Colon Cancer: Advantages of the Laparoscopic Approach and the Principles of Enhanced Recovery



The aim of this chapter is to review the spectrum of common laparoscopic colorectal complications, to review the best data available concerning safety issues, and to interrogate available analyses which compare open or “conventional” colorectal surgery and take an overview of all these issues.


Laparoscopic Surgery Surgical Site Infection Sexual Dysfunction Compartment Syndrome Laparoscopic Group 
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  1. 1.
    Jayne DG, Guillou PJ, Thorpe H, Quirke P, Copeland J, Smith AM, Heath RM, Brown JM, UK MRC CLASSICC Trial Group. Randomized trial of laparoscopic-assisted resection of colorectal carcinoma: 3-year results of the UK MRC CLASSICC Trial Group. J Clin Oncol. 2007;25:3061–8.PubMedCrossRefGoogle Scholar
  2. 2.
    Jayne DG, Thorpe HC, Copeland J, Quirke P, Brown JM, Guillou PJ. Five-year follow-up of the Medical Research Council CLASSICC trial of laparoscopically assisted versus open surgery for colorectal cancer. Br J Surg. 2010;97:1638–45.PubMedCrossRefGoogle Scholar
  3. 3.
    Taylor GW, Jayne DG, Brown SR, Thorpe H, Brown JM, Dewberry SC, Parker MC, Guillou PJ. Adhesions and incisional hernias following laparoscopic versus open surgery for colorectal cancer in the CLASSICC trial. Br J Surg. 2010;97:70–8.PubMedCrossRefGoogle Scholar
  4. 4.
    Hazebroek EJ, Color Study Group. COLOR: a randomized clinical trial comparing laparoscopic and open resection for colon cancer. Surg Endosc. 2002;16:949–53.PubMedCrossRefGoogle Scholar
  5. 5.
    COST Study Group. A comparison of laparoscopically assisted and open colectomy for colon cancer. N Engl J Med. 2004;350:2050–9.CrossRefGoogle Scholar
  6. 6.
    Braga M, Vignali A, Zuliani W, Radaelli G, Gianotti L, Toussoun G, Carlo V. Training period in laparoscopic colorectal surgery. Surg Endosc. 2002;16:31–5.PubMedCrossRefGoogle Scholar
  7. 7.
    Schwenk W, Haase O, Neudecker J, Müller JM. Short term benefits for laparoscopic colorectal resection. Cochrane Database Syst Rev. 2005;(3):CD003145.Google Scholar
  8. 8.
    Reza MM, Blasco JA, Andradas E, Cantero R, Mayol J. Systematic review of laparoscopic versus open surgery for colorectal cancer. Br J Surg. 2006;93:921–8. review.PubMedCrossRefGoogle Scholar
  9. 9.
    Abraham NS, Young JM, Solomon MJ. Meta-analysis of short-term outcomes after laparoscopic resection for colorectal cancer. Br J Surg. 2004;91:1111–24.PubMedCrossRefGoogle Scholar
  10. 10.
    Abraham NS, Byrne CM, Young JM, Solomon MJ. Meta-analysis of non-randomized comparative studies of the short-term outcomes of laparoscopic resection for colorectal cancer. ANZ J Surg. 2007;77:508–16.PubMedCrossRefGoogle Scholar
  11. 11.
    Leung KL, Kwok SP, Lam SC, Lee JF, Yiu RY, Ng SS, Lai PB, Lau WY. Laparoscopic resection of rectosigmoid carcinoma: prospective randomised trial. Lancet. 2004;363:1187–92.PubMedCrossRefGoogle Scholar
  12. 12.
    Milsom JW, Hammerhofer KA, Böhm B, Marcello P, Elson P, Fazio VW. Prospective, randomized trial comparing laparoscopic vs. conventional surgery for refractory ileocolic Crohn’s disease. Dis Colon Rectum. 2001;44:1–8.PubMedCrossRefGoogle Scholar
  13. 13.
    Schwenk W, Böhm B, Witt C, Junghans T, Gründel K, Müller JM. Pulmonary function following laparoscopic or conventional colorectal resection: a randomized controlled evaluation. Arch Surg. 1999;134:6–12.PubMedCrossRefGoogle Scholar
  14. 14.
    Bonjer HJ, Hop WC, Nelson H, Sargent DJ, Lacy AM, Castells A, Guillou PJ, Thorpe H, Brown J, Delgado S, Kuhrij E, Haglind E, Påhlman L, Transatlantic Laparoscopically Assisted vs Open Colectomy Trials Study Group. Laparoscopically assisted vs open colectomy for colon cancer: a meta-analysis. Arch Surg. 2007;142:298–303.PubMedCrossRefGoogle Scholar
  15. 15.
    Lourenco T, Murray A, Grant A, McKinley A, Krukowski Z, Vale L. Laparoscopic surgery for colorectal cancer: safe and effective? – A systematic review. Surg Endosc. 2008;22:1146–60.PubMedCrossRefGoogle Scholar
  16. 16.
    Lacy AM, García-Valdecasas JC, Delgado S, Castells A, Taurá P, Piqué JM, Visa J. Laparoscopy-assisted colectomy versus open colectomy for treatment of non-metastatic colon cancer: a randomised trial. Lancet. 2002;359:2224–9.PubMedCrossRefGoogle Scholar
  17. 17.
    El-Gazzaz G, Geisler D, Hull T. Risk of clinical leak after laparoscopic versus open bowel anastomosis. Surg Endosc. 2010;24:1898–903.PubMedCrossRefGoogle Scholar
  18. 18.
    Rosin D, Zmora O, Hoffman A, Khaikin M, Munz Y, Zakai BB, Goldes Y, Shabtai EL, Shabtai M, Ayalon A. Laparoscopic colon and rectal surgery – after ten years and 350 operations. Harefuah. 2007;146:176–80. 247–8.PubMedGoogle Scholar
  19. 19.
    Di Palo S, Vignali A, Tamburini A, Parolini D, Orsenigo E, Staudacher C. Colorectal laparoscopic surgery. Single center experience with 599 cancer patients. Suppl Tumori. 2005;4:S133–4.PubMedGoogle Scholar
  20. 20.
    Leroy J, Jamali F, Forbes L, Smith M, Rubino F, Mutter D, Marescaux J. Laparoscopic total mesorectal excision (TME) for rectal cancer surgery: long-term outcomes. Surg Endosc. 2004;18:281–9.PubMedCrossRefGoogle Scholar
  21. 21.
    Poon JT, Law WL, Wong IW, Ching PT, Wong LM, Fan JK, Lo OS. Impact of laparoscopic colorectal resection on surgical site infection. Ann Surg. 2009;249:77–81.PubMedCrossRefGoogle Scholar
  22. 22.
    Quah HM, Jayne DG, Eu KW, Seow-Choen F. Bladder and sexual dysfunction following laparoscopically assisted and conventional open mesorectal resection for cancer. Br J Surg. 2002;89:1551–6.PubMedCrossRefGoogle Scholar
  23. 23.
    Jayne DG, Brown JM, Thorpe H, Walker J, Quirke P, Guillou PJ. Bladder and sexual function following resection for rectal cancer in a randomized clinical trial of laparoscopic versus open technique. Br J Surg. 2005;92:1124–32.PubMedCrossRefGoogle Scholar
  24. 24.
    Jones OM, Stevenson AR, Stitz RW, Lumley JW. Preservation of sexual and bladder function after laparoscopic rectal surgery. Colorectal Dis. 2009;11:489–95.PubMedCrossRefGoogle Scholar
  25. 25.
    Morino M, Parini U, Allaix ME, Monasterolo G, Brachet Contul R, Garrone C. Male sexual and urinary function after laparoscopic total mesorectal excision. Surg Endosc. 2009;23(6):1233–40.PubMedCrossRefGoogle Scholar
  26. 26.
    Aalbers AG, Mannaerts GH. Introduction of laparoscopic colorectal surgery in the Sint Franciscus Gasthuis, Rotterdam, 2002/2005. Ned Tijdschr Geneeskd. 2006;150:1455–61.PubMedGoogle Scholar
  27. 27.
    Regadas FS, Rodrigues LV, Nicodemo AM, Siebra JA, Furtado DC, Regadas SM. Complications in laparoscopic colorectal resection: main types and prevention. Surg Laparosc Endosc. 1998;8:189–92.PubMedCrossRefGoogle Scholar
  28. 28.
    Turnbull D, Farid A, Hutchinson S, Shorthouse A, Mills GH. Calf compartment pressures in the Lloyd-Davies position: a cause for concern? Anaesthesia. 2002;57:905–8.PubMedCrossRefGoogle Scholar
  29. 29.
    Ramos JM, Beart Jr RW, Goes R, Ortega AE, Schlinkert RT. Role of laparoscopy in colorectal surgery. A prospective evaluation of 200 cases. Dis Colon Rectum. 1995;38:494–501.PubMedCrossRefGoogle Scholar
  30. 30.
    Franklin Jr ME, Rosenthal D, Abrego-Medina D, Dorman JP, Glass JL, Norem R, Diaz A. Prospective comparison of open vs. laparoscopic colon surgery for carcinoma. Five-year results. Dis Colon Rectum. 1996;39(10 Suppl):S35–46.PubMedCrossRefGoogle Scholar
  31. 31.
    Silecchia G, Perrotta N, Giraudo G, Salval M, Parini U, Feliciotti F, Lezoche E, Morino M, Melotti G, Carlini M, Rosato P, Basso N, Italian Registry of Laparoscopic Colorectal Surgery. Abdominal wall recurrences after colorectal resection for cancer: results of the Italian registry of laparoscopic colorectal surgery. Dis Colon Rectum. 2002;45:1172–7.PubMedCrossRefGoogle Scholar
  32. 32.
    Zmora O, Gervaz P, Wexner SD. Trocar site recurrence in laparoscopic surgery for colorectal cancer. Surg Endosc. 2001;15:788–93.PubMedCrossRefGoogle Scholar
  33. 33.
    Kuhry E, Schwenk WF, Gaupset R, Romild U, Bonjer HJ. Long-term results of laparoscopic colorectal cancer resection. Cochrane Database Syst Rev. 2008;(2):CD003432.Google Scholar
  34. 34.
    Fleshman J, Sargent DJ, Green E, Anvari M, Stryker SJ, Beart Jr RW, Hellinger M, Flanagan Jr R, Peters W, Nelson H, for The Clinical Outcomes of Surgical Therapy Study Group. Laparoscopic colectomy for cancer is not inferior to open surgery based on 5-year data from the COST Study Group trial. Ann Surg. 2007;246:655–62.PubMedCrossRefGoogle Scholar
  35. 35.
    Cuthbertson DP. The disturbance of metabolism by bony and non-bony injury, with notes on certain abnormal conditions of bone. Biochem J. 1930;24:1244–63.PubMedGoogle Scholar
  36. 36.
    Wilmore D. From Cuthbertson to fast-track surgery: 70 years of progress in reducing stress in surgical patients. Ann Surg. 2002;236(5):643–8.PubMedCrossRefGoogle Scholar
  37. 37.
    Cullen DJ, Greenfield S, Guadagnoli E, Cleary P. ASA physical status and age predict morbidity after three surgical procedures. Ann Surg. 1994;220:3–9.PubMedCrossRefGoogle Scholar
  38. 38.
    Slim K, Vicaut E, Launey-Savary M, Contant C, Chipponi J. Updated systematic review and meta-analysis of randomised clinical trials on the role of mechanical bowel preparation before colorectal surgery. Ann Surg. 2009;249:203–9.PubMedCrossRefGoogle Scholar
  39. 39.
    Beloosesky Y, Grinblat J, Weiss A. Electrolyte disorders following oral sodium picosulphate administration for bowel cleansing in elderly patients. Arch Intern Med. 2003;163:803–8.PubMedCrossRefGoogle Scholar
  40. 40.
    Guenaga KKFG, Matos D, Wille-Jorgenson P. Mechanical bowel preparation for elective colorectal surgery. Cochrane Database Syst Rev. 2009;(1):CD001544. doi:10.1002/14651858.CD001544.pub3.Google Scholar
  41. 41.
    ACPGBI Expert Advisory Group. Guidelines for the management of colorectal cancer. London: Association of Coloproctology Great Britain and Ireland; 2007.Google Scholar
  42. 42.
    Thorell A, Nygren J, Ljungqvist O. Insulin resistance: a marker of surgical stress. Curr Opin Clin Nutr Metab Care. 1999;2(1):69–78.PubMedCrossRefGoogle Scholar
  43. 43.
    Crowe PJ, Dennison A, Royle GT. The effect of preoperative glucose loading on postoperative nitrogen metabolism. Br J Surg. 1884;71:635–7.CrossRefGoogle Scholar
  44. 44.
    Lazar H, Phillipides G, Fitzgerald C, Lancaster D, Shemin R, Apstein C. Glucose-insulin-potassium solutions enhance recovery after urgent coronary artery bypass grafting. J Thorac Cardiovasc Surg. 1997;113(2):1–12.CrossRefGoogle Scholar
  45. 45.
    Hessov I, Ljungqvist O. Perioperative oral nutrition. Curr Opin Clin Metab Care 1998;1:29–33.Google Scholar
  46. 46.
    Noblett SE, Watson D, Huong H, Davison B, Hainsworth PJ, Horgan AF. Pre-operative carbohydrate loading in colorectal surgery: a randomised controlled trial. Colorectal Dis. 2006;8(7):563–9.PubMedCrossRefGoogle Scholar
  47. 47.
    Donati D, Brown S, Eu KW, Seow-Choen F. Comparison between midline incision and limited right skin crease incision for right sided colonic cancers. Tech Coloproctol. 2002;6:1–4.PubMedCrossRefGoogle Scholar
  48. 48.
    Kam MH, Seow-Choen F, Peng XH, Eu KW, Tang CL, Heah SM, Ooi BS. Minilaparotomy left iliac fossa skin crease incision vs midline incision for left sided colorectal cancer. Tech Coloproctol. 2004;8:85–8.PubMedCrossRefGoogle Scholar
  49. 49.
    Gan TJ, Hardman D, Booth JV, Chitester C, Ray J, Mythen M, Glass PSA. Intraoperative volume expansion guided by esophageal Doppler reduces the incidence of gastric mucosal hypoperfusion and may be associated with an improved outcome following major surgery. Anesthesiology. 1997;87(3A):A391.CrossRefGoogle Scholar
  50. 50.
    Noblett SE, Snowden C, Shenton BK, Horgan AF. Randomised clinical trial assessing the effect of Doppler-optimized fluid management on outcome after elective colorectal surgery. Br J Surg. 2006;93:1069–76.PubMedCrossRefGoogle Scholar
  51. 51.
    Wakeling HG, McFall MR, Jenkins CS, Woods WGA, Miles WFA, Barclay GR, Fleming SC. Intraoperative oesophageal Doppler guided fluid management shortens postoperative hospital stay after major bowel surgery. Br J Anaesth. 2005;95(5):634–42.PubMedCrossRefGoogle Scholar
  52. 52.
    Kehlet H. Multimodal approach to control postoperative pathophysiology and rehabilitation. Br J Anaesth. 1997;78:606–17.PubMedGoogle Scholar
  53. 53.
    Kurz A, Lenhardt R. Perioperative normothermia to reduce incidence of wound infection and shorten hospitalisation. N Engl J Med. 1996;334:1209–15.PubMedCrossRefGoogle Scholar
  54. 54.
    Holte K, Kehlet H. Postoperative ileus: a preventable event. Br J Surg. 2000;87(11):1480–93.PubMedCrossRefGoogle Scholar
  55. 55.
    Karliczek A, Jesus E, Matos D, Castro AA, Atallah AN, Wiggers T. Drainage or nondrainage in elective colorectal anastomosis: a systematic review and meta-analysis. Colorectal Dis. 2006;8(4):259–65.PubMedCrossRefGoogle Scholar
  56. 56.
    Jesus EC, Karliczek A, Matos D, Castro AA, Atallah AN. Prophylactic anastomotic drainage for colorectal surgery. Cochrane Database Syst Rev. 2004;(4):CD002100. doi:1002/14651858.CD002100.pub2.Google Scholar
  57. 57.
    Kehlet H. Multimodal approach to control pathophysiology and rehabilitation. Br J Anaesthesia 1997;78:606–617.Google Scholar
  58. 58.
    Soop M, Carlson G, Hopkinson J, Clarke S, Thorell A, Nygren J, Lungqvist O. Randomised clinical trial of the effects of immediate enteral nutrition on metabolic responses to major colorectal surgery in an enhanced recovery protocol. Br J Surg. 2004;91:1138–45.PubMedCrossRefGoogle Scholar
  59. 59.
    Delaney CP, Wolff B, Viscussi ER, Senagore AJ, Fort JG, Du W, Techner L, Wallin B. Alvimopan for postoperative ileus following bowel resection: a pooled analysis of phase III studies. Ann Surg. 2007;245:355–63.PubMedCrossRefGoogle Scholar
  60. 60.
    Muehling B, Schelzig H, Steffen P, Meierhenrich R, Sunder-Plassmann L, Orend K. A prospective randomised trial comparing traditional and fast-track patient care in elective open infrarenal aneurysm repair. World J Surg. 2009;33:577–85.PubMedCrossRefGoogle Scholar
  61. 61.
    Balzano G, Zerbi A, Braga M, Rocchetti S, Beneduce AA, Di Carlo V. Fast-track recovery programme after pancreaticoduodenectomy reduces delayed gastric emptying. Br J Surg. 2008;95:1387–93.PubMedCrossRefGoogle Scholar
  62. 62.
    van Dam RM, Hendry P, Coolsen MME, Bemelmans MHA, Lassen K, Revhaug A, Fearon KCH, Garden OJ, Dejong CHC. Initial experience with a multimodal enhanced recovery programme in patients undergoing liver resection. Br J Surg. 2008;95(8):969–75.PubMedCrossRefGoogle Scholar
  63. 63.
    Kehlet H, Mogenson T. Hospital stay of 2 days after open sigmoid colectomy with a multimodal rehabilitation programme. Br J Surg. 1999;86(2):227–30.PubMedCrossRefGoogle Scholar
  64. 64.
    Levy BF, Scott MJ, Fawcett WJ, Rockall TA. 23-hour stay laparoscopic colectomy. Dis Colon Rectum. 2009;52(7):1239–43.PubMedCrossRefGoogle Scholar
  65. 65.
    Wind J, Polle SW, Fung Kon Jin PHP, Dejong CHC, Meyenfeldt MF, Ubbink DT, Gouma DJ, Bemelman WA. Systematic review of enhanced recovery programmes in colonic surgery. Br J Surg. 2006;93:800–9.PubMedCrossRefGoogle Scholar
  66. 66.
    Delaney CP, Fazio V, Senagore AJ, Robinson B, Halverson AL, Remzi FH. Fast-track postoperative management protocol for patients with high co-morbidity undergoing complex abdominal and pelvic colorectal surgery. Br J Surg. 2001;88:1533–8.PubMedCrossRefGoogle Scholar
  67. 67.
    Maessen J, Dejong CHC, Hausel J, Nygren J, Lassen K, Anderson J, Kessels AGH, Revhaug A, Kehlet H, Ljungqvist O, Fearon KCH, von Meyenfeldt MF. A protocol is not enough to implement an enhanced recovery programme for colorectal resection. Br J Surg. 2007;94:224–31.PubMedCrossRefGoogle Scholar

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© Springer-Verlag London Limited 2012

Authors and Affiliations

  1. 1.Department of SurgeryThe Newcastle upon Tyne Hospitals NHS Foundation TrustNewcastle upon TyneUK

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