According to the Mayo clinic research, is laparoscopy the gold standard for colon/rectal cancer surgery? what is your approach regarding colonic neoplasia, right of left side or rectal cancer, there is any place for laparoscopy in your practice?
Yes, in my practice I always start approximately 90% of my colorectal procedures for cancer (right, left or rectal) by laparoscopy
In our practice, we are gradually transitioning to a laparoscopy in diseases of the colon
To decide about what kind of surgery for colon and rectal cancer is better, we must keep in mind several aspects:
1. Staging. If an intervention will be performed to resect liver metastases at the same time, and they are not superficial, I think conventional surgery should be used.
2. Learning curve. It is not only to have the skills, but to have performed at least 20 a year, because surgical time and quality may vary.
3. To keep in mind the cardiorespiratory evaluation in all laparoscopic surgery that allows to support intra-abdominal pressures of approximately 15 mm Hg in the patient.
The world is moving towards personalization of medicine and surgery must take that way, so we should not be absolute in deciding one way or another for all the cases.
Yes I am also the same opinion on it, but it is necessary to have long experience in this technique
No laparoscopic colo rectal surgery couldn't be considered a Gold Standard for every case. The surgical approach must be individualised.
Every case would be treated in the most appropriate way, not always with a standard procedure
However ALaCaRT, COLOR II, ACOSOG Z0651 ,and COREAN trails have failed to show non inferiority of laparoscopic surgery. Even if you look at subgroup analyzes in COLOR II upper rectal cancer with open approach lead to better results while lower rectal cancer with lap approach reach signifficantly bettter results. So nothing is so clear to put it into gold standard list.
Laparoscopic low anterior resection may be friendlier to the surgeon, if at all not beneficial to patient, viz a viz open approach. Working deep down in a narrow pelvis is really testing for the surgeon!
Do what you master it.this should be the way if choosing type of surgery
Prof Roberto has put it very well,for colorectal surgery there is nothing called Gold standard like cholecystectomy.We have open,Laparoscopic and Robotic methods.If one is good in one technique, he should continue.But world is moving towards technology driven procedures.For example Low rectal surgery is undoubtedly safer and easier with a Robot.After due evaluation I perform all colorectal surgeries Laparoscopically with extra corporeal anastamosis for over 20 yrs and quite Happy.Request you to glance at my video clips in www.medtube.net.