Oncologic Outcomes Of Laparoscopic Resection Research Articles

Clinically suspected T4 colorectal cancer may be resected using a laparoscopic approach.

BackgroundThe role of laparoscopic resection in patients with clinically suspicious T4 colorectal cancer remains controversial. The aim of this study was to compare the long-term and oncologic outcomes of laparoscopic resection and the open approach in clinical T4 colorectal cancer.MethodsTwo hundred ninety-three consecutive patients undergoing curative surgery for colorectal cancer suspected to be T4 by computed tomography and/or magnetic resonance imaging were reviewed.ResultsDespite clinical suspicion of T4 disease in all cases, concordance with pathologic determination of T4 was only 37.9 %. Of the 71 patients in the laparoscopic group, four (5.6 %) were converted to the open technique. Patients in the laparoscopic group had significantly lower estimated blood loss (p < 0.001), fewer days to first flatus (p = 0.001), shorter length of hospital stay (p < 0.001), and fewer adverse events (14.1 % versus 31.5 %, p = 0.004). After a median follow-up of 36 months, 5-year disease-free survival was not significantly different between the two groups (81.8 % in laparoscopic versus 73.9 % in open surgery, p = 0.433). The clinical factors that predicted T4 staging on pathologic examination were found to be male sex (p = 0.038), preoperative carcinoembryonic antigen status (p = 0.021), clinical N status (p = 0.046), and clinical cancer perforation (p = 0.004).ConclusionsLaparoscopic colorectal resection for T4 colorectal cancer has perioperative and long-term oncologic outcomes similar to those of the open approach when performed by an experienced surgeon.

Influence of conversion on the perioperative and oncologic outcomes of laparoscopic resection for rectal cancer compared with primarily open resection

This study aimed to evaluate the influence of conversion on perioperative and short- and long-term oncologic outcomes in laparoscopic resection for rectal cancer and to compare these with those for an open control group. The data of 276 consecutive patients who underwent surgery for rectal cancer between 2006 and 2010 at a single institution were prospectively collected. Of the 276 patients, 114 underwent primarily open surgery, and 162 underwent laparoscopic surgery (on an intention-to-treat basis). Of the 162 laparoscopic patients, 38 (23.5%) underwent conversion to open surgery. The three groups of patients were compared: the conversion surgery group, the open surgery group, and the completed laparoscopy surgery group. The converted patients had more wound infections (18.4 vs 4.8%, p = 0.009), but the wound infection rate in the primarily open group also was significantly higher than in the laparoscopic resection group (p = 0.007). No further differences in perioperative morbidity, including anastomotic leakage, were found. The perioperative 30-day mortality rate was comparable between all the groups (0.6 vs 2.6 vs 2.6%, nonsignificant difference). The oncologic parameters such as number of harvested lymph nodes and rate of R0 resection were equal in all the groups. The completed laparoscopy group had a shorter hospital stay [12 vs 16 days in the primarily open group (p = 0.02) vs 15 days in the converted group (p = 0.03)]. The rates for survival, local recurrence (4.5 vs 3 vs 3%), and metachronous metastasis (10.1 vs 9.3 vs 9%) did not differ significantly between the three groups after a period of 3 years. Conversion to open surgery in laparoscopic rectal resection has no negative effect on perioperative or long-term oncologic outcome.

Laparoscopic versus open colorectal resections in patients with symptomatic stage IV colorectal cancer

The purpose of this study was to evaluate short-term and oncologic outcomes of laparoscopic resection (LR) for patients with symptomatic stage IV colorectal cancer compared with open resection (OR). This study is a retrospective analysis of a prospective database. Patients with a minimum follow-up of 12 months after LR or OR for metastatic colorectal cancer were included. All analyses were performed on an "intention-to-treat" basis. A total of 162 consecutive patients submitted to LR and 127 submitted to OR were included. In the LR group, conversion rate was 26.5 %, mostly due to locally advanced disease (88.4 %). A greater risk of conversion was observed among patients with a tumor size greater than 5 cm regardless the tumor site (P = 0.07). Early postoperative outcome was significantly better for LR group, with a shorter hospital stay (P = 0.008), earlier onset of adjuvant treatment, and similar postoperative complications (P = 0.853) and mortality rates (P = 0.958). LR for rectal cancer was associated with a higher morbidity compared with colon cancer (P = 0.058). During a median follow-up time of 72 months, there was no significant difference in overall survival between the two groups (P = 0.622). LR for symptomatic metastatic CRC is safe and, compared with OR, is associated with a shorter hospital stay and with similar survival rates. Concerns remain about LR of bulky tumors and rectal cancers due to the increased risk of conversion and postoperative complications.

A single surgeon’s experience with 54 consecutive cases of multivisceral resection for locally advanced primary colorectal cancer: can the laparoscopic approach be performed safely?

Laparoscopic resection for colorectal cancer has become popular. However, no previous studies have compared the laparoscopic and open approaches for colorectal cancer adherent to adjacent organs. This study analyzed the short- and long-term survival outcomes after laparoscopic multivisceral resection of the locally advanced primary colorectal cancer compared with open procedure in an effort to address appropriate patient selection. From a prospectively collected database, 54 patients with locally advanced primary colorectal cancer who had undergone multivisceral resection from March 2001 to September 2009 were identified. Laparoscopic and open surgeries were selectively performed for 38 and 16 patients, respectively. The two groups had similar demographics, with no differences in age, sex, and comorbidity. However, five emergency or urgency operations were included in the open group. No differences existed between the two groups in terms of tumor node metastasis (TNM) staging, histologic tumor infiltration rates, or curative resection rates. Three patients (7.9%) in the laparoscopic group required conversion to open procedure. In the laparoscopic group, the operation time was longer (330 vs. 257 min; p = 0.018), the volume of blood loss was less (269 vs. 638 ml; p = 0.000), and the time until return of bowel movement was shorter (3.7 vs. 4.7 days; p = 0.029) than in the open group. The perioperative morbidity rates were similar in the two groups (21.1% vs. 43.7%; p = 0.107), and no perioperative mortality occurred in either group. The mean follow-up period after curative resection was 40 months in the laparoscopic group and 35 months in the open group. The two groups showed similar rates for local recurrence (7.7% vs. 27.3%; p = 0.144) and distant metastasis (15.4% vs. 45.5%; p = 0.091). The overall 5-year survival rate was 60.5% for the laparoscopic group and 47.7% for the open group (p = 0.044, log-rank test). In terms of TNM stages, the overall 5-year survival rate for pathologic stage 3 disease was 58.3% for the laparoscopic group and 25% for the open group (p = 0.022, log rank test), but no difference was noted for the stage 2 patients (p = 0.384). No adverse long-term oncologic outcomes of laparoscopic resection were observed in this study. Although inherent limitations exist in this nonrandomized study, laparoscopic multivisceral resection seems to be a feasible and effective treatment option for colorectal cancer for carefully selected patients. Patients with colon cancer should be much more carefully selected for laparoscopic multivisceral resection than patients with rectal cancer because anatomic uncertainty can make oncologic en bloc resection incomplete.

Long-term Oncologic Outcomes of Laparoscopic Resection for Colorectal Cancer

See Article on Page 64-70 Several large randomized trials comparing laparoscopic versus open resection for colon cancer have demonstrated that the laparoscopic-assisted colectomy can be an acceptable alternative to an open colectomy for colon cancer [1-4]. These trials suggested similar oncologic outcomes (local recurrence and overall survival) for laparoscopic-assisted and open colectomies. In addition, laparoscopic-assisted resection may be associated with a shorter hospital stay with no difference in intra-, peri- and postoperative complications. To date, however, the laparoscopic resection for rectal cancer has not gained level-1 evidence in surgical practice. A subset analysis of the UK Medical Research Council (MRC) trial, Conventional versus Laparoscopic-Assisted Surgery in Colorectal Cancer (CLASICC), reported a 34% conversion rate with 59% morbidity during the first 30 days after laparoscopic surgery for rectal cancer. Laparoscopic procedures for rectal cancer are regarded as technically demanding because a total mesorectal excision (TME) and autonomic nerve preservation are prerequisites for functional and oncological safety. In Korea, the laparoscopic resection for colorectal cancer was introduced by some pioneering surgeons in the early 1990's and currently, it is growing in popularity. In this issue, Lee et al. reported the long term oncologic outcomes for 303 patients who underwent a laparoscopic resection for colorectal cancer (colon, 115; rectum, 188). The recurrence rate was 2.2% for colon cancer and 4.4% for rectal cancer. The five-year overall and disease-free survival rates were 86.1% and 89.8% for colon cancer and 68.6% and 74.5% for rectal cancer, respectively. The authors concluded that laparoscopic surgery for colorectal cancer is a good alternative method to open surgery, with tolerable oncologic long-term results. The oncologic outcomes in their study are comparable to those of a conventional open resection for colorectal cancer, even when compared to those of high-volume, leading cancer centers. The results of this study can stimulate a surge in applications of laparoscopy in the field of colorectal cancer surgery. However, as with open surgery, the safety and the benefits of laparoscopy still lie with the surgeons, who must develop competency along a personal learning curve that assures proper patient selection, technical performance, and a low conversion rate. In addition, surgeons who have already overcome the learning curve and attained proficiency should endeavor to develop and establish systematic teaching programs for young surgeons, including surgical residents and fellows.

Current status of laparoscopic resection for colorectal cancer.

To define the current role of laparoscopic resection for colorectal cancer. Perhaps in no other field has so much controversy been generated by laparoscopy as in its application to curative resection of cancer of the colon and rectum. The main controversy centers around the oncologic outcomes of laparoscopic resections. The 3 major issues are: the adequacy of oncologic resection, recurrence rates and patterns, and the long-term survival. A review of published data by search of Medline database with focus on clinical studies. Laparoscopic colectomy is feasible and safe. Modest benefits in the quality of life are observed. Same oncologic resection can be performed laparoscopically with no adverse influence on the recurrence rates. In particular, wound recurrences are not a specific complication of laparoscopic technique. At least equivalent survival is obtained by laparoscopic colectomy. Laparoscopy does not seem to adversely affect chance of cure of colorectal cancer.