A less invasive type of surgery appears to be just as effective as traditional surgery for treating early stage colon cancer, according to a study published in the New England Journal of Medicine (Vol. 350, No. 20: 2050-2059). Researchers found similar rates of complications and recurrences among patients undergoing laparoscopic (or keyhole) assisted surgery and standard open surgery.

The finding suggests that for some patients, laparoscopy is a reasonable treatment option, said Heidi Nelson, MD, a colorectal surgeon at Mayo Clinic and leader of the study.

"As a general principle now, we know it's safe," she said.

But not every patient is a good candidate for the procedure.

"It should not be used for patients whose cancer requires extensive surgery to other organs besides the colon," Nelson noted. And the surgeon performing the procedure must be experienced, she said.

Laparoscopic surgery is an attractive option for patients because it uses smaller incisions than traditional open surgery, and patients typically recover from the operation sooner. It has not been widely used for colon cancer, however, because of concerns that the cancer was more likely to return after laparoscopy than standard surgery. The new study puts some of those concerns to rest.

Nelson and her colleagues randomized 428 patients to have traditional open surgery and 435 to have keyhole surgery for colon cancer. Those who had the less invasive procedure recovered slightly faster, spending an average of 5 days in the hospital compared to 6 days for patients in the open surgery group. The keyhole patients also stopped using painkillers about 1 day sooner than the other patients.

After more than 4 years of follow-up, there was no difference between the groups in the number of patients whose cancers returned. Survival rates were also very similar between the groups.

The laparoscopic surgeries did require more time under anesthesia, however, and about one-fifth of the procedures had to be "converted" into conventional open surgeries during the operation, for a number of reasons.

Nelson predicted that the study results would inspire wider use of laparoscopy for colon cancer in the United States. But patients considering this option must choose their surgeon carefully, she said, because the good study results may be partially due to the safety precautions required in the protocol.

The surgeons who participated in the study had to become credentialed by proving they had performed at least 20 laparoscopic colon surgeries. And an independent team evaluated videotapes of the surgeons operating, to make sure they were using proper technique. Patients were also selected carefully; if locally advanced disease was discovered during laparoscopy, open surgery was performed instead to be sure all the tumors were removed.

Nelson advised patients to ask surgeons about their training for laparoscopy, their familiarity with laparoscopy for cancer, and how many colon laparoscopies they do each year. Patients should also feel free to get a second opinion, she said.