Study Supports Laparoscopic Surgery for Rectal Cancer

Image © Paul Polach

Patients who had either laparoscopic surgery or open surgery for localized rectal cancer had similar overall survival and disease-free survival rates. After 3 years, the rate of locoregional recurrence was 5.0% for both surgical procedures. The overall survival rates were 86.7% in the laparoscopic surgery group and 83.6% in the open surgery group. The disease-free survival rates were 74.8% in the laparoscopic surgery group and 70.8% in the open surgery group.

The results of the international Colorectal Cancer Laparoscopic or Open Resection (COLOR) II trial were published in the New England Journal of Medicine, by H. Jaap Bonjer, MD, PhD, of VU University Medical Center in Amsterdam, and colleagues.

The trial, conducted in 30 hospitals, randomized 1,044 rectal cancer patients 2:1 to either laparoscopic surgery or open surgery. A total of 699 patients underwent laparoscopic surgery and 345 patients had open surgery. Sixty-four percent of the patients in the laparoscopic surgery arm and 61% of the patients in the open surgery arm were men.

All patients had a single adenocarcinoma of the rectum that was within 15 cm of the anus, had no detectable cancer in adjacent tissues, and no distant metastases.

Laparoscopic surgery has been used for decades. It appears to have favorable outcomes in the short term, and causes less pain and less blood loss compared with standard open surgery. Prior colon cancer trials have suggested that disease-free and overall survival rates do not differ between the two techniques. The authors of the COLOR II trial had also previously shown that laparoscopic surgery had similar surgical safety and improved recovery time compared with open surgery.

Locoregional recurrence was detected in 31 patients in the laparoscopic surgery group and 15 patients in the open surgery group after 3 years.

The rates of disease-free survival were similar between the study groups for those patients with stage I and II disease. However, the rate of disease-free survival among those with stage III disease differed for the two surgical techniques: 64.9% of patients in the laparoscopic surgery group vs 52% in the open surgery group.

Three years after surgery, distant metastases were reported in 19.1% of the laparoscopic surgery group patients and 22.1% of the open surgery group patients.

“Long-term outcomes of the COLOR II trial indicate that laparoscopic surgery is as safe and effective as open surgery in patients with rectal cancers without invasion of adjacent tissues,” the authors concluded.

Limitations of the study, according to the authors, included an absence of centralized macroscopic and microscopic assessment of resected tumors, and use of various imaging methods to determine tumor location.