Minimally invasive surgery: a safe and effective option for rectal cancer2 Apr 2015
People undergoing surgery for rectal cancer fare just as well whether they have conventional or minimally invasive laparoscopic surgery, suggests a new international comparison study. However, when the tumor is in the lower rectum, laparoscopic surgery seems better, according to the results.
About 466,000 people develop rectal cancer worldwide each year. Although, doctors have begun to favor laparoscopic "keyhole" surgery, there has been lingering concern over whether the gas that was injected in the abdomen to create a working space for laparoscopic surgery tools would displace too many cancer cells and transfer those tumor cells to the incisions in the abdominal wall. The new study, known as COLOR II, was designed to address that question.
"With laparoscopic surgery, the short-term outcomes are better. What that means is patients experience less pain after surgery, bowel function returns earlier and the post-operative recovery goes more quickly," commented Dr. Jaap Bonjer, the lead author, of the VU University Medical Center in Amsterdam.
A study with more than 1.000 patients from thirty hospitals around the world
This is the largest trial to date and “we can now state with evidence that laparoscopic surgery is safe and associated with long-term cancer outcomes that are at least similar to open surgery” commented Dr. Bonjer. Thirty hospitals in Europe, North America and Asia enrolled 1,044 patients with adenocarcinoma of the rectum in the study. People whose tumors had spread to other tissues were excluded.
Although both types of surgery generally gave comparable results, the researchers found that:
- The location of the tumor made a difference
- When the cancer was in the lower rectum, the three-year recurrence rate was 3.8% with laparoscopic surgery versus 12.7% with traditional surgery
- With conventional open surgery, it can be harder for a surgeon to see deep into the pelvis. A laparoscope can get a better view, and the image is magnified. Consequently, the surgeon can operate with greater precision.
- Overall survival rates were 86.7% when the surgery was done with just a few puncture holes in the body versus 83.6% when the abdomen was opened up. Just 5% of people in both groups had a cancer recurrence within three years.
Over all, laparoscopic surgery also produced a higher rate of disease-free survival in people with stage 3 disease, where the tumor has spread to adjacent lymph nodes.
Limitations and possible drawbacks
"We only included patients whose cancers had not invaded adjacent organs such as the bladder and ureters," Bonjer said. "With patients who have larger cancers, it needs to be done open because it's too complex to do laparoscopically."
Additionally, Dr. Heather Yeo, an assistant professor of surgery at Weill Cornell Medical College and New York-Presbyterian Hospital, urged caution because:
- the test involved highly-skilled surgeons operating on specially-selected patients whose tumors had not spread
- And the new findings do not discuss which group was more likely to retain proper bowel and bladder control, or sexual function.
However, she added the surgeons in the study "had multiple evaluations of their skill and their experience before they were even enrolled in the trial," so the results show what can happen under ideal conditions. Moreover, she underlined “it is important to have a surgeon highly experienced in rectal cancer surgery” adding that "the big question is going to be the functional outcomes”, referring to how well patients retain their bowel, bladder and sexual functioning. "So those are the kinds of reasons you should go to a specialist."