Comparison of open and laparoscopic surgical techniques in colorectal cancer surgery, early and late term results

Aim: The role of laparoscopy in colorectal cancer surgery in terms of oncological outcomes and survival is still a subject of debate worldwide. In this study, clinical outcomes of techniques applied in laparoscopic and open colorectal cancer surgeries were evaluated comparatively, and the obtained data were analyzed in comparison with the literature. Materials and Methods: Our study was conducted by retrospectively analyzing the data of 462 patients who underwent colorectal cancer surgery between January 2015 and June 2020. Demographic data, labarotary values, surgical details, early and long-term clinical and pathological outcomes, and survival rates were evaluated retrospectively. Results: Of the 462 patients included in the study, 271 (58.7%) underwent open surgery, and 191 (41.3%) underwent laparoscopic surgery. Twenty patients who required conversion to open surgery were analyzed within the open surgery group. Regarding demographic data, the median age was 61.6 ± 12.32 years in the open surgery group and 59.6 ± 12.45 years in the laparoscopic group. Among male patients, 166 (57.0%) underwent open surgery and 125 (43.0%) underwent laparoscopic surgery. Among female patients, 105 (61.4%) underwent open surgery and 66 (38.6%) underwent laparoscopic surgery. A total of 57 patients (22.7%) were operated under emergency conditions, while 405 patients (77.3%) underwent elective surgery. All emergency surgeries were performed using the open approach. Intraoperative complications occurred in 10 (3.7%) of the 271 patients (100%) in the open surgery group, and in 3 (1.6%) of the 191 patients (100%) in the laparoscopic group. Postoperative surgical complications were observed in 138 patients (50.9%) in the open surgery group and in 104 patients (54.5%) in the laparoscopic group. All 462 patients underwent surgery due to malignancy. According to the TNM staging system. In the open surgery group (271 patients), 4 (1.5%) were stage 0, 41 (15.2%) stage I, 81 (30.1%) stage II, 97 (36.1%) stage III, and 46 (17.1%) stage IV. In the laparoscopic group (191 patients), 13 (6.8%) were stage 0, 35 (18.3%) stage I, 63 (33%) stage II, 66 (34.6%) stage III, and 14 (7.3%) stage IV. The 5-year overall survival rate was 136 patients (52.3%) in the open surgery group and 122 patients (67%) in the laparoscopic group, showing a statistically significant difference. However, it is important to note that the majority of advanced-stage cases and all emergency surgeries were treated with the open approach. When overall survival rates at 1, 3, and 5 years were analyzed by stage, there was no statistically significant difference between the two groups. Conclusion: In our study, colorectal cancer patients who underwent laparoscopic surgery appeared to have significantly longer survival compared to those who underwent open surgery. However, it should be noted that the majority of advanced-stage cases and all emergency surgeries were treated using the open approach. When survival rates were analyzed by cancer stage, there were no statistically significant differences between the two groups in most time intervals. Due to its association with fewer postoperative complications, shorter hospital stays, earlier initiation of enteral feeding, quicker return to daily activities, reduced pain, and a lower inflammatory response, we believe that laparoscopic surgery should be the preferred method for colorectal cancer surgery. Nevertheless, due to ongoing debates on this subject, there remains a need for large-scale, multicenter randomized controlled trials and meta-analyses to further clarify the long-term oncological outcomes of laparoscopic versus open surgery.