Comparison of short and long-time outcomes between laparoscopic and conventional open multivisceral resection for primary T4b colorectal cancer

Abstract

Background: This study aimed to compare laparoscopic multivisceral resection (LMVR) with conventional open multivisceral resection (OMVR) for primary T4b colorectal cancer (CRC) in short and long-time outcomes.

Methods: Patients receiving LMVR or OMVR for primary T4b CRC from January 2009 to June 2016 were enrolled. Patients' clinicopathological characteristics and survival data were collected and analyzed. Multivariable analysis was performed to find the factors related with survival. All statistical analysis was performed by SPSS 22.0.

Results: A total of 91 patients (LMVR 38, OMVR 53) were included in this study. Patients undergoing LMVR were associated with smaller incision length (P < 0.001), less blood loss (P = 0.01) and comparable operative time (P = 0.071). Patients in LMVR group also had less time to first flatus (P = 0.025). The results also suggested LMVR could reduce the incidence of postoperative complication. The conversion rate was 28.9%. The 3-year OS was 64.2%, 68.4% in OMVR, LMVR group respectively and the 3-year DFS was 56.6%, 52.6% in OMVR, LMVR group respectively. The Kaplan curves demonstrated that LMVR group had similar OS (P = 0.896) and DFS (P = 0.806) when compared with OMVR group. In addition, the multivariate analysis demonstrated that laparoscopic surgery was not associated with poorer survival.

Conclusion: Not all MVR for T4b CRC should be performed by open procedure, LMVR can be safe and feasible for primary T4b CRC in selected patients. It can faster the postoperative recovery and reduce the incidence of postoperative complication. The OS and DFS are also not inferior to open group.

Keywords: Colorectal cancer; Laparoscopic; Multivisceral resection; Open; Outcomes; T4b.