| Laparoscopic surgery has many advantages such as minor invasion, less trauma, better recuperation when compared with traditional surgery. This procedure has been performed widely for cholecystectomy and gradually for appendectomy, splenectomy, nephrectomy, hysterectomy, et al. Abundant literature had confirmed the feasibility of this method as used for the colon cancer. And a reduction of complication of this method had been seen. However some controversy still remained, mainly about the effect of this method for the colon cancer. The thoroughness of laparoscopic procedure, recurrence rate and survival rate of patients versus open procedure need further investigation. Can laparoscopic procedure comply with the "no tumor principle"? Will it lead to the spread of cancer? In order to evaluate the effect of laparoscopic colonectomy for colon cancer, we investigate two unrandomized groups, one group of patients underwent laparoscopic procedures, and the other underwent open procedures. The pathologic examination of the specimens, the recuperation and prognosis of their patients werecompared.Cases and MethodsPatients with colon cancer who underwent radical resection during January 2000 to January 2004 in Sir Run Run Shaw Hospital (Medical College of Zhejiang University) were enrolled. Patients were ruled out when they had one of the following items: palliative resection, emergency operation for bowel obstruction, abdominal operation before, combined operation of partial hepatectomy for liver metastasis. The patients were distributed to one of the two groups according to their own choices after introducing them both open and laparoscopic procedures in detail. All the operations were performed by two attending doctors. In order to ensure the radical treatment, both laparoscopic and open procedures following the approaches of sequential exploration, incision protection, ligate the proximal and distal intestine before disection, avoid direct tumor pressing and lymphodectomy for around mesentery vessels. Specimens were sent to pathological department after operations. The size, infiltration depth, margins, total and positive lymph nodes of each specimen were recorded. Patients were followed up according their addresses and telephone Letters were adopted as a supplement.Results141 cases of colon cancer underwent operations during January 2000 to January 2004. 102 cases were finally enrolled to our research according to the case selecting criteria while 39 cases were eliminated. 47 cases underwent laparoscopic procedures and 55 cases underwent open procedures. No difference was seen between the two groups on their age and gender. The laparoscopic group had a longer mean operation time than the open group (182±62min VS 140.7±36.7min, P<0.05). With gradually development of laparoscopic procedure, operation time decreased obviously (203.1±71.4min of the early 20 cases VS 161.9±54.3min of the late 20cases, P<0.05). Patients of the laparoscopic group had shorter hospital stays. There were no differences with lymph nodes numbers and margins between the two groups. The laparoscopic group had a mean lymph nodes of 12.3 while the open group had 14 (P>0.05). All margins were negative. No substantial differences with Dukes staging between two groups. The patients were followed up ranged from 12-48 months, with a losing rate of 2.1% (1/47) and 3.6% (2/55) respectively. No incision metastasis was observed. The two groups had similar rates of local recurrence and distal metastasis.ConclusionLaparoscopic radical resection of colon cancer have minor invasion and better recuperation than open procedure. There were similar in the local recurrence rate and distal metastasis after surgery of the two methods.
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