Long-Term Outcomes of the Australasian Randomized Clinical Trial Comparing Laparoscopic and Conventional Open Surgical Treatments for Colon Cancer: The Australasian Laparoscopic Colon Cancer Study Trial

• Published in: Annals of surgery Vol. 256; no. 6; pp. 915 - 919
• Main Authors: BAGSHAW, Philip F, ALLARDYCE, Randall A, FRAMPTON, Christopher M, FRIZELLE, Francis A, HEWETT, Peter J, MCMURRICK, Paul J, RIEGER, Nicholas A, SHONA SMITH, J, SOLOMON, Michael J, STEVENSON, Andrew RL
• Format: Journal Article
• Language: English
• Published: Hagerstown, MD Lippincott Williams & Wilkins 01-12-2012
• Subjects: Adenocarcinoma - surgery; Aged; Australia; Biological and medical sciences; Colectomy - methods; Colonic Neoplasms - surgery; Digestive system. Abdomen; Endoscopy; Female; Gastroenterology. Liver. Pancreas. Abdomen; General aspects; Humans; Investigative techniques, diagnostic techniques (general aspects); Laparoscopy; Male; Medical sciences; Neoplasm Recurrence, Local - epidemiology; New Zealand; Stomach. Duodenum. Small intestine. Colon. Rectum. Anus; Treatment Outcome; Tumors; Australasia; Oceania; New Zealand; Australia; Prognosis; Laparoscopy; Malignant tumor; Long term; Colonic disease; Medicine; Colon cancer; Treatment; Surgery; Digestive diseases; Intestinal disease; Clinical trial; Evolution; Endoscopy; Comparative study; Cancer
• ISSN: 0003-4932; 1528-1140
• DOI: 10.1097/SLA.0b013e3182765ff8

: We report a multicentered randomized controlled trial across Australia and New Zealand comparing laparoscopic-assisted colon resection (LCR) with open colon resection (OCR) for colon cancer.
: Colon cancer is a significant worldwide health issue. This trial investigated whether the short-term benefits associated with LCR for colon cancer could be achieved safely, without survival disadvantages, in our region.
: A total of 601 patients with potentially curable colon cancer were randomized to receive LCR or OCR. Primary endpoints were 5-year overall survival, recurrence-free survival, and freedom from recurrence rates, compared using an intention-to-treat analysis.
: On April 5, 2010, 587 eligible patients were followed for a median of 5.2 years (range, 1 week-11.4 years) with 5-year confirmed follow-up data for survival and recurrence on 567 (96.6%). Significant differences between the 2 trial groups were as follows: LCR patients were older at randomization, and their pathology specimens showed smaller distal resection margins; OCR patients had some worse pathology parameters, but there were no differences in disease stages. There were no significant differences between the LCR and OCR groups in 5-year follow-up of overall survival (77.7% vs 76.0%, P = 0.64), recurrence-free survival (72.7% vs 71.2%, P = 0.70), or freedom from recurrence (86.2% vs 85.6%, P = 0.85).
: In spite of some differences in short-term surrogate oncological markers, LCR was not inferior to OCR in direct measures of survival and disease recurrence. These findings emphasize the importance of long-term data in formulating evidence-based practice guidelines.