Short- and long-term outcomes following laparoscopic vs open surgery for pathological T4 colorectal cancer: 10 years of experience in a single center

Table 1 Clinical information of 211 colorectal cancer cases

Clinical information		LAP	OPEN	P value
		n = 101	n = 110
Age	> 60 yr	55	58	0.270
	≤ 60 yr	46	52
Gender	Male	67	66	0.392
	Female	34	44
BMI (kg/m2)	< 24	67	73	0.348
	≥ 24	34	37
Comorbidities	Yes	39	42	1.000
	No	62	68
ASA score	I	8	9	0.715
	II	63	72
	III	30	29
Tumor location	Mid/upper Rectum	33	35	0.989
	Left colon	43	47
	Right colon	25	28
HBG (g/L)	mean ± SD	124.0 ± 27.1	120.7 ± 22.9	0.263
CA19-9 (U/mL)	< 27	78	75	0.163
	≥ 27	23	35
CEA (ng/mL)	< 5	60	64	0.666
	≥ 5	41	46
Postoperative adjuvant chemotherapy	Yes	49	46	0.332
	No	52	64
Recurrence	Yes	22	25	0.711
	No	79	85

CRC: Colorectal cancer; LAP: Laparoscopic surgery group; OPEN: Open surgery group; BMI: Body mass index; ASA: American Society of Anesthesiology; HGB: Hemoglobin; CA19-9: Carbohydrate antigen 19-9; CEA: Caicinoembryonic antigen; SD: Standard deviation.

Table 2 Surgical outcomes of 211 colorectal cancer cases

Surgical outcome		LAP	OPEN	P value
		n = 101	n = 110
Conversion to open (n/%)		15 (12.9)	NR	/
Tumor size (cm)	mean ± SD	5.4 ± 1.9	5.2 ± 2.5	0.765
Resection length (cm)	mean ± SD	15.5 ± 7.3	19.5 ± 10.4	0.046
Operative time (min)	mean ± SD	210.8 ± 88.9	173.5 ± 72.7	0.028
Blood loss (mL)	mean ± SD	155.0 ± 75.9	235.1 ± 120.5	0.033
Intraoperative complications		3	8	0.117
Combined organ resection	Total (%)	5 (5.0)	21 (19.1)	0.001
	Abdominal wall	2	3
	Small bowel (except duodenum)	1	5
	Duodenum	0	3
	Urinary organs	0	2
	Stomach	1	1
	Gynecologic organs	1	4
	Liver	0	3
Postoperative complications within 30 d	Total (%)	12 (12.9)	35 (31.8)	0.006
	Anastomotic Hemorrhage	1	2
	Urinary injury	0	1
	Intraabdominal bleeding	1	2
	Leakage	1	4
	Gastroplegia	2	4
	Infection	6	15
	(incision and abdomen)
	Disruption of incision	0	5
	Obstruction	1	2
Postoperative morbidity within 30 d		0	1	0.667

CRC: Colorectal cancer; LAP: Laparoscopic surgery group; OPEN: Open surgery group.

Table 3 Pathologic outcomes of 211 colorectal cancer cases

Pathologic outcome		LAP	OPEN	P value
		n = 101	n = 110
Number of lymph nodes dissected	< 12	25	38	0.134
	≥ 12	76	72
Lymph node status	+	67	74	1.000
	-	34	36
Margin	R1	2	3	0.779
	R0	99	107
pT stage	T4a	96	89	0.021
	T4b	5	21
pN stage	N0	36	35	0.841
	N1	28	32
	N2	37	43
pTNM stage	IIB + IIC	34	35	0.282
	IIIB	30	24
	IIIC	37	51
Dukes	B	34	35	0.883
	C	67	75
Histological subtype	Adenocarcinoma	87	94	1.000
	Myxoadenocarcinoma	14	16
Differentiation	Poor	20	25	0.719
	Median/high	81	85
HER2	-/+	86	96	0.871
	++	10	10
	+++	5	4

CRC: Colorectal cancer; LAP: Laparoscopic surgery group; OPEN: Open surgery group; SD: Standard deviation; p: Pathological.

Table 4 Postoperative recovery outcomes of 211 colorectal cancer cases

Recovery outcome		LAP	OPEN	P value
		n = 101	n = 110
Time to flatus (d)	Median (range)	2 (1-9)	4 (3-15)	0.037
Time to diet (d)	Median (range)	3 (2-18)	7 (5-27)	0.003
Time to ambulation (d)	Median (range)	2 (1-5)	5 (3-9)	0.027
Hospital stays	Median (range)	7 (5-21)	15 (7-31)	0.004

LAP: Laparoscopic surgery group; OPEN: Open surgery group.

Table 5 Univariate and multivariate analyses of 211 pathological T4 colorectal cancer patients for overall survival

	Univariate analysis		Multivariate analysis
Variable	HR (95%CI)	P value	HR (95%CI)	P value
Age	1.217 (0.784-1.888)	0.381
Gender	0.807 (0.508-1.281)	0.363
Surgical method (LAP and OPEN)	1.528 (0.982-2.377)	0.060
Tumor location
Mid/upper rectum	Reference group	-
Left colon	1.303 (0.813-2.091)	0.272
Right colon	0.792 (0.409-1.533)	0.489
Comorbidities	1.603 (1.007-2.552)	0.047	2.519 (1.436-4.419)	0.142
pT4a/b	0.790 (0.692-1.236)	0.445
N stage
N0	Reference group	-
N1	1.328 (0.701-2.517)	0.384
N2	2.079 (1.170-3.697)	0.013
TNM stage
IIB + IIC	Reference group	-	Reference group	-
IIIB	1.229 (0.564-2.679)	0.604	1.324 (0.785-1.753)	0.019
IIIC	3.092 (1.617-5.913)	0.001	1.104 (0.333-3.662)	0.001
Lymph node status	0.560 (0.324-0.968)	0.038	0.307 (0.103-0.919)	0.035
No. of lymph nodes resected	0.593 (0.385-0.915)	0.018	0.432 (0.264-0.708)	0.123
Histological subtype	0.369 (0.212-0.640)	0.000	0.433 (0.218-0.859)	0.247
Differentiation	0.326 (0.204-0.519)	0.000	0.460 (0.273-0.775)	0.087
CA19-9	1.868 (1.195-2.922)	0.006	1.662 (1.212-2.280)	0.002
CEA	1.089 (0.706-1.680)	0.013	0.608 (0.356-1.038)	0.068
Chemotherapy	1.611 (1.040-2.494)	0.033	2.225 (1.394-3.552)	0.181

CRC: Colorectal cancer; LAP: Laparoscopy surgery; OPEN: Open surgery; p: Pathological; CA19-9: Carbohydrate antigen 19-9; CEA: Carcinoembryonic antigen; HR: Hazard ratio.

Table 6 Univariate and multivariate analyses of 211 pathological T4 colorectal cancer patients for disease-free survival

	Univariate analysis		Multivariate analysis
Variable	HR (95%CI)	P value	HR (95%CI)	P value
Age	1.621 (1.010-2.601)	0.045	1.892 (1.111-3.223)	0.419
Gender	1.328 (0.824-2.141)	0.243
Surgical method (LAP and OPEN)	1.503 (0.933-2.422)	0.094
Tumor location
Mid/upper rectum	Reference group	-
Left colon	1.010 (0.601-10697)	0.969
Right colon	0.818 (0.411-1.629)	0.568
Comorbidities	1.787 (1.058-3.019)	0.030	2.261 (1.235-4.139)	0.080
pT4a/b	0.818 (0.618-1.725)	0.013	1.214 (0.784-1.974)	0.001
N stage
N0	Reference group	-
N1	1.134 (0.594-2.167)	0.703
N2	1.553 (0.861-2.801)	0.144
TNM stage
IIB + IIC	Reference group	-	Reference group	-
IIIB	1.034 (0.471-2.269)	0.933	0.884 (0.393-1.989)	0.765
IIIC	2.284 (1.202-4.337)	0.012	1.831 (0.935-3.584)	0.018
Lymph node status	0.710 (0.411-1.229)	0.221
No. of lymph nodes resected	0.661 (0.411-1.061)	0.087
Histological subtype	0.456 (0.243-0.854)	0.014	0.469 (0.225-0.974)	0.042
Differentiation	0.439 (0.266-0.725)	0.001	0.662 (0.374-1.170)	0.156
CA19-9	2.458 (1.526-3.960)	0.000	3.372 (1.968-5.778)	0.000
CEA	1.268 (0.790-2.036)	0.326	0.608 (0.356-1.038)	0.072
Chemotherapy	2.157 (1.323-3.514)	0.002	3.817 (2.194-6.639)	0.000

CRC: Colorectal cancer; LAP: Laparoscopic surgery; OPEN: Open surgery; p-Pathological; CA19-9: Carbohydrate antigen 19-9; CEA: Carcinoembryonic antigen; HR: Hazard ratio.

Table 7 Studies about laparoscopic surgery for pathological T4 colorectal cancer

Ref.	n (LAP:OPEN)	Study period	Study design	Country	Single/Multi center	Conversion rate	Location	Complication rate (LAP:OPEN)	Tumor stage	Combined resection (LAP:OPEN)	RI rate(LAP:OPEN)	5 years DFS (LAP:OPEN)	5 years OS (LAP:OPEN)
Park et al[22], 2016	93:18	2000-2010	RS	South Korea	Single	5.6%	Colon	14.1%:31.5%	-	9.9%:32.5%	5.5%:4.5%	81.8%:73.9%	95.3%:86.5%
							rectum
Shukla et al[20], 2015	61:22	2003-2011	RS	United States	Single	21%	Colon	28%:36%	II:35	23%:41%	0%:4%	75%:65%	82%:81%
									III:48			(3 yr)	(3 yr)
Kang et al[29], 2016	52:57	2003-2013	RS	South Korea	Single	7.7%	Colon	13.5%:36.8%	II:41	13.5%:36.8%	-	53.6%:62.6%	60.7%:61.9%
									III:68
de’Angelis et al[18], 2016	106:106	2005-2014	RPSM	France	Multi	12.2%	Colon	29.1%:35.3%	II:85	14.2%:18.9%	5.7%:6.6%	58.6%:59.9%	57.6%:50.2%
				Switzerland					III:127
de’Angelis et al[17], 2016	52:52	2005-2015	RPSM	France	Multi	21.2%	Rectum	30.8%:48.1%	II:42	26.9%:30.8%	19.2%:17.3%	66.7%:64.1%	55.4%:53.3%
				Switzerland					III:33
				Spain					IV:29
Chan et al[30], 2016	93:59	2008-2014	RS	Singapore	Single	8.6%	Colon	-	-	0%:3.4%	0%:0.7%	-	75%:80%
Leon et al[27], 2017	68:79	2008-2015	RS	Italy	Single	19%	Colon	7.4%:16.5%	II:69	-	11.8%:11.5%	40.3%:38.9%	44.6%:39.4%
									III:78
Ahmad et al[25], 2015	455:406	2011-2012	RS	Canada	ACSNS	24.7%	Colon	-	-	-	26.2%:24.3%	-	-
					QIP

LAP: Laparoscopy; RS: Retrospective study; RPSM: Retrospective propensity score matching; ACSNS: American College of Surgeons National Surgical Quality Improvement Program; OS: Overall survival; DFS: Disease-free survival.