Laparoscopic Surgery For Colon And Rectal Cancer (pp. 209-240)
Authors: Zmora,Oded and Rosin, Danny (Tel Aviv University, Tel Aviv, Israel)
Abstract: The application of laparoscopic techniques for curative resection of colorectal cancer is controversial, mainly owing to reports of cancer recurrence at the port site wounds. Despite research efforts of clinical studies and animal models, neither the actual rate nor the mechanisms causing port site metastasis are known. In this review, we gathered data from clinical series of laparoscopic surgery for colorectal cancer, having more then 50 patients each. The port site recurrence in 3901 patients participated in these series was approximately 0.67%. Although the methods and patient selection in these studies varies, this numbers may be comparable to the incidence reported for other malignancies, and in laparotomies for colorectal cancer. This chapter reviews the technical aspects relative to laparoscopic resection of colorectal cancer, and summarizes the research regarding the potential causes for port site metastasis, and suggested protective measures. This review suggests that wound recurrence may possibly be a result of an unfortunate learning curve, rather then an inherited concern. The final results of the large randomized studies will hopefully solve this question in the near future.