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Minimally invasive laparoscopic surgery, when performed by experienced surgeons, is a safe and effective alternative to standard open surgery for most patients with cancer that is confined to the colon. That is the main finding of a seven-year international study, which will be published in the May 13 issue of the New England Journal of Medicine. NewYork-Presbyterian Hospital/Columbia University Medical Center is the largest New York City-area contributor to the study.

The study the first and largest of its kind involves 872 patients with colon cancer. It addresses concerns raised in the early 1990s about higher rates of colon cancer recurrence after laparoscopic surgery. Those concerns resulted in policies recommending that laparoscopic colon surgery not be performed until clinical studies showed it was effective in cancer patients.

The randomized study headed by the Mayo Clinic and under the direction of Dr. Heidi Nelson, involving 48 medical centers in the U.S. and Canada compared rates of complications, cancer recurrence, length of time patients were cancer-free, and the overall survival in both laparoscopic and traditional patients. Patients who had been diagnosed with potentially curable colon cancer were randomly assigned to undergo either the minimally invasive laparoscopic procedure or the standard surgery and were followed for several years to check for cancer recurrence.

This study confirms that in the majority of patients with colon cancer that the laparoscopic method is a reasonable treatment alternative to the traditional large incision surgical method, says Dr. Richard L. Whelan, chief of the section of colon and rectal surgery at NewYork-Presbyterian Hospital/Columbia and associate professor of surgery at Columbia University College of Physicians Surgeons. It is important to note that laparoscopic colon surgery should not be used for patients whose cancer extends to areas beyond the colon. Importantly, the study also makes the point that laparoscopic colon resections should only be done by surgeons with considerable laparoscopic experience.

The study demonstrates that the minimally invasive approach offers patients short-term recovery benefits such as a briefer hospital stay and an earlier resumption of bowel activity. Study principals listed the following additional findings and patient benefits:

• Almost exact rate of recurrence in both sets of patients. The cancer returned in 160 of the 872 patients; 76 had undergone laparoscopic surgery and 84 had the standard operation.
• The return of the cancer in the location of the surgical wound was less than one percent in both sets of patients, occurring in two patients who had laparoscopic surgery and one patient who had standard surgery.
• The survival rate was almost identical 86 percent of patients who had undergone laparoscopic surgery were alive three years after surgery and 85 percent receiving the standard surgery were alive.
• Similar rates of complications during surgery and within 30 days of surgery in terms of hospital re-admissions, re-operations and deaths.
• Shorter hospitalization for patients who had laparoscopic surgery on average, five days in the hospital compared to six days for the standard surgery group.
• Shorter use of intravenous pain-relieving medications after surgery for the laparoscopic group three days versus four days. Also, briefer use of oral pain relievers one day for laparoscopic group compared to two days for the standard surgery group.

Minimally invasive laparoscopic surgery typically involves the creation of three, half-inch incisions through which a small video camera and surgical instruments are inserted. A two-inch incision is used to bring the colon out of the abdomen, cut away the portion containing cancer, then reconnect the two healthy parts and put the colon back inside the abdomen. With standard surgery, an incision of six to eight inches or longer is required for opening the abdomen to perform the operation.

The use of minimally invasive laparoscopic surgery began in the 1980s for removal of the appendix and gallbladder. The success of those procedures made surgeons think the technique could provide equal benefit for removal of colon cancer. In 1990, surgeons began performing minimally invasive surgery for colon cancer but stopped in 1994 because of concerns about increased recurrence of cancer at the surgery wound site. It was not known whether laparoscopic surgery provided the same extent of abdominal exploration and information about cancer in the lymph nodes as standard surgery or whether the laparoscopic technique changed the pattern of cancer cell spread.

The National Cancer Institute (NCI) funded this comparison study as a top priority clinical research project. The study was coordinated by the North Central Cancer Treatment Group (NCCTG) in conjunction with other National Cancer Institute Cooperative Groups.

This year in the United States about 100,000 people will be diagnosed with colon cancer. More than 90 percent of them will be told they need surgery to remove all or part of the colon or large intestine to get rid of the cancer.