Should All Colon Cancer Patients Undergo Laparoscopic Colectomy? The Evidence from the Randomized Clinical Trials

Although more than 20 years have elapsed since the performance of the first laparoscopic colectomy, the scien- tific community is still divided between the overoptimistic enthusiasm of surgeons who would apply this procedure to all colon cancers and those who would favor a more prudent and selective approach. In the last years the issue was further complicated by the results of a randomized clinical trial which repeatedly claimed better oncologic results in patients undergoing laparoscopic colectomy as compared with those receiving the traditional open procedure. This short review focuses on the distinct randomized clinical trials comparing the two procedures, the published meta- analyses obtained thereof, in order to comment on the reliability of the studies claiming the evidence of an oncologic benefit with the laparoscopic approach. There is a scientific evidence that in the patients' population eligible for randomization in the published randomized clini- cal trials the oncologic results appear quite similar. Nothing can be stated for the vast patients' population which did not meet the inclusion criteria in the trial and was there- fore excluded. The actual difficulty to generalise the results of randomized clinical trials to all the colon cancer patients suggests a cau- tious approach to the problem and emphasizes the need of a full explanation to the patients about the limits of the cur- rently available scientific evidence. In the meantime the short-term benefits of the laparoscopic approach have to be weighed against the recent results of the enhanced recovery programmes.