Aim of this study is to report the clinical results of 852 consecutive colorectal cancer (CRC) resections between April 2001 and December 2006.
Laparoscopic bowel resection (LAC) with lymph node dissection (D2/D3) was applied for advanced CRC as well as LAC with D1 lymph node dissection for early CRC where endoscopic mucosal resection was not indicated. Invasion to the adjacent organ (T4), greater than 7 cm in size, extensive lymph node involvement, bowel obstruction, or advanced lower rectal cancer were excluded from the indication of LAC.
LAC was performed in 520(60.1%) patients; 350 (66.3%) out of 528 patients with colon cancer, 170(52.6%) out of 323 patients with rectal cancer. Conversion to open surgery (OS) was 48 patients (9.2%, 14 for T4, 10 for intestinal adhesions, etc). No significant difference between LAC and open surgery was found in operation time. Postoperative morbidity was intestinal obstruction4.7%, leakage4.5% in LAC, while 8.2%, 2.7% respectively in OS. In all other cases, the immediate postoperative course was uneventful with a hospital stay of 5 to 10 days and quick resumption of physical activity.
Although OS was indicated to far-advanced CRC in this study, LAC for advanced CRC was comparable to OS in terms of operation time and morbidity. LAC for advanced colorectal cancer is a feasible and safe operation with an acceptable complication rate in our study. Recurrence rate or long-term functional outcome needs longer follow-up. To clarify feasibility or non-inferiority of LAC for advanced CRC, prospective randomized control study is now ongoing in Japan.
Program Number: P086