Laparoscopic approach to colonic cancer: critical appraisal of the literature.

Full Abstract

BACKGROUND/AIMS:
As laparoscopic colectomy finds its place in the surgical armamentarium, the literature concerning the safety, efficacy, and oncological rational for treatment of colonic cancer is also enriched. A review and critical appraisal of the literature on this subject was the aim of this paper.

METHODS:
A systematic research and a hand search were conducted to gain access to all controlled studies involving laparoscopic colectomy using the Medline, Embase, HealthSTAR, Cumulative Index for Nursing and Allied Health Literature, CancerLit data bases and the Cochrane Central Register of Controlled Trials for the years 1991-2006.

RESULTS:
Over 40 controlled randomized trials and ten systematic reviews and/or meta-analyses were found. Several of the completed controlled randomized trials have published either short- or long-term results; only partial and short-term results are available in rectal cancer. The principal conclusions are that the laparoscopic approach affords better short-term outcomes including surgical site morbidity, but with increased operative times and direct costs. Among the proven long-term outcomes, cancer recurrence and survival do not seem to be worse. Whether conversion, a source of increased operative time and costs, is responsible for poorer outcomes or whether specific settings associated with poorer outcomes are among the causes of conversion remains to be shown. However, there are still concerns as regards specific laparoscopic-related complications.

CONCLUSION:
There seems to no real safety problems in performing laparoscopic colectomy for cancer; improvement in operative times, conversion rates, and complications should make laparoscopy the best cost-effective approach to colectomy.Copyright 2007 S. Karger AG, Basel.

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Author information

Author/s: Fingerhut, Abe (A); Ata, Toufik (T); Chouillard, Elie (E); Alexakis, Nicholas (N); Veyrie, Nicolas (N);

Affiliation: Digestive Surgery Unit, Centre Hospitalier Intercommunal, Poissy, France. AbeFinger(-atsign-)aol.com

Journal and publication information

Publication Type: Journal Article; Meta-Analysis

Journal: Digestive diseases (Basel, Switzerland) (Dig Dis), published in Switzerland. (Language: eng)

Reference: 2007-; vol 25 (issue 1) : pp 33-43

Dates: Created 2007/03/26; Completed 2007/05/16; Revised 2007/11/15;

PMID: 17384506, status: MEDLINE (last retrieval date: 12/26/2008)

Sourced from the National Library of Medicine. Abstract text and other information may be subject to copyright.

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MeSH headings (categories)

This article was linked to the MESH Headings shown below.

Colonic Neoplasms - surgery; therapy
Humans
Laparoscopy

Meta-Analysis as Topic
Randomized Controlled Trials as Topic
Treatment Outcome

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