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Minimally invasive colon cancer surgery is effective
Source: (cancerfacts.com)
Thursday, May 13, 2004
DALLAS – May 13, 2004 – Less invasive "keyhole" surgery for a common type of colon cancer is just as effective as conventional open surgery, according to findings of international study.
The finding could make shorter recoveries from colon cancer surgery more common as more surgeons become proficient in the technique, called laparoscopic assisted colectomy. The National Cancer Institute-funded study appears in today's New England Journal of Medicine, and was presented May 12 at the annual meeting of the American Society of Colon and Rectal Surgeons in Dallas.
Dr. Heidi Nelson, a colorectal surgeon at Mayo Clinic, led the study team of 66 colorectal surgeons at 48 medical centers in the United States and Canada. The study team compared rates of complications, cancer recurrence, length of time patients were cancer-free and the overall survival in both sets of patients.
"Our study shows that while laparoscopic surgery is safe and effective for treatment of colon cancer, it must be performed selectively," Nelson said in a prepared statement. "It should not be used for patients whose cancer requires extensive surgery to other organs besides the colon, and it should be done by surgeons who are experienced in performing laparoscopic colon surgery."
All patients in the study had been diagnosed with potentially curable cancer of the colon. Each patient was randomly assigned to undergo either the minimally invasive laparoscopic procedure or the standard surgery and was afterwards followed for eight years to check for cancer recurrence.
Among the findings:
- Almost exact rate of recurrence in both sets of patients. The cancer returned in 160 of the 872 patients; 76 had undergone laparoscopic surgery and 84 had the standard operation.
- The return of the cancer in the location of the surgical wound was less than 1 percent in both sets of patients, occurring in two patients who had laparoscopic surgery and one patient who had standard surgery.
- The survival rate was almost identical -- 86 percent of patients who had undergone laparoscopic surgery were alive three years after surgery and 85 percent receiving the standard surgery were alive.
- Shorter hospitalization for patients who had laparoscopic surgery -- on average, five days in the hospital compared to six days for the standard surgery group.
Typically, surgeons open the abdomen with a six-to-eight-inch incision and then cut away the portion of the colon containing cancer. During laparoscopically assisted colectomy, the same procedure is performed through three one-half-inch incisions and one two-inch incision.
The minimally invasive version has been performed since 1980s, but some small studies suggested that patients who underwent laparoscopically assisted colectomy were more likely to have another bout of colon cancer or to develop cancer at or near the surgical incisions.
The authors caution, however, that these positive results were due in large part to the study's stringent requirements. The research team has submitted a position statement for review by the American Society of Colon and Rectal Surgeons proposing that credentials for performing laparoscopically assisted colectomies should only be given to surgeons who meet specific qualifications and strictly adhere to standard operating procedures. At the moment, no such credentialing system exists.
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