In the hands of experts, laparoscopic surgery for rectal cancer was as successful as an open abdominal operation. Cancer free survival after five years wasn’t any different, and cancer was no more likely to return in and around the rectum.
Even if surgeons had to change their approach during the operation and convert from laparoscopic to open surgery, outcomes were not affected.
A surgical team in France compared two similar groups of patients with rectal cancer that had not spread beyond the rectum. 238 had laparoscopic surgery, 233 a more traditional open operation.
They found that there was no difference in deaths immediately after surgery, surgical complications, or quality of surgery. After five years:
- 3.9 percent of patients in laparoscopic group had cancer return locally versus 5.5 percent of open operations, but this was not a significant difference.
- Cancer-free survival was also not different, with 82 percent of laparoscopic and 79 percent of open patients alive without recurrences.
- Overall survival (death from any cause) was lower among patients who had open surgery (72 percent were alive) compared to 83 percent in the laparoscopic group. This difference was almost entirely found in stage III patients.
During 36 laparoscopic operations (15 percent), surgeons had to change tactics and perform an open surgery, but this had no negative impact on death after surgery, local recurrence, or survival.
Study results were limited because patients were not randomized. All surgery was done by a team of colorectal surgeons in a single hospital center using standardized approaches to surgery. Surgeons removed all signs of cancer in more than 90 percent of both laparoscopic and open operations.
Christophe Laurent, MD, PhD, and his team at the University of Bordeaux in France concluded,
The efficacy of laparoscopic surgery in a team specialized in rectal excision for cancer (open and laparoscopic surgery) is suggested with similar long-term local control and cancer-free survival than open surgery. Moreover, conversion had no negative impact on survival.
SOURCE: Laurent et al., Annals of Surgery, Volume 250, Issue 1, July 2009.
The complete study can be found on Medscape Today. (registration is required to view it.)
What This Means for Patients
The study reinforces the message that patients with rectal cancer should be treated by specialists in colon and rectal surgery. In addition, patients should ask their surgeons about their experience in laparoscopic surgery for rectal cancer.
To find a colorectal surgeon, go to the American Society of Colon and Rectal Surgeons website where you can search members both within the United States and internationally.