Results of laparoscopic vs open resections for colon cancer in patients with a minimum follow-up of 3 years F. Feliciotti, 1 A. M. Paganini, 1 M. Guerrieri, 1 A. De Sanctis, 1 R. Campagnacci, 1 E. Lezoche 2 1 Department of General Surgery, University of Ancona, ``Umberto I'' Hospital, Largo Cappelli 1, 60121, Ancona, Italy 2 Department of Surgery ``Paride Stefanini,'' II Clinica Chirurgica, University ``La Sapienza,'' Viale del Policlinico, 00161 Rome, Italy Received: 25 April 2001/Accepted in ®nal form: 30 October 2001/Online publication: 3 May 2002 Abstract Background: Laparoscopic resection for colon cancer is still a controversial procedure, the major cause of con- cern being the lack of long-term results. The aims of this study was to compare long-term outcome in unselected patients undergoing either laparoscopic LH) or open hemicolectomy OH) for colonic cancer. Methods: From March 1992 to August 1997, 197 elec- tive patients were included in this prospective nonran- domized study. The patients were operated on by the same surgical team following the same type of surgical technique for both right and left hemicolectomy, ex- cluding segmental resections; the only dierence was the type of access, which was either laparoscopic or open. Each patient gave a written consent, and the allocation to each group laparoscopic or open) was done on the basis of the patientÕs choice. The long-term outcomes of the two groups were compared. Follow-up for both groups ranged from 36 to 96 months mean, 48.9). Results: In all, 149 74 LH, 75 OH) of 197 patients were studied, excluding palliative resections, conversions to open surgery, perioperative deaths, and deaths not re- lated to cancer. Only two patients in the laparoscopic group were lost to follow-up. The local recurrence after LH was 1.3% vs 2.7% after OH p = 0.105). Meta- chronous metastases rates were similar for the two groups 10.8% for LH and 10.7% for OH). Cumulative survival probability CSP) in the LH group vs the OH group was 0.892 vs 0.867 p = 0.513), respectively. CSP for DukeÕs stage B and C in the LH group vs the OH group was 0.910 vs 0.895 p = 0.506) and 0.800 vs 0.734 p = 0.544) respectively. Sixty-four LH patients 86.5%) and 65 OH patients 86.7%) are disease-free. Conclusion: In our series of patients, no statistically signi®cant dierence was found between the two groups in terms of long-term survival rate. Key words: Colon cancer Ð Laparoscopic colonic re- section Ð Port site recurrence Ð Cancer Laparoscopic colon resection for malignancy is now regarded as a valid alternative to traditional laparoto- my. As compared to the open technique, the new sur- gical approach allows the same oncological radicality in terms of length of specimen, extent of regional lym- phoadenectomy, and recurrence rate [2, 4, 5, 6, 7, 9, 12, 13, 14, 15, 18]. However, the validity of laparoscopic resection for malignancy has yet to be con®rmed in larger series with longer follow-up periods. The purpose of this study was to compare the long-term outcomes in a cohort of unselected consecutive patients with colon cancer treated with a laparoscopic or an open approach. In both groups, the same type of surgical technique was followed for right and left hemicolectomy, according to previously de®ned standards. Colonic segmental resec- tions were excluded from the study. Our study is not a randomized series; instead, the selection of the patients was based on arbitrary criteria related to the patientÕs own choices, extraneous to the surgeonÕs evaluation. Patients and methods From March 1992 to August 1997, all patients with colon cancer ad- mitted to our institution were included according to the design of the study. Patients were not selected according to age, general condition ASA IV were also included in the study), or oncological stage. This was not a randomized series; the choice of procedure open or lapa- roscopic) was based strictly on the patientÕs decision, as made after reading the informed consent form. The same surgical team performed all surgical procedures following the same oncological and clinical criteria in both the laparoscopic and open arms of the study. Emergency cases and patients with tumors located in the transverse colon and splenic ¯exure were excluded. Only two types of operation were performed Ð right hemicolectomy cecum, right colon, and he- patic ¯exure cancers) and left hemicolectomy descending colon and sigmoid cancers). Patients with rectal tumors were included in another prospective study. Surg Endosc 2002) 16: 1158±1161 DOI: 10.1007/s00464-001-8333-1 Ó Springer-Verlag New York Inc. 2002 Original articles Correspondence to: E. Lezoche