Five-year results of 206 laparoscopic left colectomies for cancer

The purpose of this study was to evaluate the 5-year survival of 206 consecutive patients with left colon carcinoma operated with a laparoscopic procedure between March 1992 and December 2000.

Patients with obstructing or bulky cancers were excluded from this study. Tumor stage was defined according to the Dukes modified classification. The laparoscopic-assisted technique included primary high vascular ligation, centrifugal dissection of the mesentery, and "no touch" technique. The survival rates were calculated with the Kaplan-Meier test.

There were 109 males and 97 females, median age 67 (range 34-91). There were 30 left hemicolectomies (15%) and 177 sigmoid colectomies (85%). 22 patients required open conversion (11%). Overall operative mortality (1 month) was 1% and morbidity 12% (surgical and medical). There were 56 Dukes A carcinomas (27%), 69 Dukes B (34%), 54 Dukes C (26%), and 27 Dukes D (13%). 125 patients (61%) are alive and disease free, 22 (11%) are alive with disease recurrence, and 59 patients (28%) are deceased. None have been lost to follow-up. Only 1 case of trocar site implantation occurred after curative resections. Three-year observed survival rate were 93% for Dukes A + B (node negative tumors confined to the bowel wall), 78% for Dukes C, and 15% for Dukes D. The 5-year survival rates were 85% for Dukes A + B, 61% for Dukes C, and 8% for Dukes D.

Laparoscopic colectomy for cancer seems to be a safe procedure. The long-term results are comparable to those of open surgery. Further randomized trials will be necessary to confirm the value of this technique.