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Laparoscopic Colectomy May Improve Outcomes in Colon Cancer

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10/06/2006

According to a recent article published in The Lancet, a laparoscopic colectomy may improve outcomes compared to an open colectomy in patients with colon cancer.

The colon is an important part of the bodys digestive system, consisting of the last few feet of the large intestine. In patients with potentially curable colon cancer, a properly performed surgical operation is essential for optimal results. In the majority of such cases, operative intervention involves a resection (removal) of the primary cancer and regional lymph nodes, along with the removal of sections on both sides of the normal bowel. There are several different types of surgical procedures used in the treatment and management of colon cancer. The size and spread of the cancer determines the appropriate procedure to use.

Historically, a surgical procedure called an open colectomy (OC) involved large incisions and opening of the abdomen in order to remove the cancer. More recently, laparoscopic procedures have been associated with decreasing the side effects caused by extensive surgery. In a laparoscopic-assisted colectomy (LAC), a few incisions approximately one-centimeter long are made in the patients abdomen. Then, a very small tube that holds a video camera can be inserted through the incisions, creating a live picture of the inside of the patients body. This picture is continually displayed on a television screen so that physicians can perform the entire surgery by watching the screen. Before the section of the colon containing the cancer is removed from the body, the incision through which it will be removed is enlarged to allow its passage with minimal contact. This approach is associated with reduced pain and shortened hospitalization.

Researchers in Spain recently conducted a clinical trial to directly compare LAC to OC in 219 patients with colon cancer. Patients treated with an LAC had significantly shorter hospital time following surgery, significantly fewer surgery-related complications, fewer cancer recurrences and improved cancer-free survival. Researchers can only speculate as to why cancer recurrences were reduced in patients undergoing LAC. There were no differences in cancer-free survival between patients treated with LAC or OC who had stage I-II colon cancer; however, there was a significant increase in cancer-free survival between the two groups of treated patients who had stage III colon cancer. Time in surgery was longer for patients undergoing LAC, but blood loss was significantly reduced compared to patients undergoing OC.

These researchers concluded that LAC appears to decrease surgery-related complications, reduce cancer recurrences and/or improve cancer-free survival compared to OC for patients with colon cancer. The researchers believe that if these results are confirmed in future clinical trials, LAC will become the standard surgical approach for patients with colon cancer who are eligible for a colectomy. Patients with colon cancer may wish to discuss the risks and benefits of LAC with their physician or the participation in clinical trials further evaluating LAC or other promising therapies. Two sources of information regarding ongoing clinical trials include the National Cancer Institute ( cancer.gov) and www.eCancerTrials.com. eCancerTrials.com also provides personalized clinical trial searches on behalf of patients.

Reference: Lacy A, Garcia-Valdecasas J, Delgado S, et al. Laparoscopy-assisted colectomy versus open colectomy for treatment of non-metastatic colon cancer: a randomized trial. The Lancet. 2002;359:2224-2229.


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