Current Status of Laparoscopic Therapy of Colorectal Cancer

Abstract

Laparoscopic colorectal resections offer several benefits postoperatively, including minimal impairment of gastrointestinal and pulmonary function, less immunosuppression, shorter hospital stay and improved reconvalescence. Since the introduction of laparoscopic surgery for the therapy of curable colorectal cancer, some concern was voiced in terms of oncologic radicality, the issue of port-site metastases and tumor cell distribution. However, the clinical reality has demonstrated that oncologic radicality is equivalent to open surgery, and the incidence of port-site metastases is not increased when compared to wound recurrence at the laparotomy site. Focusing on colon and rectum, various indications of laparoscopic-endoscopic ‘rendezvous’ procedures exist including laparoscopic-assisted endoscopic transluminal resection, endoscopic-assisted wedge or anatomical resections, and, finally, intraoperative tumor location by colonoscopy to achieve oncologic resection margins in laparoscopic curative resections. In terms of colorectal curative resections, long-term results provide level I evidence that laparoscopic surgery for colon cancer is oncologically adequate and can be performed with equivalent morbidity and mortality rates when compared to conventional surgery. In terms of rectal cancer, no level I evidence is available. However, short-term data from experienced centers do not report inferior oncologic outcome particularly related to laparoscopic total mesorectal excision.

Minimalinvasive Chirurgie bei Malignomen des Gastrointestinaltrakts: Kolon - Pro-Position

“…Daten von Marusch et al [19] zeigen jedoch deutlich, dass die Lernkurve für laparoskopische Eingriffe weit über den vorgegebenen 20-30 Resektionen liegt. Darüber hinaus liegen die Konversionsraten an spezialisierten Zentren mit 4-8% weit unter den in den vorliegenden Arbeiten publizierten Raten [20,21,22]. Somit sollte die Qualität der laparoskopischen Chirurgie in den einzelnen Studien zumindest kritisch beleuchtet werden, obgleich sie wohl die praktische Realität in den 1990er-Jahren darstellten, in denen die meisten Patienten der betrachteten Studien operiert wurden.…”

Laparoskopik Kolon Rezeksiyonları

“…Bu durum ciddi tartışmalara neden olmuştur. Fakat port yeri nüksü veya metaztazı kesin nedeni bilinmemekle bereber, artan tecrübey-le oranı %21'lerden % 0-4 oranlarına kadar inmiştir (21)(22). Daha sonra çıkan çalışmaların sonuçları göstermiştirki port yeri metastazı büyütüldüğü ve korkulduğu kadar olmamaktadır.…”

“…Bu olayın gelişme-sinde birden fazla faktörün rol oynadığının farkına varılmıştır. Port yerinde metastazın azalmasında tümörün evresi ve cerrahın tecrü-besi en önemli faktörler arasında bulunmuştur (22,23).…”

Operative Behandlung von Rektumkarzinomen im Vergleich

“…Hinsichtlich der onkologischen Langzeitergebnisse liegen jedoch nur Daten aus größeren Fallserien oder unizentrischen Fall-Kontroll-Studien vor, die der offenen Chirurgie vergleichbare onkologische Langzeitergebnisse nahe legen [2,5,6,13,15,17,26]. Ergebnisse aus prospektiv-randomisierten Multicenterstudien fehlen, so dass der Stellenwert der laparoskopischen Resektion von Rektumkarzinomen gegenwärtig nicht beurteilbar ist.…”