It has been more than a decade since the first laparoscopic colorectal surgery was performed, and all indications are that the minimally invasive technique “is a significant advance in the way we treat colorectal cancer and other conditions,” said John H. Winston III, M.D., M.B.A., assistant professor of surgery at the Health Science Center. Dr. Winston recently was recruited to the Health Science Center from The Ohio State University. March is National Colorectal Cancer Awareness Month.
“Scientifically, patients who have the laparoscopic approach vs. traditional open surgery use much less pain medication, recover faster and suffer fewer side effects of the pain medications,” Dr. Winston said. “These patients have shorter hospital stays, less pain and fewer complications of open surgery, such as pneumonia and wound infection. Older people can generally be discharged to home instead of to a rehabilitation or nursing facility. This is a significant advantage in a large health care system where costs may need to be addressed.”
Dr. Winston is a specialist in the laparoscopic approach. He performs surgeries at Health Science Center clinical partner hospitals including University Hospital and the South Texas Veterans Health Care System, Audie Murphy Division, and sees patients in clinic at the University Physicians Group and the Cancer Therapy and Research Center.
Open surgery is performed through a 4- to 8-inch-long abdominal incision, whereas a laparoscopic colectomy surgery is performed through three or four small abdominal incisions that usually are less than one-fourth of an inch wide. Thin plastic or metal tubes are placed through the small incisions, and carbon dioxide gas is used to inflate the abdomen to give the surgeon access to the colon and inner portion of the rectum. A thin instrument called a laparoscope is then placed through one of the incisions. Long, narrow surgical instruments are placed through the other incisions. Dr. Winston performs the surgery by skillfully manipulating the instruments within the visual field provided by the laparoscope.
A key concern for surgeons is removing all cancerous cells to prevent recurrence and obtain appropriate survival without cancer. How does the laparoscopic approach fare against the open approach? “By all parameters, based on several international randomized controlled trials, oncologically the results are equal,” Dr. Winston said. “We have to raise the question of whether the long-term survival is equal, and indications are that it is. There have been three small trials that indicate it may even be superior in some groups of patients, but again, this issue needs to be proven in a well-designed trial.”
Laparoscopic surgery can be used to treat both cancer and benign colorectal disease, he noted.
If you have any questions about colorectal cancer, visitwww.surgery.uthscsa.edu/surgicaloncology/coloncancer.asp. Topics include screening and detection, prevention, risk factors, symptoms, treatment and follow-up.