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Study Supports Use of Laparoscopic Surgery for Rectal Cancer
Less-invasive procedure had survival rates similar to open surgery, with less pain and shorter hospital stays
By Steven Reinberg
WEDNESDAY, April 1, 2015 (HealthDay News) -- Patients with localized rectal cancer may achieve similar survival rates by having minimally invasive laparoscopic surgery, instead of more invasive open surgery, a European study finds.
According to the American Cancer Society, close to 40,000 new cases of rectal cancer are diagnosed each year in the United States.
In standard open surgery, surgeons must make a large incision in the patient's abdomen. Using the laparoscopic procedure, they make only a small incision through which an instrument is passed to remove the cancerous tumor.
This results in shorter time to recovery with less pain and a shorter hospital stay, explained study lead author Dr. H. Jaap Bonjer, chairman of the department of surgery at VU University Medical Center in Amsterdam.
For the study, Bonjer's team randomly assigned more than a thousand patients with rectal cancer, seen at 30 hospitals, to either laparoscopic surgery or open surgery.
Three years after the procedures, the cancer recurrence rate was 5 percent for both groups, the researchers reported in the April 2 issue of the New England Journal of Medicine.
About 75 percent of those who had the laparoscopic procedure survived without recurrent disease, compared with about 71 percent of those who had undergone open surgery, the investigators found.
The overall survival rates were about 87 percent for those who had the laparoscopic procedure and close to 84 percent for those who underwent open surgery, according to the report.
Overall, "laparoscopic surgery for rectal cancer has proven to be safe, and results in the same cancer outcomes as open surgery," Bonjer said.
The laparoscopic method is commonly used to remove tumors in the colon, he said, but there haven't been many studies investigating it for rectal cancer.
"Now doctors will probably use this technique in rectal cancer," Bonjer said.
"Patients can have laparoscopic surgery without any greater concern about their cancer recurring or survival," he added. "Patients can expect less pain after laparoscopic surgery and also quicker recovery than after open surgery."
Dr. John Daly is a surgical oncologist at Fox Chase Cancer Center in Philadelphia. He said that the management of patients with rectal cancer typically involves surgery, chemotherapy and radiotherapy.
The rise in laparoscopic techniques "has provided the opportunity to perform abdominal procedures with less trauma to the patient," Daly explained.
However, "like all new techniques, it has provoked questions as to its applicability and generalizability," Daly said.
Bonjer agreed, cautioning that laparoscopic surgery might not be suitable for all patients with rectal cancer.
For example, the technique can only be used in patients whose cancer has not spread into the urinary bladder or uterus, he said.
"When a patient has a very large rectal cancer, then it should be removed with open surgery, because it is too complex to be done laparoscopically," Bonjer said.
For more on rectal cancer, visit the American Cancer Society.
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