Ichiro Takemasa, MD, Tomohisa Furuhata, MD, Kenji Okita, MD, Toshihiko Nishidate, Tomomi Ueki, Emi Akizuki. Department of Surgery, Surgical Oncology and Science, Sapporo Medical University, Sapporo Japan
INTRODUCTION: Minimally invasive surgery (MIS) such as single port surgery or reduced port surgery yields reduced postoperative pain and improved cosmesis in comparison to standard multiport laparoscopic surgery (MPS). However, the oncological outcomes of MIS for colorectal cancer (CRC) are still matters for debate. Standardization for total mesorectal excision (TME) for rectal cancer or complete mesenteric excision (CME) for colon cancer is resulting in an improvement in the oncologic quality with decreasing the postoperative complication rates. The purpose of this study is to evaluate the benefits of MIS with TME/CME for CRC in a case-matched control study.
METHODS AND PROCEDURES: Prospectively collected data of patients with stage 0-III CRC who underwent MIS (n=323) or MPS (n=392) between 2008 and 2016 were analyzed. Cases with invasion to other organs or ileus were excluded. The observation data in terms of clinical characteristics and tumor location was adjusted with employing propensity score matching. Their short-term outcomes and prognoses, 3-year disease free survival (DFS) and over all survival (OAS), were compared between the two procedures overall and per side (right, left-sided and rectum).
RESULTS: Each 250 cases were evaluated after matching. Their short-term outcomes, including operation time, blood loss, number of lymph nodes harvested, length of the resected specimen, and complications, were similar between the two procedures, whereas postoperative pain and patients satisfaction for cosmesis were clear advantages in MIS. Operation time for right-sided MIS was significantly shortened. MIS was completed successfully in 98% of right-sided cases and in 98% of left-sided cases. Twelve with ileus and three with anastomotic leakage were observed postoperatively. All of these cases were recovered with conservative treatment. The umbilical scars were nearly invisible 3 months after the procedure, and most patients reported being quite satisfied with the cosmetic outcomes. 3-year DFS and 5-year OS were similar in each pathological stage between two groups.
CONCLUSIONS: We concluded that MIS for colorectal cancer is feasible when performed by experienced surgeons in selected patients. Excellent cosmesis and reduced postoperative pain as well as oncologic clearance can be expected. A large-scale, prospective, randomized, controlled trial should be conducted to confirm the superiority of this procedure over MIS.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 79884
Program Number: P248
Presentation Session: Poster (Non CME)
Presentation Type: Poster