Laparoscopy May Be Better Than Open Colectomy for Colon Cancer

Laurie Barclay, MD

June 27, 2002

June 28, 2002 — In a randomized trial reported in the June 29 issue of The Lancet, laparoscopy-assisted colectomy (LAC) offered greater benefits than did open colectomy (OC) for colon cancer, suggesting that it might eventually become the new standard of care.

"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," lead author Antonio M. Lacy, MD, from Hospital Clinic, Barcelona, Spain, says in a news release. "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."

In this study, 219 patients with colon cancer were randomized to treatment with either LAC or OC. Adjuvant therapy and postoperative follow-up were the same in both groups.

Compared with patients who received conventional open surgery, those treated with laparoscopy had shorter hospital stays (5 days vs. 8 days; P=.005) and fewer surgery-related complications (12 of 111 patients vs. 31 of 108 patients; P=.001). Patients receiving LAC also recovered faster than those treated with OC in terms of time before detection of peristalsis and oral intake.

Relative risk reduction for LAC compared with OC was 61% for tumor relapse (hazard ratio, 0.39; 95% confidence interval [CI], 0.19-0.82); 52% for death from all causes (hazard ratio 0.48; 95% CI, 0.23-1.01); and 62% for cancer-related death (hazard ratio, 0.38; 95% CI, 0.16-0.91).

"If these results were confirmed by ongoing multicenter randomized trials, LAC would become the standard surgical approach to patients with colon cancer," Lacy says. Lancet. 2002;359:2224-2229

Reviewed by Gary D. Vogin, MD

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