Laparscopic vs Open Colectomy

8/6/2019 Laparscopic vs Open Colectomy

1/18

Laparoscopic Surgery for ColonCancer: Is there a Difference?

Scott Goldstein, MD, FACS, FASCRS


2/18

Annual incidence in US: 145,000 new cases of CRC, 55,000 CRC deaths (910% of all cancerdeaths).

Treatment costs over $6.5 billion per year Among malignancies, second only to breast cancer at$6.6 billion per year


3/18

Goals of Surgery for Colon CancerRemove the CancerObtain an Adequate Lymph Node sample to beevaluated by a PathologistLook for signs of Cancer Spread within the

Abdomen

Keep the Patient Safe

http://scienceblogs.com/denialism/colon_cancer.jpg


4/18

What is Laparoscopic Colon Surgery?

http://www.stjohn.org/HealthInfoLib

http://www.columbiasurgery.org/pat/colorectal/procedures.html

http://content.answers.com/main/content/img/galeSurgery

vs.

Open Laparoscopic


5/18


6/18


7/18


8/18


9/18


10/18

Issues to Address about

Laparosocopic Colon SurgeryCan it be done?Is it Safe?

Can it meet our criteria for Colon Cancer Surgery?Remove the CancerObtain an Adequate Lymph Node sample to be evaluated by aPathologistLook for signs of Cancer Spread within the Abdomen

Does it offer any Advantages over Open Surgery? Are the long-term results of the Surgery Equivalent toOpen Surgery with regard to Colon Cancer?


11/18

Clinical Outcomes of Surgical

Therapy (COST) Study Group TrialRandomized patients with resectable colon cancer of the Right, Left, and Sigmoid colon

66 Surgeons NationwidePatients underwent either Open Colon Resection orLaparoscopic Colon ResectionPreliminary data published in 1996 and 2002Final study published October 2007

Ann Surg. 2007 Oct;246(4):655-62; discussion 662-4. Laparoscopic colectomy for cancer is not inferior to open surgery based on 5-year data from the COSTStudy Group trial. Fleshman J, Sargent DJ, Green E, Anvari M, Stryker SJ, Beart RW Jr, Hellinger M, Flanagan R Jr, Peters W, Nelson H; for The ClinicalOutcomes of Surgical Therapy Study Group.


12/18


Therapy (COST) Study Group Trial

Five-year Cancer Outcomes for Laparoscopic and Open Colectomy PatientsFrom: Fleshman: Ann Surg, Volume 246(4).October 2007.655-664


13/18




14/18



All Stages (I-III) Stage I

Stage II Stage III

5-Year Overall Survival


15/18

Other Comparison Studies of Laparscopic to

Open Colon Resection for CancerMore than 40 Controlled studies world-wide

Almost all studies show that Laparoscopic Colon Resection isNo Different from Open Colon Resection with regards toCancer Outcome

Advantages of Laparoscopic Surgery Shorter Hospital Stay Less Postoperative PainLess Blood LossFaster Return of Bowel Function

Disadvantages of Laparoscopic Surgery More Equipment and Cost of Surgery Longer Operative Time

Cochrane Database Syst Rev. 2008 Apr 16;(2):CD003432. Long-term results of laparoscopic colorectal cancer resection. Kuhry E,Schwenk WF, Gau set R, Romild U, Bon er H


16/18

Laparoscopic Colon Surgery is

Not for Everyone Very Large CancersCancers in Certain Parts of the bowel

Patients who may have Abdominal Scarring from Previous SurgeriesPatients with other Serious Medical Conditions

Whenever it is Safer to do the surgery OpenIn the COST trial, 21% of Laparoscopic Cases wereConverted to Open Cases


17/18


18/18

Laparscopic vs Open Colectomy

Documents

Transcript of Laparscopic vs Open Colectomy