Laparoscopic colonic resections versus open surgery: a prospective non-randomized study on 310 unselected cases.

BACKGROUND/AIMS: Laparoscopic colorectal surgery, particularly for malignancy, is still debated. The aim of this study was to prospectively evaluate the postoperative outcome as well as the short- and medium-term results of laparoscopic surgery compared with those after open conventional surgery.
METHODOLOGY: A series of 310 consecutive patients, operated on by the same surgical team, have been included in this study; 150 patients (75% with malignant lesions) underwent laparoscopic surgery, whereas 160 patients (73% with malignant lesions) were treated by open surgery. The treatment modality was selected by the patients after reading the informed consent form.
RESULTS: Laparoscopic surgery was technically feasible in 91.4% of cases. Mean operative time for laparoscopic surgery was longer than for open surgery (251 vs. 175 min) (P < 0.001). Mean postoperative hospital stay after laparoscopic surgery was 10.5 days, as compared to 13.3 days after open surgery (P < 0.05). In the laparoscopic surgery group minor complications' rate was 3.6% and compared favorably to the 7.5% observed after open surgery (P = 0.261). No statistically significant difference was observed in the major complications rate (9.4% after laparoscopic surgery and 6.8% after open surgery) and in operative mortality (1.4% for laparoscopic surgery and 0.6% for open surgery). The local recurrence rate was lower after laparoscopic surgery as compared to open surgery: 3% versus 9.2% (P = 0.152), respectively. Mean follow-up was 34.2 months during which time we observed 2 cases of port site recurrence. After implementing adequate prophylactic measures, no parietal implants were observed in the last 80 patients who underwent laparoscopic surgery for malignancy. Distant site metastases occurred in 11% in both groups. At 36 months cumulative survival probability in laparoscopic surgery completed malignant cases was 0.74% as compared to 0.66% after open surgery.
CONCLUSIONS: Morbidity and mortality were similar in the 2 groups. Laparoscopic patients experienced less pain. A slightly higher incidence of local recurrence was observed in the open surgery group, whereas the percentage of distant site metastases and the cumulative survival probability in the 2 groups were similar. Port site recurrences are a cause of concern but they can be prevented with adequate prophylactic measures. The short- and medium-term results of laparoscopic surgery compared favorably with those of open surgery in this prospective non-randomized study. Long-term oncological result are not known yet. In patients with malignancy prospective randomized trials on larger patient numbers are required.