Comparing surgical techniques: less invasive surgery reduces the interval between surgery and chemotherapy

This study investigated the effect of the surgical technique on the timing of chemotherapy administration.

Colon surgery (colectomy) is the main treatment for curing patients with colorectal cancer. There are 2 possible surgical techniques: laparoscopic surgery or open surgery. Laparoscopic surgery is a more recent, minimally-invasive technique involving very small incisions into the abdomen to access the colon. Open surgery is an older surgical technique, which involves a large incision into the abdomen.

The short-term benefits of laparoscopic surgery are clear: decreased hospital stay and quicker recovery. However, questions remain as to whether laparoscopic surgery also offers oncologic benefits to patients. As some studies suggest that the timing of chemotherapy can improve the outcome of advanced colon cancer the aim of this study was to investigate differences in timing.

This study examined the medical records of 241 patients with stage III or IV colon cancer, indicating that the cancer had also spread to the lymph nodes or to distant organs. These patients were deemed appropriate for chemotherapy and 156 patients went on to receive it. 57 patients underwent laparoscopic surgery (36.5%) and 99 patients (63.5%) underwent open surgery.

The average interval between surgery and chemotherapy was 42.9 days for patients who underwent laparoscopic surgery compared to 60.3 days for patients who underwent open surgery. Statistical analysis revealed that laparoscopic surgery increased the chance of starting chemotherapy earlier by over 50% compared to open surgery.

Patients who underwent laparoscopic surgery were less likely to suffer from postoperative complications (39% of patients experienced) compared to patients who underwent open surgery (53% of patients). The number of patients requiring readmission to the hospital following surgery did not significantly differ between the groups (18% for laproscopic surgery, 11% for open). The most common complications included wound infections, urinary tract infections and ileus (failure of the intestine to contract and relax normally). Overall, complications, readmission, urinary tract infections and wound infections delayed the start of chemotherapy.

The authors concluded that laparoscopic colectomy decreases the time interval from surgery to the start of chemotherapy compared with open colectomy. Postoperative complications increase the time to chemotherapy for both open and laparoscopic surgery.