| Theme |
What endoscopists should know about laparoscopy-assisted colectomy |
| Title |
Present status and future of laparoscopic colorectal surgery in western countries |
| Author |
Yoshihisa Saida |
Third Department of Surgery, Toho University School of Medicine |
| Author |
Yoshinobu Sumiyama |
Third Department of Surgery, Toho University School of Medicine |
| Author |
Masashi Uramatsu |
Third Department of Surgery, Toho University School of Medicine |
| Author |
Jiro Nagao |
Third Department of Surgery, Toho University School of Medicine |
| Author |
Steven D. Wexner |
Department of Colorectal Surgery, Cleveland Clinic Florida |
| [ Summary ] |
Surgeons in western countries extended the indications for laparoscopic surgery to the colorectal field in the early 1990s. Laparoscopic surgery has been clearly shown to offer advantages for patients with benign diseases of the colon, rectum, anus, and small bowel. However, routine application for attempted treatment of malignancies is still under investigation. In Asian countries, including Japan, good screening techniques may detect early stage lesions in asthenic patients. Therefore, technically performing even low resections in these patients may be much more feasible than in western countries. Part of the problem for western surgeons is the exorbitantly high incidence of obesity, which is virtually rampant and epidemic in western countries. Furthermore, late stage tumors often preclude the laparoscopic approach. Certainly until a definitive answer has been proven by scientifically dependable prospective randomized externally funded peer review trials, laparoscopy for attempted treatment of malignancies at least in the United States, should only be offered within the context of such trials. Therefore, there are very limited applications, probably less than 10% of all colorectal resections; limited to specialty centers for either colorectal or laparoscopic surgery. Palliative operations for patients with metastatic malignancy are certainly feasible and may be encouraged at the present time. |