The Short-Term and Oncologic Outcomes of Laparoscopic Versus Open Surgery for T4 Colon Cancer

Abstract

Introduction: There are still concerns regarding the technical difficulty and oncologic safety of laparoscopic surgery for T4 colon cancer. We hypothesized that not all T4 tumors are candidates for laparoscopy. However, in selected patients, the laparoscopic approach offers a faster postoperative recovery time and potentially comparable oncologic outcomes. Therefore, the purpose of this study was to compare the short-term and oncologic outcomes between laparoscopic and open surgery for T4 colon cancer. Methods: Patients with non-metastatic T4 colon cancer (n=117) underwent treatment either by laparoscopy (n=51) or open surgery (n=66). Conversion to open surgery occurred in 7 cases (13.7%). Results: History of previous abdominal surgery (2.0% vs. 12.1%) and emergency operation (2.1% vs. 24.2%) were less frequent in the laparoscopy group. Conversion to open surgery occurred in 7 cases (13.7%). Resection of adjacent organs was less frequently performed in the laparoscopy group (27.5% vs. 53.0%, p=.005). Mean operative time (189 min vs. 210 min) and rates of 30-day postoperative complications (12% vs. 24%) were similar between the two groups. Shorter time to soft diet (7days vs. 9days, p=.018) and hospital stay (14days vs. 18days, p=.044) were observed in the laparoscopy group. T4b tumor was also less frequent in the laparoscopy group (3.9% vs. 18.2%, p=.018), while R0 resection rates were similar between the laparoscopy (96.1%) and open surgery group (95.5%). The mean number of lymph nodes was 22 in the laparoscopy and 27 in the open surgery group (p=.021). No differences in the three-year overall survival rate (82.5% vs. 75.7%), recurrence-free survival rate (61.9% vs. 63.5%), and local recurrence-free survival rate (89.8% vs. 88.5%) were observed between the groups. All outcomes in terms of operative time, blood loss, 30-day complication rate, time to diet, duration of hospital stay, R0 resection rate, 3-year overall and local recurrence-free survival rates did not differ between the converted and open surgery groups. Conclusion: Our results indicate that laparoscopy is a surgically safe and oncologically acceptable approach, and thus could be considered for well-selected patients with T4 colon cancer to allow faster short-term recovery.