Laparoscopic colorectal cancer surgery

Colorectal cancer: current care, future innovations and economic considerations

For those involved in colorectal cancer management, the present day is an exciting time. There is a multitude of new techniques to be considered for early detection (screening). National population screening for 60-69-year olds in England is due to start this year. Also, minimally invasive surgical techniques and multimodal pathways of care are aiding faster recovery, and there are increasing options for both adjuvant and palliative therapies. This article summarizes how colorectal cancer is currently managed in the UK and discusses the developments that are in the early stages of clinical use or on the horizon. Current management is discussed in detail in the hope that innovators reading the article may identify areas for improvement and allow comparison of new interventions with what are currently the gold standards. As changes are moving so fast, this review will probably only relate to the next 10 years at most. It does not provide a detailed reference list to support all therapies but indicates the key publications that will enable more detailed reading.

Results of laparoscopic surgery for colorectal cancer in palliative intent: short-term end points in 331 patients in comparison with procedures in benign indications

BACKGROUND AND AIMS

Colorectal surgery performed in palliative intent is a relatively common intervention. The present study investigates the question whether such interventions are suitable for laparoscopic procedure.

PATIENTS AND METHODS

The data presented herein were collected from 4834 patients within the framework of a multicenter study initiated by the "Laparoscopic Colorectal Surgery Study Group (LCSSG)." In a subgroup analysis of 331 operated palliative-intent patients, the short-term outcomes were evaluated and compared with those obtained in patients undergoing surgery for benign indications.

RESULTS

Overall, the morbidity and mortality rates were significantly higher in the cancer patients than in patients with a benign indication, with no significant differences between the 2 groups in terms of intraoperative complications, conversion, and reoperation rates. The analysis of the individual complications revealed that the significant differences were due exclusively to the more frequent presence of general medical complications, and thus were unrelated to the laparoscopic procedure.

CONCLUSIONS

The laparoscopic approach to the palliation of incurable colorectal carcinomas was associated with comparable results with regard to intraoperative complications, conversion, reoperation rates, and postoperative surgical complications in comparison with surgical procedures for benign indications, with significantly higher morbidity and mortality rates related solely to general-medical complications.