Prospective randomized study of laparoscopicversus open colonic resection for adenocarcinoma

Stage, Jan; Schulze, Svend; Møller, P.; H, Overgaard; Andersen, Marit Helen; Rebsdorf-Pedersen, V. B.; Nielsen, Hans Jørgen

doi:10.1002/bjs.1800840339

Cited by 207 publications

(21 citation statements)

References 40 publications

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“…Laparoscopic segmental colectomy is a well established surgical technique that, compared to traditional open colectomy, is characterized by less morbidity, less postoperative pain, a fast postoperative recovery and a short hospital stay, even though both methods are associated with the same radical surgery [7], [8]. However, although the short-term benefits of laparoscopy compared to conventional open surgery are now well recognized in the management of different colorectal diseases, this remains a controversial issue for the right-sided tumors [9], [10].…”

Section: Introductionmentioning

confidence: 99%

Recovery of Immunological Homeostasis Positively Correlates Both with Early Stages of Right-Colorectal Cancer and Laparoscopic Surgery

et al. 2013

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Differences in postoperative outcome and recovery between patients subjected to laparoscopic-assisted versus open surgery for colorectal cancer (CRC) resection have been widely documented, though not specifically for right-sided tumors. We investigated the immunological responses to the different surgical approaches, by comparing postoperative data simultaneously obtained at systemic, local and cellular levels. A total of 25 right-sided CRC patients and controls were managed, assessing -in the immediate followup- the conventional perioperative parameters and a large panel of cytokines on plasma, peritoneal fluids and lipopolysaccharide (LPS)-stimulated peripheral blood mononuclear cells (PBMC) tissue cultures. A general better recovery for patients operated with laparoscopy compared to conventional procedure, as indicated by the analysis of typical pre- and post-surgical parameters, was observed. The synchronous evaluation of 12 cytokines showed that preoperative plasma levels of the proinflammatory cytokines IL-6, IL-8, IL-1β, TNFα were significantly lower in healthy donors versus CRC patients and that such differences progressively increase with tumor stage. After surgery, the IL-6 and IL-8 increases were significantly higher in open compared to laparoscopic approach only in CRC at early stages. The postsurgical whole panel of cytokine levels were significantly higher in peritoneal fluids compared to corresponding plasma, but with no significant differences depending on kind of surgery or stage of disease. Then we observed that, pre- compared to the corresponding post-surgery derived LPS-stimulated PBMC cultures, produced higher supernatant levels of the whole cytokine panel. In particular IL-6 in vitro production was significantly higher in PBMC derived from patients subjected to laparoscopic versus open intervention, but -again- only in CRC at early stages of disease. Our results thus show that laparoscopy compared to open right resection is associated with a shorter compromission of the immunological homeostasis, mainly in early stages of right-CRC patients.

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Section: Introductionmentioning

confidence: 99%

Recovery of Immunological Homeostasis Positively Correlates Both with Early Stages of Right-Colorectal Cancer and Laparoscopic Surgery

et al. 2013

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“…Finally, 11 trials obtained a total of two or less “low risk of bias" marks, highlighting a greater overall risk of bias based on reported information. Among these, six trials obtained at least three “high risk of bias" marks [15]–[18], [20], [21], [23], [27], [28], of which five trials did not carry out intention-to-treat analyses.…”

Section: Resultsmentioning

confidence: 99%

Expert Opinion on Laparoscopic Surgery for Colorectal Cancer Parallels Evidence from a Cumulative Meta-Analysis of Randomized Controlled Trials

et al. 2012

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BackgroundThis study sought to synthesize survival outcomes from trials of laparoscopic and open colorectal cancer surgery, and to determine whether expert acceptance of this technology in the literature has parallel cumulative survival evidence.Study DesignA systematic review of randomized trials was conducted. The primary outcome was survival, and meta-analysis of time-to-event data was conducted. Expert opinion in the literature (published reviews, guidelines, and textbook chapters) on the acceptability of laparoscopic colorectal cancer was graded using a 7-point scale. Pooled survival data were correlated in time with accumulating expert opinion scores.ResultsA total of 5,800 citations were screened. Of these, 39 publications pertaining to 23 individual trials were retained. As well, 414 reviews were included (28 guidelines, 30 textbook chapters, 20 systematic reviews, 336 narrative reviews). In total, 5,782 patients were randomized to laparoscopic (n = 3,031) and open (n = 2,751) colorectal surgery. Survival data were presented in 16 publications. Laparoscopic surgery was not inferior to open surgery in terms of overall survival (HR = 0.94, 95% CI 0.80, 1.09). Expert opinion in the literature pertaining to the oncologic acceptability of laparoscopic surgery for colon cancer correlated most closely with the publication of large RCTs in 2002–2004. Although increasingly accepted since 2006, laparoscopic surgery for rectal cancer remained controversial.ConclusionsLaparoscopic surgery for colon cancer is non-inferior to open surgery in terms of overall survival, and has been so since 2004. The majority expert opinion in the literature has considered these two techniques to be equivalent since 2002–2004. Laparoscopic surgery for rectal cancer has been increasingly accepted since 2006, but remains controversial. Knowledge translation efforts in this field appear to have paralleled the accumulation of clinical trial evidence.

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“…As there is no large abdominal incision, the corresponding postoperative pain and the ensuing need for analgesia is reduced. [2023274748] As the wound is smaller, the likelihood of wound infection is less. [2949] This attains significance when the patient is a candidate for adjuvant chemotherapy at which time, a wound infection can delay institution of the chemotherapy.…”

Section: Resultsmentioning

confidence: 99%

Laparoscopic surgery for colorectal cancers: Current status

et al. 2006

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Prospective randomized study of laparoscopicversus open colonic resection for adenocarcinoma

Abstract: Laparoscopic colonic resection is an acceptable and safe alternative to open procedures; the differences between the two techniques are not marked.

Cited by 207 publications

References 40 publications

Recovery of Immunological Homeostasis Positively Correlates Both with Early Stages of Right-Colorectal Cancer and Laparoscopic Surgery

Recovery of Immunological Homeostasis Positively Correlates Both with Early Stages of Right-Colorectal Cancer and Laparoscopic Surgery

Expert Opinion on Laparoscopic Surgery for Colorectal Cancer Parallels Evidence from a Cumulative Meta-Analysis of Randomized Controlled Trials

Laparoscopic surgery for colorectal cancers: Current status

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