For conditions requiring bowel resection, such as colorectal cancer, laparoscopic surgery is a widely accepted treatment approach.1 With ongoing advancements in techniques and continuous surgeon training, it is considered as safe and effective as open colorectal surgery. Advantages include lower postoperative complications, shorter hospital stay, reduced intraoperative blood loss, decreased systemic inflammatory response, and improved cosmetic outcomes.2 3
Despite its advantages, laparoscopic colorectal surgery has several challenges. Even for experienced surgeons, safe identification and transection of vascular structures, determination of target segments, bowel mobilization and resection, specimen retrieval, and creation of anastomoses can be difficult.3 4 5 6 7 Moreover, the procedure is still evolving and not universally adopted due to the lack of standardized techniques, technical complexity, concerns about adequacy of oncologic resection, and longer operative times.6 8 9
Since 2011, minimally invasive procedures have been performed at Southern Philippines Medical Center (SPMC) across multiple specialties, including gynecology, hepatobiliary surgery, colorectal surgery, pediatric surgery, orthopedics, neurosurgery, and surgical endoscopy. However, data on surgical outcomes remain unavailable. We did this study to describe the demographic, clinical, tumor, and operative characteristics of patients with colorectal cancer who underwent laparoscopic surgery at SPMC.
Characteristics and outcomes of patients with colorectal cancer who underwent laparoscopic colorectal surgery: descriptive study
SPMC J Health Care Serv. 2025;11(2):7 ARK: https://n2t.net/ark:/76951/jhcs659dhm
1Department of General Surgery, Southern Philippines Medical Center, JP Laurel Ave, Davao City, Philippines
Correspondence Kim Recoli S de los Reyes, kdlr.surgery@gmail.com
Received 18 April 2025
Accepted 18 December 2025
Cite as de los Reyes KRS, Basilio OR Jr. Characteristics and outcomes of patients with colorectal cancer who underwent laparoscopic colorectal surgery: descriptive study. SPMC J Health Care Serv. 2025;11(2):7. https://n2t.net/ark:/76951/jhcs659dhm
Introduction
Methodology
Setting
We did a retrospective descriptive study among patients who underwent laparoscopic colorectal surgery under the Surgery Department - Colorectal Surgery section of SPMC between August 2014 to August 2018. The department handles an average of approximately 125 colorectal cancer surgical cases annually.
Participants
We included patients aged 19 years and up with colorectal cancer who underwent elective laparoscopic colorectal surgery at SPMC. All patients had preoperative localization of tumor using either colonoscopy or computed tomography. We excluded patients initially operated on at another institution and subsequently transferred to SPMC for management, as well as those who underwent emergency laparoscopic colorectal surgery.
To determine the minimum sample size for this study, we assumed that the mortality rate of patients who underwent colorectal surgery is 6.52%.10 Using a sample size calculation for descriptive research carried out with a 5% margin of error, a design effect of 1.0, and a 90% confidence level, a minimum sample size of 66 would be needed.
To determine the minimum sample size for this study, we assumed that the mortality rate of patients who underwent colorectal surgery is 6.52%.10 Using a sample size calculation for descriptive research carried out with a 5% margin of error, a design effect of 1.0, and a 90% confidence level, a minimum sample size of 66 would be needed.
Data collection
We reviewed the medical records of each patient with colorectal cancer who underwent elective laparoscopic colorectal surgery and were included in the study. From the records of these patients, we collected data on age, sex, place of residence (within or outside Davao Region), comorbidities (hypertension, diabetes mellitus, hyperthyroidism, pneumonia, bronchial asthma, pulmonary tuberculosis, and others), history of previous abdominal surgery, and serum albumin levels. We also collected data on tumor profiles such as tumor location (rectum, left or right colon, sigmoid colon, or transverse colon), postoperative cancer staging, and Tumor/Node/Metastasis (TNM) classification. The operative profiles were also collected including the type of procedure performed (anterior resection, abdominoperineal resection, hemicolectomies, Hartmann’s procedure, intersphincter resection, sigmoidectomy or total colectomy), intraoperative blood loss, conversion to open surgery, if blood transfusion was done, time to resumption of oral diet, postoperative morbidity, mortality, and length of postoperative hospital stay.
Statistical analysis
We summarized continuous variables using means and standard deviations, and expressed categorical variables as frequencies and percentages. For all our statistical tests, we utilized Epi InfoTM 7.2.2.6.
Results
This study included 87 records of patients with colorectal cancer who underwent laparoscopic colorectal surgery. Table 1 shows the preoperative demographic and clinical profiles of the participants. Participants had a mean age of 56.55 ± 11.99 years, and a sex distribution of 47/87 (54.02%) males and 40/87 (45.98%) females. Most of the participants (63/87; 72.41%) lived within Davao Region, while the remaining participants (24/87; 27.59%) lived outside of Davao Region. Of the 87 participants, 22.99% had hypertension, 9.20% had diabetes mellitus, 1.15% had hyperthyroidism, 1.15% had pneumonia, 5.75% had tuberculosis, 1.15% had asthma, and 3.45% had other comorbidities. Out of the 87 participants, 9 (6.90%) had history of previous abdominal surgery. The mean baseline serum albumin of all participants was 32.56 ± 6.91 g/L.
| Table 1 Demographic and clinical profile of patients who underwent colorectal surgery | |
| Characteristics | Values (n=87) |
|---|---|
| Mean age ± SD, years | 256.55 ± 11.99 |
| Sex, frequency (%) | |
| Male | 47 (54.02) |
| Female | 40 (45.98) |
| Place of residence, frequency (%) | |
| Within Davao Region | 63 (72.41) |
| Outside Davao Region | 24 (27.59) |
| Comorbidities, frequency (%) | |
| Hypertension | 20 (22.99) |
| Diabetes mellitus | 8 (9.20) |
| Hyperthyroidism | 1 (1.15) |
| Pneumonia | 1 (1.15) |
| Tuberculosis | 5 (5.75) |
| Asthma | 1 (1.15) |
| Others | 3 (3.45) |
| With history of abdominal surgeries, frequency (%) | 6 (6.90) |
| Baseline serum albumin ± SD, g/L | 32.56 ± 6.91 |
Table 2 shows the tumor profile based on the biopsy of tumors from the 87 participants in the study. Of the 87 participants, 62.07% of the tumors were located in the rectum, 4.60% in the left colon, 10.34% in the right colon, 1.15% in both left and right colon, 20.69% in the sigmoid colon, and 1.15% in the transverse colon. For the postoperative cancer staging distribution, 2.30% had Stage I colorectal cancer, 13.79% had Stage IIA, 3.45% had Stage IIB, 6.90% had Stage IIIA, 59.77% had Stage IIIB, 2.30% had Stage IIIC, 10.34% had Stage IVA, and 1.15% had Stage IVB. For the TNM classification, most patients presented with advanced T stage disease, 60.92% classified as T3 and 32.18% as T4. Lymph node involvement was common among the participants, such that 75.86% of patients were staged as N1, while 22.99% had no nodal involvement. Distant metastasis was identified in 11.49% of patients, with the liver being the most frequent metastatic site (70%), followed by the lungs (30%).
| Table 2 Postoperative tumor profile | |
| Characteristics | Values (n=87) |
|---|---|
| Tumor location, years | |
| Rectum | 54 (62.07) |
| Left colon | 4 (4.60) |
| Right colon | 9 (10.34) |
| Bilateral colon | 1 (1.15) |
| Sigmoid colon | 18 (20.69) |
| Transverse colon | 1 (1.15) |
| Postoperative cancer staging, frequency (%) | |
| I | 2 (2.30) |
| IIA | 12 (13.79) |
| IIB | 3 (3.45) |
| IIIA | 6 (6.90) |
| IIIB | 52 (59.77) |
| IIIC | 2 (2.30) |
| IVA | 9 (10.34) |
| IVB | 1 (1.15) |
| T stage, frequency (%) | |
| T0 | 0 (0.00) |
| T1 | 0 (0.00) |
| T2 | 6 (6.90) |
| T3 | 53 (60.92) |
| T4 | 28 (32.18) |
| N stage, frequency (%) | |
| N0 | 20 (22.99) |
| N1 | 66 (75.86) |
| N2 | 1 (1.15) |
| M stage, frequency (%) | |
| M0 | 77 (88.51) |
| M1 | 10 (11.49) |
| Metastasis location, frequency (%) (n=10) | |
| Liver | 7 (70.00) |
| Lungs | 3 (30.00) |
The operative profile of patients who underwent laparoscopic colorectal surgery is shown in Table 3. Among the 87 patients included, the most frequently performed procedure was low anterior resection (39.08%), followed by anterior resection (17.24%) and abdominoperineal resection (12.64%). Other surgical procedures include hemicolectomies, Hartmann’s procedure, intersphincter resection, sigmoidectomy and total colectomy. The mean intraoperative blood loss was 476.73 ± 341.86 mL, and conversion to open surgery occurred in 23.26% of cases. The mean duration of surgery was 278.89 ± 72.76 minutes. Blood transfusion was required in 18.39% of patients, with a mean of 1.33 ± 1.29 units transfused among those who received transfusions. Postoperatively, the mean time it took for patients to resume oral intake was 4.02 ± 2.17 days. Overall morbidity and mortality rates were 26.44% and 3.45%, respectively. The mean length of postoperative hospital stay was 8.35 ± 6.38 days.
| Table 3 Operative profile of patients who underwent laparoscopic colorectal surgery | |
| Characteristics | Values (n=87) |
|---|---|
| Type of procedure performed, frequency (%) | |
| Abdominoperineal resection | 11 (12.64) |
| Anterior resection | 15 (17.24) |
| Extended left hemicolectomy | 1 (1.15) |
| Extended right hemicolectomy | 1 (1.15) |
| Hartmann's procedure | 9 (10.34) |
| Intersphincter resection | 1 (1.15) |
| Left hemicolectomy | 4 (4.6) |
| Right hemicolectomy | 8 (9.20) |
| Low anterior resection | 34 (39.08) |
| Sigmoidectomy | 1 (1.15) |
| Total colectomy | 1 (1.15) |
| Total proctocolectomy with radical cystoprstatectomy | 1 (1.15) |
| Mean volume of blood loss ± SD, mL (n=75) | 476.73 ± 341.86 |
| Converted to open surgery, frequency (%) | 20 (23.26) |
| Mean operating time ± SD, mins | 278.89 ± 72.76 |
| With blood transfusion, frequency (%) | 16 (18.39) |
| Mean number of blood units transfused ± SD, (n=15) | 1.33 ± 1.29 |
| Mean time to resumption of oral intake ± SD, (n=75) | 4.02 ± 2.17 |
| Postoperative morbidity, frequency (%) | 23 (26.44) |
| Mortality, frequency (%) | 3 (3.45) |
| Mean length of postoperative hospital stay ± SD, days (n=83) | 8.35 ± 6.38 |
Discussion
Key results
This study showed that laparoscopic colorectal surgery at our institution was most commonly performed in middle-aged patients, with a slight male predominance, and a high proportion of rectal cancer cases. The majority of patients presented with stage IIIB disease, characterized by T3 or T4 tumors and frequent lymph node involvement. Distant metastasis was observed in a small proportion of patients, most commonly involving the liver and lungs. Low anterior resection was the most frequently performed procedure. The mean operative time was 279 minutes, and conversion to open surgery occurred in nearly one-fourth of cases. The mean intraoperative blood loss was 476 mL, with 16 patients requiring blood transfusion. Among these, the mean transfusion transfusion requirement was one unit of blood. Patients resumed oral intake after an average of 4 days postoperatively, and the mean length of postoperative hospital stay was 8 days. Postoperative morbidity occurred in 23 patients, and 3 in-hospital deaths were recorded.
Strengths and limitations
This study provided a detailed description of the demographic and clinical characteristics, as well as postoperative outcomes, of patients with colorectal cancer who underwent laparoscopic colorectal surgery at SPMC. However, since this is a descriptive research, we cannot establish associations between preoperative or intraoperative characteristics and postoperative outcomes. To explore these associations, conducting an analytic research is recommended. We also recommend looking at long-term outcomes, including disease recurrence and disease-free survival.
Interpretation
Colorectal cancer predominantly affects older adults, particularly those aged over 50 years, making age a well-established risk factor for disease development.11 12 13 14 However, advances in colorectal cancer screening—especially in developed countries—have coincided with a rising incidence among younger adults (<50 years). 15 16 Early-stage colorectal cancer is often asymptomatic, contributing to delayed diagnosis and a higher likelihood of advanced-stage disease at presentation.17 Although distant metastases occur in approximately 20% of patients at the time of diagnosis—lower than in many other malignancies—they most commonly affect the liver and lungs.18 19 20 21 22 The operative time in our study was comparable to those reported in previous literature.23 24 While laparoscopic colorectal surgery typically requires longer operative times than open surgery,24 25 it offers several advantages, including reduced blood loss, shorter hospital stay, earlier resumption of oral intake, and lower postoperative morbidity and mortality.23 24 26
Generalizability
In this study, we focused on patients with colorectal cancer who underwent laparoscopic colorectal surgery. As one of the institutions providing minimally invasive surgery for colorectal cancers, findings of this study are applicable to majority of patients seeking medical treatment for this disease.
Conclusion
In this study, laparoscopic colorectal surgery was primarily performed in middle-aged patients, with a slight male predominance, and rectal cancer as the most common diagnosis. Most patients presented with advanced disease (stage IIIB), characterized by T3–T4 tumors and frequent lymph node involvement, while distant metastases were uncommon, primarily affecting the liver and lungs. Low anterior resection was the most frequently performed procedure. The mean operative time was 279 minutes, with nearly one-fourth of cases converted to open surgery. Mean intraoperative blood loss was 476 mL, and 16 patients required blood transfusion, receiving an average of one unit. Patients resumed oral intake after a mean of 4 days, had a mean hospital stay of 8 days, and postoperative morbidity and mortality were observed in 23 and 3 patients, respectively.
Contributors
KRSDLR and ORBJr had substantial contributions to the study design, and to the acquisition, analysis and interpretation of data. KRSDLR wrote the original draft and subsequent revisions. All authors reviewed, edited, and approved the final version of the manuscript. All authors agreed to be accountable for all aspects of the work.
AI use declaration
We used an AI language model to assist with phrasing, structural refinement, and summarization of publicly available information. We independently verified all evidence, and the final analysis and opinions in this editorial are entirely our own.
Ethics approval
This study was reviewed and approved by the Department of Health XI Cluster Ethics Review Committee (DOH XI CERC reference P19030801).
Reporting guideline used
Article source
Submitted
Peer review
External
Funding
Supported by personal funds of the authors
Competing interests
None declared
Access and license
This is an Open Access article licensed under the Creative Commons Attribution-NonCommercial 4.0 International License, which allows others to share and adapt the work, provided that derivative works bear appropriate citation to this original work and are not used for commercial purposes. To view a copy of this license, visit https://creativecommons.org/licenses/by-nc/4.0/.
References
1 Kirchhoff P, Clavien PA, Hahnloser D. Complications in colorectal surgery: risk factors and preventive strategies. Patient Saf Surg. 2010 Mar 25;4(1):5.
2 Lim SW, Kim YJ, Kim HR. Laparoscopic surgery for colorectal cancer in patients over 80 years of age: the morbidity outcomes. Ann Surg Treat Res. 2017 Jun;92(6):423-428.
3 Pascual M, Salvans S, Pera M. Laparoscopic colorectal surgery: Current status and implementation of the latest technological innovations. World J Gastroenterol. 2016 Jan 14;22(2):704-17.
4 Kaiser AM. Evolution and future of laparoscopic colorectal surgery. World J Gastroenterol. 2014 Nov 7;20(41):15119-24.
5 Shah PR, Joseph A, Haray PN. Laparoscopic colorectal surgery: learning curve and training implications. Postgrad Med J. 2005 Aug;81(958):537-40.
6 Lu L, Zhou D, Jian X, Deng J, Yang P, Ding W. Laparoscopic colorectomy for colorectal cancer: retrospective analysis of 889 patients in a single center. Tohoku J Exp Med. 2012 Jul;227(3):171-7.
7 Luglio G, De Palma GD, Tarquini R, Giglio MC, Sollazzo V, Esposito E, Spadarella E, Peltrini R, Liccardo F, Bucci L. Laparoscopic colorectal surgery in learning curve: Role of implementation of a standardized technique and recovery protocol. A cohort study. Ann Med Surg (Lond). 2015 Mar 20;4(2):89-94.
8 Kang CY, Halabi WJ, Luo R, Pigazzi A, Nguyen NT, Stamos MJ. Laparoscopic colorectal surgery: a better look into the latest trends. Arch Surg. 2012 Aug;147(8):724-31.
9 Wong MC, Ding H, Wang J, Chan PS, Huang J. Prevalence and risk factors of colorectal cancer in Asia. Intest Res. 2019 Jul;17(3):317-329.
10 Krutsri C, Sumpritpradit P, Singhatas P, Thampongsa T, Phuwapraisirisan S, Gesprasert G, Jirasiritham J, Choikrua P. Morbidity, mortality, and risk factors of emergency colorectal surgery among older patients in the Acute Care Surgery service: A retrospective study. Ann Med Surg (Lond). 2020 Nov 6;62:485-489.
11 Mayo Clinic. Colon cancer. 2024 Dec 19 [cited 2025 Dec 26]. Available from: https://www.mayoclinic.org/diseases-conditions/colon-cancer/symptoms-causes/syc-20353669#:~:text=Colon%20cancer%20happens%20when%20cells,the%20risk%20of%20colon%20cancer.
12 World Health Organization. Colorectal cancer. 2023 Jul 11 [cited 2025 Dec 26]. In: World Health Organization [Internet]. Geneva: World Health Organization. c2025. Available from: https://www.who.int/news-room/fact-sheets/detail/colorectal-cancer#:~:text=Colorectal%20cancer%20is%20a%20type,smoking%20tobacco%20and%20limiting%20alcohol.
13 Rex DK, Johnson DA, Anderson JC, Schoenfeld PS, Burke CA, Inadomi JM, et al. American College of Gastroenterology guidelines for colorectal cancer screening 2009 [corrected]. Am J Gastroenterol. 2009 Mar;104(3):739-50. Erratum in: Am J Gastroenterol. 2009 Jun;104(6):1613.
14 Sung JJ, Ng SC, Chan FK, Chiu HM, Kim HS, Matsuda T, et al. An updated Asia Pacific Consensus Recommendations on colorectal cancer screening. Gut. 2015 Jan;64(1):121-32.
15 Nguyen SP, Bent S, Chen YH, Terdiman JP. Gender as a risk factor for advanced neoplasia and colorectal cancer: a systematic review and meta-analysis. Clin Gastroenterol Hepatol. 2009 Jun;7(6):676-81.e1-3.
16 Jung KW, Won YJ, Kong HJ, Lee ES; Community of Population-Based Regional Cancer Registries. Cancer Statistics in Korea: Incidence, Mortality, Survival, and Prevalence in 2015. Cancer Res Treat. 2018 Apr;50(2):303-316.
17 Duan B, Zhao Y, Bai J, et al. Colorectal Cancer: An Overview. In: Morgado-Diaz JA, editor. Gastrointestinal Cancers [Internet]. Brisbane (AU): Exon Publications; 2022 Sep 30. Chapter 1. Available from: https://www.ncbi.nlm.nih.gov/books/NBK586003/.
18 Ciardiello F, Ciardiello D, Martini G, Napolitano S, Tabernero J, Cervantes A. Clinical management of metastatic colorectal cancer in the era of precision medicine. CA Cancer J Clin. 2022 Jul;72(4):372-401
19 Riihimäki M, Hemminki A, Sundquist J, Hemminki K. Patterns of metastasis in colon and rectal cancer. Sci Rep. 2016 Jul 15;6:29765.
20 Abdelazeem B, Abbas KS, Rao DN, Tariq R, Wahab A. Incidence and comparative prognosis of cancers with metastasis to noncommon sites: A population-based study. Medicine (Baltimore). 2022 Jul 22;101(29):e29743.
21 Haraldsdottir S, Einarsdottir HM, Smaradottir A, Gunnlaugsson A, Halfdanarson TR. Krabbamein í ristli og endaþarmi [Colorectal cancer - review]. Laeknabladid. 2014 Feb;100(2):75-82.
22 City of Hope. Metastatic colorectal cancer (stage 4). [cited 2025 Dec 26]. In: City of Hope [Internet]. c2025. Available from: https://www.cancercenter.com/cancer-types/colorectal-cancer/types/metastatic-colorectal-cancer.
23 van der Pas MH, Haglind E, Cuesta MA, Fürst A, Lacy AM, Hop WC, et al. Laparoscopic versus open surgery for rectal cancer (COLOR II): short-term outcomes of a randomised, phase 3 trial. Lancet Oncol. 2013 Mar;14(3):210-8.
24 Saraiya S, Darji D. Comparison of Clinical Outcomes Between Laparoscopic and Open Surgery in Colorectal Cancer Patients. J Pharm Bioallied Sci. 2024 Jul;16(Suppl 3):S2461-S2463.
25 Nakajima K, Akagi T, Kono Y, Shiroshita H, Ohyama T, Saito S, et al. Laparoscopic versus open colectomy for locally advanced colon cancer in obese patients: a nationwide, multicenter, propensity score-based analysis of short- and long-term outcomes. Jpn J Clin Oncol. 2025 Jan 8;55(1):21-28.
26 Hsu YJ, Yu YL, Jhuang JR, You JF, Liao CK, Tsai WS, et al. Comparison of laparoscopic and open surgery for colorectal malignancy in obese patients: a propensity score-weighted cohort study. Int J Surg. 2024 Aug 1;110(8):4598-4607.
Copyright © 2025 KRS de los Reyes, et al.
Published
December 26, 2025
Issue
Volume 11 Issue 2 (2025)
Section
Research
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
Authors who publish with this journal agree to the following terms:
- Authors retain copyright and grant the journal right of first publication with the work simultaneously licensed under a Creative Commons Attribution-NonCommercial 4.0 International License that allows others to share the work for non-commercial purposes with an acknowledgement of the work's authorship and initial publication in this journal.
- Authors are able to enter into separate, additional, non-commercial contractual arrangements for the non-exclusive distribution of the journal's published version of the work (e.g., post it to an institutional repository or publish it in a book), with an acknowledgement of its initial publication in this journal.
- Authors grant the journal permission to rewrite, edit, modify, store and/or publish the submission in any medium or format a version or abstract forming part thereof, all associated supplemental materials, and subsequent errata, if necessary, in a publicly available publication or database.
- Authors warrant that the submission is original with the authors and does not infringe or transfer any copyright or violate any other right of any third parties.