Laparoscopic Colectomy for Cancer Is Not Inferior to Open Surgery Based on 5-Year Data From the COST Study Group Trial

Fleshman, James W.; Sargent, Daniel J.; Green, Erin; Anvari, Mehran; Stryker, Steven J.; Beart, Robert W.; Hellinger, Michael D.; Flanagan, R.J.; Peters, Walter R.; Nelson, Heidi

doi:10.1097/sla.0b013e318155a762

Cited by 1,032 publications

(693 citation statements)

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“…This has been observed in other series as well [4,6,13,14]. A meta-analysis of the large randomized trials has shown a conversion rate of 19% [16]. However, when the patients who underwent a conversion to an open surgery were excluded, the difference was not marked.…”

Section: Resultssupporting

confidence: 61%

“…Despite this, the better short term recovery of the LAC group could be demonstrated by the fewer days spent in the ICU and shorter hospital stay. This has been demonstrated in most of the other series as well [5,[10][11][12][13][14]16].…”

Section: Resultsmentioning

confidence: 55%

“…This could be probably due to less tissue trauma in laparoscopic surgery [5]. Dissection through small incisions, precise dissection aided by magnification, lack of manual handling of viscera and forceful retraction in laparoscopy helps in early recovery of gut function [10,11,16]. However the ability to tolerate semisolid diet was not different between the LAC and OR group.…”

Section: Resultsmentioning

confidence: 99%

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Laparoscopic Colonic Resection for Rectosigmoid Colonic Tumours: A Retrospective Analysis and Comparison with Open Resection

et al. 2010

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Laparoscopic approach for treatment of colorectal malignancy is gaining acceptance gradually; however the benefits of laparoscopic surgery in colonic and rectal tumours is still open to debate. This study aims at a retrospective analysis of operative and short term outcome of patients with rectosigmoid tumours. A retrospective analysis of operative, postoperative and short-term outcome of 62 patients who underwent laparoscopic colorectal resection for cancer of rectosigmoid region were compared with a same number of parameters-matched patients who underwent open colorectal resection. Blood transfusion requirement was significantly more in the open group compared to the laparoscopy group (38.7% versus 6.4%, p=0.001). ICU stay was less in the laparoscopy group (p=<0.05) and they were started on oral liquid diet earlier (p=0.013). The number of the lymph nodes retrieved, positive distal margin and radial involvement were similar in both groups. The hospital stay was significantly shorter in laparoscopy group (8.4 versus 13.8 days, p < 0.05). Radical operation for rectosigmoid tumors is technically feasible with laparoscopic surgery. Laparoscopic approach is associated with less blood loss, transfusion and significantly less ICU stay. Laparoscopic group recovers early and needs less hospital stay

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Section: Resultssupporting

confidence: 61%

Section: Resultsmentioning

confidence: 55%

Section: Resultsmentioning

confidence: 99%

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Laparoscopic Colonic Resection for Rectosigmoid Colonic Tumours: A Retrospective Analysis and Comparison with Open Resection

et al. 2010

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“…Vários trabalhos foram realizados com o objetivo de avaliar a laparoscopia no tratamento das doenças malignas colorretais 3,4,5,6,7,8,17 . O câncer colorretal representa um problema importante de saúde pública.…”

Section: Introductionunclassified

Resultados do registro de cirurgias colorretais videolaparoscópicas realizadas no Estado de Minas Gerais - Brasil de 1996 a 2009

Queiroz

Côrtes²,

Neto³

et al. 2010

Rev bras. colo-proctol.

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INTRODUÇÃO: A partir de 1991, a videolaparoscopia começou a ser considerada no tratamento de doenças colorretais. O aprimoramento da técnica cirúrgica associado aos benefícios encontrados em diversos estudos publicados levou a modificações nas perspectivas da videolaparoscopia. A partir da publicação do estudo COST as ressecções oncológicas laparoscópicas foram reconhecidas como alternativa viável, com resultados semelhantes à cirurgia convencional. PACIENTES E MÉTODOS: Realizou-se pesquisa através de formulário específico e consulta a prontuários dos principais serviços de coloproctologia de Belo Horizonte. Avaliando-se sexo, idade, indicação cirúrgica, procedimento realizado, técnica laparoscópica, complicações, conversão, estadiamento e recidiva (no caso de neoplasias). RESULTADOS: Foram levantados dados sobre 503 cirurgias colorretais laparoscópicas: 347 (68,9%) em mulheres e 156 (31,1%) homens. A técnica cirúrgica foi totalmente laparoscópica em 137 casos, vídeo-assistida 245 casos. O procedimento mais realizado foi a retossigmoidectomia (41,1%), seguido pela colectomia direita (12,5%), colectomia esquerda (6,9%). Doenças benignas foram responsáveis por 259 (51,5%) casos, destes as principais indicações cirúrgicas foram endometriose 126 (48,6%), pólipos 40 (15,4%), doença diverticular 30 (11,6%). Das 240 cirurgias realizadas por doenças malignas as mais frequentes foram retossigmoidectomia 102 (42,5%), colectomia direita 46 (19,1%), colectomia esquerda 18 (7,5%), amputação abdominoperineal 18 (7,5%). Houve 54 conversões (10.7%) dos casos, 12,9% (31/240) nos casos de neoplasias, 8,5% (22/259) nos de doenças benignas. Complicações sistêmicas ou cirúrgicas ocorreram em 31 (6,1%) e 56 (11,1%) casos, respectivamente. Foram registrados onze (2,18%) óbitos nos primeiros 30 dias após a cirurgia. CONCLUSÃO: O estudo atual foi o primeiro levantamento da implantação de cirurgias colorretais laparoscópicas realizado de forma multicêntrica em Minas Gerais. Os dados levantados são consistentes com registros nacionais de videocirurgia colorretal, mostrando a eficiência do método de aprendizado com realização de cirurgias com tutor. Além disso, que pequena parte das cirurgias colorretais são realizadas por via laparoscópica no estado, restritos apenas a centros especializados, sobrecarregando esses serviços e limitando o acesso para a população.

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“…Recent large RCTs [5,6] as well as a systematic review and metaanalysis of the literature [7] have reported similar advantages of laparoscopic rectal resection and total mesorectal excision (TME) compared with open surgery for extraperitoneal rectal cancer. Evidence from the literature also has shown comparable outcomes in terms of oncologic clearance and long-term survival between laparoscopic and open resection for colon [1,[8][9][10] and rectal cancer [10][11][12]. The rates for conversion of laparoscopic colon resection to open surgery reported in the largest multicenter RCTs range from 17 to 25 % [2-4], whereas the conversion rates for laparoscopic rectal resection vary between 0.6 and 32.4 % [7].…”

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confidence: 99%

Does conversion affect short-term and oncologic outcomes after laparoscopy for colorectal cancer?

et al. 2013

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Background Conversion of laparoscopic colorectal resection (LCR) for cancer has been associated with adverse short-term and oncologic outcomes. However, most studies have had small sample sizes and short follow-up periods. This study aimed to evaluate the impact of conversion to open surgery on early postoperative outcomes and survival among patients undergoing LCR for nonmetastatic colorectal cancer. Methods A prospective database of consecutive LCRs for nonmetastatic colorectal cancer was reviewed. Patients who required conversion (CONV group) were compared with those who had completed laparoscopic resection (LAP group). Only patients with a minimum 5-year follow-up period were included in the oncologic analysis. Kaplan-Meier curves were compared to analyze survival. A multivariate analysis was performed to identify predictors of poor survival. Results The conversion rate was 10.9 %. The most common reason for conversion was a locally advanced tumor (48.4 %). Conversion was associated with a significantly longer operative time and a greater blood loss. No differences were observed in terms of postoperative morbidity, mortality, or hospital stay between the CONV and LAP patients. During a median follow-up period of 120 months (range, 60-180 months), the CONV group had a significantly worse 5-year overall survival (OS) (79.4 vs 87.4 %; p = 0.016) and disease-free survival (DFS) (65.4 vs 79.6 %; p = 0.013). Univariate analysis showed that conversion to open surgery, postoperative complications, anastomotic leakage, pT4 cancer, stage 3 disease, and adjuvant chemotherapy were significant risk factors for OS and DFS. On multivariate analysis, pT4 cancer and a lymph node ratio (LNR) of 0.25 or greater were the only independent predictors of DFS and OS, whereas a LNR of 0.01 to 0.24 showed a trend that did not reach statistical significance. Recent large RCTs [5,6] as well as a systematic review and metaanalysis of the literature [7] have reported similar advantages of laparoscopic rectal resection and total mesorectal excision (TME) compared with open surgery for extraperitoneal rectal cancer. Evidence from the literature also has shown comparable outcomes in terms of oncologic clearance and long-term survival between laparoscopic and open resection for colon [1,[8][9][10] and rectal cancer [10][11][12]. The rates for conversion of laparoscopic colon resection to open surgery reported in the largest multicenter RCTs range from 17 to 25 % [2-4], whereas the conversion rates for laparoscopic rectal resection vary between 0.6 and 32.4 % [7]. With the exception of the conventional versus laparoscopic-associated surgery in colorectal cancer (CLASICC) trial, all RCTs have analyzed converted patients in the laparoscopic group on an "intention-to-treat" basis. A few nonrandomized studies have examined the short-term outcomes for converted cancer patients. Some studies have reported higher morbidity and mortality rates and a longer postoperative hospital stay [3,[13][14][15][16][17][18], whereas others did not find si...

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Laparoscopic Colectomy for Cancer Is Not Inferior to Open Surgery Based on 5-Year Data From the COST Study Group Trial

Abstract: Laparoscopic colectomy for curable colon cancer is not inferior to open surgery based on long-term oncologic endpoints from a prospective randomized trial.

Cited by 1,032 publications

References 25 publications

Laparoscopic Colonic Resection for Rectosigmoid Colonic Tumours: A Retrospective Analysis and Comparison with Open Resection

Laparoscopic Colonic Resection for Rectosigmoid Colonic Tumours: A Retrospective Analysis and Comparison with Open Resection

Resultados do registro de cirurgias colorretais videolaparoscópicas realizadas no Estado de Minas Gerais - Brasil de 1996 a 2009

Does conversion affect short-term and oncologic outcomes after laparoscopy for colorectal cancer?

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