Skip Navigation LinksHome > October 2007 - Volume 246 - Issue 4 > Laparoscopic Colectomy for Cancer Is Not Inferior to Open Su...
Annals of Surgery:
doi: 10.1097/SLA.0b013e318155a762
Original Articles

Laparoscopic Colectomy for Cancer Is Not Inferior to Open Surgery Based on 5-Year Data From the COST Study Group Trial

Fleshman, James MD*; Sargent, Daniel J. PhD†; Green, Erin BS†; Anvari, Mehran MD‡; Stryker, Steven J. MD§; Beart, Robert W. Jr MD¶; Hellinger, Michael MD∥; Flanagan, Richard Jr MD**; Peters, Walter MD††; Nelson, Heidi MD§§; for The Clinical Outcomes of Surgical Therapy Study Group

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Abstract

Purpose: Oncologic concerns from high wound recurrence rates prompted a multi-institutional randomized trial to test the hypothesis that disease-free and overall survival are equivalent, regardless of whether patients receive laparoscopic-assisted or open colectomy.

Methods: Eight hundred seventy-two patients with curable colon cancer were randomly assigned to undergo laparoscopic-assisted or open colectomy at 1 of 48 institutions by 1 of 66 credentialed surgeons. Patients were followed for 8 years, with 5-year data on 90% of patients. The primary end point was time to recurrence, tested using a noninferiority trial design. Secondary endpoints included overall survival and disease-free survival. (Kaplan–Meier)

Results: As of March 1, 2007, 170 patients have recurred and 252 have died. Patients have been followed a median of 7 years (range 5–10 years). Disease-free 5-year survival (Open 68.4%, Laparoscopic 69.2%, P = 0.94) and overall 5-year survival (Open 74.6%, Laparoscopic 76.4%, P = 0.93) are similar for the 2 groups. Overall recurrence rates were similar for the 2 groups (Open 21.8%, Laparoscopic 19.4%, P = 0.25). These recurrences were distributed similarly between the 2 treatment groups. Sites of first recurrence were distributed similarly between the treatment arms (Open: wound 0.5%, liver 5.8%, lung 4.6%, other 8.4%; Laparoscopic: wound 0.9%, liver 5.5%, lung 4.6%, other 6.1%).

Conclusion: Laparoscopic colectomy for curable colon cancer is not inferior to open surgery based on long-term oncologic endpoints from a prospective randomized trial.

© 2007 Lippincott Williams & Wilkins, Inc.

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