title: Patterns of recurrence and survival after laparoscopic and conventional resections for colorectal carcinoma.
abstract: OBJECTIVE
  To determine whether survival and recurrence after laparoscopic-assisted surgery for colorectal cancer is compromised by an initial laparoscopic approach.
  
  
  BACKGROUND
  Laparoscopic colorectal resection for malignancy remains controversial 8 years after its first description. Fears regarding compromised oncologic principles and early recurrence (particularly the phenomenon of port-site metastases) have tempered enthusiasm for this approach. Long-term follow-up data are at present scarce.
  
  
  METHODS
  A prospective comparative trial was undertaken between December 1993 and May 1996, during which 114 patients had laparoscopic-assisted resection by a single laparoscopic colorectal surgeon or conventional open surgery by a second specialist colorectal surgeon. Intensive follow-up for at least 2 years is available on 109 patients. Analysis was performed on an intention-to-treat basis.
  
  
  RESULTS
  Recurrent disease has developed in 27 patients (25%), 16 of 57 in the laparoscopic group (28%) and 11 of 52 in the conventional group (21%). Crude death rates are 26/57 (46%) in the laparoscopic group and 24/52 (46%) in the conventional group. No port-site metastases have occurred; however, wound metastases associated with disseminated disease have developed in three patients in the open group and one in the laparoscopic group. Stage-for-stage survival and recurrence figures are comparable.
  
  
  CONCLUSIONS
  Oncologic outcome at a minimum of 2 years is not compromised by the laparoscopic approach. Wound recurrences are a feature of laparoscopic and conventional surgery for advanced disease.
authors.affiliation: University of Hull, Academic Surgical Unit, Castle Hill Hospital, Cottingham, East Yorkshire, United Kingdom.
authors.forename: J E
authors.initials: JE
authors.lastname: Hartley
authors.forename: B J
authors.initials: BJ
authors.lastname: Mehigan
authors.forename: A W
authors.initials: AW
authors.lastname: MacDonald
authors.forename: P W
authors.initials: PW
authors.lastname: Lee
authors.forename: J R
authors.initials: JR
authors.lastname: Monson
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015179:Colorectal Neoplasms / Q000401:mortality / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D010535:Laparoscopy; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000453:epidemiology*; D011446:Prospective Studies; D015996:Survival Rate