Five-year Results of 206 Laparoscopic Left Colectomies for Cancer

Background: 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.

Methods: 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.

Results: 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.

Conclusion: 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.