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Laparoscopy-Assisted Colectomy Improves Survival in Single-Center Trial

Laparoscopy-assisted colectomy (LAC) for colon cancer is more effective than open colectomy, according to a report in the July Annals of Surgery.

"Considering the small but significant short-term advantages of the minimally invasive approach, LAC should now be regarded as the standard of care for the treatment of colon cancer," Dr. Antonio M. Lacy from University of Barcelona, Spain told Reuters Health.

In 2002, Dr. Lacy's team reported their single-center experience with colon cancer patients who were randomized to treatment with either LAC or open surgery. Following the subsequent publication -- by another group -- of results from a larger trial that showed no recurrence or survival benefit with LAC vs open surgery, the Barcelona investigators collected long-term follow-up data on their original patients.

At a mean follow-up of more than 5 years, there were nonsignificant trends toward higher overall survival, higher cancer-related survival, and lower tumor recurrence in the LAC group vs the open colectomy group, the authors report.

When patients were stratified by tumor stage, those with stage III tumors who underwent LAC had significantly higher overall survival, cancer-related survival, and likelihood of being free of recurrence compared to stage III patients managed with open colectomy, the researchers note.

In contrast, the investigators say, survival curves in patients with stage I or II tumors overlapped for the 2 treatments.

"LAC is definitely not inferior to open colectomy for the treatment of colon cancer from an oncologic perspective," Dr. Lacy said. "For now, patients should be referred to centers where trained surgeons in this technically demanding procedure are available."

Editorialist Dr. Robin McLeod from University of Toronto, Ontario, Canada believes that while the authors' finding of improved survival may be due to differences in the patient and operative factors, "it is much more likely that it is a chance occurrence."

Dr. McLeod points out that data from multiple earlier reports "provide strong evidence that oncological outcomes are not compromised with surgery being performed laparoscopically. On the other hand, there is no evidence to suggest that oncologic outcomes are superior following laparoscopic-assisted colectomy."

Dr. Lacy responds: "I understand with great respect Dr. McLeod's comment considering the available evidence from larger multicenter randomized controlled trials showing no differences in oncological outcomes when comparing LAC and open colectomy. Nevertheless, I must emphasize the value of single institution experiences, particularly when a very small group of highly experienced surgeons adheres to standard surgical oncologic principles and technique. In such a case, the probability of variations in the surgical practice or patient care is minimized when compared to multicenter studies. From this perspective, this is an added value when evaluating our results."

Ann Surg 2008.




Reviewed by Ramaz Mitaishvili, MD

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