EARLY RESULTS OF LAPAROSCOPIC SURGERY FOR COLORECTAL-CANCER - RETROSPECTIVE ANALYSIS OF 372 PATIENTS TREATED BY CLINICAL OUTCOMES OF SURGICAL THERAPY (COST) STUDY-GROUP

PURPOSE: This study was undertaken to determine the early experience o f 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 th e COST Study Group before August 1994. Tumor site, stage, differentiat ion, procedure completion, presence of recurrence (local, distant, tro car site), and cause of death were analyzed. RESULTS: A total of 372 p atients with adenocarcinoma of the colon and rectum were treated by la paroscopic 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; col ostomy, 8; total colectomy, 6; transverse colectomy, 7; exploration, 2 . Conversion to an open procedure was required in 15.6 percent of case s. Operative mortality was 2 percent. Tumor characteristics were as fo llows: TNM state: I, 40 percent; II, 25 percent; III, 18 percent; IV, 17 percent; Differentiation: well-moderate, 88 percent; poor, 12 perce nt; carcinomatosis, 5 percent. Local (3.6 percent) and distant implant ation occurred in four patients (1.1 percent). Only one of these patie nts died a cancer-related death (Stage III at 36 months). Cancer-relat ed death rates increased with increasing stage of tumor: I, -4 percent ; II, 17 percent; III, 31 percent; IV, 70 percent. CONCLUSION: A lapar oscopic approach to colorectal cancer results in early outcome after t reatment that is comparable with conventional therapy for colorectal c ancer. A randomized trial is needed to compare long-term outcomes of o pen and laparoscopic approaches with colorectal cancer.