A large-scale study has shown that laparoscopic or 'keyhole' surgery for colon cancer is as safe and effective as conventional surgery, dispelling fears about a link with increased tumour recurrence.

Laparoscopic removal of colon tumours is less invasive than open surgery, requiring much smaller incisions, but its use has been held back by safety concerns. The first results of a randomized, controlled study comparing the two types of surgery now show that these fears are unfounded (New England Journal of Medicine, 13 May 2004).

The study reveals almost identical survival rates for both methods and shows that levels of recurrence are no higher in patients who have undergone keyhole surgery. “These findings will have a substantial and far-reaching effect and should remove some final obstacles to the use of laparoscopic colectomy”, commented surgeons Theodore Pappas and Danny Jacobs in an accompanying editorial.

There were also important advantages for patients who had keyhole surgery — they needed shorter stays in hospital and less pain medication. “Now we can say it's safe, it's effective and it's beneficial for patients with colon cancer,” said Heidi Nelson, the lead researcher in the team that carried out the study (The New York Times, 13 May 2004).

However, it could be some time before laparoscopic surgery is carried out routinely on patients with colon cancer: “...keyhole surgery needs well-trained surgeons,” commented John Toy, Medical Director of Cancer Research UK (http://news.bbc.co.uk, 14 May 2004), and relatively few surgeons are trained to carry out the procedure. “The world of colorectal surgery will have to adapt,” say Pappas and Jacobs.