Laparoscopic surgery for colorectal cancer

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First described in 1990 with the resulting series of 51 patients published in 1992.[1] Now an accepted surgical treatment for colorectal cancer.

  • Evidence is that oncologically, it is no worse than open, though less clear for anterior resections.
  • Initial concerns about port-site recurrence not observed in other studies.
  • Learning curve.
  • More expensive.
  • Longer surgery.
  • Less morbidity (less pain, earlier recovery, less bowel ileus, etc.).

Contents

Evidence

Studies

Several randomised control trials. Concerns that many studies collected data on surgeons still early in their learning curve.

  • COST [2]
  • MRC CLASICC Trial [3]
  • COLOR [4]
  • Concerns over oncological clearence margin particulary in low rectal tumours. Evidence reviewed in [5]

Reviews

  • Cochrance review overall in favour. [6]
  • The NICE 2000 Guidance[7] was produced prior to publication of most of the randomised controlled trials. As such, it concluded that all surgery should take place only in the context of a randomised controlled trial. This has been reviewed in 2006 and the current stance is that the long-term outcomes between open and laparoscopic approaches are similar with benefits in the shorter term for laparoscopic surgery. NICE do acknowledge that the UK has a relative dearth of expertise in laparoscopic colorectal surgery and have put a caveat that such surgery should be performed by adequately trained surgeons.[8]

References

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