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Recurrence Rates Similar After Laparoscopic or Open Colectomy for Colon Cancer

Patients undergoing laparoscopically-assisted or open colectomy for colon cancer had similar recurrence rates, according to the findings of a prospective, randomised trial.

"Our multi-institutional study provides data in support of the safety of laparoscopically assisted Colectomy for colon cancer with respect to complications, time to recurrence, disease-free survival, and overall survival," writes Heidi Nelson, MD, Division of Colon and Rectal Surgery, Mayo Clinic, Rochester, Minnesota, United States, and colleagues for the Clinical Outcomes of Surgical Therapy Study Group.

Over a median follow up of 4.4 years, the investigators assessed time to tumour recurrence among 435 patients randomised to laparoscopic and 428 patients randomised to open colectomy for adenocarcinoma of the colon. The patients ranged in age from 28 to 96 years, and the characteristics of the groups were well balanced.

The rate of recurrence among those in the laparoscopic group was 16% compared with 18% in the open colectomy group, and both groups had a recurrence rate in surgical wounds of less than 1%. The 3-year overall survival rate was 86% and 85% in the laparoscopic and open colectomy groups, respectively. The surgical groups showed no significant differences in time to recurrence or overall survival at any stage of cancer.

Of the patients assigned to laparoscopic surgery, 21% converted to open colectomy due to advanced or complicating disease, inadequate margins of resection, no visualization of critical structures, adhesions, and other operative complications.

While operating times in the laparoscopic group were significantly longer than were those in the open colectomy group, patients undergoing laparoscopic surgery generally required 1 less day of oral analgesics, parenteral narcotics, and hospital stay than did those in the open colectomy group. The rates of in and out of hospital complications, hospital readmission, and reoperation were similar between groups.

"Out findings confirm that laparoscopically assisted colectomy is not associated with a significant increase in overall complications," the authors write, adding "On the whole, these data suggest that because laparoscopically assisted colectomy provides no additional risk of cancer, it is an acceptable alternative to open surgery for colon cancer."

N Engl J Med 2004;350:2050-9

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