By Steven A. Fassler, MD, FACS, FASCRS
Until just a few years ago, a moratorium prevented laparoscopic colectomy—the removal of a cancerous colon by minimally invasive surgical techniques—from being used instead of traditional open surgery. At the time, there was concern that the laparoscopic procedure would not produce as good results as open surgery for many patients.
Those of us who were involved in laparoscopic clinical trials during that time, and who received extensive training in minimally invasive methods, knew that study results would bear out the benefits of laparoscopic colectomy. That happened in 2004, when the moratorium was lifted. Our work at Abington Memorial Hospital since then, in one of the largest single specialty colorectal surgical practices in the Philadelphia area, has provided further evidence of the benefits of minimally invasive surgery for colon cancer and other colorectal diseases.
Laparoscopic colectomy performed by experienced, board-certified colorectal surgeons results in benefits for patients such as decreased time in the operating room and reduced risks of complications such as wound infections, hernias, abscesses and bowel obstructions. Minimally invasive surgery also shortens recovery time significantly, sometimes to three weeks instead of three months. That helps patients get to chemotherapy faster and speeds the time it takes for them to heal and return to their normal lives.
This can make an enormous difference in a person’s life. One of my patients, a 52-year-old woman with a left colon cancer, wanted to be healthy for her daughter’s wedding. We scheduled the patient’s laparoscopic colectomy for the time between her daughter’s wedding shower and the main event. The woman was in the hospital for two and one-half days and, four weeks later, she was able to walk her daughter down the aisle.
At Abington Memorial Hospital, we achieve such good results because we have a team of experienced nurses and operating rooms dedicated to laparoscopic surgery. Our advanced technology, voice-activated equipment, board-certified colorectal surgeons and dedicated nursing staff all contribute to our good outcomes.
That expertise and technical capability have enabled us to perform a high volume of work at a level that might not be expected even in a large community hospital. In the past five years, our practice has conducted over 1,250 minimally invasive surgeries for colorectal cancer (and 2,500 total laparoscopic colon surgeries), which we believe may be more than any other single specialty practice in the area. My partners D. Mark Zebley, MD, Soo Yoon Kim, MD, and I perform about 95 percent of our surgeries laparoscopically. Such experience has brought us collaborations with many oncologists and gastroenterologists throughout the region.
Because of the large number of patients we see, our research data has relevance for advancing knowledge about minimally invasive colorectal procedures. One study we conducted at Abington Memorial Hospital, in conjunction with the Department of Surgery and Department of Geriatrics, looked at whether laparoscopic colectomy is beneficial to the elderly. Our research showed that, contrary to what many had believed, minimally invasive colectomy is a better option than open surgery for those aged 80 and above.
Where once it was thought that laparoscopic colectomy exposed the elderly to greater physiologic and operative stresses, the opposite turned out to be true. The data revealed that octogenarians showed the same reduced operating time, shortened length of stays in the hospital and decreased complications as did younger patients. Moreover, the chances that elderly patients would need to go to a nursing facility were greatly reduced: about 85 percent of those having a laparoscopic colectomy were able to go directly home from the hospital, while only 25 percent of those having open surgery were able to do so.[i]
Another study we conducted with Abington’s Department of Surgery showed that there was no survival difference for patients needing conversion of laparoscopic procedures to open surgery for colon cancer. Conversions are not often necessary, but may occur due to adhesions, previous surgery or the physiology of the tumor itself.[ii]
In our practice, we dedicate a great deal of time to promoting the prevention of colorectal cancer through regular screenings (colonoscopy). When cancer does occur, however, we’ve seen that minimally invasive colectomy offers patients the best surgical treatment combined with the emotional and physical benefits of regaining one’s health and activity level quickly.
[i] Suryadevara SK, Vaughn D, Kurian A, Kim S, Zebley DM, Fassler SA, Hofmann M. “Laparoscopic Colectomies in Octogenarians: A Better Option to Open Surgery?” American Geriatric Society 2009 Annual Meeting.
[ii] Franko J, Fassler SA, Rezvani M, O’Connell BG, Harper SG, Neiman JH, Zebley DM. “Conversion of Laparoscopic Colon Resection Does Not Affect Survival in Colon Cancer.” Surgical Endoscopy, 22(12): 2631-2634, 2008.
Steven A. Fassler, MD, FACS, FASCRS is a Colorectal Surgeon at Abington Memorial Hospital; and Colon and Rectal Associates, Ltd.