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'Keyhole' Surgery Found Effective for Colorectal Cancer

But there are a limited number of qualified surgeons for the small-incision procedure

FRIDAY, May 13, 2005 (HealthDay News) -- Echoing an American study done a year earlier, British researchers have found that minimally invasive surgery for colorectal cancer is just as effective as conventional surgery.

Additionally, the surgery -- done through an incision just a few inches long -- reduces pain, gets patients out of the hospital faster, and allows them to recover faster, the researchers said.

The study also follows the American finding that emphasized the difficulty in mastering the less-invasive procedure, which limits the number of surgeons who can do it.

The British findings appear in the May 14 issue of the journal The Lancet.

"It certainly is an issue for us in the United Kingdom," said Dr. Pierre Guillou, professor of surgery at St. James University Hospital in Leeds, and lead author of the report. Only 30 surgeons in the United Kingdom were judged to be skilled enough to be included in the trial, done between 1996 and 2002, he said, "and that number has not increased."

"It has been suggested that this will become the gold standard for colorectal cancer surgery," Guillou said. "If that becomes the case, it presents quite a challenge in training up surgeons."

The British trial closely follows the results of the American study. As in the U.S. trial, the 484 U.K. patients who had minimally invasive surgery got out of the hospital faster, reported less pain and had fewer complications, and had a survival rate no worse than the 253 patients who underwent conventional surgery.

The U.K. survey was different in one respect. It included a detailed analysis of results in patients whose cancer affected primarily the rectum, and in those where malignancy occurred higher up in the colon, something that had not been done before.

Preliminary results indicate more benefits for patients with rectal cancer, Guillou said, although analysis is still going on. Patients will be followed to determine three- to five-year survival rates, "which will provide us with definitive evidence."

The major point, Guillou said, is that "what this is saying is that the quality of surgery in this study was exceedingly high."

In an accompanying editorial by Dr. Myriam J. Curet, associate professor of surgery at Stanford University, using another name for the procedure, noted that "keyhole surgery for colon cancer has not been adopted as quickly by the surgical community as other keyhole procedures," in part because it is difficult to master.

"There clearly is a very steep learning curve," Curet said. Patients who are advised to have surgery for colorectal cancer should seek a surgeon who has had extensive training in the discipline of minimally invasive surgery and who has done at least 200 such operations for colorectal cancer, she said.

"The learning curve is probably longer than that, but at least 200 procedures should give these types of good results," Curet said.

More information

For more on colorectal cancer surgery, visit the National Library of Medicine.

SOURCES: Pierre Guillou, M.D., professor, surgery, St. James University Hospital, Leeds, England; Myriam J. Curet, M.D., associate professor, surgery, Stanford University, Palo Alto, Calif.; May 14, 2005, The Lancet
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