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Summer 2004 |
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Laparoscopic Surgery for Colorectal Cancer The long awaited randomized trial of laparoscopic versus open resection for curable colon cancer was finally released in May 2004 with results presented in the New England Journal of Medicine and at the annual meeting of the American Society of Colon and Rectal Surgeons. The survival rates, overall mortality and disease specific mortality were comparable between the conventional open surgery group and the laparoscopic surgery group. The laparoscopic group had a slightly lower morbidity rate and slightly lower hospital stay. There was a definite improvement in post hospital recovery in the laparoscopic group. Tumor implants in the wound were low in both groups, but actually slightly lower in the laparoscopic group. The results of this study are encouraging to many surgeons who have long felt that laparoscopic surgery would be of benefit to many cancer patients, but have been waiting for confirmation of that impression. Laparoscopic colon surgery is more difficult than most other laparoscopic operations due to the wide field of dissection, the presence of major vascular structures, more difficult exposure and the size of the specimen removed. All the surgeons in the study had done at least 20 laparoscopic colon resections and submitted an unedited videotape of one laparoscopic colon resection before being allowed to enter patients in the study. Intermittent audits were then done of subsequent laparoscopic resections. The American Society of Colon and Rectal Surgeons has made the following statement regarding laparoscopic surgery for colorectal cancer: |
“Laparoscopic colectomy for curable cancer results in
equivalent cancer related survival to open colectomy when performed by
experienced surgeons. Adherence to standard cancer resection techniques
including but not limited to complete exploration of the abdomen, adequate
proximal and distal margins, ligation of the major vessels at their
respective origins, containment and careful tissue handling, and en bloc
resection with negative tumor margins using the laparoscopic approach will
result in acceptable outcomes. Based upon the COST* trial, pre-requisite
experience should include at least 20 laparoscopic colorectal resections
with anastomosis for benign disease or metastatic colon cancer before
using the technique to treat curable cancer. Hospitals may base
credentialing for laparoscopic colectomy for cancer on experience gained
by formal graduate medical educational training or advanced laparoscopic
experience, participation in hands on training courses and outcomes.” REMEMBER: COLORECTAL CANCER IS PREVENTABLE!!! |
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Kitsap ColoRectal Surgery, Johnny B. Green, MD, FACS, FASCRS |
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