Department of Colorectal Surgery, Cleveland Clinic Foundation, Cleveland Clinic Main Campus, 9500 Euclid Ave, A30, Cleveland, OH, 44122, USA.
Surg Endosc. 2023 Jul;37(7):5679-5686. doi: 10.1007/s00464-023-09944-5. Epub 2023 Mar 9.
The laparoscopic approach for colon cancer has become widely accepted. However, its safety for T4 tumors, and particularly for T4b tumors when local invasion to adjacent structures occurs, remains controversial. This study aimed to compare short and long-term outcomes in patients undergoing laparoscopic vs. open resection for T4a and T4b colon cancers.
A prospectively maintained, single-institution database was queried to identify patients with pathological stage T4a and T4b colon adenocarcinomas electively operated on between 2000 and 2012. Patients were divided into two groups based on the use of laparoscopy. Patient characteristics, perioperative, and oncologic outcomes were compared.
One hundred and nineteen patients [41 laparoscopic (L), 78 open surgeries (O)] met the inclusion criteria. No difference was observed in age, gender, BMI, ASA, and procedure between groups. Tumors treated by L were smaller than O (p = 0.003). No difference was observed in morbidity, mortality, reoperation, or readmission between the groups. Length of hospital stay was shorter in L than O (6 vs. 9 days, p = 0.005). Conversion to open was necessary in 22% of all T4 tumors laparoscopic cases. However, when tumors were subdivided by pT4 classification, conversion was necessary for 4 of 34 (12%) pT4a patients vs. 5 of 7 (71%) pT4b patients (p = 0.003). In the pT4b cohort (n = 37), more tumors were treated by the open approach (30 vs. 7). For pT4b tumors, the R0 resection rate was 94% (86% in L vs. 97% in O, p = 0.249). The use of laparoscopy did not impact overall survival, disease-free survival, cancer-specific survival, or tumor recurrence overall in all T4 or T4a and T4b tumors.
Laparoscopic surgery can be safely performed in pT4 tumors with similar oncologic outcomes as compared to open surgery. However, for pT4b tumors, the conversion rate is very high. The open approach may be preferable.
腹腔镜治疗结肠癌已被广泛接受。然而，对于局部侵犯邻近结构的 T4 肿瘤，特别是 T4b 肿瘤，其安全性仍存在争议。本研究旨在比较腹腔镜与开腹手术治疗 T4a 和 T4b 结肠癌的短期和长期疗效。
前瞻性维护的单中心数据库中检索 2000 年至 2012 年间选择性接受手术治疗的 T4a 和 T4b 结肠腺癌患者。根据是否使用腹腔镜将患者分为两组。比较患者的一般情况、围手术期和肿瘤学结果。
119 例患者（腹腔镜 41 例，开腹手术 78 例）符合纳入标准。两组患者在年龄、性别、BMI、ASA 和手术方式方面无差异。腹腔镜治疗的肿瘤小于开腹手术（p=0.003）。两组间的发病率、死亡率、再次手术或再入院率无差异。腹腔镜组的住院时间短于开腹组（6 天比 9 天，p=0.005）。所有 T4 肿瘤腹腔镜手术中，有 22%需要转为开腹手术。然而，当按 pT4 分类对肿瘤进行细分时，pT4a 患者中有 4 例（12%）需要转为开腹手术，而 pT4b 患者中有 5 例（71%）需要转为开腹手术（p=0.003）。在 pT4b 组（n=37），更多的肿瘤采用开腹手术治疗（30 例 vs. 7 例）。对于 pT4b 肿瘤，R0 切除率为 94%（腹腔镜组 86%，开腹组 97%，p=0.249）。腹腔镜的使用对所有 T4 或 T4a 和 T4b 肿瘤的总生存、无病生存、癌症特异性生存或肿瘤复发均无影响。
腹腔镜手术治疗 T4 肿瘤是安全的，其肿瘤学结果与开腹手术相似。然而，对于 pT4b 肿瘤，转化率非常高。开腹手术可能更可取。
