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March 16, 2009

Is Laparoscopic Colectomy a Good Operation for Colon Cancer?

Arch Surg. 2009;144(3):289-292. doi:10.1001/archsurg.2008.566

The article “Use and Outcomes of Laparoscopic-Assisted Colectomy for Cancer in the United States” by Bilimoria et al1 concluded that “laparoscopic-assisted colectomy and [open colectomy] outcomes are generally comparable in the population.” The 2 procedures may be comparable, but the study raises questions as to the adequacy of resections in both arms. A 2003 study using the National Cancer Data Base showed a direct correlation between the number of resected lymph nodes and survival in stage II colon cancer.2 Another study, by Le Voyer et al,3 showed a similar correlation in stage II and III colon cancer. Most now agree that to be adequate, a resection should have a minimum of 12 nodes. In the study by Bilimoria et al, more than 50% of the patients had fewer than 12 lymph nodes resected and therefore inadequate resections. It is also disconcerting to note that some patients had a positive resection margin, which should not happen when treating colon cancer.

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