Debate over benefits of keyhole surgery for colorectal cancer

Researchers conducted a retrospective analysis on elective resections for colorectal cancer (CRC) from 2000 to 2008. Over this period they found that the proportion of resections for colon cancer performed using keyhole surgery increased from 2.4 per cent to 27.5 per cent. For rectal cancer, the increase was from 1.1 per cent to 21.5 per cent.

The researchers found the largest increase in laparoscopic resections was seen in high-volume (40 or more elective resections per year) private hospitals, but increases were seen across all sectors.

The authors have called for adequate resource allocation by medical bodies to optimise uptake of laparoscopic resection for colorectal cancer in Australia.

“Impetus for the increased uptake of laparoscopic surgery for CRC comes not just from good quality evidence from randomised trials and recommendations by medical bodies, but also from the positive experiences of surgeons and their patients in everyday clinical practice,” said lead author Bridie Thompson of The University of Queensland.

In the accompanying editorial, Assoc Professor Ned Abraham of the University of New South Wales, said the authors of the largest Australasian randomised trial of the topic to date indicated that the short-term advantages for laparoscopic resection for CRC were arguably relatively minor and often subjective, and that the patients who benefited most were older patients.

“Despite its proven benefits, it seems that, on the whole, laparoscopic surgery for CRC has probably not been successful in delivering the outstanding benefits suggested by early reports,” Prof Abraham said.

In contrast, he suggested that attention to a multimodal approach to rehabilitation, such as the Enhanced Recovery After Surgery programs, may produce more clinical benefits for patients and cost benefits for hospitals.

“Whether the laparoscopic approach adds to these benefits or not has not been established,” he said.

The Medical Journal of Australia is a publication of the Australian Medical Association.

The statements or opinions that are expressed in the MJA  reflect the views of the authors and do not represent the official policy of the AMA unless that is so stated.

CONTACT:                 Assoc Prof Ned Abraham                    0414 567 820 / 02 6651 7066

                                Ms Bridie Thompson                          0423 820 363