Clinically suspected T4 colorectal cancer may be resected using a laparoscopic approach.

Jong Seob Park,Yong Beom Cho,Jung Wook Huh,Seong Hyeon Yun,Woo Yong Lee,Ho-Kyung Chun,Yoon Ah Park,Hee Cheol Kim

doi:10.1186/s12885-016-2753-8

Abstract

BackgroundThe role of laparoscopic resection in patients with clinically suspicious T4 colorectal cancer remains controversial. The aim of this study was to compare the long-term and oncologic outcomes of laparoscopic resection and the open approach in clinical T4 colorectal cancer.MethodsTwo hundred ninety-three consecutive patients undergoing curative surgery for colorectal cancer suspected to be T4 by computed tomography and/or magnetic resonance imaging were reviewed.ResultsDespite clinical suspicion of T4 disease in all cases, concordance with pathologic determination of T4 was only 37.9 %. Of the 71 patients in the laparoscopic group, four (5.6 %) were converted to the open technique. Patients in the laparoscopic group had significantly lower estimated blood loss (p < 0.001), fewer days to first flatus (p = 0.001), shorter length of hospital stay (p < 0.001), and fewer adverse events (14.1 % versus 31.5 %, p = 0.004). After a median follow-up of 36 months, 5-year disease-free survival was not significantly different between the two groups (81.8 % in laparoscopic versus 73.9 % in open surgery, p = 0.433). The clinical factors that predicted T4 staging on pathologic examination were found to be male sex (p = 0.038), preoperative carcinoembryonic antigen status (p = 0.021), clinical N status (p = 0.046), and clinical cancer perforation (p = 0.004).ConclusionsLaparoscopic colorectal resection for T4 colorectal cancer has perioperative and long-term oncologic outcomes similar to those of the open approach when performed by an experienced surgeon.

Highlights

The role of laparoscopic resection in patients with clinically suspicious T4 colorectal cancer remains controversial
Several randomized studies have reported that the laparoscopic approach is associated with decreased postoperative pain, shorter hospital stay, and reduced postoperative adverse events compared to conventional surgery [1,2,3,4]
The guidelines from the American Society of Colon & Rectal Surgeons (ASCRS) and the European Association of Endoscopic Surgery have suggested that a laparoscopic approach is the optimal technique for colorectal cancer resection [5,6,7]

Summary

Introduction

The role of laparoscopic resection in patients with clinically suspicious T4 colorectal cancer remains controversial. The aim of this study was to compare the long-term and oncologic outcomes of laparoscopic resection and the open approach in clinical T4 colorectal cancer. The guidelines from the American Society of Colon & Rectal Surgeons (ASCRS) and the European Association of Endoscopic Surgery have suggested that a laparoscopic approach is the optimal technique for colorectal cancer resection [5,6,7]. It is recommended that resection for locally advanced colorectal cancer be performed via an open approach, according to the Society of American Gastrointestinal and Endoscopic Surgeons guidelines (SAGES); the ASCRS guidelines suggest that laparoscopic and open colectomies result in equivalent oncological outcomes for localized colon cancer [5, 7]

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