Laparoscopic-assisted colon resections : long-term results and survival.

Objective : To review the long term results and survival curves forlaparoscopic-assisted resection of colorectal malignancies.Summary background data : The place of laparoscopic colectomyfor colorectal carcinomas is controversial. The techniques and expectedsurgical outcomes for patients undergoing laparoscopic andlaparoscopic-assisted colectomies are slowly being defined as theseprocedures become more common and widely available. There areanecdotal reports in the literature describing port site recurrencesand wound recurrences in patients undergoing laparoscopic-assistedcolectomies for colorectal malignancies. This raises concerns aboutwhether these recurrences are more common in these patients andwhether their survival is compromised by the laparoscopic technique.The authors reviewed data from 110 patients who underwent laparoscopic-assisted colectomies for colorectal cancer, to determine thelong term results and survival, and compared the safety and efficacyof the procedure to open colectomies.Patients and methods : Three hundred and fifty patients underwentlaparoscopic assisted colectomies between July 1991 and June1999. Of these, 110 patients had colorectal malignancies. Survivalrates and pat terns of recurrence rates were compared between thevarious TNM stages and compared with conventional data afteropen surgery. The AJCC staging for colorectal carcinomas and theKaplan-Meier method were used to determine the survival curves.Results : One hundred and ten patients underwent laparoscopicassistedcolon resections for colorectal malignancies. 50.9% of thepatients were females and 49.1% were males with a mean age of78.17 years. The mean follow-up was 43 months. Thirteen caseswere converted to open, due to various difficulties encounteredduring surgery. Mean OR time was 128.16 minutes and mean hospitalstay was 6.91 days. Perioperative mortality was 2.8%. Therewere four local recurrences. The survival rates for the various st ageswere 73.33% /84 months for stage I, 29.19%/89 months forstage II, 29.19%/84 months for stage III, and 12.5%/34 months forstage IV. There were no port site recurrences.Conclusion : Laparoscopic-assisted colon resection of colorectalcarcinomas is technically feasible and safe. It allows earlier postoperativerecovery and a shorter hospital stay. The long-term survivalis also satisfactory. The incidence of port site recurrences is alsono more than with the conventional open technique. Its benefitsover the conventional open technique, however, still await prospectiverandomized trials.