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Survival following laparoscopic and open colorectal surgery

Surgical Endoscopy volume 27, pages 2415–2421 (2013)Cite this article

Abstract

Background

Laparoscopic colorectal surgery is known to provide increased benefits to patients during the postoperative recovery period. Initial scepticism over the oncological adequacy of resection has been dismissed by a number of major randomized trials. Emerging evidence indicates that laparoscopic surgery may provide a potential survival benefit in colorectal cancer.

Methods

Patients undergoing elective laparoscopic or open resection for colorectal cancer between October 2003 and December 2010 were analyzed. Data were collated and a database compiled. Survival analysis was calculated by using the Kaplan–Meier method.

Results

A total of 665 resections were performed with 457 laparoscopically and 208 open. The median length of stay was 4 days following laparoscopic resection and 7 days following open (p < 0.0005). There was no significant difference between the two groups apart from gender (p = 0.03), ASA (p = 0.03), and the number of patients with extranodal metastatic disease (p = 0.01). The 5-year overall survival (OS) in the completed laparoscopic group was 75.8 versus 72.5 % in the open group (p = 0.12). The 5-year OS in patients who were converted was 52 %. The 5-year OS for nonmetastatic disease in the completed laparoscopic group was significantly greater at 79.4 versus 74 % in the open group (p = 0.03). There was no difference between the groups in OS for rectal cancer (p = 0.66), but there was an OS advantage for laparoscopically resected colon cancer (p = 0.02).

Conclusions

Laparoscopic resection for nonmetastatic colon cancer may provide an overall survival advantage.

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References

  1. Aly EH (2009) Laparoscopic colorectal surgery: summary of the current evidence. Ann R Coll Surg Engl 91(7):541–544

    PubMed  Article  Google Scholar 

  2. Neudecker J, Klein F, Bittner R, Carus T, Stroux A, Schwenk W, Trialists LAPKONII (2009) Short-term outcomes from a prospective randomized trial comparing laparoscopic and open surgery for colorectal cancer. Br J Surg 96(12):1458–1467

    PubMed  Article  CAS  Google Scholar 

  3. 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(7):477–484

    PubMed  Article  Google Scholar 

  4. Schwenk W, Haase O, Neudecker J, Müller JM (2005) Short-term benefits for laparoscopic colorectal resection. Cochrane Database Syst Rev (Online) (3):CD003145

  5. Abraham NS, Young JM, Solomon MJ (2004) Meta-analysis of short-term outcomes after laparoscopic resection for colorectal cancer. Br J Surg 91(9):1111–1124

    PubMed  Article  CAS  Google Scholar 

  6. Reza MM, Blasco JA, Andradas E, Cantero R, Mayol J (2006) Systematic review of laparoscopic versus open surgery for colorectal cancer. Br J Surg 93(8):921–928

    PubMed  Article  CAS  Google Scholar 

  7. Tjandra JJ, Chan MK (2006) Systematic review on the short-term outcome of laparoscopic resection for colon and rectosigmoid cancer. Colorectal Dis 8(5):375–388

    PubMed  Article  CAS  Google Scholar 

  8. 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(9472):1718–1726

    PubMed  Article  Google Scholar 

  9. Clinical Outcomes of Surgical Therapy Study Group (2004) A comparison of laparoscopically assisted and open colectomy for colon cancer. N Engl J Med 350(20):2050–2059

    Article  Google Scholar 

  10. Buunen M, Gholghesaei M, Veldkamp R, Meijer DW, Bonjer HJ, Bouvy ND (2004) Stress response to laparoscopic surgery: a review. Surg Endosc 18(7):1022–1028

    PubMed  Article  CAS  Google Scholar 

  11. Evans C, Galustian C, Kumar D et al (2009) Impact of surgery on immunologic function: comparison between minimally invasive techniques and conventional laparotomy for surgical resection of colorectal tumors. Am J Surg 197(2):238–245

    PubMed  Article  CAS  Google Scholar 

  12. Veenhof AA, Sietses C, von Blomberg BM et al (2011) The surgical stress response and postoperative immune function after laparoscopic or conventional total mesorectal excision in rectal cancer: a randomized trial. Int J Colorectal Dis 26(1):53–59

    PubMed  Article  CAS  Google Scholar 

  13. Whelan RL, Franklin M, Holubar SD et al (2003) Postoperative cell mediated immune response is better preserved after laparoscopic vs open colorectal resection in humans. Surg Endosc 17(6):972–978

    PubMed  Article  CAS  Google Scholar 

  14. Novitsky YW, Litwin DE, Callery MP (2004) The net immunologic advantage of laparoscopic surgery. Surg Endosc 18(10):1411–1419

    PubMed  Article  CAS  Google Scholar 

  15. Lacy AM, García-Valdecasas JC, Delgado S, Castells A, Taurá P, Piqué JM, Visa J (2002) Laparoscopy-assisted colectomy versus open colectomy for treatment of non-metastatic colon cancer: a randomised trial. Lancet 359(9325):2224–2229

    PubMed  Article  Google Scholar 

  16. Day W, Lau PY, Li KM, Kwok SY, Yip AW (2011) Clinical outcome of open and laparoscopic surgery in Dukes’ B and C rectal cancer: experience from a regional hospital in Hong Kong. Hong Kong Med J 17(1):26–32

    PubMed  CAS  Google Scholar 

  17. Law WL, Poon JT, Fan JK, Lo SH (2009) Comparison of outcome of open and laparoscopic resection for stage II and stage III rectal cancer. Ann Surg Oncol 16(6):1488–1493

    PubMed  Article  Google Scholar 

  18. Jayne DG, Thorpe HC, Copeland J, Quirke P, Brown JM, Guillou PJ (2010) Five-year follow-up of the Medical Research Council CLASICC trial of laparoscopically assisted versus open surgery for colorectal cancer. Br J Surg 97(11):1638–1645

    PubMed  Article  CAS  Google Scholar 

  19. Gonzalez R, Smith CD, Mason E, Duncan T, Wilson R, Miller J, Ramshaw BJ (2006) Consequences of conversion in laparoscopic colorectal surgery. Dis Colon Rectum 49(2):197–204

    PubMed  Article  Google Scholar 

  20. Veldkamp R, Gholghesaei M, Bonjer HJ, Meijer DW, Buunen M et al (2004) European Association of Endoscopic Surgery (EAES) Laparoscopic resection of colon cancer: consensus of the European Association of Endoscopic Surgery (EAES). Surg Endosc 18(8):1163–1185

    PubMed  Article  CAS  Google Scholar 

  21. Wu FP, Sietses C, von Blomberg BM, van Leeuwen PA, Meijer S, Cuesta MA (2003) Systemic and peritoneal inflammatory response after laparoscopic or conventional colon resection in cancer patients: a prospective, randomized trial. Dis Colon Rectum 46(2):147–155

    PubMed  Article  CAS  Google Scholar 

  22. Berglund A, Cedermark B, Glimelius B (2008) Is it deleterious to delay the start of adjuvant chemotherapy in colon cancer stage III. Ann Oncol 19(2):400–402

    PubMed  Article  CAS  Google Scholar 

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Disclosures

Andrew Day, Ralph Smith, Iain Jourdan, and Tim Rockall have no conflict of interest or financial ties to disclose.

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Affiliations

  1. Minimal Access Therapy Training Unit, Postgraduate Medical School, University of Surrey, Manor Park, Guildford, UK

    Andrew R. Day, Ralph V. P. Smith, Iain C. Jourdan & Tim A. Rockall

  2. Consultant Colorectal Surgeon, The Royal Surrey County Hospital, Egerton Road, Guildford, UK

    Iain C. Jourdan & Tim A. Rockall

Authors
  1. Andrew R. Day
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  2. Ralph V. P. Smith
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  3. Iain C. Jourdan
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  4. Tim A. Rockall
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Correspondence to Andrew R. Day.

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Day, A.R., Smith, R.V.P., Jourdan, I.C. et al. Survival following laparoscopic and open colorectal surgery. Surg Endosc 27, 2415–2421 (2013). https://doi.org/10.1007/s00464-012-2750-1

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  • DOI: https://doi.org/10.1007/s00464-012-2750-1

Keywords

  • Colorectal cancer
  • Survival
  • Laparoscopy