Laparoscopic treatment of colorectal neoplasia

A recent major advance in the surgical treatment of colorectal cancer has been the introduction of laparoscopic surgery. Laparoscopic colectomy is associated with decreased postoperative pain, faster ileus resolution, shorter hospital stay, improved cosmesis, and decreased morbidity when compared with open colectomy. However, early reports of high rates of laparoscopic wound metastases gave rise to questions regarding the adequacy of the laparoscopic technique for curative resection of malignancies. These concerns over oncologic outcomes are addressed by several single and multi-institutional randomized trials in the United States and throughout the world that have compared laparoscopic-assisted colectomy with conventional open colectomy. These studies have established both the short- and long-term safety and oncologic efficacy of laparoscopic colectomy for cancer. To ensure successful outcomes, surgeons performing laparoscopic colectomy should be adequately experienced. Limitations include the technical requirements of advanced laparoscopic skills and training, increased operative time, and equipment costs. Despite these limitations, patient recovery benefits may offset the increased operative costs and result in improved outcome overall.