The Outcome of Colonoscopy-Assisted Laparoscopic Wedge Resections (CAL-WR) for Colon Cancer: A Retrospective Cohort Study.

UNLABELLED

Local excision is gaining acceptance as standard treatment for T1 colon cancer (CC); however, not all patients are eligible for endoscopic resection. Colonoscopy-assisted laparoscopic wedge resection (CAL-WR) is a relatively new technique that could fill the gap between endoscopic resection and major surgery. The aim of this study was to analyze the oncological safety of CAL-WR for CC.

METHODS

A retrospective cohort study was performed, including patients that underwent CAL-WR for CC. Exclusion criteria were double tumors, <1 year follow-up, previous other colorectal malignancy, inflammatory bowel disease or synchronous metastases. The primary outcome was disease recurrence and the secondary outcome was overall survival.

RESULTS

Fifty-three patients were included; 35 patients were diagnosed with T1 CC. CAL-WR was radical (R0) for all T1 CC in 94.3% and 94.7% for tumors with deep submucosal invasion (sm2-3 Kikuchi). The mean follow-up was 3.3 years (Q1: 2.0; Q3: 4.3) for disease recurrence and 4.2 years (Q1: 2.8; Q3: 5.2) for overall survival. None of the patients with T1 CC had disease recurrence or died due to their malignancy. There were 14 patients with a T2 and 4 patients with a T3 CC, 17/18 patients underwent completion surgery. Three patients with T2 and one with T3 CC developed a locoregional recurrence (peritoneal). One patient with T3 CC developed lung metastases. Two patients with T3 and one with T2 CC died due to their malignancy.

CONCLUSIONS

This study suggests that CAL-WR is oncologically safe as treatment for T1 CC. The safety of incidental CAL-WR for >T1 CC, followed by completion surgery, remains unclear. Prospective studies are needed to evaluate these results.