L Stocchi1, H Nelson. 1. Mayo Clinic, Division of Colon and Rectal Surgery, 200 First Street SW, Rochester, MN 55905, USA.
Abstract
OBJECTIVES: To determine the incidence and clinical relevance of wound recurrences (WRs) following laparoscopic-assisted colectomy for cancer; to analyze the most recent experimental studies examining possible pathogenic mechanisms; and to delineate possible prevention strategies. DATA SOURCES: A MEDLINE search was conducted using the words "colectomy," "laparoscopy," and "recurrence, local." Additional articles were retrieved by cross-referencing. STUDY SELECTION: All clinical and experimental studies retrieved were reviewed and subjectively selected according to their relevance for clinical practice. DATA EXTRACTION: Clinical data from 1990 to 2000 with series analyzing 50 or more patients were preferentially considered. Experimental data were considered based on the most rigorous study designs and the potential impact of experimental findings on clinical practice. DATA SYNTHESIS: The incidence of WRs in large series and based on current techniques is comparable to what has been reported for WR following open colectomy. While the pathogenesis of early WR occurrences remains unclear, experience and appropriate training in laparoscopic-assisted colectomy are essential to minimize the incidence of WRs. Results from experimental studies are still controversial, and available data from prospective randomized clinical trials are still limited. CONCLUSIONS: Results from prospective randomized trials are needed to provide definitive answers regarding the incidence and survival impact of WRs. Until then, WR may be considered a technical complication following laparoscopic-assisted colectomy.
OBJECTIVES: To determine the incidence and clinical relevance of wound recurrences (WRs) following laparoscopic-assisted colectomy for cancer; to analyze the most recent experimental studies examining possible pathogenic mechanisms; and to delineate possible prevention strategies. DATA SOURCES: A MEDLINE search was conducted using the words "colectomy," "laparoscopy," and "recurrence, local." Additional articles were retrieved by cross-referencing. STUDY SELECTION: All clinical and experimental studies retrieved were reviewed and subjectively selected according to their relevance for clinical practice. DATA EXTRACTION: Clinical data from 1990 to 2000 with series analyzing 50 or more patients were preferentially considered. Experimental data were considered based on the most rigorous study designs and the potential impact of experimental findings on clinical practice. DATA SYNTHESIS: The incidence of WRs in large series and based on current techniques is comparable to what has been reported for WR following open colectomy. While the pathogenesis of early WR occurrences remains unclear, experience and appropriate training in laparoscopic-assisted colectomy are essential to minimize the incidence of WRs. Results from experimental studies are still controversial, and available data from prospective randomized clinical trials are still limited. CONCLUSIONS: Results from prospective randomized trials are needed to provide definitive answers regarding the incidence and survival impact of WRs. Until then, WR may be considered a technical complication following laparoscopic-assisted colectomy.