The Laparoscopic Approach in the Treatment of Distal Colorectal Cancer

Purpose: The use of laparoscopic techniques has been widely accepted for most solid organ malignancies, but its use for distal colorectal cancer is still controversial. The aim of this study is to review our experience with laparoscopic resections of distal colorectal cancer and to assess patients' outcome. Methods: A retrospective chart review of prospectively entered data base was made to identify patients who underwent laparoscopic resections of distal colorectal cancer. Data relative to demographics, tumor characteristics, surgical proce- dure and adjuvant or neoadjuvant treatment were recorded. Long term follow up (survival and recurrence) was established from the patients' charts and telephone interviews. Results: 94 consecutive patients underwent laparoscopic resections due to distal colorectal cancer. Surgery was in curative intent in 89 cases (95%). Conversion rate was 20%. Four patients (4%) died from different septic complications in the early postoperative period. Complete long term follow up follow up was achieved in 71 (75%) patients. There were no port site metastases. Local recurrence was diagnosed in 3 cases (4%). Twenty one patients (30%) died during this period, 11 due to metastatic disease, 1 from pneumonia, 9 patients from other non cancer related reasons. Conclusions: Laparoscopic surgery may be safe and feasible for the treatment of distal colorectal cancer with acceptable long term oncologic results. The complexity of the procedure as well as the level of anastomosis results in relatively high complication rate, which may potentially improve by overcoming the "institutional learning curve". Randomized con- trolled trials comparing open and laparoscopic surgery for rectal cancer should verify these results, before the laparo- scopic approach can be widely recommended.