Laparoscopic Colectomy for Colon Cancer: Comparable to Conventional Oncologic Surgery?

Abstract

As a result of the obvious benefits of laparoscopic cholecystectomy, minimally invasive techniques have been applied to more complex gastrointestinal procedures, including colorectal resections. The goal in adapting laparoscopic techniques for colorectal surgery is to offer an operation that results in less pain, shorter hospital stay, more rapid return to normal activities, and improved cosmesis compared with conventional operation. The challenge has been to show that this can be done safely and efficiently and that for cancer patients there is no detrimental oncologic effect. The major issues that have been and continue to be addressed are (1) whether an adequate resection can be performed laparoscopically, (2) whether there is a high rate of wound or port site recurrence following these operations, and (3) whether, by using these techniques, we are trading short-term benefits for a poor long-term oncologic outcome. To answer these fundamental questions, several prospective randomized trials have been conducted and several more are under way. The results of these trials indicate that, in terms of cancer outcome, there is no difference in overall survival, disease-free survival, and wound recurrences in patients treated using laparoscopic techniques compared with conventional operation. In addition, there are short-term benefits associated with the use of these techniques. It can now be said that from an oncologic standpoint, in experienced hands, laparoscopic colectomy for curable colon cancer is equivalent to conventional therapy, and it is superior to conventional operation regarding short-term outcomes. Laparoscopic colectomy for colon cancer should be offered to appropriately selected patients. KEYWORDS: Laparoscopy, colon cancer, laparoscopic colectomyObjectives: Upon completion of this article, the reader should be able to understand the evolution and current role of minimally invasive surgery in the treatment of colon cancer.Worldwide, colon cancer is the second most common gastrointestinal malignancy.1 Surgery is the basis of treatment for most patients with colon cancer and the primary component of any curative treatment plan. Overall, more than 50% of colon cancer patients are cured by surgery alone. It is no surprise, then, that a basic and critical issue in the care of colon cancer patients is the conduct of the colon cancer operation.

Clinical outcomes and cost–benefit analysis comparing laparoscopic and robotic colorectal surgeries

“…The introduction of minimally invasive techniques for colorectal surgerylaparoscopy and more recently robotics-has allowed surgeons to treat these conditions with smaller incisions, shortened hospital stays, less postoperative pain, and an often quicker return of bowel function and return to normal activity [1][2][3][4]. The use of the robotic platform also offers significant benefits to the surgeon including improved ergonomics, 3D visualization, endo-wrist maneuverability, and precision movements, especially when working in narrow spaces like the pelvis.…”

“…Each year, thousands of surgeries are performed in the USA to treat colorectal diseases such as colorectal cancer, ulcerative colitis, and diverticular disease [1,2]. The introduction of minimally invasive techniques for colorectal surgerylaparoscopy and more recently robotics-has allowed surgeons to treat these conditions with smaller incisions, shortened hospital stays, less postoperative pain, and an often quicker return of bowel function and return to normal activity [1][2][3][4].…”

New alternative for wound protection in laparoscopic colectomy

“…Several studies were conducted to elucidate the reason for this so high incidence 4 . In 2007 Fleshman et al, based on the COST study (tested with follow-up of five years), showed that there is no statistical difference in tumor recurrence in the surgical wound when comparing laparotomic or laparoscopic colectomy 6 .…”

Distribution and Volume of Extrauterine Disease in Uterine Serous Carcinoma: Is Minimally Invasive Surgery a Suitable Approach?

“…12,13 A suboptimal surgical approach may, therefore, potentially lead to understaging of advanced disease and contribute to poorer survival outcomes. 9 The feasibility of identifying and resecting peritoneal disease within multiple abdominal quadrants has been identified as a potential limitation of MIS, 14 and data evaluating the appropriateness of MIS in the management of type II ECs are limited. Finally, recognizing that, in some centers, adjuvant chemotherapy is omitted in noninvasive stage IA USC, inadequate staging may result in undertreatment.…”