Laparoscopic-Assisted Colectomy vs Open Colectomy
Although laparoscopic-assisted colectomy (LAC) is currently the preferred minimally invasive surgical procedure for colon pathology, its safety and efficacy for the treatment of colon cancer are unknown. Quality-of-life (QOL) issues related to LAC for colon cancer also need definition. We undertook a study to compare short-term QOL outcomes following LAC for colon cancer with those following open colectomy.
This was a multicenter, randomized, controlled trial, designated Clinical Outcomes of Surgical Therapy, or COST. The study period was September 1994 through February 1999. A total of 37 centers from around the country participated. Of the 576 patients who were enrolled and randomized to receive either LAC or open colectomy, 428 met evaluation criteria and completed QOL assessments. Of these 428 patients, 213 were to receive open colectomy and 215, LAC.
QOL assessments included a Symptoms Distress Scale (SDS), a 5-item QOL Index, and a single-item global rating scale. They were completed at 2 days, 2 weeks, and 2 months postoperatively. The main outcomes measures were defined by data from these rating scales as well as data on duration of postoperative in-hospital analgesic use and length of hospital stay.
An intention-to-treat analysis comparing SDS pain intensity, SDS summary, QOL Index summary, and global rating scale scores found that the only statistically significant difference between groups was in the global rating scale score at 2 weeks postsurgery (76.9 for the LAC group vs 74.4 for the open colectomy group; P = .009). Days on both parenteral and oral analgesics were less among patients in the LAC group compared with patients in the open colectomy group (mean, 3.2 vs 4.0 days for parenteral analgesics: P < .001; and mean, 1.9 vs 2.2 days for oral analgesics: P = .03).
Use of LAC to treat colon cancer resulted in only minimal short-term QOL benefits compared with open colectomy. Therefore, until it can be established that LAC is as effective as open colectomy in preventing recurrence and death from colon cancer, this procedure should not be offered to this patient population.
Although laparoscopic-assisted colectomy (LAC) is currently the preferred minimally invasive surgical procedure for colon pathology, its safety and efficacy for the treatment of colon cancer are unknown. Quality-of-life (QOL) issues related to LAC for colon cancer also need definition. We undertook a study to compare short-term QOL outcomes following LAC for colon cancer with those following open colectomy.
This was a multicenter, randomized, controlled trial, designated Clinical Outcomes of Surgical Therapy, or COST. The study period was September 1994 through February 1999. A total of 37 centers from around the country participated. Of the 576 patients who were enrolled and randomized to receive either LAC or open colectomy, 428 met evaluation criteria and completed QOL assessments. Of these 428 patients, 213 were to receive open colectomy and 215, LAC.
QOL assessments included a Symptoms Distress Scale (SDS), a 5-item QOL Index, and a single-item global rating scale. They were completed at 2 days, 2 weeks, and 2 months postoperatively. The main outcomes measures were defined by data from these rating scales as well as data on duration of postoperative in-hospital analgesic use and length of hospital stay.
An intention-to-treat analysis comparing SDS pain intensity, SDS summary, QOL Index summary, and global rating scale scores found that the only statistically significant difference between groups was in the global rating scale score at 2 weeks postsurgery (76.9 for the LAC group vs 74.4 for the open colectomy group; P = .009). Days on both parenteral and oral analgesics were less among patients in the LAC group compared with patients in the open colectomy group (mean, 3.2 vs 4.0 days for parenteral analgesics: P < .001; and mean, 1.9 vs 2.2 days for oral analgesics: P = .03).
Use of LAC to treat colon cancer resulted in only minimal short-term QOL benefits compared with open colectomy. Therefore, until it can be established that LAC is as effective as open colectomy in preventing recurrence and death from colon cancer, this procedure should not be offered to this patient population.
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