History: In the early 1990’s multiple reports suggested that laparoscopic surgery for colon cancer might not be safe. These reports suggested that tumor spillage occurred routinely during surgery resulting in a higher chance of tumor recurring at the surgical incisions. Many of these reports were faulted in that the colon surgeons were not experienced in laparoscopic surgery and tumor spillage occurred as a result of complications at surgery or poor technique. Since the 1990’s there has been advances in surgical techniques, safety measures and randomized colon cancer clinical trials to ensure that laparoscopic colon resection is safe for colon cancer treatment.
Surgical Techniques: Advances in laparoscopic colon surgery have occurred as a result of innovative surgeons and advancements in technology. Technological advances include the use of high definition video monitors and laparoscopic instruments for controlling bleeding, performing the colectomy and reconstructing the colon after colon removal. Recently I have pioneered a technique of performing laparoscopic colon resection surgery that allows a high success rate (over 95%) for even the most complicated patients. View Dr.Blumberg’s surgical advance at press.abc-directory.com/press/4922
Safety Measures: The standard of care for colorectal cancer surgery is that the surgery includes colon removal with a normal margin around the tumor and all the lymph nodes around the colon cancer. This standard of care is required whether the operation is performed via open or laparoscopically. Recently I published a study showing that seemingly benign colon polyps may harbor an occult colon cancer and I recommend that patients undergoing colon polyp surgery laparoscopically should also have a complete colon cancer operation as well. See this original article by Dr. Blumberg at journals.lww.com/... laparoscopy/.../ Laparoscopic_Colon_Resection_of_Benign_ Polyps_.18.aspx . All colon tumors should be removed using an impermeable bag (ie endocatch bag) to avoid tumor spillage. It is also recommended that all surgeons performing laparoscopic colectomy for colon cancer perform a minimum of 20 cases first in patients with benign diseases.
Colon Cancer Trials: One of the first randomized controlled clinical trials comparing laparoscopic colon resection to open colon resection was a U.S. trial involving over 800 patients with colon cancer and initially published in 2004 and results were updated in 2007 (COST study).This study has shown that the survival and cancer recurrence at 5 years of patients undergoing laparoscopic hemicolectomy is the same as those having an open hemicolectomy. In addition the risk of cancer recurrence in the laparoscopic surgical incisions (port-site recurrence) was no different compared to the incision following open colon surgery (open colectomy) thus dismissing the concerns raised in the 1990’s regarding port site recurrence. The COLOR trial (published in 2009) is the latest trial randomizing over 1200 patients with colon cancer to laparoscopic colectomy and open colectomy showing no difference in survival or recurrence.
These studies indicate that laparoscopic colon surgery is safe for treatment of colon cancer. Just make sure your surgeon is an experienced laparoscopic colon cancer surgeon. Contact us for more information or to make an appointment (412-682-333).