Laparoscopic Colectomy for Colon Cancer New Proven Safe with Significant Advantages
James A. Harris, MD, FACS

This special edition of Surgical Insights reviews a landmark article that was published May 13, 2004 in the New England Journal of Medicine: A Comparison of Laparoscopically Assisted and Open Colectomy for Colon Cancer

In the early 1990s, with the explosion of laparoscopic techniques, there was concern that laparoscopic colectomy for colon cancer may compromise survival by failing to achieve proper oncologic resection, by inadequate staging or by altering the pattern of recurrence. This led to a multi-institutional prospective randomized trial based at the Mayo Clinic and funded by the National Institutes of Health. For nearly 10 years, there has been a virtual moratorium on laparoscopic colectomy for colon cancer outside of clinical trials awaiting the results of this study.

Between 1994 and 2001, a total of 872 patients with potentially curable colon cancer were randomized to either open colectomy or laparoscopically assisted colectomy. Participation in this trial was limited to surgeons experienced in advanced laparoscopic techniques, particularly laparoscopic colon resections.

Results:

Survival and recurrence rate was similar in both groups: overall survival, disease free survival, incidence and pattern of recurrence. (see figures)

Postoperative recovery was faster in the laparoscopic group as reflected by significantly shorter hospital stay and shorter use of parenteral and oral analgesics.

The extent of resection was similar in both groups: bowel margins, mesenteric margins and number of lymph nodes harvested.

The rate of complications was similar in both groups.

Incidence of Recurrence

Overall Survival

SUMMARY:
This landmark article confirms the safety and advantages of laparoscopic colon resection for colon cancer when performed by surgeons experienced in these procedures. Quality of life and postoperative recovery are significantly improved by laparoscopic techniques without compromising oncologic principles. Because of the results of this landmark study, Dr. Harris will now begin offering this option of treatment to his patients with colon cancer.

Nelson H. A Comparison of Laparoscopically Assisted and Open Colectomy for Colon Cancer: The Clinical Outcomes of Surgical Therapy Study Group. New England Journal of Medicine 2004; 350:2050-2059.