Laparoscopy-assisted versus open surgery for multiple colorectal cancers with two anastomoses: a cohort study.

Hiroaki Nozawa,Toshiaki Tanaka,Hironori Yamaguchi,Tomomichi Kiyomatsu,Keisuke Hata,Kensuke Otani,Koji Murono,Koji Yasuda,Takeshi Nishikawa,Toshiaki Watanabe,Soichiro Ishihara,Kazushige Kawai

doi:10.1186/s40064-016-1948-4

Abstract

Laparoscopy-assisted surgery has been widely accepted in the treatment of colorectal cancer. The aim of the present study was to investigate the feasibility and outcomes of laparoscopy-assisted combined resection for multiple colorectal cancers in comparison to open surgery. We retrospectively reviewed patients with synchronous multiple colorectal cancers who underwent combined resection resulting in two anastomotic sites by either open or laparoscopy-assisted surgery in the University of Tokyo Hospital between April 2005 and March 2015. Nine patients underwent laparoscopic surgery using five ports, whereas 16 underwent open surgery. Blood loss was less (median 65 vs 295 mL, p = 0.0015), but the operative time was longer (median 429 vs 310 min, p = 0.09) in the laparoscopic surgery group than in the open surgery group. No intergroup difference was observed in the number of lymph nodes retrieved (median 32 vs 27, p = 0.50). The frequency of clinically significant postoperative complications was also similar between the two groups. Our results suggest that laparoscopy-assisted combined resection is an acceptable alternative to open surgery for multiple colorectal cancers.

Highlights

Colorectal cancer (CRC) is one of the most prevalent malignancies in the world and carries the second highest mortality rate (Jemal et al 2011)
Surgical procedures including the extent of lymphadenectomy and temporary stoma, operative time, estimated blood loss, intraoperative blood transfusion, total number of lymph nodes harvested, and complications occurring within 30 days of surgery were documented
Elevated carcinoembryonic antigen (CEA) and carbohydrate antigen 19-9 (CA19-9) levels in the serum were observed in more patients in the open laparotomy (OP) (62 and 31 %) than in the LAP groups (22 and 0 %), but these differences were not significant

Summary

Introduction

Colorectal cancer (CRC) is one of the most prevalent malignancies in the world and carries the second highest mortality rate (Jemal et al 2011). CRCs are more likely to develop simultaneously with malignant neoplasms in other segments than other gastrointestinal cancers. The recent reported incidence of synchronous CRCs ranged from 1 to 8 % (Piñol et al 2004; van Leersum et al 2014; Lam et al 2014). These cancers often require the resection of multiple segments when lesions are located separately from one another. Laparoscopic surgery has become the standard for CRC in many institutions and has considerable benefits such as being less invasiveness and achieving better cosmetic outcomes. Previous randomized studies demonstrated that a laparoscopic approach was

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