Abstract
BackgroundLaparoscopic surgery for T4 colon cancer may be safe in selected patients. We hypothesized that small tumor size might preoperatively predict a good laparoscopic surgery outcome. Herein, we compared the clinicopathologic and oncologic outcomes of laparoscopic and open surgery in small T4 colon cancer.MethodsIn a retrospective multicenter study, we reviewed the data of 449 patients, including 117 patients with tumors ≤ 4.0 cm who underwent surgery for T4 colon cancer between January 2014 and December 2017. We compared the clinicopathologic and 3-year oncologic outcomes between the laparoscopic and open groups. Survival curves were estimated using the Kaplan–Meier method and compared using the log-rank test. Univariate and multivariate analyses were performed using the Cox proportional hazards model. A p < 0.05 was considered statistically significant.ResultsBlood loss, length of hospital stay, and postoperative morbidity were lower in the laparoscopic group than in the open group (median [range], 50 [0–700] vs. 100 [0–4000] mL, p < 0.001; 8 vs. 10 days, p < 0.001; and 18.0 vs. 29.5%, p = 0.005, respectively). There were no intergroup differences in 3-year overall survival or disease-free survival (86.6 vs. 83.2%, p = 0.180, and 71.7 vs. 75.1%, p = 0.720, respectively). Among patients with tumor size ≤ 4.0 cm, blood loss was significantly lower in the laparoscopic group than in the open group (median [range], 50 [0–530] vs. 50 [0–1000] mL, p = 0.003). Despite no statistical difference observed in the 3-year overall survival rate (83.3 vs. 78.7%, p = 0.538), the laparoscopic group had a significantly higher 3-year disease-free survival rate (79.2 vs. 53.2%, p = 0.012).ConclusionsLaparoscopic surgery showed similar outcomes to open surgery in T4 colon cancer patients and may have favorable short-term oncologic outcomes in patients with tumors ≤ 4.0 cm.
Highlights
Laparoscopic surgery for T4 colon cancer may be safe in selected patients
Several recent studies [8,9,10] have reported that laparoscopic surgery for T4 colon cancer had better shortterm outcomes than open surgery, as well as noninferiority in oncologic outcomes
Studies [11, 12] have reported that a technical difficulty during laparoscopic surgery could threaten oncological safety, while tumor size is a factor that is known to influence the technical difficulty associated with tumor resection
Summary
Laparoscopic surgery for T4 colon cancer may be safe in selected patients. We compared the clinicopathologic and oncologic outcomes of laparoscopic and open surgery in small T4 colon cancer. Several meta-analyses and randomized controlled trials [4,5,6,7] have reported that laparoscopic surgery is noninferior to open surgery for colon cancer. In T4 colon cancer, the feasibility of laparoscopic surgery with regard to oncologic outcomes remains debatable. Several recent studies [8,9,10] have reported that laparoscopic surgery for T4 colon cancer had better shortterm outcomes (e.g., less intraoperative blood loss and shorter hospital stay) than open surgery, as well as noninferiority in oncologic outcomes. The exact clinical conditions wherein laparoscopic surgery for T4 colon cancer is feasible or harmful, with regard to oncologic outcomes, need to be ascertained. Studies [11, 12] have reported that a technical difficulty during laparoscopic surgery could threaten oncological safety, while tumor size is a factor that is known to influence the technical difficulty associated with tumor resection
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