Experience with laparoscopic colorectal surgery for malignant disease.

Laparoscopic or laparoscopic-assisted surgery for colorectal cancer was attempted in 59 patients suffering from malignant disease of the anus, rectum and colon over a 20-month period. Conversion to open surgery was necessary in 5 patients (8.4%). The peroperative (30-day) mortality was 5.8%, and in two of the three patients who died this was attributable to thrombo-embolic complications. The cancer-related mortality was 8%. There were 5 Dukes' A, 21 Dukes' B and 25 Dukes' C lesions resected, and thus far all recurrences were in patients who had Dukes' C lesions. The resection margins and lymph node yield in these specimens were similar to those achieved with conventional open surgery. Six patients also had hepatic metastases recognized at the time of primary surgery. These preliminary data indicate the feasibility of performing laparoscopic-assisted resection of colorectal cancer without compromising the accepted principles of excisional surgery for malignant disease. However, a number of important issues such as thrombo-embolic prophylaxis, specimen retrieval and the long-term recurrence rates require further study before these procedures are widely adopted for colorectal cancer.