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General Surgery


Answer 3
  1. The rate of cancer recurrence in surgical wounds is similar to that of the open approach. Quality-of-life outcomes were found to be superior 2 weeks’ postsurgery in patients who had undergone laparoscopic-assisted versus open colectomy, as evidenced by reduced pain perception and decreased need for intravenous and oral analgesics.7 However, no significant differences existed in quality-of-life outcomes 2 months postsurgery between the 2 groups.7 The Clinical Outcomes of Surgical Therapy (COST) trial8 showed that the extent of resection was similar in both laparoscopic-assisted and open colectomy and that the median number of lymph nodes dissected in each group was 12. At 3 years, rates of local recurrence, survival, and recurrence in surgical wounds were similar between the 2 groups.8 The COlon cancer Laparoscopic or Open Resection (COLOR) trial9 further supported the use of the laparoscopic approach for treatment of colon cancer. Cost analysis revealed that the total costs to society measured within 12 weeks of surgery did not differ significantly between laparoscopic and open colectomy, although the costs of operation and first admission were higher for the laparoscopic group. The operating times in both the COST and COLOR trials were significantly longer (by 30-55 min) with the laparoscopic approach.

    REFERENCE
    7. Weeks JC, Nelson H, Gelber S, et al. Short-term quality-of-life outcomes following laparoscopic-assisted colectomy vs open colectomy for colon cancer: a randomized trial. JAMA 2002;287:321-8.

    8. A comparison of laparoscopically assisted and open colectomy for colon cancer. Clinical Outcomes of Surgical Therapy Study Group. N Engl J Med 2004;350:2050-9.

    9. Veldkamp R, Kuhry E, Hop WC, et al. Laparoscopic surgery versus open surgery for colon cancer: short-term outcomes of a randomised trial. Lancet Oncol 2005;6:477-84.

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