Commentary: Maryland surgeon helps prove safety of colon surgery

On May 13 the prestigious New England Journal of Medicine reported that laparoscopic colon surgery has been found to be a safe and effective alternative to the traditional open abdominal approach. This conclusion was based on a seven-year study led by Dr. Heidi Nelson of the Mayo Clinic involving 872 patients from 48 medical centers in the U.S. and Canada, carried out by 66 highly credentialed, experienced colorectal surgeons.

One of those 66 chosen to participate was Dr. Charles Kim, director of colorectal surgery at St. Joseph Medical Center in Towson, the only surgeon to be selected from Maryland.

The important conclusions and benefits to the 872 patients were:

* An almost identical rate of reoccurrence in the two groups.

* Surgical wound recurrence in less than 1 percent of both groups.

* Survival rate almost identical after three years' follow-up.

* Complication rate similar in the two groups.

* Shorter hospital stay for those undergoing the laparoscopic procedure.

* Lesser amount of pain relievers required for the laparoscopic group.

* Faster and more comfortable return to work in the laparoscopic patients.

I requested an interview with Kim, which was carried out at 7:30 a.m., before he started his busy surgical day. He confirmed that due to his 12-year experience with laparoscopic colon cancer surgery, he felt certain early on that this study would show that laparoscopic surgery was both safe and effective for treatment of early colon cancer.

His own experience covered approximately a thousand laparoscopic cases, about 700 of them involving early colon cancers. As a result of his extensive and successful experience, Kim has been certified as a teaching surgeon in this laparoscopic technique not only for other Baltimore area colorectal surgeons, but also for surgical fellows from outside Maryland as well as interested residents going through the program at St. Joseph.

Kim reported that this study, funded by the National Cancer Institute of the National Institutes of Health, was considered a top priority clinical research project. Now, with the publication of the results of this study, he anticipates that teaching hospitals will soon begin to adopt the new cutting edge technology, hiring skilled colorectal surgeons experienced in the laparoscopic approach in order to train a larger number of residents to develop their skills in this technique.

Nevertheless, Kim estimates that it will probably take 10 years before there will be enough experienced laparoscopic colorectal surgeons to serve the needs of the approximately 250,000 patients annually diagnosed with colon cancer in the United States.

Kim has found that patients with colon cancer are far less intimidated by the prospect of surgery when they are offered a laparoscopic procedure that involves a smaller incision and faster recovery.

However, because of the limited availability of surgeons trained in the technique today, Kim advises that before a colon cancer patient chooses a surgeon to perform a laparoscopic procedure, the surgeon should be asked how many laparoscopic procedures the surgeon performs annually, whether the surgeon feels comfortable doing such surgery, and where the surgeon received training in the procedure. If the patient is not comfortable with the answers, a second opinion should be sought or the patient should consider the standard open abdominal surgical approach.

Kim predicts that in approximately 10 years, 70 percent of small and large bowel surgery will be performed laparoscopically. Patients are increasingly knowledgeable, and will expect and request laparoscopic surgery for this type of surgery, as they do now for gall bladder surgery.

Robert S. Coplan, M.D., M.P.H., has spent a half century studying, practicing and writing about medicine and issues facing the health care and biotechnology industries.

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