Laparoscopic colonic resection.
OBJECTIVE
In the last decade, laparoscopy has dramatically changed colonic surgery. Laparoscopic procedures are applied to the treatment of almost all colonic diseases, including both benign and malignant lesions. Focusing our attention on the laparoscopic oncologic operative technique, we compared the perioperative results and the long-term outcome of laparoscopic surgery (LS) with those of conventional open surgery (OS) in a series of 360 unselected consecutive patients.


METHODS
Between 1992 and 2001, excluding 102 patients with rectal tumors, 207 patients underwent laparoscopic colonic resection (72.5% for malignant lesions), whereas 153 (71.9% with malignant lesions) were treated by OS. The treatment modality was selected by the patients after reading the informed consent form. The statistical significance of differences in the morbidity and mortality rates, local recurrence rate, and incidence of distant metastases in the two groups was assessed by chi2 test. The survival probability analysis was performed by the Kaplan-Meier method. Significant differences in survival probability between groups were assessed by the log-rank test. A level of 5% was used as the criterion of statistical significance.


RESULTS
Laparoscopic surgery was technically feasible in 95.7% of the patients. No statistically significant difference was observed in the major complication rate (3.5% after LS and 3.3% after OS; P = 0.870) or in perioperative mortality (1.5% v 1.3%; P = 0.769). The mean follow-up in the patients with malignant disease was 42.2 months, during which time, we observed 2 cases of abdominal wall metastases (1.9%) in patients with advanced disease. The local recurrence rate was lower after LS than OS: 2.8% v 8.1%; P = 0.223). Distant metastases occurred in 8.6% of patients after LS and 9.3% after OS (P = 0.926). At 48 months of follow-up, the cumulative survival probability in the LS-completed malignant group was 0.934 compared with 0.860 after OS (P = 0.781).


CONCLUSIONS
Laparoscopic colonic resection for both benign and malignant lesions is technically feasible, without additional risks for the patients. However, oncologic outcomes have not been determined because no data from the ongoing randomized controlled trials are yet available.
Lezoche
E
E
Department of Surgery Paride Stefanini, II Clinica Chirurgica, University La Sapienza, Rome, Italy. lezoche@uniroma1.it
Feliciotti
F
F
Paganini
A M
AM
Guerrieri
M
M
De Sanctis
A
A
Campagnacci
R
R
D000230:Adenocarcinoma / Q000601:surgery; D000236:Adenoma / Q000601:surgery; D003082:Colectomy / Q000379:methods*; D003108:Colonic Diseases / Q000401:mortality / Q000601:surgery*; D003110:Colonic Neoplasms / Q000601:surgery; D004241:Diverticulum, Colon / Q000601:surgery; D006801:Humans; D010535:Laparoscopy; D011028:Pneumoperitoneum, Artificial; D011446:Prospective Studies; D016019:Survival Analysis; D016896:Treatment Outcome