Laparoscopic Approaches to Colonic Malignancy

  • Juliane Bingener
  • Heidi Nelson


The last two decades have witnessed the surge and success of laparoscopic approaches in several surgical arenas. Laparoscopic cholecystectomy, laparoscopic solid organ surgery, and laparoscopic gastric bypass have become the standard of care. Adoption of laparoscopic colectomy has remained low until the middle of this decade and is approaching 10% for benign disease [1].

Concerns over the appropriateness of laparoscopic colectomy for colon cancer had been raised with regard to possible limitations in tumor staging, patterns of tumor recurrences related to the use of the pneumoperitoneum, and effective cost containment. Well-designed prospective randomized trials have now reported data necessary to support laparoscopic colectomy as an alternative technique for colon cancer. This chapter analyzes the technical aspects of laparoscopic colectomy (LAC) as a cancer operation, discusses the results experienced with LAC, addresses cancer staging and unusual patterns of tumor recurrence, describes the results of prospective randomized trials and meta-analyses, and gives an outlook on possible future developments.


Laparoscopic Cholecystectomy Laparoscopic Procedure Laparoscopic Group Laparoscopic Technique Laparoscopic Colectomy 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


  1. 1.
    Kemp J, Finlayson S (2008) Nationwide trends in laparoscopic colectomy from 2000 to 2004. Surg Endosc 22(5):1181–1187PubMedCrossRefGoogle Scholar
  2. 2.
    Bouvet M et al (1998) Clinical, pathologic, and economic parameters of laparoscopic colon resection for cancer. Am J Surg 176(6):554–558PubMedCrossRefGoogle Scholar
  3. 3.
    Falk PM et al (1993) Laparoscopic colectomy: a critical appraisal. Dis Colon Rectum 36(1):28–34PubMedCrossRefGoogle Scholar
  4. 4.
    Franklin ME Jr. et al (1996) Prospective comparison of open vs. laparoscopic colon surgery for carcinoma. Five-year results. Dis Colon Rectum 39(10 Suppl):S35–S46PubMedCrossRefGoogle Scholar
  5. 5.
    Gellman L, Salky B, Edye M (1996) Laparoscopic assisted colectomy. Surg Endosc 10(11):1041–1044PubMedCrossRefGoogle Scholar
  6. 6.
    Hoffman GC, Baker JW, Fitchett CW, Vansant JH (1994) Laparoscopic-assisted colectomy. Initial experience. Ann Surg 219(6):732–740, discussion 740–3PubMedCrossRefGoogle Scholar
  7. 7.
    Khalili TM et al (1998) Colorectal cancer: comparison of laparoscopic with open approaches. Dis Colon Rectum 41(7):832–838PubMedCrossRefGoogle Scholar
  8. 8.
    Lacy AM et al (1995) Short-term outcome analysis of a randomized study comparing laparoscopic vs open colectomy for colon cancer. Surg Endoc 9(10):1101–1105Google Scholar
  9. 9.
    Leung KL et al (1997) Laparoscopic-assisted resection of rectosigmoid carcinoma. Immediate and medium-term results. Arch Surg 132(7):761–764, discussion 765PubMedCrossRefGoogle Scholar
  10. 10.
    Liberman MA et al (1996) Laparoscopic colectomy vs traditional colectomy for diverticulitis. Outcome and costs [see comment]. Surg Endosc 10(1):15–18PubMedCrossRefGoogle Scholar
  11. 11.
    Lord SA et al (1996) Laparoscopic resections for colorectal carcinoma. A three-year experience. Dis Colon Rectum 39(2):148–154PubMedCrossRefGoogle Scholar
  12. 12.
    Milsom JW et al (1998) A prospective, randomized trial comparing laparoscopic versus conventional techniques in colorectal cancer surgery: a preliminary report [see comment]. J Am Coll Surg 187(1):46–54, discussion 54–5PubMedCrossRefGoogle Scholar
  13. 13.
    Musser DJ et al (1994) Laparoscopic colectomy: at what cost? Surg Laparosc Endosc 4(1):1–5PubMedGoogle Scholar
  14. 14.
    Peters WR, Bartels TL (1993) Minimally invasive colectomy: are the potential benefits realized? Dis Colon Rectum 36(8):751–756PubMedCrossRefGoogle Scholar
  15. 15.
    Saba AK et al (1995) Laparoscopic assisted colectomies versus open colectomy. J Laparoscop Surg 5(1):1–6CrossRefGoogle Scholar
  16. 16.
    Senagore AJ et al (1993) Open colectomy versus laparoscopic colectomy: are there differences? Am Surg 59(8):549–553, discussion 553–4PubMedGoogle Scholar
  17. 17.
    Leung KL et al (1999) Laparoscopic-assisted resection of colorectal carcinoma: five-year audit. Dis Colon Rectum 42(3):327–332, discussion 332–3PubMedCrossRefGoogle Scholar
  18. 18.
    Boulez J (1996) Surgery of colorectal cancer by laparoscopic approach. Ann Chir 50(3):219–230PubMedGoogle Scholar
  19. 19.
    Schwandner O, Schiedeck TH, Bruch HP (1999) Advanced age–indication or contraindication for laparoscopic colorectal surgery? Dis Colon Rectum 42(3):356–362PubMedCrossRefGoogle Scholar
  20. 20.
    Stocchi L et al (2000) Safety and advantages of laparoscopic vs. open colectomy in the elderly: matched-control study. Dis Colon Rectum 43(3):326–332PubMedCrossRefGoogle Scholar
  21. 21.
    Schwenk W et al (2005) Short term benefits for laparoscopic colorectal resection. Cochrane Database Syst Rev 20(3):CD003145Google Scholar
  22. 22.
    Lourenco T et al (2008) Laparoscopic surgery for colorectal cancer: safe and effective? – A systematic review. Surg Endosc 22(5):1146–1160PubMedCrossRefGoogle Scholar
  23. 23.
    Schwenk W et al (1999) Pulmonary function following laparoscopic or conventional colorectal resection: a randomized controlled evaluation. Arch Surg 134(1):6–12, discussion 13PubMedCrossRefGoogle Scholar
  24. 24.
    Stevenson AR et al (1998) Laparoscopically assisted anterior resection for diverticular disease: follow-up of 100 consecutive patients. Ann Surg 227(3):335–342PubMedCrossRefGoogle Scholar
  25. 25.
    Kuhry E et al (2008) Long-term outcome of laparoscopic surgery for colorectal cancer: a cochrane systematic review of randomised controlled trials. Cancer Treat Rev 34(6):498–504PubMedCrossRefGoogle Scholar
  26. 26.
    Levrant SG, Bieber EJ, Barnes RB (1997) Anterior abdominal wall adhesions after laparotomy or laparoscopy. J Am Assoc Gynecol Laparosc 4(3):353–356PubMedCrossRefGoogle Scholar
  27. 27.
    Braga M et al (2005) Laparoscopic vs. open colectomy in cancer patients: long-term complications, quality of life, and survival. Dis Colon Rectum 48(12):2217–2223PubMedCrossRefGoogle Scholar
  28. 28.
    Kloosterman T et al (1994) Unimpaired immune functions after laparoscopic cholecystectomy. Surgery 115(4):424–428PubMedGoogle Scholar
  29. 29.
    Bessler M et al (1994) Is immune function better preserved after laparoscopic versus open colon resection? Surg Endosc 8(8):881–883PubMedCrossRefGoogle Scholar
  30. 30.
    Harmon GD et al. (1994) Interleukin-6 response to laparoscopic and open colectomy. Dis Colon Rectum 37(8):754–759PubMedCrossRefGoogle Scholar
  31. 31.
    Delgado S et al (2001) Acute phase response in laparoscopic and open colectomy in colon cancer: randomized study. Dis Colon Rectum 44(5):638–646PubMedCrossRefGoogle Scholar
  32. 32.
    Leung KL et al (2000) Systemic cytokine response after laparoscopic-assisted resection of rectosigmoid carcinoma: a prospective randomized trial. Ann Surg 231(4):506–511PubMedCrossRefGoogle Scholar
  33. 33.
    Dean PA et al (1994) Laparoscopic-assisted segmental colectomy: early Mayo Clinic experience. Mayo Clin Proc 69(9):834–840PubMedCrossRefGoogle Scholar
  34. 34.
    Radice E, Young-Fadok TM, Nelson H (1998) Benefits of laparoscopic stoma creation: a casematched series (Abstract # G0145). Gastroenterology 114(Suppl 1):A35CrossRefGoogle Scholar
  35. 35.
    Kockerling F et al (1998) Prospective multicenter study of the quality of oncologic resections in patients undergoing laparoscopic colorectal surgery for cancer. The Laparoscopic Colorectal Surgery Study Group. Dis Colon Rectum 41(8):963–970PubMedCrossRefGoogle Scholar
  36. 36.
    Rosser JC Jr., Rosser LE, Savalgi RS (1998) Objective evaluation of a laparoscopic surgical skill program for residents and senior surgeons [see comment]. Arch Surg 133(6):657–661PubMedCrossRefGoogle Scholar
  37. 37.
    Slim K et al (1995) High morbidity rate after converted laparoscopic colorectal surgery. Br J Surg 82(10):1406–1408PubMedCrossRefGoogle Scholar
  38. 38.
    Ramos JM et al (1995) Role of laparoscopy in colorectal surgery. A prospective evaluation of 200 cases.[see comment]. Dis Colon Rectum 38(5):494–501PubMedCrossRefGoogle Scholar
  39. 39.
    Fine AP et al (1995) Laparoscopic colon surgery: report of a series. Am Surg 61(5):412–416PubMedGoogle Scholar
  40. 40.
    Moore JW et al (1996) Lymphovascular clearance in laparoscopically assisted right hemicolectomy is similar to open surgery. Aus NZ J Surg 66(9):605–607CrossRefGoogle Scholar
  41. 41.
    Stage JG et al (1997) Prospective randomized study of laparoscopic versus open colonic resection for adenocarcinoma [see comment]. Br J Surg 84(3):391–396PubMedCrossRefGoogle Scholar
  42. 42.
    Tucker JG et al (1995) Laparoscopically assisted bowel surgery. Analysis of 114 cases. Surg Endosc 9(3):297–300PubMedCrossRefGoogle Scholar
  43. 43.
    Van Ye TM, Cattey RP, Henry LG (1994) Laparoscopically assisted colon resections compare favorably with open technique. Surg Laparosc Endosc 4(1):25–31PubMedGoogle Scholar
  44. 44.
    Clinical Outcomes of Surgical Therapy Study G (2004) A comparison of laparoscopically assisted and open colectomy for colon cancer [see comment]. N Engl J Med 350(20):2050–2059CrossRefGoogle Scholar
  45. 45.
    Stocchi L et al (1999) Laparoscopic ultrasonography: a developmental model (Abstract). Dis Colon Rectum 42(4):A51Google Scholar
  46. 46.
    Milsom JW et al (2000) Prospective, blinded comparison of laparoscopic ultrasonography vs. contrast-enhanced computerized tomography for liver assessment in patients undergoing colorectal carcinoma surgery. Dis Colon Rectum 43(1):44–49PubMedCrossRefGoogle Scholar
  47. 47.
    Hartley JE et al (2000) Laparoscopic ultrasound for the detection of hepatic metastases during laparoscopic colorectal cancer surgery. Dis Colon Rectum 43(3):320–324, discussion 324–5PubMedCrossRefGoogle Scholar
  48. 48.
    Berends FJ et al (1994) Subcutaneous metastases after laparoscopic colectomy [see comment]. Lancet 344(8914):58PubMedCrossRefGoogle Scholar
  49. 49.
    Fleshman JW et al (1996) Early results of laparoscopic surgery for colorectal cancer. Retrospective analysis of 372 patients treated by Clinical Outcomes of Surgical Therapy (COST) Study Group. Dis Colon Rectum 39(10 Suppl):S53–S58PubMedCrossRefGoogle Scholar
  50. 50.
    Guillou PJ et al (2005) Short-term endpoints of conventional versus laparoscopic-assisted surgery in patients with colorectal cancer (MRC CLASICC trial): multicentre, randomised controlled trial [see comment]. Lancet 365(9472):1718–1726PubMedCrossRefGoogle Scholar
  51. 51.
    Lacy AM et al (2002) Laparoscopy-assisted colectomy versus open colectomy for treatment of non-metastatic colon cancer: a randomised trial [see comment]. Lancet 359(9325):2224–2229PubMedCrossRefGoogle Scholar
  52. 52.
    Veldkamp R et al (2005) Laparoscopic surgery versus open surgery for colon cancer: short-term outcomes of a randomised trial. Lancet Oncol 6(7):477–484PubMedCrossRefGoogle Scholar
  53. 53.
    Dozois E et al (2008) Transvaginal colonic extraction following combined hysterectomy and laparoscopic total colectomy: a natural orifice approach. Tech Coloproctol 12(3):251–254PubMedCrossRefGoogle Scholar
  54. 54.
    Lacy AM et al (2008) MA-NOS radical sigmoidectomy: report of a transvaginal resection in the human. Surg Endosc 22(7):1717–1723PubMedCrossRefGoogle Scholar
  55. 55.
    Zorron R. NOTES transvaginal cholecystectomy – comparative clinical study with Laparoscopy. Proceedings of the 3rd International Conference on NOTES, San Francisco, 2008.Google Scholar
  56. 56.
    Whiteford MH, Denk PM, Swanstrom LL (2007) Feasibility of radical sigmoid colectomy performed as natural orifice translumenal endoscopic surgery (NOTES) using transanal endoscopic microsurgery. Surg Endosc 21(10):1870–1874PubMedCrossRefGoogle Scholar
  57. 57.
    Young-Fadok TM et al (2007) NOTES right colectomy: a feasibility study (Abstract #790). Gastroenterology 132(4):A115Google Scholar
  58. 58.
    Young-Fadok TM, Nelson H (2000) Laparoscopic right colectomy: five-step procedure. Dis Colon Rectum 43(2):267–271PubMedCrossRefGoogle Scholar
  59. 59.
    Stocchi L, Nelson H (1998) Laparoscopic colectomy for colon cancer: trial update. J Surg Oncol 68:255–267PubMedCrossRefGoogle Scholar
  60. 60.
    Jansen A (1994) Laparoscopic-assisted colon resection. Evolution from an experimental technique to a standardized surgical procedure. Ann Chir Gynecol 83:86–91Google Scholar
  61. 61.
    Simons AJ, Anthone GJ, Ortega AE et al (1995) Laparoscopic-assisted colectomy learning curve. Dis Colon Rectum 38:600–603PubMedCrossRefGoogle Scholar
  62. 62.
    Wishner JD, Baker JW Jr, Hoffman GC et al (1995) Laparoscopic-assisted colectomy. The learning curve. Surg Endosc 9:1179–1183PubMedCrossRefGoogle Scholar
  63. 63.
    Stitz RW, Lumley JW (1996) Laparoscopic colorectal surgery – new advances and techniques. Ann Acad Med Singapore 25:653–656PubMedGoogle Scholar
  64. 64.
    Agachan F, Joo JS, Sher M, Weiss EG, Nogueras JJ, Wexner SD (1997) Laparoscopic colorectal surgery. Do we get faster? Surg Endosc 11:331–335PubMedCrossRefGoogle Scholar
  65. 65.
    Musser DJ, Boorse RC, Madera F, Reed JF 3rd. (1994) Laparoscopic colectomy: at what cost? Surg Laparosc Endosc 4:1–5PubMedGoogle Scholar
  66. 66.
    Guillou PJ, Darzi A, Monson JR (1993) Experience with laparoscopic colorectal surgery for malignant disease. Surg Oncol 2(Suppl 1):43–49PubMedCrossRefGoogle Scholar
  67. 67.
    Drouard F, Passone-Szerzyna N. Les greffes neoplasiques parietales en chirurgie laparoscopique colo-rectale. Communication III Symposium SFCE, Bordeaux, 1995Google Scholar
  68. 68.
    Hoffman GC, Baker JW, DoxeyJ B, Hubbard GW, Ruffin WK, Wishner JA (1996) Minimally invasive surgery for colorectal cancer. Initial follow-up. Ann Surg 223:790–796PubMedCrossRefGoogle Scholar
  69. 69.
    Kwok SP, Lau WY, Carey PD, Kelly SB, Leung KL, Li AK (1996) Prospective evaluation of laparoscopic-assisted large bowel excision for cancer. Ann Surg 223:170–176PubMedCrossRefGoogle Scholar
  70. 70.
    Lacy AM, Garcia-Valdecasas JC, Delgado S et al (1997) Postoperative complications of laparoscopic-assisted colectomy. Surg Endosc 11:119–122PubMedCrossRefGoogle Scholar
  71. 71.
    Larach SW, Patankar SK, Ferrara A, Williamson PR, Perozo SE, Lord AS (1997) Complications of laparoscopic colorectal surgery. Analysis and comparison of early vs. latter experience. Dis Colon Rectum 40:592–596PubMedCrossRefGoogle Scholar
  72. 72.
    Vukasin P, Ortega AE, Greene FL et al (1996) Wound recurrence following laparoscopic colon cancer resection. Results of the American society of colon and rectal surgeons laparoscopic registry. Dis Colon Rectum 39:S20–S23PubMedCrossRefGoogle Scholar
  73. 73.
    Fielding GA, Lumley J, Nathanson L, Hewitt P, Rhodes M, Stitz R (1997) Laparoscopic colectomy. Surg Endosc 11:745–749PubMedCrossRefGoogle Scholar
  74. 74.
    Fleshman J, Sargent D, Green E et al (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(4):655–664PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC 2009

Authors and Affiliations

  • Juliane Bingener
    • 1
  • Heidi Nelson
    • 2
  1. 1.Division of General SurgeryMayo ClinicRochesterUSA
  2. 2.Department of Colon and Rectal SurgeryMayo ClinicRochesterUSA

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