectal cancer resection.  Arch Surg. 1994;  129 431-435
• 26 Foroutani A, Garland A, Berber E et al.. Laparoscopic ultrasound vs. triphasic computed tomography for detecting liver tumors.  Arch Surg. 2000;  135 933-938
• 27 Stewart P J, Chu J M, Kos S C et al.. Intraoperative ultrasound for the detection of hepatic metastases from colorectal cancer.  Aust N Z J Surg. 1993;  63 530-534
• 28 Nduka C C, Monson J R, Menzies-Gow N, Darzi A. Abdominal wall metastases following laparoscopic surgery.  Br J Surg. 1994;  81 648-652
• 29 Vukasin P, Ortega A E, Greene F L et al.. Wound recurrence following laparoscopic colon cancer resection: results of the American Society of Colon and Rectal Surgeons Laparoscopic Registry.  Dis Colon Rectum. 1996;  39(suppl) S20-S23
• 30 Reilly W T, Nelson H, Schroeder G et al.. Wound recurrence following conventional treatment of colorectal cancer: a rare but perhaps underestimated problem.  Dis Colon Rectum. 1996;  39 200-207
• 31 Gertsch P, Baer H U, Kraft R et al.. Malignant cells are collected on circular staplers.  Dis Colon Rectum. 1992;  35 238-241
• 32 Hartley J E, Mehigan B J, Monson J R. Alterations in the immune system and tumor growth in laparoscopy.  Surg Endosc. 2001;  15 305-313
• 33 Wang P H, Yuan C C, Lin G. Risk factors contributing to early occurrence of port site metastases of laparoscopic surgery for malignancy.  Gynecol Oncol. 1999;  72 38-44
• 34 Berends F J, Kazemier G, Bonjer H J et al.. Subcutaneous metastases after laparoscopic colectomy [letter].  Lancet. 1994;  344 58
• 35 Jessup J M, McGinnis L S, Steele Jr G D et al.. The national cancer database. Report on colon cancer.  Cancer. 1996;  78 918-926
• 36 Fleshman J W, Nelson H, Peters W R et al.. Early results of laparoscopic surgery for colorectal cancer. Retrospective analysis of 372 patients treated by Clinical Outcomes of Surgical Therapy (COST) Study Group.  Dis Colon Rectum. 1996;  39 S53-S58
• 37 Gellman L, Salky B, Edye M. Laparoscopic assisted colectomy.  Surg Endosc. 1996;  10 1041-1044
• 38 Franklin M E, Rosenthal D, Abrego-Medina D. Prospective comparison of open versus laparoscopic resection of the colon and rectum for cancer.  Dis Colon Rectum. 1996;  39 35-46
• 39 Lacy A M, Garcia-Valdecasas J C, Delgado S et al.. Postoperative complications of laparoscopic-assisted colectomy.  Surg Endosc. 1997;  11 119-122
• 40 Leung K L, Yiu R Y, Lai P B et al.. Laparoscopic-assisted resection of colorectal carcinoma: five year audit.  Dis Colon Rectum. 1999;  42 327-332
• 41 Bohm B, Schwenk W, Muller J M. Long-term results after laparoscopic resection of colorectal carcinoma.  Chirurg. 1999;  70 453-455
• 42 Poulin E C, Mamazza J, Schlachta C M et al.. Laparoscopic resection does not adversely affect early survival curves in patients undergoing surgery for colorectal adenocarcinoma.  Ann Surg. 1999;  229 487-492
• 42a Lechaux D, Trebuchet G, Le Calve J L. Five-year results of 206 laparoscopic left colectomies for cancer.  Surg Endosc. 2002;  16 1409-1412
• 42b Lumley J, Stitz R, Stevenson A, Fielding G, Luck A. Laparoscopic colorectal surgery for cancer: intermediate to long-term outcomes.  Dis Colon Rectum. 2002;  45 867-872
• 43 Lujan H J, Plasencia G, Jacobs M et al.. Long-term survival after laparoscopic colon resection for cancer.  Dis Colon Rectum. 2002;  45 491-501
• 44 Lacy A M, Garcia-Valdecasas J C, Delgado S et al.. Laparoscopic assisted colectomy vs. open colectomy for treatment of non-metastatic colon cancer: a randomized trial.  Lancet. 2002;  359 2224-2229
• 45 Patankar S, Larach S, Ferrara A et al.. Prospective comparison of laparoscopic vs. open resections for colorectal adenocarcinoma over a ten-year period.  Dis Colon Rectum. 2003;  46 601-611
• 45a Schwenk W, Bohm B, Muller J M. Post operative pain and fatigue after laparoscopic or conventional colorectal resections. A prospective randomised trial.  Surg Endosc. 1998;  12 1131-1136
• 45b Milsom J W, Bohm B, Hammerhoer K A et al.. A prospective randomised trial comparing laparoscopic versus conventional techniques in colorectal cancer surgery: a preliminary report.  J Am Coll Surg. 1998;  187 46-47
• 45c Curet M J, Putrakul K, Pitcher D E et al.. Laparoscopically assisted colon resection for colon carcinoma: perioperative results and long term outcome.  Surg Endosc. 2000;  14 1062-1066
• 45d Hasegawa H, Kabeshima Y, Watanabe M et al.. Randomised controlled trial of laparoscopic versus open colectomy for advanced colorectal cancer.  Surg Endosc. 2003;  17 631-640
• 46 Ries LA, Eisner MP, Kosary CL, et al SEER Cancer Statistic Review, 1973-1997. Bethesda, MD; Kosary National Cancer Institute 2000
• 47 Anderson C A, Kennedy F R, Potter M. Results of laparoscopically assisted colon resection for carcinoma. The first 100 patients.  Surg Endosc. 2002;  16 607-610
• 48 Stage J, Schulze S, Moller P et al.. Prospective randomised study of laparoscopic vs open colonic resection for adenocarcinoma.  Br J Surg. 1997;  84 391-396
• 49 Lacy A M, Garcia-Valdecasas J, Delgado S. Laparoscopy assisted colectomy versus open colectomy for treatment of non-metastatic colon cancer: a randomised trial.  Lancet. 2002;  359 2224-2229
• 50 Guillou P J. Phase III randomized study of conventional versus laparoscopic assisted surgery for colorectal cancer.  Cancernet. Available at: http://cancernet.nci.nih.gov/ Accessed December 2004;