title: Randomized clinical trial of laparoscopic versus open left colonic resection.
abstract: BACKGROUND
  The main aim of this study was to compare short-term results and long-term outcomes of patients undergoing laparoscopic versus open left colonic resection.
  
  
  METHODS
  Between February 2000 and December 2004, all adult patients undergoing elective left colonic resection were assessed for eligibility to the study. The protocol for postoperative care was the same in both groups. Cost-benefit analysis was based on hospital costs. Quality of life, long-term morbidity and 5-year survival were also evaluated.
  
  
  RESULTS
  Some 268 patients undergoing left colonic resection were assigned randomly to the laparoscopic (n = 134) or open (n = 134) approach. The short-term morbidity rate was 20.1 per cent in the open group and 11.9 per cent in the laparoscopic group (P = 0.094). Hospital stay was longer in the open group (8.7 versus 7.0 days for the laparoscopic approach; P = 0.002). Cost-benefit analysis showed an additional cost of euro66 per patient randomly allocated to the laparoscopic group. Quality of life was significantly improved in the laparoscopic group 6 months after surgery, but no difference was found subsequently. The long-term morbidity rate was 11.9 per cent in the open group and 7.5 per cent in the laparoscopic group (P = 0.413). The 5-year survival rate of patients with cancer was 66 and 72 per cent for open and laparoscopic groups respectively (P = 0.321).
  
  
  CONCLUSIONS
  Laparoscopic left colonic resection resulted in an earlier recovery after surgery. As cost-benefit analysis and long-term follow-up showed similar results, the laparoscopic approach should be preferred to open surgery.
authors.affiliation: Department of Surgery, San Raffaele University, Via Olgettina 60, 20132 Milan, Italy. braga.marco@hsr.it
authors.forename: M
authors.initials: M
authors.lastname: Braga
authors.forename: M
authors.initials: M
authors.lastname: Frasson
authors.forename: W
authors.initials: W
authors.lastname: Zuliani
authors.forename: A
authors.initials: A
authors.lastname: Vignali
authors.forename: N
authors.initials: N
authors.lastname: Pecorelli
authors.forename: V
authors.initials: V
authors.lastname: Di Carlo
mesh_terms: D003082:Colectomy / Q000379:methods*; D003106:Colon / Q000601:surgery*; D003110:Colonic Neoplasms / Q000191:economics / Q000601:surgery*; D003362:Cost-Benefit Analysis; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D010535:Laparoscopy / Q000191:economics / Q000379:methods*; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000191:economics / Q000209:etiology; D011788:Quality of Life