Small-Incision Surgery Safe and Effective For Colon Cancer

It reduces pain, hospital time for patients, a new study says

WEDNESDAY, May 12, 2004 (HealthDayNews) -- A minimally invasive form of surgery saves colon cancer patients one day in the hospital and two days of pain -- and is just as effective as conventional surgery, a new study shows.

The study found almost identical results for 872 patients, half of whom underwent conventional surgery and half who received laparoscopic surgery, the formal name for the small-incision procedure.

After an average of three years, the overall survival rate was almost identical -- 85 percent for conventional surgery and 86 percent for laparoscopy. The recurrence rate of cancer for the minimal procedure was slightly lower, 16 percent, compared to 18 percent for conventional surgery, a difference that is not statistically significant.

Patients who had the less-invasive operation spent an average of five days in the hospital, compared to six days for those who had conventional surgery. And laparoscopic patients needed injected narcotic painkillers for three days and oral painkillers for one day, compared to four days and two days, respectively, for those who had conventional surgery.

"The most important point is that this is the first study to show that minimally invasive surgery [for colon cancer] is safe, effective and offers patient-related benefits," said study leader Dr. Heidi Nelson, chairwoman of the division of colorectal surgery at the Mayo Clinic in Rochester, Minn. "For the first time, we can be confident that this is the right way to go for most patients in most settings."

Results of the study appear in the May 13 issue of the New England Journal of Medicine.

The small-incision procedure is a potential option for about 70 percent of the 90,000 Americans who have colon cancer surgery every year, said Dr. Theodore Pappas. He is a professor of surgery at Duke University Medical Center, and wrote an editorial accompanying the journal report.

But it will be a while before that potential is met because not all surgeons are skilled in the procedure, Pappas said. The study researchers have asked the American College of Colon and Rectal Surgeons to limit credentials for the minimally invasive operation to surgeons who meet specific qualifications and follow fixed rules. All the surgeons at the 48 centers in the United States and Canada who took part in the study met the proposed criteria.

Meanwhile, Pappas said, "for people who want to seek out the minimally invasive procedure, they have to ask about it specifically before they go to surgery." Patients must ask whether the procedure is appropriate for them and whether the surgeon is qualified to do it, he said.

One way to judge, said Dr. James W. Fleshman Jr., is to ask "how many operations the surgeon does a year and whether he or she has done much colorectal surgery, because we have found that you need a certain level of experience in doing the procedure."

Fleshman is a professor of surgery at the Washington University School of Medicine in St. Louis who participated in the trial.

Presently, there are 41 training programs for the minimally invasive colon cancer procedure in the United States, Fleshman said, but data on the number of surgeons who are qualified to do it are not available.

As to cost, there is a running debate about whether the minimally invasive operation saves money, Fleshman said.

The money saved by getting patients home a day earlier must be balanced against the cost of the specialized equipment needed for the procedure, he said, and "there are data on both sides of the issue. Some say it costs more, some say it costs less."

There is no debate about the wisdom of screening that could reduce the need for surgery of any kind, he said, using such recommended procedures as colonoscopy to detect polyps -- growths that can become cancerous.

"If people get screened and get polyps removed, we wouldn't need this operation," Freshman said.

More information

You can learn more about the detection and treatment of colon cancer from the National Cancer Institute and the American Cancer Society.

SOURCES: Heidi Nelson, M.D., chairwoman, division of colorectal cancer, Mayo Clinic, Rochester, Minn.; Theodore Pappas, M.D., professor, surgery, Duke University Medical Center, Durham, N.C; James W. Fleshman Jr., M.D., professor, surgery, Washington University School of Medicine, St. Louis; May 13, 2004, New England Journal of Medicine
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