[Present status and problems of laparoscopic surgery for colorectal cancer, especially indications and limitations]

Ten years have passed since laparoscopic surgery for colorectal cancer was performed for the first time in Japan. Health insurance has covered laparoscopic surgery for every stage of colorectal cancer since April 2002, indicating that this method will become an established operative procedure in the 21st century. As lymph node dissection is performed not only in D1 or D1 + alpha but also in D2 or D3, this method is being used in advanced as well as early cancers. When extensive colorectal resection with appropriate lymph node dissection is performed in laparoscopic surgery, the laparoscopic mobilization of the colon and rectum and lymph node dissection are essential points, which require understanding of the anatomic characteristics of the colon and rectum. It is generally recognized that there is no difference in D3 lymph node dissection except for no. 223 and in lateral lymph node dissection between this method and the conventional method. However, this method involves various problems such as intraoperative accidents, difficulties in lymph node dissection and rectal exfoliation and excision, cost-effect issues, technical problems, port site recurrences, and long-term prognosis. The most decisive factor in the future development of this method is the concern about long-term prognosis. The results of a randomized controlled trial conducted in the USA/Europe will have considerable effect in determining the indications for this method. Care should be taken not to expand the indications for laparoscopic surgery in the absence of skilled techniques.