| Background: Despite the theoretical advantages of laparoscopic surgery, it is stillnot considered the standard treatment for colorectal cancer patients because of criticismconcerning oncologic stability. This study aimed at comparing the clinical efficacyresults of laparoscopic-assisted versus open radical resection for colorectal cancer and atinvestigating the feasibility, oncologic safety, and any potential advantages anddisadvantages of laparoscopic-assisted radical resection of colorectal cancer.Material and Methods: We retrospectively analyzed a database containing theinformation about patients who underwent surgery for colorectal cancer from January2010to January2013at our hospital. The database was consisted of80cases oflaparoscopic surgery（laparoscopic group）and80cases of traditional open surgery（opengroup). The clinical data of two groups no significant difference. Use the method ofclinical comparative study, for the laparoscopic group and open group of clinicalindicators, surgery-related parameters, oncology indicators and follow-up indicators,such as comparative analysis conducted to determine the feasibility, oncologic safety,and any potential advantages and disadvantages of laparoscopic-assisted resection ofcolorectal cancer.Results: All parents by laparoscopic-assisted radical resection of colorectal cancerwere successfully completed and one case converted to open surgery. There was nointraoperative deaths in the two groups. The rate of conversion to open surgery is1.25%.The two groups were statistically similar regarding age, sex, tumor site, ASAclassification, BMI, preoperative co-morbid diseases and TNM stage(P>0.05).Thepatients who underwent the laparoscopic-assisted procedure showed a significantlybetter than those who underwent open surgery, namely, less blood loss(97.3±9.97ml vs221.3±37.46, P=0.002), time to flatus(2.3±0.12d vs3.8±0.17d, P=0.000), time to bowelmovement(3.4±0.28d vs4.9±0.18, P=0.009), time to intake liquid diet(3.7±0.15d vs 4.3±0.19d, P=0.015), earlier ambulation time(1.6±0.11d vs2.2±0.17, P=0.006), smallerlength of the incision(5.0±0.18cm vs19.9±0.62cm, P=0.000) and shorter postoperativehospital stay(10.7±0.59d vs12.4±0.67d, P=0.007), however, laparoscopic colorectalsurgery caused longer operative time(201.7±6.91min vs177.2±7.21min, P=0.015),leading to higher surgery spends (0.8±0.31*104yuan vs0.4±0.10*104yuan, P=0.003)and hospitalization costs(4.8±1.1*104yuan vs3.2±0.75*104yuan, P=0.000), comparedwith patients who underwent open surgery. There was no statistically significant inpostoperative spends(1.0±0.37*104yuan vs1.1±0.62*104yuan, P=0.372) and surgicalapproaches(2=0.499, P=0.416) between the two groups. The wound infection rate inlaparoscopic group was lower than open group(3.75%vs12.5%，P=0.043). Theincidence of postoperative complications(17.5%vs36.25%，P=0.032) in laparoscopicgroup was lower than open group, but there was no significant difference in theincidence of intraoperative complications(2.5%vs7.5%, P=0.147). There was nostatistical difference in oncology indicators, such as tumor size(4.8±0.21cm vs5.2±0.24cm, P=0.251), colon specimen length(25.33±3.0cm vs21.4±1.8cm, P=0.247),rectal specimen length(17.6±1.0cm vs15.6±0.92cm, P=0.174), colon distal mangindistance(10.9±0.77cm vs11.2±0.59cm, P=0.705), rectal distal mangindistance(3.1±0.16cm vs2.8±0.12cm, P=0.190), number of lymph nodessampled(10.9±0.95piece vs12.2±1.17piece, P=0.363) or number of positive lymphnodes(1.7±0.37piece vs1.1±0.28piece, P=0.246) between the two groups.Followed-up time in the two groups including80cases in laparoscopic group and80cases in open group is3to39months, average16.7months. There was no difference inthe local recurrence rate(5%vs3.75%, P=0.699) and distant metastasis rate(3.75%vs5%, P=0.699). No differences were found in overall survival(P=0.894) and disease-freesurvival(P=0.701).Conclusions:1. Laparoscopic-assisted colorectal cancer surgery is safe andfeasible.2. Laparoscopic-assisted radical resection of colorectal cancer has clearadvantages of minimally invasive, it also exists some disadvantages, such as longeroperation time, higher surgery spends and hospitalization costs, however, thesedisadvantages will be eliminated by the improvement of laparoscopic techniques andequipment and the depth of the health care reform.3. Laparoscopic-assisted cancersurgery can reduce the incidence of postoperative complications, especially lower theincidence of wound infection.4. Laparoscopic colorectal cancer procedure can followthe principles of radical tumor which were consistent with open surgery.5. Laparoscopic colorectal cancer surgery had similar rates of local recurrence and distantmetastasis compared to open surgery.6. Laparoscopic colorectal cancer procedure hadsimilar overall survival and disease-free survival compared to open surgery. |
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