If done by an experienced doctor, minimally invasive surgery for colon cancer is as effective and safe as standard open abdominal surgery, an international team of surgeons has found.
In addition to the cosmetic benefit of a smaller incision, patients having the procedure also spent a day less in the hospital and needed to take intravenous and oral painkillers a day less compared to those getting the standard operation.
The surgery, called laparoscopically assisted colectomy, has been frequently performed since 1990. However, some smaller studies indicated that such patients were more likely to have a recurrence of colon cancer or develop cancer at or near the small surgical incisions than those getting the conventional open surgery.
"Most patients ask for minimally invasive surgery because it's less painful and requires a smaller incision. But no one had rigorously evaluated the safety and effectiveness of the procedure," said Dr. James Fleshman, a professor of surgery at the Washington University School of Medicine in St. Louis. He was one of 66 surgeons in the United States and Canada who took part in the study, published today in the New England Journal of Medicine.
All the surgeons who took part had to meet certain qualifications, including having done at least 20 laparoscopic procedures.
About 100,000 Americans are diagnosed with colon cancer each year, with most of them requiring surgery to remove all or part of the colon or large intestine.
Traditionally, surgeons open the abdomen with a 6- to 8-inch incision and remove the section of colon with cancer. With laparoscopic surgery, three half-inch incisions and one 2-inch cut are made. Doctors use a miniature video camera to guide work inside the body. They thread the colon out of the body, do the surgery, reconnect the healthy sections and return the colon to the abdomen.
The study was carried out at 48 medical centers. Doctors randomly selected 872 patients to receive either standard or minimally invasive surgery and followed their progress for up to eight years after the operations.
In about a fifth of the patients assigned to get the less invasive operation, surgeons switch to the standard operation after they began. That was mainly because the disease was more advanced than they had thought, or due to technical problems.
Cancer returned in 160 patients, 84 with the standard operation and 76 who had the less invasive surgery. The survival rate among all the patients was almost identical, 86 percent after three years for those getting laparoscopic surgery and 85 percent receiving standard care.
"Our study shows that while laparoscopic surgery is safe and effective for treatment of colon cancer, it must be performed selectively," said Dr. Heidi Nelson, a colorectal surgeon at the Mayo Clinic in Rochester, Minn.
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