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Erschienen in: Surgical Endoscopy 3/2018

25.08.2017

Oncologic outcomes following laparoscopic colon cancer resection for T4 lesions: a case–control analysis of 7-years’ experience

verfasst von: Piera Leon, Michele Giuseppe Iovino, Fabiola Giudici, Antonio Sciuto, Nicolò de Manzini, Diego Cuccurullo, Francesco Corcione

Erschienen in: Surgical Endoscopy | Ausgabe 3/2018

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Abstract

Background

According to many Societies’ guidelines, patients presenting with clinical T4 colorectal cancer should conventionally be approached by a laparotomy. Results of emerging series are questioning this attitude.

Methods

We retrospectively analysed the oncologic outcomes of 147 patients operated on between June 2008 and September 2015 for histologically proven pT4 colon cancers. All patients were treated with curative intent, either by a laparoscopic or open “en bloc” resection.

Results

Median operative time, blood loss and hospital length of stay were significantly reduced in the laparoscopic group. Postoperative surgical complication rate and 30-day mortality did not significantly differ between the two groups ( p = 0.09 and p = 0.99, respectively). R1 resection rate and lymph nodes harvest, as well, did not remarkably differ when comparing the two groups. In the laparoscopic group, conversion rate was 19%. Long-term outcomes were not affected in patients who had undergone conversion. Five-year overall survival and disease-free survival did not significantly differ between the two groups (44.6% and 40.3% vs. 39.4% and 38.9%). Locally advanced stages (IIIB–IIIC) and R1 resections were detected as independent prognostic factors for overall survival.

Conclusion

Laparoscopic approach might be safe and acceptable for locally advanced colon cancer and does not jeopardize the oncologic results. Conversion to open surgery should be a part of a strategy as it does not seem to adversely affect perioperative and long-term outcomes. We consider laparoscopy, in expert hands, the last diagnostic tool and the first therapeutic approach for well-selected locally advanced colon cancers. Larger prospective studies are needed to widely assess this issue.
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Metadaten
Titel
Oncologic outcomes following laparoscopic colon cancer resection for T4 lesions: a case–control analysis of 7-years’ experience
verfasst von
Piera Leon
Michele Giuseppe Iovino
Fabiola Giudici
Antonio Sciuto
Nicolò de Manzini
Diego Cuccurullo
Francesco Corcione
Publikationsdatum
25.08.2017
Verlag
Springer US
Erschienen in
Surgical Endoscopy / Ausgabe 3/2018
Print ISSN: 0930-2794
Elektronische ISSN: 1432-2218
DOI
https://doi.org/10.1007/s00464-017-5784-6

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