Minimally Invasive Laproscopic Colectomy to Remove Colon Cancer

NEJM and other studies demonstrate that minimally invasive laparoscopic surgery is safe, effective and standard of care.

by C.H. Weaver M.D. updated 2/2019

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.

If you’ve been diagnosed with colon cancer and your healthcare team has determined that you’re a candidate for either complete or partial removal of your colon (colectomy) or a minimally invasive surgical approach (laparoscopic surgery), you’re likely wandering about the benefits and risks of each. Specially, you may want to know how the less invasive laparoscopic approach measures up in terms of short- and long-term outcomes and side effects when compared with its more extensive counterpart.

A basic understanding of the laparoscopic approach is a good place to begin:

Laparoscopic surgery involves the use of a video camera to create a live picture of the inside of the patient’s body, allowing surgeons to do procedures by making only a few small incisions rather than a larger opening in the abdomen.

In laparoscopic surgery, a few one-centimeter incisions are made in the patient’s abdomen. A 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. The cancer is removed through a larger incision.

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.

According to results published in The New England Journal of Medicine, laparoscopic surgery for early colon cancer is safe and effective.

Researchers from Clinical Outcomes of Surgical Therapy Study Group of the Laparoscopic Colectomy Trial reported the results of 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.

In the study 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. (see Table 1). Furthermore, patients who underwent laparoscopic surgery used less pain medication and their stay in the hospital was reduced by an average of one day compared with patients who underwent standard surgery.

Table 1 Laparoscopic surgery versus conventional surgery in the treatment of early-stage colon cancer

Benefits of minimally invasive laparoscopic surgery:

  • Whereas extensive surgery can cause serious side effects, including infections, severe pain, and a long recovery period, laparoscopic surgery is a less invasive surgical technique and has been shown to be as effective as standard surgery with fewer side effects.
  • This type of surgery is associated with reduced pain and shortened hospitalization.

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)

Laparoscopic surgery is an effective and safe alternative to conventional surgery for the treatment of early colon cancer. However, it is important for surgeons to be skilled in laparoscopic techniques in order to provide optimal outcomes. Patients with early colon cancer who are to undergo surgery may wish to speak with their physician about the risks and benefits of laparoscopic surgery, as well as inquire about the experience of their surgeon with laparoscopic techniques.

References:

  1. 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.
  2. 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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