Source: Oncology  |  Posted 5 years ago

By Norra MacReady

LAS VEGAS, NV -- October 20, 2006 -- Laparoscopic colectomy gathers as many lymph nodes as the open procedure, making the two techniques equal in diagnostic yield, researchers reported here at the American Society for Clinical Pathology (ASCP) Annual Meeting.

In addition, the laparoscopic procedure is associated with less morbidity and a shorter hospital stay than the open procedure, so it is a viable choice for colon cancer surgery in the community hospital setting, according to a poster presentation by Neil L. Davis, MD, department of pathology, St. Barnabas Hospital, Livingston, New Jersey, and colleagues.

These findings are important because the areas of pericolic fat removed during the 2 procedures are different, they explained. Since the lymph nodes reside in the adipose tissue, it was uncertain if the laparoscopic procedure removed the same number of lymph nodes as open surgery, which could have important diagnostic consequences.

While the surgeon decides what type of procedure to use and how much bowel to remove, "it is the pathologist who is responsible for the ultimate staging of the patient's malignant disease," the researchers said in their poster. "Thus, it is of great importance to us to know that we are being given the greatest possible opportunity to find and examine potentially involved lymph nodes, and an understanding of the impact of the surgeon's choices is of paramount importance."

The authors retrospectively reviewed 157 laparoscopic and 349 open colectomies performed at a tertiary-care community hospital over 42 months. They created a database that tracked the number of lymph nodes harvested and length of bowel removed in each case.

The average length of bowel removed through laparoscopic colectomy was 24.7 cm, compared to 29.7 cm taken with open colectomy. Laparoscopic colectomy yielded an average of 14.5 lymph nodes compared with 15.2 with the open procedure. This difference was not statistically significant.

Surgeons generally agree that laparoscopic colectomy is preferable to open surgery, citing benefits such as less pain and blood loss, shorter length of hospital stay, and earlier resumption of oral food intake. There is also evidence that prognosis and survival are better when patients undergo more extensive lymphadenectomy. However, there is no consensus among surgeons on which procedure yields more lymph nodes, and the papers that have been published on this topic contain virtually no references to anything in the pathology literature.

This analysis confirms that lymph node yield from open and laparoscopic colectomy is similar, the investigators said.

[Presentation title: Laparoscopic Colectomy is a Viable Alternative to Open Colectomy for Colon Cancer: A 42-Month Community Hospital-Based Analysis Comparing Final Diagnosis and Adequacy of Lymph Node Examination. Poster 64]