Abstract
PurposeFor locally advanced pathological T4 (pT4) colon cancer, the safety and feasibility of laparoscopic procedures remain controversial. Therefore, this study aimed to assess short-term and long-term outcomes and to identify the prognostic factors in laparoscopic surgery for pT4 colon cancer.MethodsThe study group included 130 patients who underwent laparoscopic radical resection for pT4 colon and rectosigmoid cancer from January 2004 through December 2012. The short-term outcomes, long-term outcomes, and prognostic factors in pT4 colon cancer were analyzed.ResultsThe median operative time was 205 min, with a median blood loss of 10 ml. The conversion rate was 3.8%, and 13 patients (10.0%) had postoperative complications. The radial resection margin was positive in 1 patient (0.8%). The median follow-up time was 73 months. The 5-year overall survival (OS) and recurrence-free survival (RFS) were 77.2 and 63.5%, respectively. On a multivariate analysis, a male sex [hazard ratio (HR) 3.09, p < 0.001], lymph node ratio ≥ 0.06 (HR 2.35, p = 0.021), tumor diameter < 38 mm (HR 2.57, p = 0.007), and right-sided colon cancer (HR 2.11, p = 0.047) were significantly related to a poor OS.ConclusionsThese results suggest that laparoscopic surgery for pT4 colon cancer is safe and feasible, and the oncological outcomes are acceptable. Based on the present findings, select patients with locally advanced colon cancer should not be excluded from laparoscopic surgery.
Highlights
Laparoscopic surgery for advanced colorectal cancer has become widespread, with demonstrated short-term benefits and better long-term oncological outcomes than open surgery [1,2,3,4,5,6,7,8,9,10]
All 130 patients with pathological T4 (pT4) colon and RS cancer who underwent radical laparoscopic resection between January 2004 and December 2012 were selected for study analyses with a median follow-up period of 73 months
The guidelines from the European Association of Endoscopic Surgery (EAES) recommend that preoperative T4 colorectal cancer be treated with open resection [30]
Summary
Laparoscopic surgery for advanced colorectal cancer has become widespread, with demonstrated short-term benefits and better long-term oncological outcomes than open surgery [1,2,3,4,5,6,7,8,9,10]. In pT4 colon cancer, technically demanding surgical procedures, including en bloc resection of adjacent infiltrated organs or structures, are generally required. Some retrospective studies have reported satisfactory surgical and oncological outcomes of laparoscopic surgery for T4 colon cancer [14,15,16,17,18,19,20,21,22], but these studies were relatively small series, or the duration of follow-up was short in some
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