Laparoscopic surgery for T4 colon cancer: a systematic review and meta-analysis

Abstract

BackgroundIn colon cancer, T4 stage is still assumed to be a relative contraindication for laparoscopic surgery considering the oncological safety. The aim of this systematic review with meta-analysis was to evaluate short- and long-term oncological outcomes after laparoscopic surgery for T4 colon cancer, and to compare these with open surgery.MethodsUsing systematic review of literature, studies reporting on radicality of resection, disease-free survival (DFS), and/or overall survival (OS) after laparoscopic surgery for T4 colon cancer were identified, with or without a control group of open surgery. Pooled proportions and risk ratios were calculated using an inverse variance method.ResultsThirteen observational cohort studies published between 2012 and 2017 were included, together consisting of 1217 patients that received laparoscopic surgery and 1357 with an open procedure. The proportion of multivisceral resections was larger in the open group in five studies. Based on 11 studies, the pooled proportion of R0 resection was 0.96 (95% CI: 0.91–0.99) and 0.96 (95% CI: 0.90–0.98) after laparoscopic and open surgery, respectively. Analysing (mainly) T4a subgroups in 6 evaluable studies revealed pooled R0 resection rates of 0.94 in both groups. No significant differences were found between laparoscopic and open surgery for any survival measure: RR 1.07 (95% CI: 0.96–1.20) for 3-year DFS, RR 1.04 (95% CI: 0.95–1.15) for 5-year DFS, RR 1.07 (95% CI: 0.99–1.14) for 3-year OS, and RR 1.05 (95% CI: 0.98–1.12) for 5-year OS.ConclusionLiterature on laparoscopic surgery for T4 colon cancer is restricted to non-randomized comparisons with substantial allocation bias. Laparoscopic surgery for T4a tumours might be safe, whereas for T4b colon cancer requiring multivisceral resection it should be applied with caution.Electronic supplementary materialThe online version of this article (doi:10.1007/s00464-017-5544-7) contains supplementary material, which is available to authorized users.

Laparoscopic surgery for locally advanced T4 colon cancer: the long-term outcomes and prognostic factors

“…In the COLOR trial, the overall conversion rate was 17%, whereas 50% of patients with pT4 tumor required conversion to open surgery [ 6 ]. Regarding previous reports with only T4 colorectal cancer, the conversion rate ranged from 5.6 to 24.7% [ 14 – 22 , 31 , 32 ]. In the present study, conversion to open surgery was required in only 5 patients (3.8%) with pT4 colon cancer.…”

“…Indeed, although this study focused on pT4 cancer, the median operative time of 205 min, blood loss of 10 ml, and postoperative hospital stay of 7.5 days were comparable to those of large randomized trials of colorectal cancer of all TNM stages [ 4 , 8 ]. Furthermore, some authors have shown no marked differences in morbidity and mortality between laparoscopic procedures and open surgery for T4 colorectal cancer [ 16 – 21 , 32 ]. Morbidity rates ranged from 7.7 to 30% in these reports.…”

“…A systematic review of laparoscopic surgery for T4 colon cancer was recently reported [ 32 ]. It included 13 observational cohort studies published between 2012 and 2017, consisting of a total of1217 patients who underwent laparoscopic procedures and 1357 who underwent open surgery.…”

Recurrence Rate in a Patient Treated with Colon Resection Followed by Chemotherapy in Comparison to a Patient Treated with Colon Resection without Chemotherapy

“…A complete or partial colectomy is used in all five stages of colon cancer depending on the feasibility of resection and tissue involvement. A recent systematic review reported laparoscopic colectomy had lower risks of adhesion-related small bowel obstruction and incisional hernia; however, the three-year disease-free survival between open and laparoscopic surgeries remained unchanged [8].…”

Laparoscopic en bloc resection of T4b splenic flexure cancer with infiltration of the stomach and tail of the pancreas – a video vignette

“…Treatment of T4b colonic cancer requires multiorgan resection, and it is usually considered a contraindication for the laparoscopic approach. Nevertheless, recent results from non‐randomized studies demonstrate that, if R0 resection is obtained, the well‐known short‐ and long‐term benefit of laparoscopic surgery can be achieved with similar survival to those operated by open resection.…”