Oncologic Outcomes Following Laparoscopic versus Open Resection of pT4 Colon Cancer: A Systematic Review and Meta-analysis.

Abstract

Locally advanced colon cancer is considered a relative contraindication for laparoscopic resection, and clinical trials addressing the oncologic safety are lacking. The aim of this study was to synthesize the oncologic outcomes associated with laparoscopic versus conventional open surgery for locally advanced colon cancers. We systematically searched Medline, Embase, Central, and ClinicalTrials.gov. Two reviewers independently screened the literature for controlled trials or observational studies comparing curative-intent laparoscopic and open surgery for colon cancer. Studies were included if it was possible to determine outcomes for the T4 colon cancers separately, either reported in the article or calculated with individual patient data. Included studies were systematically reviewed and assessed for risk of bias. Meta-analyses were done by using random-effects models. Outcomes of interest were disease-free survival, overall survival, resection margins, and lymph node harvest. Of 2878 identified studies, 5 observational studies met eligibility criteria with a total of 1268 patients (675 laparoscopic, 593 open). There was no significant difference in overall survival (HR, 1.28; 95% CI, 0.94-1.72), disease-free survival (HR, 1.20; 95% CI, 0.90-1.61), or positive surgical margins (OR, 1.16; 95% CI, 0.58-2.32) between the groups. The open group had a larger lymph node retrieval (pooled mean difference, 2.26 nodes; 95% CI, 0.58-3.93). The pooled rate of conversion from laparoscopy to an open procedure was 18.6% (95% CI, 9.3%-27.9%). These results are limited by the inherent selection bias in the included nonrandomized studies. Based on the available literature, minimally invasive resection of selected locally advanced colon cancer is oncologically safe. There is a small increase in lymph node harvest with open resections, but it is unclear whether this is clinically significant. Surgeons should be prepared for a significant rate of conversion to laparotomy as required to perform en bloc resection.