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Study Backs Less Invasive Colon Cancer Surgery

Laparoscopy reduces hospital stay, complications, deaths

THURSDAY, June 27, 2002 (HealthDayNews) -- A Spanish study gives a ringing endorsement to a new kind of surgery for colon cancer that uses just a few small incisions and a camera-guided scalpel.

Patients who had the procedure, called laparoscopy-assisted colectomy (LAC), recovered faster and got out of the hospital sooner, had fewer postoperative complications, and had a higher survival rate than those who had conventional colon cancer surgery, says a report in this week's issue of The Lancet.

"If these results are confirmed by ongoing multi-center trials, laparoscopy-assisted colectomy for treatment could become the standard approach in patients with colon cancer," surgeons at the Hospital Clinic in Barcelona write in the report.

In the United States, the procedure is still regarded by many as experimental. The National Cancer Institute is sponsoring a controlled study at a number of medical centers in this country. Results are not expected until the end of this year, at best.

Colon cancer is diagnosed in more than 107,300 Americans each year, and the American Cancer Society says it will cause 48,100 deaths in 2002.

The Barcelona surgeons treated 219 patients, of whom 111 had LAC and 108 had conventional open colectomy (OC), which requires a foot-long incision. LAC patients had an average hospital stay of five days, compared to eight days for the OC patients. There were surgery-related complications in 12 of the LAC patients and 31 of the OC patients. Colon cancer recurred in 17 percent of the LAC patients and 27 percent of the OC patients, and the death rate was 19 percent in the LAC group versus 27 percent in the OC group.

Physician reactions to the report indicate the LAC controversy is not over.

The study is one more indication that LAC is the coming thing, says Dr. Joseph E. Martz, an attending surgeon at Lenox Hill Hospital in New York City who specializes in the procedure.

"It is something I saw as the future in surgery," says Martz, who trained in the technique at the Lahey Clinic in Boston. "I've done over 40 laparoscopic colon cancer resections this year, with good results. There have been other studies that show it to be at least equal to conventional surgery."

However, Dr. Nicholas Petrelli, medical director of the Helen F. Graham Cancer Center in Delaware and professor of surgery at Jefferson Medical College, says a close look at the journal report keeps him in the ranks of doubters.

The benefits of LAC were concentrated entirely in one class of patients, those with advanced cancer that had not spread to other parts of the body, Petrelli says, and "I have some concern about that subset analysis."

As for complications, the report shows an unusually high 10 percent wound infection rate in the OC patients. "The wound infection rate should be under 2 percent," Petrelli says. "Why is it so high?"

"In view of the issues I have raised, in my mind the role of LAC as curative in colon cancer is still investigational," Petrelli says. It will take a positive result in the NCI-sponsored trial to convince him, he adds.

The Spanish report doesn't settle the controversy, but it is "a big step in answering the question," says Dr. Martin Weiser, of the colorectal surgery division of Memorial Sloan-Kettering Cancer Center. About 30 percent of his operations use LAC, he says.

"It's an important study for me, because I always have told my patients that we have no long-term data showing that survival is equivalent, if not better," Weiser says. "Now we do." However, he also believes the ongoing NCI report will be pivotal.

Martz has his own caveat. Like any new technique, LAC requires a mastery that not all surgeons have, he says. "There are very few who have trained in colon and rectal surgery, and can do laparoscopic surgery," Martz says. "Consumers should be careful. A lot of people say they can put the camera in and do laparoscopic surgery, but unless they are trained in it, the benefits won't be seen."

What To Do

You can learn about colon cancer from the American Cancer Society or the American Gastroenterological Association. If you want a peek into how LAC is done, visit the Mayo Clinic.

SOURCES: Joseph E. Martz, M.D., attending surgeon, Lenox Hill Hospital, New York City; Nicholas Petrelli, M.D., medical director, Helen F. Graham Cancer Center, Newark, Del.; Martin Weiser, M.D., surgeon, Memorial Sloan-Kettering Cancer Center, New York City; June 29, 2002, The Lancet
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