Revista chilena de cirugía
versión On-line ISSN 0718-4026
LOPEZ KOSTNER, Francisco et al. Laparoscopic surgery in colorectal cancer. Rev Chil Cir [online]. 2006, vol.58, n.2, pp. 106-113. ISSN 0718-4026. http://dx.doi.org/10.4067/S0718-40262006000200006.
The first laparoscopic surgery for colorectal cancer was reported fifteen years ago. After a long period, the evidence seems to support this technique as a safety treatment for oncologic cases and for some authors there is no doubt that better result can be obtained. At our institution, a protocol in laparoscopic colorectal surgery was started in 1998, the main aim was to progress in oncologic cases according to complexity and advances in the learning curve. The aim of this paper is to analize early results and the safety of oncologic resection in patients who underwent laparoscopic surgery for colorectal cancer. Material and Method: This is a prospective study which include all patients operated on for colorectal cancer by laparoscopy between 1998 and 2004. Results: During this period, 131 patients underwent laparoscopic colorectal surgery and colorectal cancer was the indication for surgery in 32 patients (24%). The mean age was 64 year old (r: 26-88) and 47% of patients were female. The tumor location was rectum in 9 patients and colon in 23 patients (rigth 6, left 7 and sigmoid 10). The tumor resection was performed with curative intent in 29 patients. The surgical technique was sigmoid resection in 10 patients, left hemicolectomy in 7, right hemicolectomy in 6, low anterior resection in 4, abdominoperineal resection in 3 and restorative proctocolectomy with J pouch in two cases. Four patients were converted to open surgery (12%) due to anatomic dificulty. One or more complications were observed in 8 patients (25%) and one patient died after surgery. The mean number of lymph nodes retrieved was 23 (r: 4-86) and a positive histopathologic margin was not observed at any patient. According to TNM clasification, stage I, II, III and IV was observed in 31%, 28% 28% and 13% of patients respectively. The median time of passing flatus, solid oral feeding and hospital stay was 2 days, 3 days and 5 days respectively. All patients have been followed up (mean time 16.4 months) and no tumor trocar implants have been observed. No tumor progression have been observed in any stage I or II patients. Conclusion: Working under a protocol allows to obtain satisfactory surgical results. Considering results obtained from the surgical specimens and a short follow-up, looks like colorectal cancer can be treated by laparoscopy whitout compromising the oncologic standard observed after open surgery
Palabras llave : Laparoscopic surgery; protocol; colorectal cancer; cancer recurrence; survival.