by Dr.C.H. Weaver M.D. updated 2/2019
According to results published in The New England Journal of Medicine, laparoscopic surgery for early colon cancer is as safe and effective as standard surgery.
Colorectal cancer remains the second leading cause of cancer deaths in the United States. The surgical removal of the cancer remains an integral part of the treatment strategy for patients with cancer that has not spread to distant and/or several sites in the body. The conventional surgical procedure involves the opening of the pelvis and/or abdomen to gain access to the large intestine.
Laparoscopic surgery involves the placement of small probes into the area of surgery. The probes contain a camera, which displays images onto large television screens in the operating room. The surgeon can perform the surgery through the probes while watching his or her movements on the screen. This type of procedure prevents the need for large surgical incisions, and may reduce the risk of infection, healing complications, pain and/or blood loss. However, researchers have been hesitant in accepting its use as the accepted standard surgical procedure for early-stage colon cancer due to limited data regarding long-term outcomes. Concern surrounding laparoscopic surgery included the ability for a physician to achieve optimal removal of the cancer, possible increases in recurrence rates (associated with previous data indicating increased recurrences at the site of the surgical wound), and the ability of a physician to adequately assess the extent to which the cancer may have spread. Results from recent clinical trials have demonstrated the effectiveness of laparoscopic surgery for colon cancer; however, the use of laparoscopic surgery has not yet become widely used in common practice for colon cancer.
Researchers from Clinical Outcomes of Surgical Therapy Study Group of the Laparoscopic Colectomy Trial recently completed a clinical trial directly comparing conventional surgery to laparoscopic surgery in the treatment of colon cancer. This trial included 48 different medical institutions and 872 patients diagnosed with early colon cancer. Approximately half of the patients underwent laparoscopic surgery to remove their cancer, and the other half underwent conventional surgery. At approximately 3 years following surgery, cancer recurred in 16% of patients treated with laparoscopic surgery, and 18% of patients treated with standard surgery. Recurrences at the site of the surgical wound occurred in less than 1% of patients in both groups. Overall survival at 3 years following surgery was 86% and 85% for the laparoscopic-surgery group and the conventional-surgery group, respectively. The average time in the hospital was reduced by 1 day and pain medication use was reduced in the group that underwent laparoscopic surgery, compared to the group that underwent standard surgery.
The researchers concluded that laparoscopic surgery is an effective and safe alternative to conventional surgery for the treatment of early colon cancer. However, the researchers note that it is important for surgeons to be skilled in laparoscopic techniques in order to provide optimal outcomes in patients. Patients with early colon cancer who are to undergo surgery may wish to speak with their physician about their risks and benefits of laparoscopic surgery, as well as inquire about the experience of their surgeon with laparoscopic techniques.
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The safety and effectiveness of less invasive laparoscopic colectomy surgery for colon cancer has also been confirmed in the community setting and with longer follow up.
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 these studies, 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.(2)
- Nelson H, Sargent D, Wie H, et al. A Comparison of Laparoscopically Assisted and Open Colectomy for Colon Cancer. The New England Journal of Medicine. 2004;350:2050-2059.
- 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.