Laparoscopy in Colonic Cancer

Abstract

This is the era of minimally invasive surgery which has been extended to cancer surgeries as well because laparoscopic surgery better preserves the oncologic and immunologic functions. Laparoscopic surgery for colonic cancer dates back to 1990, yet its widespread use is not uniform or universal possibly because of the concerns on oncological clearance, long learning curve, long operative times, more complications in the form of bleeding and bowel injury, extremes of positions needed for colonic resections with laparoscopy and high conversion rates due to tumour fixity. The feasibility and safety of laparoscopic surgery for colon cancer with comparable short- and long-term outcomes have been demonstrated in the various randomized controlled trials like COST (Clinical Outcomes of Surgical Therapies) and COLOR (Colon Cancer Laparoscopic or Open Resection). Proper case selection and appropriate preparation and use of different laparoscopic techniques can make the use of laparoscopy in colonic cancer more widespread. For case selection, though studies have shown laparoscopic resection of T4a lesions, these tumors have been classified as high-risk cases and considered as contraindication for laparoscopic surgery according to National Comprehensive Cancer Network (NCCN); hence, early cancers are better dealt with laparoscopy. For preoperative preparation, proper tumour localization and bowel preparation followed by use of surgical techniques like complete laparoscopic resection, laparoscopic-assisted and laparoscopic-facilitated resections should be used depending on case and expertise. Standardization of procedures and formalized training of surgeons would be useful in extending its widespread use across institutions.