Classical colorectal cancer surgery has been considered the gold standard in the surgical treatment of this disease for decades. Advances in technology and modern medicine have led to the emergence and progression of minimally invasive surgery in the treatment of this malignancy. Surgical procedures differ in relation to the localization of the tumor, as well as in relation to the pathways of hematogenous and lymphogenic spread of the disease. These surgical procedures are applied to the same extent during both classical and laparoscopic surgery. Regarding the indications for the laparoscopic approach in the elective treatment of colorectal cancer, there are no differences compared to classical colorectal surgery. The specificity of the method of work and visualization in laparoscopic colorectal surgery has developed the existence of two characteristic approaches: a) the lateral approach is taken from the classical-open colorectal surgery (“lateral-to medial approach”). It implies that the operation itself begins with the separation and preparation of the adjacent lateral peritoneum from the colon (rectum), and only then is the vascular structures approached from the medial side; b) medial-to-lateral approach, is an approach where after the creation of the pneumoperitoneum and access to the abdomen, the operation begins with the preparation of vascular elements (a.mesentericae inferior and v.mesenterice inferior, for example), and only then access to the lateral associated peritoneum. Most laparoscopic surgeons apply a more medial approach given the numerous advantages of this approach over the medial one that have been proven in comparative analyzes of these two approaches on a large sample of patients. At the same time, these studies did not show statistically significant differences in terms of postoperative complications, mortality, and malignant recurrence rate between the two approaches.

The debate of proponents of laparoscopic and classical colorectal surgery is still ongoing, especially on the oncological principles of colorectal malignancy treatment. For now, there are promising results in terms of the adequacy of laparoscopic surgery in the treatment of this disease. The study involved 60 patients with acceptable generalized operability and a diagnostically verified malignant neoplasm of colorectum. Patients were divided into two groups of 30 patients: patients who were operated with open and laparoscopically assisted colorectal surgery. Two groups of factors were collected and analyzed for all patients. The first group of factors was known preoperatively and the second group of factors was known postoperatively. There was no significant differences between the two groups concerning the age, sex, ASA score, preoperative hemoglobin values, blood type. Both groups were the most represented in the rectum cancer. The largest number of patients was G2 grade 49.1%. Surgical margins were negative for cancer in all examined patients. There was a statistically significant difference, in terms of a larger number of removed lymph glands in open surgery treated patients. The average number of lymph nodes removed laparoscopically was 14 (range 5-40), while in the classic-open group number was 20 (range 8-44). Laparoscopic group were able to retrieve >12 LNs in 70% of the cases while in classic-open group were able to retrieve >12 LNs in 93% of the cases. The third stage of the disease was significantly more prevalent in the classical group of patients than in laparoscopic group of patients (17: 7 patients). The average volume of the removed tumor in the laparoscopic group is 73 cm3, while in the classical group the average volume is 99 cm3. Our results show that classic-open and laparoscopic approaches in colorectal cancer surgery are associated with the retrieval of greater than 12 LNs, therefore both are adeqate for safe oncological treatment of this disease. With classic-open colorectal surgery, we are still able to retrive more matching LNs, compared to laparoscopic surgery.