Surgical Endoscopy

, Volume 32, Issue 3, pp 1133–1140 | Cite as

Oncologic outcomes following laparoscopic colon cancer resection for T4 lesions: a case–control analysis of 7-years’ experience

  • Piera Leon
  • Michele Giuseppe Iovino
  • Fabiola Giudici
  • Antonio Sciuto
  • Nicolò de Manzini
  • Diego Cuccurullo
  • Francesco Corcione
Article

Abstract

Background

According to many Societies’ guidelines, patients presenting with clinical T4 colorectal cancer should conventionally be approached by a laparotomy. Results of emerging series are questioning this attitude.

Methods

We retrospectively analysed the oncologic outcomes of 147 patients operated on between June 2008 and September 2015 for histologically proven pT4 colon cancers. All patients were treated with curative intent, either by a laparoscopic or open “en bloc” resection.

Results

Median operative time, blood loss and hospital length of stay were significantly reduced in the laparoscopic group. Postoperative surgical complication rate and 30-day mortality did not significantly differ between the two groups ( p = 0.09 and p = 0.99, respectively). R1 resection rate and lymph nodes harvest, as well, did not remarkably differ when comparing the two groups. In the laparoscopic group, conversion rate was 19%. Long-term outcomes were not affected in patients who had undergone conversion. Five-year overall survival and disease-free survival did not significantly differ between the two groups (44.6% and 40.3% vs. 39.4% and 38.9%). Locally advanced stages (IIIB–IIIC) and R1 resections were detected as independent prognostic factors for overall survival.

Conclusion

Laparoscopic approach might be safe and acceptable for locally advanced colon cancer and does not jeopardize the oncologic results. Conversion to open surgery should be a part of a strategy as it does not seem to adversely affect perioperative and long-term outcomes. We consider laparoscopy, in expert hands, the last diagnostic tool and the first therapeutic approach for well-selected locally advanced colon cancers. Larger prospective studies are needed to widely assess this issue.

Keywords

T4 colon cancer Locally advanced colon cancers Infiltrating colon cancers Laparoscopy Oncological results Multi-visceral resection 

Notes

Compliance with ethical standards

Disclosure

Drs. Piera Leon, Michele Giuseppe Iovino, Fabiola Giudici, Antonio Sciuto, Nicolò de Manzini, Diego Cuccurullo and Francesco Corcione have no conflicts of interest or financial ties to disclose.

References

  1. 1.
    Ferlay J et al (2013) Cancer incidence and mortality patterns in Europe: estimates for 40 countries in 2012. Eur J Cancer 49(6):1374–1403CrossRefPubMedGoogle Scholar
  2. 2.
    Jacobs M, Verdeja JC, Goldstein HS (1991) Minimally invasive colon resection (laparoscopic colectomy). Surg Laparosc Endosc 1(3):144–150PubMedGoogle Scholar
  3. 3.
    Capussotti L et al (2004) Laparoscopy as a prognostic factor in curative resection for node positive colorectal cancer: results for a single-institution nonrandomized prospective trial. Surg Endosc 18(7):1130–1135CrossRefPubMedGoogle Scholar
  4. 4.
    Bilimoria KY et al (2008) Use and outcomes of laparoscopic-assisted colectomy for cancer in the United States. Arch Surg 143(9):832–839 discussion 839–840 CrossRefPubMedGoogle Scholar
  5. 5.
    Lacy AM et al (2008) The long-term results of a randomized clinical trial of laparoscopy-assisted versus open surgery for colon cancer. Ann Surg 248(1):1–7CrossRefPubMedGoogle Scholar
  6. 6.
    Law WL et al (2012) Survival following laparoscopic versus open resection for colorectal cancer. Int J Colorectal Dis 27(8):1077–1085CrossRefPubMedPubMedCentralGoogle Scholar
  7. 7.
    Huscher CG, Bretagnol F, Corcione F (2015) Laparoscopic colorectal cancer resection in high-volume surgical centers: long-term outcomes from the lapcolon group trial. World J Surg 39(8):2045–2051CrossRefPubMedGoogle Scholar
  8. 8.
    Veldkamp R et al (2005) Laparoscopic surgery versus open surgery for colon cancer: short-term outcomes of a randomised trial. Lancet Oncol 6(7):477–484CrossRefPubMedGoogle Scholar
  9. 9.
    Guillou PJ et al (2005) Short-term endpoints of conventional versus laparoscopic-assisted surgery in patients with colorectal cancer (MRC CLASICC trial): multicentre, randomised controlled trial. Lancet 365(9472):1718–1726CrossRefPubMedGoogle Scholar
  10. 10.
    Braga M et al (2002) Laparoscopic versus open colorectal surgery: a randomized trial on short-term outcome. Ann Surg 236(6):759–766 (discussion 767) CrossRefPubMedPubMedCentralGoogle Scholar
  11. 11.
    Hemandas AK et al (2010) Laparoscopic colorectal surgery produces better outcomes for high risk cancer patients compared to open surgery. Ann Surg 252(1):84–89CrossRefPubMedGoogle Scholar
  12. 12.
    Veldkamp R et al (2004) Laparoscopic resection of colon Cancer: consensus of the European Association of Endoscopic Surgery (EAES). Surg Endosc 18(8):1163–1185CrossRefPubMedGoogle Scholar
  13. 13.
    Society of American Gastrointestinal and Endoscopic Surgeons (SAGES) (2012) Guidelines for laparoscopic resection of curable colon and rectal cancer. https://www.sages.org/publications/guidelines/guidelines-for-laparoscopic-resection-of-curable-colon-and-rectal-cancer/
  14. 14.
    Franklin ME Jr et al (1996) Prospective comparison of open vs. laparoscopic colon surgery for carcinoma. Five-year results. Dis Colon Rectum 39(10 Suppl):S35–S46CrossRefPubMedGoogle Scholar
  15. 15.
    Feinberg AE, Chesney TR, Acuna SA et al (2017) Oncologic outcomes following laparoscopic versus open resection of pT4 colon cancer: a systematic review and meta-analysis. Dis Colon Rectum 60(1):116–125CrossRefPubMedGoogle Scholar
  16. 16.
    Kang J, Baik SH, Lee KY et al. Outcomes of laparoscopic surgery in pathologic T4 colon cancers compared to those of open surgery (2016) Int J Colorectal Dis.Google Scholar
  17. 17.
    Kim KY et al (2012) 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? Surg Endosc 26(2):493–500CrossRefPubMedGoogle Scholar
  18. 18.
    Lacy AM et al (2002) Laparoscopy-assisted colectomy versus open colectomy for treatment of non-metastatic colon cancer: a randomised trial. Lancet 359(9325):2224–2229CrossRefPubMedGoogle Scholar
  19. 19.
    Vignali A et al (2013) Laparoscopic treatment of advanced colonic cancer: a case-matched control with open surgery. Colorectal Dis 15(8):944–948CrossRefPubMedGoogle Scholar
  20. 20.
    Scheidbach H, Garlipp B, Oberländer H et al (2011) Conversion in laparoscopic colorectal cancer surgery: impact on short- and long-term outcome. J Laparoendosc Adv Surg Tech A 21:923–927CrossRefPubMedGoogle Scholar
  21. 21.
    Franko J et al (2008) Conversion of laparoscopic colon resection does not affect survival in colon cancer. Surg Endosc 22(12):2631–2634CrossRefPubMedGoogle Scholar
  22. 22.
    Allaix ME et al (2013) Does conversion affect short-term and oncologic outcomes after laparoscopy for colorectal cancer? Surg Endosc 27(12):4596–4607CrossRefPubMedGoogle Scholar
  23. 23.
    Li J et al (2015) The impact of laparoscopic converted to open colectomy on short-term and oncologic outcomes for colon cancer. J Gastrointest Surg 19(2):335–343CrossRefPubMedGoogle Scholar
  24. 24.
    Rickert A, Herrle F, Doyon F et al (2013) Influence of conversion on the perioperative and oncologic outcomes of laparoscopic resection for rectal cancer compared with primarily open resection. Surg Endosc 27(12):4675–4683. doi: 10.1007/s00464-013-3108-z CrossRefPubMedGoogle Scholar
  25. 25.
    Bretagnol F et al (2011) T4 colorectal cancer: is laparoscopic resection contraindicated? Colorectal Dis 13(2):138–143CrossRefPubMedGoogle Scholar
  26. 26.
    Lehnert T et al (2002) Multivisceral resection for locally advanced primary colon and rectal cancer: an analysis of prognostic factors in 201 patients. Ann Surg 235(2):217–225CrossRefPubMedPubMedCentralGoogle Scholar
  27. 27.
    Nakafusa Y et al (2004) Comparison of multivisceral resection and standard operation for locally advanced colorectal cancer: analysis of prognostic factors for short-term and long-term outcome. Dis Colon Rectum 47(12):2055–2063CrossRefPubMedGoogle Scholar
  28. 28.
    Gezen C et al (2012) Results after multivisceral resections of locally advanced colorectal cancers: an analysis on clinical and pathological t4 tumors. World J Surg Oncol 10:39CrossRefPubMedPubMedCentralGoogle Scholar
  29. 29.
    Hoffmann M et al (2012) Multivisceral and standard resections in colorectal cancer. Langenbecks Arch Surg 397(1):75–84CrossRefPubMedGoogle Scholar
  30. 30.
    Elnahas A, Sunil S, Jackson TD et al (2016) Laparoscopic versus open surgery for T4 colon cancer: evaluation of margin status. Surg Endosc 30(4):1491–1496. doi: 10.1007/s00464-015-4360-1 CrossRefPubMedGoogle Scholar
  31. 31.
    Kim IY, Kim BR, Kim YW (2016) The short-term and oncologic outcomes of laparoscopic versus open surgery for T4 colon cancer. Surg Endosc 30(4):1508–1518. doi: 10.1007/s00464-015-4364-x CrossRefPubMedGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC 2017

Authors and Affiliations

  1. 1.Department of Medical, Surgical and Health Sciences, General Surgery ClinicUniversity of TriesteTriesteItaly
  2. 2.Department of General Surgery, Azienda Ospedaliera Dei ColliMonaldi HospitalNaplesItaly

Personalised recommendations