Comparison study of laparoscopic surgery <i>vs</i>. open surgery for colon cancer of T4a stage_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

YANG Xiaoquan , SUN Xiyu , ZHONG Miner , XIAO Yi , LIN Guole , ZHOU Jiaolin , NIU Beizhan , QIU Huizhong ,  WU Bin

Department of General Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100730, P. R. China;

Corresponding author：

WU Bin, Email: wubin0279@hotmail.com

Keywords：

colon cancer of T4a stage; laparoscopic; open surgery

DOI：

10.7507/1007-9424.201905009

Video：

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Objective To compare clinical outcomes between laparoscopic (LAP) and open surgery for non-metastatic colon cancer of T4a stage.Methods We retrospectively analyzed clinical data of non-metastatic colon cancer patients of T4a stage with confirmed pathological results who underwent curative resection in Peking Union Medical College Hospital between January 2011 and December 2017. These patients were allocated into LAP group (n=107, underwent laparoscopic radical operation) and open group (n=52, underwent open surgery).Results There were no significant difference in operating time, number of lymph nodes harvested, number of positive lymph nodes, incidence of complications within 30 days, and Clavien-Dindo grading between the LAP group and open group (P>0.05), but intraoperative blood loss, postoperative exhaust time, and postoperative hospital stay in the LAP group were less than (shorter than) those of the open group (P<0.05).Conclusion Laparoscopic approach for non-metastatic colon cancer of T4a stage is safe and feasible, and it has advantages including less intraoperative blood loss, faster recovery, and shorter hospital stay.

Citation： YANG Xiaoquan, SUN Xiyu, ZHONG Miner, XIAO Yi, LIN Guole, ZHOU Jiaolin, NIU Beizhan, QIU Huizhong, WU Bin. Comparison study of laparoscopic surgery vs. open surgery for colon cancer of T4a stage. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2019, 26(9): 1051-1055. doi: 10.7507/1007-9424.201905009 Copy

1.	Colon Cancer Laparoscopic or Open Resection Study Group, Buunen M, Veldkamp R, et al. Survival after laparoscopic surgery versus open surgery for colon cancer: long-term outcome of a randomised clinical trial. Lancet Oncol, 2009, 10(1): 44-52.
2.	Jacobs M, Verdeja JC, Goldstein HS. Minimally invasive colon resection (laparoscopic colectomy). Surg Laparosc Endosc, 1991, 1(3): 144-150.
3.	Benson AB, Venook AP, Al-Hawary MM, et al. NCCN guidelines insights: colon cancer, version 2.2018. J Natl Compr Canc Netw, 2018, 16(4): 359-369.
4.	Grothey A, Sobrero AF, Shields AF, et al. Duration of adjuvant chemotherapy for stage Ⅲ colon cancer. N Engl J Med, 2018, 378(13): 1177-1188.
5.	Kitano S, Inomata M, Mizusawa J, et al. Survival outcomes following laparoscopic versus open D3 dissection for stage Ⅱ or Ⅲ colon cancer (JCOG0404): a phase 3, randomised controlled trial. Lancet Gastroenterol Hepatol, 2017, 2(4): 261-268.
6.	Yang X, Zhong ME, Xiao Y, et al. Laparoscopic vs open resection of pT4 colon cancer: a propensity score analysis of 94 patients. Colorectal Dis, 2018, 20(11): O316-O325.
7.	Chen W, Zheng R, Baade PD, et al. Cancer statistics in China, 2015. CA Cancer J Clin, 2016, 66(2): 115-132.
8.	郑民华, 马君俊. 2018版《腹腔镜结直肠癌根治手术操作指南》更新要点. 中华外科杂志, 2019, 57(3): 224-226.
9.	肖毅. 腹腔镜结直肠手术争议与共识. 中国实用外科杂志, 2018, 38(2): 175-178.
10.	Yang ZF, Wu DQ, Wang JJ, et al. Short- and long-term outcomes following laparoscopic vs open surgery for pathological T4 colorectal cancer: 10 years of experience in a single center. World J Gastroenterol, 2018, 24(1): 76-86.
11.	Klaver CEL, Kappen TM, Borstlap WAA, et al. Laparoscopic surgery for T4 colon cancer: a systematic review and meta-analysis. Surg Endosc, 2017, 31(12): 4902-4912.
12.	Vignali A, Ghirardelli L, Di Palo S, et al. Laparoscopic treatment of advanced colonic cancer: a case-matched control with open surgery. Colorectal Dis, 2013, 15(8): 944-948.
13.	Bellio G, Lo Cicero A, Barbieri V, et al. Is T4 colon cancer still an absolute contraindication to laparoscopic surgery? Minerva Chir, 2017, 72(6): 483-490.
14.	Krishnamurty DM, Hawkins AT, Wells KO, et al. Neoadjuvant radiation therapy in locally advanced colon cancer: a cohort analysis. J Gastrointest Surg, 2018, 22(5): 906-912.
15.	Odermatt M, Miskovic D, Siddiqi N, et al. Short- and long-term outcomes after laparoscopic versus open emergency resection for colon cancer: an observational propensity score-matched study. World J Surg, 2013, 37(10): 2458-2467.
16.	Jayne DG, Guillou PJ, Thorpe H, et al. Randomized trial of laparoscopic-assisted resection of colorectal carcinoma: 3-year results of the UK MRC CLASICC Trial Group. J Clin Oncol, 2007, 25(21): 3061-3068.
17.	Chan AC, Poon JT, Fan JK, et al. Impact of conversion on the long-term outcome in laparoscopic resection of colorectal cancer. Surg Endosc, 2008, 22(12): 2625-2630.
18.	Kim IY, Kim BR, Kim YW. The short-term and oncologic outcomes of laparoscopic versus open surgery for T4 colon cancer. Surg Endosc, 2016, 30(4): 1508-1518.
19.	de’Angelis N, Vitali GC, Brunetti F, et al. Laparoscopic vs. open surgery for T4 colon cancer: a propensity score analysis. Int J Colorectal Dis, 2016, 31(11): 1785-1797.
20.	Leon P, Iovino MG, Giudici F, et al. Oncologic outcomes following laparoscopic colon cancer resection for T4 lesions: a case-control analysis of 7-years’ experience. Surg Endosc, 2018, 32(3): 1133-1140.
21.	Feinberg AE, Chesney TR, Acuna SA, et al. Oncologic outcomes following laparoscopic versus open resection of pT4 colon cancer: a systematic review and meta-analysis. Dis Colon Rectum, 2017, 60(1): 116-125.
22.	Berends FJ, Kazemier G, Bonjer HJ, et al. Subcutaneous metastases after laparoscopic colectomy. Lancet, 1994, 344(8914): 58.
23.	康建省, 刘国超, 乔占英, 等. 腹腔镜与开腹手术治疗结肠癌远期疗效的 Meta 分析. 腹腔镜外科杂志, 2011, 16(10): 737-741.
24.	Shukla PJ, Trencheva K, Merchant C, et al. Laparoscopic resection of t4 colon cancers: is it feasible? Dis Colon Rectum, 2015, 58(1): 25-31.
25.	Yamanashi T, Nakamura T, Sato T, et al. Laparoscopic surgery for locally advanced T4 colon cancer: the long-term outcomes and prognostic factors. Surg Today, 2018, 48(5): 534-544.
26.	中华医学会外科学分会腹腔镜与内镜外科学组. 腹腔镜结直肠手术手术入路选择专家共识. 中国实用外科杂志, 2017, 37(4): 415-419.
27.	朱德祥, 任黎, 许剑民. Ⅳ 期结直肠癌转移病灶的局部根治性与姑息性处理进展. 中国普外基础与临床杂志, 2017, 24(11): 1306-1310.
28.	Miyake Y, Nishimura J, Takahashi H, et al. The short-term outcomes of laparoscopic multivisceral resection for locally advanced colorectal cancer: our experience of 39 cases. Surg Today, 2017, 47(5): 575-580.

1. Colon Cancer Laparoscopic or Open Resection Study Group, Buunen M, Veldkamp R, et al. Survival after laparoscopic surgery versus open surgery for colon cancer: long-term outcome of a randomised clinical trial. Lancet Oncol, 2009, 10(1): 44-52.
2. Jacobs M, Verdeja JC, Goldstein HS. Minimally invasive colon resection (laparoscopic colectomy). Surg Laparosc Endosc, 1991, 1(3): 144-150.
3. Benson AB, Venook AP, Al-Hawary MM, et al. NCCN guidelines insights: colon cancer, version 2.2018. J Natl Compr Canc Netw, 2018, 16(4): 359-369.
4. Grothey A, Sobrero AF, Shields AF, et al. Duration of adjuvant chemotherapy for stage Ⅲ colon cancer. N Engl J Med, 2018, 378(13): 1177-1188.
5. Kitano S, Inomata M, Mizusawa J, et al. Survival outcomes following laparoscopic versus open D3 dissection for stage Ⅱ or Ⅲ colon cancer (JCOG0404): a phase 3, randomised controlled trial. Lancet Gastroenterol Hepatol, 2017, 2(4): 261-268.
6. Yang X, Zhong ME, Xiao Y, et al. Laparoscopic vs open resection of pT4 colon cancer: a propensity score analysis of 94 patients. Colorectal Dis, 2018, 20(11): O316-O325.
7. Chen W, Zheng R, Baade PD, et al. Cancer statistics in China, 2015. CA Cancer J Clin, 2016, 66(2): 115-132.
8. 郑民华, 马君俊. 2018版《腹腔镜结直肠癌根治手术操作指南》更新要点. 中华外科杂志, 2019, 57(3): 224-226.
9. 肖毅. 腹腔镜结直肠手术争议与共识. 中国实用外科杂志, 2018, 38(2): 175-178.
10. Yang ZF, Wu DQ, Wang JJ, et al. Short- and long-term outcomes following laparoscopic vs open surgery for pathological T4 colorectal cancer: 10 years of experience in a single center. World J Gastroenterol, 2018, 24(1): 76-86.
11. Klaver CEL, Kappen TM, Borstlap WAA, et al. Laparoscopic surgery for T4 colon cancer: a systematic review and meta-analysis. Surg Endosc, 2017, 31(12): 4902-4912.
12. Vignali A, Ghirardelli L, Di Palo S, et al. Laparoscopic treatment of advanced colonic cancer: a case-matched control with open surgery. Colorectal Dis, 2013, 15(8): 944-948.
13. Bellio G, Lo Cicero A, Barbieri V, et al. Is T4 colon cancer still an absolute contraindication to laparoscopic surgery? Minerva Chir, 2017, 72(6): 483-490.
14. Krishnamurty DM, Hawkins AT, Wells KO, et al. Neoadjuvant radiation therapy in locally advanced colon cancer: a cohort analysis. J Gastrointest Surg, 2018, 22(5): 906-912.
15. Odermatt M, Miskovic D, Siddiqi N, et al. Short- and long-term outcomes after laparoscopic versus open emergency resection for colon cancer: an observational propensity score-matched study. World J Surg, 2013, 37(10): 2458-2467.
16. Jayne DG, Guillou PJ, Thorpe H, et al. Randomized trial of laparoscopic-assisted resection of colorectal carcinoma: 3-year results of the UK MRC CLASICC Trial Group. J Clin Oncol, 2007, 25(21): 3061-3068.
17. Chan AC, Poon JT, Fan JK, et al. Impact of conversion on the long-term outcome in laparoscopic resection of colorectal cancer. Surg Endosc, 2008, 22(12): 2625-2630.
18. Kim IY, Kim BR, Kim YW. The short-term and oncologic outcomes of laparoscopic versus open surgery for T4 colon cancer. Surg Endosc, 2016, 30(4): 1508-1518.
19. de’Angelis N, Vitali GC, Brunetti F, et al. Laparoscopic vs. open surgery for T4 colon cancer: a propensity score analysis. Int J Colorectal Dis, 2016, 31(11): 1785-1797.
20. Leon P, Iovino MG, Giudici F, et al. Oncologic outcomes following laparoscopic colon cancer resection for T4 lesions: a case-control analysis of 7-years’ experience. Surg Endosc, 2018, 32(3): 1133-1140.
21. Feinberg AE, Chesney TR, Acuna SA, et al. Oncologic outcomes following laparoscopic versus open resection of pT4 colon cancer: a systematic review and meta-analysis. Dis Colon Rectum, 2017, 60(1): 116-125.
22. Berends FJ, Kazemier G, Bonjer HJ, et al. Subcutaneous metastases after laparoscopic colectomy. Lancet, 1994, 344(8914): 58.
23. 康建省, 刘国超, 乔占英, 等. 腹腔镜与开腹手术治疗结肠癌远期疗效的 Meta 分析. 腹腔镜外科杂志, 2011, 16(10): 737-741.
24. Shukla PJ, Trencheva K, Merchant C, et al. Laparoscopic resection of t4 colon cancers: is it feasible? Dis Colon Rectum, 2015, 58(1): 25-31.
25. Yamanashi T, Nakamura T, Sato T, et al. Laparoscopic surgery for locally advanced T4 colon cancer: the long-term outcomes and prognostic factors. Surg Today, 2018, 48(5): 534-544.
26. 中华医学会外科学分会腹腔镜与内镜外科学组. 腹腔镜结直肠手术手术入路选择专家共识. 中国实用外科杂志, 2017, 37(4): 415-419.
27. 朱德祥, 任黎, 许剑民. Ⅳ 期结直肠癌转移病灶的局部根治性与姑息性处理进展. 中国普外基础与临床杂志, 2017, 24(11): 1306-1310.
28. Miyake Y, Nishimura J, Takahashi H, et al. The short-term outcomes of laparoscopic multivisceral resection for locally advanced colorectal cancer: our experience of 39 cases. Surg Today, 2017, 47(5): 575-580.

CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Comparison study of laparoscopic surgery vs. open surgery for colon cancer of T4a stage

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