Each year, approximately 250,000 people have colectomies (the surgical removal of a portion of the colon). During a colectomy, which is most often performed to treat colon cancer , a surgeon will remove the diseased part of the colon, and either sew the loose ends together or create a colostomy (a temporary or permanent opening in the abdominal wall for the remaining colon).

Until now, most colectomies have been performed using an open procedure, in which a large incision is cut in the abdomen, allowing the surgeon to view and operate on the colon. In 1990, researchers began considering the use of laparoscopic surgery for colectomies.

Laparoscopic surgery is commonly used to treat gallbladder disease , severe obesity , and acid reflux . In laparoscopic surgery, several small incisions are made (instead of a single large incision), through which tiny video cameras and surgical instruments can be passed. Surgeons use images projected onto a video screen to view internal organs and perform surgical procedures. Laparoscopic surgery results in smaller scars and a shorter recovery time than traditional open surgery.

But surgeons have been reluctant to switch to laparoscopic colectomy, since a fair amount of controversy has surrounded its use. Some surgeons are concerned that laparoscopic colectomy may be more dangerous and/or not as effective as open colectomy. But a new study in the May 13, 2004 issue of the New England Journal of Medicine suggests that laparoscopic colectomy can be just as safe and effective as open colectomy, and it requires a shorter recovery period.

About the Study

This study included 872 people who were having surgery for colon cancer. Participants with advanced colon cancer were excluded, since open surgery is thought to be more effective in treating advanced colon cancer than laparoscopic surgery.

The participants were randomly assigned to undergo either open (428) or laparoscopic (435) colectomy performed by screened, experienced surgeons. All surgeries were performed according to a specified protocol.

The researchers kept track of total operation and recovery time for each patient, and tracked complications for 18 months. They also followed the participants to determine the rates of tumor recurrence for both groups.

The Findings

After a 4.4-year followup, the participants who had laparoscopic surgery were no more likely than those who had open surgery to have tumor recurrence (76 in the laparoscopic group and 84 in the open group). Additionally, survival rates were not significantly different between the groups.

In the operating room, laparoscopic surgery took significantly more time than open surgery (150 minutes versus 95 minutes, respectively). However, recovery time from laparoscopic surgery was significantly shorter, reflected by a shorter hospital stay (five days versus six) and less time on pain medications.

There was no significant difference between the groups in terms of the rate of complications during the operation, but 90 of the laparoscopic operations (21%) were converted to open operations because of safety concerns, technical difficulties, the presence of associated conditions, or the findings of advanced disease.

How Does This Affect You?

These findings suggest that laparoscopic colectomy is a safe and viable alternative to traditional open colectomy for certain people with colon cancer (those without advanced disease). This study refutes the notion that laparoscopic colectomy is less effective or riskier than open colectomy. And the extra time spent in the operating room during a laparoscopic colectomy is balanced by a shorter recovery time.

In general, patients and some physicians are convinced that when available, laparoscopic procedures are better than traditional open surgeries. While the available evidence does not suggest that laparoscopic surgeries are safer than open surgeries, it is well established that laparoscopy results in less scaring and a shorter recovery period.

Considering this new evidence, will more surgeons turn to laparoscopic colectomy as an alternative to open colectomy? Probably. The authors of an accompanying editorial predict that resistance to using laparoscopic techniques will recede and technology to help surgeons perform these operations will quickly evolve in response to these findings. Improvements in screening and operation techniques will lead to even better outcomes, including a reduced rate of conversions to open operations. And laparoscopic colectomy may just be the beginning. In the future, it is quite likely that more and more traditionally open procedures will evolve into laparoscopic ones.