By Edward Susman
Special to DG News
FORT LAUDERDALE, FL -- March 21, 2000 -- Laparoscopic surgery to perform lymph node harvest in colon cancer should only be conducted in the context of a clinical trial, researchers writing treatment guidelines for the 17-hospital National Comprehensive Cancer Network (NCCN) said. Doctors speaking at the annual meeting of the National Comprehensive Cancer Network (NCCN) said the laparoscopic procedure has not yet proved itself to be beneficial in helping to diagnose patients with colon cancer.
"Patients want this surgery. They ask for the 'surgery with the little hole'," said Paul Engstrom, MD, professor of medicine at Temple University School of Medicine, in Philadelphia, PA. But Dr. Engstrom, senior vice president for population science at Fox Chase Cancer Center, in Philadelphia, PA, and chairman of the NCCN committee writing colon cancer treatment guidelines, said the evidence for using laparoscopic procedures to harvest lymph nodes in diagnosing cancer is still incomplete.
"The jury is still out on that," he said. The guidelines say that if doctors and patients seek laparoscopic treatment they should enter an ongoing clinical trial in which patients are to receive either a traditional open operation or the "key hole" procedure.
The question is whether the laparoscopic operation is as successful as the open procedure in harvesting the lymph nodes for pathological evaluation to determine the status of the cancer, said John Skibber, MD, associate professor of surgical oncology at the University of Texas M.D. Anderson Cancer Center, in Houston, TX.
An estimated 130,200 cases of colon cancer will be diagnosed in 2000, including 93,800 of colon cancer and 36,400 of rectal cancer. Colorectal cancers are the third most common cancers in men and women. An estimated 56,300 people -- 47,700 with colon cancer and 8,600 with rectal cancer -- will die from the disease this year.
Dr. Engstrom said his committee also made other changes in the colon cancer guidelines. The fine-tuning of the treatment algorithm was the first major review of the treatment pathways since they were first adopted by NCCN-member institutions in 1996.
The guidelines now include hepatic artery infusion, in which anti-cancer drugs are delivered directly to the liver to combat spread of the colon cancer to that organ. Krystyna Kiel, MD, attending radiation oncologist at the Robert Lurie Comprehensive Cancer Center and assistant professor of radiology at Northwestern University Medical School, in Chicago, said new studies have found that the surgical technique "as being useful in removal of liver metastases."
The guidelines also include the new drug, irinotecan, in the treatment of advanced cancer patients. The guidelines committee also removed levamisole, an immune modifier, from the treatment pathways. Dr. Engstrom said irinotecan has been found to benefit patients, while studies with levamisole have shown no such benefit.