Department of Colorectal Surgery Department of Radiology Department of Pathology, Beaujon Hospital (APHP), Clichy, France.
Colorectal Dis. 2011 Feb;13(2):138-43. doi: 10.1111/j.1463-1318.2010.02380.x.
T4 colorectal cancer remains a contraindication for laparoscopy. It is argued that the risk of incomplete resection could be higher than in open surgery. Furthermore, difficulty in dissection could lead to a very high rate of conversion. There is little information on this. The study aimed at assessing feasibility and operative and oncologic results of laparoscopic resection for T4 colorectal cancer.
Between 2006 and 2009, 39 patients with colorectal cancer with suspected involvement of another organ (T4) on computed tomography scanning and/or magnetic resonance imaging were included. The cancers were in the right colon (n = 18), left colon (n =9) and rectum (n = 12). The distribution of possible organ involvement was abdominal or pelvic side-wall (n = 21), urinary bladder (n = 4), small bowel or colon (n = 6), vagina and ovary (n = 3), prostate or seminal vesicles (n = 3) and duodenum (n = 2).
The overall conversion rate was 18%. Postoperative mortality and morbidity were 2.5 and 33%, respectively. Clinical anastomotic leakage rate was 15% (n = 6). Abdominal reoperation was required in three (7%) patients. Pathological invasion to other organs (pT4) was confirmed in 30 (77%) patients. The R1 resection rate was 13% (4 of 30). After a median follow up of 19 months (range 1.5-45 months), the overall survival and disease-free survival rates were 97 and 89%, respectively.
This study suggests that laparoscopic surgery is feasible for colorectal T4 cancer resection. Laparoscopy cannot therefore be considered an absolute contraindication for T4 colorectal cancer.
T4 结直肠癌仍然是腹腔镜手术的禁忌症。有人认为，不完全切除的风险可能高于开放手术。此外，分离的困难可能导致极高的转化率。关于这方面的信息很少。本研究旨在评估腹腔镜 T4 结直肠癌切除的可行性以及手术和肿瘤学结果。
2006 年至 2009 年间，共纳入 39 例 CT 扫描和/或磁共振成像怀疑累及其他器官（T4）的结直肠癌患者。这些癌症位于右结肠（n = 18）、左结肠（n = 9）和直肠（n = 12）。可能涉及的器官包括腹部或盆腔侧壁（n = 21）、膀胱（n = 4）、小肠或结肠（n = 6）、阴道和卵巢（n = 3）、前列腺或精囊（n = 3）和十二指肠（n = 2）。
总的中转率为 18%。术后死亡率和发病率分别为 2.5%和 33%。临床吻合口漏发生率为 15%（n = 6）。有 3 名（7%）患者需要再次进行腹部手术。30 例（77%）患者病理检查证实存在其他器官侵犯（pT4）。R1 切除率为 13%（4/30）。中位随访 19 个月（1.5-45 个月）后，总生存率和无病生存率分别为 97%和 89%。
本研究表明，腹腔镜手术对 T4 结直肠癌切除是可行的。因此，腹腔镜不能被视为 T4 结直肠癌的绝对禁忌症。
