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Laparoscopic approach for left-sided T4 colon cancer is a safe and feasible procedure, compared to open surgery

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Abstract

Background

A laparoscopic approach can be attempted for pathologic T4 (pT4) colon cancer. Our aim was to evaluate the clinico-oncologic outcomes following laparoscopic versus open surgery for right and left-sided pT4 colon cancer.

Methods

From a multicentric collaborative database, we enrolled 245 patients with right-sided colon cancer (RCC, 128 laparoscopy and 117 open) and 338 with left-sided colon cancer (LCC, 176 laparoscopy and 162 open). All patients underwent intended curative surgery for histologically proven T4 adenocarcinoma, between 2004 and 2013. The primary end-point of our analysis was the oncologic outcome, including the 5-year disease-free survival (5 year-DFS) and the 5-year overall survival (5 year-OS). The secondary end-points included the R0 resection rate and postoperative complications.

Results

Our study group included 224 T4N0 and 359 T4N+ tumors. The median follow-up was 53 months. For patients with RCC, the rate of postoperative morbidities was lower for the laparoscopy than that for the open surgery group (12.5 vs. 22.2%, p = 0.044). There was no difference in the R0 resection rate (94.5 vs. 96.6%, p = 0.425) between the groups. The 5 year-DFS and 5 year-OS rates were lower for the laparoscopy than that in the open group (48.9% vs. 59.2%, p = 0.093; 60.0% vs. 70.0%, p = 0.284, respectively), but this difference was not statistically significant. Among patients with LCC, there were no differences in the rate of postoperative complication and R0 resection (15.3 vs. 21.0%, p = 0.307; 96.0 vs. 95.7%, p = 0.875, respectively). Both groups had comparable 5 year-DFS and 5 year-OS rates (62.7% vs. 61.1%, p = 0.552; 72.0% vs. 71.8%, p = 0.611, respectively).

Conclusions

Laparoscopic surgery appears to be a safe procedure for patients with pT4 LCC, but requires careful consideration for patients with pT4 RCC.

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Authors and Affiliations

  1. Department of Surgery, Hallym University College of Medicine, Anyang, South Korea

    Jung Ho Park & Hyoung-Chul Park

  2. Center for Colorectal Cancer, National Cancer Center, 323 Ilsan-Ro, Ilsan Dong-Gu, Goyang, 10408, South Korea

    Hyoung-Chul Park, Sung Chan Park, Dae Kyung Sohn & Jae Hwan Oh

  3. Department of Surgery, Seoul National University Bundang Hospital, Seongnam, South Korea

    Sung-Bum Kang

  4. Department of Surgery, Seoul Metropolitan Government-Seoul National University Boramae Medical Center, Seoul, South Korea

    Seung Chul Heo

  5. Department of Surgery, Seoul National University College of Medicine, Seoul, South Korea

    Min Jung Kim, Ji Won Park, Seung-Yong Jeong & Kyu Joo Park

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  1. Jung Ho Park
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On behalf of the SEoul COlorectal research Group (SECOG)

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Correspondence to Hyoung-Chul Park.

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Disclosures

Jung Ho Park, Hyoung-Chul Park, Sung Chan Park, Dae Kyung Sohn, Jae Hwan Oh, Sung-Bum Kang, Seung Chul Heo, Min Jung Kim, Ji Won Park, Seung-Yong Jeong, and Kyu Joo Park have no conflicts of interest or financial ties to disclose.

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Park, J.H., Park, HC., Park, S.C. et al. Laparoscopic approach for left-sided T4 colon cancer is a safe and feasible procedure, compared to open surgery. Surg Endosc 33, 2843–2849 (2019). https://doi.org/10.1007/s00464-018-6579-0

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  • DOI: https://doi.org/10.1007/s00464-018-6579-0

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