Laparoscopic Surgery for Advanced Colorectal Cancer: Selection Criteria and Exclusion Factors in our department

Introduction: Laparoscopic assisted colectomy (LAC) for early colorectal cancer has been established and been proven to be equivalent to open colectomy in terms of survival and safety. Although the indications for LAC in advanced colorectal cancer remain controversial, LAC has been performed increasingly often. Purpose: To clarify the selection criteria of laparoscopic surgery for advanced colorectal cancer. Methods: The indications for laparoscopic surgery in advanced colorectal cancer were established from 2001∼2004, as: 1) the cecum, ascending colon, descending colon, sigmoid colon, and rectosigmoid colon, 2) tumor depth within the subserosa, 3) no regional lymph node involvement, and 4) no distant metastasis. Indications established from 2005 to 2007 were: 1) all colorectal cancer with none in the lower rectum, 2) no distant metastasis, and 3) no direct invasion to neighboring organs. The reasons to exclude indications and the exclusion factors for laparoscopic colectomy for advanced colorectal cancer were analyzed. Results: The percentage of cases consistent with the indications were 55% (2001∼2004) and 78% (2005∼2007). The reasons for exclusion were liver metastasis (19% and 40%), tumor location (33% and 37%), direct invasion to the neighboring organs (21% and 17%), and peritoneal dissemination (3% and 6%). The exclusion factors for laparoscopic colectomy were tumor size (31% and 27%), synchronous malignancies (11% and 26%), ileus and emergencies (17% and 14%), history of previous abdominal surgery (15% and 14%), age and general condition (17% and 9%), and obesity (8% and 5%). There was no significant difference between the short-term performance of LAC from 2001∼2004 and from 2005 to 2007. Operation time, blood loss, conversion rate to open surgery and postoperative complications were similar between the patients with a body mass index (BMI) less than 25 and those with a body mass index greater than 25. Conclusion: Practical indications for LAC in advanced colorectal cancer are 1) all colorectal cancer with none in the lower rectum, 2) no distant metastasis, and 3) no direct invasion to neighbouring organs. Obesity is not necessarily an exclusion factor for LAC. However long-term analysis is still necessary.