Laparoscopic Colon Resection

Laparoscopic procedures must fulfill a number of criteria same as those for open surgeries.
First, the oncologic quality of the resected specimen must be at least as good as in open surgery..
High vessel ligation
Lymph node dissection
Adequate resection margins.
 
 
Also laparoscopic port- and wound-site metastasis rates must not be higher than in open surgery
The long-term results of laparoscopic surgery for colo rectal cancer must be equivalent to those for open surgery in terms of local recurrence, hepatic metastases, and 5-year disease-free survival.
Variables for comparision
1. Early postop recovery-
There is less tissue handling, less trauma, decreased blood loss, there is less post operative pain in the 1st and 3rd day
There was short duration of ileus and improved pulmonary function
All this led to shorter hospital stay
 
2. Mortality
No difference in mortality between laparoscopic (0.8%) and conventional (1.1%) surgery
 
3. Oncological specimen
The principles remain the same with en bloc removal of the primary tumor along with adherent or locally involved structures and high ligation of vascular and lymphaticstructures.
There is no difference in the mean number of lymph nodes resected in both groups and also thers is no statistical significance in the incidence of positive surgical margins
- Bonjer H.J., Hop W.C., Nelson H., et al:  Laparoscopically assisted vs open colectomy for colon cancer: a meta-analysis.  Arch Surg 142. (3): 298-303.2007
 
4. Disease free survival
The more recent meta-analysis by Jackson and colleagues  found no difference in cancer-related survival and disease recurrence between the two groups.
Jackson T.D., Kaplan G.G., Arena G., et al:  Laparoscopic versus open resection for colorectal cancer: a metaanalysis of oncologic outcomes.  J Am Coll Surg 204. (3): 439-446.2007
Average Disease-free survival was 68.4% and 69.2% (P = .94), respectively. Local recurrence rates were 2.6% and 2.3% (P = .79), respectively, and overall rates of recurrence were 21.8% and 19.4% (P = .25), respectively. There was no significant difference in hepatic and pulmonary metastases.
 
5. Bladder dysfunction is not significantly different in the two groups, however thesexual function is definately worse in the laparoscopic group.
one possible reason was that total mesorectal excision was performed more commonly in the laparoscopic rectal group than in the open rectal group.
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