Laparoscopic-assisted surgery for colorectal cancer has been widely adopted without data from large-scale randomised trials to support its use.
Dr Pierre Guillou and colleagues from England compared short-term endpoints of conventional versus laparoscopic-assisted surgery in patients with colorectal cancer to predict long-term outcomes.
The investigators undertook a a multicentre, randomized clinical trial in 794 patients with colorectal cancer from 27 UK centres between 1996 and 2002.
The team reported that 526 patients were allocated to receive laparoscopic-assisted and 268 to open surgery.
Primary short-term endpoints were positivity rates of circumferential and longitudinal resection margins, proportion of Dukes' C2 tumours, and in-hospital mortality.
The investigative team performed analysis by intention to treat.
The team found that 6 patients, with 2 in the open and 4 in laparoscopic group had no surgery, and 23 had missing surgical data.
| In-hospital mortality occurred in 13 patients in the open group versus 21 in the laparoscopic group|
The researchers noted that 253 and 484 patients actually received open and laparoscopic-assisted treatment, respectively.
The research team observed that 143 patients underwent conversion from laparoscopic to open surgery.
In addition, the researchers noted that the proportion of Dukes' C2 tumours did not differ between treatments with 18 patients in the open versus 34 in the laparoscopic groups.
The team also found that in-hospital mortality did not differ between treatments with 13 versus 21 patients in the open and laparoscopic groups, respectively.
Apart from patients undergoing laparoscopic anterior resection for rectal cancer, rates of positive resection margins were similar between treatment groups.
The investigators observed that patients with converted treatment had raised complication rates.
Dr Guillou’s team concludes, “Laparoscopic-assisted surgery for cancer of the colon is as effective as open surgery in the short term and is likely to produce similar long-term outcomes.”
“However, impaired short-term outcomes after laparoscopic-assisted anterior resection for cancer of the rectum do not yet justify its routine use.”