Laparoscopic versus open surgery for the treatment of colorectal cancer: a literature review and recommendations from the Comité de l'évolution des pratiques en oncologie.
BACKGROUND
Adoption of the laparoscopic approach for colorectal cancer treatment has been slow owing to initial case study results suggesting high recurrence rates at port sites. The use of laparoscopic surgery for colorectal cancer still raises a number of concerns, particularly with the technique's complexity, learning curve and longer duration. After exploring the scientific literature comparing open and laparoscopic surgery for the treatment of colorectal cancer with respect to oncologic efficacy and shortterm outcomes, the Comité de l'évolution des pratiques en oncologie (CEPO) made recommendations for surgical practice in Quebec.


METHODS
Scientific literature published from January 1995 to April 2012 was reviewed. Phase III clinical trials and meta-analyses were included.


RESULTS
Sixteen randomized trials and 10 meta-analyses were retrieved. Analysis of the literature confirmed that for curative treatment of colorectal cancer, laparoscopy is not inferior to open surgery with respect to survival and recurrence rates. Moreover, laparoscopic surgery provides short-term advantages, including a shorter hospital stay, reduced analgesic use and faster recovery of intestinal function. However, this approach does require a longer operative time.


CONCLUSIONS
Considering the evidence, the CEPO recommends that laparoscopic resection be considered an option for the curative treatment of colon and rectal cancer; that decisions regarding surgical approach take into consideration surgeon experience, tumour stage, potential contraindications and patient expectations; and that laparoscopic resection for rectal cancer be performed only by appropriately trained surgeons who perform a sufficient volume annually to maintain competence.
From the Direction québécoise du cancer, Ministère de la Santé et des Services sociaux du Québec (MSSS).
Mélanie
M
Morneau
Jim
J
Boulanger
Patrick
P
Charlebois
Jean-François
JF
Latulippe
Rasmy
R
Lougnarath
Claude
C
Thibault
Normand
N
Gervais
D003110:Colonic Neoplasms / Q000473:pathology / Q000601:surgery*; D013505:Digestive System Surgical Procedures / Q000379:methods*; D019317:Evidence-Based Medicine; D006801:Humans; D010535:Laparoscopy; D007902:Length of Stay; D009364:Neoplasm Recurrence, Local / Q000453:epidemiology; D061646:Operative Time; D010149:Postoperative Pain / Q000453:epidemiology; D011788:Quality of Life; D016032:Randomized Controlled Trials as Topic; D012004:Rectal Neoplasms / Q000473:pathology / Q000601:surgery*; D016896:Treatment Outcome