Laparoscopy as a prognostic factor in curative resection for node positive colorectal cancer

Results for a single-institution nonrandomized prospective trial

L. Capussotti, P. Massucco, A. Muratore, M. Amisano, C. Bima, D. Zorzi

Research output: Contribution to journalArticle

41 Citations (Scopus)

Abstract

Background: Several studies reporting preliminary long-term survival data after laparoscopic resections for colonic adenocarcinoma did not show any detrimental effect in comparison with historic studies of laparotomies. A previous randomized study has reported an unforeseen better long-term survival for node-positive patients treated by laparoscopic colectomy. Methods: A single-institution prospective nonrandomized trial compared short- and long-term results of laparoscopic and open curative resection for adenocarcinoma of the left colon or rectum in 255 consecutive patients from January 1996 to December 2000. Results: In this study, 34 left hemicolectomy, 202 anterior resections, and 19 abdominoperineal resections were performed. A total of 74 patients underwent a laparoscopic resection (LR), and 181, an open resection (OR). The tumor site was the descending colon in 32 cases, the sigmoid colon in 98 cases, and the rectum in 125 cases, including 87 mid-low rectal cancers. Ten LR procedures (13.5%) were converted to open surgery. The hospital mortality was 0.08%, and in hospital morbidity was 16.2% for LR and 13.3% for OR (p = 0.56). The median postoperative stay was 1 day shorter for LR (9 days) than for OR (10 days) (p = 0.09). The mean number of lymph nodes retrieved were 13.8 ± 5.7 for OR and 12.7 ± 5; for LR (p = 0.23). Age exceeding 70 years, T stage, N stage, grading, mid-low rectal site, and laparoscopy were found by multivariate analysis to be significant prognostic factors for disease-free and cancer-related survival. When patients were stratified by stage, a trend toward a better disease-free and cancer-related survival was identifyed in stage III patients undergoing LR. Conclusions: Laparoscopic colonic resection is a safe procedure in terms of postoperative outcome and long-term survival. Multivariate analysis showed that laparoscopy is a positive prognostic factor for disease-free and cancer-related survival. The current data agrees with the data for the only randomized study reported so far. Both suggest a better outcome for node-positive patients treated by laparoscopy.

Original languageEnglish
Pages (from-to)1130-1135
Number of pages6
JournalSurgical Endoscopy and Other Interventional Techniques
Volume18
Issue number7
Publication statusPublished - Jul 2004

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Laparoscopy
Colorectal Neoplasms
Survival
Rectum
Neoplasms
Adenocarcinoma
Multivariate Analysis
Descending Colon
Colectomy
Sigmoid Colon
Rectal Neoplasms
Hospital Mortality
Laparotomy
Colon
Lymph Nodes
Morbidity

Keywords

  • Colorectal neoplasms
  • Laparoscopy

ASJC Scopus subject areas

  • Surgery

Cite this

Laparoscopy as a prognostic factor in curative resection for node positive colorectal cancer : Results for a single-institution nonrandomized prospective trial. / Capussotti, L.; Massucco, P.; Muratore, A.; Amisano, M.; Bima, C.; Zorzi, D.

In: Surgical Endoscopy and Other Interventional Techniques, Vol. 18, No. 7, 07.2004, p. 1130-1135.

Research output: Contribution to journalArticle

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abstract = "Background: Several studies reporting preliminary long-term survival data after laparoscopic resections for colonic adenocarcinoma did not show any detrimental effect in comparison with historic studies of laparotomies. A previous randomized study has reported an unforeseen better long-term survival for node-positive patients treated by laparoscopic colectomy. Methods: A single-institution prospective nonrandomized trial compared short- and long-term results of laparoscopic and open curative resection for adenocarcinoma of the left colon or rectum in 255 consecutive patients from January 1996 to December 2000. Results: In this study, 34 left hemicolectomy, 202 anterior resections, and 19 abdominoperineal resections were performed. A total of 74 patients underwent a laparoscopic resection (LR), and 181, an open resection (OR). The tumor site was the descending colon in 32 cases, the sigmoid colon in 98 cases, and the rectum in 125 cases, including 87 mid-low rectal cancers. Ten LR procedures (13.5{\%}) were converted to open surgery. The hospital mortality was 0.08{\%}, and in hospital morbidity was 16.2{\%} for LR and 13.3{\%} for OR (p = 0.56). The median postoperative stay was 1 day shorter for LR (9 days) than for OR (10 days) (p = 0.09). The mean number of lymph nodes retrieved were 13.8 ± 5.7 for OR and 12.7 ± 5; for LR (p = 0.23). Age exceeding 70 years, T stage, N stage, grading, mid-low rectal site, and laparoscopy were found by multivariate analysis to be significant prognostic factors for disease-free and cancer-related survival. When patients were stratified by stage, a trend toward a better disease-free and cancer-related survival was identifyed in stage III patients undergoing LR. Conclusions: Laparoscopic colonic resection is a safe procedure in terms of postoperative outcome and long-term survival. Multivariate analysis showed that laparoscopy is a positive prognostic factor for disease-free and cancer-related survival. The current data agrees with the data for the only randomized study reported so far. Both suggest a better outcome for node-positive patients treated by laparoscopy.",
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