Impact of laparoscopic resection for colorectal cancer on operative outcomes and survival

Abstract

Objective: This study aimed to compare the outcomes of patients who underwent laparoscopic and open resections for colorectal cancer. Comparison of colectomy in 2 consecutive periods (period 1: January 1996-May 2000; period 2: June 2000-December 2004), with laparoscopic surgery being a surgical option in period 2, was also performed.

Summary background data: Prospective data of 1134 patients (448 in period 1; 656 in period 2) who underwent elective resection for colon and upper rectal cancer (above 12 cm from anal verge) were analyzed.

Methods: The operative outcome and survival were compared between patients who underwent laparoscopic and open resection in period 2. The outcomes of colorectal resections in the 2 periods were also compared.

Results: During period 2, the operative mortality rates of patients with laparoscopic (n = 401) and open resection (n = 255) were 0.8% and 3.7%, respectively (P = 0.022), and the morbidity rates were 21.7% and 15.7%, respectively (P = 0.068). The patients who underwent laparoscopic resection had significantly earlier return of bowel function, earlier resumption of diet, and shorter hospital stay. The 3-year overall survivals in those with nondisseminated disease were 74.4% and 78.8% for open and laparoscopic resection, respectively (P = 0.046). The operative morality rates were 4.4% and 2.6% in period 1 and period 2, respectively (P = 0.132). The 3-year overall survivals for patients with nondisseminated disease were 69.7% and 76.1% for period 1 and period 2, respectively (P = 0.019). The overall survivals in patients who underwent open resection in the 2 periods were similar (P = 0.284).

Conclusions: The short-term favorable outcome of laparoscopic resection for colorectal cancer was confirmed and improvement of survival was observed with the practice of laparoscopic resection.

FIGURE 1. Comparison of survival of patients with stage I to stage III disease who underwent open and laparoscopic surgery.

FIGURE 2. Comparison of survival of patients with stage I disease who underwent open and laparoscopic surgery.

FIGURE 3. Comparison of survival of patients with stage II disease who underwent open and laparoscopic surgery.

FIGURE 4. Comparison of survival of patients with stage III disease who underwent open and laparoscopic surgery.

FIGURE 5. Comparison of overall survival of patients during period 1 and period 2.

FIGURE 6. Comparison of survival of patients with open surgery during period 1 and period 2.