PROSPECTIVE COMPARISON OF OPEN VS LAPAROSCOPIC COLON SURGERY FOR CARCINOMA - 5-YEAR RESULTS

Laparoscopy for colonic diseases began in 1990 and has established a r ole in benign disease. Early observations and experiences demonstrated feasibility of laparoscopic surgery for a variety of colonic disease processes, but the applicability to colonic carcinoma was unclear. MET HODS: In 1990, we began a comparative study of open (OCR) vs. laparosc opic (LCR) approach to colon cancer. The study progressed 65 months, w ith 224 patients in OCR group and 191 patients in LCR group. Parameter s studied are stage, location, length of specimen, number of lymph nod es resected, margins, postoperative course, wound complications, recur rence rates, and immediate and long-term survival. OCR were standardiz ed by one group, and LCR were standardized by a second group. All pati ents undergoing LCR were given freedom to choose either OCR or LCR, an d informed consent was obtained. RESULTS: Equal or greater lymph node retrieval, resections, and distal margins were evident with LCR. Benef its with LCR were shown with shorter hospitalization (5.7 vs. 9.7 days ), less blood loss, less wound problems (1 vs. 14), and quicker return of bowel function. Survival, recurrence, and death rates were essenti ally the same. There were no trocar implants in the LCR group. CONCLUS ION: After five years, this study shows that laparoscopy does no harm to the patient, offers comparable oncologic resections, and seems to b e patient-friendly, with less pain, quicker return of bowel functions, shortened hospitalization, and quicker return to full activity.