Colon and Rectal Cancer: Laparoscopic or Open?

Abstract

Early experiences with laparoscopic colectomy were unfavorable, with higher than expected rates of wound tumor implants and concerns about short and long-term compromised oncologic outcomes. Several international randomized controlled trials were initiated to address concerns regarding compromised oncologic outcomes. Each of the trials was designed to test the hypothesis that level 1 evidence supports the general feasibility and recovery advantage as well as cancer equivalence of laparoscopic colectomy in curable colon cancer. The following four phase III randomized controlled trials have completed accrual and reported early data on recovery benefits for laparoscopic colectomy: Barcelona, Clinical Outcomes of Surgical Therapy Study Group (COSTSG), Colon Cancer Laparoscopic or Open Resection (COLOR), and Conventional versus Laparoscopic-Assisted Surgery in Colorectal Cancer (CLASICC). These trials have uniformly and consistently shown a significant reduction in the use of narcotics and oral analgesics and length of hospital stay, as well as a faster return of diet and bowel function, with laparoscopic colectomy. Two of the trials, Barcelona and COSTSG, have sufficient maturation and follow-up to report recurrence and survival data, and neither has found a survival disadvantage in patients treated with laparoscopic colectomy. Results of the Barcelona trial suggest a cancer-related survival advantage in patients treated with laparoscopic colectomy, based solely on differences in patients with stage III disease; this is not confirmed by the COSTSG trial. Results of the CLASICC and COLOR trials, as well as 5-year data from the COSTSG trial, should definitively address survival results. The investigational experience with laparoscopic rectal cancer is not as mature; the subset of rectal cancer patients (n = 253) in the CLASICC trial provides the only available randomized controlled trial data. Laparoscopic colectomy in patients with curable cancer is accepted as an alternative to open colectomy, whereas the viability of laparoscopic rectal cancer resection requires further investigation.

Laparoscopic Surgery For Colon Cancer - A Favorite Method? A Review of Literature

“…The results undergo constant improvements parallel with the access to better laparoscopic equipment and achieving experience by operating surgeons (12,14,16). Similar findings are observed in concern of laparoscopic treatment of rectal cancer (3,16). It is found, that the fact of minimizing the operative stress allows for better preservation of natural immunity to fight neoplasmatic disease.…”

“…Improving the effectiveness of treatment of the disease is a great challenge for modern surgery and oncology. Advantages of miniinvasive procedures in oncology are: quicker return of peristalsis, allowing fast return to oral diet, less postoperative pain, less blood loss, less surgical wound related complications, better cosmetic effect, quicker return of normal activity, shorter hospital stay (2)(3)(4)(5)(6)(7)(8)(9)(10)(11).…”

“…To date early and late results of laparoscopic colon cancer treatment observed are not worse than after laparotomy (2,3,6,8,(12)(13)(14)(15)(16)(17)(18). The results undergo constant improvements parallel with the access to better laparoscopic equipment and achieving experience by operating surgeons (12,14,16).…”

Análise comparativa inicial de critérios oncológicos de 120 pacientes submetidos a cirurgias colorretais por via laparotômica (60 pacientes) e por via videolaparoscópica (60 pacientes) para câncer colorretal no Programa de Pós-graduação sensu lato pelo Grupo de Coloproctologia de Belo Horizonte

“…Apesar das preocupações iniciais sobre a utilização da técnica videolaparoscópica para a remoção de câncer de cólon, uma série de estudos foram realizados para apoiar a sua equivalência com o méto-do convencional, e os dados apresentados por quatro estudos prospectivos randomizados controlados são convincentes [8][9][10][11][12] , com taxas de recorrência e sobrevivência equivalentes à cirurgia laparotômica.…”

Emerging Role of Laparoscopic and Robotic Surgery for Rectal Cancers

“…These results are consistent with other studies showing that laparoscopic colon resection provides better perioperative outcomes compared with open laparotomy, including decreased postoperative pain, earlier return to normal physical function, quicker return to bowel function, and shorter hospital stays. [10][11][12][13][14][15][16] Laparoscopic total mesorectal excision is more technically difficult, and the learning curve is steep. Conventional laparoscopic surgery is limited in a confined surgical field as a result of fixed instrument tips, limited dexterity of the instruments, and a two-dimensional view.…”