RATIONALE: Less invasive types of surgery may help reduce the number of side effects and improve recovery. It is not yet known which type of surgery is more effective for colon cancer.

PURPOSE: Randomized phase III trial to compare the effectiveness of laparoscopic-assisted colectomy with open colectomy in treating patients who have colon cancer.

OBJECTIVES:

• Compare the disease-free and overall survival rates of patients with colon cancer treated with laparoscopic-assisted colectomy vs open colectomy.
• Compare the safety of these regimens in terms of early and late morbidity and 30-day mortality of these patients.
• Compare the differences in costs and cost effectiveness between these treatments in this patient population.
• Compare the differences in quality of life of patients treated with these regimens. (closed as of 4/30/99)

OUTLINE: This is a randomized, multicenter study. Patients are stratified according to participating center, primary surgeon, site of primary tumor (right vs left vs sigmoid), and American Society of Anesthesiologists disease classification (I and II vs III). Patients are randomized to one of two treatment arms.

The extent of colon resection is identical for both arms.

• Arm I: Patients undergo open laparotomy and colectomy. A standard incision is made through the abdominal wall and the abdominal cavity is explored. A right or left colectomy or a sigmoid resection is performed.
• Arm II: Patients undergo a laparoscopic-assisted colectomy. A small infraumbilical incision is made through the abdominal skin and the abdominal cavity is insufflated with CO2 to allow access and visualization. The abdominal cavity is explored. If advanced local disease is identified, a celiotomy and colectomy are performed. Otherwise, a right or left colectomy or sigmoid resection is performed using laparoscopic-assisted techniques.

Patients may be entered on adjuvant chemotherapy trials after surgery provided the subsequent trial does not include radiotherapy and allows entry of patients from both arms.

Quality of life is assessed at baseline and on days 2 and 14 after surgery, at 2 months, and then at 18 months. (closed as of 4/30/99)

Patients are followed every 3 months for 1 year, every 6 months for 4 years, and then annually for 3 years.

PROJECTED ACCRUAL: A total of 810 patients will be accrued for this study within 3 years.

• Procedure: conventional surgery
• Procedure: laparoscopic surgery

• Larson DW, Marcello PW, Larach SW, Wexner SD, Park A, Marks J, Senagore AJ, Thorson AG, Young-Fadok TM, Green E, Sargent DJ, Nelson H. Surgeon volume does not predict outcomes in the setting of technical credentialing: results from a randomized trial in colon cancer. Ann Surg. 2008 Nov;248(5):746-50.
• Clinical Outcomes of Surgical Therapy Study Group. A comparison of laparoscopically assisted and open colectomy for colon cancer. N Engl J Med. 2004 May 13;350(20):2050-9.
• Weeks JC, Nelson H, Gelber S, Sargent D, Schroeder G; Clinical Outcomes of Surgical Therapy (COST) Study Group. Short-term quality-of-life outcomes following laparoscopic-assisted colectomy vs open colectomy for colon cancer: a randomized trial. JAMA. 2002 Jan 16;287(3):321-8.

DISEASE CHARACTERISTICS:

• Clinical diagnosis of primary adenocarcinoma

  • Involving a single colon segment:

    • Right colon from the ileocecal valve up to and including the hepatic flexure
    • Left colon from the splenic flexure to the junction of the sigmoid and descending colon
    • Sigmoid colon between the descending colon and the rectum (at least 15 cm from the dentate)
• Diagnosis based on physical exam plus either a proctosigmoidoscopy and barium enema or a colonoscopy
• No advanced local disease that renders laparoscopic resection impossible
• No acutely obstructed or perforated colon cancer requiring urgent surgery
• No transverse colon cancer (i.e., between distal hepatic flexure and proximal splenic flexure)
• No stage IV disease
• No rectal cancer (i.e., below the peritoneal reflection, lower edge of tumor less than 15 cm from dentate)
• No American Society of Anesthesiologists IV/V disease classification
• No associated gastrointestinal diseases (i.e., Crohn's, chronic ulcerative colitis, or familial polyposis) that require additional extensive operative evaluation or intervention

PATIENT CHARACTERISTICS:

Age:

• 18 and over

Performance status:

• Not specified

Hematopoietic:

• Not specified

Hepatic:

• Not specified

Renal:

• Not specified

Other:

• No other prior or concurrent malignancy within the past 5 years except superficial squamous cell or basal cell skin cancer or carcinoma in situ of the cervix
• Not pregnant or nursing
• Negative pregnancy test
• Fertile patients must use effective contraception

PRIOR CONCURRENT THERAPY:

Biologic therapy:

• Not specified

Chemotherapy:

• Not specified

Endocrine therapy:

• Not specified

Radiotherapy:

• Not specified

Surgery:

• See Disease Characteristics
• No prohibitive scars/adhesions from prior abdominal surgery

Other:

• No concurrent investigational treatments or invasive diagnostic procedures within 30 days after surgery

• National Cancer Institute (NCI)
• Southwest Oncology Group
• Eastern Cooperative Oncology Group
• Radiation Therapy Oncology Group
• Cancer and Leukemia Group B
• NCIC Clinical Trials Group
• National Surgical Adjuvant Breast and Bowel Project (NSABP)