Retrospective Study
Copyright ©The Author(s) 2023. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Surg. Sep 27, 2023; 15(9): 1969-1977
Published online Sep 27, 2023. doi: 10.4240/wjgs.v15.i9.1969
Short- and long-term results of open vs laparoscopic multisegmental resection and anastomosis for synchronous colorectal cancer located in separate segments
Ji-Chuan Quan, Xin-Jun Zhou, Shi-Wen Mei, Jun-Guang Liu, Wen-Long Qiu, Jin-Zhu Zhang, Bo Li, Yue-Gang Li, Xi-Shan Wang, Hu Chang, Jian-Qiang Tang
Ji-Chuan Quan, Shi-Wen Mei, Wen-Long Qiu, Jin-Zhu Zhang, Bo Li, Yue-Gang Li, Xi-Shan Wang, Jian-Qiang Tang, Department of Colorectal Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China
Xin-Jun Zhou, Department of Colorectal Anorectal Surgery, Shengli Oilfield Central Hospital, Dongying 257000, Shandong Province, China
Jun-Guang Liu, Department of General Surgery, Peking University First Hospital, Beijing 100034, China
Hu Chang, Department of Hospital Administration Office, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China
Author contributions: Quan JC and Zhou XJ contributed equally to this work; Quan JC and Chang H wrote the manuscript; Tang JQ, Zhou XJ and Wang XS conceived and designed the study; Quan JC, Liu JG, Chang H, Mei SW and Zhou XJ collected the data; Zhang JZ, Qiu WL, Li B and Li YG analyzed the data; all authors made critical revisions for the manuscript and approved the final manuscript.
Institutional review board statement: This study was approved by the Ethics Committee of Cancer Hospital, Chinese Academy of Medical Sciences.
Informed consent statement: Patients were not required to give informed consent to the study because the analysis used anonymous clinical data that were obtained after each patient agreed to treatment by written consent.
Conflict-of-interest statement: The authors declare no conflict of interest.
Data sharing statement: No additional data are available.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (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: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Jian-Qiang Tang, MD, Surgeon, Department of Colorectal Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, No. 17 Panjiayuan Nanli, Chaoyang District, Beijing 100021, China. doc_tjq@hotmail.com
Received: May 3, 2023
Peer-review started: May 3, 2023
First decision: June 13, 2023
Revised: June 29, 2023
Accepted: July 27, 2023
Article in press: July 27, 2023
Published online: September 27, 2023
Processing time: 142 Days and 10.4 Hours
Abstract
BACKGROUND

It remains unclear whether laparoscopic multisegmental resection and anastomosis (LMRA) is safe and advantageous over traditional open multisegmental resection and anastomosis (OMRA) for treating synchronous colorectal cancer (SCRC) located in separate segments.

AIM

To compare the short-term efficacy and long-term prognosis of OMRA as well as LMRA for SCRC located in separate segments.

METHODS

Patients with SCRC who underwent surgery between January 2010 and December 2021 at the Cancer Hospital, Chinese Academy of Medical Sciences and the Peking University First Hospital were retrospectively recruited. In accordance with the inclusion and exclusion criteria, 109 patients who received right hemicolectomy together with anterior resection of the rectum or right hemicolectomy and sigmoid colectomy were finally included in the study. Patients were divided into the LMRA and OMRA groups (n = 68 and 41, respectively) according to the surgical method used. The groups were compared regarding the surgical procedure’s short-term efficacy and its effect on long-term patient survival.

RESULTS

LMRA patients showed markedly less intraoperative blood loss than OMRA patients (100 vs 200 mL, P = 0.006). Compared to OMRA patients, LMRA patients exhibited markedly shorter postoperative first exhaust time (2 vs 3 d, P = 0.001), postoperative first fluid intake time (3 vs 4 d, P = 0.012), and postoperative hospital stay (9 vs 12 d, P = 0.002). The incidence of total postoperative complications (Clavien-Dindo grade: ≥ II) was 2.9% and 17.1% (P = 0.025) in the LMRA and OMRA groups, respectively, while the incidence of anastomotic leakage was 2.9% and 7.3% (P = 0.558) in the LMRA and OMRA groups, respectively. Furthermore, the LMRA group had a higher mean number of lymph nodes dissected than the OMRA group (45.2 vs 37.3, P = 0.020). The 5-year overall survival (OS) and disease-free survival (DFS) rates in OMRA patients were 82.9% and 78.3%, respectively, while these rates in LMRA patients were 78.2% and 72.8%, respectively. Multivariate prognostic analysis revealed that N stage [OS: HR hazard ratio (HR) = 10.161, P = 0.026; DFS: HR = 13.017, P = 0.013], but not the surgical method (LMRA/OMRA) (OS: HR = 0.834, P = 0.749; DFS: HR = 0.812, P = 0.712), was the independent influencing factor in the OS and DFS of patients with SCRC.

CONCLUSION

LMRA is safe and feasible for patients with SCRC located in separate segments. Compared to OMRA, the LMRA approach has more advantages related to short-term efficacy.

Keywords: Synchronous colorectal cancer; Separate segments; Laparoscopic surgery; Multisegmental resection; Short-term efficacy; Prognosis

Core Tip: The efficacy and safety of laparoscopic multisegmental resection and anastomosis (LMRA) in patients with synchronous colorectal cancer involving separate segments has not been fully evaluated. We compared the short-term efficacy and long-term prognosis between LMRA and open multisegmental resection and anastomosis, and found that the LMRA approach has more advantages related to faster postoperative recovery, less intraoperative blood loss, reduced postoperative hospital stay, fewer postoperative complications, and a greater total number of lymph nodes dissected.