Laparoscopic resection of rectosigmoid cancer does not impair survival

Several reports have shown that post-operative recovery is improved with laparoscopic rather than conventional open resection of colon cancer. Now, new research indicates that the laparoscopic approach does not adversely affect disease control or jeopardize survival.

There has been concern about the adequacy of resection with the laparoscopic approach after reports linked the procedure with early port site recurrence. Until the long-term effects were clear, it was recommended that laparoscopic resection be limited to the clinical trial setting. In a study reported in The Lancet for April 10th, Dr. Ka Lau Leung, from the Chinese University of Hong Kong, and colleagues describe the outcomes of 403 patients with rectosigmoid cancer who were randomized to undergo laparoscopic assisted or conventional open resection between 1993 and 2002. After curative resection, the probability of survival at 5 years in the laparoscopic group was 76.1%–higher, but not significantly different from the 72.9% rate in the conventional group, the researchers note. The disease-free probability at 5-years for the laparoscopic and conventional groups was 75.3 and 78.3%, respectively.Consistent with previous reports, the laparoscopic surgery took longer to perform than open surgery. The average operating time for laparoscopic resection was 189.9 minutes-about 45 minutes longer than the time needed for open surgery.Postoperative recovery, as determined by factors such as time to first bowel movement and hospital stay, was significantly accelerated in the laparoscopic group. However, this benefit came at the expense of a higher direct cost–$9297 per patient for laparoscopic resection versus $7148 per patient for open surgery (p < 0.001). No differences were seen between the groups in distal resection margin, number of lymph nodes in the surgical specimen, overall morbidity, and operative mortality, the investigators point out."Laparoscopic resection did not worsen survival and disease control for patients with rectosigmoid cancer compared with open resection, and its benefits in reducing pain and allowing earlier postoperative recovery were confirmed," the authors state. "The justification for preferential use of laparoscopic technique would depend on the perceived value of its effectiveness in improving short-term postoperative outcomes."(Source: Lancet 2004;363:1187-1192: Reuters Health: April 2004: Oncolink)