The feasibility of laparoscopic resection compared to open surgery in clinically suspected T4 colorectal cancer.
ABSTRACT The role of laparoscopic resection in patients with clinical T4 colorectal cancer remains controversial. This study compared the outcome of laparoscopic resection for clinical T4 colorectal cancer with that of an open approach.
Forty-three consecutive patients undergoing surgery for colorectal cancer with suspected involvement of another organ (T4) by computed tomography and/or magnetic resonance imaging were reviewed. Twenty-four patients who underwent laparoscopic colorectal resection were matched with 19 patients who underwent an open approach. All available clinicopathologic variables possibly associated with the outcome were compared.
Two patients (8.3%) who underwent the laparoscopic procedure were converted to the open technique. Patients in the open group displayed more advanced pathologic T category (P = .008) and underwent more combined operation than patients in the laparoscopic group (P = .017). The R0 resection rate was 75% in the laparoscopic group and 52.6% in the open group (P = .135). Patients in the laparoscopic group displayed a tendency for lower estimated blood loss (P = .083), sooner bowel movement (P=.075), and shorter length of hospital stay (P = .089) than patients in the open group. No significant differences in postoperative complications were observed between the laparoscopic and open groups (20.8% versus 36.8%, P = .246). After a median follow-up of 27 months, the 3-year disease-free survival rate in the laparoscopic group was found to be not significantly different from that in the open group (76.7% versus 58.8%; P=.303).
Laparoscopic colorectal resection for T4 colorectal cancer is feasible and has perioperative and short-term oncologic outcomes similar to those of an open approach. However, further studies with long-term follow-up are needed to resolve these issues.
- [show abstract] [hide abstract]
ABSTRACT: High rates of conversion to open operation and morbidity have been reported after laparoscopic total mesorectal excision (TME) with sphincter preservation for rectal cancer. This study examined risk factors for conversion and morbidity to determine which patients with rectal cancer could benefit from a laparoscopic resection. Two hundred patients (117 men) with mid and low rectal cancer treated by laparoscopic TME were studied. The impact of clinical and pathological characteristics on conversion and complications was assessed by multivariable analysis. Reconstruction after TME included 79 low colorectal and 121 coloanal anastomoses. Conversion was necessary in 31 patients (15.5 per cent), and was independently associated with sex, type of anastomosis and intraoperative rectal fixity. Postoperative morbidity in 50 patients (25.0 per cent) was independently associated with sex and type of anastomosis. Men with a stapled anastomosis had a threefold higher rate of conversion (13 (34 per cent) of 38 versus 18 (11.1 per cent) of 162; P < 0.001) and morbidity (22 (58 per cent) versus 28 (17.3 per cent); P < 0.001) than other patients. Laparoscopic TME is a good option for women and for men treated by coloanal anastomosis. Technical improvement of laparoscopic stapling is needed before the laparoscopic approach can be offered to all patients.British Journal of Surgery 12/2007; 94(12):1555-61. · 4.84 Impact Factor
Article: CT staging of colon cancer.[show abstract] [hide abstract]
ABSTRACT: Computer tomography (CT) has been the principal investigation in the staging of colon cancers. The information obtained with routine CT has been limited to identifying the site of the tumour, size of the tumour, infiltration into surrounding structures and metastatic spread. The Foxtrot trial National Cancer Research Institute (NCRI) has been specifically designed to evaluate the efficacy of neoadjuvant treatment in colon cancers by using preoperative chemotherapy with or without an anti-Epidermal Growth Factor Receptor (EGFR) monoclonal antibody to improve outcome in high-risk operable colon cancer. Patients are selected based on their staging CT examination. The criteria for poor prognosis are T4 and T3 tumours with more than 5mm extramural depth. Thus the success of the trial would depend upon the confidence of the radiologist to identify the patients that would receive the neoadjuvant treatment. The aim of this review is to explain the process of identifying high-risk features seen on the staging CT images. This will help to identify a cohort of patients that could truly benefit from neoadjuvant strategies.Clinical radiology 01/2009; 63(12):1372-9. · 1.65 Impact Factor
- [show abstract] [hide abstract]
ABSTRACT: Although laparoscopic resection of colorectal carcinoma improves post-operative recovery, long-term survival and disease control are the determining factors for its application. We aimed to test the null hypothesis that there was no difference in survival after laparoscopic and open resection for rectosigmoid cancer. From Sept 21, 1993, to Oct 21, 2002, 403 patients with rectosigmoid carcinoma were randomised to receive either laparoscopic assisted (n=203) or conventional open (n=200) resection of the tumour. Survival and disease-free interval were the main endpoints. Patients were last followed-up in March, 2003. Perioperative data were recorded and direct cost of operation estimated. Data were analysed by intention to treat. The demographic data of the two groups were similar. After curative resection, the probabilities of survival at 5 years of the laparoscopic and open resection groups were 76.1% (SE 3.7%) and 72.9% (4.0%) respectively. The probabilities of being disease free at 5 years were 75.3% (3.7%) and 78.3% (3.7%), respectively. The operative time of the laparoscopic group was significantly longer, whereas postoperative recovery was significantly better than for the open resection group, but these benefits were at the expense of higher direct cost. The distal margin, the number of lymph nodes found in the resected specimen, overall morbidity and operative mortality did not differ between groups. Laparoscopic resection of rectosigmoid carcinoma does not jeopardise survival and disease control of patients. The justification for adoption of laparoscopic technique would depend on the perceived value of its effectiveness in improving short-term post-operative outcomes.The Lancet 05/2004; 363(9416):1187-92. · 39.06 Impact Factor