Skip to main content
SpringerLink
Log in

Early results of laparoscopic surgery for colorectal cancer

Retrospective analysis of 372 patients treated by clinical outcomes of Surgical Therapy (Cost) Study Group

  • Original Contributions
  • Published:
Diseases of the Colon & Rectum

Abstract

PURPOSE: This study was undertaken to determine the early experience of the embers of the COST Study Group with colorectal cancer treated by laparoscopic approaches. METHOD: A retrospective review was performed of all patients with colorectal cancer treated with laparoscopy by the COST Study Group before August 1994. Tumor site, stage, differentiation, procedure completion, presence of recurrence (local, distant, trocar site), and cause of death were analyzed. RESULTS: A total of 372 patients with adenocarcinoma of the colon and rectum were treated by laparoscopic approach between October 1991 and August 1994 (170 men and 192 women): right colectomy, 170; sigmoid colectomy, 55; low anterior resection, 56; abdominoperineal resection, 44; left colectomy, 22; colostomy, 8; total colectomy, 6; transverse colectomy, 7; exploration, 2. Conversion to an open procedure was required in 15.6 percent of cases. Operative mortality was 2 percent. Tumor characteristics were as follows: TNM state: I, 40 percent; II, 25 percent; III, 18 percent; IV, 17 percent; Differentiation: well-moderate, 88 percent; poor, 12 percent; carcinomatosis, 5 percent. Local (3.6 percent) and distant implantation occurred in four patients (1.1 percent). Only one of these patients died a cancer-related death (Stage III at 36 months). Cancer-related death rates increased with increasing stage of tumor: I, −4 percent; II, 17 percent; III, 31 percent; IV, 70 percent. CONCLUSION: A laparoscopic approach to colorectal cancer results in early outcome after treatment that is comparable with conventional therapy for colorectal cancer. A randomized trial is needed to compare long-term outcomes of open and laparoscopic approaches with colorectal cancer.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Lord SA, Larach SW, Ferrara A, Williamson PR, Lago CP, Lube MW. Laparoscopic resection for colorectal carcinoma: a three-year experience. Dis Colon Rectum 1996;39:148–54.

    PubMed  CAS  Google Scholar 

  2. Lumley JW, Fielding GA, Rhodes M, Nathanson LK, Siu S, Stitz RW. Laparoscopic-assisted colorectal surgery: lessons learned from 240 consecutive patients. Dis Colon Rectum 1996;39:155–9.

    PubMed  CAS  Google Scholar 

  3. Ortega AE, Beart Jr RW, Steele GD, Winchester DP, Greene FL. Laparoscopic bowel surgery registry: preliminary results. Dis Colon Rectum 1995;38:681–6.

    PubMed  CAS  Google Scholar 

  4. Zucker KA, Pitcher DE, Martin DT, Ford RS. Laparoscopic-assisted colon resection. Surg Endosc 1994;8:12–8.

    Article  PubMed  CAS  Google Scholar 

  5. Hoffman GC, Baker JW, Fitchett CW, Vansant JH. Laparoscopic-assisted colectomy: initial experience. Ann Surg 1994;219:732–43.

    PubMed  CAS  Google Scholar 

  6. Mathis CR, MacFadyen BV. Laparoscopic colorectal resection: a review of the current experience. Int Surg 1994;79:221–225.

    PubMed  CAS  Google Scholar 

  7. Falk PM, Beart RW Jr, Wexner SD,et al. Laparoscopic colectomy: a critical appraisal. Dis Colon Rectum 1993;36:28–34.

    PubMed  CAS  Google Scholar 

  8. Dean PA, Beart RW Jr, Nelson H, Elftmann TD, Schlinkert RT. Laparoscopic-assisted segmental colectomy: early Mayo Clinic experience. Mayo Clin Proc 1994;69:834–40.

    PubMed  CAS  Google Scholar 

  9. Wexner SD, Cohen SM. Port site metastases after laparoscopic colorectal surgery for cure of malignancy. Br J Surg 1995;82:295–8.

    PubMed  CAS  Google Scholar 

  10. Jacquet P, Averbach AM, Jacquet N. Abdominal wall metastasis and peritoneal carcinomatosis after laparoscopic-assisted colectomy for colon cancer. Eur J Surg Oncol 1995;21:568–70.

    PubMed  CAS  Google Scholar 

  11. Fusco MA, Paluzzi MW. Abdominal wall recurrence after laparoscopic-assisted colectomy for adenocarcinoma of the colon: report of a case. Dis Colon Rectum 1993;36:858–61.

    PubMed  CAS  Google Scholar 

  12. Walsh DC, Wattchow DA, Wilson TG. Subcutaneous metastases after laparoscopic resection of malignancy. Aust N Z J Surg 1993;63:563–5.

    PubMed  CAS  Google Scholar 

  13. Montorsi M, Fumagalli U, Rosati R, Bona S, Chella B, Huscher C. Early parietal recurrence of adenocarcinoma of the colon after laparoscopic colectomy. Br J Surg 1995;82:1036–7.

    PubMed  CAS  Google Scholar 

  14. Ugarte F. Laparoscopic cholecystectomy port seeding from a colon carcinoma. Am Surg 1995;61:820–1.

    PubMed  CAS  Google Scholar 

  15. Jacquet P, Averbach AM, Stephens AD, Sugarbaker PH. Cancer recurrence following laparoscopic colectomy: report of two patients treated with heated intraperitoneal chemotherapy. Dis Colon Rectum 1995;38:1110–4.

    PubMed  CAS  Google Scholar 

  16. Fodera M, Pello MJ, Atabek U, Spence RK, Alexander JB, Camishion RC. Trocar site tumor recurrence after laparoscopic-assisted colectomy. J Laparoendosc Surg 1995;5:259–62.

    PubMed  CAS  Google Scholar 

  17. Lacy AM, Garcia-Valdecasas JC, Pique JM,et al. Shortterm outcome analysis of randomized study comparing laparoscopic vs open colectomy for colon cancer. Surg Endosc 1995;9:1101–5.

    PubMed  CAS  Google Scholar 

  18. Franklin ME Jr, Rosenthal D, Norem RF. Prospective evaluation of laparoscopic colon resectionversus open colon resection for adenocarcinoma: a multicenter study. Surg Endosc 1995;9:811–6.

    PubMed  Google Scholar 

  19. Gray D, Lee H, Schlinkert R, Beart RW Jr. Adequacy of lymphadenectomy in laparoscopic-assisted colectomy for colorectal cancer: a preliminary report. J Surg Oncol 1994;57:8–10.

    PubMed  CAS  Google Scholar 

  20. Milsom JW, Bohm B, Decanini C, Fazio VW. Laparoscopic oncologic proctosigmoidectomy with low colorectal anastomosis in a cadaver model. Surg Endosc 1994;8:1117–23.

    PubMed  CAS  Google Scholar 

  21. Ota DM, Nelson H, Weeks JC. Controversies regarding laparoscopic colectomy for malignant diseases. Curr Opin Gen Surg 1994:208–213.

  22. Stoker ME. Laparoscopic colon surgery for cancer: controversy, caution and common sense. Int Surg 1994;79:240–1.

    PubMed  CAS  Google Scholar 

  23. Senagore AJ, Luchtefeld MA, MacKeigan JM. What is the learning curve for laparoscopic colectomy? Am Surg 1995;61:681–5.

    PubMed  CAS  Google Scholar 

  24. Wishner JD, Baker JW Jr, Hoffman GC,et al. Laparoscopic-assisted colectomy: the learning curve. Surg Endosc 1995;9:1179–83.

    PubMed  CAS  Google Scholar 

  25. Simons AJ, Anthone GJ, Ortega AE,et al. Laparoscopicassisted colectomy learning curve. Dis Colon Rectum 1995;38:600–3.

    PubMed  CAS  Google Scholar 

  26. Fleshman JW, Fry RD, Birnbaum EH. Laparoscopicassisted minilaparotomy approaches to colorectal diseases are similar in early outcome. Dis Colon Rectum 1996;39:15–22.

    PubMed  CAS  Google Scholar 

  27. Nelson H, Weeks JC, Wieand HS. Proposed Phase III trial comparing laparoscopic-assisted colectomyversus open colectomy for colon cancer. J Nad Cancer Inst Monographs 1995;19:51–6.

    Google Scholar 

  28. Reilly WT, Nelson H, Schroeder G, Wieand HS, Bolton J, O'Connell MJ. Wound recurrence following conventional treatment of colorectal cancer: a rare but perhaps underestimated problem. Dis Colon Rectum 1996;39:200–7.

    PubMed  CAS  Google Scholar 

  29. Hughes ES, McDermott FT, Polglase AL, Johnson WR. Tumor recurrence in the abdominal wall scar tissue after large-bowel cancer surgery. Dis Colon Rectum 1983;26:571–2.

    PubMed  CAS  Google Scholar 

  30. Corman ML. Colon and rectal surgery. Philadelphia: JB Lippincott, 1993:563.

    Google Scholar 

  31. Beahrs OH, Henson DE, Hutter RV, Kennedy BJ. Manual for staging for cancer. 4th ed. Philadelphia: JB Lippincott, 1992:76–7.

    Google Scholar 

  32. Allendorf JD, Bessler M, Kayton ML, Whelan RL, Treat MR, Nowygrod TR. Tumor growth after laparotomy or laparoscopy: a preliminary study. Surg Endosc 1995;9:49–52.

    PubMed  CAS  Google Scholar 

  33. Jones DB, Guo L-W, Reinhard MK,et al. Impact of pneumoperitoneum on trocar site implantation of colon cancer in hamster model. Dis Colon Rectum 1995;38:1182–8.

    PubMed  CAS  Google Scholar 

  34. Harmon GD, Senagore AJ, Kilbride MJ, Warzynski MJ. Interleukin-6 response to laparoscopic and open colectomy. Dis Colon Rectum 1994;37:754–9.

    PubMed  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. St. Louis, Missouri

    James W. Fleshman M.D.

  2. Rochester, Minnesota

    Heidi Nelson M.D.

  3. Columbia, Missouri

    Walter R. Peters M.D.

  4. Baltimore, Maryland

    H. Charles Kim M.D.

  5. Orlando, Florida

    Sergio Larach M.D.

  6. Allentown, Pennsylvania

    Richard R. Boorse M.D.

  7. Atlanta, Georgia

    Wayne Ambroze M.D.

  8. Dallas, Texas

    Phillip Leggett M.D.

  9. Boston, Massachusetts

    Ronald Bleday M.D.

  10. Chicago, Illinois

    Steven Stryker M.D.

  11. Salt Lake City, Utah

    Brent Christenson M.D.

  12. Fort Lauderdale, Florida

    Steven Wexner M.D.

  13. Grand Rapids, Michigan

    Anthony Senagore M.D.

  14. Boston, Massachusetts

    David Rattner M.D.

  15. Dartmouth, Massachusetts

    John Sutton M.D.

  16. Clairton, Pennsylvania

    Arthur P. Fine M.D.

Authors
  1. James W. Fleshman M.D.
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Heidi Nelson M.D.
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Walter R. Peters M.D.
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. H. Charles Kim M.D.
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Sergio Larach M.D.
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Richard R. Boorse M.D.
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Wayne Ambroze M.D.
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Phillip Leggett M.D.
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Ronald Bleday M.D.
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. Steven Stryker M.D.
    View author publications

    You can also search for this author in PubMed Google Scholar

  11. Brent Christenson M.D.
    View author publications

    You can also search for this author in PubMed Google Scholar

  12. Steven Wexner M.D.
    View author publications

    You can also search for this author in PubMed Google Scholar

  13. Anthony Senagore M.D.
    View author publications

    You can also search for this author in PubMed Google Scholar

  14. David Rattner M.D.
    View author publications

    You can also search for this author in PubMed Google Scholar

  15. John Sutton M.D.
    View author publications

    You can also search for this author in PubMed Google Scholar

  16. Arthur P. Fine M.D.
    View author publications

    You can also search for this author in PubMed Google Scholar

Additional information

Read in part at the meeting of The American Society of Colon and Rectal Surgeons, Seattle, Washington, June 9 to 14, 1996.

About this article

Cite this article

Fleshman, J.W., Nelson, H., Peters, W.R. et al. Early results of laparoscopic surgery for colorectal cancer. Dis Colon Rectum 39 (Suppl 10), S53–S58 (1996). https://doi.org/10.1007/BF02053806

Download citation

  • Issue Date:

  • DOI: https://doi.org/10.1007/BF02053806

Key words

Search

Navigation