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Open colectomy is the standard form of surgery for colon cancer patients, but laparascopically assisted colectomy is gaining momentum as an alternative that is just as effective but is less invasive, leading to a quicker post-operation recovery time. Patients undergoing laparoscopic surgery for colon cancer may also experience less pain post-surgery than those who have conventional open colectomy.

For David E. Rivadeneira, MD, assistant professor of surgery, Division of Surgical Oncology, and a board-certified colon and rectal surgeon, these are significant reasons for patients to consider the procedure as an alternative to open colectomy. When he joined our faculty in 2003, he brought ten years of laparoscopic surgery experience to his new practice at Stony Brook. Since then, many of Dr. Rivadeneira's colon and rectal cancer patients have opted for the procedure, and he reports that results in these patients have been extremely favorable.

Abdominal incisions for traditional colectomy can be as long as 10 to 12 inches, but with laparoscopic surgery, each small incision is usually less than 1 inch. This approach helps to minimize patient trauma and enhance recovery for most patients.

Use of a laparosocope, a lighted viewing tube that is inserted into the abdominal cavity, has been effectively used for years for gallbladder removal, during appendectomies and other procedures. The laparoscope is connected to a video camera for viewing. In laparoscopically assisted colon cancer surgery, several small incisions usually less than 1 inch are made in the abdomen, and the lighted laparoscope is inserted into one of them to guide the surgery. The effectiveness of laparoscopic surgery for removing parts or the entire colon continues to be debated, but recent evidence indicates that it is a viable option for some patients.

A Multi-Institutional Five-Year Study

In May 2004, it was reported in the New England Journal of Medicine that after nearly five years of follow-up in hundreds of patients who had either conventional (open colectomy) or laparoscopic surgery for colon cancer, patients who had laparoscopic colectomy recovered more quickly and had a shorter duration of pain medication. Patients who had open colectomy had a median hospital recovery time of six days and took pain medications for a median of four days. Patients who had laparoscopic colectomy had a median hospital recovery time of five days and took pain medications for three days.

A total of 872 patients at 48 institutions in the United States and Canada participated in the study. Individuals were randomly assigned to receive open colectomy or laparoscopic colectomy. The median follow-up time was 4.4 years.

Survival rates were similar in both groups after three years (86% for laparoscopic, 85% for conventional), as was the cancer recurrence rate (16% for laparoscopic, 18% for conventional). The principal investigators of the multi-institutional study concluded that because recurrence rates were similar between both groups thereby validating the effectiveness of the procedure to remove cancerous colon tissue the laparoscopic approach is an acceptable alternative to open colectomy for colon cancer.

Dr. Rivadeneira believes that the study results clearly indicate that laparoscopic colectomy is an acceptable alternative to open colectomy and that it may even have some advantages over conventional surgery for many patients. This year he directed an educational program for surgeons who seek to gain expertise in laparoscopic procedures for colon and rectal surgery. The workshops, sponsored by Stony Brook University's School of Medicine, are one-day courses for Stony Brook surgeons and community surgeons.

For consultations/appointments with Dr. Rivadeneira, please call 631-444-4545 or 631-444-1793.

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