Surgical Oncology 1993; 2: Supplement 1, 43-49 Experience with laparoscopic colorectal surgery for malignant disease P. J. GUILLOU, A. DARZI AND J. R. T. MONSON Academic Surgical Unit, Imperial College of Science, Technology & Medicine, St. Mary’s Hospital Medical School, London, UK Laparoscopic or laparoscopic-assisted surgery for colorectal cancer was attempted in 59 patients suffering from malignant disease of the anus, rectum and colon over a 20- month period. Conversion to open surgery was necessary in 5 patients (8.4%). The per- operative (30-day) mortality was 5.8%. and in two of the three patients who died this was attributable to thrombo-embolic complications. The cancer-related mortality was 8%. There were 5 Dukes’ A, 21 Dukes’ B and 25 Dukes’ C lesions resected, and thus far all recurrences were in patients who had Dukes’ C lesions. The resection margins and lymph node yield in these specimens were similar to those achieved with conventional open surgery. Six patients also had hepatic metastases recognized at the time of pri- mary surgery. These preliminary data indicate the feasibility of performing laparo- scopic-assisted resection of colorectal cancer without compromising the accepted principles of excisional surgery for malignant disease. However, a number of important issues such as thrombo-embolic prophylaxis, specimen retrieval and the long-term recurrence rates require further study before these procedures are widely adopted for colorectal cancer. Surgical Oncology 1993; 2 : Suppl. 1, 43-49. Keywords: colon cancer, laparoscopy, surgery. INTRODUCTION The technological revolution which has, over the past five years, established laparoscopic chole- cystectomy as the standard procedure for chole- lithiasis, is now beginning to invigorate many other branches of abdominal surgery. A number of recent reports have documented preliminary experience with laparoscopic approaches to disease of the colon and rectum [l-5]. It was anticipated that the use of minimally invasive techniques would possess the advantages for colorectal surgery which they have brought to other forms of surgery such as smaller incisions, more rapid postoperative recuperation, and shorter hospital stay. However, the introduction of these minimally invasive methods of the management of malignant colorectal Correspondence: Professor P. J. Guillou, Academic Unit of Surgery, Institute for Molecular Medicine, St James’ University Hospital, Leeds LS9 7TF, UK. disease raises many practical and theoretical questions. Not the least of these is how to develop techniques for the laparoscopic surgical treatment of colorectal cancer which do not contravene the prin- ciples of excisional surgery which have evolved over many decades [6]. In the development of our own programme for laparoscopic colorectal surgery, we began with the basic premise that we would endeavour to conduct the same resectional pro- cedure which we would have performed if the operation were being conducted as a conventional open operation. In the evolution of this programme a number of issues and challenges have presented themselves. The preliminary data on our first 28 successful procedures for colorectal cancer have been reported elsewhere [7]. The purpose of this communication is to report our experience with these procedures in an extended series of patients suffering from colorectal cancer with particular emphasis on the problems encountered, complica- tions and early recurrence rates. 43