La chirurgia laparoscopica nel tumore del colon. Stato dell’arte e revisione della letteratura


Paolo P. Bianchi, Chiara Ceriani e Marco Montorsi

Ann. Ital. Chir., 2006; 77: 289-294

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Over the past decade advances in laparoscopic surgery have revolutionized the surgical approach to many diseases. Although
the first case series on laparoscopic segmental colectomy in patient with sigmoid cancer was described in 1991, this technique
has not been readily accepted. Despite reduced morbidity and improved convalescence after laparoscopic surgery for
benign disorders, surgeons have been sceptical about similar advantages of laparoscopic colectomy for cancer. The safety
of the procedure has been questioned because of early reports of port-site metastases and there has been uncertainty about
whether minimally invasive surgery for colonic malignancies would achieve adequate oncologic resection. Open surgical
resection of the primary tumor, until just recently, has been widely considered the most effective treatment of colon cancer.
The adherence to the principles of complete abdominal exploration, high ligation of mesenteric vessels, lymphnodal
clearance and adequate bowel resection margins is essential. Several randomized trials were initiated in the early 1990s
to compare the short- and long-term outcomes of patients undergoing minimally invasive and conventional open surgery
for colon cancer. Today the results of this large multiinstitutional randomized trials have been reported. This review examines
recent data from randomized, controlled trials and meta-analysis, that report the short- and long-term outcomes
after laparoscopic colectomy for cancer.


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