Surgical resection for colon cancer: laparoscopic assisted vs. open colectomy.
OBJECTIVE
Laparoscopic surgery has been considered for more than a decade for treatment of colorectal cancer. Although its benefits in term of postoperative comfort and parietal preservation are commonly accepted, its efficiency to achieve proper oncologic resection and to prevent tumor recurrence are still debated. The purpose of this retrospective study is to compare results of a minimally invasive laparoscopic approach to these of open surgery for treatment of colorectal cancer.


METHODS
From January 1st 1999 to September 30th 2004, 239 patients underwent colorectal cancer resections; 28 of these patients underwent surgery in an emergent context and were excluded from this study. Accurate follow-up was available for 165 of the 239 patients (69%). For the study, 165 patients were divided into 3 groups: 39 patients underwent a laparoscopically assisted surgery (L group), 120 patients underwent an open colectomy (O group) and 6 patients initially treated with a laparoscopic approach were converted to open colectomy (L/O group) (conversion rate: 8.8%).


RESULTS
Sex ratio, mean age and A.S.A. score, as well as patients' past records were similar in the 3 groups. Histological staging was more often stages 3 and 4 in the O group (62.5%) comparing to the L group (41%) (p < 0.5). Mean operating time was slightly longerwhen a laparoscopically assisted approach was used. Overall early mortality rate of this study was 1.8%. Combined local and general overall morbidity rate was 36%. Overall incidence of anastomotic fistulae was 4% and reintervention rate during the early postoperative period was 8%. Postoperative ileus period was often longer for patients of the O group but without statistical significance. Mean duration of hospital stay was similar in the 3 groups. Data concerning surgical resection did not show any difference between groups. None of the patients experienced a metastatic skin settlement. Overall anastomotic stenosis rate was low (2%). The overall locoregional recurrence rate was 12%, without difference between the 3 groups. Forty-two percent of these recurrences were secondarily treated by curative surgery. Similar survival rates as well as oncological spreading frequencies were found.


CONCLUSIONS
Results obtained when comparing minimal invasive laparoscopically assisted surgery to open procedure are similar and efficient.
Cermak
K
K
Department of Abdominal, Laparoscopic and Thoracic Surgery, C.H.U. Brugmann, U.L.B., Bruxelles, Belgium.
Thill
V
V
Simoens
C H
CH
Smets
D
D
Ngongang
C H
CH
da Costa
P Mendes
PM
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003082:Colectomy / Q000379:methods*; D003110:Colonic Neoplasms / Q000601:surgery*; D005260:Female; D006801:Humans; D010535:Laparoscopy; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies