Laparoscopic surgery for the cure of colorectal cancer - Results of a German five-center study

PURPOSE: The aim of this study was to assess the feasibility and safety of laparoscopic surgery for the cure of colorectal cancer with emphasis on onc ologic follow-up in particular. METHODS: A study was performed of patients with colorectal cancer treated by laparoscopy in five German centers betwee n May 1991 and September 1997. Surgical and pathologic data were recorded i n an anonymous registry database and analyzed by type of resection. Standar d procedures were sigmoid or left colectomy, anterior resection, abdominope rineal resection, and right hemicolectomy. follow-up information included i ncidence of local, distant, and port site recurrence and cancer-related dea th. RESULTS: A total of 399 patients (212 females) with a mean age of 66.6 years underwent laparoscopic curative resections (sigmoid resection, 89; le ft colectomy, 11; anterior resection, 157; abdominoperineal resection, 102; right hemicolectomy, 40). Conversion was as necessary in 6.3 percent (n = 25). Complications requiring reoperation occurred in 9 percent (n = 35). Co mplications that were treated conservatively occurred in 27.6 percent (n = 110). Thirty-day mortality was 1.8 percent (n = 7). First bowel movements r esumed on the third postoperative day; patients did not use analgesics afte r a mean of five days. Mean postoperative hospitalization was two weeks. Ac cording to International Union Against Cancer classification, 147 patients had Stage I cancer, 35 had Stage II cancer, and 217 underwent curative rese ction for Stage III cancer. Mean number of lymph nodes resected was 12.1. A t a mean follow-up of 30 months, one port site recurrence was documented. N o local recurrence was observed after curative resection of Stage I colorec tal cancer. Of 399 patients, local recurrence occurred in 6 patients (Stage II, 2; Stage III, 4), and distant metastases were documented in 25 patient s (Stage I, 3; Stage II, 3; Stage III, 19). The highest incidence of cancer -related death occurred after abdominoperineal resection (4.9 percent). CON CLUSION: To assess the role of laparoscopic colorectal surgery for the cure of cancer objectively, prospective randomized trials are necessary.