Which colon cancer surgery is safest when lymph nodes are also being removed?

This study investigated which surgical technique for colon cancer is safest when lymph nodes are also being dissected.

The two main surgeries for treating colon cancer are open surgery and laparoscopic surgery. Open surgery is the original technique involving a large incision to remove part of the bowel. Laparoscopic surgery is a modern, minimally-invasive technique involving very small incisions.

Nearby lymph nodes can also be removed during surgery. Lymph node removal is classified depending on how many nodes are removed and from where. D2 dissections involve removal of the lymph nodes beside the colon and intermediate nodes (located along vessels that drain to main lymph nodes). D3 dissection includes the D2 nodes plus removal of main lymph nodes located at the base of supplying arteries. Whether it is safer to do D3 dissection along with laparoscopic or open surgery is unclear.

This study included 1050 patients with colon cancer. All patients had T3 or T4 tumors, indicating that the tumor had spread into or through the outer layer of the colon. 521 patients had open surgery plus D3 dissection and 529 patients had laparoscopic surgery plus D3 dissection.

Patients who had laparoscopic surgery had significantly less blood loss than the open surgery group, 30 ml compared to 85 ml. They also required less pain medication and had shorter hospital stays than patients who had open surgery. However, their surgery was an average of 52 minutes longer.

14.3% of patients in the laparoscopic surgery group had complications after surgery, compared to 22.3% of patients who had open surgery. The most common complications included issues with wound healing or a blocked or leaky intestine.

The authors concluded that laparoscopic surgery was associated with less surgical complications than open surgery in patients undergoing D3 dissection.