brand logo

Am Fam Physician. 2005;71(2):356

Laparoscopic removal of the gallbladder is widely employed, yet the extension of laparoscopic approaches to other intra-abdominal surgeries has been slower. An early surgical case series reported concerns about increased cancer recurrence after laparoscopic removal of colon cancer. The Clinical Outcomes of Surgical Therapy Study Group presents long-term follow-up data on a trial of laparoscopic versus open colectomy in patients with colon cancer.

This large multicenter study enrolled adults with adenocarcinoma of the colon, excluding those with severe abdominal adhesions, advanced local or metastatic disease, rectal or transverse colon cancer, inflammatory bowel disease, concurrent cancer, and other severe medical illness. Participants were randomized to laparoscopic or open colectomy. However, 21 percent of patients randomized to a laparoscopic technique had to be converted to open colectomy at the time of surgery.

Complete follow-up data after four years were available for 98 percent of trial participants. Laparoscopic removal of the colon required a longer average operating time (150 minutes) compared with an open approach (95 minutes). Surgical margins and the number of lymph nodes examined were similar between the two techniques. Intraoperative complications occurred in 4 percent of laparoscopic cases and 2 percent

Over a median follow-up period of 4.4 years, the rate of tumor recurrence was not significantly different between laparoscopic colectomy and open colonic resection (16 versus 18 percent). Overall survival rates and disease-free survival also were similar, and this finding held true for all stages of colon cancer. Tumor recurrence at the site of surgical wounds was uncommon; rates were similar between groups (0.5 in the laparoscopy group compared with 0.2 percent in the open-surgery group). Postoperative recovery was quicker in the laparoscopic group, with a shorter hospital stay (median, five versus six days) and briefer use of parenteral narcotics (median, three versus four days). Short-term postoperative mortality, and rates of readmission and re-operation were similar for both techniques.

The study group concludes that laparoscopic colectomy is at least as effective as a standard open technique with respect to rates of operative complications, tumor recurrence, and overall survival. Laparoscopic removal of the colon requires longer operating times but is associated with quicker postoperative recovery.

Continue Reading


More in AFP

Copyright © 2005 by the American Academy of Family Physicians.

This content is owned by the AAFP. A person viewing it online may make one printout of the material and may use that printout only for his or her personal, non-commercial reference. This material may not otherwise be downloaded, copied, printed, stored, transmitted or reproduced in any medium, whether now known or later invented, except as authorized in writing by the AAFP.  See permissions for copyright questions and/or permission requests.