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 About Laparoscopic Technology

BACKGROUND: Minimally invasive, laparoscopically assisted surgery
Minimally invasive, laparoscopically assisted surgery was first considered in 1990 for patients undergoing colectomy for cancer. Concern that this approach would compromise survival by failing to achieve a proper oncologic resection or adequate staging or by altering patterns of recurrence (based on frequent reports of tumor recurrences within surgical wounds) prompted a controlled trial evaluation.

Summary: Laparoscopic Surgery a Good Alternative for Some Colon Cancer Patients: The study reported that patients with colon cancer experienced similar rates of cancer recurrence whether they were treated with laparoscopically assisted surgery or conventional open abdominal surgery (open colectomy) in a large randomized clinical trial. The trial’s investigators concluded that laparoscopically assisted surgery is an acceptable, less invasive alternative. However, they caution that not all patients with colon cancer will be appropriate candidates for the laparoscopic operation. Source: New England Journal of Medicine, May 13, 2004.

Minimally Invasive, Laparoscopically Assisted Surgery Overview
Laparoscopic surgery, an alternative to conventional open surgical procedures, is widely used to treat noncancerous abdominal diseases such as appendicitis, hiatal hernia, and gall bladder disease. A laparoscope, attached to a video camera, is inserted through a small cut or incision in the abdomen to guide the surgery. Surgical instruments are then inserted through other small abdominal incisions and used to perform the surgical procedure.

For the patient, the potential advantages of laparoscopic surgery include less pain after surgery, a shorter hospital stay, and a shorter recovery period. However, laparoscopic surgery for colon cancer was considered experimental because it was not known whether the technique removed tumors as effectively as the conventional, open surgical operation called a colectomy. Inadequate surgical removal of tumors increases the risk that the cancer will come back.

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The Study
The primary aim of this phase III study was to find out whether colon cancer was more likely to come back in patients treated with laparoscopically assisted surgery. A total of 872 patients at 48 centers in the United States and Canada were randomly assigned to receive either a conventional open colectomy or a laparoscopic colectomy. Patients were followed up for a median of 4.4 years.

The study was conducted by the Clinical Outcomes of Surgical Therapy Study Group, a collaboration among researchers affiliated with the National Cancer Institute’s (NCI’s) Clinical Trial Cooperative Groups program. The principal investigator was Heidi Nelson, M.D., of the Mayo Clinic in Rochester, Minnesota.

Rates of cancer recurrence were not significantly different in the two groups of patients. In addition, overall survival was very similar in both groups.

Patients who had laparoscopic surgery recovered more quickly than those who had conventional surgery. They were hospitalized for a median of five days and took non-oral pain medications for a median of three days. By contrast, patients who had an open colectomy were hospitalized for a median of six days and took non-oral pain medications for a median of four days.

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Patients with colon cancer that had spread to other tissues were not included in this study. One in every five patients randomly assigned to receive laparoscopic surgery was switched to open colectomy on the operating table when surgeons found that their disease had spread or when other complications were encountered making it difficult to perform the surgery laparoscopically.

All surgeons participating in the study had performed at least 20 laparoscopic surgeries for colon cancer and their surgical techniques were scrutinized on videotape. Surgeons with less expertise with the procedure than this might not achieve the same results, cautions Meg Mooney, M.D., a surgical oncologist with NCI’s Cancer Therapy Evaluation Program.

Laparoscopic surgery took longer to perform – 2½ hours, compared with 1 hour 35 minutes for the conventional open colectomy. However, this time difference may diminish in the future, says Mooney, as both surgical instruments and surgeons’ expertise with the procedure improve.

The study was not designed to show that laparoscopic colectomy is better than open colectomy, only that it is not worse – that is, that the risk of cancer coming back was not significantly greater using the laparoscopic procedure.

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“This trial has laid to rest most of the concerns that existed about laparoscopic surgery for patients with colon cancer that can be removed with surgery,” says Mooney. “As a result of these findings, surgeons will feel more comfortable that laparoscopic surgery is an acceptable alternative to an open procedure for many patients with colon cancer.”

Because laparoscopic colorectal surgery requires extensive and highly specialized training, few surgeons are qualified to perform these procedures.
Florida Hospital Celebration Health is one of the few hospitals in the country with a surgeon certified to use laparoscopic surgery in the treatment of colon conditions including diverticulitis, colon cancer, Crohn's disease (occurring in the small intestine as well as the colon), chronic ulcerative colitis, constipation, sigmoid volvulus, and endometriosis
Florida Hospital Celebration Health is equipped with the latest laparoscopic technology, including three-dimensional imaging equipment and the most advanced ultrasound instruments in use anywhere.

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This information is not intended to take the place of your discussion with your surgeon about your need for colon surgery. If you have questions about your need for a colon operation, your alternatives, the cost of the procedure, billing or insurance, or your surgeon's training and experience, do not hesitate to ask your surgeon or his/her office staff about it. If you have questions about the operation or subsequent follow-up, please discuss them with your surgeon before or after the operation. Terms of Use