Advertisement

Surgical Endoscopy

, Volume 16, Issue 4, pp 596–602 | Cite as

Laparoscopic vs open hemicolectomy for colon cancer

Long-term outcome
  • E. Lezoche
  • F. Feliciotti
  • A. M. Paganini
  • M. Guerrieri
  • A. De Sanctis
  • S. Minervini
  • R. Campagnacci
Original Articles

Abstract

Background

The role of laparoscopic resection in the management of colon cancer is still a subject of debate. In this clinical study, we compared the perioperative results and long-term outcome for two unselected groups of patients undergoing either laparoscopic or open hemicolectomy for colon cancer.

Methods

This prospective nonrandomized study was based on a series of 248 consecutive patients operated on by the same surgical team using the same type of surgical technique for right (RHC) and left (LHC) hemicolectomy, excluding segmental resections; the only difference was the type of access, which was either laparoscopic or open. The choice of type of access was left up to the patient after he or she had read the informed consent form. Operative time, length of stay, complications, and long-term outcome for the two groups were compared. Follow-up time ranged between 12 and 92 months (mean, 42).

Results

Between March 1992 and January 2000, 140 patients underwent a laparoscopic hemicolectomy (55 RHC and 86 LHC); at the same time, 107 patients (44 RHC and 63 LHC) were treated via an open approach. There were no conversions to open surgery in the laparoscopic RHC group, but six patients (7%) in the laparoscopic LHC group were converted. The mean operative time for laparoscopic surgery was significantly longer than the time for open surgery (190 vs 140 min for RHC, 240 vs 190 min for LHC); however, with increasing experience, this time decreased significantly. The mean hospital stay for the patients who underwent laparoscopic procedures was significantly shorter in both the RHC and the LHC groups (9.2 vs 13.2 days for RHC, 10.0 vs 13.2 days for LHC). No statistically significant difference between the two laparoscopic and open groups was observed for the major complication rate (1.9% vs 2.3% for RHC, 7.5% vs 6.3% for LHC). The patient in the laparoscopic RHC group were lost to follow-up. The local recurrence rate was lower after laparoscopic surgery in both arms (5.4% vs 9% for RHC, 1.5% vs 7.5% for LHC), but the differences were not statistically significant. Two port site recurrences were observed in the laparoscopic groups, one after RHC (2.7%) and one after LHC (1.5%). Metachronous metastases rates were similar for the two groups (16.2% vs 15.1% for RHC, 4.4% vs 5.7% for LHC). Cumulative survival probability at 48 months after laparoscopic RHC was 0.865, as compared to 0.818 after open surgery, and 0.971 after laparoscopic LHC, as compared to 0.887 after open surgery.

Conclusion

These results suggest that laparoscopic hemicolectomy for colonic cancer can be performed safely, with morbidity, mortality, and long-term results comparable to those of open surgery.

Key words

Colon cancer Hemicolectomy Laparoscopic colonic resection Port site recurrence Cancer 

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

References

  1. 1.
    Bressler M, Whelan RL, Holversan A, Treat MR, Nwygrod R (1994) Is immune function better preserved after laparoscopic vs open colon resections? Surg Endosc 8: 881–883CrossRefGoogle Scholar
  2. 2.
    Curet MJ, Putrakul K, Pitcher DE, Josloff RK, Zucker KA (2000) Laparoscopically assisted colon resection for colon carcinoma: perioperative results and long-term outcome. Surg Endosc 14: 1062–1066CrossRefPubMedGoogle Scholar
  3. 3.
    Franklin ME, Kazantsev GB, Abrego-Medina D, Diaz A, Balli J, Glass JL (2000) Laparoscopic surgery for stage III colon cancer. Surg Endosc 14: 612–616CrossRefPubMedGoogle Scholar
  4. 4.
    Franklin ME, Rosenthal D, Abrego-Medina D, Dorman JP, Glass JL, Norem R, Diaz A (1996) Prospective comparison of open vs laparoscopic colon surgery for carcinoma. Dis Colon Rectum 10: 35–46CrossRefGoogle Scholar
  5. 5.
    Hartley JE, Mehigan BJ, MacDonald AW, Lee AW, Monson JR (2000) Patterns of recurrence and survival after laparoscopic and conventional resections for colorectal carcinoma. Ann Surg 2: 181–186CrossRefGoogle Scholar
  6. 6.
    Khalili TM, Fleshner PR, Hiatt JR, Sokol TP, Manookian M, Tsushima G, Phillips EH (1998) Colorectal cancer: comparison of laparoscopic with open approach. Dis Colon Rectum 41: 832–838CrossRefPubMedGoogle Scholar
  7. 7.
    Kockerling F (1998) Prospective multicenter study of the quality of oncologic resections in patients undergoing laparoscopic colorectal surgery for cancer. Dis Colon Rectum 8: 963–970CrossRefGoogle Scholar
  8. 8.
    Kuntz C, Wunsch F, Windeler J, Glaser F, Herfarth C (1998) Prospective randomized study of stress and immune response after laparoscopy vs conventional colonic resections. Surg Endosc 7: 963–967CrossRefGoogle Scholar
  9. 9.
    Lanvin D, Elhage A, Henry B, Leblanc E, Querleu D, Delobelle-Deraide A (1997) Accuracy and safety of laparoscopic lymphadenectomy: an experimental prospective randomised study. Gynecol Oncol 1: 83–87CrossRefGoogle Scholar
  10. 10.
    Lezoche E, Feliciotti F, Paganini AM, Guerrieri M, Campagnacci R, De Sanctis A (2000) Colonic cancer by elective laparoscopy versus open procedures. E.A.E.S. Experts’ Opinion Conference on Colonic Cancer by Elective Laparoscopy. Eighth International E.A.E.S. Congress, Nice, France E.A.E.S.Google Scholar
  11. 11.
    Lezoche E, Feliciotti F, Paganini AM, Guerrieri M, Campagnacci R, De Sanctis A (2000) Laparoscopic colonic resections versus open surgery: a prospective non-randomized study on 310 unselected cases. Hepatogastroenterology 47: 697–710PubMedGoogle Scholar
  12. 12.
    Lord SA, Larach SW, Ferrara A, Williamson PR, Lago CP, Lube MW (1996) Laparoscopic resection for colorectal carcinoma: a three-year experience. Dis Colon Rectum 39: 148–154CrossRefPubMedGoogle Scholar
  13. 13.
    Milsom JW, Bohm B, Hammerhofer KA, Fazio V, Steiger E, Elson P (1998) A prospective, randomized trial comparing laparoscopic versus conventional techniques in colorectal surgery: a preliminary report. J Am Coll Surg 187: 46–57CrossRefPubMedGoogle Scholar
  14. 14.
    Puolin EC, Mamazza J, Schlachta CM, Gregoire R, Roy N (1999) Laparoscopic resection does not adversely affect early survival curves in patients undergoing surgery for colorectal adenocarcinoma. Ann Surg 4: 487–492CrossRefGoogle Scholar
  15. 15.
    Stocchi L, Nelson H (1998) Laparoscopic colectomy for colon cancer: trial update. J Surg Oncol 68: 255–267CrossRefPubMedGoogle Scholar
  16. 16.
    Tomita H, Marcello PW, Milsom JW (1999) Laparoscopic surgery of the colon and rectum. World J Surg 4: 397–405CrossRefGoogle Scholar
  17. 17.
    Wexner SD (2000) Trocar site recurrences: myth of real concern? Postgraduate course: laparoscopy in the management of malignancy. Annual meeting of the Society of American Gastrointestinal Endoscopic Surgeons (SAGES), Atlanta, GA, USA, 2000Google Scholar
  18. 18.
    Wexner SD, Latulippe JF (1998) Laparoscopic colorectal surgery and cancer. Dig Surg 15: 117–123CrossRefPubMedGoogle Scholar

Copyright information

© Springer Science+Business Media New York 2002

Authors and Affiliations

  • E. Lezoche
    • 1
  • F. Feliciotti
    • 2
  • A. M. Paganini
    • 2
  • M. Guerrieri
    • 2
  • A. De Sanctis
    • 2
  • S. Minervini
    • 1
  • R. Campagnacci
    • 2
  1. 1.Department of Surgery “Paride Stefanini”, II Clinica ChirurgicaUniversity “La Sapienza”RomeItaly
  2. 2.Department of General SurgeryUniversity of Ancona, “Umberto I” HospitalAnconaItaly

Personalised recommendations