Laparoscopic Surgery for Colon Cancer: Is there a Difference?

Scott Goldstein, MD, FACS, FASCRS

Annual incidence in US: 145,000 new cases of CRC, 55,000 CRC deaths (910% of all cancer deaths). Treatment costs over $6.5 billion per year

Among malignancies, second only to breast cancer at $6.6 billion per year

Goals of Surgery for Colon Cancer

Remove the Cancer Obtain an Adequate Lymph Node sample to be evaluated by a Pathologist Look for signs of Cancer Spread within the Abdomen Keep the Patient Safe

http://scienceblogs.com/denialism/colon_cancer.jpg

What is Laparoscopic Colon Surgery?

Open Laparoscopic

vs.

http://www.columbiasurgery.org/pat/colorectal/procedures.html http://content.answers.com/main/content/img/galeSurgery http://www.stjohn.org/HealthInfoLib

Can it be done? Is it Safe? Can it meet our criteria for Colon Cancer Surgery?

Issues to Address about Laparosocopic Colon Surgery

Remove the Cancer Obtain an Adequate Lymph Node sample to be evaluated by a Pathologist Look for signs of Cancer Spread within the Abdomen

Does it offer any Advantages over Open Surgery? Are the long-term results of the Surgery Equivalent to Open Surgery with regard to Colon Cancer?

Clinical Outcomes of Surgical Therapy (COST) Study Group Trial

Randomized patients with resectable colon cancer of the Right, Left, and Sigmoid colon 66 Surgeons Nationwide Patients underwent either Open Colon Resection or Laparoscopic Colon Resection Preliminary data published in 1996 and 2002 Final study published October 2007

Ann Surg. 2007 Oct;246(4):655-62; discussion 662-4. Laparoscopic colectomy for cancer is not inferior to open surgery based on 5-year data from the COST Study Group trial. Fleshman J, Sargent DJ, Green E, Anvari M, Stryker SJ, Beart RW Jr, Hellinger M, Flanagan R Jr, Peters W, Nelson H; for The Clinical Outcomes of Surgical Therapy Study Group.

Clinical Outcomes of Surgical Therapy (COST) Study Group Trial

Five-year Cancer Outcomes for Laparoscopic and Open Colectomy Patients From: Fleshman: Ann Surg, Volume 246(4).October 2007.655-664

Clinical Outcomes of Surgical Therapy (COST) Study Group Trial

Clinical Outcomes of Surgical Therapy (COST) Study Group Trial

5-Year Overall Survival
All Stages (I-III) Stage I

Stage II

Stage III

Other Comparison Studies of Laparscopic to Open Colon Resection for Cancer

More than 40 Controlled studies world-wide Almost all studies show that Laparoscopic Colon Resection is No Different from Open Colon Resection with regards to Cancer Outcome Advantages of Laparoscopic Surgery

Disadvantages of Laparoscopic Surgery

Shorter Hospital Stay Less Postoperative Pain Less Blood Loss Faster Return of Bowel Function

More Equipment and Cost of Surgery Longer Operative Time

Cochrane Database Syst Rev. 2008 Apr 16;(2):CD003432. Long-term results of laparoscopic colorectal cancer resection. Kuhry E, Schwenk WF, Gaupset R, Romild U, Bonjer HJ

Very Large Cancers Cancers in Certain Parts of the bowel Patients who may have Abdominal Scarring from Previous Surgeries Patients with other Serious Medical Conditions Whenever it is Safer to do the surgery Open

Laparoscopic Colon Surgery is Not for Everyone

In the COST trial, 21% of Laparoscopic Cases were Converted to Open Cases

Laparoscopic Colon Resection for

Safe in Appropriate Patients Long-term results are the same as Open Surgery There are some Short-term advantages to Laparoscopic Surgery Surgical Decisions should always be based upon Patient Safety and Appropriate Cancer Surgery

Cancer: Conclusions