Keyhole Bowel Cancer Surgery is Both Safe and Effective

Laparoscopic surgery is a safe and effective way of removing bowel tumors and it should be offered to all patients undergoing surgery for colorectal cancer, according to a new study.

Researchers at the University of Leeds (United Kingdom) reported the results of the 5-year follow‐up of the laparoscopically assisted versus open surgery for colorectal cancer (CLASICC) trial, a multicentre study that involved 400 patients with colon cancer and another 400 with rectal cancer; the trial drew on patients from 27 hospitals across the United Kingdom, and included a detailed analysis of all tissue samples that were removed to assess the quality of surgery. Five‐year outcomes were analyzed and included overall and disease‐free survival, and local, distant, and wound and port‐site recurrences. Two exploratory analyses were performed to evaluate the effect of age (older and younger than 70 years) on overall survival between the two groups, and the effect of the learning curve.

The results showed that no differences were found between laparoscopically assisted and open surgery in terms of overall survival, disease‐free survival, and local and distant recurrence; wound and port‐site recurrence rates in the laparoscopic arm also remained stable at 2.4%. Conversion to open surgery was associated with significantly worse overall but not disease‐free survival, which was most marked in the early follow‐up period. The effect of surgery did not differ between the age groups, and surgical experience did not affect the 5‐year results. The researchers concluded that the use of laparoscopic surgery to maximize short‐term outcomes does not compromise the long‐term oncologic results. The study was published in the November 2010 issue of the British Journal of Surgery (BJS).

"There is still a body of surgeons who are skeptical about laparoscopic colorectal cancer surgery and particularly laparoscopic rectal surgery. These long-term follow-up results should now help to convince any remaining skeptics that the minimally invasive technique is safe and effective for most patients with colorectal cancer,” said lead author David Jayne, M.D., a senior lecturer in surgery at the University of Leeds.

"Surgery remains the most important of the methods of treatment of bowel cancer and this study confirms that tumors can be removed equally well by keyhole surgery as by standard surgery,” added coauthor Professor Phil Quirke, M.D., of the department of Pathology. "We must, however, continue to strive for surgical excellence through audit of both types of surgery and by exploration of new techniques, such as robotic surgery.”

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