Abstract
PURPOSE: We compared laparoscopic with open colectomy for treatment of colorectal cancer. METHODS: We performed a retrospective review of patients undergoing colectomy for colorectal cancer between January 1991 and March 1996 at a large private metropolitan teaching hospital. Operative techniques included open (n=90) and laparoscopic (n=80) colectomy. Laparoscopic colectomy was further subdivided into the following groups: facilitated (n=62), with extracorporeal anastomosis; near-complete (n=9), with small incision for specimen delivery only; complete (n=3), with specimen removal through the rectum; and converted to an open procedure (n=6). Main outcome measures included operative time, blood loss, time to oral intake, length of postoperative hospitalization, morbidity, lymph node yield, recurrence, survival, and costs. RESULTS: Operative time was equivalent in the laparoscopic and open groups (laparoscopic, 161 minutes; open, 163 minutes;P=0.94). Blood loss was less for the laparoscopic group (laparoscopic, 104 ml; open, 184 ml;P=0.001), and resumption of oral intake was earlier (laparoscopic, 3.9 days; open, 4.9 days;P=0.001), but length of hospitalization was similar. Mean lymph node yield in the laparoscopic group was 12 compared with 16 in the open group (P=0.16). Rates of morbidity, recurrence, and survival were similar in both groups. No port-site recurrences occurred. CONCLUSIONS: Laparoscopic and open colectomy were therapeutically similar for treatment of colorectal cancer in terms of operative time, length of hospitalization, recurrence, and survival rates. The laparoscopic approach was superior in blood loss and resumption of oral intake.
Similar content being viewed by others
References
Phillips EH, Rosenthal RJ, eds. Operative strategies in laparoscopic surgery. New York: Springer-Verlag, 1995.
Jacobs M, Verdeja JC, Goldstein HS. Minimally invasive colon resection (laparoscopic colectomy). Surg Laparosc Endosc 1991;1:144–50.
Astler VB, Coller FA. Prognostic significance of direct extension of carcinoma of colon and rectum. Ann Surg 1954;139:846–55.
Peters WR, Bartels TL. Minimally invasive colectomy: are the potential benefits realized? Dis Colon Rectum 1993;36:751–6.
Scoggin SD, Frazee RC, Snyder SK,et al. Laparoscopic-assisted bowel surgery. Dis Colon Rectum 1993;36:747–50.
Hoffman GC, Baker JW, Fitchett CW, Vansant JH. Laparoscopic-assisted colectomy: initial experience. Ann Surg 1994;219:732–43.
Monson JT, Darzi A, Carey PD, Guillou P. Prospective evaluation of laparoscopic-assisted colectomy in an unselected group of patients. Lancet 1992;340:831–3.
Beart RW Jr. Laparoscopic colectomy: status of the art. Dis Colon Rectum 1994;37(Suppl):S47–9.
Franklin ME Jr, Rosenthal D, Abrego-Medina D,et al. Prospective comparison of open vs laparoscopic colon surgery for carcinoma: five-year results. Dis Colon Rectum 1996;39(Suppl):S35–46.
Daly JM, Steiger E, Vars HM, Dudrick SJ. Post operative oral and intravenous nutrition. Ann Surg 1974;180:709–15.
Delany HM, Demetriou AA, Teh E,et al. Effect of early postoperative nutritional support on skin wound and colon anastomosis healing. J Parenter Enter Nutr 1990;14:357–61.
Zalago GP, Borternschlager L, Black KW, Prielipp R. Immediate postoperative enteral feeding decreases weight loss and improves wound healing after abdominal surgery in rats. Crit Care Med 1992;20:115–8.
Bufo AJ, Feldman S, Daniels GA, Lieberman RC. Early postoperative feeding. Dis Colon Rectum 1994;37:1260–5.
Choi J, O'Connell TX. Safe and effective early postoperative feeding and hospital discharge after open colon resection. Am Surg 1996;62:853–6.
Hawasli A, Schroder DM, Lloyd LR, Featherstone R. Elective conventional colectomy in the era of laparoscopic surgery. Am Surg 1996;62:589–93.
Reissman P, Teoh TA, Cohen SM, Weiss EG, Nogueras JJ, Wexner SD. Is early oral feeding safe after elective colorectal surgery. Ann Surg 1995;222:73–7.
Wexner SD, Cohen SM. Port site metastases after laparoscopic colorectal surgery for cure of malignancy. Br J Surg 1995;82:295–8.
Ramos JM, Gupta S, Anthone GJ, Ortega AE, Simons AJ, Beart RW. Laparoscopy and colon cancer, is the port site at risk? A preliminary report. Arch Surg 1994;129:897–9.
Johnstone PA, Rohde DC, Swartz, Fetter JE, Wexner SD. Port site recurrences after laparoscopic and thorascopic procedures in malignancy. J Clin Oncol 1996;14:1950–6.
Cass AW, Million RR, Pfaff WW. Patterns of recurrence following surgery alone for adenocarcinoma of the colon and rectum. Cancer 1976;37:2861–5.
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 1995;39:200–7.
Scott KW, Grace RH. Detection of lymph node metastases in colorectal carcinoma before and after fat clearance. Br J Surg 1989;76:1165–7.
Phillips EH, Franklin M, Carroll BJ, Fallas MJ, Ramos R, Rosenthal D. Laparoscopic colectomy. Ann Surg 1992;216:703–7.
Kwok SP, Lau Wy, Carey PD, Kelly SB, Leung KL, Li AK. Prospective evaluation of laparoscopic-assisted large-bowel excision for cancer. Ann Surg 1996;223:170–6.
Author information
Authors and Affiliations
About this article
Cite this article
Khalili, T.M., Fleshner, P.R., Hiatt, J.R. et al. Colorectal cancer. Dis Colon Rectum 41, 832–838 (1998). https://doi.org/10.1007/BF02235361
Issue Date:
DOI: https://doi.org/10.1007/BF02235361