Are open incisions that cause pain and require lengthy healing times unnecessary to treat colorectal cancer patients? Are surgeons no longer afraid that laparoscopy might impair survival in colorectal cancer patients and cause metastases in the skin openings that are used to insert the trocars and instruments? Is the expeditious traditional open approach to cancer removal not in the best interest of the patient and is the laparoscopic approach to colorectal cancer resection equivalent in terms of cancer control?
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…Colorectal cancer is one of the most common types of cancer in the United States. According to the National Cancer Institute, there will be 148,810 new diagnoses of colorectal cancer in 2008.
In a meta-analysis that combined the results of 12 trials involving 3,346 patients, the reviewers compared outcomes of laparoscopic and open surgeries used in colorectal cancer treatment and found no significant differences between the two types of surgeries when it came to long-term survival and cancer recurrence rates.
Five studies took place in the United States; the others occurred in China, Taiwan, Portugal, Italy, Spain and the United Kingdom.
The review appears in the latest issue of The Cochrane Library, a publication of The Cochrane Collaboration, an international organization that evaluates medical research. Systematic reviews draw evidence-based conclusions about medical practice after considering both the content and quality of existing medical trials on a topic.
In laparoscopic procedures, the surgeon conducts the surgery through small holes in the abdomen and uses a camera to visualize the person’s abdominal contents. These procedures have revolutionized the operating room, leading to smaller incisions, less pain and quicker recovery times for patients requiring gallbladder removal, appendectomies, gastric bypass and other common gastrointestinal surgeries.
Still, because of a lack of information about laparoscopic surgery’s long-term outcomes, surgeons have traditionally relied on open surgery to treat colon cancer patients. In open surgery, surgeons cut through the abdominal wall and use longer incisions to directly view the patient’s colon and remove cancerous tissue.
Based on the review results, “laparoscopic surgery for colon cancer is associated with survival and mortality rates that are equal to open surgery,” Kuhry said. The review found no significant differences between the two groups in terms of cancer metastasis, short-term and five-year survival rates and deaths caused by cancer.
The reviewers also evaluated the incidence of adhesions — bands of scar tissue that form between organs and tissue — and hernias at the incision site, two common complications after colorectal cancer surgery. They found no significant differences in the rates of these complications between the laparoscopic and open surgery groups.
However, for rectal cancer, not enough evidence is available to draw reliable conclusions about whether laparoscopic surgery safely compares to open surgery, Kuhry said. Only two included studies evaluated patients with rectal cancer separately…
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