Comparison Between Laparoscopic Surgery and Open Surgery for Patients with Locally Advanced Colon Cancer by Propensity Score Matching

Shoichi Fujii, PhD1, Takahiro Yagi1, Mitsuo Tsukamoto1, Yoshihisa Fukushima1, Takuya Akahane1, Ryu Shimada1, Keisuke Nakamura1, Tamuro Hayama1, Takeshi Tsuchiya1, Keijiro Nozawa1, Keiji Matsuda1, Hirokazu Suwa2, Atsushi Ishibe2, Jun Watanabe2, Mitsuyoshi Ota2, Yojiro Hashiguchi, Prof1. 1Teikyo University, 2Yokohama City University Medical Center

Background

Laparoscopic colectomy (LC) was not able to show non-inferiority in overall survival (OS) from results of JCOG0404 study that was RCT of LC versus open colectomy (OC) for the advanced colon cancer. However, 5y-OS was 90% or higher in both arms, and the relapse-free survival (RFS) was also equal. LC was favorable in the short-term results compared with OC. The transverse and descending colon were excluded, and participated facilities were limited strictly in JCOG0404.

Purpose

To clarify whether LC is applicable as a standard surgery for patients with advanced colon cancer by analysis of treatment results

Patients & Methods

The short-term and long-term results were compared between 675 LC and 815 OC to p-stageII/III of the colon and rectosigmoid cancers that were treated from 2000 to 2014. Because the indication of LC changed over the years, the backgrounds were matched by propensity score matching. The variables were as follows: gender, age (>70), ASA (2 or more), history of laparotomy, location (right or left), pT4, diameter (>50mm), p-Stage, operator (certified surgeon by JSES), and observation time (3 years).

Result

The conversion from LC to OC was 3.9% (26 patients). Each of the 379 patients was extracted by propensity score matching. There was no difference in both groups' backgrounds. In the short-term, the results of LC were favorable in terms of blood loss (292ml:77), transfusion (9.0%:3.4), all early complications (35.9%:19.5), grade 2≤ (23.5:10.6), grade 3≤ (7.4:2.6) and postoperative stay (17days:14), however, operative time (197min:214) was longer. In the pathologic findings, there were no differences in the number of dissected lymph nodes (25.1:25.8), proximal margin (107mm:106), distal margin (108mm:101), and the positive vertical margin (1.1%:1.3). In the long-term, the results of LC were excellent in 5y-OS (79.4%:87.8). There was no difference in 5y-RFS between both arms (69.6%:74.9). LC was excellent in OS (94.0%:92.8) of p-stageII in the analysis of each stage. There were no differences in the recurrence (15.0%:18.7) and the first recurrent organs. Pathological T4 and p-stage III were risk factors in the analysis of recurrence. The peritoneal recurrences of pT4 were higher in LC than OC (6.3%:16.1).

Conclusion

The short-term results of LC were excellent, and the long-term results were equal to OC. It was suggested that LC was possible to be regarded as a standard surgery for most patients with advanced colon cancer. However, it seemed that greater caution was necessary for T4 cases with respect to peritoneal recurrence.

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