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 However, when the tumor is in the lower rectum, laparoscopic surgery
seems better, according to the results in the New England Journal of
Medicine.
Overall survival rates were 86.7 percent when the surgery was done
with just a few puncture holes in the body versus 83.6 percent when
the abdomen was opened up. Just 5 percent of people in both groups
had a cancer recurrence within three years.
"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," Dr. Jaap Bonjer, the lead author, told Reuters Health.
"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," said Bonjer of the VU University Medical Center in
Amsterdam.
But 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, an
important element for patients, noted Yeo, who was not involved in
the study.
About 466,000 people develop rectal cancer worldwide each year.
Doctors have begun to favor such "keyhole" surgery because it is so
much less invasive.
But there has been lingering concern over whether the gas that was
injected in the abdomen to create a working space for laparascopic
surgery tools would displace too many cancer cells and transfer
those tumor cells to the incisions in the abdominal wall, Bonjer
said.
The new study, known as COLOR II, was designed to address that
question.
Thirty hospitals in Europe, North America and Asia enrolled patients
with adenocarcinoma of the rectum in the study. People whose tumors
had spread to other tissues were excluded. Ethicon Endo-Surgery
Europe, a subsidiary of Johnson & Johnson, paid for the study.
Yeo said 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.
Although both types of surgery generally gave comparable results,
the researchers found that the location of the tumor made a
difference.
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When the cancer was in the lower rectum, the three-year recurrence
rate was 3.8 percent with laparoscopic surgery versus 12.7 percent
with traditional surgery.
With conventional open surgery, it can be harder for a surgeon to
see deep into the pelvis, Bonjer explained. A laparoscope can get a
better view, and the image is magnified, he said, “so the surgeon
can operate with greater precision."
Over all, laparoscopic surgery also produced a higher rate of
disease-free survival - 64.9 percent versus 52.0 percent - in people
with stage 3 disease, where the tumor has spread to adjacent lymph
nodes.
The type of surgery did not affect the risk of death, regardless of
the stage of the cancer. The risk of distant metastases was also
similar in the two groups.
"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."
Yeo said, "For patients, I think the important thing is to make sure
their surgeon is a high-volume surgeon" with lots of experience in
rectal cancer surgery.
"The big question is going to be the functional outcomes," she said,
referring to how well patients retain their bowel, bladder and
sexual functioning.
"Forty percent to 60 percent have bowel problems; 20 percent to 30
percent have problems with urinary function and probably 30 percent
to 40 percent have sexual function problems after rectal cancer
surgery," she said. "So those are the kinds of reasons you should go
to a specialist."
SOURCE: http://bit.ly/1DilP48 New England Journal of Medicine,
online April 1, 2015.
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