EXPERIENCE IN INTRODUCING LAPAROSCOPIC TECHNOLOGIES INTO COLORECTAL CANCER SURGERY

Background. Although minimally invasive surgery has undoubted advantages, the proportion of endovideosurgical interventions in the treatment of patients with colorectal cancer (CRC) remains insignificant and indications for their application have not been defined until the present time. The authors describe their experience with laparoscopic CRC surgery.

Objective and methods. 132 endovideosurgical interventions and 143 open surgeries for рТ2–4N0–2М0–1а CRC were performed for 25 months of surgical practice. The above patient groups were assessed for body index, patient age, comorbidity severity (CR-ROSSUM scale), T index, number of lymph nodes removed, blood loss, operation time, and complication rate and pattern. The learning curve was studied from the duration of each type of laparoscopic surgery.

Results. No significant differences were found between the groups in the ratio of surgery types, the number of lymph nodes removed, and the rate of complications. More significant blood loss and a larger number of postoperative wound infections were seen in the patients who had been operated on through open access with the significantly shorter duration of open surgery. All the types of laparoscopic surgery for CRC are characterized by a marked learning curve, except for those for rectal resection with total mesorectumectomy.

Conclusion. Laparoscopic surgery for CRC compares well with routine surgery. The principles of laparoscopic resections should be employed in CRC and open surgery. It is possible and necessary to more extensively use endovideosurgical techniques.

1. Clinical Outcomes of Surgical Therapy Study Group. A comparison of laparoscopically assisted and open colectomy for colon cancer. N Engl J Med 2004;350(20):2050–9.

2. Veldkamp R., Kuhry E., Hop W.C. et al. Laparoscopic surgery versus open surgery for colon cancer: short-term outcomes of a randomised trial. Lancet Oncol 2005;6(7): 477–84.

3. Guillou P.J., Quirke P., Thorpe H. et al. Short-term endpoints of conventional versus laparoscopic-assisted surgery in patients with colorectal cancer (MRC CLASICC trial): multicentre, randomised controlled trial. Lancet 2005 May 14–20;365(9472):1718–26.

4. van der Pas M.H., Haglind E., Cuesta M.A. et al. Laparoscopic versus open surgery for rectal cancer (COLOR II): short-term outcomes of a randomised, phase 3 trial. Lancet Oncol 2013;14(3):210–8.

5. Kang S.B., Park J.W., Jeong S.Y. et al. Open versus laparoscopic surgery for mid or low rectal cancer after neoadjuvant chemoradiotherapy (COREAN trial): short-term outcomes of an open-label randomised controlled trial. Lancet Oncol 2010;11(7): 637–45.

6. Jeong S., Park J., Nam B. et al. Open versus laparoscopic surgery for mid-rectal or low-rectal cancer after neoadjuvant chemoradiotherapy (COREAN trial): survival outcomes of an openlabel, non-inferiority, randomised controlled trial. Lancet Oncol 2014 May;15(7):767–74.

7. Green B., Marshall H., Collinson F. et al. Long-term follow-up of the Medical Research Council CLASICC trial of conventional versus laparoscopically assisted resection in colorectal cancer. Br J Surg 2013;100(1):75–82.