LAPAROSCOPIC RESECTIONS FOR COLORECTAL-CARCINOMA - A 3-YEAR EXPERIENCE

Laparoscopic resection for carcinoma of the colon and rectum is curren tly under intense scrutiny. PURPOSE: The purpose of this study is to r eview our three-year experience of laparoscopic surgery for colon and rectal carcinoma. METHODS: From October 1991 to September 1994, 76 lap aroscopic procedures were performed for colorectal neoplasia (32 males and 44 females; mean age, 69 years). Fifty-five procedures were done for carcinoma, 16 for large polyps, and five for diversion in patients with unresectable cancer. For resectable tumors, the average size was 4 cm; staging was as follows. Dukes A, 10 patients; Dukes B1, 11; Duk es B2, 18; Dukes C1, 1; Dukes C2, 9; and Dukes D, 8. Fourteen cases (2 5 percent) that were converted to open procedures were compared with t he 41 cases that were completed laparoscopically for differences in tu mor size, surgical margins, number of lymph nodes harvested, length of hospital stay, and evidence of recurrence. Procedures completed lapar oscopically were then compared with a group of open controls completed during the same time period. RESULTS: During the first six months, th e conversion rate was 32 percent but dropped to 8 percent in the fast six months. There were a total of 19 complications (25 percent), of wh ich 8 (14 percent) were directly related to the laparoscopic technique . The mean number of lymph nodes harvested in laparoscopic resection f or carcinoma was 8.5, and the average closest tumor margin was 4.5 cm. When laparoscopic resections were compared with converted and standar d open colectomies, there was no significant difference in tumor margi ns or numbers of nodes resected. Length of stay was significantly shor ter for anterior resections completed laparoscopically than for conver ted or conventional colectomies. Although this was also the trend for right hemicolectomies, it did not reach statistical significance. Mean follow-up of the group completed laparoscopically was 16.7 months, du ring which there was one recurrence. There were no trocar site recurre nces. CONCLUSIONS: This early experience seems to indicate that laparo scopic surgery for colorectal carcinoma does not per se compromise sur gical oncologic principles and encourages us to continue out critical appraisal of this technique.