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.
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ABSTRACT: Resection of the primary tumour in patients with stage IV colorectal cancer may be performed for related local symptoms to avoid future tumour-related complications whilst on systemic treatment. We compared the safety and efficacy of laparoscpic and open colectomy in this patient group. Pubmed, Medline and Cochrane library were searched in the English literature for studies between January 2000 to October 2012 dealing with the laparoscopic resection of the primary tumour in Stage IV disease. Single-arm laparoscopic studies were systematically reviewed. Prospective and retrospective studies were included for meta-analysis. Endpoints include safety, complications, mortality an cancer specific outcome including 5-year and median survival. Eleven studies comprising 1165 patients undergoing palliative laparoscopic colectomy for stage IV colorectal cancer were included. Five studies were comparative studies of laparoscopic and open colectomy. The former took longer (Pooled mean difference (MD) = 41.52; 95% CI = 11.47 to 71.56; Z = 2.71; p = 0.007), but resulted in shorter length of stay (Pooled MD = -2.41; 95% CI = -3.84 to -0.99; Z = 3.32; p = 0.0009), with fewer postoperative complications (pooled odds ratio = 0.53; 95% CI = 0.32 to 0.87; Z = 2.51; p = 0.01) and less estimated blood loss (Pooled MD = -47.71; 95% CI = -80.00 to -15.42; Z = 2.90; p = 0.004). Median survival ranged between 11.4 and 30.1 months. Palliative colectomy performed laparoscopically is safe and is associated with a better perioperative outcome than open colectomy. The survival in this group of patients remains dependant on the response to systemic chemotherapy. This article is protected by copyright. All rights reserved.Colorectal Disease 04/2013; · 2.08 Impact Factor