Minimally invasive surgery does not match standard surgery for the treatment of rectal cancer, new research indicates.
The finding is based on a pair of studies, one conducted in the United States and Canada, and the other conducted in Australia and New Zealand.
“Back in 2000, research concluded that rectal cancer can be treated with a minimally invasive laparoscopic approach that uses small holes in the abdominal wall and guided cameras, and that it gave good outcomes and provided early recovery,” explained Dr. James Fleshman, study author of the North American report. Fleshman is chairman of the department of surgery at Baylor University Medical Center in Dallas.
“But what we found is that laparoscopic surgery is not equivalent to [standard] open surgery, based on our determination as to whether or not either operation achieved adequate success,” Fleshman said. “So, that basically means that some patients may not be able to be treated safely with the laparoscopic approach.”
The findings are published in the Oct. 6 issue of the Journal of the American Medical Association.
A second, similar study, led by Andrew Stevenson from the University of Queensland in Brisbane, Australia, appears in the same issue of the journal.
Though covered by insurance, laparoscopic surgery is a slightly more expensive operation, said Fleshman.
Fleshman’s team focused on rectal cancer patients who underwent surgery at one of 35 different health centers in the United States and Canada between 2008 and 2013.
All the patients were diagnosed with advanced but curable (stage 2 or 3) rectal cancer that had not yet spread beyond the area in which it had initially developed. For such cases, surgery is the typical go-to treatment. Every year, more than 39,000 new cases of rectal cancer are diagnosed in the United States, according to the American Cancer Society.
Laparoscopic surgery was performed on 240 of the patients, while another 222 underwent standard invasive surgery.
Among the top 10 surgeons (who performed 137 of the laparoscopic procedures and 134 of the open surgeries), operational “success” was based on three very specific criteria. They were: having to do with which tumor tissue was removed, how precisely it was removed and how the removal process affected surrounding healthy tissue. Information regarding post-surgery survival and disease recurrence rates is still being gathered and analyzed.
Fleshman and colleagues determined that eight of the 10 surgeons achieved a success rate with laparoscopic surgery that was either worse or no better than the success rate they achieved with standard surgery.
That translated into an 82 percent success rate for laparoscopic procedures versus 87 percent for standard surgeries, according to the study.
Both procedures had a roughly similar risk for complications, and were comparable in terms of length of hospital stay and readmission risk. However, laparoscopic surgery required much more time under the knife than standard surgery, the findings showed.
The Australian team also compared the two procedures among 475 patients who were diagnosed with both early stage and advanced rectal cancer (stage 1 to stage 3). About half underwent laparoscopic surgery and half got standard surgery at one of 24 centers in Australia and New Zealand.
In the end, the findings almost matched the results of Fleshman’s team: 82 percent success rate among the laparoscopic group versus 89 percent for the standard group.
“Now, I’m sure there will still be some patients who would be better treated with laparoscopic surgery,” Fleshman acknowledged.
“Overall, it reduces pain, can shorten a hospital stay, improves recovery and generally gets people back to their daily activities faster than we can with open surgery. And we would all like to provide that to our patients. But we need to make sure that the successful treatment of cancer is our main priority,” Fleshman said.
Dr. Andrew Chan, an associate professor in the department of medicine at Harvard Medical School in Boston, said the findings should give surgeons pause.
“Of course, we need to await the results of longer term follow-up of these patients to determine how laparoscopic surgery compares to traditional surgery for the most important outcomes, such as cancer recurrence or survival,” Chan said.
“Until then, these data do suggest that we should be cautious about assuming that laparoscopic surgery offers a better alternative to traditional surgery for our patients,” Chan added.
There’s more on rectal cancer at the U.S. National Cancer Institute.
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