Lap Assisted Colorectal Resections for Cancer

After over a decade of debate and controversy, it is now well established that laparoscopic colon surgery for cancer when compared with open surgery, results in short-term benefits while maintaining at least equivalent long-term outcomes. Consequently, more and more patients are undergoing laparoscopic colon surgery, but the adoption rate still remains relatively low. Similarly, there are many potential benefits to performing rectal surgery laparoscopically. Laparoscopic rectal surgery is under active investigation and may result in the usual short-term benefits associated with laparoscopic surgery.

Laparoscopy for colon cancer

Purported benefits of laparoscopic surgery include decreased pain, shorter length of stay, quicker return of bowel function, quicker recovery, and decreased wound infection rate. These are justification enough for performing laparoscopic surgery for benign indications but prior to its application for cancer, at least equivalent long-term oncologic outcomes must be demonstrated.

Hand-Assisted Laparoscopic Surgery

One way to potentially decrease operative time while maintaining benefits of laparoscopic surgery may be to use hand-assisted laparoscopic technique. Hand-assisted laparoscopic devices allow placement of a hand into the abdomen while maintaining pneumoperitoneum. This allows preservation of proprioception and tactile feedback and ability to perform manual dissection and retraction.

Laparoscopy for rectal cancer

There are many potential benefits to performing rectal surgery laparoscopically. Recent meta-analysis of studies of nonrandomized trials comparing laparoscopic versus open surgery showed the usual benefits associated with laparoscopy after laparoscopic rectal surgery for cancer: shorter time to bowel function and shorter length of stay. In addition, compared with open surgery, laparoscopy can provide unprecedented, unobstructed views of the rectal dissection planes even in a patient with a narrow pelvis, not only for the surgeon but to the entire surgical team. Magnified views of the surgical planes may allow more precise dissection. The pneumoperitoneum can also help open up the planes for mobilization of the mesorectum.

Hand-Assisted Laparoscopic Surgery

In efforts to retain the benefits of laparoscopic surgery while not compromising oncologic rectal dissection, some have advocated performing hybrid procedures in which colonic portion of the surgery is performed using the pure laparoscopic technique and rectal dissection is performed open through a limited low midline or Pfannenstiel incision.

Outcomes

Laparoscopic colon surgery for cancer has become the gold standard. Laparoscopic colon resection for cancer, in experienced hands, can be performed safely and reliably with many short-term benefits to the patients while resulting in at least equivalent long-term outcomes as open surgery. Other potential, but less conclusively demonstrated benefits include better preservation of cell-mediated immune function and reduced tumor cell proliferation.