Colon Cancer - Benefits of the Laparoscopic Method

When cancer of the colon is localized in the bowel, it is a highly treatable, often curable disease. Indeed, almost half of those who develop colon cancer re cured. The survival rate increases to 92% if the colon cancer is detected and treated at an early stage of development, before it has spread. Unfortunately, only about 37% of colon cancers are detected at an early stage, and the survival rate drops to 64% with metastasis.

It is critically important that colon cancer be detected and treatment initiated at the earliest possible stage. Because of the frequency of the disease, the identification of high-risk groups, the demonstrated slow growth of primary lesions the better survival of patients with early-stage lesions, and the relative simplicity and accuracy of screening tests, screening for colon cancer should be a part of routine care for all adults starting at age 50, especially for those with first-degree relatives with colorectal cancer. More common conditions with an increased risk include a personal history of colorectal cancer or adenomas and a personal history of ovarian, endometrial or breast cancer.

Diagnostic Aspects/Treatment Choices

Screenings by the general practitioner or referring gastroenterologist should encompass a fecal occult blood test, a sigmoidoscopy, a colonoscopy and a CT scan, if malignancy is found. A range of diagnostic tests is necessary to spot malignant cells, which can develop anywhere along the cecum, transverse colon, descending colon or sigmoid colon. Research has shown that almost 95% of all colon cancers are caused by precancerous adenomatous polyps, which can become malignant tumors.

Staging of the cancer will reflect the patient's prognosis, which is clearly related to the degree of penetration of the tumor through the bowel wall and the presence or absence of nodal involvement. However, when resection can be performed with clear margins, patients whose tumors extend through the bowel wall and to adjacent structures have no worse prognosis than similarly staged patients without such invasion. Surgery is also curative in 20% of patients who develop resectable metastases in the liver.

Stage 0 is the earliest stage and signifies that malignant tumors have not developed beyond the first lining of the colon tissue. Stage 1 signifies that the cancerous tumor has grown through the inner lining and into the third layer of the lining, although it has not left the tissue wall of the colon. Stage 2 signifies that the cancerous tumor has grown through the wall of the colon, damaging nearby tissue. Stage 3 signifies metastasis to the lymph nodes. Stage 4 signifies metastasis to other organs such as the liver, lung or ovary.

Regardless of the stage, a surgical excision of any cancerous tissue is indicated. The wide surgical resection and anastomosis necessary to treat colon cancer have traditionally been accomplished by open colectomy, the "gold standard" treatment, but a more recent advance in laparoscopic surgery offers decreased incisions size, less pain and blood loss and faster recovery.
 

The Laparoscopic Approach

Traditional open procedures begin with a large abdominal incision measuring 8 to 12 inches long, which requires longer healing time and cases significant postoperative pain. With laparoscopic surgery, the surgery utilizes three to five small incisions, leading to reduced patient pain and a quicker recovery. Virtually all patients needing colorectal operations are candidates for laparoscopy.

The minimally invasive laparoscopic procedure involves insertion of several trocars through the small incisions. One accommodates the laparoscope, and the others accommodate a series of surgical instruments manipulated by the surgeon. Once the cancerous region is located, the vessels surrounding the diseased portions of the colon are sealed and cut, and the diseased segment of the colon is extracted through the trocar site, after being placed in an impermeable bag. For bulky tumors, the procedure cannot be completed and a traditional approach must be used.

The health parts of the colon are then secured together, and the incisions are closed with surgical tape or stitches.

Clinical Trials Continue

Early experiences with laparoscopic surgery for colon cancer raised concerns about port site local recurrences. Because of these concerns, organized clinical trials were undertaken. "A Prospective, Randomized Trial Comparing Laparoscopic Versus Conventional Techniques in Colorectal Cancer Surgery: A Preliminary Report" was issued by the Cleveland Clinic from 1993-1998. The goal of the study was to identify quantifiable short-term advantages to laparoscopic surgery for colon cancer.

Early results show that margins of resection and lymph node removal with the minimal-access techniques compare favorably with those of open colectomy and offer earlier recovery of pulmonary and GI function compared with conventional surgery. Laparoscopic surgery for colon cancer is safe, but long-term follow-up is mandatory to fully assess the oncologic outcome.

Following Surgery

A series of other clinical trials has led to recommendations that successful excision of later-stage cancer be followed by post-operative chemotherapy. It is clear that treatment of colon cancer can necessitate a multifaceted approach by several specialists.

A Surgeon You Can Trust

Dr. William G. Cloud is a board-certified surgeon who has significant experience in cancer and abdominal surgery, and particularly laparoscopic surgery. His expertise is a worthy resource in many treatment plans, and referral to a skilled surgeon should always be taken into account during management planning of a disease as serious as colon cancer. For more information, please contact Dr. Cloud at 828.437.0847.