Patterns of recurrence and survival after laparoscopic and conventional resections for colorectal carcinoma

• Published in: Annals of surgery 2000-08, Vol.232 (2), p.181-186
• Main Authors: HARTLEY, J. E, MEHIGAN, B. J, MACDONALD, A. W, LEE, P. W. R, MONSON, J. R. T
• Format: Article
• Language: English
• Subjects: Adult; Aged; Aged, 80 and over; Biological and medical sciences; Colorectal Neoplasms - mortality; Colorectal Neoplasms - surgery; Female; Follow-Up Studies; Humans; Laparoscopy; Male; Medical sciences; Middle Aged; Neoplasm Recurrence, Local - epidemiology; Original; Prospective Studies; Stomach, duodenum, intestine, rectum, anus; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases; Surgery of the digestive system; Survival Rate
• ISSN: 0003-4932; 1528-1140
• DOI: 10.1097/00000658-200008000-00005

To determine whether survival and recurrence after laparoscopic-assisted surgery for colorectal cancer is compromised by an initial laparoscopic approach. Laparoscopic colorectal resection for malignancy remains controversial 8 years after its first description. Fears regarding compromised oncologic principles and early recurrence (particularly the phenomenon of port-site metastases) have tempered enthusiasm for this approach. Long-term follow-up data are at present scarce. A prospective comparative trial was undertaken between December 1993 and May 1996, during which 114 patients had laparoscopic-assisted resection by a single laparoscopic colorectal surgeon or conventional open surgery by a second specialist colorectal surgeon. Intensive follow-up for at least 2 years is available on 109 patients. Analysis was performed on an intention-to-treat basis. Recurrent disease has developed in 27 patients (25%), 16 of 57 in the laparoscopic group (28%) and 11 of 52 in the conventional group (21%). Crude death rates are 26/57 (46%) in the laparoscopic group and 24/52 (46%) in the conventional group. No port-site metastases have occurred; however, wound metastases associated with disseminated disease have developed in three patients in the open group and one in the laparoscopic group. Stage-for-stage survival and recurrence figures are comparable. Oncologic outcome at a minimum of 2 years is not compromised by the laparoscopic approach. Wound recurrences are a feature of laparoscopic and conventional surgery for advanced disease.