Surgical resection of T4 colon cancers: an NCDB propensity score-matched analysis of open, laparoscopic, and robotic approaches

Parascandola, Salvatore A.; Horsey, Michael L.; Hota, Salini; Sparks, Andrew; Tampo, Mayou Martin T.; Kim, George; Obias, Vincent

doi:10.1007/s11701-020-01166-4

Cited by 9 publications

(9 citation statements)

References 19 publications

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“…The rate of R1 in the LAP group was similar to rates reported in randomised controlled trials. The overall increased rate of R1 resections in the OPEN group which remained significant despite adjustment for characteristics associated with more advanced tumours and in the weighted analysis is similar to findings reported in recent register studies 12,15 . R1 resection is a wellknown negative prognostic factor affecting long-term survival and follow-up is required to evaluate if the increase www.nature.com/scientificreports/ in positive margins seen in this study will lead to long term survival benefits following LAP compared to OPEN as indicated in few population based studies 19,37 .…”

Section: Discussionsupporting

confidence: 86%

“…Regardless of the approach, the resection must follow essential oncological principles including central ligation of the primary vessel, proper mesocolic excision, an adequate resection margin and a surgical specimen containing a minimum of 12 lymph nodes [5][6][7][8][9] . It can be technically challenging to perform laparoscopically for T4 tumours although recent meta-analyses and register studies have indicated that LAP is safe and possibly even superior with regard to oncological outcomes when compared to OPEN even for T4 tumours [10][11][12] .…”

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confidence: 99%

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Short term results in a population based study indicate advantage for laparoscopic colon cancer surgery versus open

Petersson

Matthiessen

Jadid

et al. 2023

Sci Rep

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The aim of this study was to compare LAP with OPEN regarding short-term mortality, morbidity and completeness of the cancer resection for colon cancer in a routine health care setting using population based register data. All 13,683 patients who were diagnosed 2012–2018 and underwent elective surgery for right-sided or sigmoid colon cancer were included from the Swedish Colorectal Cancer Registry and the National Patient Registry. Primary outcome was 30-day mortality. Secondary outcomes were 90-day mortality, length of hospital stay, reoperation, readmission and positive resection margin (R1). Weighted and unweighted multi regression analyses were performed. There were no difference in 30-day mortality: LAP (0.9%) and OPEN (1.3%) (OR 0.89, 95% CI 0.62–1.29, P = 0.545). The weighted analyses showed an increased 90-day mortality following OPEN, P < 0.001. Re-operations and re-admission were more frequent after OPEN and length of hospital stay was 2.9 days shorter following LAP (P < 0.001). R1 resections were significantly more common in the OPEN group in the unweighted and weighted analysis with P = 0.004 and P < 0.001 respectively. Therefore, the favourable short-term outcomes following elective LAP versus OPEN resection for colon cancer in routine health care indicate an advantage of laparoscopic surgery.

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Section: Discussionsupporting

confidence: 86%

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confidence: 99%

Short term results in a population based study indicate advantage for laparoscopic colon cancer surgery versus open

Petersson

Matthiessen

Jadid

et al. 2023

Sci Rep

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“…Recently, there had also been studies on the safety and effectiveness of robot approaches for T4 colon cancer (68)(69)(70). An NCDB propensity score-matched analysis of open, laparoscopic, and robotic approaches demonstrated that compared with T4 colon cancer open resection, laparoscopic and robot-assisted surgery had achieved better tumor prognosis and survival rate and robot-assisted surgery was significantly associated with a lower conversion rate compared with laparoscopic surgery (69). This case-matching study demonstrated the safety of using minimally invasive techniques in T4 colon cancers (69).…”

Section: Discussionmentioning

confidence: 99%

Laparoscopic vs. open colectomy for T4 colon cancer: A meta-analysis and trial sequential analysis of prospective observational studies

et al. 2022

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BackgroundTo evaluate short- and long-term outcomes of laparoscopic colectomy (LC) vs. open colectomy (OC) in patients with T4 colon cancer.MethodsThree authors independently searched PubMed, Web of Science, Embase, Cochrane Library, and Clinicaltrials.gov for articles before June 3, 2022 to compare the clinical outcomes of T4 colon cancer patients undergoing LC or OC.ResultsThis meta-analysis included 7 articles with 1,635 cases. Compared with OC, LC had lesser blood loss, lesser perioperative transfusion, lesser complications, lesser wound infection, and shorter length of hospital stay. Moreover, there was no significant difference between the two groups in terms of 5-year overall survival (5y OS), and 5-year disease-free survival (5y DFS), R0 resection rate, positive resection margin, lymph nodes harvested ≥12, and recurrence. Trial Sequential Analysis (TSA) results suggested that the potential advantages of LC on perioperative transfusion and the comparable oncological outcomes in terms of 5y OS, 5y DFS, lymph nodes harvested ≥12, and R0 resection rate was reliable and no need of further study.ConclusionsLaparoscopic surgery is safe and feasible in T4 colon cancer in terms of short- and long-term outcomes. TSA results suggested that future studies were not required to evaluate the 5y OS, 5y DFS, R0 resection rate, positive resection margin status, lymph nodes harvested ≥12 and perioperative transfusion differences between LC and OC.Systematic Review Registration:https://www.crd.york.ac.uk/PROSPERO/, identifier: CRD42022297792.

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“…Several large-scale studies showed that both laparoscopic and robotic approaches are correlated with lower morbidity and mortality and improved survival in T4 colon and rectal cancers. 2 Furthermore, the lack of standardization in colonic neoplasia preoperative staging can have significant effects on treatment strategy. 3 In this study, only two-thirds of patients actually had T4 colon cancer, where HIPEC may confer some real benefit.…”

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confidence: 99%

Efficacy, Safety, and Analysis Issues in a Study of Intraoperative Hyperthermic Intraperitoneal Chemotherapy for Locally Advanced Colon Cancer

Horesh

Emile

2023

JAMA Surg

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Surgical resection of T4 colon cancers: an NCDB propensity score-matched analysis of open, laparoscopic, and robotic approaches

Cited by 9 publications

References 19 publications

Short term results in a population based study indicate advantage for laparoscopic colon cancer surgery versus open

Short term results in a population based study indicate advantage for laparoscopic colon cancer surgery versus open

Laparoscopic vs. open colectomy for T4 colon cancer: A meta-analysis and trial sequential analysis of prospective observational studies

Efficacy, Safety, and Analysis Issues in a Study of Intraoperative Hyperthermic Intraperitoneal Chemotherapy for Locally Advanced Colon Cancer

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