A comparison of laparoscopically assisted and open colectomy

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Available here: PMID 15141043

Citation: Clinical Outcomes of Surgical Therapy (COST) Study Group (2004 May 13) A comparison of laparoscopically assisted and open colectomy. N Engl J Med (Volume 2004;350:2050-9.) (RSS)

doi: 10.1056/NEJMoa032651

Download: http://www.ncbi.nlm.nih.gov/pubmed/?term=A+comparison+of+laparoscopic%5Dally+assisted+and+open+colectomy+for+colon+cancer

Tagged: Medicine (RSS)


Summary:

In a multi-center randomized, clinical trial, patients who underwent a laparoscopic colectomy for colon cancer were found to have noninferior oncologic results when compared to patients who underwent an open colectomy for colon cancer. Oncologic outcomes was defined as the rate of colon cancer recurrence. At 3 years followup, 16% of the laparoscopically treated patients had a recurrence; 18% of the patients treated with open surgery had a colon cancer recurrence. Secondary outcomes documented a shorter length of stay in the laparoscopic-surgery group when compared with the open-surgery group (five days vs. six days, P<0.001) and briefer use of parenteral narcotic (three days vs. four days, P<0.001) and oral analgesics (one day vs. two days, P<0.001). The rates of intraoperative complications, 30-day postoperative mortality, complications at discharge and 60 days, hospital readmission, and reoperation were very similar between groups.




Commentary

  • Summary of conclusions: Laparoscopic colectomy for colon cancer results in equivalent cancer outcomes when compared to open colectomy, but results in a quicker recovery.
  • This study is sometimes referred to as the COST trial for the authors: Clinical Outcomes of Surgical Therapy (COST) Study Group, which is a fairly large group of surgeons. The lead author and the Principal Investigator of the study is Heidi Nelson, a colorectal surgeon at the Mayo Clinic. The members of the writing committee of the COST Study Group are listed in the left margin of the first page of the manuscript.
  • Sample size: about 430 surgeries of each type, spread across more than 40 institutions.
  • Before this paper, there was considerable doubt whether cancer of the colon could be treated well by laparoscopic surgery. Most surgeons would not do a laparoscopic colectomy for colon cancer because of fear that it was inferior treatment. This was a seminal paper in changing that attitude. Other randomized trials have mostly confirmed these results. Still in 2014, most colon surgery for cancer is not done laparoscopically because of technical challenges.
  • An estimated 40% of colectomies are done laparoscopicically according to this wikipedia article which cites PMID 22868361.

A significant earlier study is this one:

This work uses source Laparoscopy-assisted colectomy versus open colectomy for treatment of non-metastatic colon cancer: a randomised trial for its findings.

Source Laparoscopy-assisted colectomy versus open colectomy for treatment of non-metastatic colon cancer: a randomised trial was a significant predecessor to this work.

Later works citing this study or on the same subject (each of which could have its own wiki page):

  • The Colon cancer Laparoscopic or Open Resection Study group. Laparoscopic surgery versus open surgery for colon cancer : short term outcomes of a randomized trial. Lancet Oncology, 2005, 10.1016/S1470-2045.3
  • Jayne DG, Guillou PJ, Thorpe H, et al. Randomized trial of laparoscopic-assisted resection of colorectal carcinoma: 3-year results of the UK MRC CLASICC Trial Group. J Clin Oncol 2007; 25: 3061-8.
  • Fleshman J, Sargent DJ, Green E, et al. Laparoscopic colectomy for cancer is not inferior to open surgery based on 5-year data from the COST Study Group trial. Ann Surg 2007; 246: 655-62.
  • Bonjer HJ, Hop WC, Nelson H, Sargent DJ, Lacy AM, Castells A, et al. Laparoscopically assisted vs open colectomy for colon cancer: a meta-analysis. Arch Surg 2007; 142: 298-303.
  • Schwenk W, Haase O, Neudecker J, Müller JM. Short term benefits for laparoscopic colorectal resection. Cochrane Database Syst Rev. 2005 Jul 20;(3):CD003145.
  • Jackson TD, Kaplan GG, Arena G, et al. Laparoscopic versus open resection for colorectal cancer: a meta-analysis of oncologic outcomes. J Am Coll Surg 2007; 204: 439-46.
  • Short term benefits for laparoscopic colorectal resection. Cochrane Database of Systematic Reviews. 2005, Issue 2.
  • Young-Fadok TM, Fanelli RD, Price RR, Earle DB. Laparoscopic resection of curable colon and rectal cancer: an evidence-based review. Surg Endosc 2007; 21(7): 1063-8.