The effect of laparoscopic surgery in stage II and III right-sided colon cancer: a retrospective study.

Kye, Bong-Hyeon; Kim, Jun-Gi; Cho, Hyeon-Min; Lee, Jung Hwan; Kim, Hyung-Jin; Suh, Young-Jin; Chun, Chung-Soo

BACKGROUND This retrospective study compared the clinicopathological results among three groups divided by time sequence to evaluate the impact of introducing laparoscopic surgery on long-term oncological outcomes for right-sided colon cancer. METHODS From April 1986 to December 2006, 200 patients who underwent elective surgery with stage II and III right-sided colon cancer were analyzed. The period for group I referred back to the time when laparoscopic approach had not yet been introduced. The period for group II was designated as the time when first laparoscopic approach for right colectomy was carried out until we overcame its learning curve. The period for group III was the period after overcoming this learning curve. RESULTS When groups I and II, and groups II and III were compared, overall survival (OS) did not differ significantly whereas disease-free survival (DFS) in groups I and III were statistically higher than in group II (P = 0.042 and P = 0.050). In group III, laparoscopic surgery had a tendency to provide better long-term OS ( P = 0.2036) and DFS ( P = 0.2356) than open surgery. Also, the incidence of local recurrence in group III (2.6%) was significantly lower than that in groups II (7.4%) and I (12.1%) ( P = 0.013). CONCLUSIONS Institutions should standardize their techniques and then provide fellowship training for newcomers of laparoscopic colon cancer surgery. This technique once mastered will become the gold standard approach to colon surgery as it is both safe and feasible considering the oncological and technical aspects.