Camera-guided colon surgery works best for most patients

Camera-guided surgery through small incisions works better than conventional surgery for colon cancer and related diseases, at least in the short term recovery, a new review of previous studies confirms. In the long term, researchers found no difference between the two.

Researchers at Charité – Universitätsmedizin Berlin analyzed 25 randomized controlled trials in which the laparoscopic method – or “keyhole” surgery — was compared with the conventional method, in which a large vertical incision is made in the abdomen and the surgeon directly handles the organs. The studies compared outcomes up to three months following surgery.

In these trials, patients underwent colon resections, in which the diseased portion of the colon was excised, much like cutting a section out of a rubber hose, and the two disease-free ends stapled together. The trials included 3,526 patients, most of whom had colon cancer. Laparoscopy can also be used for diverticulitis, Crohn’s disease and ulcerative colitis.

The study appears in the current issue of The Cochrane Library, a publication of The Cochrane Collaboration, an international organization that produces systematic reviews of healthcare interventions, based on the content and quality of existing clinical trials on the topic.

“We found that the laparoscopic approach has advantages, at least in the short-term,” says Dr. Wolfgang Schwenk, who led the review. “It causes less pain, pulmonary function is improved, and gastrointestinal function returns to normal sooner. Also, patients can be discharged from the hospital earlier, and overall, they just feel better.”

The only disadvantage of the laparoscopic approach is that it takes an average of 42 minutes longer. “The laparoscopic approach is technically more demanding,” says Schwenk. “It’s more difficult to work with the indirect view than it is to touch the organs and handle them with your hands.”

Most, but not all, colorectal cancers are suitable for the new technique, says the review, which appears to confirm other recent individual studies showing positive results for laparoscopy for colon cancer.

Dr. Michael Stamos, chief of colorectal surgery at the University of California, Irvine, thinks that the difference in operating time will decrease as surgeons improve their laparoscopic skills. “If you look at what some of the top surgeons were doing with the laparoscopic approach even five years ago and compare it to what they can do today, there’s a world of difference, in terms of the speed of the operation, the outcomes and the quality,” says Stamos.

Why patients who receive laparoscopic surgery rather than conventional surgery do better is not yet known, although there are several theories. “First off, the incisions are smaller,” says Stamos. “Consequently, it hurts less and so you’re getting less pain medication, which translates into fewer medication side effects. One of the side effects of pain medications is ileus, in which the gut slows down its passage of food particles.”

Another factor is that the small intestine is less traumatized during a laparoscopic operation. “We put the patient in a position so that gravity causes the small intestine to fall away from where we’re operating,” explains Stamos. “When you do conventional surgery, you use retractors to hold the abdominal wall apart and you also have to pack the small intestine out of the way and that traumatizes the bowel, which probably contributes to the ileus.”

Stamos thinks this study “is going to help convince the naysayers in this field” and that eventually, all surgeons will be using the laparoscopic approach in most of their colon cases.