The Feasibility of Laparoscopic Resection Compared to Open Surgery in Clinically Suspected T4 Colorectal Cancer

Abstract

The role of laparoscopic resection in patients with clinical T4 colorectal cancer remains controversial. This study compared the outcome of laparoscopic resection for clinical T4 colorectal cancer with that of an open approach. Forty-three consecutive patients undergoing surgery for colorectal cancer with suspected involvement of another organ (T4) by computed tomography and/or magnetic resonance imaging were reviewed. Twenty-four patients who underwent laparoscopic colorectal resection were matched with 19 patients who underwent an open approach. All available clinicopathologic variables possibly associated with the outcome were compared. Two patients (8.3%) who underwent the laparoscopic procedure were converted to the open technique. Patients in the open group displayed more advanced pathologic T category (P = .008) and underwent more combined operation than patients in the laparoscopic group (P = .017). The R0 resection rate was 75% in the laparoscopic group and 52.6% in the open group (P = .135). Patients in the laparoscopic group displayed a tendency for lower estimated blood loss (P = .083), sooner bowel movement (P=.075), and shorter length of hospital stay (P = .089) than patients in the open group. No significant differences in postoperative complications were observed between the laparoscopic and open groups (20.8% versus 36.8%, P = .246). After a median follow-up of 27 months, the 3-year disease-free survival rate in the laparoscopic group was found to be not significantly different from that in the open group (76.7% versus 58.8%; P=.303). Laparoscopic colorectal resection for T4 colorectal cancer is feasible and has perioperative and short-term oncologic outcomes similar to those of an open approach. However, further studies with long-term follow-up are needed to resolve these issues.