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Laparoscopic resection of curable colon and rectal cancer: an evidence-based review

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Abstract

The initial enthusiastic application of laparoscopic techniques to colorectal surgical procedures was tempered in the early 1990s by reports of tumor implants in the laparoscopic incisions. Substantial evidence has accumulated, including evidence from randomized controlled trials, to support that laparoscopic resection results in oncologic outcomes similar to open resection, when performed by well-trained, experienced surgeons. This review was developed in conjunction with guidelines published by the Society of American Gastrointestinal and Endoscopic Surgeons. Data from the surgical literature concerning laparoscopic resection of curable colorectal cancer was evaluated regarding diagnostic evaluation, preoperative preparation, operative techniques, prevention of tumor implants, and training and experience. Recommendations are accompanied by an assessment of the level of supporting evidence available at the time of the development of the guidelines.

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References

  1. Guidelines for laparoscopic resection of curable colon and rectal cancer. SAGES publication #32, July 2005. http://sages.org/publications.html#guide

  2. Simmang CL, Senatore P, Lowry A, Hicks T, Burnstein M, Dentsman F, Fazio V, Glennon E, Hyman N, Kerner B, Kilkenny J, Moore R, Peters W, Ross T, Savoca P, Vernava A, Wong WD (1999) Practice parameters for detection of colorectal neoplasms. Dis Colon Rectum 42: 1123–1129

    Article  PubMed  CAS  Google Scholar 

  3. Winawer S, Fletcher R, Rex D, Bond J, Burt R, Ferrucci J, Ganiats T, Levin T, Woolf S, Johnson D, Kirk L, Litin S, Simmang C, Gastrointestinal Consortium Panel (2005) Colorectal cancer screening and surveillance: clinical guidelines and rationale: update based on new evidence. Gastroenterol 124: 544–560

    Article  Google Scholar 

  4. Otchy D, Hyman NH, Simmang C, Anthony T, Buie WD, Cataldo P, Church J, Cohen J, Dentsman F, Ellis CN, Kilkenny JW III, Ko C, Moore R, Orsay C, Place R, Rafferty J, Rakinic J, Savoca P, Tjandra J, Whiteford M, Standards Practice Task force (2004) Practice parameters for colon cancer. Dis Colon Rectum 47: 1269–1284

    Article  PubMed  Google Scholar 

  5. Larach SW, Patankar SK, Ferrara A, Williamson PR, Perozo SE, Lord AS (1997) Complications of laparoscopic colorectal surgery: analysis and comparison of early vs latter experience. Dis Colon Rectum 40: 592–596

    Article  PubMed  CAS  Google Scholar 

  6. Piscatelli N, Hyman N, Osler T (2005) Localizing colorectal cancer by colonoscopy. Arch Surg 140: 932–935

    Article  PubMed  Google Scholar 

  7. Feingold DL, Addona T, Forde KA, Arnell TD, Carter JJ, Huang EH, Whelan RL (2004) Safety and reliability of tattooing colorectal neoplasms prior to laparoscopic resection. J Gastrointest Surg 8: 543–546

    Article  PubMed  Google Scholar 

  8. Ashar BH, Hughes MT, Marinopoulos SS, Prokopowicz GP, Berkenblit GV, Sisson SD, Simonson LA, Miller RG (2005) Current evidence for the use of emerging radiologic technologies for disease screening. Am J Manag Care 11: 385–392

    PubMed  Google Scholar 

  9. Banarjee S, Van Dam J (2006) CT colongraphy for colon cancer screening. Gastrointest Endosc 63: 121–133

    Article  Google Scholar 

  10. Ward J, Naik KS, Guthrie JA, Wilson D, Robinson PJ (1999) Hepatic lesion detection: comparison of MR imaging after the administration of superparamagnetic iron oxide with dual-phase CT by using alternative-free response receiver operating characteristic analysis. Radiology 210: 459–466

    PubMed  CAS  Google Scholar 

  11. Nelson H, The Clinical Outcomes of Surgical Therapy Study Group (2004) A comparison of laparoscopically assisted and open colectomy for colon cancer. N Eng J Med 350: 2050–2059

    Article  CAS  Google Scholar 

  12. Abel ME, Rosen L, Kodner IJ, et al. (1993) Practice parameters for the treatment of rectal carcinoma. Dis Colon Rectum 36: 989–1006

    Article  Google Scholar 

  13. Platell C, Hall J (1998) What is the role of mechanical bowel preparation in patients undergoing colorectal surgery? Dis Colon Rectum 41: 875–882

    Article  PubMed  CAS  Google Scholar 

  14. Fa-Si-Oen P, Roumen R, Buitenweg J, van de Velde C, van Geldere D, Putter H, Verwaest C, Verhoef L, de Waard JW, Swank D, D'Hoore A, Croiset van Uchelen F (2005) Mechanical bowel preparation or not? Outcome of a multicenter, randomized trial in elective open colon surgery. Dis Colon Rectum 48:1509–1516

    Article  PubMed  Google Scholar 

  15. Burke P, Mealy K, Gillen P, Joyce W, Traynor O, Hayland J (1994) Requirement for bowel preparation in colorectal surgery. Br J Surg 81:580–581

    Article  Google Scholar 

  16. Santos JC Jr, Batista J, Sirimarco MT, Guimaraes AS, Levy CE (1994) Prospective randomized trial of mechanical bowel preparation in patients undergoing elective colorectal surgery. Br J Surg 81: 1673–1676

    Article  PubMed  Google Scholar 

  17. Miettinen RP, Laitinen ST, Makela JT, Paakkonen ME (2000) Bowel preparation with oral polyethylene glycol electrolyte solution vs no preparation in elective open colorectal surgery: prospective, randomized study. Dis Colon Rectum 43: 669–677

    Article  PubMed  CAS  Google Scholar 

  18. Zmora O, Mahajna A, Bar-Zakai B, Rosin D, Hershko D, Shabtai M, Krausz MM, Ayalon A (2003) Colon and rectal surgery without mechanical bowel preparation: randomized prospective trial. Ann Surg 237: 363–367

    Article  PubMed  Google Scholar 

  19. Franklin ME Jr, Rosenthal D, Abrego-Medina D, Dorman JP, Glass JL, Norem R, Diaz A (1996) Prospective comparison of open vs laparoscopic colon surgery for carcinoma: five-year results. Dis Colon Rectum 39: S35–S46

    Article  PubMed  Google Scholar 

  20. Nelson H, Petrelli N, Carlin A, Couture J, Fleshman J, Guillem J, Miedema B, Ota D, Sargent D, National Cancer Institute Expert Panel (2001) Guidelines 2000 for colon and rectal cancer surgery. J Natl Cancer Inst 93: 583–596

    Article  PubMed  CAS  Google Scholar 

  21. Lacy AM, Garcia-Valdecasas JC, Delgado S, Castells A, Taura P, Pique JM, Visa J (2002) Laparoscopy-assisted colectomy versus open colectomy for treatment of nonmetastatic colon cancer: a randomised trial. Lancet 359: 2224–2229

    Article  PubMed  Google Scholar 

  22. Stocchi L, Nelson H (1998) Laparoscopic colectomy for colon cancer: trial update. J Surg Oncol 68: 255–267

    Article  PubMed  CAS  Google Scholar 

  23. Tjandra JJ, Kilkenny JW, Buie WD, Hyman N, Simmang C, Anthony T, Orsay C, Church J, Otchy D, Cohen J, Place R, Denstman F, Rakinic J, Moore R, Whiteford M, The Standards Practice Task Force, The American Society of Colon and Rectal Surgeons (2005) Practice parameters for the management of rectal cancer. Dis Colon Rectum 48: 411–423

    Article  PubMed  Google Scholar 

  24. Wu WX, Sun YM, Hua YB, Shen LZ (2004) Laparoscopic versus conventional open resection of rectal carcinoma: a clinical comparative study. World J Gastroenterol 10: 1167–1170

    PubMed  Google Scholar 

  25. Tsang WW, Chung CC, Li MK (2003) Prospective evaluation of laparoscopic total mesorectal excision with colonic J-pouch reconstruction for mid and low rectal cancers. Br J Surg 90: 867–871

    Article  PubMed  CAS  Google Scholar 

  26. Leroy J, Jamali F, Forbes L, Smith M, Rubino F, Mutter D, Marescaux J (2004) Laparoscopic total mesorectal excision (TME) for rectal cancer surgery: long-term outcomes. Surg Endosc 18: 281–289

    Article  PubMed  CAS  Google Scholar 

  27. Anthuber M, Fuerst A, Elser F, Berger R, Jauch KW (2003) Outcome of laparoscopic surgery for rectal cancer in 101 patients. Dis Colon Rectum 46: 1047–1053

    Article  PubMed  Google Scholar 

  28. Veldkamp R, Gholghesaei M, Bonjer HJ, Meijer DW, Buunen M, Jeekel J, Anderberg B, Cuesta MA, Cuschierl A, Fingerhut A, Fleshman JW, Guillou PJ, Haglind E, Himpens J, Jacobi CA, Jakimowicz JJ, Koeckerling F, Lacy AM, Lezoche E, Monson JR, Morino M, Neugebauer E, Wexner SD, Whelan RL, European Association of Endoscopic Surgery (EAES) (2004) Laparoscopic resection of colon cancer. Consensus of the European Association of Endoscopic Surgery. Surg Endosc 18: 1163–1185

    Article  PubMed  CAS  Google Scholar 

  29. Slanetz CA Jr (1984) The effect of inadvertent perforation on survival and recurrence in colorectal cancer. Dis Colon Rectum 27: 792–797

    Article  PubMed  Google Scholar 

  30. Turnbull RB Jr, Kyle K, Watson FR, Spratt J (1967) Cancer of the colon: the influence of the no-touch isolation technique on survival rates. Ann Surg 166: 420–427

    Article  PubMed  Google Scholar 

  31. Wiggers T, Jeekel J, Arends JW, Brinkhorst AP, Kluck HM, Luyk CI, Munting JD, Povel JA, Rutten AP, Volovics A, et al. (1988) No-touch isolation technique in colon cancer: a controlled prospective trial. Br J Surg 75: 409–415

    Article  PubMed  CAS  Google Scholar 

  32. Berends FJ, Kazemier G, Bonjer HJ, Lange JF (1994) Subcutaneous metastases after laparoscopic colectomy. Lancet 344: 58

    Article  PubMed  CAS  Google Scholar 

  33. Johnstone PAS, Rohde DC, Swartz SE, Fetter JE, Wexner SD (1996) Port-site recurrences after laparoscopic and thoracoscopic procedures in malignancy. J Clin Oncol 14: 1950–1956

    PubMed  CAS  Google Scholar 

  34. Cirocco WC, Schwartzman A, Golub RW (1994) Abdominal wall recurrence after laparoscopic colectomy for colon cancer. Surgery 116: 842–846

    PubMed  CAS  Google Scholar 

  35. Kirman I, Poltaratskaia N, Cekic V, Forde KA, Ansari P, Boulay C, Whelan RL (2004) Depletion of circulating insulin-like growth factor binding protein 3 after open surgery is associated with high interleukin-6 levels. Dis Colon Rectum 47: 911–917; discussion 917–918

    Article  PubMed  Google Scholar 

  36. Lee SW, Feingold DL, Carter JJ, Zhai C, Stapleton G, Gleason N, Whelan RL (2003) Peritoneal macrophage and blood monocyte functions after open and laparoscopic-assisted cecectomy in rats. Surg Endosc 17: 1996–2002

    Article  PubMed  CAS  Google Scholar 

  37. Carter JJ, Feingold DL, Kirman I, Oh A, Wildbrett P, Asi Z, Fowler R, Huang E, Whelan RL (2003) Laparoscopic-assisted cecectomy is associated with decreased formation of postoperative pulmonary metastases compared with open cecectomy in a murine model. Surgery 134: 432–436

    Article  PubMed  Google Scholar 

  38. Whelan RL, Franklin M, Holubar SD, Donahue J, Fowler R, Munger C, Doorman J, Balli JE, Glass J, Gonzalez JJ, Bessler M, Xie H, Treat M (2003) Postoperative cell-mediated immune response is better preserved after laparoscopic vs open colorectal resection in humans. Surg Endosc 17: 972–978

    Article  PubMed  CAS  Google Scholar 

  39. Lee SW, Gleason N, Blanco I, Asi ZK, Whelan RL (2002) Higher colon cancer tumor proliferative index and lower tumor cell death rate in mice undergoing laparotomy versus insufflation. Surg Endosc 16: 36–39

    Article  PubMed  CAS  Google Scholar 

  40. Carter JJ, Whelan RL (2001) The immunologic consequences of laparoscopy in oncology. Surg Oncol Clin North Am 10: 655–677

    CAS  Google Scholar 

  41. Whelan RL, Lee SW (1999) Review of investigations regarding the etiology of port-site tumor recurrence. J Laparoendosc Adv Surg Techniques Part A 9: 1–16

    Article  CAS  Google Scholar 

  42. Allendorf JD, Bessler M, Horvath KD, Marvin MR, Laird DA, Whelan RL (1999) Increased tumor establishment and growth after open vs laparoscopic surgery in mice may be related to differences in postoperative T-cell function. Surg Endosc 13: 233–235

    Article  PubMed  CAS  Google Scholar 

  43. Whelan RL, Allendorf JD, Gutt CN, Jacobi CA, Mutter D, Dorrance HR, Bessler M, Bonjer HJ (1998) General oncologic effects of the laparoscopic surgical approach. 1997 Frankfurt international meeting of animal laparoscopic researchers. Surg Endosc 12: 1092–1095

    Article  PubMed  CAS  Google Scholar 

  44. Southall JC, Lee SW, Allendorf JD, Bessler M, Whelan RL (1998) Colon adenocarcinoma and B-16 melanoma grow larger following laparotomy vs pneumoperitoneum in a murine model. Dis Colon Rectum 41: 564–569

    Article  PubMed  CAS  Google Scholar 

  45. Bouvy ND, Marquet RL, Jeekel H, Bonjer HJ (1996) Impact of gas(less) laparoscopy and laparotomy on peritoneal tumor growth and abdominal wall metastases. Ann Surg 224: 694–700

    Article  PubMed  CAS  Google Scholar 

  46. Watson DI, Mathew G, Ellis T, Baigrie CF, Rofe AM, Jamieson GG (1997) Gasless laparoscopy may reduce the risk of port-site metastases following laparoscopic tumor surgery. Arch Surg 132: 166–168

    PubMed  CAS  Google Scholar 

  47. Gutt CN, Riemer V, Kim ZG, Jacobi CA, Paolucci V, Lorenz M (1999) Impact of laparoscopic colonic resection on tumour growth and spread in an experimental model. Br J Surg 86: 1180–1184

    Article  PubMed  CAS  Google Scholar 

  48. Iwanaka T, Arya G, Ziegler MM (1998) Mechanism and prevention of port-site tumor recurrence after laparoscopy in a murine model. J Pediatr Surg 33: 457–461

    Article  PubMed  CAS  Google Scholar 

  49. Wittich P, Steyerberg EW, Simons SH, Marquet RL, Bonjer HJ (2000) Intraperitoneal tumor growth is influenced by pressure of carbon dioxide pneumoperitoneum. Surg Endosc 14: 817–819

    Article  PubMed  CAS  Google Scholar 

  50. Jacobi CA, Sterzel A, Braumann C, Halle E, Stosslein R, Krahenbuhl L, Muller JM (2001) The impact of conventional and laparoscopic colon resection (CO2 or helium) on intraperitoneal adhesion formation in a rat peritonitis model. Surg Endosc 15: 380–386

    Article  PubMed  CAS  Google Scholar 

  51. Neuhaus SJ, Ellis T, Rofe AM, Pike GK, Jamieson GG, Watson DI (1998) Tumor implantation following laparoscopy using different insufflation gases. Surg Endosc 12: 1300–1302

    Article  PubMed  CAS  Google Scholar 

  52. Jacobi CA, Wildbrett P, Volk T, Muller JM (1999) Influence of different gases and intraperitoneal instillation of antiadherent or cytotoxic agents on peritoneal tumor cell growth and implantation with laparoscopic surgery in a rat model. Surg Endosc 13: 1021–1025

    Article  PubMed  CAS  Google Scholar 

  53. Bouvy ND, Giuffrida MC, Tseng LN, Steyerberg EW, Marquet RL, Jeekel H, Bonjer HJ (1998) Effects of carbon dioxide pneumoperitoneum, air pneumoperitoneum, and gasless laparoscopy on body weight and tumor growth. Arch Surg 133: 652–656

    Article  PubMed  CAS  Google Scholar 

  54. Wu JS, Guo LW, Ruiz MB, Pfister SM, Connett JM, Fleshman JW (1998) Excision of trocar sites reduces tumor implantation in an animal model. Dis Colon Rectum 41: 1107–1111

    Article  PubMed  CAS  Google Scholar 

  55. Watson DI, Ellis T, Leeder PC, Neuhaus SJ, Dodd T, Jamieson GG (2003) Excision of laparoscopic port sites increases the likelihood of wound metastases in an experimental model. Surg Endosc 17: 83–85

    Article  PubMed  CAS  Google Scholar 

  56. Wittich P, Marquet RL, Kazemier G, Bonjer HJ (2000) Port-site metastases after CO2 laparoscopy: is aerosolization of tumor cells a pivotal factor? Surg Endosc 14: 189–192

    Article  PubMed  CAS  Google Scholar 

  57. Whelan RL, Sellers GJ, Allendorf JD, Laird D, Bessler MD, Nowygrod R, Treat MR (1996) Trocar-site recurrence is unlikely to result from aerosolization of tumor cells. Dis Colon Rectum 39: S7–S13

    Article  PubMed  CAS  Google Scholar 

  58. Tseng LN, Berends FJ, Wittich P, Bouvy ND, Marquet RL, Kazemier G, Bonjer HJ (1998) Port-site metastases: impact of local tissue trauma and gas leakage. Surg Endosc 12: 1377–1380

    Article  PubMed  CAS  Google Scholar 

  59. Neuhaus SJ, Watson DI, Ellis T, Rofe AM, Jamieson GG (1999) Influence of cytotoxic agents on intraperitoneal tumor implantation after laparoscopy. Dis Colon Rectum 42: 10–15

    Article  PubMed  CAS  Google Scholar 

  60. Lee SW, Gleason NR, Bessler M, Whelan RL (1999) Peritoneal irrigation with povidone-iodine solution after laparoscopic-assisted splenectomy significantly decreases port-tumor recurrence in a murine model. Dis Colon Rectum 42: 319–326

    Article  PubMed  CAS  Google Scholar 

  61. Neuhaus SJ, Ellis T, Jamieson GG, Watson DI (1999) Experimental study of the effect of intraperitoneal heparin on tumour implantation following laparoscopy. Br J Surg 86: 400–404

    Article  PubMed  CAS  Google Scholar 

  62. Braumann C, Ordemann J, Wildbrett P, Jacobi CA (2000) Influence of intraperitoneal and systemic application of taurolidine and taurolidine/heparin during laparoscopy on intraperitoneal and subcutaneous tumour growth in rats. Clin J Exp Metastasis 18: 547–552

    Article  CAS  Google Scholar 

  63. Jacobi CA, Peter FJ, Wenger FA, Ordemann J, Muller JM (1999) New therapeutic strategies to avoid intra- and extraperitoneal metastases during laparoscopy: results of a tumor model in the rat. Dig Surg 16: 393–399

    Article  PubMed  CAS  Google Scholar 

  64. Eshraghi N, Swanstrom LL, Bax T, Jobe B, Horvath K, Sheppard B, Deveney C (1999) Topical treatments of laparoscopic port sites can decrease the incidence of incision metastasis. Surg Endosc 13: 1121–1124

    Article  PubMed  CAS  Google Scholar 

  65. Fleshman JW, Nelson H, Peters WR, Kim HC, Larach S, Boorse RR, Ambroze W, Leggett P, Bleday R, Stryker S, Christenson B, Wexner S, Senagore A, Rattner D, Sutton J, Fine AP (1996) Early results of laparoscopic surgery for colorectal cancer: retrospective analysis of 372 patients treated by Clinical Outcomes of Surgical Therapy (COST) Study Group. Dis Colon Rectum 39(Suppl): S53–S58

    Article  PubMed  CAS  Google Scholar 

  66. Reilly WT, Nelson H, Schroeder G, Wieand HS, Bolton J, O’Connell MJ (1996) Wound recurrence following conventional treatment of colorectal cancer: a rare but perhaps underestimated problem. Dis Colon Rectum 39: 200–207

    Article  PubMed  CAS  Google Scholar 

  67. Nelson H, Weeks JC, Wieand HS (1995) Proposed phase II trial comparing laparoscopic-assisted colectomy versus open colectomy for colon cancer. In: Journal of the National Cancer Institute monographs. No. 19. Bethesda, MD: National Cancer Institute, 51-6 (NIH publication no. 94-03839)

  68. Wishner JD, Baker JW Jr, Hoffman GC, Hubbard GW II, Gould RJ, Wohlgemuth SD, Ruffin WK, Melick CF (1995) Laparoscopic-assisted colectomy: the learning curve. Surg Endosc 9: 1179–1183

    Article  PubMed  CAS  Google Scholar 

  69. Lumley JW, Fielding GA, Rhodes M, Nathanson LK, Siu S, Stitz RW (1996) Laparoscopic-assisted colorectal surgery: lessons learned from 240 consecutive patients. Dis Colon Rectum 39: 155–159

    Article  PubMed  CAS  Google Scholar 

  70. Kuhry E, Bonjer HJ, Haglind E, Hop WC, Veldkamp R, Cuesta MA, Jeekel J, Pahlman L, Morino M, Lacy A, Delgado S, COLOR Study Group (2005) Impact of hospital case volume on short-term outcome after laparoscopic operation for colonic cancer. Surg Endosc 19: 687–692

    Article  PubMed  CAS  Google Scholar 

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Authors and Affiliations

  1. Division of Colon and Rectal Surgery, Mayo Clinic, Scottsdale, Arizona, United States

    T. M. Young-Fadok MD, MS, FACS, FASCRS Chair & D. B. Earle MD, FACS

  2. Surgical Endoscopy, Berkshire Medical Center, Pittsfield, MA, USA

    R. D. Fanelli MD, FACS

  3. Department of Surgery, University of Massachusetts Medical School, Pittsfield, MA, USA

    R. D. Fanelli MD, FACS

  4. Surgical Education, LDS Hospital, Saltlake city, Utah, USA

    R. R. Price MD, FACS

  5. Intermountain Healthcare, University of Utah, Saltlake city, Utah, USA

    R. R. Price MD, FACS

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  1. T. M. Young-Fadok MD, MS, FACS, FASCRS Chair
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  2. R. D. Fanelli MD, FACS
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  3. R. R. Price MD, FACS
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  4. D. B. Earle MD, FACS
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Correspondence to T. M. Young-Fadok MD, MS, FACS, FASCRS Chair.

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Young-Fadok, T.M., Fanelli, R.D., Price, R.R. et al. Laparoscopic resection of curable colon and rectal cancer: an evidence-based review. Surg Endosc 21, 1063–1068 (2007). https://doi.org/10.1007/s00464-006-9172-x

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