Comparison of long-term outcome of laparoscopic and conventional surgery for advanced colon and rectosigmoid cancer.
OBJECTIVE
Although after laparoscopic surgery for colorectal cancer postoperative recovery is better than after open surgery, oncologic outcome after this minimally invasive technique remains unclear. In this study we tested the null hypothesis that there is no difference in the outcome of advanced colorectal cancer according to whether it is treated by laparoscopic or conventional open resection.


METHODS
The long-term outcome of 79 patients with advanced colorectal cancer who underwent laparoscopic surgery between 1996 and 2002 was compared with that of 79 who underwent open surgery during the same period, being well-matched patients for age, gender, tumor site, and pathological TNM stage (II or III). Adjuvant therapy and postoperative follow-up were the same in both groups.


RESULTS
The median follow-up time after laparoscopic and open surgery was 36 months and 47 months, respectively (p = 0.0756). No significant difference was found between the groups in overall or disease-free survival rates (96% versus 88%, p = 0.12; 96% versus 86%, p = 0.09, respectively). The recurrence rate was 23% in both groups, and liver metastasis was the most frequent form of recurrence. No port site recurrence was observed in the laparoscopic surgery group.


CONCLUSIONS
The laparoscopic approach is an acceptable alternative to open surgery for advanced colorectal cancer because of the comparable medium-term outcome. Longer follow-up and large scale RCT is needed to fully assess the oncologic outcome.
Nakamura
Takatoshi
T
Department of Surgery, Kitasato University Hospital, Kanagawa, Japan.
Mitomi
Hiroyuki
H
Ohtani
Yoshimasa
Y
Kokuba
Yukihito
Y
Sato
Takeo
T
Ozawa
Heita
H
Ihara
Atusi
A
Watanabe
Masahiko
M
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015179:Colorectal Neoplasms / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D018572:Disease-Free Survival; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D010535:Laparoscopy; D008113:Liver Neoplasms / Q000556:secondary; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local; D012811:Sigmoid Neoplasms / Q000401:mortality / Q000473:pathology / Q000601:surgery*