United Kingdom National Institute for Health and Care Excellence (NICE) Technology Appraisal Guidance (TA105) on the Use of Laparoscopic Surgery for Colorectal Cancer

  • Laparoscopic (including laparoscopically assisted) resection is recommended as an alternative to open resection for individuals with colorectal cancer in whom both laparoscopic and open surgery are considered suitable.
  • Laparoscopic colorectal surgery should be performed only by surgeons who have completed appropriate training in the technique and who perform this procedure often enough to maintain competence.
  • The decision about which of the procedures (open or laparoscopic) is undertaken should be made after informed discussion between the patient and the surgeon. In particular, they should consider:

-   The suitability of the lesion for laparoscopic resection

-   The risks and benefits of the two procedures

-   The experience of the surgeon in both procedures

Society of American Gastrointestinal and Endoscopic Surgeons (SAGES) Guidelines for Laparoscopic Resection of Curable Colon and Rectal Cancer

  • We recommend that laparoscopic resection follow standard oncologic principles: proximal ligation of the primary arterial supply to the segment harboring the cancer, appropriate proximal and distal margins, and adequate lymphadenectomy. (strong)
  • We recommend that laparoscopic resection for rectal cancer follow standard oncologic principles: Adequate distal margin, ligation at the origin of the arterial supply for the involved rectal segment, and mesorectal excision. (strong)
  • For locally advanced adherent colon and rectal tumors, an en bloc resection is recommended. We suggest an open approach if a laparoscopic en bloc resection cannot be performed adequately. (weak)
  • We recommend that patients with an obstructing right or transverse colon cancer undergo a right or extended right colectomy. The open approach is required if the laparoscopic approach will not result in an oncologically sound resection. (strong)
  • We suggest that for patients with an obstructing left-sided colon cancer, the procedure be individualized according to clinical factors. Colonic stenting may increase the likelihood of completing a one-stage procedure and may decrease the likelihood of an end colostomy. (weak)
  • The use of a wound protector at the extraction site and the irrigation of port sites and extraction site incisions may reduce abdominal wall cancer recurrences. (strong)
  • Before surgeons apply the laparoscopic approach for the resection of curable colon and rectal cancer, they must have adequate knowledge, training, and experience in laparoscopic techniques and oncologic principles. (strong)