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
Processing time: 72 Days and 20.2 Hours
ARTICLE HIGHLIGHTS
Research background

Laparoscopy has been widely used in the treatment of colorectal cancer and it has achieved a good radical effect in oncology. However, for the current clinical guidelines, laparoscopic surgery is not recommended in T4 colorectal cancer.

Research motivation

Due to the characteristics of T4 colorectal cancer, laparoscopic complete resection is difficult for the resection of this kind of tumor. The current colorectal studies about laparoscopy have fewer cases of T4 colorectal cancer, and some studies do not enroll any such cases. We tried to collect and analyze the data about laparoscopy in T4 colorectal cancer in order to add evidence-based clinical evidence.

Research objectives

We aimed to analyze the short- and long-term outcomes of proven pathological T4 colorectal cancer patients who underwent complete resection by laparoscopic or open surgery.

Research methods

We collected and analyzed the data of pT4 colorectal cancer cases at Guangdong General Hospital from 2006 to 2015. All patients were staged according to the AJCC 7th edition manual for colorectal cancer. We compared the laparoscopy (LAP) group and open (OPEN) group in clinical information, surgical and pathological outcomes, postoperative recovery outcomes, and survival.

Research results

There were 101 cases in the LAP group and 110 cases in the OPEN group [including15 (12.9%) cases of conversion to open surgery]. Clinical information 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 subtype, CA19-9, and adjuvant chemotherapy were independent factors affecting disease-free survival.

Research conclusions

Laparoscopic surgery may be safe and acceptable in the treatment of pathologic T4 colorectal cancer patients with fast recovery outcomes and oncologic outcomes compared with open surgery. We recommend that it can be carried out in experienced centers. It is required to screen the appropriate cases for laparoscopic surgery, optimize the preoperative diagnosis process, and reduce the conversion rate.

Research perspectives

Although our study shows that laparoscopy is able to achieve good clinicopathological and oncologic outcomes similar to those of open surgery, this study is only a retrospective study in a single center with a small sample, and the results need to be confirmed by prospective, multi-center and large sample clinical studies.