Retrospective Study
Copyright ©The Author(s) 2018. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Jan 7, 2018; 24(1): 76-86
Published online Jan 7, 2018. doi: 10.3748/wjg.v24.i1.76
Short- and long-term outcomes following laparoscopic vs open surgery for pathological T4 colorectal cancer: 10 years of experience in a single center
Zi-Feng Yang, De-Qing Wu, Jun-Jiang Wang, Ze-Jian Lv, Yong Li
Zi-Feng Yang, De-Qing Wu, Jun-Jiang Wang, Ze-Jian Lv, Yong Li, Department of General Surgery, Guangdong General Hospital, Guangdong Academy of Medical Sciences, Guangzhou 510080, Guangdong Province, China
Author contributions: Yang ZF and Wu DQ contributed equally to this work and designed the research; Wang JJ and Lv ZJ acquired the data; Yang ZF and Wu DQ analyzed and interpreted the data; Lv ZJ drafted the manuscript; all authors made critical revisions related to important intellectual content of the manuscript, and have read and approved the final version to be published.
Supported by Natural Science Foundation of Guangdong Province, No. 2016A030310328 and No. 2016A030313762.
Institutional review board statement: This study was evaluated and approved by the ethics committee at our institution.
Informed consent statement: All study participants, or their legal guardian, provided informed written consent prior to study enrollment.
Conflict-of-interest statement: All authors declare no conflict of interest.
Data sharing statement: No additional data are available.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Yong Li, MD, PhD, Professor, Chief Doctor, Department of General Surgery, Guangdong General Hospital, Guangdong Academy of Medical Sciences, No. 106, Zhongshan 2nd Road, Guangzhou 510080, Guangdong Province, China. s_09zfyang@163.com
Telephone: +86-20-83827812-60910 Fax: +86-20-83827812
Received: October 26, 2017
Peer-review started: October 27, 2017
First decision: November 8, 2017
Revised: November 17, 2017
Accepted: November 21, 2017
Article in press: November 21, 2017
Published online: January 7, 2018
Abstract
AIM

To evaluate the short-term and long-term outcomes following laparoscopic vs open surgery for pathological T4 (pT4) colorectal cancer.

METHODS

We retrospectively analyzed the short- and long-term outcomes of proven pT4 colorectal cancer patients who underwent complete resection by laparoscopic or open surgery from 2006 to 2015 at Guangdong General Hospital.

RESULTS

A total of 211 pT4 colorectal cancer patients were included in this analysis, including 101 cases in the laparoscopy (LAP) group and 110 cases in the open surgery (OPEN) group [including 15 (12.9%) cases of conversion to open surgery]. Clinical information (age, gender, body mass index, comorbidities, American Society of Anesthesiologists score, etc.) did not differ between the two groups. In terms of blood loss, postoperative complications and rate of recovery, the LAP group performed significantly more favorably (P < 0.05). With regard to pT4a/b and combined organ resection, there were significantly more cases in the OPEN group (P < 0.05). The 3- and 5-year overall survival rates were 74.9% and 60.5%, respectively, for the LAP group and 62.4% and 46.5%, respectively, for the OPEN group (P = 0.060). The 3- and 5-year disease-free survival rates were 68.0% and 57.3%, respectively, for the LAP group and 55.8% and 39.8%, respectively, for the OPEN group (P = 0.053). Multivariate analysis showed that IIIB/IIIC stage, lymph node status, and CA19-9 were significant predictors of overall survival. PT4a/b, IIIC stage, histological subtypes, CA19-9, and adjuvant chemotherapy were independent factors affecting disease-free survival.

CONCLUSION

Laparoscopy is safely used in the treatment of pT4 colorectal cancer while offering advantages of minimal invasiveness and faster recovery. Laparoscopy is able to achieve good oncologic outcomes similar to those of open surgery. We recommend that laparoscopy be carried out in experienced centers. It is still required to screen the appropriate cases for laparoscopic surgery, optimize the preoperative diagnosis process, and reduce the conversion rate. Multi-center, prospective, and large-sample studies are required to assess these issues.

Keywords: pT4 colorectal cancer, Laparoscopy, Open surgery

Core tip: Laparoscopy has been widely used in the treatment of colorectal cancer and has achieved a good radical effect in oncology. However, current clinical association guidelines do not recommend laparoscopic surgery for T4 colorectal cancer. This study retrospectively collected the data of pathological T4 (pT4) colorectal cancer patients at Guangdong General Hospital from 2006 to 2015, aiming to compare outcomes of laparoscopic vs open surgery. The conclusion is that laparoscopy is safely used in the treatment of pT4 colorectal cancer while offering advantages of faster recovery. Laparoscopy is able to achieve good oncologic outcomes similar to those of open surgery.