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.).




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]


  • 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]


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