A single surgeon's experience with 54 consecutive cases of multivisceral resection for locally advanced primary colorectal cancer: can the laparoscopic approach be performed safely?

BACKGROUND: Laparoscopic resection for colorectal cancer has become popular. However, no previous studies have compared the laparoscopic and open approaches for colorectal cancer adherent to adjacent organs. This study analyzed the short- and long-term survival outcomes after laparoscopic multivisceral resection of the locally advanced primary colorectal cancer compared with open procedure in an effort to address appropriate patient selection.
METHODS: From a prospectively collected database, 54 patients with locally advanced primary colorectal cancer who had undergone multivisceral resection from March 2001 to September 2009 were identified. Laparoscopic and open surgeries were selectively performed for 38 and 16 patients, respectively.
RESULTS: The two groups had similar demographics, with no differences in age, sex, and comorbidity. However, five emergency or urgency operations were included in the open group. No differences existed between the two groups in terms of tumor node metastasis (TNM) staging, histologic tumor infiltration rates, or curative resection rates. Three patients (7.9%) in the laparoscopic group required conversion to open procedure. In the laparoscopic group, the operation time was longer (330 vs. 257 min; p = 0.018), the volume of blood loss was less (269 vs. 638 ml; p = 0.000), and the time until return of bowel movement was shorter (3.7 vs. 4.7 days; p = 0.029) than in the open group. The perioperative morbidity rates were similar in the two groups (21.1% vs. 43.7%; p = 0.107), and no perioperative mortality occurred in either group. The mean follow-up period after curative resection was 40 months in the laparoscopic group and 35 months in the open group. The two groups showed similar rates for local recurrence (7.7% vs. 27.3%; p = 0.144) and distant metastasis (15.4% vs. 45.5%; p = 0.091). The overall 5-year survival rate was 60.5% for the laparoscopic group and 47.7% for the open group (p = 0.044, log-rank test). In terms of TNM stages, the overall 5-year survival rate for pathologic stage 3 disease was 58.3% for the laparoscopic group and 25% for the open group (p = 0.022, log rank test), but no difference was noted for the stage 2 patients (p = 0.384).
CONCLUSIONS: No adverse long-term oncologic outcomes of laparoscopic resection were observed in this study. Although inherent limitations exist in this nonrandomized study, laparoscopic multivisceral resection seems to be a feasible and effective treatment option for colorectal cancer for carefully selected patients. Patients with colon cancer should be much more carefully selected for laparoscopic multivisceral resection than patients with rectal cancer because anatomic uncertainty can make oncologic en bloc resection incomplete.