'Keyhole' Surgery Effective for Colon Cancer
Researchers Say Operation With Small Incisions Works as Well as Traditional Surgery
May 12, 2005 --"Keyhole" surgery may become the new standard for colon cancer surgery, says an editorial in The Lancet.
That is, for "appropriately selected patients who are operated on by experienced surgeons," writes Myriam Curet of Stanford University's minimally invasive surgery program.
Curet wrote about a study also published in The Lancet. That study, according to researchers, shows that keyhole surgery for colon cancer "is as effective as open surgery in the short term and is likely to produce similar long-term outcomes."
However, keyhole surgery isn't perfect. Patients who had to be switched to open surgery were more likely to have complications, and keyhole surgery wasn't as successful in rectal cancer, says the study.
The "keyhole" approach uses a few small incisions in the abdomen instead of the one large incision required in open surgery. The "keyholes" let doctors insert a tiny camera and small surgical instruments to perform the operation.
The technique -- called laparoscopic-assisted surgery -- has been used in gallbladder surgery and other operations. It's been widely adopted for colorectal cancer but hadn't been tested in large-scale studies, say Pierre Gillou, MD, and colleagues. There have been previous concerns about unusual patterns of cancer spread or recurrence, such as cancer appearing at the keyhole incision sites, say the researchers.
A year ago, another study found that keyhole surgery was a viable option for colon cancer patients. That study -- published in The New England Journal of Medicine in May 2004 -- only included colon cancer patients with early disease that had not spread.
Which Patients Had the Longest Hospital Stay?
Gillou's study included 800 British colorectal cancer patients. Keyhole surgery was performed on 484 participants, while 253 patients underwent open surgery.
Both groups had similar in-hospital death rates (4% and 5%, respectively). Complications, tumor status, and scores on quality-of-life surveys were also the same in both groups.
The keyhole group left the hospital a day or two earlier than those who got open surgery (8-10 days in hospital with keyhole surgery, compared with 10-13 days with open surgery).They also resumed a normal diet and had their first bowel movement a day or so earlier than the open surgery patients. A bowel movement after the procedure is an indication of recovery.
With local cancer recurrence rates for keyhole surgery matching that of open surgery, the researchers say their study lends support to other findings that keyhole surgery for colon cancer is safe. Survival, in terms of cancer, was similar in both groups.