engleski

Laparoscopic vs open surgery for colorectal cancer

Colorectal cancer is one of the most common cancers in developed countries and the surgical resection is mainstay of curative treatment. Over the last 20 years laparoscopic surgery has had a tremendous impact on gastrointestinal surgery. Contrary to the laparoscopic cholecystectomy which was very shortly adopted in surgical armamentarium worldwide, the uptake of colon resection has been dramatically slower. The explanation for this included initial concern of adequate oncologic efficacy in colorectal malignancy and steep learning curve of technically demanding procedure working in multiple abdominal quadrants, division of large vessels, bowel resection and bowel anastomosis. A significant factor in the delay in the uptake of laparoscopic colorectal surgery has been concerns that the laparoscopic approach may have inferior results to open resection in terms of recurrence and overall survival in patients with colorectal cancer. To accurately evaluate the efficacy of laparoscopic surgery for colorectal cancer the short and long term outcomes should be compared to open surgery. Numerous comparative trials of open and laparoscopic approaches have been conducted over past 20 years. In this lecture all data from RCT, as well as meta-analysis, published in last decade were presented to show the differences in short and long term outcomes after open and laparoscopic colorectal surgery. A number of multicenter randomized controlled trials have shown the short term benefits of laparoscopic colon and rectal cancer resection over open surgery. There is strong evidence that lower overall postoperative complications rates, less blood loss and shorter hospital stay were associated with laparoscopic approach. Long term oncologic outcomes such as overall and cancer-related mortality, overall recurrence, local recurrence, distant metastasis, and wound-site recurrence, does not differ considerably from that of open conventional surgery. At the end experience in Clinical Hospital “Dubrava” in Zagreb by assessing the results of laparoscopic colorectal resections performed in our hospital over a five-year period is presented.

olorectal cancer; surgery; laparoscopic; open suregery

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