Advertisement

Surgical Endoscopy

, Volume 22, Issue 12, pp 2588–2595 | Cite as

Feasibility of laparoscopic techniques as the surgical approach of choice for primary colorectal cancer

An analysis of 570 consecutive cases
  • Seok-Byung Lim
  • Hyo Seong ChoiEmail author
  • Seung-Yong Jeong
  • Jae-Gahb Park
Article

Abstract

Background

Since the Clinical Outcomes of Surgical Therapy (COST) trial data were reported in May 2004, the laparoscopic technique for primary colorectal cancer has been increasingly used and become the approach of choice at our center. This study aimed to evaluate our laparoscopic experience of 570 consecutive patients between October 2000 and December 2006, and assess the feasibility of this technique as the surgical approach of choice for primary colorectal cancer.

Methods

The study times were divided into three periods based on the COST trial report and the time when the laparoscopic technique was accepted as the surgical approach of choice at our center (period I: October 2000 to May 2004, II: June 2004 to December 2005, III: January to December 2006). Data regarding clinicopathological, surgical, and perioperative outcomes were collated from registry and compared between periods.

Results

The use of laparoscopic surgery increased from 2.4% in period I, to 19.2% in period II, to 66.1% in period III. Over the periods, the proportion of rectal cancer and right colon cancer increased (p < 0.001), T- and N-stage became more advanced (p < 0.001, p = 0.011 respectively), and operative time decreased (p < 0.001). The overall open conversion and morbidity rates were 3.5% and 9.8%, respectively, and these did not differ between periods.

Conclusion

It was possible to apply laparoscopic approach in two-thirds of primary colorectal cancer patients. The short-term favorable outcomes support the feasibility of laparoscopic technique as surgical approach of choice for colon cancer. Laparoscopic resection for rectal cancer may require a randomized clinical trial prior to gain similar acceptance.

Keywords

Colon cancer Rectal cancer Laparoscopy 

Notes

Acknowledgments

The authors would like to thank Dr. Woon Kyung Jeong, Dr. Sang-Woo Lim, M.D., Dr. Tae-Sung Chung, and Dr. Dong Hyun Choi for their extensive help and assistance in performing laparoscopic surgeries, and the staff at Center for Colorectal Cancer, National Cancer Center for their patience and assistance throughout this study.

References

  1. 1.
    Jacobs M, Verdeja JC, Goldstein HS (1991) Minimally invasive colon resection (laparoscopic colectomy). Surg Laparosc Endos 1:144–150Google Scholar
  2. 2.
    Bennett CL, Stryker SJ, Ferreira MR, Adams J, Beart RW Jr (1997) The learning curve for laparoscopic colorectal surgery. Preliminary results from a prospective analysis of 1194 laparoscopic-assisted colectomies. Arch Surg 132:41–44PubMedGoogle Scholar
  3. 3.
    National Institute for Clinical Excellence (2000) Guideline on the use of laparoscopic surgery for colorectal cancer, Technology Appraisal Guidance No. 17. NICE, LondonGoogle Scholar
  4. 4.
    Braga M, Vignali A, Gianotti L, Zuliani W, Radaelli G, Gruarin P, Dellabona P, Di Carlo V (2002) Laparoscopic versus open colorectal surgery: a randomized trial on short-term outcome. Ann Surg 236:759–766PubMedCrossRefGoogle Scholar
  5. 5.
    Lacy AM, Garcia-Valdecasas JC, Delgado S, Castells A, Taura P, Pique JM, Visa J (2002) Laparoscopy-assisted colectomy versus open colectomy for treatment of non-metastatic colon cancer: a randomized trial. Lancet 359:2224–2229PubMedCrossRefGoogle Scholar
  6. 6.
    Hasegawa H, Kabeshima Y, Watanabe M, Yamamoto S, Kitajima M (2003) Randomized controlled trial of laparoscopic versus open colectomy for advanced colorectal cancer. Surg Endosc 17:636–640PubMedCrossRefGoogle Scholar
  7. 7.
    Clinical Outcomes of Surgical Therapy Study Group (2004) A comparison of laparoscopically assisted and open colectomy for colon cancer. N Engl J Med 350:2050–2059CrossRefGoogle Scholar
  8. 8.
    Veldkamp R, Kuhry E, Hop WC, Jeekel J, Kazemier G, Bonjer HJ, Haglind E, Pahlman L, Cuesta MA, Msika S, Morino M, Lacy AM, COlon cancer Laparoscopic or Open Resection Study Group (COLOR) (2005) Laparoscopic surgery versus open surgery for colon cancer: short-term outcomes of a randomised trial. Lancet Oncol 6:477–484PubMedCrossRefGoogle Scholar
  9. 9.
    Guillou PJ, Quirke P, Thorpe H, Walker J, Jayne DG, Smith AM, Heath RM, Brown JM, MRC CLASICC trial group (2005) Short-term endpoints of conventional versus laparoscopic-assisted surgery in patients with colorectal cancer (MRC CLASICC trial): multicentre, randomized controlled trial. Lancet 365:1718–1726PubMedCrossRefGoogle Scholar
  10. 10.
    Leung KL, Kwok SP, Lam SC, Lee JF, Yiu RY, Ng SS, Lai PB, Lau WY (2004) Laparoscopic resection of rectosigmoid carcinoma: prospective randomized trial. Lancet 363:1187–1192PubMedCrossRefGoogle Scholar
  11. 11.
    Abraham NS, Young JM, Solomon MJ (2004) Meta-analysis of short-term outcomes after laparoscopic resection for colorectal cancer. Br J Surg 91:1111–1124PubMedCrossRefGoogle Scholar
  12. 12.
    Greene FL, Page DL, Fleming ID, Fritz A, Balch CM, Haller DG, Morrow M (2002) AJCC cancer staging manual, 6th edn. Springer-Verlag, New York, NYGoogle Scholar
  13. 13.
    Phillips RK (2005) A companion to specialist surgical practice: colorectal surgery, 3rd edn. Elsevier Saunders, LondonGoogle Scholar
  14. 14.
    Phillips RK, Clark S (2005) Frontiers in colorectal surgery, 1st edn. TFM publishing, Shrewsbury, UKGoogle Scholar
  15. 15.
    Milsom JW, Nakajima K (2006) Laparoscopic colorectal surgery, 2nd edn. Springer, New York, NYGoogle Scholar
  16. 16.
    Simons AJ, Anthone GJ, Ortega AE, Franklin M, Fleshman J, Geis WP, Beart RW Jr (1995) Laparoscopic-assisted colectomy learning curve. Dis Colon Rectum 38:600–603PubMedCrossRefGoogle Scholar
  17. 17.
    Yamamoto S, Watanabe M, Hasegawa H, Kitajima M (2002) Prospective evaluation of laparoscopic surgery for rectosigmoidal and rectal carcinoma. Dis Colon Rectum 45:1648–1654PubMedCrossRefGoogle Scholar
  18. 18.
    Barlehner E, Benhidjeb T, Anders S, Schicke B (2005) Laparoscopic resection for rectal cancer: outcomes in 194 patients and review of the literature. Surg Endosc 19:757–766PubMedCrossRefGoogle Scholar
  19. 19.
    Kim SH, Park IJ, Joh YG, Hahn KY (2006) Laparoscopic resection for rectal cancer: a prospective analysis of thirty-month follow-up outcomes in 312 patients. Surg Endosc 20:1197–1202PubMedCrossRefGoogle Scholar
  20. 20.
    Marusch F, Gastinger I, Schneider C, Scheidbach H, Konradt J, Bruch HP, Kohler L, Barlehner E, Kockerling F, Laparoscopic Colorectal Surgery Study Group (LCSSG) (2001) Experience as a factor influencing the indications for laparoscopic colorectal surgery and the results. Surg Endosc 15:116–120PubMedCrossRefGoogle Scholar
  21. 21.
    Larach SW, Patankar SK, Ferrara A, Williamson PR, Perozo SE, Lord AS (1997) Complications of laparoscopic colorectal surgery: analysis and comparison of early vs. later experience. Dis Colon Rectum 40:592–596PubMedCrossRefGoogle Scholar
  22. 22.
    Tekkis PP, Senagore AJ, Delaney CP, Fazio VW (2005) Evaluation of the learning curve in laparoscopic colorectal surgery: comparison of right-sided and left-sided resections. Ann Surg 242:83–91PubMedCrossRefGoogle Scholar
  23. 23.
    Fleshman J, Sargent DJ, Green E, Anvari M, Stryker SJ, Beart RW Jr, Hellinger M, Flanagan R Jr, Peters W, Nelson H, for The Clinical Outcomes of Surgical Therapy Study Group (2007) Laparoscopic colectomy for cancer is not inferior to open surgery based on 5-year data from the COST Study Group trial. Ann Surg 246:655–662PubMedCrossRefGoogle Scholar
  24. 24.
    Park JG, Suh KS, Chung HW, Kim SW, Oh YS, Song IS, Park YH (1993) Laparoscopic segmental resection and intracorporeal anastomosis of the colon: report of a case. J Korean Soc Coloproctol 9:73–76Google Scholar
  25. 25.
    Delgado S, Momblan D, Salvador L, Bravo R, Castells A, Ibarzabal A, Pique JM, Lacy AM (2004) Laparoscopic-assisted approach in rectal cancer patients: lessons learned from >200 patients. Surg Endosc 18:1457–1462PubMedCrossRefGoogle Scholar
  26. 26.
    Leroy J, Jamali F, Forbes L, Smith M, Rubino F, Mutter D, Marescaux J (2004) Laparoscopic total mesorectal excision (TME) for rectal cancer surgery: long-term outcomes. Surg Endosc 18:281–289PubMedCrossRefGoogle Scholar
  27. 27.
    Morino M, Parini U, Giraudo G, Salval M, Brachet Contul R, Garrone C (2003) Laparoscopic total mesorectal excision: a consecutive series of 100 patients. Ann Surg 237:335–342PubMedCrossRefGoogle Scholar
  28. 28.
    Jayne DG, Guillou PJ, Thorpe H, Quirke P, Copeland J, Smith AM, Heath RM, Brown JM, UK MRC CLASICC Trial Group (2007) Randomized trial of laparoscopic-assisted resection of colorectal carcinoma: 3-year results of the UK MRC CLASICC Trial Group. J Clin Oncol 25:3061–3068PubMedCrossRefGoogle Scholar
  29. 29.
    Glynne-Jones R, Mawdsley S, Pearce T, Buyse M (2006) Alternative clinical end points in rectal cancer–are we getting closer? Ann Oncol 17:1239–1248PubMedCrossRefGoogle Scholar
  30. 30.
    Birbeck KF, Macklin CP, Tiffin NJ, Parsons W, Dixon MF, Mapstone NP, Abbott CR, Scott N, Finan PJ, Johnston D, Quirke P (2002) Rates of circumferential resection margin involvement vary between surgeons and predict outcomes in rectal cancer surgery. Ann Surg 235:449–457PubMedCrossRefGoogle Scholar
  31. 31.
    Tekkis PP, Heriot AG, Smith J, Thompson MR, Finan P, Stamatakis JD (2005) Comparison of circumferential margin involvement between restorative and nonrestorative resections for rectal cancer. Colorectal Dis 7:369–374PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC 2008

Authors and Affiliations

  • Seok-Byung Lim
    • 1
  • Hyo Seong Choi
    • 1
    Email author
  • Seung-Yong Jeong
    • 1
  • Jae-Gahb Park
    • 1
    • 2
  1. 1.Center for Colorectal CancerResearch Institute & Hospital, National Cancer CenterGyeonggi-doKorea
  2. 2.Department of SurgerySeoul National University College of MedicineSeoulKorea

Personalised recommendations