Abstract
Background
The use of laparoscopic surgery for colorectal cancer has become widespread recently. However, the safety and oncological outcomes of laparoscopic surgery for primary advanced colorectal cancer need extensive investigation. We analyzed the short- and long-term outcomes after laparoscopic multivisceral resection for primary colon cancer with suspected invasion of other organs at a single institution.
Methods
Between January 2000 and December 2014, 118 patients underwent laparoscopic multivisceral resection for primary colon cancer invading or adhering to adjacent organs or structures; their short- and long-term outcomes were retrospectively evaluated.
Results
The median operating time was 254 min (range 130–1051 min), and median blood loss was 48 ml (range 0–2777 ml). The overall conversion rate was 6.8%. The postoperative complication rate was 17.8%. The number of patients with R0 and R1 resection was 112 (94.9%) and 6 (5.1%), respectively. At a median follow-up period of 32 months (range 0–157 months), the local recurrence rate in patients who underwent R0 resection was 1.8%, while for R1 resection it was 66.7%. In multivariate analysis, R1 resection and LN metastases were found to be predictors of poor prognosis. The cancer-specific 5-year survival was 87% when R0 resection was achieved; within these, the 5-year survival rates for patients with stages II, III, and IV disease were 94, 81, and 40%, respectively.
Conclusions
Laparoscopic en bloc multivisceral resection for clinically suspected T4 colon cancer is a safe and feasible procedure for precisely selected patients, attaining satisfactory oncological outcomes when R0 resection is achieved.
This is a preview of subscription content, log in via an institution to check access.
Similar content being viewed by others
References
Guillou PJ, Quirke P, Thorpe H et al (2005) Short-term endpoints of conventional versus laparoscopic-assisted surgery in patients with colorectal cancer (MRC CLASICC trial): multicentre, randomised controlled trial. Lancet 365:1718–1726
Veldkamp R, Kuhry E, Hop WC et al (2005) Laparoscopic surgery versus open surgery for colon cancer: short-term outcomes of a randomised trial. Lancet Oncol 6:477–484
Jayne DG, Guillou PJ, Thorpe H et al (2007) Randomized trial of laparoscopic-assisted resection of colorectal carcinoma: 3-year results of the UK MRC CLASICC Trial Group. J Clin Oncol 25:3061–3068
Veldkamp R, Gholghesaei M, Bonjer HJ et al (2004) Laparoscopic resection of colon cancer: consensus of the European Association of Endoscopic Surgery (EAES). Surg Endosc 18:1163–1185
Zerey M, Hawver LM, Awad Z et al (2013) SAGES evidence-based guidelines for the laparoscopic resection of curable colon and rectal cancer. Surg Endosc 27:1–10
Nelson H, Petrelli N, Carlin A et al (2001) Guidelines 2000 for colon and rectal cancer surgery. J Natl Cancer Inst 93:583–596
Lehnert T, Methner M, Pollok A et al (2002) Multivisceral resection for locally advanced primary colon and rectal cancer: an analysis of prognostic factors in 201 patients. Ann Surg 235:217–225
Hoffmann M, Phillips C, Oevermann E et al (2012) Multivisceral and standard resections in colorectal cancer. Langenbeck’s Arch Surg/Deutsche Gesellschaft fur Chirurgie 397:75–84
Eveno C, Lefevre JH, Svrcek M et al (2014) Oncologic results after multivisceral resection of clinical T4 tumors. Surgery 156:669–675
Moloo H, Sabri E, Wassif E et al (2008) Laparoscopic resection for colon cancer: would all patients benefit? Dis Colon Rectum 51:173–180
Bretagnol F, Dedieu A, Zappa M et al (2011) T4 colorectal cancer: is laparoscopic resection contraindicated? Colorectal Dis 13:138–143
Kim KY, Hwang DW, Park YK et al (2012) A single surgeon’s experience with 54 consecutive cases of multivisceral resection for locally advanced primary colorectal cancer: can the laparoscopic approach be performed safely? Surg Endosc 26:493–500
Nagasue Y, Akiyoshi T, Ueno M et al (2013) Laparoscopic versus open multivisceral resection for primary colorectal cancer: comparison of perioperative outcomes. J Gastrointest Surg 17:1299–1305
Vignali A, Ghirardelli L, Di Palo S et al (2013) Laparoscopic treatment of advanced colonic cancer: a case-matched control with open surgery. Colorectal Dis 15:944–948
Edge SB, Compton CC (2010) The American Joint Committee on Cancer: the 7th edition of the AJCC cancer staging manual and the future of TNM. Ann Surg Oncol 17:1471–1474
Peeters KC, Marijnen CA, Nagtegaal ID et al (2007) The TME trial after a median follow-up of 6 years: increased local control but no survival benefit in irradiated patients with resectable rectal carcinoma. Ann Surg 246:693–701
Roh MS, Colangelo LH, O’Connell MJ et al (2009) Preoperative multimodality therapy improves disease-free survival in patients with carcinoma of the rectum: NSABP R-03. J Clin Oncol 27:5124–5130
Marusch F, Gastinger I, Schneider C et al (2001) Experience as a factor influencing the indications for laparoscopic colorectal surgery and the results. Surg Endosc 15:116–120
Hohenberger W, Weber K, Matzel K et al (2009) Standardized surgery for colonic cancer: complete mesocolic excision and central ligation–technical notes and outcome. Colorectal Dis 11:354–364 (discussion 364–355)
Croner RS, Merkel S, Papadopoulos T et al (2009) Multivisceral resection for colon carcinoma. Dis Colon Rectum 52:1381–1386
Gezen C, Kement M, Altuntas YE et al (2012) Results after multivisceral resections of locally advanced colorectal cancers: an analysis on clinical and pathological t4 tumors. World J Surg Oncol 10:39. doi:10.1186/1477-7819-10-39
Gebhardt C, Meyer W, Ruckriegel S et al (1999) Multivisceral resection of advanced colorectal carcinoma. Langenbeck’s Arch Surg/Deutsche Gesellschaft fur Chirurgie 384:194–199
Luna-Perez P, Rodriguez-Ramirez SE et al (2002) Multivisceral resection for colon cancer. J Surg Oncol 80:100–104
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Conflict of interest
None.
Rights and permissions
About this article
Cite this article
Kumamoto, T., Toda, S., Matoba, S. et al. Short- and Long-Term Outcomes of Laparoscopic Multivisceral Resection for Clinically Suspected T4 Colon Cancer. World J Surg 41, 2153–2159 (2017). https://doi.org/10.1007/s00268-017-3976-9
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00268-017-3976-9