Looking Good: Colon Cancer Keyhole Surgery
With Laparoscopy, Recovery Is Easier and Cancer Risk No Worse
May 12, 2004 -- Laparoscopic "keyhole" surgery is a viable option for colon cancer surgery, a new study shows.
In terms of complication and survival rates, the minimally invasive surgery measures up to the conventional surgery, reports researcher Heidi Nelson, MD, a colon and rectal surgeon with the Mayo Clinic.
Her paper appears in this week's New England Journal of Medicine.
Laparoscopic surgery has revolutionized gallbladder and other surgeries, writes Nelson. It requires only a few small or "keyhole" incisions, rather than a large incision required by standard surgical techniques. With laparoscopic surgery patients usually return home quicker compared with the extended hospital stays required after standard procedures. During laparoscopy, a camera and small surgical instruments are inserted through the small incisions to guide the surgeon in the removal of the tumor.
However, surgeons have been hesitant to apply the procedure to colon cancer. Their concerns: Could they really get enough information about how far cancer has spread? Because the procedure does not involve opening the entire abdominal cavity, can minimally invasive surgery allow the surgeon to adequately remove the entire tumor? Could the procedure disturb tumor cells, possibly causing cancer to grow or spread at the laparoscopic keyhole incision? Some surgeons have reported high rates of recurrence with laparoscopic colon surgeries, Nelson notes.
However, her nationwide study put their fears to rest.
On the whole, the results show that the laparoscopic procedure carries no additional risk of cancer recurrences. "It is an acceptable alternative to open surgery for colon cancer," she writes. The greater benefit may be in quality of life and recovery -- at least, for those who don't end up needing the traditional open surgery procedure after all, she explains.
Laparoscopic Procedure Good to Go
Her study involved 48 hospitals and 872 patients, all diagnosed with colon cancer -- but with no metastasis or other complicating conditions. They were randomly assigned to have either traditional, open surgery or the laparoscopic, minimally invasive method to remove the colon cancer.
Three years after surgery both groups had similar recurrence rates of their cancer - it came back in 16 % for those undergoing the laparoscopic procedure and in 18% undergoing the traditional, open procedure. Recurrences at the site of the surgery were similar in both groups and were less than 1%.
Among their other findings:
- The laparoscopic group spent significantly longer time in the operating room -- about one hour longer.
- The laparoscopic group recovered faster, and had a shorter hospital stay.
- The laparoscopic group also required less anesthesia and painkillers.
- The traditional, open-surgery group had more cancerous lesions identified in other organs after their procedure.
- Both groups of surgeons were able to get similar amounts of tissue and lymph node samples to test for metastases.
- Both groups had similar differences in rates of surgical complications or need for second surgeries.