Laparoscopic versus conventional open surgery in T4 rectal cancer: A case–control study

Abstract

Background:Laparoscopic surgery (LAS) for T4 rectal cancer (RC) is still controversial. This study aims to compare LAS with conventional open surgery in patients with T4 RC.Patients and Methods:Patients undergoing laparoscopic or open curative resection for T4 RC from January 2010 to September 2014 in our hospital were enrolled. Patients’ clinicopathological characteristics and survival outcomes were collected and compared. All statistical analysis was performed using SPSS 22.0.Results:A total of 125 patients (39 open, 86 LAS) were included in this study finally. The baseline information between the two groups were comparable except that LAS group had a more anterior resection (P = 0.012) and less combined resection (P = 0.003). The results demonstrated that patients in LAS group had less blood loss (P < 0.001), smaller incision length (P < 0.001), faster time to first soft diet (P = 0.010) and less incidence of post-operative complications, although it was not significantly different (P = 0.063). In addition, the operative time was also comparable (P = 0.140) and the conversion rate was low (2/86). The 3-year overall survival (OS) was 71.8%, 79.1% in open, LAS group respectively and the 3-year disease-free survival (DFS) was 66.7%, 68.6% in open, laparoscopic group, respectively. The Kaplan curves demonstrated that there was no significant difference between the two groups in OS (P = 0.981) or DFS (P = 0.900).Conclusions:LAS is safe and feasible in selected patients with T4 RC. It can achieve a better perioperative outcomes, and the long-time survival is not inferior to open surgery. Prospective studies should be conducted in the future to reduce the selection bias.

Laparoscopic and robotic multivisceral resection in colorectal cancer: A case series and systematic review

“…Out of 590 articles, 22 17–36 fulfilled the selection criteria and were included in the systematic review, with a total of 1055 patients with MVR. Figure 1 is a flow chart demonstrating the study search, selection and inclusion criteria applied in this study.…”

“…Out of 590 articles, 22 [17][18][19][20][21][22][23][24][25][26][27][28][29][30][31][32][33][34][35][36] fulfilled the selection criteria and were included in the systematic review, with a total of 1055 patients with MVR. Figure 1…”

Laparoscopy is non‐inferior to open surgery for rectal cancer: A systematic review and meta‐analysis

“…All the guidelines suggest T4 rectal cancer as a contraindication for laparoscopic surgery, because the locally advanced tumor have a high risk of CMR or need en bloc resection of the adjacent infiltrated organs which might increase the convention rates and collateral increasing morbidity. Some studies have assessed the pathologic and oncologic results and suggested that laparoscopic surgery was feasible for T4 colorectal cancer 108,124 . In this study, laparoscopic resection for all the stages of rectal cancer were merged and generally compared with open surgery.…”

“…Some studies have assessed the pathologic and oncologic results and suggested that laparoscopic surgery was feasible for T4 colorectal cancer. 108,124 In this study, laparoscopic resection for all the stages of rectal cancer were merged and generally compared with open surgery. In that case, the analysis to some foci of controversy was ignored, such as T4 tumor, resection of primary tumor following nCRT and so on.…”

Intervention Beyond Total Mesorectal Excision in Rectal Cancer: Is Laparoscopic Approach Justified?

“…Одно из наиболее крупных исследований было выполнено китайскими специалистами [32]. Оно являлось ретроспективным и включило 125 больных раком прямой кишки pT4, получивших лечение в Западно-китайский госпитале при Сычуаньском университете.…”