Laparoscopic-assisted Colon Resections: Long-term Results and Survival

OBJECTIVE: We reviewed the long-term results and patient survival for laparoscopic-assisted resection of colorectal malignancies. The place of laparoscopic colectomy for colorectal carcinomas is controversial. The techniques and expected surgical outcomes for patients undergoing laparoscopic and laparoscopic-assisted colectomies are being defined as these procedures become more acceptable and reach parity with, or even surpass, results of traditional operations. Anecdotal reports in the literature describe port-site and incisional tumor implantation in patients undergoing laparoscopic-assisted colectomies for colorectal malignancies. This raises concerns about whether these incisional tumor sites are more common in these patients and whether their survival is compromised by the laparoscopic technique. METHODS: The authors reviewed data from 110 patients who underwent laparoscopic-assisted colectomies for colorectal cancer to determine the long-term results and survival and to compare the safety and efficacy of laparoscopic-assisted colectomy to the safety and efficacy of open colectomy. Between July 1991 and June 1999, 350 patients underwent laparoscopic-assisted colectomies. Of these, 110 patients had colorectal malignancies. Survival rates and patterns of recurrence were compared within the various TNM stages and compared with conventional data after open surgery. The American Joint Committee on Cancer staging for colorectal carcinomas and the Kaplan-Meier method were used to determine the survival curves. RESULTS: Laparoscopic-assisted colon resections for colorectal malignancies were performed in 110 patients. Fifty-one percent of the patients were women, and 49% percent were men, with a mean age of 78.17 years. The mean follow-up was 43 months. Thirteen patients were converted to open operation due to various difficulties encountered during the procedure. Mean operative time was 128.16 minutes, and mean hospital stay was 6.91 days. Perioperative mortality was 2.77%. There were 4 local recurrences. The ten-year survival rates for the various stages were 78% for stage I, 33% for stage II, 30% for stage III, and 0% for stage IV. No port-site implantations occurred. CONCLUSION: Laparoscopic-assisted colon resection of colorectal carcinomas is technically feasible and safe. It allows earlier postoperative recovery and a shorter hospital stay. The long-term survival is also satisfactory. The incidence of port-site implants is no more than that with the conventional open technique. Determination of any benefits over the conventional open technique, however, still await prospective randomized trials.