Authors' objectives:

The aim of this study is to assess the benefit of laparoscopic surgery for colorectal cancer rather than open surgery (the current standard approach).

Authors' results and conclusions: Oncological efficacy: In colon cancer, 4-year survival and recurrence rates were similar after laparoscopic and open surgery. In colorectal cancer, quality of resection (resection margins and lymph node clearance) and risk of wound recurrence were also similar for both techniques. Technical efficacy: In colorectal cancer, pain, ileus, reduced postoperative respiratory function and blood loss were lower after laparoscopy than after open surgery although the clinical relevance of these observations is debatable. The technique used had little effect on changes in immune response. Hospital stay was shorter after laparoscopy. Safety in colorectal cancer: Data were insufficient to judge peroperative mortality. Morbidity rates for laparoscopy and open surgery were similar. Technical results: The percentage of conversions after laparoscopy for colorectal cancer was in the range 5-20%. Laparoscopy took longer than open surgery. Specific results for rectal cancer: There are insufficient data relating to rectal cancer to allow any conclusion, even in terms of short-term results.

Authors' recommendations: In conclusion, oncological results for laparoscopic and open surgery of colorectal cancer are similar. The short-term benefits obtained with laparoscopy appear to be minor in terms of medical service delivered. Absence of data makes it impossible to judge the medical service delivered in the longer term. The main needs identified by the working group were: - establishing a regional cancer registry; - producing a standardised single document for multidisciplinary cancer units;- drawing up standardised trial protocols (learned societies); - cost analysis studies that include quality of life; - specific randomised controlled trials in rectal cancer and right colon cancer, to provide a definitive response regarding technique for these two indications, and specific trials in left colon cancer, to standardise the technique; - an assessment by the colleges of the experience required for performing laparoscopy, of training methods and continuing medical education.

Authors' methods: Systematic review

Project Status: Completed

URL for project: http://www.has-Sante.fr/

Year Published: 2005

English language abstract: An English language summary is available

Publication Type: Not Assigned

Country: France

Organisation Name: Haute Autorité de Santé

Contact Address: 2 avenue du Stade de France, 93218 Saint-Denis La Plaine Cedex, France. Tel: +33 01 55 93 71 88; Fax: +33 01 55 93 74 35;

Contact Name: has.seap.secretariat@has-sante.fr

Contact Email: has.seap.secretariat@has-sante.fr

Copyright: Haute Autorite de Sante/French National Authority for Health (HAS)