The COLOR II trial has shown that laparoscopic surgery appears to be safe and leads to completeness of resection comparable to the more invasive, open procedure. Here are the conclusions of this large phase III trial:
• For selected patients with rectal cancer managed by skilled surgeons, laparoscopic surgery results in similar safety outcomes, resection margins, and completeness of resection.
• Laparoscopic surgery is linked to less blood loss and a shorter hospital stay.
• BUT, we still need results for local and regional recurrence. These should be out by the end of 2013.
The study: Between January 2004 and May 2010, 1,044 patients with rectal cancer (and no distant spread) were randomly assigned to laparoscopic surgery or open surgery. Patients with T4 tumors were excluded, as were T3 tumors within 2mm of the endopelvic fascia, or with invasion of adjacent tissues.
Results: Laparoscopic procedures were converted to open surgery in 17% of patients in the laparoscopic surgery group. The lap procedures took longer than open procedures on average (240 vs 188 minutes), but were linked to less blood loss (median 200 mL versus 400 mL). Bowel function returned to normal quicker in the the laparoscopi group (2 versus 3 days). There were no differences in postoperative complications such as lung problems, abscess, wound infections, heart problems, or ileus. Hospital stay was slightly shorter in the laparoscopic grou0 (8 versus 9 days), and the risk of death in the first 28 days after surgery similar (1-2%).
My take: For selected patients managed by skilled surgeons, laparoscopic resection of rectal cancer appears to be a reasonable alternative to open surgery. Still, we must have long-term follow-up to assess local recurrence and survival before we are sure that it is a good cancer operation for rectal cancer. I’m Dr. Michael Hunter.
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