Last LAFA trial5 (LAparoscopy and/or FAst track multimodal


Last two decades have seen some
revolutionary changes in the field of surgery as a whole, and more so in
abdominal surgery. This era has not only seen a quantum leap in instrument
development, but also in its applications. Since Eric Mauhe1 and
Philip Mouret2 did the first laparoscopic cholecystectomy in the
late 1980’s, Minimal Invasive Surgery has established itself as the preferred
mode of treatment for most benign diseases. However, application of Minimal
Invasive Surgery to gastrointestinal malignancies including colorectal cancers
has been rather snail paced.


 I would like to discuss the era of
laparoscopic surgery for colorectal cancer in three phases. In early 90’s it
was ridiculed because of high incidence of port site metastasis reported in the
literature up to 21%.3 In the mid 90’s its use beyond trials was
violently opposed. In the beginning of the new millennium it is said that short
term advantages of laparoscopy are self evident as proven by most of the
trials. So we have moved from a period where technical feasibility and
oncological safety were a big concern, to a period where both these issues have
been put to rest. Today the issue is whether laparoscopic colorectal surgery
for cancer extends any long term oncological benefits in terms of overall
survival or disease-free survival to the patient as compared to conventional
surgery for colorectal cancer.

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There are certain advantages of
laparoscopic colorectal surgery over open surgery that have been proven beyond
reasonable doubt in the literature. These are:


Shorter hospital stay. The literature
is full of studies proving this point. Recently, a group of people applied ERP4
(Enhance Recovery Programme) to conventional colorectal surgery and
demonstrated that hospital stay after conventional surgery can be brought down

Currently LAFA trial5
(LAparoscopy and/or FAst track multimodal management versus
standard care) is underway which was conceived to determine whether for
patients having segmental colectomy for malignant disease, laparoscopic
surgery, fast track peri-operative care, or a combination of both is preferred
over open surgery with standard care. It will not be unfair or illogical to
preempt that if ERP is applied to laparoscopic group, it should bring down the
hospital stay. However, we would have to wait till LAFA trial results are out.


There are numerous studies
demonstrating short term advantages of  laparoscopic resection which include less
post-operative pain, earlier restoration of bowel function, and earlier mobilization
6,7,8 which lead to shorter hospital stay and
reduced direct costs25. In addition there
is less morbidity from blood loss and transfusion requirements9,
respiratory complications 10, wound infections 11,
better cosmesis 12, adhesions and incisional hernias 13.


There are certain technical
concerns about laparoscopic colectomy for cancer that too have been addressed
adequately in the literature and have shown to be equivalent to open surgery
for the same. These are as follows: