Laparoscopic colorectal cancer surgery

BACKGROUND: A number of controversies exist in the laparoscopic treatment o f colorectal cancer, and thus the technique has so far failed to gain wides pread acceptance throughout the United Kingdom. This review aims to discuss these issues in the context of ongoing published trials, assessing both pu rported advantages and disadvantages. METHODS: The United States National Library of Medicine Medline database, a nd the Bath Information Data Service (BIDS) were searched using keywords re lated to laparoscopic colorectal cancer surgery. Recent surgical journals w ere also reviewed for relevant publications. Attempts have been made to quo te only the most recent work from institutions with multiple publications u sing the same group of patients, in order to present the most coherent pict ure. The data are presented as randomized controlled trials, nonrandomized controlled studies, and series comprising more than 10 patients. CONCLUSIONS: This review confirms that laparoscopic colorectal cancer surge ry is technically feasible, In addition patients lose less blood, have less immunosuppression, and have shorter postoperative ileus, in-patient stay, and require less analgesia. However, concerns still remain as to the develo pment of port-site metastases, the longer operating times, and the overall cost of the equipment. In view of these concerns, the place of laparoscopic ally assisted colorectal cancer surgery is likely to remain controversial f or some years yet. Randomized, controlled trials are as yet too few to prov ide definitive answers to all these issues. (C) 2000 by Excerpta Medica, In c.