Laparoscopic surgery for stage IV colorectal cancer

The role of laparoscopic surgery in the management of stage IV colorectal cancer remains uncertain.

Sixty-five patients with stage IV disease from among 578 colorectal cancer patients who underwent laparoscopic surgery since 2001 were compared with 513 patients who had stage 0–III disease. The criteria for excluding stage IV patients from laparoscopic surgery were huge tumors, low rectal cancer, massive ascites due to peritoneal seeding, bowel perforation and/or obstruction, and poor general condition and/or cachexia. Data were analyzed by chi-square test or Student’s t-test, with P < 0.05 being considered significant.

The two groups of patients had similar demographic features. The open conversion rate was 4.6% (3/65 patients) in the stage IV group and 2.7% (14/513 patients) in the stage 0–III group, and the difference between the groups was not significant. In the stage IV group, depth of tumor invasion and tumor diameter were both significantly greater than in the stage 0–III group. However, operating time and blood loss were similar in the two groups (stage IV: 189.0 min and 95.0 g; stage 0–III: 182.5 min and 60.0 g), although blood loss was significantly greater in the stage IV group when patients undergoing rectal surgery were compared. The incidence of postoperative complications and the postoperative course of the two groups were similar.

Despite their larger and more invasive tumors, the short-term outcome of laparoscopic surgery in patients with stage IV colorectal cancer was similar to that for stage 0–III patients. This result indicates that laparoscopic surgery can be successfully performed in selected stage IV colorectal cancer patients.