Laparoscopic Sigmoid Resection for Cancer

Abstract

PURPOSE: Despite reservations about compliance with oncologic radical criteria, laparoscopic resection of the sigmoid colon is increasingly being used with curative intent in oncologic surgery of the colorectum. The aim of the present study was to obtain further information on the perioperative course, the oncologic radicalness of the procedure, and medium-term outcome. METHODS: The data presented here were obtained from a prospective, multicenter study conducted in Germany and Austria. These data were acquired from an analysis of subgroups derived from a total of 3,133 recruited patients. RESULTS: A total of 292 patients from 36 hospitals underwent laparoscopic resection of the sigmoid colon with curative intent. The definitive histopathologic work-up of surgical specimens revealed the following International Union Against Cancer tumor stages: 122 Stage I, 86 Stage II, and 84 Stage III. The mean operating time was 172 minutes, and the mean intraoperative blood loss was 241 ml. The conversion rate to open surgery was 5.5 percent, the majority of such conversions being made necessary by vascular lesions. Sixty-five of the patients reported at least one postoperative problem or complication (22.3 percent); the mortality rate was 2.7 percent. With a mean of 13.4 recovered lymph nodes and a mean aboral safety margin of 72 mm, the formal criteria for the assessment of oncologic radicalness were met. Intraoperative cell dissemination occurred in two patients. The long-term results, which, at a mean follow-up of 2.1 years and a follow-up rate of 73.3 percent, must be considered preliminary, show a calculated stage-related survival rate of 88.8, 90.9, and 64.1 percent, respectively, for the International Union Against Cancer Stages I, II, and III. CONCLUSIONS: Laparoscopic sigmoid resection can be performed technically reliably—also with curative intent—with acceptable complication and mortality rates and, to date, with survival rates that are at least comparable with those achieved with open surgical procedures.