• J E Hartley, B J Mehigan, A W MacDonald, P W Lee, and J R Monson.
• University of Hull, Academic Surgical Unit, Castle Hill Hospital, Cottingham, East Yorkshire, United Kingdom.
• Ann. Surg. 2000 Aug 1; 232 (2): 181186181-6.

ObjectiveTo determine whether survival and recurrence after laparoscopic-assisted surgery for colorectal cancer is compromised by an initial laparoscopic approach.Summary Background DataLaparoscopic colorectal resection for malignancy remains controversial 8 years after its first description. Fears regarding compromised oncologic principles and early recurrence (particularly the phenomenon of port-site metastases) have tempered enthusiasm for this approach. Long-term follow-up data are at present scarce.MethodsA prospective comparative trial was undertaken between December 1993 and May 1996, during which 114 patients had laparoscopic-assisted resection by a single laparoscopic colorectal surgeon or conventional open surgery by a second specialist colorectal surgeon. Intensive follow-up for at least 2 years is available on 109 patients. Analysis was performed on an intention-to-treat basis.ResultsRecurrent disease has developed in 27 patients (25%), 16 of 57 in the laparoscopic group (28%) and 11 of 52 in the conventional group (21%). Crude death rates are 26/57 (46%) in the laparoscopic group and 24/52 (46%) in the conventional group. No port-site metastases have occurred; however, wound metastases associated with disseminated disease have developed in three patients in the open group and one in the laparoscopic group. Stage-for-stage survival and recurrence figures are comparable.ConclusionOncologic outcome at a minimum of 2 years is not compromised by the laparoscopic approach. Wound recurrences are a feature of laparoscopic and conventional surgery for advanced disease.

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