Colorectal carcinoma: Laparoscopic versus traditional open surgery. A clinical trial

BACKGROUND/AIMS: The purpose of this perspective study was to define the ro le of laparoscopic surgery in the treatment of colorectal carcinoma. METHODOLOGY: One hundred colorectal cancer patients were submitted to surgi cal treatment between 1993 and 1996. Fifty patients were operated on by vid eolaparoscopy, the other 50 were operated on according to the standard "ope n" technique. The two groups had similar demographic (age, gender), patholo gical (site, stage), and surgical (type and extent of resection) data. Earl y and late results, benefits and drawbacks of the minimally invasive techni que are compared to those of standard open surgery. RESULTS: No intra-operative complications and no operative mortality occurr ed in the two groups. Early results (complications within 30 days from surg ery) were: 1 pneumonia, 3 wound sepsis, and 3 fistulas (one required a reop eration) in the laparoscopic group; 2 wound sepsis and 5 fistulas (spontane ousIy recovered) in the open group. Late complications occurred in the lapa roscopic group only: 1 bowel bridle occlusion 2 months after surgery (that required a reoperation), and 2 stenoses of the colorectal Knight-Griffen an astomosis, successfully treated by dilatation. Concerning the oncologic-res ults, data were calculated on 40 laparoscopic and 43 open curative resectio ns (stage I, II and III): 20% (8/40) of the laparoscopic and 23% (10/43) of the open group patients resulted in neoplastic progression. The neoplastic recurrences were single site (liver or regional) in 3 laparoscopic and in 5 open patients; multiple sites of relapse were observed in 5 laparoscopic (liver, peritoneum and 1 trocar site) and in 5 open (liver, peritoneum and 1 scar) cases. Five-year disease-free survival mates (Kaplan-Meier method) were similar in the two groups: 73.2% in the laparoscopic and 70.1% in the open. CONCLUSIONS: Laparoscopic surgery seems to be a feasible and effective trea tment of colorectal cancer and, with the improvement of technology and surg eon skill, it will represent an excellent alternative to the more diffuse a nd consolidated open surgery technique.