Laparoscopy: Promising Surgical Option for Colorectal Cancer

This year more than 112,000 Americans will be diagnosed with colon cancer, and an additional 41,000 will be told they have rectal cancer. Colorectal cancers kill more than 52,000 men and women annually, making them the second leading cause of cancer deaths in the United States (behind lung cancer).

The good news, however, is that deaths from the disease have been dropping for the past two decades because of improvements in early detection methods and treatment options. In fact, many people with colorectal cancer live long, full lives after undergoing surgery—the cornerstone of treatment for the disease. Three out of four people whose colorectal cancer is found at an early stage, before it has spread through the intestinal wall and into nearby lymph nodes, can be cured with surgery alone.

The gold standard operation for colorectal cancer is “open” surgery, in which surgeons cut into the abdomen to open it entirely. This allows them to examine the whole area to tell whether a tumor has spread from the colon or rectum to other organs such as the liver or, in women, the ovaries and other reproductive organs. The surgeons remove all of the cancer, as well as some of the normal tissue on either side of it to help prevent the cancer from returning. In addition, they take out all the blood vessels and lymph nodes in and around the affected intestine to eliminate the flow of malignant cells through this network and into other parts of the body.

Nearly all forms of colorectal cancer are treated with open surgery. The main exceptions are certain early stage cancers, which have not penetrated very deeply into the intestinal wall. Superficial tumors in the rectum can sometimes be removed with instruments inserted through the anus—a technique known as transanal resection. Very early colon cancers can also be taken out with a colonoscope, a long, lighted instrument that can be used to view the entire colon and to remove polyps—benign or cancerous growths of tissue.

Speeding the Recovery Time

Although open surgery can cure colorectal cancer, it is a major operation typically requiring a three-to-six-day hospital stay and six to eight weeks recovering at home, before returning to work and other routine activities. For the past few years, the National Cancer Institute (NCI) has been studying a new technique that allows patients to leave the hospital within a day or two and to resume their normal daily activities in about seven to 10 days. Known as laparoscopy, it can be used on patients whose cancer is confined to the colon.

Laparoscopy involves inflating the intestine with carbon dioxide and then feeding a tiny light and video camera into the area through half-inch slits in the skin. The camera is attached to a monitor that gives the surgical team a good view inside the abdomen. Once the cancerous areas are found, small surgical tools are used to remove them.

With laparoscopic surgery, “you can see as well as you could” with open surgery, says Dr. Edward Trimble, head of the surgery section at the NCI. The technique allows surgeons to view the intestine, lymph nodes, liver, and other areas to look for cancer.

Another advantage of laparoscopic surgery is that it causes less post-operative pain than open surgery, because the incision is smaller. Dr. Heidi Nelson, associate professor of surgery at Mayo Clinic, was head of an NCI trial that looked at laparoscopy as an alternative to open surgery for colorectal cancer. She has found that people in her practice who have laparoscopy need only about half the amount of pain-killing drugs as do patients treated with open surgery.

The NCI trial, which was completed in 2004, found that colorectal cancer was no more likely to come back in patients treated with laparoscopy than in their counterparts who underwent open surgery. Survival rates were also similar for both groups.

Other Issues

But unlike open surgery, in which a surgeon can look and feel for changes in tissue, with laparoscopy you “can’t get your fingers in there,” says Dr. Trimble. As a result, a physician can’t notice, say, a thickening in the intestinal wall or an enlarged lymph node—changes that might indicate the presence of cancerous cells.

What’s more, both laparoscopic and open surgery can sometimes shake loose malignant cells, raising the risk that they can settle elsewhere. With the laparoscopic technique, however, researchers have raised a “theoretical concern that the increased pressure [resulting from inflating the intestine] may cause more spreading of any cancer cells that escape during surgery,” says Dr. Trimble.

People who are interested in undergoing laparoscopy should be sure they are in the hands of a specialist who has performed it several dozen times or more.