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 20 November 2017

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News

Further research needed before laparoscopic-assisted surgery is used for colon cancer

Despite an increase in the use of laparoscopic-assisted surgery instead of standard open surgery for treating colon cancer, only minimal short-term quality of life benefits are found with use of the newer procedure, according to an article in the latest issue of the Journal of the American Medical Association.

News image

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Dr Jane C. Weeks, from the Dana-Farber Cancer Institute, Boston, and colleagues studied 428 patients (at 2 days, at 2 weeks, and at 2 months) after surgery for colon cancer.

Each provided responses to several questionnaires (Symptoms Distress Scale, Quality of Life Index, and a single-item global rating scale) to compare short-term quality of life (QOL) outcomes after laparoscopic-assisted colectomy (LAC) versus open colectomy for colon cancer.

Data were collected between September 1994 and February 1999 from 37 centers participating in the Clinical Outcomes of Surgical Therapy (COST) trial.

"Only minimal short-term QOL benefits were found with LAC for colon cancer compared with standard open colectomy," the authors write.

"Until ongoing trials establish that LAC is as effective as open colectomy in preventing recurrence and death from colon cancer, this procedure should not be offered to patients with colon cancer."

The patients studied had an average age of approximately 69 years old and had a diagnosis of colon cancer involving a single segment of the colon.

Minimal short-term QOL benefits with laparoscopic-assisted colectomy for colon cancer.
Journal of the American Medical Association

Compared with patients in the conventional colectomy group, patients in the LAC group required shorter courses of pain medication while hospitalized, and their mean length of stay was shorter by 0.8 days.

"However, these differences do not translate into statistically significant improvements in symptoms or QOL in the immediate postoperative period or over 2 months of follow-up," the authors state.

"The modest benefits in short-term QOL proxy measures we observed are not sufficient to justify the use of this procedure in the routine care setting until the safety and efficacy of the procedure in the treatment of cancer have definitively been established," the authors conclude.

In an accompanying editorial, Nicholas J. Petrelli, from the Helen F. Graham Cancer Center, Newark, Delaware, comments, "The findings that LAC provided only modest advantages compared with open colectomy are important for surgeons treating patients with colon cancer.

"However, the study also emphasizes the need for high-quality, rigorous randomized trials for improving surgical cancer care, and underscores the importance of physicians to increase their efforts to enroll patients in such studies."

Dr Petrelli adds, "Based on current evidence, LAC as a potentially curative procedure for colon cancer should be considered investigational and should not be performed outside of a randomized clinical trial."

JAMA 2002; 287: 321-8, 377-8
16 January 2002

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