Coelioscopie en chirurgie du cancer colo rectal - Surgery colorectal cancer abstract

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Posted on Mar 01 2005 A summary statement in English will be available in due course. Posted on Mar 01 2005

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Published 01 March 2005
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  Comparison of laparoscopic and open surgery in colorectal cancer  Haute Autorité de Santé (French National Authority for Health), Saint-Denis La Plaine, France Author: Nathalie Poutignat, M.D.  Aim To assess the benefit of laparoscopic surgery for colorectal cancer rather than open surgery (the current standard approach).  
Results and conclusions (i)Oncological efficacycancer, 4-year survival and recurrence rates were similar. In colon 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. (ii)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. (iii)Safety in colorectal cancer. were insufficient to judge peroperative mortality. Data Morbidity rates for laparoscopy and open surgery were similar. (iv)Technical resultspercentage of conversions after laparoscopy for colorectal. The cancer was in the range 5–20%. Laparoscopy took longer than open surgery. (v)Specific results for rectal cancer.There are insufficient data relating to rectal cancer to allow any conclusion, even in terms of short-term results. 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.  
Methods ANAES systematically searched the Medline, Embase and Pascal databases, and useful websites (articles in English or French). The search retrieved 398 articles. These articles were filtered (exclusion of cost analyses, studies not distinguishing results for malignant and benign disease, studies assessing complications of surgery or laparoscopic management of metastases, insufficient data) and 70 studies were selected. Studies were graded by level of evidence; 63 were analysed (1 meta-analysis, 17 randomised controlled trials, 21 comparative trials and 24 non-comparative trials). Each conclusion was given a level of evidence according to the French Federation of Cancer Centres (FNCLCC) classification. This literature review was discussed by a working group of 8 experts (surgeons specialising in digestive surgery) and then submitted to 9 peer reviewers for their opinion.  Looking ahead 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.  HAS. 2 avenue du Stade de France, 93218 Saint-Denis La Plaine Cedex, France tel: +33 1 55 93 70 00, fax: +33 1 55 93 74 00, www.has-sante.fr