Laparoscopic-assisted resection of colorectal carcinoma - Five-year audit

INTRODUCTION: The place of laparoscopic-assisted colectomy for colorectal c arcinoma is controversial. This study reviewed a consecutive series of pati ents who underwent laparoscopic-assisted resection of colorectal carcinoma in the past five years. METHODS: Two hundred seventeen laparoscopic-assiste d resections of colorectal carcinoma were attempted starting in April 1992. Initially, we only selected patients with metastatic disease or patients w ho were older than 65 years. Subsequently, both palliative and curative res ections were attempted in patients with a suitable tumor, with no age limit ation. Thus, all suitable patients were randomly assigned to received eithe r laparoscopic-assisted or conventional open surgery. RESULTS: Data collect ion was completed in 201 patients. In 22 patients open surgery was performe d after a diagnostic laparoscopy. In the remaining 179 patients (90 males) in whom laparoscopic dissection was actually performed, the mean follow-up was 19.8 months, and the mean age was 66.3 years. The procedures performed included right hemicolectomy or extended right hemicolectomy (30 patients), transverse colectomy (2 patients), left hemicolectomy (3 patients), sigmoi dectomy (48 patients), anterior resection (59 patients), and abdominoperine al resection (37 patients). Thirty-two (17.7 percent) procedures were conve rted to open surgery. The mean operation time was 203 minutes. The median b lood loss was negligible, and the median requirement of transfusion was zer o. The median number of postoperative parenteral analgesic injections was t hree. The median time to resume diet and hospital discharge were four and s ix days, respectively. The operative mortality was 1.7 percent. The surviva l rates at four years were 100, 88.3, and 64.5 percent for patients with Du kes A, B, and C disease, respectively. There was only one (0.65 percent) po rt-site recurrence. CONCLUSION: Laparoscopic-assisted resection of colorect al carcinoma was technically feasible and safe. It allowed early postoperat ive recovery with satisfactory long-term survival. This is at the expense o f a long operation. Its benefits over the conventional open technique await the results of the randomized trials.