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Surgical Endoscopy
Published in: Surgical Endoscopy 4/2016

01-04-2016

Laparoscopic versus open surgery for T4 colon cancer: evaluation of margin status

Authors: Ahmad Elnahas, Supreet Sunil, Timothy D. Jackson, Allan Okrainec, Fayez A. Quereshy

Published in: Surgical Endoscopy | Issue 4/2016

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Abstract

Background

Laparoscopic resection has been considered a relative contraindication for T4 colonic and rectal lesions due to concern over inadequate margins. The objective of this study was to compare planned laparoscopic and open resections of T4 lesions with respect to the positive margin rate.

Methods

Data were obtained from the American College of Surgeons National Surgical Quality Improvement Program participant use file to perform a retrospective cohort analysis. The study population consisted of patients that underwent a colorectal resection for a primary T4 lesion during 2011 and 2012. A multiple logistic regression analysis was conducted to determine the adjusted odds ratio (OR) of positive margins based on surgical approach. An inverse probability of treatment weighting (IPTW) analysis was used to account for confounding by indication. A sensitivity analysis including only “as-treated” cases was also performed.

Results

The sub-selected population consisted of 455 and 406 patients in the laparoscopic and open group, respectively. In the original cohort, demographic variables were similar. The open group had a higher incidence of comorbidities, metastatic disease, and emergency cases. Laparoscopic surgery was found to be no different than open surgery with respect to positive margin status (OR 1.10, p = 0.54). After IPTW adjustment, surgical approach remained a nonsignificant predictor of positive margins (OR 1.18, p = 0.31). The “as-treated” analysis also showed that surgical approach had no significant effect on the positive margin rate (OR 1.24, p = 0.24).

Conclusions

Using this large national surgical database, select patients with T4 lesions who underwent planned laparoscopic colorectal resections did not have a significantly higher positive margin rate compared with patients with open operations. Further research is needed to identify the role of laparoscopy in managing T4b lesions before any consensus can be reached regarding its application in locally advanced colon cancer.
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Metadata
Title
Laparoscopic versus open surgery for T4 colon cancer: evaluation of margin status
Authors
Ahmad Elnahas
Supreet Sunil
Timothy D. Jackson
Allan Okrainec
Fayez A. Quereshy
Publication date
01-04-2016
Publisher
Springer US
Published in
Surgical Endoscopy / Issue 4/2016
Print ISSN: 0930-2794
Electronic ISSN: 1432-2218
DOI
https://doi.org/10.1007/s00464-015-4360-1

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