New
Service for TodaysSeniorsNetwork.com
readers...roll mouse over, click on
highlighted links in stories to review items
from Amazon
Now, keep up to date
with daily feeds of newly posted stories
about America's Seniors...click on the box
to the left
Similar outcomes for minimally invasive,
open surgery in Colon Cancer
Newswise — Large, open incisions that cause
pain and require lengthy healing times might
be unnecessary to treat colorectal cancer
patients successfully, according to a new
review of studies.
“For a long time, many surgeons have been
afraid that laparoscopy might impair
survival in colorectal cancer patients and
cause metastases in the skin openings that
are used to insert the instruments, but this
has proven not to be the case,” said lead
reviewer Esther Kuhry, M.D., a general
surgery resident at Namsos Hospital in
Norway.
Colorectal cancer is one of the most common
types of cancer in the United States.
According to the National Cancer Institute,
there will be 148,810 new diagnoses of
colorectal cancer in 2008.
In a meta-analysis that combined the results
of 12 trials involving 3,346 patients, the
reviewers compared outcomes of laparoscopic
and open surgeries used in colorectal cancer
treatment and found no significant
differences between the two types of
surgeries when it came to long-term survival
and cancer recurrence rates.
Five studies took place in the United
States; the others occurred in China,
Taiwan, Portugal, Italy, Spain and the
United Kingdom.
The review appears in the latest issue of
The Cochrane Library, a publication
of The Cochrane Collaboration, an
international organization that evaluates
medical research.
Systematic reviews draw evidence-based
conclusions about medical practice after
considering both the content and quality of
existing medical trials on a topic.
In laparoscopic procedures, the surgeon
conducts the surgery through small holes in
the abdomen and uses a camera to visualize
the person’s abdominal contents.
These
procedures have revolutionized the operating
room, leading to smaller incisions, less
pain and quicker recovery times for patients
requiring gallbladder removal,
appendectomies, gastric bypass and other
common gastrointestinal surgeries.
Still, because of a lack of information
about laparoscopic surgery’s long-term
outcomes, surgeons have traditionally relied
on open surgery to treat colon cancer
patients. In open surgery, surgeons cut
through the abdominal wall and use longer
incisions to directly view the patient’s
colon and remove cancerous tissue.
Based on the review results, “laparoscopic
surgery for colon cancer is associated with
survival and mortality rates that are equal
to open surgery,” Kuhry said.
The review found no significant differences
between the two groups in terms of cancer
metastasis, short-term and five-year
survival rates and deaths caused by cancer.
The reviewers also evaluated the incidence
of adhesions — bands of scar tissue that
form between organs and tissue — and hernias
at the incision site, two common
complications after colorectal cancer
surgery.
They found no significant differences in the
rates of these complications between the
laparoscopic and open surgery groups.
However, for rectal cancer, not enough
evidence is available to draw reliable
conclusions about whether laparoscopic
surgery safely compares to open surgery,
Kuhry said. Only two included studies
evaluated patients with rectal cancer
separately.
“More studies are emerging that suggest the
laparoscopic approach to colorectal cancer
resection is equivalent in terms of cancer
control. However, more long-term data is
needed to verify that and more thorough data
is required before anyone can say it is
better or preferred,” said Janice Rafferty,
M.D., chief of the division of colon and
rectal surgery at the University of
Cincinnati College of Medicine.
Rafferty, who was not involved with the
review, said that it includes “only a few
studies and the numbers therefore become
quite small to be overwhelmingly powerful.”
“It is true that it appears that
laparoscopic outcomes in cancer surgery are
equivalent, but that is not a strong enough
argument to say it must be offered to all
cancer patients, which [the authors] say in
the conclusion,” she said.
The authors fail to discuss surgical
experience and the learning curve necessary
for laparoscopic colon cancer resection, and
whether or not this influenced results,
Rafferty said: “After all, if every
abdominal surgeon is going to hang their hat
on these results, there have to be
guidelines established about who is
qualified to do this ‘equivalent’ cancer
resection.”
Before laparoscopy can be widely used to
treat colorectal cancer, surgeons must have
adequately training to perform these
minimally invasive colorectal cancer
surgical procedures, Kuhry said in an
interview. Until recently, surgeons have
mainly performed laparoscopic surgery for
colorectal cancer treatment within the
framework of clinical studies, she noted.
When it comes to evaluating colorectal
cancer treatments, it is vital for patients
to remember that laparoscopy is a technique,
not a science, Rafferty said.
“It’s not for every patient,” she said.
“Sometimes it is in the best interest of the
patient to have an expeditious traditional
approach to cancer removal, because — what
is getting lost here — is that the whole
patient needs to be considered, not just the
size of their incision.”
Kuhry E, et al. Long-term results of
laparoscopic colorectal cancer resection (Review).Cochrane
Database of Systematic Reviews 2008, Issue
2.
The Cochrane Collaboration is an
international nonprofit, independent
organization that produces and disseminates
systematic reviews of health care
interventions and promotes the search for
evidence in the form of clinical trials and
other studies of interventions. Visit
http://www.cochrane.org for more
information.
...
...
...