Laparoscopic Approaches to Colonic Malignancy

  • L. Stocchi
  • Heidi Nelson


The last decade has witnessed the surge and success of laparoscopic approaches in several surgical arenas. Laparoscopic cholecystectomy has become the standard of care, Nissen fundoplication has replaced the open approach in many cases, and successful applications of the laparoscopic technique for splenectomy and adrenalectomy are increasingly reported. Although laparoscopic-assisted colectomy (LAC) has been shown to be technically safe and feasible, the laparoscopic approach to colonic malignancy remains controversial. Besides technical difficulties, the extent of patient-related benefits is unclear. In addition, concerns over the appropriateness of laparoscopic colectomy for cancer have been raised with regard to possible limitations in tumor staging, patterns of tumor recurrences related to the use of a pneumoperitoneum, and effective cost containment. The laparoscopic approach for palliative procedures appears attractive but has not been extensively reported. Therefore, it is increasingly clear that well-designed prospective randomized trials are necessary to support laparoscopic colectomy as an alternative technique for colon cancer. This chapter analyzes the technical aspects of laparoscopic colectomy as a cancer operation, discusses the results expected with LAC, addresses cancer staging and unusual patterns of tumor recurrence, and describes the design and purpose of the National Cancer Institute (NCI)-sponsored prospective randomized trial.


Laparoscopic Approach Laparoscopic Colectomy Laparoscopic Colorectal Surgery Open Colectomy Laparoscopic Ultrasonography 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.


  1. 1.
    Falk PM, Beart RW Jr, Wexner SD, et al. Laparoscopic colectomy: a critical appraisal. Dis Colon Rectum 1993; 36: 28–34.PubMedCrossRefGoogle Scholar
  2. 2.
    Peters WR, Bartels TL. Minimally invasive colectomy: are the potential benefits realized? Dis Colon Rectum 1993; 36: 751–756.PubMedCrossRefGoogle Scholar
  3. 3.
    Senagore AJ, Luchtefeld MA, Mackeigan JM, Ma- 17. zier WP. Open colectomy versus laparoscopic colectomy: are there differences? Am Surg 1993; 59: 549–553.PubMedGoogle Scholar
  4. 4.
    Hoffman GC, BakerJW, Fitchett CW, VansantJH. 18. Laparoscopic-assisted colectomy. Initial experience. Ann Surg 1994; 219: 732–740.PubMedCrossRefGoogle Scholar
  5. 5.
    Musser DJ, Boorse RC, Madera F, Reed JF 3rd. Laparoscopic colectomy: at what cost? Surg La 19. parosc Endosc 1994; 4: 1–5.Google Scholar
  6. 6.
    Lacy AM, Garcia-Valdecasas JC, Pique JM, et al. Short-term outcome analysis of a randomized study comparing laparoscopic vs open colectomy for colon cancer. Surg Endosc 1995; 9: 1101–20. 1105.Google Scholar
  7. 7.
    Saba AK, Kerlakian GM, Kasper GC, Hearn AT. Laparoscopic assisted colectomies versus open colectomy. J Laparosc Surg 1995; 5: 1–6.CrossRefGoogle Scholar
  8. 8.
    Franklin ME Jr, Rosenthal D, Abrego-Medina D, et al. Prospective comparison of open vs. laparoscopic colon surgery for carcinoma. Five-year results. Dis Colon Rectum 1996; 39: 535–46.CrossRefGoogle Scholar
  9. 9.
    Gellman L, Salky B, Edye M. Laparoscopic assisted colectomy. Surg Endosc 1996; 10: 1041–1044.PubMedCrossRefGoogle Scholar
  10. 10.
    Liberman MA, Phillips EH, Carroll BJ, Fallas M, Rosenthal R. Laparoscopic colectomy vs traditional colectomy for diverticulitis. Outcome and costs. Surg Endosc 1996; 10: 15–18.PubMedCrossRefGoogle Scholar
  11. 11.
    Lord SA, Larach SW, Ferrara A, Williamson PR, Lago CP, Lube MW. Laparoscopic resections for colorectal carcinoma. A three-year experience. Dis Colon Rectum 1996; 39: 148–154.PubMedCrossRefGoogle Scholar
  12. 12.
    Leung KL, Kwok SP, Lau WY, et al. Laparoscopicassisted resection of rectosigmoid carcinoma. Immediate and medium-term results. Arch Surg 1997; 132: 761–764.PubMedCrossRefGoogle Scholar
  13. 13.
    Milsom JW, Bohm B, Hammerhofer KA, Fazio V, Steiger E, Elson P. A prospective, randomized trial comparing laparoscopic versus conventional techniques in colorectal cancer surgery: a preliminary report. J Am Coll Surg 1998; 187: 46–54.PubMedCrossRefGoogle Scholar
  14. 14.
    Bouvet M, Mansfield PF, Skibber JM, et al. Clinical, pathologic, and economic parameters of laparoscopic colon resection for cancer. Am J Surg 1998; 176: 554–558.PubMedCrossRefGoogle Scholar
  15. 15.
    Khalili TM, Fleshner PR, HiattJR, et al. Colorectal cancer: comparison of laparoscopic with open approaches. Dis Colon Rectum 1998; 41: 832–838.PubMedCrossRefGoogle Scholar
  16. 16.
    Leung KL, Yiu RYC, Lai PBS, Lee JFY, Thung KH, Lau WY. Laparoscopic-assisted resection of colorectal carcinoma. Dis Colon Rectum 1999; 42: 327–333.PubMedCrossRefGoogle Scholar
  17. 17.
    Boulez J. Chirurgie du cancer colo-rectal par voie coelioscopique [Surgery of colorectal cancer by laparoscopic approach]. Ann Chir 1996; 50: 219–230.PubMedGoogle Scholar
  18. 18.
    Schwandner O, Schiedeck THK, Bruch HP. Advanced age-indication or contraindication for laparoscopic colorectal surgery? Dis Colon Rectum 1999; 42: 356–362.PubMedCrossRefGoogle Scholar
  19. 19.
    Stocchi L, Nelson H, Young-Fadok T, Larson D, Ilstrup D. Safety and advantages of laparoscopic vs. open colectomy in the elderly: matched-control study. Dis Colon Rectum 2000; 43: 326–332.PubMedCrossRefGoogle Scholar
  20. 20.
    Dean PA, Beart RW Jr, Nelson H, Elftmann TD, Schlinkert RT. Laparoscopic-assisted segmental colectomy: early Mayo Clinic experience. Mayo Clin Proc 1994; 69: 834–840.PubMedCrossRefGoogle Scholar
  21. 21.
    Lumley JW, Fielding GA, Rhodes M, Nathanson LK, Siu S, Stitz RW. Laparoscopic-assisted colorectal surgery. Lessons learned from 240 consecutive patients. Dis Colon Rectum 1996; 39: 155–159.PubMedCrossRefGoogle Scholar
  22. 22.
    Franklin ME Jr, Rosenthal D, Norem RF. Prospective evaluation of laparoscopic colon resection versus open colon resection for adenocarcinoma. A multicenter study. Surg Endosc 1995; 9: 811–816.PubMedGoogle Scholar
  23. 23.
    Schwenk W, Bohm B, Witt C, Junghans T, Grundel K, Muller JM. Pulmonary function following laparoscopic or conventional colorectal resection: a randomized controlled evaluation. Arch Surg 1999; 134: 6–12.PubMedCrossRefGoogle Scholar
  24. 24.
    Stevenson AR, Stitz RW, LumleyJW, Fielding GA. Laparoscopically assisted anterior resection for diverticular disease: follow-up of 100 consecutive patients. Arm Surg 1998; 227: 335–342.CrossRefGoogle Scholar
  25. 25.
    Levrant SG, Bieber EJ, Barnes RB. Anterior abdominal wall adhesions after laparotomy or laparoscopy. J Am Assoc Gynecol Laparosc 1997; 4: 353–356.PubMedCrossRefGoogle Scholar
  26. 26.
    Kloosterman T, von Blomberg BM, Borgstein P, Cuesta MA, Scheper RJ, Meijer S. Unimpaired immune functions after laparoscopic cholecystectomy. Surgery 1994; 115: 424–428.PubMedGoogle Scholar
  27. 27.
    Bessler M, Whelan RL, Halverson A, Treat MR, Nowygrod R. Is immune function better preserved after laparoscopic versus open colon resection? Surg Endosc 1994; 8: 881–883.PubMedCrossRefGoogle Scholar
  28. 28.
    Harmon GD, Senagore AJ, Kilbride MJ, Warzyn- 41. ski MJ. Interleukin-6 response to laparoscopic and open colectomy. Dis Colon Rectum 1994; 37: 754–759.PubMedCrossRefGoogle Scholar
  29. 29.
    Radice E, Young-Fadok TM, Nelson H. Benefits of laparoscopic stoma creation: a case-matched series. Gastroenterology 1998; 4: G0145.Google Scholar
  30. 30.
    Kockerling F, Reymond MA, Schneider C, et al. Prospective multicenter study of the quality of oncologie resections in patients undergoing laparoscopic colorectal surgery for cancer. The Laparoscopic Colorectal Surgery Study Group. Dis Colon Rectum 1998; 41: 963–970.PubMedCrossRefGoogle Scholar
  31. 31.
    Rosser JC Jr, Rosser LE, Savalgi RS. Objective evaluation of a laparoscopic surgical skill program for residents and senior surgeons. Arch Surg 1998; 133: 657–661.PubMedCrossRefGoogle Scholar
  32. 32.
    Slim K, Pezet D, Riff Y, Clark E, Chipponi J. High morbidity rate after converted laparoscopie colorectal surgery. Br J Surg 1995; 82: 1406–1408.PubMedCrossRefGoogle Scholar
  33. 33.
    Ramos JM, Beart RW Jr, 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
  34. 34.
    Van Ye TM, Cattey RP, Henry LG. Laparoscopically assisted colon resections compare favorably with open technique. Surg Laparos Endosc 1994; 4: 25–31.Google Scholar
  35. 35.
    Fine AP, Lanasa S, Gannon MP, Cline CW, James R. Laparoscopie colon surgery: report of a series. Am Surg 1995; 61: 412–416.PubMedGoogle Scholar
  36. 36.
    Tucker JG, Ambroze WL, Orangio GR, Duncan TD, Mason EM, Lucas GW. Laparoscopically assisted bowel surgery. Analysis of 114 cases. Surg Endosc 1995; 9: 297–300.PubMedCrossRefGoogle Scholar
  37. 37.
    Moore JW, Bokey EL, Newland RC, Chapuis PH. Lymphovascular clearance in laparoscopically as- 51. sisted right hemicolectomy is similar to open surgery. Aust NZ J Surg 1996; 66: 605–607.CrossRefGoogle Scholar
  38. 38.
    Stage JG, Schulze S, Moller P, et al. Prospective randomized study of laparoscopic versus open colonic resection for adenocarcinoma. Br J Surg 1997; 84: 391–396.PubMedCrossRefGoogle Scholar
  39. 39.
    Stocchi L, Nelson H, Young-Fadok T, Larson DR, Ilstrup DM. Laparoscopie ultrasonography: a developmental model. Dis Colon Rectum 1999; 42: A51.CrossRefGoogle Scholar
  40. 40.
    Milsom JW, Jerby BL, Kessler H, Hale J, Herts B, O'Malley C. Prospective blinded comparison of laparoscopic ultrasonography vs. contrast-enhanced computerized tomography for liver assessment in patients undergoing colorectal carcinoma surgery. Dis Colon Rectum 2000; 43: 44–49.PubMedCrossRefGoogle Scholar
  41. 41.
    Hartley JE, Kumar H, Drew PJ, Heer K. Avery GR, Cuthie GS, Monson JR. Laparoscopie ultrasound for the detection of hepatic metastases during laparoscopie colorectal cancer surgery. Dis Colon Rectum 2000; 43: 320–325.PubMedCrossRefGoogle Scholar
  42. 42.
    Berends FJ, Kazemier G, Bonjer HJ, Lange JE. Subcutaneous metastases after laparoscopie colectomy. Lancet 1994; 344: 58.PubMedCrossRefGoogle Scholar
  43. 43.
    Fleshman JW, Nelson H, Peters WR, et al. Early results of laparoscopie surgery for colorectal cancer. Retrospective analysis of 372 patients treated by Clinical Outcomes of Surgical Therapy (COST) Study Group. Dis Colon Rectum 1996; 39: S53–58.PubMedCrossRefGoogle Scholar
  44. 44.
    Stocchi L, Nelson H. Laparoscopie colectomy for colon cancer: trial update. J Surg Oncol 1998; 68: 255–267.PubMedCrossRefGoogle Scholar
  45. 45.
    Mehigan B, Hartley J, MacDonald A, Duthie G, Lee P, Monson J. Prospective trial of laparoscopie-assisted vs. conventional resection for colorectal cancer. Dis Colon Rectum 1999; 42: A20.Google Scholar
  46. 46.
    Lumley J, Stitz R, Stevenson A. Laparoscopie resection for cancer. Dis Colon Rectum 1999; 42: A21.Google Scholar
  47. 47.
    Jansen A. Laparoscopie-assisted colon resection. Evolution from an experimental technique to a standardized surgical procedure. Ann Chir Gynecol 1994; 83: 86–91.Google Scholar
  48. 48.
    Simons AJ, Anthone GJ, Ortega AE, et al. Laparoscopic-assisted colectomy learning curve. Dis Colon Rectum 1995; 38: 600–603.PubMedCrossRefGoogle Scholar
  49. 49.
    Wishner JD, Baker JW Jr, Hoffman GC, et al. Laparoscopic-assisted colectomy. The learning curve. Surg Endosc 1995; 9: 1179–1183.PubMedCrossRefGoogle Scholar
  50. 50.
    Stitz RW, Lumley JW. Laparoscopie colorectal surgery-new advances and techniques. Ann Acad Med Singapore 1996; 25: 653–656.PubMedGoogle Scholar
  51. 51.
    Agachan F, Joo JS, Sher M, Weiss EG, Nogueras JJ, Wexner SD. Laparoscopie colorectal surgery. Do we get faster? Surg Endosc 1997; 11: 331–335.PubMedCrossRefGoogle Scholar
  52. 52.
    Guillou PJ, Darzi A, Monson JR. Experience with laparoscopie colorectal surgery for malignant disease. Surg Oncol 1993; 2 (suppl 1): 43–49.PubMedCrossRefGoogle Scholar
  53. 53.
    Drouard F, Passone-Szerzyna N. Les greffes neoplasiques parietales en chirurgie laparoscopique colo-rectale. Communication III Symposium SFCE 1995; Bordeaux.Google Scholar
  54. 54.
    Hoffman GC, Baker JW, DoxeyJB, Hubbard GW, Ruffin WK, Wishner JA. Minimally invasive surgery for colorectal cancer. Initial follow-up. Ann Surg 1996; 223: 790–796.PubMedCrossRefGoogle Scholar
  55. 55.
    Kwok SP, Lau WY, Carey PD, Kelly SB, Leung KL, Li AK. Prospective evaluation of laparoscopicassisted large bowel excision for cancer. Ann Surg 1996; 223: 170–176.PubMedCrossRefGoogle Scholar
  56. 56.
    Lacy AM, Garcia-Valdecasas JC, Delgado S, et al. Postoperative complications of laparoscopicassisted colectomy. Surg Endosc 1997; 11: 119–122.PubMedCrossRefGoogle Scholar
  57. 57.
    Larach SW, Patankar SK, Ferrara A, Williamson PR, Perozo SE, Lord AS. Complications of laparoscopic colorectal surgery. Analysis and comparison of early vs. latter experience. Dis Colon Rectum 1997; 40: 592–596.PubMedCrossRefGoogle Scholar
  58. 58.
    Vukasin P, Ortega AE, Greene FL, et al. Wound recurrence following laparoscopic colon cancer resection. Results of the American Society of Colon and Rectal Surgeons Laparoscopic Registry. Dis Colon Rectum 1996; 39: S20–23.PubMedCrossRefGoogle Scholar
  59. 59.
    Fielding GA, Lumley J, Nathanson L, Hewitt P, Rhodes M, Stitz R. Laparoscopic colectomy. Surg Endosc 1997; 11: 745–749.PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media New York 2001

Authors and Affiliations

  • L. Stocchi
  • Heidi Nelson

There are no affiliations available

Personalised recommendations