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 23 February 2018

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News

Laparoscopy for colon cancer could offer long-term survival benefit over open surgery

A study in this week's Lancet suggests that laparoscopy-assisted surgery to treat colon cancer could be more favorable than conventional open surgery, with the potential to reduce operative complications, hospital stay, and increase cancer-related survival in the longer term.

News image

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Colorectal cancer is the second leading cause of cancer-related death in Western countries.

Prognosis associated with this disease has improved due to early diagnosis and changes in medical therapy.

Adjuvant chemotherapy in colon cancer, radiotherapy, and introduction of the total mesorectal excision technique in rectal cancer have increased survival, especially in patients with advanced (stage III) tumors.

Although early reports on laparoscopy-assisted colectomy (LAC) in patients with colon cancer suggest that it can reduce complications around the time of surgery, its influence on long-term outcomes is unknown.

Antonio Lacy and colleagues from Hospital Clinic, Barcelona, Spain, aimed to compare the efficacy of LAC and open colectomy (OC) for treatment of non-metastatic colon cancer, in terms of tumor recurrence and survival.

Some 219 patients with colon cancer were randomly assigned to receive either LAC or OC.

Benefits of laparoscopy:
- Shorter hospital stay
- Fewer surgical complications
- Reduced tumor relapse
- Improved survival
Lancet
Patients in the LAC group required shorter stays in hospital (around 5 days) compared with patients given conventional surgery (8-day hospital stay).

Surgery-related complications were less frequent in patients given laparoscopy (12 of 111 patients) than those given open surgery (31 of 108 patients).

It was found that patients who underwent laparoscopy had a 60% reduced risk of tumor relapse, compared with those given open surgery.

Patients in the LAC group also had a relative risk reduction of 50% of death from all causes, compared with patients in the OC group.

Antonio Lacy comments, "Our results show that LAC should be preferred to OC in patients with colon cancer.

"This is because it reduces perioperative morbidity, shortens hospital stay, and prolongs cancer-related survival.

"This latter benefit was mainly due to differences in the subset of patients with stage III tumors, in whom LAC was also associated with lower tumor recurrence and longer overall survival."

"If these results were confirmed by ongoing multicenter randomized trials, LAC would become the standard surgical approach to patients with colon cancer," Dr Lacy concludes.

Lancet 2002; 359(9325): 2224
28 June 2002

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