Keyhole surgery set to become the new gold standard for colon cancer treatment

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 pro-longed the learning curve and minimised enthusi

Contact: Joe Santangelo

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