Survival and surgical outcome after laparoscopic versus open surgery for T4 colon cancer: a retrospective study

Abstract

Background and Aims: Laparoscopic resection for colon cancer is less invasive and can achieve similar oncological safety as open surgery. Yet for pathological T4 cancer, laparoscopic surgery is still controversial and is not recommended by American Joint Committee on Cancer and European Association of Endoscopic Surgery. This study aimed to compare the outcomes of laparoscopic and open surgery in T4 colon cancer. Methods: This study retrospectively analyzed the disease-free and overall survival, as well as the short-term surgical outcome of pT4 colon cancer patients who received curative resection from 1996 to 2015 in our hospital. Results: A total of 190 patients were identified, including 81 laparoscopic surgery and 109 open surgery (including 9 conversions). Patient demographics including age, gender, cancer locations, and types of operations did not differ between the 2 groups. Sixteen patients received liver resection for colorectal liver metastasis. The 3-year and 5-year disease-free survival rates in the laparoscopic group were 58% and 33.3%, respectively; while for the open group, they were 56.0% and 43.3%, respectively (P = 0.620). The 3-year and 5-year overall survival in the laparoscopic group were 70.4% and 50.0%, respectively; while for the open group, they were 65.1% and 45.6%, respectively (P = 0.876). Regarding surgical outcome, the laparoscopic group had less blood loss (84.7 ml vs 384.8 ml, P < 0.001), a shorter hospital stay by 2.8 days (6.4 vs 9.2 days, P < 0.001), and more lymph nodes harvested (19.8 vs 14.7, P < 0.001). Operative time and complication rates didn’t differ significantly. With regard to combined resection of surrounding organs, there were significantly more in the open group (35.8% vs 8.6%, P < 0.001). Conclusion: Laparoscopic resection in pT4 colon cancer offered advantages of minimally invasive surgery without compromising oncological outcome.