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document
A comparison of laparoscopically assisted and open colectomy for colon cancer . BACKGROUND Minimally invasive , laparoscopically assisted surgery was first considered in 1990 for patients undergoing colectomy for cancer . Concern that this approach would compromise survival by failing to achieve a proper oncologic resection or adequate staging or by altering patterns of recurrence ( based on frequent reports of tumor recurrences within surgical wounds ) prompted a controlled trial evaluation . METHODS We conducted a noninferiority trial at 48 institutions and randomly assigned 872 patients with adenocarcinoma of the colon to undergo open or laparoscopically assisted colectomy performed by credentialed surgeons . The median follow-up was 4.4 years . The primary end point was the time to tumor recurrence . RESULTS At three years , the rates of recurrence were similar in the two groups -- 16 percent among patients in the group that underwent laparoscopically assisted surgery and 18 percent among patients in the open-colectomy group ( two-sided P=0.32 ; hazard ratio for recurrence , 0.86 ; 95 percent confidence interval , 0.63 to 1.17 ) . Recurrence rates in surgical wounds were less than 1 percent in both groups ( P=0.50 ) . The overall survival rate at three years was also very similar in the two groups ( 86 percent in the laparoscopic-surgery group and 85 percent in the open-colectomy group ; P=0.51 ; hazard ratio for death in the laparoscopic-surgery group , 0.91 ; 95 percent confidence interval , 0.68 to 1.21 ) , with no significant difference between groups in the time to recurrence or overall survival for patients with any stage of cancer . Perioperative recovery was faster in the laparoscopic-surgery group than in the open-colectomy group , as reflected by a shorter median hospital stay ( five days vs. six days , P < 0.001 ) and briefer use of parenteral narcotics ( three days vs. four days , P < 0.001 ) and oral analgesics ( one day vs. two days , P=0.02 ) . The rates of intraoperative complications , 30-day postoperative mortality , complications at discharge and 60 days , hospital readmission , and reoperation were very similar between groups . CONCLUSIONS In this multi-institutional study , the rates of recurrent cancer were similar after laparoscopically assisted colectomy and open colectomy , suggesting that the laparoscopic approach is an acceptable alternative to open surgery for colon cancer .
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Intervention_Surgical
laparoscopically assisted and open colectomy
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Intervention_Surgical
laparoscopically assisted surgery
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Intervention_Surgical
open or laparoscopically assisted colectomy
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Intervention_Surgical
laparoscopically assisted colectomy
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Intervention_Surgical
open colectomy
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Outcome_Other
time to tumor recurrence .
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Outcome_Other
rates of recurrence
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Outcome_Other
Recurrence rates in surgical wounds
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Outcome_Mortality
overall survival rate
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Outcome_Mortality
hazard ratio for death
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Outcome_Other
time to recurrence
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Outcome_Mortality
overall survival
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Outcome_Physical
Perioperative recovery
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Outcome_Other
median hospital stay
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Outcome_Adverse-effects
intraoperative complications
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Outcome_Mortality
30-day postoperative mortality
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Outcome_Adverse-effects
complications at discharge and 60 days
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Outcome_Other
hospital readmission , and reoperation
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Outcome_Other
rates of recurrent cancer
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Participant_Condition
colon cancer
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Participant_Condition
patients undergoing colectomy for cancer
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Participant_Sample-size
872
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Participant_Condition
adenocarcinoma of the colon