Colon Cancer: Laparoscopic Surgery
The operative choices available for colec-tomy for cancer expanded in May of 2004 with the publication of Clinical Outcomes of Surgical Therapy (COST) (Nelson and COST Study Group, 2004). Laparoscopic or minimally invasive surgery (MIS) for the treatment of malignant disease had the evidence needed to ethically offer it to patients with cancer. Although laparo-scopic surgery for colonic disease languished with relatively slow adoption in the 1990s and early 21st century, it has more recently gained momentum. This interest in MIS has been due in large part to the growing and expanding array of surgical indications given trials such as COST, Conventional vs. Laparoscopic-Assisted Surgery in Patients with Colorectal Cancer (CLASICC), and Colon Cancer Laparoscopic or Open resection (COLOR) (Nelson and COST Study Group., 2004; Guillou et al., 2005; Veldkamp et al., 2005; Jayne et al., 2007; Fleshman et al., 2007) as well as the improvement in instrumentation and surgical education. Both the growth in clinical indications and academic publication and education has altered the tenor of surgical debate, to one committed to minimally invasive approaches. However, there remain many important issues which the surgeon must weigh in order to properly implement these modern techniques in the setting of colon cancer.
The use of laparoscopic surgery for colonic cancer requires much thought and consideration. Technically, the surgery is much more demanding than its open counterpart. Although the actual details of the operation have changed little from the open approach, the integration of imaging, instrumentation, and surgical expertise have added a dimension of complexity to the operation that many surgeons find unfamiliar. As one overcomes these significant obstacles, the results for the patient are obvious with multiple publications demonstrating improved postoperative morbidity and improved recovery (Nelson and COST Study Group., 2004; Guillou et al., 2005; Veldkamp et al., 2005; Noel et al., 2007; Lacy et al., 2002). Here we hope to articulate the presentation and staging, risks and complications, oncologic outcomes, and techniques regarding the use of a laparoscopic approach in the treatment of colon cancer.
KeywordsColon Cancer Laparoscopic Surgery Staple Line Pelvic Brim Vessel Ligation
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