Authors
Baiju Senadhipan, MS, MNAMS, MCh (Gastro), Consultant Surgical Gastroenterologist and Laparoscopic Surgeon, Holy Cross Hospital, Kollam
Abstract
Background: Though laparoscopy was introduced decades ago, its role in colorectal surgery was not well established for want of better skills and technology. Recent increases in reports and trials now provide sufficient data to support its role.
Rationale: This article examines the advantages of laparoscopy in the management of colorectal cancer, comparing its safety, oncological clearance, effects on the immune system, and long-term outcomes with conventional surgical procedures.
Findings: Studies confirm laparoscopic surgery is as safe as open surgery, offering short-term benefits such as decreased pain, shorter hospital stays, and early return to work. Oncological clearance, concerning lymph node extraction and resection margins, has been shown to be comparable. While the immunological benefits remain debated, some research suggests less immunosuppression with laparoscopic methods. Initial fears of port-site metastasis have largely subsided, with current incidences being low and similar to incisional recurrences in open surgery, especially with proper precautions. Numerous randomized controlled trials (e.g., Barcelona, COST, COLOR, MRC CLASICC) have demonstrated equivalent morbidity, mortality, oncologic outcomes, recurrence rates, and overall and disease-free survival rates, often with improved short-term patient benefits.
Conclusion: Given that laparoscopic colorectal cancer surgery offers equivalent morbidity, mortality, oncological clearance, and long-term survival compared to open surgery, it should be offered to patients to provide the added benefits of decreased pain, reduced hospital stay, less disability, early return to work, and better cosmetic results, provided the procedure is performed by adequately trained surgeons.