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Laparoscopy For Colon Cancer Could Offer Long-term Survival Benefit Over Conventional Surgery
June 26, 2002A study in this week's issue of THE LANCET suggests that laparoscopy-assisted surgery to treat colon cancer could be more favourable than conventional open surgery, with the potential to reduce operative complications, hospital stay, and increase cancer-related survival in the longer term.
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) tumours. 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 tumour recurrence and survival.
219 patients with colon cancer were randomly assigned to receive either LAC or open colectomy (OC). Patients in the LAC group required shorter stays in hospital (around five days) compared with patients given conventional surgery (eight 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). Patients given laparoscopy had a 60% reduced risk of tumour 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 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 tumours, in whom LAC was also associated with lower tumour recurrence and longer overall survival. If these results were confirmed by ongoing multicentre randomised trials, LAC would become the standard surgical approach to patients with colon cancer."
Lancet
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