When is laparoscopic surgery contraindicated for the treatment of colorectal tumors?

Updated: Jun 06, 2020
  • Author: Jaime Shalkow, MD, FACS; Chief Editor: Cameron K Tebbi, MD  more...
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Answer

Answer

Good surgical outcomes depend on careful patient selection. Historic contraindications to a minimally invasive approach include elderly or high-risk patients, multiple previous abdominal operations, technically challenging surgery, and patients with serious comorbidities. All these factors can add a level of difficulty to the performance of an operation, and they are certainly associated with increased morbidity and mortality. But clearly none of these factors are hard but rather are relative contraindications to minimally invasive surgery. The surgeon’s main goal is the performance of a safe and adequate operation. [42]

Laparoscopic surgery has been found to be equal to open surgery in terms of oncologic outcome, margins, lymph node sampling, recurrence, and disease-free survival. The ability to obtain an R0 resection with tumor-free margins is a keystone of oncologic colectomy. [42]  

As of now, the following are the only 2 absolute contraindications to laparoscopic CRC surgery [42] :

  • A tumor large enough that the extraction site to remove it would be of sufficient size to perform the entire operation.
  • A high-grade large bowel obstruction leading to a reduced intra-abdominal domain. The impaired visibility coupled with the friability of the tissue associated with a cancer makes minimally invasive surgery an ill-advised approach in this setting.

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