Laparoscopic or 'keyhole' surgery is a safe, effective way of removing bowel tumours and should be offered to all patients undergoing surgery for colorectal cancer, according to researchers from the University of Leeds.
Patients who have laparoscopic surgery spend less time in hospital and recover more quickly from the operation. Now long-term follow-up data has confirmed that this way of doing surgery does not make patients with colorectal cancer more vulnerable to the disease returning, as some had feared. And overall survival rates for keyhole surgery are just the same as those for conventional, open surgery, researchers concluded after tracking the progress of patients for five years.
The results are the latest from the CLASICC trial - a multicentre study funded by the Medical Research Council that involved around 400 patients with colon cancer and another 400 with rectal cancer. The trial drew on patients from 27 hospitals across the UK and unlike other head-to-head assessments of these two surgical techniques, included a detailed analysis of all tissue samples that were removed to assess the quality of surgery.
Initial results from the study, published previously, showed that keyhole surgery was as safe as open surgery for colorectal cancer and that in the short term the cancer was no more likely to return. These findings contributed to the decision by the UK National Institute of Clinical Excellence (NICE) and European regulators to back the use of laparoscopic techniques by surgeons for the treatment of colon and bowel cancers.
However, some surgeons were concerned that the minimally invasive technique would not be as good at removing all cancer cells from tissue around the tumour and that after a few years, the cancer would simply come back. This risk was thought to be highest for patients with rectal cancer.
These latest findings show that this is not the case and that in the hands of an experienced surgeon, the chance of colorectal cancer recurring does not depend on the surgical method. Also, the overall survival rate of patients with colorectal cancer is not affected by the type of surgery they have. Full details are published in the November issue of the British Journal of Surgery.
"There is still a body of surgeons who are sceptical about laparoscopic colorectal cancer surgery and particularly laparoscopic rectal surgery. These long-term follow-up results should now help to convince any remaining sceptics that the minimally invasive technique is safe and effective for most patients with colorectal cancer," said David Jayne, Senior Lecturer in Surgery at the University of Leeds and lead author of the paper.
"Patients too should be reassured that any short-term gains from minimally invasive surgery have not been at the expense of compromised long-term outcomes," he said. "Where suitable, laparoscopic surgery should now be offered to all patients with colorectal cancer so that they can benefit from the recognised advantages, such as quicker recovery, shorter hospital stay and earlier return to normal function."
"Surgery remains the most important of the methods of treatment of bowel cancer and this study confirms that tumours can be removed equally well by keyhole surgery as by standard surgery. We must, however, continue to strive for surgical excellence through audit of both types of surgery and by exploration of new techniques, such as robotic surgery," said Professor Phil Quirke, Yorkshire Cancer Research Centenary Professor of Pathology at the University of Leeds, and co-author of the paper.
For further information: Paula Gould, University of Leeds press office: Tel +44 (0)113 343 8059, email p.a.gould@leeds.ac.uk
Notes to editors:
1. The paper: DG Jayne et al, 'Five-year follow-up of the Medical Research Council CLASICC trial of laparoscopically assisted versus open surgery for colorectal cancer', British Journal of Surgery, 97(11), November 2010, is available online at www.bjs.co.uk/view/0/currentissue.html
2. One of the UK's largest medical, health and bioscience research bases, the University of Leeds delivers world leading research in medical engineering, cancer, cardiovascular studies, epidemiology, molecular genetics, musculoskeletal medicine, dentistry, psychology and applied health. Treatments and initiatives developed in Leeds are transforming the lives of people worldwide with conditions such as diabetes, HIV, tuberculosis and malaria. www.leeds.ac.uk
3. The Medical Research Council is dedicated to improving human health through excellent science. It invests on behalf of the UK taxpayer. Its work ranges from molecular level science to public health research, carried out in universities, hospitals and a network of its own units and institutes. The MRC liaises with the Health Departments, the National Health Service and industry to take account of the public's needs. The results have led to some of the most significant discoveries in medical science and benefitted from the health and wealth of millions of people in the UK and around the world. www.mrc.ac.uk
Journal
BJS (British Journal of Surgery)