NEW YORK (Reuters Health) Jan 15 – For patients with colon cancer, laparoscopic-assisted colectomy (LAC) provides minimal improvements in short-term quality of life (QOL) compared with open colectomy, according to a report published in the January 16th issue of The Journal of the American Medical Association.
It remains to be determined whether LAC is able to prevent disease recurrence and death from colon cancer as effectively as open colectomy can. Until then, LAC could be a tough sell for patients given that the QOL outcomes are similar to those of the open procedure.
Dr. Jane C. Weeks, from the Dana-Farber Cancer Institute in Boston, and colleagues assessed the QOL outcomes of 449 patients with colon cancer who were randomized to undergo LAC or standard open colectomy. Various rating systems were used to measure QOL at 2 days, 2 weeks, and 2 months postoperatively. In-hospital analgesic use and length of stay were also determined.
The only significant difference in QOL between the groups was a higher global rating scale score for the LAC patients at 2 weeks (p = 0.009). By 2 months, the groups were comparable in terms of QOL scores.
LAC patients required fewer days of parenteral and oral analgesics than did standard colectomy patients (p < 0.001 and p = 0.03, respectively). Hospital length of stay was slightly but significantly shorter for the LAC group (p < 0.001).
"There really isn't much difference in short-term QOL between LAC and standard open colectomy," Dr. Weeks told Reuters Health. "The differences in analgesic requirements and length of stay did not translate into meaningful benefits in QOL," she added.
"The impetus for the study came out of the interest in minimally-invasive surgery for noncancerous conditions," Dr. Weeks noted. "It has been really impressive how procedures like laparoscopic cholecystectomy have improved QOL and length of stay," she added. "When it comes to colon cancer, however, there are a whole other set of issues such as the ability to prevent tumor recurrence."
Dr. Weeks said that "the study's primary goal was to answer whether minimally-invasive surgery for colon cancer is safe." QOL was a secondary endpoint, "but because these findings became available earlier we felt obligated to make them known," she added.
"Until clinical trials have adequately addressed the safety issues, LAC should be regarded as experimental," Dr. Weeks noted. "We won't know for a couple of years whether LAC is as effective as open colectomy in preventing disease recurrence," she said. "However, given that the QOL benefits are so modest, it really raises the bar for the safety profile needed of LAC."