Trocar site recurrence in laparoscopic surgery for colorectal cancer. Myth or real concern?
Despite extensive research efforts, the incidence of wound recurrence and its causes are unknown. The data reviewed in this article suggest [table: see text] that the actual rate of port-site metastasis is much lower than initially reported. Thus port-site metastasis may not be an inherent detriment of laparoscopic colectomy, but rather an unfortunate sequelae of the learning curve of the application of laparoscopy for colorectal cancer. However, the learning curve may not be easily conquered for the average general surgeon in the United States who performs six to seven colorectal resections annually. The learning curve for laparoscopic colorectal surgery has been estimated to range from 20 to 70 cases. Thus, it is intuitive that the average general surgeon in the United States may never be able to conquer these technically challenging procedures. Even in a high volume practice, some patients will be operated on within the early experience thus being placed at higher risk of this complication. Clearly, a special informed consent is needed to alert patients to the existence of this complication, the individual surgeon's experience, and the preventative measures being employed to prevent it. In the interim, the safest approach is only to offer laparoscopic colorectal resections for attempted cure of carcinoma within prospectively randomized, externally monitored, peer-reviewed trials. The final results of the large randomized prospective studies which are currently underway, and information drawn from the continuous basic science efforts, will hopefully solve these questions in the near future.
Zmora
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Department of Colorectal Surgery, Cleveland Clinic Florida, Fort Lauderdale, Florida, USA. ozmora@hotmail.com
Weiss
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D003110:Colonic Neoplasms / Q000473:pathology* / Q000601:surgery; D006801:Humans; D015994:Incidence; D010535:Laparoscopy / Q000009:adverse effects*; D009366:Neoplasm Seeding; D012004:Rectal Neoplasms / Q000473:pathology* / Q000601:surgery