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01-09-2019 | Laparotomy | Original Article

The Short- and Long-Term Feasibility of Laparoscopic Surgery in Colon Cancer Patients with Bulky Tumors

Authors: Toshiya Nagasaki, Takashi Akiyoshi, Yosuke Fukunaga, Tetsuro Tominaga, Tomohiro Yamaguchi, Tsuyoshi Konishi, Yoshiya Fujimoto, Satoshi Nagayama, Masashi Ueno

Published in: Journal of Gastrointestinal Surgery | Issue 9/2019

Abstract

Background

Compared to open surgery for colon cancer, randomized controlled trials have shown that laparoscopic approaches have equivalent short- and long-term outcomes. However, the feasibility of laparoscopy for removal of bulky tumors has not been evaluated. The aim of our study was to determine the short- and long-term feasibility of laparoscopic surgery for bulky (> 8 cm) colon cancer.

Methods

A total of 80 patients with bulky tumors (defined as greater than 8 cm in diameter) underwent curative resection from July 2004 to July 2014. Short- and long-term outcomes were compared between patients undergoing laparoscopic (n = 48) and open (n = 32) resection.

Results

Compared to open, the operative time was significantly longer (213 vs. 148 min, p < 0.001), return of bowel function quicker (time to oral intake; 2 vs. 5 days, p < 0.001), and length of stay shorter (10 vs. 13 days, p < 0.001) in the laparoscopic group. Five-year cancer-specific and relapse-free survival was similar with no patients developing local recurrence in either group.

Conclusions

Laparoscopic resection of colon cancers greater than 8 cm in diameter is feasible and oncologically safe with better short-term and equivalent long-term outcomes compared to open surgery.

Weeks JC, Nelson H, Gelber S, Sargent D, Schroeder G, Clinical Outcomes of Surgical Therapy (COST) Study Group. Short-term quality-of-life outcomes following laparoscopic-assisted colectomy vs open colectomy for colon cancer: a randomized trial. JAMA. 2002;287(3):321–328.CrossRefPubMed

Veldkamp R, Kuhry E, Hop WCJ, Jeekel J, Kazemier G, Bonjer HJ, Haglind E, Påhlman L, Cuesta M, Msika S, Morino M, Lacy AM, Colon cancer Laparoscopic or Open Resection Study Group (COLOR). Laparoscopic surgery versus open surgery for colon cancer: short-term outcomes of a randomised trial. Lancet Oncol. 2005;6(7):477–484.CrossRef

Guillou PJ, Quirke P, Thorpe H, Walker J, Jayne DG, Smith AMH, Heath RM, Brown JM, MRC CLASICC trial group. Short-term endpoints of conventional versus laparoscopic-assisted surgery in patients with colorectal cancer (MRC CLASICC trial): multicentre, randomised controlled trial. Lancet. 2005;365(9472):1718–1726.CrossRefPubMed

Hewett PJ, Allardyce RA, Bagshaw PF, Frampton CM, Frizelle FA, Rieger NA, Smith JS, Solomon MJ, Stephens JH, Stevenson ARL. Short-term outcomes of the Australasian randomized clinical study comparing laparoscopic and conventional open surgical treatments for colon cancer: the ALCCaS trial. Ann Surg. 2008;248(5):728–738.CrossRefPubMed

Yamamoto S, Inomata M, Katayama H, Mizusawa J, Etoh T, Konishi F, Sugihara K, Watanabe M, Moriya Y, Kitano S. Short-term surgical outcomes from a randomized controlled trial to evaluate laparoscopic and open D3 dissection for stage II/III colon cancer: Japan Clinical Oncology Group Study JCOG 0404. Ann Surg. 2014;260(1):23–30.CrossRefPubMed

Clinical Outcomes of Surgical Therapy Study Group, Nelson H, Sargent DJ, Wieand HS, Fleshman J, Anvari M, Stryker SJ, Beart RW, Helinger M, Flanagan R, Peters W, Ota D. A comparison of laparoscopically assisted and open colectomy for colon cancer. N Engl J Med. 2004;350(20):2050–2059.CrossRef

Colon Cancer Laparoscopic or Open Resection Study Group, Buunen M, Veldkamp R, Hop WCJ, Kuhry E, Jeekel J, Haglind E, Påhlman L, Cuesta MA, Msika S, Morino M, Lacy A, Bonjer HJ. 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.CrossRefPubMed

Green BL, Marshall HC, Collinson F, Quirke P, Guillou P, Jayne DG, Brown JM. Long-term follow-up of the Medical Research Council CLASICC trial of conventional versus laparoscopically assisted resection in colorectal cancer. Br J Surg. 2013;100(1):75–82.CrossRefPubMed

Kitano S, Inomata M, Mizusawa J, Katayama H, Watanabe M, Yamamoto S, Ito M, Saito S, Fujii S, Konishi F, Saida Y, Hasegawa H, Akagi T, Sugihara K, Yamaguchi T, Masaki T, Fukunaga Y, Murata K, Okajima M, Moriya Y, Shimada Y. 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.CrossRefPubMed

10.

Kitano S, Inomata M, Sato A, Yoshimura K, Moriya Y, Japan Clinical Oncology Group Study. Randomized controlled trial to evaluate laparoscopic surgery for colorectal cancer: Japan Clinical Oncology Group Study JCOG 0404. Jpn J Clin Oncol. 2005;35(8):475–477.CrossRefPubMed

11.

Fujii S, Ishibe A, Ota M, Yamagishi S, Watanabe K, Watanabe J, Kanazawa A, Ichikawa Y, Oba M, Morita S, Hashiguchi Y, Kunisaki C, Endo I. Short-term results of a randomized study between laparoscopic and open surgery in elderly colorectal cancer patients. Surg Endosc. 2014;28(2):466–476.CrossRefPubMed

12.

Veldkamp R, Gholghesaei M, Bonjer HJ, Meijer DW, Buunen M, Jeekel J, Anderberg B, Cuesta MA, Cuschieri A, Fingerhut A, Fleshman JW, Guillou PJ, Haglind E, Himpens J, Jacobi CA, Jakimowicz JJ, Koeckerling F, Lacy AM, Lezoche E, Monson JR, Morino M, Neugebauer E, Wexner SD, Whelan RL. Laparoscopic resection of colon Cancer: consensus of the European Association of Endoscopic Surgery (EAES). Surg Endosc. 2004;18(8):1163–1185.CrossRefPubMed

13.

Biondi A, Grosso G, Mistretta A, Marventano S, Tropea A, Gruttadauria S, Basile F. Predictors of conversion in laparoscopic-assisted colectomy for colorectal cancer and clinical outcomes. Surg Laparosc Endosc Percutan Tech. 2014;24(1):e21–26.CrossRefPubMed

14.

Chan ACY, Poon JTC, Fan JKM, Lo SH, Law WL. Impact of conversion on the long-term outcome in laparoscopic resection of colorectal cancer. Surg Endosc. 2008;22(12):2625–2630.CrossRefPubMed

15.

White I, Greenberg R, Itah R, Inbar R, Schneebaum S, Avital S. Impact of conversion on short and long-term outcome in laparoscopic resection of curable colorectal cancer. JSLS. 2011;15(2):182–187.CrossRefPubMedPubMedCentral

16.

Li JCM, Lee JFY, Ng SSM, Yiu RYC, Hon SSF, Leung WW, Leung KL. Conversion in laparoscopic-assisted colectomy for right colon cancer: risk factors and clinical outcomes. Int J Colorectal Dis. 2010;25(8):983–988.CrossRefPubMed

17.

Moloo H, Mamazza J, Poulin EC, Burpee SE, Bendavid Y, Klein L, Gregoire R, Schlachta CM. Laparoscopic resections for colorectal cancer: does conversion survival? Surg Endosc. 2004;18(5):732–735.CrossRefPubMed

18.

Akiyoshi T, Kuroyanagi H, Fujimoto Y, Konishi T, Ueno M, Oya M, Yamagudhi T. Short-term outcomes of laparoscopic colectomy for transverse colon Cancer. J Gastrointest Surg. 2010;14(5):818–823.CrossRefPubMed

19.

Nagasue Y, Akiyoshi T, Ueno M, Fukunaga Y, Nagayama S, Fujimoto Y, Konishi T, Nagasaki T, Nagata J, Mukai T, Ikeda A, Ono R, Yamaguchi T. Laparoscopic versus open multivisceral resection for primary colorectal cancer: comparison of perioperative outcomes. J Gastrointest Surg. 2013;17(7):1299–1305.CrossRefPubMed

20.

Mukai T, Akiyoshi T, Ueno M, Fukunaga Y, Nagayama S, Fujimoto Y, Konishi T, Ikeda A, Yamaguchi T. Laparoscopic total pelvic exenteration with en bloc lateral lymph node dissection after neoadjuvant chemoradiotherapy for advanced primary rectal cancer. Asian J Endosc Surg. 2013;6(4):314–317.CrossRefPubMed

21.

Akiyoshi T. Technical feasibility of laparoscopic extended surgery beyond total mesorectal excision for primary or recurrent rectal cancer. World J Gastroenterol. 2016;22(2):718–726.CrossRefPubMedPubMedCentral

22.

Ogura A, Akiyoshi T, Konishi T, Fujimoto Y, Nagayama S, Fukunaga Y, Ueno M. Safety of laparoscopic pelvic exenteration with urinary diversion for colorectal malignancies. World J Surg. 2016;40(5):1236–1243.CrossRefPubMed

23.

Chan DKH, Tan KK. Laparoscopic surgery should be considered in T4 colon cancer. Int J Colorectal Dis. 2017;32(4):517–520.CrossRefPubMed

24.

Bretagnol F, Dedieu A, Zappa M, Guedj N, Ferron M, Panis Y. T4 colorectal cancer: is laparoscopic resection contraindicated? Color Dis. 2011;13(2):138–143.CrossRef

25.

Elnahas A, Sunil S, Jackson TD, Okrainec A, Quereshy FA. Laparoscopic versus open surgery for T4 colon cancer: evaluation of margin status. Surg Endosc. 2016;30(4):1491–1496.CrossRefPubMed

26.

Shukla PJ, Trencheva K, Merchant C, Maggiori L, Michelassi F, Sonoda T, Lee SW, Milsom JW. Laparoscopic resection of t4 colon cancers: is it feasible? Dis Colon rectum. 2015;58(1):25–31.CrossRefPubMed

27.

Wolmark N, Fisher ER, Wieand HS, Fisher B. The relationship of depth of penetration and tumor size to the number of positive nodes in Dukes C colorectal cancer. Cancer. 1984;53(12):2707–2712.CrossRefPubMed

28.

Tekkis PP, Senagore AJ, Delaney CP, Fazio VW. Evaluation of the learning curve in laparoscopic colorectal surgery: comparison of right-sided and left-sided resections. Ann Surg. 2005;242(1):83–91.CrossRefPubMedPubMedCentral

29.

Dowson HM, Bong JJ, Lovell DP, Worthington TR, Karanjia ND, Rockall TA. Reduced adhesion formation following laparoscopic versus open colorectal surgery. Br J Surg. 2008;95(7):909–914.CrossRefPubMed

30.

Hiki N, Shimizu N, Yamaguchi H, Imamura K, Kami K, Kubota K, Kaminishi M. Manipulation of the small intestine as a cause of the increased inflammatory response after open compared with laparoscopic surgery. Br J Surg. 2006;93(2):195–204.CrossRefPubMed

Title: The Short- and Long-Term Feasibility of Laparoscopic Surgery in Colon Cancer Patients with Bulky Tumors
Authors: Toshiya Nagasaki
Takashi Akiyoshi
Yosuke Fukunaga
Tetsuro Tominaga
Tomohiro Yamaguchi
Tsuyoshi Konishi
Yoshiya Fujimoto
Satoshi Nagayama
Masashi Ueno
Publication date: 01-09-2019
Publisher: Springer US
Keywords: Laparotomy
Laparotomy
Colon Cancer
Colon Cancer
Published in: Journal of Gastrointestinal Surgery / Issue 9/2019
Print ISSN: 1091-255X
Electronic ISSN: 1873-4626
DOI: https://doi.org/10.1007/s11605-019-04114-2

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Springer Medicine

The Short- and Long-Term Feasibility of Laparoscopic Surgery in Colon Cancer Patients with Bulky Tumors

Abstract

Background

Methods

Results

Conclusions

Keynote webinar | Spotlight on sleep in brain health

Springer Medicine

Abstract

Background

Methods

Results

Conclusions

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