Oncologic impact of technical difficulties during the early experience with laparoscopic surgery for colorectal cancer: long-term follow-up results of a prospective cohort study

• This study assessed the long-term oncological effects of technical difficulties during a surgeon's early experience with laparoscopic colorectal surgery. • Young surgeons should be instructed to minimize the oncologic technical difficulties such as bowel perforations or tears near the tumor. • During laparoscopic surgery, surgeons should not hesitate to open abdominal surgery if necessary for the patient's safety. Technical difficulties during laparoscopic colorectal cancer (CRC) surgery negatively affect short-term oncological safety. The present study evaluated whether intraoperative technical difficulties are prognostic of long-term outcomes. Patients underwent laparoscopic CRC surgery between May 2003 and December 2007 were reviewed. The technical difficulties were categorized as ‘non-oncologic’ and ‘oncologic’ to compare oncologic outcomes. Technical difficulties were encountered during surgery in 44 (10.3%) patients, with 34 being non-oncologic and 10 being oncologic. The 10-year disease-free survival rate was significantly lower in patients with technical difficulties (48.8% vs. 67.5%, p=0.034). The tumor recurrence rate was higher in patients with technical difficulties (22.7% vs. 11.7%, p=0.040). Multivariate analysis showed oncologic technical difficulty (hazard ratio [HR], 3.082; p=0.040) was an independent factor related to recurrence. The oncologic technical difficulty during laparoscopic CRC surgery is a long-term risk for recurrence. Young surgeons should be instructed to minimize the technical difficulties during laparoscopic surgery for better outcomes.