Evaluation of surgical stress in laparoscopic-assisted colectomy for advanced colorectal cancer

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  • YOSHIKAWA SEIICHIRO
    Department of Surgery, Juntendo University Urayasu Hospital, Juntendo University, School of Medicine
  • KIDOKORO AKIO
    Department of Surgery, Juntendo University Urayasu Hospital, Juntendo University, School of Medicine
  • FUKUNAGA MASAKI
    Department of Surgery, Juntendo University Urayasu Hospital, Juntendo University, School of Medicine
  • IBA TOSHIAKI
    Department of Surgery, Juntendo University Urayasu Hospital, Juntendo University, School of Medicine
  • SUGIYAMA KAZUYOSHI
    Department of Surgery, Juntendo University Urayasu Hospital, Juntendo University, School of Medicine
  • FUKUNAGA TETSU
    Department of Digestive Surgery, Japanese Foundation for Cancer research Hospital
  • NAGAKARI KUNIHIKO
    Department of Surgery, Juntendo University Urayasu Hospital, Juntendo University, School of Medicine
  • SUDA MASARU
    Department of Surgery, Juntendo University Urayasu Hospital, Juntendo University, School of Medicine

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Other Title
  • 進行大腸癌に対する腹腔鏡下大腸切除術の手術侵襲度の検討
  • シンコウ ダイチョウガン ニ タイスル フククウキョウ カ ダイチョウ セツジョジュツ ノ シュジュツ シンシュウド ノ ケントウ

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Abstract

Objective : Laparoscopic-assisted colectomy (LAC) is feasible for early colorectal cancer. However, surgical stress for advanced colorectal cancer is higher than early cancer, and it is not clear that LAC is actually less invasive than open colectomy (OC) for advanced cancer. This study assessed the surgical stress of LAC and OC for advanced colorectal cancer. Patients : We compared two groups of patients undergoing either 95 cases of LAC or 41 cases of OC for advanced colorectal cancer. And we measured changes in the levels of humoral mediator in patients undergoing LAC (n=9) and OC (n=8). Method : We compared surgical procedures and perioperative results for two groups of patients undergoing either LAC or OC for advanced colorectal cancer. And we measured changes in the levels of humoral mediator to evaluate surgical stress in LAC for advanced colon cancer. The measured mediators were Granulocyte Colony-Stimulating-Factor (G-CSF), White Blood Cell (WBC), and polymorphonuclear elastase (PMN-E). Perioperative courses of these groups were compared. Resuls : LAC involved a small amount of blood loss, shorter surgical duration, faster recovery of gastrointestinal function, and shorter hospital stay. Postoperative G-CSF, WBC and PMN-E values were lower in the LAC group than in the OC group. Conclusion : LAC is technically feasible, offers many short-term advantages, and adequate lymphnode resection can be achieved. Furthermore, the observation of lower mediator levels after LAC suggests that LAC causes less surgical stress than OC for treatment of advanced colorectal cancer. This finding may indicate that surgical stress due to LAC is less than that of OC. Therefore, this procedure is not only less invasive, but also egually curative.

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