Minimally Invasive Surgery Comparable to Conventional (Open) Surgery for Colorectal Cancer

Tuesday, March 01, 2005

Could the same minimally invasive surgical technique that revolutionized gall bladder surgery also be performed for colon cancer? If so, would the results be comparable to traditional open surgery for colon cancer?

That’s what surgeons at the Milwaukee Institute of Minimally Invasive Surgery (MIMIS) asked a decade ago when they pioneered laparoscopic colon cancer surgery in Wisconsin. They wondered if laparoscopy would be comparable to open surgery in terms of laboratory results for cancer staging (the extent of the cancer), the spread of cancer to lymph nodes, and patient outcomes.

After performing the surgery on 14 patients, in 1994 they published one of the first reports on laparoscopic colon cancer surgery in Wisconsin, concluding, “Laparoscopically assisted surgery for colon cancer is safe and yields as complete a surgical specimen as is obtained with open surgery.” In addition, patients experienced shorter hospital stays, had less pain, and returned to normal activity faster. Because this was a new procedure, however, a comparison of long-term survival data was not possible at that time.

That remaining question of survival was answered recently in a report in the New England Journal of Medicine (May 2004). The study compared laparoscopic and open (conventional) surgery for colon cancer among 872 patients at 48 health care facilities in the U.S. and Canada. The report showed that, after three years of follow-up, there were no significant differences between groups in time to recurrence of disease or overall survival for patients with any stage of cancer. The study concluded that laparoscopy is an acceptable alternative to open surgery for colon cancer.

Colorectal cancer—cancer of the colon and rectum—is a silent disease that usually develops without symptoms. It’s the second leading cause of cancer-related death in the U.S., and it strikes men and women with almost equal frequency. Approximately 150,000 new cases of colorectal cancer were diagnosed in 2004, and nearly 57,000 people died from the disease. But there’s good news, both in terms of preventing the disease and in treating it with laparoscopy.

Screening Tests
Because colorectal cancer often has no symptoms, it’s important to get regular screenings. The disease and deaths from the disease are highly preventable with regular screening tests. Unfortunately, only about one-third of all colorectal cancers are diagnosed at an early stage.

Most cases of colorectal cancer begin as non-cancerous polyps—small growths on the lining of the colon and rectum. There are no symptoms related to having polyps. These polyps can become cancerous. Removing these polyps can prevent colorectal cancer from ever developing. Screening tests can detect the presence of polyps or detect cancer in its earliest, most curable stages.

The frequency of screening depends upon your medical history. Talk to your physician about the type of screening test that is right (e.g., colonoscopy) for you and how often you should be screened. Colorectal cancer is up to 90 percent curable when it’s discovered in its early stages.

Risk Factors
The risk of developing colorectal cancer increases with age, and 90 percent of cases occur after age 50. Therefore, starting at age 50, men and women who are at average risk for the disease should get screened. Men and women who have a higher risk of colorectal cancer may need to be tested earlier and should talk to their health care professional.

Some people are at a higher risk for developing colorectal cancer and may need to be tested earlier. It is very important to know your family medical history because colorectal cancer can be hereditary. African-Americans and Hispanics are more likely to be diagnosed with colorectal cancer in advanced stages. As a result, death rates are higher for these populations than they are for white Americans.

Those at a higher risk for colorectal cancer include:

  • People with a personal or family history of benign (not cancerous) colorectal polyps.
  • People with a personal or family history of colorectal cancer.
  • People with a personal or family history of inflammatory bowel disease.
  • Men and women who use tobacco, drink alcohol to excess, are obese, or lead a sedentary life.

Along with regular colorectal cancer screenings, regular exercise and maintaining a healthy weight can reduce your risk of colorectal and other forms of cancer.

Surgical Treatment
If colorectal cancer is diagnosed, various forms of treatment—surgery, radiation therapy, chemotherapy, and other treatments—may be used depending on the extent of the cancer. The majority of people with colon cancer need surgery.

During surgery, usually the cancer and a length of normal colon on either side of the cancer (as well as nearby lymph nodes) are removed. The surgeon then reconnects the healthy sections of the colon. Traditionally, this surgery is performed through a 10- to 12-inch incision in the abdomen.

But with laparoscopic surgery, the surgeon makes a few small incisions—usually less than 1 inch—in the abdomen. A trocar (a narrow tube-like instrument) is inserted in the abdomen through one of the incisions. A laparoscope (a tiny telescope connected to a video camera) is inserted through the trocar, giving the surgeon a magnified view of the internal organs on a video monitor. Several other trocars are inserted to allow the surgeon to work inside and remove part of the colon.

Laparoscopy provides many benefits for patients, including a shorter hospital stay, less pain (and less need for pain medication), faster recovery, and faster return to normal activity.

Most people who need surgery for colon cancer are candidates for laparoscopic surgery. Ask your physician about this option and which physicians have the expertise to perform this specialized surgery. The MIMIS, one of a few sites in the state that performs laparoscopic surgery for colon cancer, offers a second-opinion service.

Dr. Lyle Henry is a surgeon and co-director of the MIMIS at Columbia St. Mary’s. For more information, call MIMIS at 414-961-4343, or call 414-963-WELL (9355).

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