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Published in: Annals of Surgical Oncology 1/2007

01-01-2007

Oncologic Results of Laparoscopic Versus Conventional Open Surgery for Stage II or III Left-Sided Colon Cancers: A Randomized Controlled Trial

Authors: Jin-Tung Liang, MD, PhD, Kuo-Chin Huang, MD, PhD, Hong-Shiee Lai, MD, PhD, Po-Huang Lee, MD, PhD, Yung-Ming Jeng, MD

Published in: Annals of Surgical Oncology | Issue 1/2007

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Abstract

Introduction

Minimal invasive surgical approach can achieve quick functional recovery. However, the oncologic outcome for cancer is still a concern. This study aims to compare the oncologic outcome between laparoscopic and open methods in the curative resection of Stage II or III left-sided colon cancers.

Methods

In consideration of statistical power up to 90%, 286 eligible patients with curable left-sided colon cancer (Tumor-Node-Metastasis Stage II and Stage III disease) requiring the takedown of colonic splenic flexure to facilitate a curative left hemicolectomy were recruited randomly and equally allocated to the laparoscopic and open group. The primary endpoint was time-to-recurrence of tumor. Data was analyzed according to intention-to-treat principle.

Results

Postrandomization exclusion occurred because of metastatic disease detected intraoperatively occurred in 13 patients and because of patient withdrawal from trial in 4. Therefore, 135 and 134 patients actually comprised the laparoscopic and open group, respectively. The median follow-up of patient was 40 months (range: 18–72 months). The oncologic results were similar (P = 0.362, one-sided log-rank test) in laparoscopic and open group of patients, with the estimated cumulative recurrence rate of 13.2% (9/68) versus 17.2% (11/64) in Stage II disease and 20.9% (14/67) versus 25.7% (18/70) in Stage III disease, respectively. The recurrence patterns were similar between the two groups. Both open and laparoscopic groups were comparable in the number of dissected lymph node (15.6 ± 3.0 vs. 16.0 ± 6.0, P = 0.489), various demographic and clinicopathologic parameters.

Conclusions

The estimated cumulative recurrence rate for the surgery of Stage II or III left-sided colon cancers was the same between laparoscopic and open methods.
Literature
1.
go back to reference Nelson H, Sargent DJ, Wieand HS, et al. A comparison of laparoscopically assisted and open colectomy for colon cancer. N Engl J Med 2004; 350:2050–2059CrossRef Nelson H, Sargent DJ, Wieand HS, et al. A comparison of laparoscopically assisted and open colectomy for colon cancer. N Engl J Med 2004; 350:2050–2059CrossRef
2.
go back to reference Leung KL, Kwok SPY, Lam SCW, et al. Laparoscopic resection of rectosigmoid carcinoma: prospective randomized trial. Lancet 2004; 363:1187–1192PubMedCrossRef Leung KL, Kwok SPY, Lam SCW, et al. Laparoscopic resection of rectosigmoid carcinoma: prospective randomized trial. Lancet 2004; 363:1187–1192PubMedCrossRef
3.
go back to reference Guillou P, Quirke P, Thorpe H, et al. Short-term endpoints of conventional versus laparoscopic-assisted surgery in patients with colorectal cancer (MRC CLASICC trial): multicentre, randomized controlled trial. Lancet 2005; 365:1718–1726 and 1666–1668PubMedCrossRef Guillou P, Quirke P, Thorpe H, et al. Short-term endpoints of conventional versus laparoscopic-assisted surgery in patients with colorectal cancer (MRC CLASICC trial): multicentre, randomized controlled trial. Lancet 2005; 365:1718–1726 and 1666–1668PubMedCrossRef
4.
go back to reference Lacy AM, Carcia-Valdecasas JC, Delgado S, et al. Laparoscopy-assisted colectomy versus open colectomy for treatment of non-metastatic colon cancer: a randomized trial. Lancet 2002; 359:2224–2229PubMedCrossRef Lacy AM, Carcia-Valdecasas JC, Delgado S, et al. Laparoscopy-assisted colectomy versus open colectomy for treatment of non-metastatic colon cancer: a randomized trial. Lancet 2002; 359:2224–2229PubMedCrossRef
5.
go back to reference Yamamoto S, Watanabe M, Hasegawa H, et al. Oncologic outcome of laparoscopic versus open surgery for advanced colorectal cancer. Hepatogastroenterology 2001; 48:1248–1251PubMed Yamamoto S, Watanabe M, Hasegawa H, et al. Oncologic outcome of laparoscopic versus open surgery for advanced colorectal cancer. Hepatogastroenterology 2001; 48:1248–1251PubMed
6.
go back to reference Beart R, Kehlet H, Buechler M, et al. International trends in abdominal surgery: laparotomy compared with laparoscopy. Dis Colon Rectum 2004; 47:623CrossRef Beart R, Kehlet H, Buechler M, et al. International trends in abdominal surgery: laparotomy compared with laparoscopy. Dis Colon Rectum 2004; 47:623CrossRef
7.
go back to reference Delaney CP, Kiran RP, Senagore AJ, et al. Case-matched comparison of clinical and financial outcome after laparoscopic and open colorectal surgery. Ann Surg 2003; 238:67–72PubMedCrossRef Delaney CP, Kiran RP, Senagore AJ, et al. Case-matched comparison of clinical and financial outcome after laparoscopic and open colorectal surgery. Ann Surg 2003; 238:67–72PubMedCrossRef
8.
go back to reference Liang JT, Shieh MJ, Chen CN, et al. Prospective evaluation of laparoscopy-assisted colectomy versus laparotomy with resection in the management of complex polyps of the sigmoid colon. World J Surg 2002; 26:377–383PubMedCrossRef Liang JT, Shieh MJ, Chen CN, et al. Prospective evaluation of laparoscopy-assisted colectomy versus laparotomy with resection in the management of complex polyps of the sigmoid colon. World J Surg 2002; 26:377–383PubMedCrossRef
9.
go back to reference Liang JT, Lai HS, Huang KC, et al. Comparison of medial-to-lateral versus traditional lateral-to-medial dissection sequences for the resection of rectosigmoid cancers—a randomized controlled clinical trial. World J Surg 2003; 27:190–196PubMedCrossRef Liang JT, Lai HS, Huang KC, et al. Comparison of medial-to-lateral versus traditional lateral-to-medial dissection sequences for the resection of rectosigmoid cancers—a randomized controlled clinical trial. World J Surg 2003; 27:190–196PubMedCrossRef
10.
go back to reference Liang JT. Comparison of medial-to-lateral versus traditional lateral-to-medial dissection sequences for the resection of rectosigmoid cancers (letter, comment). World J Surg 2003; 27:1337–1338CrossRef Liang JT. Comparison of medial-to-lateral versus traditional lateral-to-medial dissection sequences for the resection of rectosigmoid cancers (letter, comment). World J Surg 2003; 27:1337–1338CrossRef
11.
go back to reference Milsom JW, Böhm B. Laparoscopic colorectal surgery. New York: Springer-Verlag; 1996 Milsom JW, Böhm B. Laparoscopic colorectal surgery. New York: Springer-Verlag; 1996
12.
go back to reference Milsom JW, Böhm B, Hammerhofer KA, et al. A prospective, randomized trial comparing laparoscopic versus conventional techniques in colorectal cancer surgery: a preliminary report. J Am Coll Surg 1998; 187:46–57PubMedCrossRef Milsom JW, Böhm B, Hammerhofer KA, et al. A prospective, randomized trial comparing laparoscopic versus conventional techniques in colorectal cancer surgery: a preliminary report. J Am Coll Surg 1998; 187:46–57PubMedCrossRef
13.
go back to reference Liang JT, Lai HS, Lee PH. Laparoscopic medial-to-lateral approach for the curative left hemicolectomy. Dis Colon Rectum 2005; 48:2142–2143CrossRef Liang JT, Lai HS, Lee PH. Laparoscopic medial-to-lateral approach for the curative left hemicolectomy. Dis Colon Rectum 2005; 48:2142–2143CrossRef
14.
go back to reference Japanese Society for Cancer of the Colon and Rectum. General Rules for Clinical and Pathological Studies on Cancer of the Colon, Rectum, and Anus. Tokyo: Kanehara, 1994 Japanese Society for Cancer of the Colon and Rectum. General Rules for Clinical and Pathological Studies on Cancer of the Colon, Rectum, and Anus. Tokyo: Kanehara, 1994
15.
go back to reference Turnbull RB, Kyle K, Watson FR, et al. Cancer of the colon: the influence of the no-touch technique on survival rates. Ann Surg 1967; 166:420–427PubMedCrossRef Turnbull RB, Kyle K, Watson FR, et al. Cancer of the colon: the influence of the no-touch technique on survival rates. Ann Surg 1967; 166:420–427PubMedCrossRef
16.
17.
go back to reference Holm T, Johansson H, Cedermark B, et al. Influence of hospital and surgeon related factors and outcome after treatment of rectal cancer with or without preoperative radiotherapy. Br J Surg 1997; 87:657–663CrossRef Holm T, Johansson H, Cedermark B, et al. Influence of hospital and surgeon related factors and outcome after treatment of rectal cancer with or without preoperative radiotherapy. Br J Surg 1997; 87:657–663CrossRef
18.
go back to reference Parry JM, Collins S, Mathers J, et al. Influence of volume of work on the outcome of treatment for patients with colorectal cancer. Br J Surg 1998; 86:475–481CrossRef Parry JM, Collins S, Mathers J, et al. Influence of volume of work on the outcome of treatment for patients with colorectal cancer. Br J Surg 1998; 86:475–481CrossRef
19.
go back to reference Kao LS, Aaron BC, Dellinger EP. Trials and tribulations: current challenges in conducting clinical trials. Arch Surg 2003; 138:59–62PubMedCrossRef Kao LS, Aaron BC, Dellinger EP. Trials and tribulations: current challenges in conducting clinical trials. Arch Surg 2003; 138:59–62PubMedCrossRef
21.
go back to reference 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; 287:321–328PubMedCrossRef 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; 287:321–328PubMedCrossRef
22.
23.
go back to reference Nishiguchi K, Okuda J, Toyoda M, et al. Comparative evaluation of surgical stress of laparoscopic and open surgeries for colorectal carcinoma. Dis Colon Rectum 2001; 44:223–230PubMedCrossRef Nishiguchi K, Okuda J, Toyoda M, et al. Comparative evaluation of surgical stress of laparoscopic and open surgeries for colorectal carcinoma. Dis Colon Rectum 2001; 44:223–230PubMedCrossRef
24.
go back to reference Liang JT, Huang KC, Jeng YM, Lee PH, Lai HS, Hsu HC. Microvessel density, cyclo-oxygenase 2 expression, K-ras mutation and p53 overexpression in colonic cancer. Br J Surg 2004; 91:355–361PubMedCrossRef Liang JT, Huang KC, Jeng YM, Lee PH, Lai HS, Hsu HC. Microvessel density, cyclo-oxygenase 2 expression, K-ras mutation and p53 overexpression in colonic cancer. Br J Surg 2004; 91:355–361PubMedCrossRef
25.
go back to reference Sargent DJ, Wieand HS, Haller DG, et al. Disease-free survival versus overall survival as a primary end point for adjuvant colon cancer studies: individual patient data from 20,898 patients on 18 randomized trials. J Clin Oncol 2005; 23:8664–8670PubMedCrossRef Sargent DJ, Wieand HS, Haller DG, et al. Disease-free survival versus overall survival as a primary end point for adjuvant colon cancer studies: individual patient data from 20,898 patients on 18 randomized trials. J Clin Oncol 2005; 23:8664–8670PubMedCrossRef
26.
go back to reference Wexner SD, Cohen SM. Port site metastases after laparoscopic colorectal surgery for cure of malignancy. Br J Surg 1995; 82:295–298PubMedCrossRef Wexner SD, Cohen SM. Port site metastases after laparoscopic colorectal surgery for cure of malignancy. Br J Surg 1995; 82:295–298PubMedCrossRef
27.
go back to reference Bouvy ND, Marquet RL, Jeekel J, Bonjer HJ. Laparoscopic surgery is associated with less tumour growth stimulation than conventional surgery: an experimental study. Br J Surg 1997; 84:358–361PubMedCrossRef Bouvy ND, Marquet RL, Jeekel J, Bonjer HJ. Laparoscopic surgery is associated with less tumour growth stimulation than conventional surgery: an experimental study. Br J Surg 1997; 84:358–361PubMedCrossRef
28.
go back to reference Hubens G, Pauwels M, Hubens A, Vermeulen P, Van Marck E, Eyskens E. The influence of a pneumoperitoneum on the peritoneal implantation of free intraperitoneal colon cancer cells. Surg Endosc 1996; 10:809–812PubMedCrossRef Hubens G, Pauwels M, Hubens A, Vermeulen P, Van Marck E, Eyskens E. The influence of a pneumoperitoneum on the peritoneal implantation of free intraperitoneal colon cancer cells. Surg Endosc 1996; 10:809–812PubMedCrossRef
29.
go back to reference Kim SH, Milsom JW, Gramlich TL, et al. Does laparoscopic vs. conventional surgery increase exfoliated cancer cells in the peritoneal cavity during resection of colorectal cancer? Dis Colon Rectum 1998; 41:971–978PubMedCrossRef Kim SH, Milsom JW, Gramlich TL, et al. Does laparoscopic vs. conventional surgery increase exfoliated cancer cells in the peritoneal cavity during resection of colorectal cancer? Dis Colon Rectum 1998; 41:971–978PubMedCrossRef
Metadata
Title
Oncologic Results of Laparoscopic Versus Conventional Open Surgery for Stage II or III Left-Sided Colon Cancers: A Randomized Controlled Trial
Authors
Jin-Tung Liang, MD, PhD
Kuo-Chin Huang, MD, PhD
Hong-Shiee Lai, MD, PhD
Po-Huang Lee, MD, PhD
Yung-Ming Jeng, MD
Publication date
01-01-2007
Publisher
Springer-Verlag
Published in
Annals of Surgical Oncology / Issue 1/2007
Print ISSN: 1068-9265
Electronic ISSN: 1534-4681
DOI
https://doi.org/10.1245/s10434-006-9135-4

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