A current status of laparoscopic bowel surgery for cancer in Japan was investigated with collaboration of the majority of main hospital in the country and by sponsership of Japanese society for cancer of colon and rectum. 81 of 113 (71.7%) main surgical departments in Japan have introduced this procedures in practice since 1993. A total of 958 cases in the last 3 years (1994-1996) have been treated by this procedure and this number indicates 7% of all surgically treated cases of the colorectal cancer during the same peirod. 796 of 958 cases (83%) were the early cancers without lymphnodes involvement. The laparoscopic bowel surgery has been generally indicated for the cancer in early stage. The cases converted from this procedure to usual open surgery were 54 (conversion rate is 6%). The main reason for conversion was technical difficulty due to intraabdominal dense adhesions. There were the early postoperative complications including, in 70 cases, local subcutaneus abscess in the place where the trockers were inserted at the time of laparoscopic surgery, anastomotic leakage in 18 cases, local bleedings in 13 cases, bowel obstructions with adhesions in 14 cases and port-site-hernia in 6 cases.
大腸癌に対する腹腔鏡下手術(腹腔鏡補助下手術を含む)を開腹術を行う立場から評価した.腹腔鏡下手術は技術的にも癌の手術として耐えうるとの報告があるが,その剥離・郭清手技は鈍的な操作が多く,癌に対する手術操作とはいえない.長期予後については今後の多数症例による解析に待たねばならないが,腹腔鏡下手術に特有のport site recurrenceとそれに伴う高頻度の腹膜再発は致命的な欠点であり,症例の選択や気腹を避けて吊り上げ法を選択する,切開口を大きくするなど手術法の検討が要求される.腹腔鏡下手術は新しく行われ出した手術技術であるから,開腹術と同等の適応や効果を目指すのではなく,本術式にふさわしい適応を確立することが期待される.