Shuji Saito, MD1, Masafumi Inomata, MD2, Hiroshi Katayama, MD3, Masashi Wakabayashi3, Tomonori Akagi, MD2, Kentaro Nakajima, MD2, Seiichiro Yamamoto, MD4, Masaaki Ito, MD5, Yusuke Kinugasa, MD1, Shoichi Fujii, MD6, Fumio Konishi, MD7, Yoshihisa Saida, MD8, Masahiko Watanabe, MD9, Yasuhiro Shimada, MD10, Yoshihiro Moriya, MD4, Seigo Kitano, MD2. 1Division of Colon and Rectal Surgery, Shizuoka Cancer Center Hospital, 2Department of Gastroenterological and Pediatric Surgery, Oita University Faculty of Medicine, 3JCOG Data Center/Operations Office, National Cancer Center, 4Division of Colorectal Surgery, National Cancer Center Hospital, 5Division of Colorectal Surgery, National Cancer Center Hospital East, 6Department of Surgery, Gastroenterological Centre, Yokohama City University, 7Department of Surgery, Jichi Medical University Saitama Medical Center, 8Departments of Surgery, Toho University Ohashi Medical Center, 9Department of Surgery, Kitasato University Hospital, 10Gastrointestinal Oncology Division, National Cancer Center Hospital
INTRODUCTION: Previously we reported that the long-term survivals in open surgery (OP) and laparoscopic surgery (LAP) were almost identical from the randomized controlled trial of Japan Clinical Oncology Group (JCOG0404) for stage II/III colon cancer patients, but long-term survival was unfavorable in the subgroup such as rectosigmoid colon, cT4, cN2 and high BMI of LAP arm (ASCO-GI 2015 #656). The purpose of the present study is to identify postoperative factors associated with poor long term survival in the LAP arm compared with the OP arm after adjusting clinical and pathological factors excluding the patients with pathological stage IV and R2 resection.
METHODS AND PROCEDURES: Eligibility criteria in JCOG0404 included patients aged 20–75, tumor located in the cecum, ascending, sigmoid, or rectosigmoid colon; clinical T3 or deeper lesion without involvement of other organs, clinical N0-2 and M0. Additionally in this analysis, the patients with pathological stage IV and R2 resection were excluded. Relapse-free survival (RFS) and overall survival (OS) from surgery were assessed using the multivariate Cox regression model adjusted by the clinical and pathological factors of which p value was smaller than 0.3 in Fisher's exact test.
RESULTS: Between Oct 2004 and Mar 2009, 1057 patients were randomized (OP 528, LAP 529), among whom 1025 patients (OP 511, LAP 514) were included in the current analysis. The adjusted HR (95% CI) of important clinicopathological factors in OS is shown in the table.
CONCLUSIONS: The subgroup analysis suggests that pT4, pN2, high BMI were factors associated with unfavorable long- term outcome of laparoscopic surgery for colon cancer with curative resection, but tumor located in RS was not associated. LAP might not be recommended for patients with high BMI and careful postoperative follow-up is recommended for patients with pT4 and pN2.
Table: Adjusted HR (95%CI) with OS
| Factors (N of OP, N of LAP) |
Adjusted by clinical factors | Adjusted by clinicopathological factors |
| BMI ≥ 25 (OP 121, LAP 133) |
3.80 |
3.37 (1.24-9.19) |
| RS (OP 136, LAP 119) |
1.33 |
0.98 (0.46-2.09) |
| pT4 (OP 87, LAP 92) |
1.29 (0.71-2.35) |
1.33 |
| pN1 (OP 144, LAP 167) |
0.79 |
0.79 |
| pN2 (OP 58, LAP 65) |
1.74 (0.76-3.97) |
1.74 (0.76-3.97) |
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 78994
Program Number: P187
Presentation Session: Poster (Non CME)
Presentation Type: Poster
