Is laparoscopic resection appropriate for colorectal adenocarcinoma?

Oncologic safety has now been demonstrated for laparoscopy-assisted surgery for colon adenocarcinoma after 3 and 5 years of follow-up. Pooled data from large multicenter and smaller single-center trials demonstrate that the modality conveys significant short-term benefits as compared with open surgery, although the full potential has probably not yet been reached. Currently, the data supports improvements in wound morbidity, intraoperative blood loss, narcotic analgesia requirements, time to resumption of bowel movements, and time to discharge from hospital. There is a large potential for improved short-term results when combined with current and developing enhanced-recovery programs. For rectal cancer, the role of laparoscopic surgery is less clear. Data from the first large multicenter trial suggest that laparoscopic dissection may compromise the circumferential resection margin, and this issue will be the focus of ongoing and planned trials. Certain short-term benefits have been shown in pooled analyses of smaller nonrandomized trials, such as a decrease in overall morbidity and a marked reduction of duration of postoperative hospital stay.