When performed by experienced surgeons, laparoscopic surgery is a safe and effective alternative to laparotomy for most patients with cancer confined to the colon, according to findings from a 7-year international study published May 13th in the New England Journal of Medicine.

Although laparoscopy for colon cancer was first attempted in 1990, surgeons quickly returned to open colectomy because of three concerns: an increase in recurrent disease at the incision site, a question whether laparoscopy could provide adequate abdominal exploration and evaluation of lymph nodes, and a question whether laparoscopy technique changed the pattern of later metastasis.

"These concerns demanded a prospective, randomized comparison of the two procedures to ensure that the laparoscope technique was properly tested before it became widely used for surgical treatment of colon cancer," said Heidi Nelson, MD, lead author of the study report. "Most surgeons supported this need for critical evaluation and adopted a policy of not performing the laparoscopic procedure outside of a clinical study."

Surgeons participating in this study had to become credentialed; they also documented that they had performed at least 20 laparoscopic colon surgeries. During the study, an audit committee evaluated randomly selected and unedited videotapes submitted by each surgeon to assure proper technique was followed.

The current study involved 872 patients with colon adenocarcinoma and is the most extensive comparison to date of the two surgical techniques. Heidi Nelson, MD, led the study team of 66 colorectal surgeons at 48 medical centers in the United States and Canada. The study team compared rates of complications, cancer recurrence, length of time patients were cancer-free, and the overall survival in both sets of patients.

All patients in the study had been diagnosed with potentially curable cancer of the colon. Each patient was randomly assigned to undergo either the minimally invasive laparoscopic procedure or standard surgery and was followed for several years to check for cancer recurrence.

Recurrence rates were equivalent (16 percent for laparoscopy group and 18 percent for open-colectomy group), as were recurrence rates near the surgical incision site (less than 1.0 percent for both groups). The 3-year survival rates were also equivalent (86 percent for laparoscopy patients and 85 percent for open-colectomy group).

In addition, the operative complication rate and 30-day adverse outcome rate were similar. Laparoscopy had an advantage in shorter hospitalizations (average stay, 5 and 6 days for laparoscopy and open colectomy, respectively) and shorter duration of intravenous analgesia use (3 and 4 days for laparoscopy and open colectomy, respectively).

"My impression from many interactions with patients is that the minimally invasive approach is less intimidating to the patient with colon cancer," said Nelson. "The smaller incision and faster recovery present less of a reminder to the patient about the serious diagnosis."

"Our study shows that while laparoscopic surgery is safe and effective for treatment of colon cancer, it must be performed selectively," said Nelson. "It should not be used for patients whose cancer requires extensive surgery to other organs besides the colon, and it should be done by surgeons who are experienced in performing laparoscopic colon surgery."