Laparoscopic surgery for stage III colon cancer - Long-term follow-up

Background: The role of laparoscopic surgery in the management of colorecta l cancer is controversial. This study was undertaken to determine the oncol ogical adequacy, in terms of margins of resection, lymph node harvest, and anastomotic and locoregional recurrence of laparoscopic colectomy in patien ts with stage III (node-positive) colorectal cancer. Methods: The results of laparoscopic colectomy in 50 consecutive patients w ith stage III colorectal cancer operated on at a single hospital between 19 91 and 1998 were analyzed with respect to postoperative morbidity, mortalit y, and longterm survival by the Kaplan-Meier method. Methodical patient fol low-up was the mainstay of the study. Results: There were 31 men (52%) and 19 women (38%) with a mean age of 67.7 years (range, 40-88). Low anterior resection was performed in 17 cases, ab dominal perineal resection in five cases sigmoid colectomy in 10 cases, lef t hemicolectomy in six cases, right hemicolectomy in seven cases, transvers e colectomy in one case, and subtotal colectomy in four cases. Conversion w as necessary in three cases (6%). Major complications included one leak, on e pelvic abscess, one perineal wound infection, and three anastomotic stric tures early in the experience, with none in the past 4 years. One early dea th occurred due to massive stroke. Median length of stay was 6 days (range. 3-37). Forty-six patients were staged as CII and four as CI colon cancer. The average number of positive nodes was 5.1 (range, 3-58). The margins of resection were adequate in all patients. Follow-up ranged from 3 to 75 mont hs (average, 29.3; median, 24). Overall cancer-related mortality was 34% (1 7 patients); three patients died of unrelated causes with no detectable can cer. All who died of cancer had dis rant disease; three of them also had pe lvic recurrence. Mean time of death was 21.7 months. There were no anastomo tic recurrences or trocar site implants. Overall 3- and 5-year survival was 54.5% and 38.5%, respectively; cancer-adjusted survival was 60.8% and 49.1 %. Conclusions: Based on this study, laparoscopic colectomy in patients with s tage III colorectal cancer is oncologically adequate. It results in a long- term outcome comparable to that of traditional open surgery and is associat ed with low perioperative mortality and morbidity (lower wound infection ra te, lower wound recurrences at trocar sites) and a shortened length of stay .