Abstract
Colon cancer is a major public health problem. The treatment of colon cancer is primarily surgical using open and minimally invasive techniques. Minimally invasive surgery approaches for colon cancer include single-port laparoscopy, natural orifice transluminal endoscopic surgery, and robotic-assisted laparoscopic surgery. The techniques are based on the same principles: complete mesocolic excision, high vascular ligation, and extended lymphadenectomy. Laparoscopic surgery is characterized by short hospital stay, reduced postoperative pain, and less need for painkillers. Laparoscopic resections are less expensive than open surgery, but with similar quality of life outcomes. Robotic surgery is an alternative to open and laparoscopic techniques. This type of surgery results in a lower conversion rate and a shorter learning curve than laparoscopic surgery. When comparing the clinical outcomes of laparoscopic surgery versus open surgery no difference in disease free survival and overall survival were found. This article shows the role of minimally invasive surgery in colon cancer, the clinical outcomes of laparoscopic and open colon being similar.
Highlights
Jacobs et al are the first to report a laparoscopic colectomy in 1991 [1]
The safety and efficacy of single-incision laparoscopic resection in stage IV colorectal cancer patients was assessed in a study and the results showed no significant differences in intra- and postoperative complications, 30day mortality rate, total lymph nodes, and postoperative hospital stay compared to the control group [27]
The results showed no significant differences between the two types of surgery in overall mortality (p=0.23), total recurrence rate (p=0.24), 5-year disease-free interval (P=0.96) and 5-year overall survival (P=0.55)
Summary
Jacobs et al are the first to report a laparoscopic colectomy in 1991 [1]. The use of laparoscopy in colorectal cancer has been slower paced, though with a lower rate than for cholecystectomy. The safety and efficacy of single-incision laparoscopic resection in stage IV colorectal cancer patients was assessed in a study and the results showed no significant differences in intra- and postoperative complications, 30day mortality rate, total lymph nodes, and postoperative hospital stay compared to the control group [27]. The results showed no significant differences between the two types of surgery in overall mortality (p=0.23), total recurrence rate (p=0.24), 5-year disease-free interval (P=0.96) and 5-year overall survival (P=0.55) This meta-analysis suggests that laparoscopy was as effective and safe as open surgery in colon cancer [50]. A prospective randomized study investigated the effect of surgery on intestinal permeability, endotoxemia, and bacterial translocation in patients undergoing elective colectomy for colon cancer by comparing classical and laparoscopic surgery It showed an increase in all monitored parameters, but without statistically significant differences between the two groups [54]. Hypercapnia can cause acidosis, arrhythmia, hypotension, myocardial ischemia, and cardiocirculatory arrest [56] and even acute respiratory failure despite endotracheal intubation [57]
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