Cariati M, Brisinda G, Chiarello MM. Has the open surgical approach in colorectal cancer really become uncommon? World J Gastrointest Surg 2024; 16(6): 1485-1492 [DOI: 10.4240/wjgs.v16.i6.1485]
Corresponding Author of This Article
Giuseppe Brisinda, MD, Professor, Surgeon, Abdominal and Endocrine Metabolic Medical and Surgical Sciences, Fondazione Policlinico Universitario A Gemelli IRCCS, 8 Largo Agostino Gemelli, Rome 00168, Italy. gbrisin@tin.it
Research Domain of This Article
Surgery
Article-Type of This Article
Editorial
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
World J Gastrointest Surg. Jun 27, 2024; 16(6): 1485-1492 Published online Jun 27, 2024. doi: 10.4240/wjgs.v16.i6.1485
Has the open surgical approach in colorectal cancer really become uncommon?
Maria Cariati, Giuseppe Brisinda, Maria Michela Chiarello
Maria Cariati, Department of Surgery, Azienda Sanitaria Provinciale di Crotone, Crotone 88900, Italy
Giuseppe Brisinda, Abdominal and Endocrine Metabolic Medical and Surgical Sciences, Fondazione Policlinico Universitario A Gemelli IRCCS, Rome 00168, Italy
Maria Michela Chiarello, Department of Surgery, Azienda Sanitaria Provinciale di Cosenza, Cosenza 87100, Italy
Author contributions: Cariati M and Chiarello MM designed the research; Cariati M performed the research; Brisinda G and Chiarello MM analyzed the data; and all the authors wrote, read and approved the final manuscript.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Giuseppe Brisinda, MD, Professor, Surgeon, Abdominal and Endocrine Metabolic Medical and Surgical Sciences, Fondazione Policlinico Universitario A Gemelli IRCCS, 8 Largo Agostino Gemelli, Rome 00168, Italy. gbrisin@tin.it
Received: December 18, 2023 Revised: April 29, 2024 Accepted: May 15, 2024 Published online: June 27, 2024 Processing time: 194 Days and 22.7 Hours
Abstract
Colorectal cancer is the third most common cancer in the world. Surgery is mandatory to treat patients with colorectal cancer. Can colorectal cancer be treated in laparoscopy? Scientific literature has validated the oncological quality of laparoscopic approach for the treatment of patients with colorectal cancer. Randomized non-inferiority trials with good remote control have answered positively to this long-debated question. Early as 1994, first publications demonstrated technical feasibility and compliance with oncological imperatives and, as far as short-term outcomes are concerned, there is no difference in terms of mortality and post-operative morbidity between open and minimally invasive surgical approaches, but only longer operating times at the beginning of the experience. Subsequently, from 2007 onwards, long-term results were published that demonstrated the absence of a significant difference regarding overall survival, disease-free survival, quality of life, local and distant recurrence rates between open and minimally invasive surgery. In this editorial, we aim to summarize the clinical and technical aspects which, even today, make the use of open surgery relevant and necessary in the treatment of patients with colorectal cancer.
Core Tip: In terms of oncological outcomes and quality of resection, laparoscopic approach allows to do just as well as open surgery, in particular the number of the lymph nodes removed is identical, regardless of the access. However, the laparoscopic approach is not recommended when the neoplasm presents with urgency, in the occlusive or perforated phase, as well as it is not recommended for locally advanced tumors. When the tumor involved the serosal layer or invades an adjacent organ, open “en-bloc” excision is recommended.
