Improving Life for Bowel Cancer Patients
Keyhole Surgery Improving Quality of Life for Bowel Cancer Patients
Keyhole - or laparoscopic surgery – can improve the quality of life of people under-going bowel cancer operations – according to a recent New Zealand research study.
The study shows patients who have laparoscopically-assisted colectomy operations (LACs) for bowel cancer, generally leave hospital and can return to work earlier than those who have traditional surgery.
The study, presented at the Annual Scientific Congress of the Royal Australasian College of Surgeons (RACS) in Perth Today, (16/5) was undertaken by Senior Lecturer at Otago University Dr Julian Hayes and Economist Dr Paul Hansen.
They reviewed the results of over 3500 LACs from major research studies undertaken in North America, Canada, Northern Europe, Spain and Hong Kong.
Trained in laparoscopic surgery in Adelaide and Brisbane, Dr Hayes has performed about fifty LACs at Dunedin Hospital. He says while the laparoscopic operations tend to be more costly at the moment “there are real benefits in terms of patient recovery.”
“If there is faster recovery for a large number of patients globally then laparoscopy is definitely worth doing economically,” he says.
Colorectal cancer is the most common form of cancer and the second most common cause of cancer death in New Zealand men. After breast cancer it is the second most common form of cancer in women for both incidence and death.
Dr Hayes says recent international trials have shown that LACs are safe with equivalent long-term survival rates to conventional open colectomies.
An earlier study of 872 patients in 48 institutions in the United States, published in the New England Journal of Medicine in May last year showed the probability of recurrence of cancer and the survival rates three years after both laparoscopic and traditional surgery were the same.
However, while research showed improved short-term patient outcomes, such as faster recovery, shorter hospital stays and fewer overall complications there were concerns about whether laparoscopy was an efficient use of scarce hospital resources such as operating theatre time and expensive disposable equipment. The Hayes and Hansen study aimed to see if LACs were cost-effective in the New Zealand public hospital system.
The study calculated that if the patients stayed in hospital for an average of two days less after a LAC (compared to an open colectomy) it would cost about $860 more than a conventional colectomy. However the laparoscopic operation could be more than $2000 more expensive than the traditional operation if theatre time was a lot longer, a lot of disposable equipment was used or if there was little difference in the time stayed in hospital.
Dr Hayes said people generally resumed normal activities at home or work between 12 days to a month earlier than after the conventional open colon operations. It was this gain in health related quality of life that made laparoscopic operations cost effective.
About 60 laparoscopic bowel operations have been done in the Dunedin Public Hospital in the past year. About 70 have been done in the North Shore Hospital in the past 2-3 years. LACs are just starting to be done at Auckland Public Hospital and are currently being performed in private clinics in Christchurch.