Short-term benefits for laparoscopic colorectal resection

Colorectal cancer is one of the most common cancers in industrialised countries, in both female and male persons. Treatment involves surgical removal (resection) of the segment of the bowel containing the tumor and wide tumorfree margins. Lymph nodes in the area are also removed (lymphadendectomy). conventional surgery which is the mainstream treatment of colorectal cancer and has good survival rates for stage-1 tumors. Other diseases that can require removal of sections of the large bowel include inflammatory diseases such as diverticulitis, Crohn's disease, ulcerative colitis, familial adenomatous polyposis (FAP) and rectal prolapse.
The conventional approach to surgery involves making a cut through the abdominal wall. For many people it is now possible to use video-endoscopic surgery (laparoscopy), which may have short term advantages that include less pain, better pulmonary function, shorter time for return of bowel function (duration of postoperative ileus), less fatigue, better quality of life and improved convalescence. However, the procedure is complex and for colorectal cancer the oncological long-term results on survival not known.
The review authors identified 25 controlled trials in which 3526 men and women were randomized to one surgical technique or the other. Colorectal resection was most often required for colorectal carcinoma. Overall, laparoscopic colon resections showed advantages over conventional surgery. Blood loss was a little less (by 113 to 31 ml, mean 72 ml); pain, which was treated with epidural or patient-controlled on demand analgesia, was less intense; time to return of bowel function was less, by about one day; lung function was improved with reduced postoperative stay in hospital (by 1.4 days) and improved quality of life in the first 30 days. The operation time was longer with laparoscopic surgery than with conventional surgery (by 42 minutes, range 30 to 55 minutes). Re-operation was not more likely after laparoscopic surgery and general complications in the lungs, heart, urinary tract or deep vein thrombosis (DVT) were similar with the two surgery techniques. Wound infections were less in laparoscopic patients. Some patients are not suitable for laparoscopy.