Evidence demonstrates short-term benefits of laparoscopic surgery for colon cancer. The situation for rectal cancer is less clear.
This review assessed the use and short-term outcomes of elective open and laparoscopic colon and rectal cancer resections within an area health service.
This was a multicenter, retrospective review of a prospective database.
All elective colon and rectal cancer resections in the western zone of Sydney South West Area Health Service from 2001 until 2008 were included.
Included were 1721 patients who underwent either a laparoscopic colon (n = 434) or rectal (n = 157) resection or an open colon (n = 742) or rectal (n = 388) resection.
Outcome measures included operating time, blood loss, adequacy of resection, conversion rate, intensive care unit admission, length of stay, and 26 acute postoperative complications.
Patients were matched for age, sex, ASA, BMI, and tumor stage. Laparoscopic surgery increased in frequency. Fewer patients experienced a complication in both the laparoscopic colon (28.8 vs 54.4%; p < 0.0001) and rectal (41.4 vs 60.3%; p < 0.0001) group irrespective of age. Laparoscopic operating time for colon and rectal cancer was 24.1 minutes (p < 0.0001) and 25.8 minutes (p < 0.0001) longer, with a low conversion-to-open rate (6.5% and 8.3%; p = 0.44). Laparoscopic surgery resulted in fewer transfusions (0.4 vs 0.7units; p = 0.0028) and length of stay (7 vs 10 days; p = 0.0011) for colon cancers, and reduced intraoperative hemoglobin drop (20.5 vs 24.8; p = 0.029) and intensive care unit admissions (26.8 vs 36.3%; p = 0.032) for rectal cancers.
This was a nonrandomized study with rectal cancers more often resected with the open technique (71.2 vs 28.8%; p < 0.001).
Within an area health service, elective laparoscopic resection for colon and rectal cancer had improved short-term outcomes in comparison with open surgery.
1 Division of Surgery, Bankstown Hospital, Bankstown, NSW, Australia
2 Division of Surgery, Fairfield Hospital, Prairiewood, NSW, Australia
3 Division of Surgery, Campbelltown Hospital, Campbelltown, NSW, Australia
4 Division of Surgery, Liverpool Hospital, Liverpool, NSW, Australia
5 Faculty of Surgery, University of Sydney, NSW, Australia
6 Clinical Cancer Registry, Sydney South West Area Health Service, Liverpool, Sydney, NSW, Australia
Financial Disclosures: None reported.
Presented at the Cairns Tripartite Colorectal meeting, Cairns, NSW, Australia, July 4 to 7, 2011.
Correspondence: Gary McKay, B.Med., F.R.A.C.S., Department of Surgery, Bankstown Hospital, NSW, 2200, Australia. E-mail: email@example.com