Study Finds Less Invasive Colon Surgery Just as Good

A decade-long study comparing conventional colon cancer surgery with “keyhole” surgery found identical success rates, disproving fears that tumors would be more likely to return if surgeons did not open up the patient’s belly for a full view.

In conventional surgery, doctors remove a cancerous colon segment through an eight-inch cut down the abdomen. In keyhole, or laparascopic, surgery, they operate with a laparoscope, or tiny video camera, and miniaturized surgical instruments that are inserted through half-inch incisions. The diseased section of colon is removed through a two-inch cut.

The biggest comparison of the two procedures to date, involving 48 U.S. and Canadian hospitals, found the same rates of survival, tumor recurrence and surgical complications. In addition, patients who had laparascopic surgery had less pain and less time in the hospital.

Experts predicted the results would end the virtual moratorium on such surgery that began in 1994 because of spotty evidence that tumors returned in up to 21% of patients getting laparoscopic procedures -- much more frequently than with open surgery.

The study was funded by the National Cancer Institute and published in today’s New England Journal of Medicine.

“Now we can say it’s safe, it’s effective and it’s beneficial for patients with colon cancer,” said lead researcher Dr. Heidi Nelson, chairwoman of colon and rectal surgery at the Mayo Clinic in Rochester, Minn. “Patients recovered faster with fewer days in the hospital and fewer days on painkillers.”

She said the laparoscopic procedure and the much smaller scars it leaves were less intimidating to many patients.

About 100,000 colon cancer operations are performed in this country each year.

Nelson and other experts predict the laparoscopic surgery now will be performed more frequently.

However, surgeons trained more than a decade ago first must learn the more-difficult laparoscopic technique, which requires lots of practice.

“I don’t see an immediate boom,” said Dr. Philip B. Paty, a colorectal surgeon at Memorial Sloan-Kettering Cancer Center in New York.

In addition, the technique is appropriate only when the tumor is easily reached with laparoscopic instruments and has not spread widely to nearby organs and lymph nodes.