Volume 350:2050-2059 May 13, 2004 Number 20

A Comparison of Laparoscopically Assisted and Open Colectomy for Colon Cancer

The Clinical Outcomes of Surgical Therapy Study Group


Editorial
by Pappas, T. N.

ABSTRACT

Background Minimally invasive, laparoscopically assisted surgery was first considered in 1990 for patients undergoing colectomy for cancer. Concern that this approach would compromise survival by failing to achieve a proper oncologic resection or adequate staging or by altering patterns of recurrence (based on frequent reports of tumor recurrences within surgical wounds) prompted a controlled trial evaluation.

Methods We conducted a noninferiority trial at 48 institutions and randomly assigned 872 patients with adenocarcinoma of the colon to undergo open or laparoscopically assisted colectomy performed by credentialed surgeons. The median follow-up was 4.4 years. The primary end point was the time to tumor recurrence.

Results At three years, the rates of recurrence were similar in the two groups — 16 percent among patients in the group that underwent laparoscopically assisted surgery and 18 percent among patients in the open-colectomy group (two-sided P=0.32; hazard ratio for recurrence, 0.86; 95 percent confidence interval, 0.63 to 1.17). Recurrence rates in surgical wounds were less than 1 percent in both groups (P=0.50). The overall survival rate at three years was also very similar in the two groups (86 percent in the laparoscopic-surgery group and 85 percent in the open-colectomy group; P=0.51; hazard ratio for death in the laparoscopic-surgery group, 0.91; 95 percent confidence interval, 0.68 to 1.21), with no significant difference between groups in the time to recurrence or overall survival for patients with any stage of cancer. Perioperative recovery was faster in the laparoscopic-surgery group than in the open-colectomy group, as reflected by a shorter median hospital stay (five days vs. six days, P<0.001) and briefer use of parenteral narcotics (three days vs. four days, P<0.001) and oral analgesics (one day vs. two days, P=0.02). The rates of intraoperative complications, 30-day postoperative mortality, complications at discharge and 60 days, hospital readmission, and reoperation were very similar between groups.

Conclusions In this multi-institutional study, the rates of recurrent cancer were similar after laparoscopically assisted colectomy and open colectomy, suggesting that the laparoscopic approach is an acceptable alternative to open surgery for colon cancer.

Source Information

The preparation of this article was overseen by the writing committee of the Clinical Outcomes of Surgical Therapy Study Group of the Laparoscopic Colectomy Trial (Heidi Nelson, M.D., Daniel J. Sargent, Ph.D., H. Sam Wieand, Ph.D., James Fleshman, M.D., Mehran Anvari, M.D., Steven J. Stryker, M.D., Robert W. Beart, Jr., M.D., Michael Hellinger, M.D., Richard Flanagan, Jr., M.D., Walter Peters, M.D., and David Ota, M.D.), who assume responsibility for the overall content and integrity of the article.

Address reprint requests to Dr. Heidi Nelson at the Division of Colon and Rectal Surgery, Mayo Clinic, 200 First St. SW, Rochester, MN 55905.