Minimally invasive colon cancer surgery is effective

Getting treated for a common type of cancer just became easier.

An international team of surgeons, including two from the School of Medicine, determined that minimally invasive surgery is as safe and effective as standard open surgery for most patients with cancer confined to the colon.

James Fleshman
James Fleshman

In addition to the cosmetic benefits of having a smaller incision, patients who received the minimally invasive procedure, called laparoscopically assisted colectomy, also required one less day in the hospital, one less day on intravenous pain killers and one less day on oral pain killers.

The team cautions, though, that the procedure is only safe and effective if stringent surgical standards are followed.

“When we started this study, we were concerned that the procedure itself could help the cancer spread, so we wanted to make sure it wasn’t going to result in a bad outcome for our patients,” said James W. Fleshman Jr., M.D., professor of surgery. “We found that, in the hands of an experienced surgeon, laparoscopically assisted colectomy is indeed an acceptable alternative for treating colon cancer. Now we have the task of defining who is an ‘experienced surgeon.'”

Fleshman was a key contributor to the study, which was led by the Mayo Clinic. The results were presented May 12 at the annual meeting of the American Society of Colon and Rectal Surgeons in Dallas and are published in the May 13 issue of the New England Journal of Medicine.

About 100,000 Americans are diagnosed with colon cancer each year, and more than 90 percent of them require surgery.

Typically, surgeons open the abdomen with a 6-8-inch incision and cut away the portion of the colon containing cancer. During laparoscopically assisted colectomy, the same procedure is performed through three half-inch incisions and one two-inch incision.

The minimally invasive version has been performed since 1990, but some small studies suggested that patients who underwent laparoscopically assisted colectomy were more likely to have another bout of colon cancer or to develop cancer at or near the surgical incisions.

“Most patients ask for minimally invasive surgery because it’s less painful and requires a smaller incision,” Fleshman says. “But no one had rigorously evaluated the safety and effectiveness of the procedure.”

So a group of American and Canadian colon surgeons did something rare in the medical field: They launched the first systematic study of the procedure and put a moratorium on laparoscopically assisted colectomy performed outside the scope of their study.

The team also enforced qualification requirements for the 66 surgeons who participated in the study and established standardized operating procedures.

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