Randomized clinical trial comparing laparoscopic and open surgery for colorectal cancer within an enhanced recovery programme.
BACKGROUND
Laparoscopic resection of colorectal cancer may improve short-term outcome without compromising long-term survival or disease control. Recent evidence suggests that the difference between laparoscopic and open surgery may be less significant when perioperative care is optimized within an enhanced recovery programme. This study compared short-term outcomes of laparoscopic and open resection of colorectal cancer within such a programme.


METHODS
Between January 2002 and March 2004, 62 patients were randomized on a 2 : 1 basis to receive laparoscopic (n = 43) or open (n = 19) surgery. All were entered into an enhanced recovery programme. Length of hospital stay was the primary endpoint. Secondary outcomes of functional recovery, quality of life and cost were assessed for 3 months after surgery.


RESULTS
Demographics of the two groups were similar. Length of hospital stay after laparoscopic resection was 32 (95 per cent confidence interval (c.i.) 7 to 51) per cent shorter than for open resection (P = 0.018). Combined hospital, convalescent and readmission stay was 37 (95 per cent c.i. 10 to 56) per cent shorter (P = 0.012). The relative risk of complications, quality of life results and cost data were similar in the two groups.


CONCLUSIONS
Despite perioperative optimization of open surgery for colorectal cancer, short-term outcomes were better following laparoscopic surgery. There was no deterioration in quality of life or increased cost associated with the laparoscopic approach.
King
P M
PM
Department of Surgery, Yeovil District Hospital, Yeovil, UK.
Blazeby
J M
JM
Ewings
P
P
Franks
P J
PJ
Longman
R J
RJ
Kendrick
A H
AH
Kipling
R M
RM
Kennedy
R H
RH
D000230:Adenocarcinoma / Q000191:economics / Q000601:surgery*; D000368:Aged; D000369:Aged, 80 and over; D000704:Analysis of Variance; D015179:Colorectal Neoplasms / Q000191:economics / Q000601:surgery*; D003365:Costs and Cost Analysis; D005260:Female; D006801:Humans; D010535:Laparoscopy / Q000191:economics; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D011182:Postoperative Care / Q000191:economics / Q000379:methods; D011788:Quality of Life; D016896:Treatment Outcome