Abstract
Patients with locally advanced colon cancer have worse outcomes. Guidelines of various organizations are conflicting about the use of laparoscopic colectomy (LC) in locally advanced colon cancer. We determined whether patient outcomes of LC and open colectomy (OC) for locally advanced (T4) colon cancer are comparable in all colon cancer patients, T4a versus T4b patients, obese versus non-obese patients, and tumors located in the ascending, descending, and transverse colon. We used data from the 2013–2015 American College of Surgeons’ National Surgical Quality Improvement Program. Patients were diagnosed with nonmetastatic pT4 colon cancer, with or without obstruction, and underwent LC (n = 563) or OC (n = 807). We used a composite outcome score (mortality, readmission, re-operation, wound infection, bleeding transfusion, and prolonged postoperative ileus); length of stay; and length of operation. Patients undergoing LC exhibited a composite outcome score that was 9.5% lower (95% CI − 15.4; − 3.5) versus those undergoing OC. LC patients experienced a 11.3% reduction in postoperative ileus (95% CI − 16.0; − 6.5) and an average of 2 days shorter length of stay (95% CI − 2.9; − 1.0). Patients undergoing LC were in the operating room an average of 13.5 min longer (95% CI 1.5; 25.6). We found no evidence for treatment heterogeneity across subgroups (p > 0.05). Patients with locally advanced colon cancer who receive LC had better overall outcomes and shorter lengths of stay compared with OC patients. LC was equally effective in obese/nonobese patients, in T4a/T4b patients, and regardless of the location of the tumor.
Highlights
Patients with locally advanced colon cancer have worse outcomes
The American Society of Colon & Rectal Surgeons recommends that “laparoscopic resection of T4 colon cancer may be performed safely and effectively with long-term oncologic outcomes that do not differ in comparison with open surgery.”[10]. In contrast, the National Comprehensive Cancer Network guidelines for colon cancer surgery recommend against laparoscopic colectomy (LC) when locally advanced disease is p resent[11]
We examined differences in 30 day outcomes of LC versus open colectomy (OC) and compared subgroups of patients: (1) T4a and T4b patients, (2) those with tumors located in the left, right, or transverse colon, and (3) obese and nonobese patients
Summary
Patients with locally advanced colon cancer have worse outcomes. Guidelines of various organizations are conflicting about the use of laparoscopic colectomy (LC) in locally advanced colon cancer. Patients with locally advanced colon cancer who receive LC had better overall outcomes and shorter lengths of stay compared with OC patients. About ten percent of patients are diagnosed with locally advanced cancer (T4) with locoregional invasion, who may have worse o utcomes[5] Such tumors have a reasonable chance of a cure when accompanied by an en bloc multivisceral resection[6,7,8], but a landmark randomized study excluded locally advanced colon cancer when comparing LC versus OC9. Studies to compare directly the effectiveness of LC versus OC across different locations in locally advanced tumors in the colon are not available, and transverse colon cancers were excluded from the landmark Clinical Outcomes of Surgical Therapy (COST) t rial[9]
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