Laparoscopic vs. open resection for colorectal adenocarcinoma
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PURPOSE: To compare the outcome after laparoscopic versus open resection for colorectal adenocarcinoma. METHODS: A retrospective cohort analysis of all patients undergoing elective resection for colorectal adenocarcinoma between November 1992 and June 1999 at a university-affiliated hospital. These included 219 open (mean age, 68.3 years) and 98 laparoscopic (mean age, 70.3 years) resections. Data from converted cases (n = 12) were included in the laparoscopic group using the intention-to-treat principle. RESULTS: Operative time, lymph node yield, resection margins and postoperative morbidity and mortality were similar between laparoscopic and open technique. Parenteral analgesic use was less in the laparoscopic group (laparoscopic, 2.7; open, 3.2 days; P = 0.021). Time to first flatus (laparoscopic, 1.8; open, 3 days; P < 0.0001) and first bowel movement (laparoscopic, 3.5; open, 4.9 days; P < 0.0001) was shorter in the laparoscopic group. Resumption of an oral liquid diet (laparoscopic, 2.1; open, 4 days; P < 0.0001) and solid diet (laparoscopic, 5.2; open, 7.1 days; P < 0.0001) was also quicker in the laparoscopic patients. Length of hospitalization was significantly shorter in the laparoscopic patients (laparoscopic, 6.9; open, 10.9 days; P < 0.001). There were less minor complications in the laparoscopic group (laparoscopic, 11.2; open, 21.5 percent; P = 0.029) but no difference in major complications or perioperative mortality. Recurrence, disease-free and overall survival were similar between the two groups. No port site recurrences occurred in the laparoscopic group but there were three wound recurrences in the open group. CONCLUSIONS: Laparoscopic resection for colorectal cancer can be performed safely and effectively in tertiary centers. Earlier discharge from hospital, quicker resumption of oral feeds and less postoperative pain are clear advantages. No adverse effect on recurrence or survival was noted, but results of prospective, randomized trials, currently underway, are needed before laparoscopic resection for colorectal cancer becomes the standard of practice.
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