Patterns of recurrence and survival after laparoscopic and conventional resections for colorectal carcinoma

Abstract

Objective: To determine whether survival and recurrence after laparoscopic-assisted surgery for colorectal cancer is compromised by an initial laparoscopic approach.

Summary background data: Laparoscopic colorectal resection for malignancy remains controversial 8 years after its first description. Fears regarding compromised oncologic principles and early recurrence (particularly the phenomenon of port-site metastases) have tempered enthusiasm for this approach. Long-term follow-up data are at present scarce.

Methods: A prospective comparative trial was undertaken between December 1993 and May 1996, during which 114 patients had laparoscopic-assisted resection by a single laparoscopic colorectal surgeon or conventional open surgery by a second specialist colorectal surgeon. Intensive follow-up for at least 2 years is available on 109 patients. Analysis was performed on an intention-to-treat basis.

Results: Recurrent disease has developed in 27 patients (25%), 16 of 57 in the laparoscopic group (28%) and 11 of 52 in the conventional group (21%). Crude death rates are 26/57 (46%) in the laparoscopic group and 24/52 (46%) in the conventional group. No port-site metastases have occurred; however, wound metastases associated with disseminated disease have developed in three patients in the open group and one in the laparoscopic group. Stage-for-stage survival and recurrence figures are comparable.

Conclusion: Oncologic outcome at a minimum of 2 years is not compromised by the laparoscopic approach. Wound recurrences are a feature of laparoscopic and conventional surgery for advanced disease.

Figure 1. Kaplan-Meier curves for survival after laparoscopic (solid line) and open (dashed line) surgery for colorectal cancer (+, censored data). P = .6264, log-rank test.