Laparoscopy for colorectal cancer.
The laparoscopic approach for colorectal cancer resection has been evolved from an experimental procedure with oncological concerns to routine daily practice within a period of two decades. Numerous randomized controlled trials and meta-analyses have shown that laparoscopic resection results in faster recovery with similar oncological outcome compared to an open approach, both for colon and rectal cancer. Besides improved cosmesis, other long-term advantages seem to be less adhesion related small bowel obstruction and reduced incisional hernia rate. Adequate patient selection and surgical experience are of crucial importance. Experience can be gradually expanded step by step, by increasing the complexity of the procedure. A decision to convert should be made early in the procedure, because the outcome after a reactive conversion is worse than initial open resection or strategic conversion. The additive value of new techniques such as robotic surgery has to be proven in randomized studies including a cost-effectiveness assessment.
Department of Surgery, Academic Medical Centre, Amsterdam, The Netherlands. Electronic address: p.j.tanis@amc.nl.
P J
PJ
Tanis
Department of Surgery, Academic Medical Centre, Amsterdam, The Netherlands.
C J
CJ
Buskens
Department of Surgery, Academic Medical Centre, Amsterdam, The Netherlands.
W A
WA
Bemelman
D000818:Animals; D015179:Colorectal Neoplasms / Q000191:economics / Q000473:pathology / Q000503:physiopathology / Q000601:surgery; D003362:Cost-Benefit Analysis; D013505:Digestive System Surgical Procedures / Q000009:adverse effects / Q000191:economics / Q000379:methods*; D017048:Health Care Costs; D006801:Humans; D010535:Laparoscopy / Q000009:adverse effects / Q000191:economics; D018579:Patient Selection; D011183:Postoperative Complications / Q000517:prevention & control; D020127:Recovery of Function; D012307:Risk Factors; D012371:Robotics; D025321:Surgery, Computer-Assisted; D013997:Time Factors; D016896:Treatment Outcome
Colon cancer; Laparoscopy; Minimally invasive surgery; Recovery; Rectal cancer; Survival