Laparoscopic resection for colorectal cancer: Is it justified?

S. W. Lee, N. R. Gleason, R. L. Whelan

Research output: Contribution to journalReview articlepeer-review

4 Scopus citations

Abstract

It has been reasonably established through both nonrandomized and randomized studies that it is possible to perform an adequate oncologic colectomy for colon cancer using minimally invasive methods, provided the surgeon has the prerequisite laparoscopic skills. The following short-term benefits have been demonstrated for laparoscopic-assisted colectomy patients: diminished pain, better preserved pulmonary function, shorter ileus, and shorter length of stay. Both animal and human studies suggest that minimally invasive colectomy is associated with less postoperative immunosuppression than open colectomy, although the clinical significance of this remains unclear. Port site and abdominal wound tumors remain a concern; however, the most recent data suggest that the incidence of port tumors is between 0 and 1.3%, which is the same range as for incisional tumors after open colectomy. Most laparoscopic surgeons believe that poor technique is likely to be an important etiologic factor. Several animal studies support this position. In patients in whom many tumor cells have been shed from the primary, the CO2 pneumoperitoneum also may contribute to the formation of port tumors. Irrigation with tumoricidal agents may decrease the likelihood of wound tumors. The moderate range follow-up data that are available from both nonrandomized and randomized studies suggest that these two methods are associated with similar oncologic outcome. The 5-year results from the randomized trials are anxiously awaited and should settle definitively the long-term outcome questions. The role of laparoscopic methods for rectal cancer resection remains unclear. The best case can be made for select distal and proximal rectal lesions, although it remains to be proven that an adequate oncologic rectal resection can be accomplished by laparoscopic methods and that the outcome after such resection is comparable to open results. Mid-rectal lesions, which present the greatest challenge, are still approached by open methods by most surgeons. Although as of yet not proven, a hybrid procedure that intentionally includes both laparoscopic and open portions may be a reasonable alternative method for rectal cancer resection. Laparoscopic colectomy for cancer, perhaps to a larger degree than for open colectomy, is a difficult procedure whose oncologic outcome varies depending on the skill and experience of the surgeon. It is crucial that a surgeon receive appropriate laparoscopic training and gain considerable experience on benign colectomies before embarking on laparoscopic-assisted colectomy for cancer.

Original languageEnglish
Pages (from-to)763-781
Number of pages19
JournalSurgical Oncology Clinics of North America
Volume9
Issue number4
DOIs
StatePublished - 2000
Externally publishedYes

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