Keyhole cancer surgery effective

Surgery produces good results

Keyhole surgery for colon cancer is just as effective as conventional methods, a major study has found.

There were concerns that tumours were more likely to return if surgeons did not open the belly for a full view.

But a 10-year study of 872 patients at US and Canadian hospitals found the same rates of survival and tumour recurrence for the two techniques.

The New England Journal of Medicine study also found keyhole patients had less pain and shorter hospital stays.

Conventional surgery involves the removal of a cancerous colon segment through a 20cm cut down the abdomen.

Keyhole, or laparoscopic, surgery makes use of a tiny camera to remove the diseased section through a 5cm cut.

Doubts

Keyhole surgery was first used on colon cancer in 1990 after it became popular for removing the appendix and gallbladder.

However, some surgeons have been reluctant to use keyhole techniques after evidence, produced in the mid-1990s, that it was linked to higher rates of tumour recurrence.

Lead researcher Dr Heidi Nelson, of the Mayo Clinic in Rochester, Minnesota, said: "Now we can say it's safe, it's effective and it's beneficial for patients with colon cancer."

Half the patients in the study had keyhole surgery, the rest conventional surgery.

Complications, such as wound infections and bleeding, occurred in 21% getting laparoscopy and 20% getting conventional surgery.

The three-year survival rate was almost the same - 86% for keyhole patients, 85% for conventional patients.

And cancer returned in 16% of keyhole patients compared to 18% of conventional patients.

Switch

The only drawback seemed to be that one in five patients who initially underwent keyhole surgery had to be fully opened up because of problems such as the cancer having spread more than first thought.

Keyhole surgery can only be used on patients with easily accessible tumours which have not spread to nearby organs.

Dr John Toy, medical director of Cancer Research UK, said: "This study takes a further step forward in caring for patients with cancer of the large bowel who are suitable for surgery.

"Patients treated successfully by keyhole surgery suffer less surgical discomfort while retaining the benefits of conventional surgery.

"However, keyhole surgery needs well trained surgeons, it takes longer and a switch to conventional open surgery had to be made in a fifth of patients who had been considered suitable for this trial."

Professor Neil Mortenson, Expert Adviser to Colon Cancer Concern, said: "This study shows similar outcomes between conventional open surgery and laparoscopic operations.

"Initial fears that cancer outcomes might be compromised are unfounded and as such, we are pleased that this will allow an expansion of laparoscopic surgery for colon cancer patients.

"It is still likely however that only around half of patients facing surgery for colon cancer will be able to have it done by the key hole method because the treatment is not suitable for their tumours."

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