Oncologic results after laparoscopic colorectal cancer resection according to the attempt of laparoscopic surgery from open surgery by single surgeon

Ji Yong Lim, MD, Jae Hwang Kim, MD, Sang Hun Jung, MD, So Hyun Kim, MD

Department of Surgery, College of Medicine, Yeungnam University, Daegu, Korea

PURPOSE
Overall survival and recurrence data have proven that laparoscopic colectomy is equivalent to open colectomy. Laparoscopic surgery is safe in expert hands, especially rectal resection. The laparoscopic approach to resection for rectal cancer remains controversial due to fears that oncologic principles may be compromised. The aim of this study was to assess the oncologic outcomes laparoscopic surgery in patients with locally advanced colorectal cancer by a consecutive surgical procedure change of a single surgeon.

MATERIAL & METHODS
This is a retrospective study of consecutive patients with stage II or III rectal cancer, from a single surgeon’s practice, from 2000 to 2009. Until 2005, all surgery was performed with open method. After 2005, most of surgery was undergone with laparoscopic methods. Stage II and III colorectal cancers (n=749) undergone curative resections were included (colon: 383, rectum: 366). Three and five-year disease free survival and recurrence rates in laparoscopic surgery (LS) and open surgery (OS) groups were estimated with Kaplan–Meier curves.

RESULTS
In rectal cancers, there was 117 (32.0%) and 249 (68.0%) in LS and OS groups. Invasion depth of tumor was more advanced in OS than LS. Others clinicopathologic features were similar in both groups. Local recurrence rate was 9.4% and 6.0% in LS and OS without significance, respectively (P=0.241). All recurrence rate was 33.3% and 29.3% in LS and OS without significance, respectively (P=0.437). Three-year and five-year disease-free survival was not statistical difference in both groups, despite of lower survival rate in LS (stage II (LS vs. OS): 3-year, 67.6% vs. OS 79.8%; 5-year, 67.6% vs. 72.6%, P=0.366)(stage III (LS vs. OS): 3-year: 63.2% vs. 69.0%; 5-year: 54.0% vs. 59.8%, p=0.293). In colon cancers, there was 155 (40.5%) and 228 (59.5%) in LS and OS groups. The clinicopathologic features in both groups was similar. Local recurrence rate was 2.6% and 3.1% in LS and OS without significance, respectively (P=0.778). All recurrence rate was 23.2% and 27.6% in LS and OS without significance, respectively (P=0.334). Three-year and five-year disease-free survival was not statistically different in both groups (stage II (LS vs. OS): 3-year, 80.8% vs. 80.8%; 5-year: 80.8% vs. 75.1%, P=0.767)(stage III (LS vs. OS): 3-year: 71.0% vs. 67.2%; 5-year:65.5% vs. 58.9%, p=0.407).

CONCLUSIONS
Most of laparoscopic surgery can safely undergo in colorectal cancers without adverse oncologic outcomes. However, a skillful rectal resection by experienced surgeon for locally advanced rectal cancer may be more needed in laparoscopic surgery comparing with colon cancer resection.


Session: Poster Presentation

Program Number: P088

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