Is laparoscopic surgery acceptable for advanced colon cancer?
Laparoscopic surgery is widespread in the treatment of colorectal cancer. In Japan, a nationwide survey has shown that the rate of advanced colorectal cancer has increased gradually to 65% of total laparoscopic surgeries in 2007. Many randomized controlled trials have demonstrated that in the short term, laparoscopic surgery is feasible, safe, and has many benefits, including reduction of peri-operative mortality. In terms of long-term outcomes, four randomized controlled trials suggest that there are no differences in laparosupic and open surgery for colon cancer. However, important issues, including long-term oncological outcome, cost effectiveness, and the impact on the quality of life of patients, should be addressed in well-designed large-scale trials. In Japan, a retrospective multicenter study has demonstrated that the short-term outcomes of laparoscopic surgery are beneficial, and the long-term outcomes are the same as for open surgery. In 2004, a prospective large-scale randomized controlled trial (JCOG0404) to compare laparoscopic surgery with open surgery was started to evaluate oncological outcomes for advanced colon cancer. This trial is supported in part by a Grant-in-Aid for Cancer Research from the Japanese Ministry of Health, Labour, and Welfare. In the present study, laparoscopic surgery is found to be acceptable for stage I disease of colon cancer, whereas it is controversial for stage II/III disease because of inadequate clinical evidence. Whether laparoscopic surgery is acceptable for advanced colon cancer or not should be confirmed by the Japanese large-scale prospective randomized controlled trial (JCOG0404) in the near future.
Kitano
Seigo
S
Department of Gastroenterological Surgery, Oita University Faculty of Medicine. colonrct@med.oita-u.ac.jp
Inomata
Masafumi
M
D002986:Clinical Trials as Topic; D012809:Colon, Sigmoid / Q000601:surgery; D003110:Colonic Neoplasms / Q000473:pathology* / Q000601:surgery*; D005260:Female; D006801:Humans; D007564:Japan; D010535:Laparoscopy; D008297:Male; D015337:Multicenter Studies as Topic; D009362:Neoplasm Metastasis; D009367:Neoplasm Staging; D016032:Randomized Controlled Trials as Topic; D012008:Recurrence; D015996:Survival Rate; D016896:Treatment Outcome