Laparoscopic Versus Open Resection for T4 Colon Cancer: a case-matched control Study

Li-Yong Huang, Xinxiang Li, San-Jun Cai, Guo-Xiang Cai, Ye Xu. Fudan University Shanghai Cancer Center

Background

Laparoscopic resection for T4 colon cancer is still not recommended as the treatment of choice because of high risk of conversion, postoperative complication, and early recurrence. In this study, we analyzed the short- and long-term survival outcomes after laparoscopic surgery (LS) for T4 colon cancer compared with open surgery (OS).

Methods

From a prospectively collected database, 102 patients with histologically proven T4 colon cancer who had undergone laparoscopic resection from April 2009 to April 2013 were identified. LS were matched 1:1 to OS during the same period by age, gender, American Society of Anesthesiologists class, body mass index, and type of surgery. Data were analyzed using Fisher’s exact, chi-square, and Kaplan–Meier estimates. P-value < 0.05 was considered statistically significant.

Results

The conversion rate was 7%. Less operative blood loss (P < 0.001), longer operation time (P = 0.001), earlier return to bowel function (P < 0.001) and shorter postoperative hospital stay(P =0.001) were observed in the LS group. A similar number of lymph nodes were harvested (P = 0.905) and the R0 resection rate (P = 0.755) was not different in the two groups. There was no difference with respect to operative morbidity and mortality between LS and OS. The local recurrence, overall survival, and disease-free survival were also similar between the two groups during a median follow-up period of 30 moths (range: 12-60 moths).

Conclusions

Laparoscopic resection for T4 colon cancer is safe and feasible, with similar local recurrence rate and equivalent oncologic survival compared with open approach. These findings support that the T4 colon cancer should not be an absolute contraindication to laparoscopic surgery in the hands of an experienced laparoscopic surgeon.