Sung Uk Bae1,2, Chun-Seok Yang3, Sohyun Kim4, Dae Ro Lim5, Woon Kyung Jeong1, Dae Dong Kim3, Jae Hwang Kim4, Eung Jin Shin5, Yoo Jin Lee6, Ju Yup Lee6, Nam Kyu Kim2, Seong Kyu Baek7. 1. Department of Surgery, School of Medicine, Keimyung University and Dongsan Medical Center, 194 Dongsan-Dong, Jung-Gu, Daegu, 700-712, Republic of Korea. 2. Division of Colorectal Surgery, Department of Surgery, Severance Hospital, Colorectal Cancer Clinic, Yonsei University College of Medicine, Seoul, Republic of Korea. 3. Department of Colorectal Surgery, School of Medicine, Catholic University of Daegu, Gyeongsan, Republic of Korea. 4. Department of Colorectal Surgery, College of Medicine, Yeungnam University, Gyeongsan, Republic of Korea. 5. Section of Colon and Rectal Surgery, Department of Surgery, Soonchunhyang University Bucheon Hospital, Soonchunhyang University College of Medicine, Bucheon, Republic of Korea. 6. Division of Gastroenterology and Hepatology, Department of Internal Medicine, Keimyung University School of Medicine, Daegu, Republic of Korea. 7. Department of Surgery, School of Medicine, Keimyung University and Dongsan Medical Center, 194 Dongsan-Dong, Jung-Gu, Daegu, 700-712, Republic of Korea. sgbeak@dsmc.or.kr.
Abstract
BACKGROUND: This study compared oncologic outcomes between open and laparoscopic surgery following self-expanding metallic stents insertion for obstructing colon cancer. METHODS: This retrospective study included 50 patients who underwent open surgery and 44 patients who underwent laparoscopic surgery for obstructing left-sided colon cancer at four tertiary referral hospitals between June 2005 and December 2013. RESULTS: The median follow-up periods were 48 months and 47 months in the open and laparoscopic groups, respectively. The median operative time, time to soft diet, and length of stay were comparable between the groups. Four cases converted to open surgery (9.1%) in the laparoscopic group. The morbidity within 30 days after surgery was comparable between the groups (OR 0.931; 95% CI 0.357-2.426; p = 0.884). The proximal and distal resection margins, the histologic grade of tumor, TNM stage, median tumor size, and presence of lymphovascular invasion did not differ significantly between the groups. The 5-year overall survival (OS) rates of the open and laparoscopic groups were 67.1% and 71.7% (HR 1.028, 95% CI 0.491-2.15, p = 0.942) and the 5-year disease-free survival (DFS) rates were 55.8% and 61.5% (HR 0.982; 95% CI 0.522-1.847; p = 0.955), respectively. The recurrence pattern did not differ between the groups. Multivariate analysis showed that sex (p = 0.027), nodal stage (p = 0.043), and the proportion of patients receiving postoperative adjuvant chemotherapy (p = 0.002) were independent prognostic factors for OS. The proportion of patients receiving postoperative adjuvant chemotherapy (p = 0.017) was an independent prognostic factor for DFS. CONCLUSIONS: Laparoscopic resection following stent insertion for obstructing colon cancer can be performed safely, with long-term oncologic outcomes comparable with those of open surgery.
BACKGROUND: This study compared oncologic outcomes between open and laparoscopic surgery following self-expanding metallic stents insertion for obstructing colon cancer. METHODS: This retrospective study included 50 patients who underwent open surgery and 44 patients who underwent laparoscopic surgery for obstructing left-sided colon cancer at four tertiary referral hospitals between June 2005 and December 2013. RESULTS: The median follow-up periods were 48 months and 47 months in the open and laparoscopic groups, respectively. The median operative time, time to soft diet, and length of stay were comparable between the groups. Four cases converted to open surgery (9.1%) in the laparoscopic group. The morbidity within 30 days after surgery was comparable between the groups (OR 0.931; 95% CI 0.357-2.426; p = 0.884). The proximal and distal resection margins, the histologic grade of tumor, TNM stage, median tumor size, and presence of lymphovascular invasion did not differ significantly between the groups. The 5-year overall survival (OS) rates of the open and laparoscopic groups were 67.1% and 71.7% (HR 1.028, 95% CI 0.491-2.15, p = 0.942) and the 5-year disease-free survival (DFS) rates were 55.8% and 61.5% (HR 0.982; 95% CI 0.522-1.847; p = 0.955), respectively. The recurrence pattern did not differ between the groups. Multivariate analysis showed that sex (p = 0.027), nodal stage (p = 0.043), and the proportion of patients receiving postoperative adjuvant chemotherapy (p = 0.002) were independent prognostic factors for OS. The proportion of patients receiving postoperative adjuvant chemotherapy (p = 0.017) was an independent prognostic factor for DFS. CONCLUSIONS: Laparoscopic resection following stent insertion for obstructing colon cancer can be performed safely, with long-term oncologic outcomes comparable with those of open surgery.
Authors: Jeanin E van Hooft; Emo E van Halsema; Geoffroy Vanbiervliet; Regina G H Beets-Tan; John M DeWitt; Fergal Donnellan; Jean-Marc Dumonceau; Robert G T Glynne-Jones; Cesare Hassan; Javier Jiménez-Perez; Søren Meisner; V Raman Muthusamy; Michael C Parker; Jean-Marc Regimbeau; Charles Sabbagh; Jayesh Sagar; Pieter J Tanis; Jo Vandervoort; George J Webster; Gianpiero Manes; Marc A Barthet; Alessandro Repici Journal: Gastrointest Endosc Date: 2014-10-15 Impact factor: 9.427
Authors: Seoung Yoon Rho; Sung Uk Bae; Se Jin Baek; Hyuk Hur; Byung Soh Min; Seung Hyuk Baik; Kang Young Lee; Nam Kyu Kim Journal: J Korean Surg Soc Date: 2013-11-26