Safety and feasibility of laparoscopic multivisceral resection for surgical T4b colon cancers: Retrospective analyses

Takahashi, Ryo; Hasegawa, Suguru; Hirai, Kunio; Hisamori, Shigeo; Hida, Koya; Kawada, Kenji; Sakai, Yoshiharu

doi:10.1111/ases.12355

Cited by 32 publications

(38 citation statements)

References 28 publications

(46 reference statements)

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“…Regarding pathological subgroups of pT4, one study included only pT4a stage [ 13 ], and in nine other studies, mainly (>60%) pT4a patients were included [ 11 , 14 , 17 – 19 , 21 – 23 , 25 ]. In two studies, MVR was the main focus, resulting in mostly pT4b stage [ 16 , 20 ]. In eight studies, patients with metastatic disease were excluded.…”

Section: Resultsmentioning

confidence: 99%

“…In eight studies, patients with metastatic disease were excluded. Emergency procedures were included in five studies [ 13 – 15 , 18 , 19 ], excluded in six other studies [ 11 , 12 , 16 , 21 – 23 ], and not mentioned in the two remaining studies [ 17 , 20 ].…”

Section: Resultsmentioning

confidence: 99%

“…Conversion rates varied from 5.6 to 23%, with a pooled proportion of 0.11 (95% CI:0.09–0.14). In six of the eight comparative studies that also included MVR [ 11 , 14 , 15 , 17 , 19 , 22 ], the proportion of MVR was higher in the open subgroups and the remaining two comparative studies included 100% MVR [ 20 , 24 ].…”

Section: Resultsmentioning

confidence: 99%

“…Inequality in distribution of T4a and T4b stages between the laparoscopic and open groups may significantly influence the results of comparative studies. In six of the included comparative studies, the proportion of T4b was substantially higher in the open group [ 14 , 15 , 17 – 20 ]. To overcome these methodological problems, Elnahas et al excluded T4b stage [ 13 ] and Nagasue selected only MVR [ 24 ].…”

Section: Discussionmentioning

confidence: 99%

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

et al. 2017

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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.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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

et al. 2017

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“…A study by Shukla et al [ 18 ] showed that laparoscopic surgery is feasible in T4 colon cancers and suggested that laparoscopy can be considered an alternative approach for T4 colon cancers with the advantage of a higher recovery rate. Takahashi et al [ 16 ] reviewed 84 T4b colon cancer patients who underwent laparoscopic MVR and revealed that the laparoscopy approach can be considered for surgical T4b cancers, except for urinary tract invasion patients who may require visceral reconstruction. Further, Yamanashi et al [ 17 ] demonstrated that selected LACC patients should not be excluded from laparoscopic surgery.…”

Section: Introductionmentioning

confidence: 99%

Feasibility and Safety of Laparoscopic Radical Colectomy for T4b Colon Cancer at a University Hospital in Vietnam

Nguyen

Tran

Thai

et al. 2020

BioMed Research International

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Background. The choice of optimal treatment strategies for T4b colon cancers has still been discussed, particularly the initiation of neoadjuvant therapy or surgery. We conducted this study to evaluate the safety and feasibility of laparoscopic multivisceral resection for T4b colon cancers. Methods. We used the retrospective design to include all 43 patients with T4b colon cancer at a university hospital in Vietnam from March 2017 to March 2019. All patients were followed 30 days after the surgery, and information about the day of the first flatus, length of hospital stay, iatrogenic complications, postoperative morbidity, mortality, and adjuvant chemotherapy was collected. Results. The mean operating time was 187 minutes (ranging from 80 to 310), the mean blood loss was 64.3 ml (5-200), and the conversion rate was 2.3%. The mean number of lymph nodes harvested was 15.5 ( SD = 8.06 ), and 33 patients (76.7%) had at least 12 lymph nodes harvested. A total of 21 patients (48.8%) had lymph node metastases with a mean number of lymph node metastases of 1.89 ( SD = 3.4 ). The radial resection margin was R0 in all 43 patients (100%). The median time until the first flatus and hospital stay were 3 days (2–5) and 7.1 (6–11) days, respectively. There was no mortality at 30 days postoperatively, and one patient had iatrogenic complication (2.3%). Conclusion. Laparoscopic radical colectomy was feasible and safe for patients with T4b colon cancer except those requiring major and complicated reconstruction.

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Short‐term and long‐term outcomes of laparoscopic colectomy with multivisceral resection for surgical T4b colon cancer: Comparison with open colectomy

Miyo

Kato

Takahashi

et al. 2020

Annals of Gastroent Surgery

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Aim In response to the rising use of laparoscopic surgery, recent studies have shown that laparoscopic multivisceral resections for locally advanced colon cancer are safe, feasible, and provide acceptable oncological outcomes. However, the usefulness of laparoscopic multivisceral resection remains controversial. Here, we aimed to compare short‐term and long‐term outcomes between laparoscopic and open multivisceral resection approaches for treating locally advanced colon cancer. Methods We retrospectively collected data on 1315 consecutive patients admitted to the National Hospital Organization, Osaka National Hospital, for surgical treatment of colorectal cancer between 2010 and 2017. We assessed invasiveness in terms of operating times, blood loss, and complications. Oncological outcomes included 5‐year survival rates and recurrences. Results We included 85 patients that underwent a colectomy with a multivisceral resection for locally advanced colon cancer; of these, 38 were treated with a laparoscopic approach and 47 were treated with an open approach. Compared to the open surgery group, the laparoscopic group had significantly less blood loss (median volume: 25 vs 140 mL, P <0.001), a lower complication rate (10.5% vs 29.8%, P = 0.036), and shorter hospital stays (12 vs 15 days, P = 0.028). After excluding patients with stage Ⅳ colon cancer, the groups showed similar pathologic outcomes and no significant differences in 5‐year disease‐free survival (73.9% vs 67.4%; P = 0.664) or 5‐year overall survival (75.8% vs 67.7%; P = 0.695). Conclusion A laparoscopic approach for locally advanced colon cancer could be less invasive than an open approach without affecting oncological outcomes in selected patients.

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Safety and feasibility of laparoscopic multivisceral resection for surgical T4b colon cancers: Retrospective analyses

Abstract: Introduction: Laparoscopic (Lap) surgery has not been established as a standard

Cited by 32 publications

References 28 publications

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

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

Feasibility and Safety of Laparoscopic Radical Colectomy for T4b Colon Cancer at a University Hospital in Vietnam

Short‐term and long‐term outcomes of laparoscopic colectomy with multivisceral resection for surgical T4b colon cancer: Comparison with open colectomy

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