Is laparoscopic resection in select T4 colorectal lesions comparable to open resection for achieving adequate margins?

Abstract

e14527 Background: Laparoscopic resection has been considered a relative contraindication for T4 colonic and rectal lesions due to concern over inadequate margins. The objective of this study is to compare planned laparoscopic and open resections of T4 lesions with respect to the positive margin rate. Methods: Data was obtained from the American College of Surgeons National Surgical Quality Improvement Program participant use file to perform a retrospective cohort analysis. The study population consisted of patients that underwent a colorectal resection for a primary T4 lesion during 2011 and 2012. Patients were excluded if they had evidence of metastatic disease. A multiple logistic regression analysis was performed to determine the adjusted odds ratio (OR) of positive margins based on surgical approach (i.e. laparoscopic vs. open). Results: The sub-selected population consisted of 304 and 478 patients in the laparoscopic and open group, respectively. There were no statistical differences between the two groups with respect to demographic and clinical variables including age, sex, body mass index, number of emergency cases, and patients with coagulopathy. However, a significantly higher proportion of patients received neoadjuvant therapy in the open group (p <0.01). The laparoscopic group had 66 (22.68%) cases with positive margins and the open group had 126 (27.9%). Among patients with a planned laparoscopic approach, 77 (25%) required conversion to an open procedure with 19 (25%) cases resulting in positive margins. No statistical difference was found between planned laparoscopic and open resections with respect to positive margin status (OR 0.76, p = 0.13, 95% CI [0.54-1.08]). In addition, no significant clinical predictors for positive margin status were identified. Conclusions: Using this large national surgical database, select patients with T4 lesions that underwent planned laparoscopic colorectal resections did not have a significantly higher positive margin rate compared to patients with open operations. Experienced laparoscopic surgeons are able to selectively perform adequate resections for T4 colorectal lesions.