Laparoscopic colectomy for cancer: The need for trials

Laparoscopic approaches are increasingly being applied to colorectal surgical procedures. This is particularly true of benign disease indications. Colon and rectal cancer is the only intra-abdominal malignancy that is knowingly resected using laparoscopic techniques. Concerns initially existed regarding the magnitude of benefits from the laparoscopic approach. Even as these were being addressed, further concerns arose regarding the appropriateness of this technique in malignancy. This controversy was highlighted by reports of early tumor implants in trocar wounds. With careful technique, training, and experience, however, wound recurrences are rarely seen, suggesting that this phenomenon, in the clinical setting, is primarily technique-related. The ultimate measures of oncological outcomes are 5-year measures of overall survival and disease-free survival. Lack of rigorous evidence either condemning or supporting the laparoscopic approach for colorectal cancer resulted in the establishment of several large-scale randomized prospective trials, all currently in progress, that aim to determine whether laparoscopic resection of colorectal cancer results in oncological outcomes comparable with those of the open approach.