Effect of laparoscopic surgery on the initiation and completion of chemotherapy in patients with colon cancer.

See Article on Page 274-279

The developments in colon cancer treatment over the past two decades can be found largely in chemotherapy and laparoscopic surgery. Adjuvant chemotherapy increases survival in stage III and select stage II colon cancer patients [1, 2]. Reports in the literature have indicated that delaying the initiation of adjuvant chemotherapy for longer than eight weeks after surgery or after failure to complete adjuvant chemotherapy adversely affects the overall survival of colon cancer patients [3, 4]. Laparoscopic surgery has several benefits in cosmesis, postoperative length of hospital stay, analgesics usage and return of bowel function while it is comparable in survival to open surgery. Therefore, many large-volume centers use laparoscopic surgery as the mainstay in colon cancer treatment.

However, few studies deal with the effect of laparoscopic surgery on the initiation or completion of adjuvant chemotherapy in colon cancer patients. In a previous study [5], only 67% of patients were reported to have completed their chemotherapy. If those effects of laparoscopic surgery are proven, some chance may exist to improve colon cancer survival by increasing compliance with chemotherapy. Recently, Gantt Jr et al. [6] reported no difference in proportions of patients who received adjuvant chemotherapy more than eight weeks after surgery between the laparoscopic and the open surgery groups. Their notable finding was that the delay in the initiation of adjuvant chemotherapy adversely affected patients' disease-free and overall survival in the open surgery group, but not in both of the laparoscopic surgery group.

Although the article has several limitations and shortcomings, vague follow-up period, uncertainty of whether cancer-specific survival was calculated or not, unclear relationship between chemotherapy completion rate and survival, no significant difference in the chemotherapy completion rate and a significant difference in survival rate between the laparoscopic surgery and the open surgery groups were noted [7]. Further studies dealing with the issue of laparoscopic surgery and chemotherapy compliance are expected to be spurred by the publication of this study.