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WJOLS
Laparoscopy in Colorectal Malignancies: Current Concepts
REVIEW ARTICLE
Laparoscopy in Colorectal Malignancies:

Current Concepts

Kaundinya Kiran Bharatam

Surgical Registrar, Global Hospitals, Hyderabad, Andhra Pradesh, India
Correspondence: Kaundinya Kiran Bharatam, Surgical Registrar, Global Hospitals, Hyderabad, Andhra Pradesh, India
e-mail: kaundinyakiran@gmail.com

Abstract
Laparoscopic surgery has widely spread in the treatment of colorectal cancer. For colorectal cancers, many randomized controlled
trials regarding short-term outcome demonstrate that laparoscopic surgery is feasible, safe and has many benefits including reduction
in a perioperative mortality. In terms of long-term outcome, four randomized controlled trials insist that there are no differences in both
laparoscopic and open surgeries proving oncologic safety and that the long-term outcome is at least not inferior to open resection.
However, there are still more important issues including long-term oncological outcome for advanced colon cancer, costeffectiveness
and the impact on quality of life of patients.
Keywords: Colorectal malignancies, laparoscopy in colorectal malignancies, cancer sigmoid colon, rectal cancer.

INTRODUCTION study, number of cases, methods of analysis, and institutions
where studies were conducted.
After the acceptance of laparoscopy as the gold standard
management for cholelithiasis, more and more thoughts are
VARIOUS OPERATIVE TECHNIQUES AVAILABLE
now being directed towards the use of laparoscopy in
colorectal cancer surgery. Advantages of laparoscopic The learning curve for laparoscopic colorectal cancer
surgery like less postoperative pain, shorter hospital stay, surgery is estimated to be 35 to 50 procedures. As mentioned
decreased incidence of paralytic ileus, improved cosmesis, the 3 minimally invasive techniques used to resect the colon/
less intraoperative blood loss, decreased use of narcotics, rectum are:
and fewer postoperative wound complications have been – Laparoscopic colorectal surgery, in which the mesentry
the driving force of this consideration. 1-3 But concerns and the bowel are mobilized and transected
remain regarding potential violation of principles of oncologic laparoscopically. The anastomosis of the colon/rectum
surgery, technical aspects of performing the procedure, is done intracorporeally or extracorporeally. The
adequate staging capability, and existing learning curves. 4,5 specimen is removed from the abdomen via a small
Port-site recurrences were the major setback in the use of extraction incision, often the same incision through
laparoscopy for colorectal malignancies. Hence investigators which the anastomosis may be performed or via the
embarked on conducting multicentric randomized controlled perineal wound created in perineal dissection of the rectal
trials to compare the effect of laparoscopic colorectal mobilization.
surgery and open surgery for colorectal malignancy in terms – Laparoscopic-assisted colorectal surgery is executed
with full laparoscopic mobilization of the colon and
of recurrence and survival.
rectum followed by externalization of the bowel through
a small incision. The resection and the anastomosis is
MATERIALS AND METHODS
done extracorporeally.
A literature search was performed using Medline and search – Hand-assisted laparoscopic colorectal surgery is a hybrid
engine Google. The following search terms were used that shares techniques of laparoscopic and open surgery,
“laparoscopy” and “colorectal malignancies”. More than a hand port is used to aid in the retraction, mobilization,
1500 citations were found. Selected papers were screened and dissection of the bowel. The actual resection and
for further references. Criteria for selection was year of anastomosis of the colon can be performed as in a

World Journal of Laparoscopic Surgery, January-April 2010;3(1):27-30 27