Laparoscopy for Colon Cancer: State of the Art

Minimally invasive surgery has rapidly evolved in the past 2 decades, revolutionizing surgical practice such that laparoscopic techniques are now favored for common abdominal procedures. The same has been true for laparoscopic colectomy, with the exception of the indication of colon cancer. When laparoscopic surgery was first considered in the early 1990s, several oncologic concerns were raised. Early reports of wound tumor implants raised the question of whether it was appropriate to implement laparoscopic techniques, particularly pneumoperitoneum, in cases in which a patient has potentially curable disease. Additional questions regarded the adequacy of laparoscopic surgery in achieving a proper oncologic resection, in particular, lymph node harvest, exploration of the abdomen, and general staging. Little was known about whether laparoscopy would alter the patterns of tumor cell dissemination. Despite these concerns, patients expressed strong interest in this new, minimally invasive approach to colon resection. The possibility of benefits continued to drive laparoscopic surgery into surgical oncology. After several years of study, the risk/ benefit discussion can be finalized with respect to laparoscopic colectomy for curable cancer. This article discusses results from several large, international, prospective, randomized trials addressing 3 key questions. First, why have thousands of patients accepted participation in a laparoscopic trial knowing that they might have an inferior oncologic result? Second, what oncologic lessons have been learned from so many years of clinical trials? And third, what are the current technical approaches that are in use, and what does the future hold for new advances in robotics and natural-orifice surgery? WHY HAVE PATIENTS PARTICIPATED IN LAPAROSCOPIC COLECTOMY TRIALS?