SEATTLE — Patients who undergo a laparoscopic procedure for colon or rectal cancer have no worse mortality beyond 5 years than those who have an open procedure, according to a prospective, randomized trial presented at the annual meeting of the American Society of Colon and Rectal Surgeons.
“We found no unusual recurrences after a median follow-up of over 7 years, and there were no wound recurrences in our laparoscopy group,” Dr. Daniel P. Geisler said in reference to the follow-up results of his 110-patient trial at the Cleveland Clinic.
No previous prospective studies of laparoscopy and colon cancer have reported postsurgical results beyond 3 years, said Dr. Geisler of the colorectal surgery department at the Cleveland Clinic. His study, with a median follow-up of 7.5 years, found overall survival rates of 82% for the 55 patients whose cancer was removed laparoscopically, and 67% for the 55 patients who underwent a conventional procedure—a difference that was not statistically significant, Dr. Geisler said.
Cancer-related survival by cancer stage was 82% for stage I (92% for laparoscopy vs. 86% for conventional), 83% for stage II (93% laparoscopy vs. 73% for conventional), 69% for stage III (67% laparoscopy vs. 70% conventional), and 0% for stage IV.
The patients in the trial were undergoing curative resective procedures for cancer or polyps of the right colon, sigmoid colon, or upper or lower rectum. Patients who turned out to have benign disease after surgery (15 patients in each randomized group) were excluded from further follow-up.
There was no difference between groups in age, gender, or overall health. They had similar distribution by postoperative staging, similar numbers of nodes removed (an average of 21 for laparoscopy versus 25 for conventional), and equivalent resection margins.
The laparoscopic procedures that were done in the mid-1990s took significantly longer to perform, but hospital stays were shorter (an average of 6 days vs. 7 days for those patients undergoing the open procedure).
The laparoscopic patients also needed less analgesia after the procedure than the open group (an average of 0.8 mg/kg of morphine equivalent on the first postoperative day vs. 1 mg/kg, with no difference on subsequent days). The laparoscopic group had a more rapid return to normal pulmonary function (a return to 80% of their preoperative function at an average of 3 days vs. 6 days for the open surgery patients).
A total of 11% of the laparoscopic procedures were converted to open procedures. But the postoperative complication rate was the same for both groups (15%). There was one death in each group within 30 days. One wound recurred, in a patient who had a conventional procedure.
Given the short-term benefits, the trial suggests laparoscopy is the preferred approach, Dr. Geisler said.
Asked to compare the laparoscopic procedures with an open procedure with an epidural, Dr. Geisler said that an epidural provides better pain coverage during open procedures, but he would still favor a laparoscopic procedure because no epidural is needed, so the immediate postoperative recovery is much shorter.
Given the short-term benefits, the trial data suggest that laparoscopy is the preferred approach. DR. GEISLER