Elsevier

The Lancet Oncology

Volume 6, Issue 7, July 2005, Pages 477-484
The Lancet Oncology

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Laparoscopic surgery versus open surgery for colon cancer: short-term outcomes of a randomised trial

https://doi.org/10.1016/S1470-2045(05)70221-7Get rights and content

Summary

Background

The safety and short-term benefits of laparoscopic colectomy for cancer remain debatable. The multicentre COLOR (COlon cancer Laparoscopic or Open Resection) trial was done to assess the safety and benefit of laparoscopic resection compared with open resection for curative treatment of patients with cancer of the right or left colon.

Methods

627 patients were randomly assigned to laparoscopic surgery and 621 patients to open surgery. The primary endpoint was cancer-free survival 3 years after surgery. Secondary outcomes were short-term morbidity and mortality, number of positive resection margins, local recurrence, port-site or wound-site recurrence, metastasis, overall survival, and blood loss during surgery. Analysis was by intention to treat. Here, clinical characteristics, operative findings, and postoperative outcome are reported.

Findings

Patients assigned laparoscopic resection had less blood loss compared with those assigned open resection (median 100 mL [range 0–2700] vs 175 mL [0–2000], p<0·0001), although laparoscopic surgery lasted 30 min longer than did open surgery (p<0·0001). Conversion to open surgery was needed for 91 (17%) patients undergoing the laparoscopic procedure. Radicality of resection as assessed by number of removed lymph nodes and length of resected oral and aboral bowel did not differ between groups. Laparoscopic colectomy was associated with earlier recovery of bowel function (p<0·0001), need for fewer analgesics, and with a shorter hospital stay (p<0·0001) compared with open colectomy. Morbidity and mortality 28 days after colectomy did not differ between groups.

Interpretation

Laparoscopic surgery can be used for safe and radical resection of cancer in the right, left, and sigmoid colon.

Introduction

Minimally invasive surgery reduces surgical trauma. Laparoscopic surgery restricts the extent of abdominal incisions, avoids manual traction and manipulation of abdominal tissue, and prevents undue blood loss, thus diminishing immune activation and catabolism as a response to surgery.1, 2 15 years after Muehe first did laparoscopic cholecystectomy, minimally invasive surgery has become the preferred approach for treatment of symptomatic cholecystolithiasis, gastro-oesophageal reflux, and morbid obesity.3, 4, 5, 6 Although Jacobs and Verdeja7 reported a case series on laparoscopic segmental colectomy in patients with sigmoid cancer in 1991, laparoscopic colectomy for cancer has not been readily accepted: the safety of the procedure has been questioned because of early reports of port-site metastases. Despite reduced morbidity and improved convalescence after laparoscopic operations for benign disorders such as gallbladder stones and reflux oesophagitis, surgeons have been sceptical about similar advantages of laparoscopic colectomy for cancer.

The European, multicentre COLOR (COlon cancer Laparoscopic or Open Resection) trial aimed to assess laparoscopic surgery as curative treatment for colon cancer by analysis of short-term outcome and of cancer-free survival 3 years after laparoscopic surgery or open surgery for colon cancer. Data for cancer-free survival will be reported later. Here, the short-term results of clinical characteristics, operative findings, and postoperative outcome are reported.

Section snippets

Patients

Between March 7, 1997, and March 6, 2003, all patients with colon cancer who presented to the 29 participating hospitals were screened for inclusion into the trial. Patients with one adenocarcinoma, localised in the caecum, ascending colon, descending colon, or sigmoid colon above the peritoneal deflection who were aged 18 years or older and who gave written informed consent were eligible. The number of eligible patients who were not randomised was not recorded. Exclusion criteria were:

Results

Figure 1 shows the trial profile. The trial was not stopped early. 11 patients allocated laparoscopic surgery underwent open surgery because of malfunctioning laparoscopic equipment (eight patients) or absence of a skilled laparoscopic surgeon (three patients). Table 1 shows baseline characteristics of participants.

Malignant disease was confirmed preoperatively by a biopsy sample in 827 (76%) of 1082 patients. To diagnose the tumour, 876 (81%) of 1082 patients had colonoscopy and 432 (40%) had

Discussion

The short-term outcomes of the COLOR trial show that although duration of surgery for laparoscopic colectomy for colon cancer was longer than that of open colectomy, patients who underwent the laparoscopic procedure had less blood loss during surgery. Moreover, tumours resected by laparoscopy or by open surgery did not differ in stage, distribution, size, histology, number of positive resection margins, and number of positive lymph nodes. After surgery, patients allocated laparoscopic colectomy

Glossary

Colonoscopic tattooing
Injection of India ink by use of a catheter, which is passed down a working channel in the colonscope, in the bowel wall surrounding the lesion. Blue ink is visualised on the serosal side of the bowel, allowing localisation of small lesions that are not readily visible.

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