More Effective Surgery for Colon Cancer with Laparoscopic versus Open Colectomy

Less invasive surgery for colon cancer with laparoscopic colectomy improves outcomes. These findings were reported in the Journal of the National Cancer Institute.

Historically, surgical treatment for colon cancer involved a procedure called open colectomy to remove section of the colon containing cancer. This involved large incisions and opening of the abdomen in order to remove the cancer. More recently, a less invasive approach known as laparoscopic colectomy has been associated with decreasing the side effects caused by open colectomy. In a laparoscopic colectomy, a few incisions—approximately one-centimeter long—are made in the patient’s abdomen. A very small tube that holds a video camera can then be inserted through the incisions, creating a live picture of the inside of the patient’s body. This picture is continually displayed on a television screen so that physicians can perform the entire surgery by watching the screen. Before the section of the colon containing the cancer is removed from the body, the incision through which it will be removed is enlarged to allow its passage with minimal contact. Laparoscopic colectomy is associated with reduced pain and shortened hospitalization.

Previous clinical trials have shown that laparoscopic colectomy provides better short-term outcomes than an open procedure. There hasn’t been data yet, however, on outcomes with laparoscopic colectomy in the real world (or outside of the clinical trials setting).

Between 2010 and 2011, researchers in the United States used the National Cancer Data Base to find 45,876 patients with colon cancer. Patients had been diagnosed with Stage I–III disease and were between 18 and 84 years old. Patients who had undergone laparoscopic colectomy were matched with those who had undergone open colectomy. There were 18,230 patients in each group.

The researchers looked at the rate of death within 30 days of colectomy, the need to be readmitted to the hospital, and length of stay. They also looked at the rate at which additional chemotherapy was started for Stage III patients.

Patients who underwent laparoscopic colectomy had a lower rate of death within 30 days following the procedure, compared with those who underwent open colectomy (1% of laparoscopic patients had died compared with 2% of open patients). Length of hospital stay was also shorter for laparoscopic patients (five versus six days). Among those with Stage III colon cancer, more of the laparoscopic patients were able to undergo additional chemotherapy (72% versus 67%).

Based on the outcomes measured in this study, laparoscopic colectomy appeared to have better results compared with open colectomy. The procedure can provide patients with a less invasive treatment option for Stage I–III colon cancer with important improvements in outcomes.

Reference: Zheng Z, Jemal A, Lin CC, Hu CY, Chang GJ. Comparative Effectiveness of Laparoscopy Vs Open Colectomy Among Nonmetastatic Colon Cancer Patients: an Analysis Using the National Cancer Data Base. Journal of the National Cancer Institute. 2015 Feb 6;107(3). pii: dju491. doi: 10.1093/jnci/dju491.

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