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Japanese Journal of Clinical Oncology Advance Access published online on June 25, 2009
Japanese Journal of Clinical Oncology, doi:10.1093/jjco/hyp063
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© The Author (2009). Published by Oxford University Press. All rights reserved

Clinical Evidences of Laparoscopic Versus Open Surgery for Colorectal Cancer

Masafumi Inomata, Kazuhiro Yasuda, Norio Shiraishi and Seigo Kitano

Department of Gastroenterological Surgery, Oita University Faculty of Medicine, Oita, Japan

For reprints and all correspondence: Masafumi Inomata, Department of Gastroenterological Surgery, Oita University Faculty of Medicine, 1-1 Idaigaoka, Hasama-machi, Oita 879-5593, Japan. E-mail: inomata{at}med.oita-u.ac.jp

Received February 18, 2009; accepted May 12, 2009

Laparoscopic surgery has widely spread in the treatment of colorectal cancer. In Japan, a nation-wide survey has shown that a rate of advanced colorectal cancer has increased gradually and reached 65% of the total cases for colorectal cancer in 2007. For colon cancer, many randomized controlled trials regarding short-term outcome demonstrate that laparoscopic surgery is feasible, safe and has many benefits including reduction in a peri-operative mortality. In terms of long-term outcome, four randomized controlled trials insist that there are no differences in both laparoscopic and open surgeries. However, there are still more important issues including long-term oncological outcome for advanced colon cancer, cost effectiveness and the impact on quality of life of patients. Meanwhile, for rectal cancer, a controversy persists with regard to the appropriateness of laparoscopic surgery because of concerns over the safety of the procedure and a necessity of lateral lymph node dissection for lower rectal cancer. In the present, laparoscopic surgery is acceptable for Stage I colon cancer, whereas there are controversies for Stage II/III colon cancer and each staged rectal cancer because of inadequate clinical evidences. Whether laparoscopic surgery further spreads to be applied for colorectal cancer or not, it would be confirmed by Japanese large-scale phase III trial (JCOG0404) estimating oncological outcome for Stage II/III colon cancer and a Phase II trial estimating the feasibility for Stage 0/I rectal cancer in near future.

Key Words: laparoscopic surgery • colorectal cancer • randomized controlled trial • multicenter study


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