COMMENTARY

Complications After Colectomy: Does Type of Procedure Matter?

Albert B. Lowenfels, MD

Disclosures

April 03, 2019

Are the long-term complications of laparoscopic surgery for rectal cancer similar to the results after open surgery? In a multicenter (30 centers, eight countries) randomized study published in the Annals of Surgery,[1] the authors examined the frequency of three common nonmalignant complications in 345 patients assigned to open surgery and 699 patients assigned to laparoscopic surgery.

During a follow-up period extending up to 5 years, the following complications were observed:

  • 12.3% of patients developed one or more episodes of bowel obstruction, with similar rates in both groups (P = 1.00);

  • 17.5% developed an incisional hernia with no difference in the two groups (P = 1.00); and

  • 14.9% of patients with a stoma developed a parastomal hernia, with a nonsignificant increase in the laparoscopic group (P = .066).

Where Does This Study Leave Us?

Reports about laparoscopic surgery for rectal cancer first began to be published about 25 years ago. This Colorectal Cancer Laparoscopic or Open Resection (COLOR) II trial is a follow-up study of a previously published randomized trial demonstrating similar cancer survival after either open or laparoscopic surgery for rectal cancer.[2] However, the current trial compares complication rates for three common nonmalignant complications: bowel obstruction or incisional or parastomal hernia. There were no significant differences in the frequency of these three complications that were related to the choice of surgical approach. The authors did find, as have others, that obesity (a body mass index > 30 kg/m2) increased the risk for incisional as well as parastomal hernias.

What are the implications for surgeons? The main take-home message from this report is that laparoscopic surgery for rectal cancer gives about the same results as open surgery and can be considered a safe alternative approach for patients with resectable rectal cancer.

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