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Keyhole Surgery Set to become Gold Standard in Colon Cancer
May 13, 2005 - 9:48:00 PM, Reviewed by: Dr.
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�Keyhole surgery for colon cancer has not been adopted as quickly by the surgical community as other keyhole procedures. In part, the technical challenges of the operation have prolonged the learning curve and minimised enthusiasm. In addition, major concerns about the oncological effects of the operation in patients whose disease has spread have limited its application in colorectal cancer. However, this trial suggests that in appropriately selected patients who are operated on by experienced surgeons, keyhole surgery for colorectal cancer may be the new gold standard.�
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By The Lancet,
Keyhole surgery for colon cancer is as effective as open surgery in the short term, concludes a randomised trial published in this week�s issue of The Lancet.
Treatment for colon cancer involves surgical excision of the primary tumour. Keyhole surgery may lead to a more rapid recovery, less pain, fewer complications and a shorter hospital stay. However, it has been widely adopted for colorectal cancer without data from large clinical trials to support its use.
Pierre Guillou (St. James�s University Hospital, Leeds, UK) and colleagues undertook a trial to compare keyhole surgery with open surgery, involving around 730 colorectal cancer patients, from 27 centres around the UK. 253 patients received open surgery and 484 received keyhole surgery. 143 patients underwent conversion from keyhole surgery to open surgery. Based on detailed pathological examination of the resected bowel, which contained the tumour, the investigators found that local recurrence rates were unlikely to be higher for keyhole surgery than for local surgery. They also found that cancer-related survival and quality of life was similar for the two groups. Conversions from keyhole to open surgery were more common in patients with cancer of the rectum; and individuals who had their operation converted had the most complications from surgery.
Professor Guillou concludes: �For cancer of the colon, little difference seems to exist between keyhole surgery and open surgery and there is no reason to expect long-term cancer outcomes to be different. However, impaired short-term outcomes after keyhole surgery for rectal cancer do not yet justify its routine use.�
In an accompanying Comment Myriam J Curet (Stanford University, California, USA) states: �Keyhole surgery for colon cancer has not been adopted as quickly by the surgical community as other keyhole procedures. In part, the technical challenges of the operation have prolonged the learning curve and minimised enthusiasm. In addition, major concerns about the oncological effects of the operation in patients whose disease has spread have limited its application in colorectal cancer. However, this trial suggests that in appropriately selected patients who are operated on by experienced surgeons, keyhole surgery for colorectal cancer may be the new gold standard.� 
- The Lancet
thelancet.com
Professor Pierre Guillou, Academic Surgical Unit, Clinical Sciences Building, Level 8, St James's University Hospital, Beckett Street, LEEDS, LS9 7TF, UK. T) 0113 206 5281
Comment Dr Myriam J Curet, Myriam J. Curet, MD, FACS, Minimally Invasive Surgery Progra, Department of Surgery, Stanford University, 300 Pasteur Drive, Stanford, CA 94305, USA. T) +1 650 723 8603
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