Laparoscopic surgery is known to have been used in the treatment of intestinal disorders for close to 20 years. However, its benefits appear to have only in recent times begun to be extended to people with rectal cancer.
A team of colon and rectal surgeons at NewYork-Presbyterian Hospital/Weill Cornell Medical Center are believed to have shown that the minimally invasive approach can be as effective as traditional open surgery in treating rectal cancers.
The advantages of laparoscopic and other minimally invasive surgical techniques seem to have been recognized by the experts. After laparoscopic surgery, patients may possibly experience shorter hospital stays, smaller scars, far less pain and faster recovery in contrast to open surgery.
NewYork-Presbyterian or Weill Cornell was observed to have offered these procedures for several years and continues to be at the forefront of innovation. Apparently, this applies the minimally invasive approach to diseases and conditions which were one time considered treatable primarily via open surgery techniques. Until recently, rectal cancer appears to be one such disease. More so, its treatment by means of laparoscopic surgery may be still seen by some as controversial.
According to Dr. Jeffrey Milsom, chief of colon and rectal surgery at NewYork-Presbyterian/Weill Cornell, rectal surgery could perhaps be inherently more challenging in contrast to colon surgery. For one, the pelvic cavity of the body where the rectum lies appears to be a narrow space thereby making rectal tumors difficult to access.
Furthermore, surgical success may possibly depend not only on the complete removal of the cancerous tumor and repair of the rectum, but also on restoring continence. For these reasons, rectal cancer could have been a difficult arena to apply advances in minimally invasive surgery.
Dr. Milsom claimed that delaying matters further, preliminary reports on the use of laparoscopic surgery in patients with rectal cancer were observed to have explained a higher incidence of cancer-positive cells at the edges of removed tumors as compared to open surgery.
Previous data suggested that as a result, more patients could suffer from a local recurrence of their rectal cancer after laparoscopic surgery in contrast to open surgery. However, the existing study is known to disprove these initial findings.
Between January 1999 and December 2006, three colon and rectal surgeons Dr. Milsom and his colleagues Dr. Toyooki Sonoda and Dr. Sang Lee at NewYork-Presbyterian/Weill Cornell were believed to have treated 103 patients with mid or low rectal cancer using an operation called total mesorectal excision (TME).
Supposedly, TME is performed by means of laparoscopic-assisted (LAP) or hand-assisted laparoscopic surgery (HALS). In order to collect the relevant data and analyze outcomes, Dr. Milsom and his team seem to have relied on inpatient and outpatient medical records, telephone interviews with patients, and standard actuarial survival calculations. Moreover, patients appear to have received regular follow-up for five years.
“More than 90 percent of the patients in our study were able to undergo laparoscopic surgery successfully. We define ‘success’ in both the short- and long-term sense: More than 95 percent emerged with an intact and functioning rectum and, as expected after a minimally invasive procedure, recovered rapidly. None had cancer-positive tumor margins, which has been a major concern in the medical literature all along. In fact, after five years, overall survival has remained high at 91 percent, with more than 73 percent of patients completely free from disease.” explains Dr. Sonoda, one of the study’s key surgeons.
“In terms of cancer cure and recovery. These outcomes are at least as good as the best outcomes seen with open surgical techniques. And when you add in all the advantages of laparoscopic surgery, it seems clear that this is an approach that could evolve to become the surgical standard,” says Dr. Lee, the other key surgeon on the study.
This study was known to have been conducted at a single institution. In addition, its moderately small sample size, lack of randomization, and relatively short follow-up period all point to the requirement of large, randomized studies before its findings could possibly be considered perfect.
Dr. Milsom reports that his surgical team is observed to be at present participating in two such studies, one in collaboration with the American College of Surgeons Oncology Group (ACSOG) and the other headed up by Dr. Lee and involving several other U.S. medical centers. Meanwhile, the group continues to explore novel minimally invasive surgical techniques to develop clinical recovery even more significantly, including new stapling instruments, robotics, and innovative endoscopy.
The findings of the study have been published in the journal of American Society of Colon and Rectal Surgeons.