Feasibility of laparoscopic techniques as the surgical approach of choice for primary colorectal cancer: an analysis of 570 consecutive cases

Abstract

Background: Since the Clinical Outcomes of Surgical Therapy (COST) trial data were reported in May 2004, the laparoscopic technique for primary colorectal cancer has been increasingly used and become the approach of choice at our center. This study aimed to evaluate our laparoscopic experience of 570 consecutive patients between October 2000 and December 2006, and assess the feasibility of this technique as the surgical approach of choice for primary colorectal cancer.

Methods: The study times were divided into three periods based on the COST trial report and the time when the laparoscopic technique was accepted as the surgical approach of choice at our center (period I: October 2000 to May 2004, II: June 2004 to December 2005, III: January to December 2006). Data regarding clinicopathological, surgical, and perioperative outcomes were collated from registry and compared between periods.

Results: The use of laparoscopic surgery increased from 2.4% in period I, to 19.2% in period II, to 66.1% in period III. Over the periods, the proportion of rectal cancer and right colon cancer increased (p < 0.001), T- and N-stage became more advanced (p < 0.001, p = 0.011 respectively), and operative time decreased (p < 0.001). The overall open conversion and morbidity rates were 3.5% and 9.8%, respectively, and these did not differ between periods.

Conclusion: It was possible to apply laparoscopic approach in two-thirds of primary colorectal cancer patients. The short-term favorable outcomes support the feasibility of laparoscopic technique as surgical approach of choice for colon cancer. Laparoscopic resection for rectal cancer may require a randomized clinical trial prior to gain similar acceptance.