Annals of Surgery

Skip Navigation LinksHome > May 2012 - Volume 255 - Issue 5 > Open Versus Laparoscopic Resection of Primary Tumor for Incu...
Annals of Surgery:
doi: 10.1097/SLA.0b013e31824a99e4
Original Articles

Open Versus Laparoscopic Resection of Primary Tumor for Incurable Stage IV Colorectal Cancer: A Large Multicenter Consecutive Patients Cohort Study

Hida, Koya MD, PhD*,††; Hasegawa, Suguru MD, PhD*; Kinjo, Yousuke MD*; Yoshimura, Kenichi PhD; Inomata, Masafumi MD, PhD; Ito, Masaaki MD, PhD§; Fukunaga, Yosuke MD, PhD; Kanazawa, Akiyoshi MD, PhD; Idani, Hitoshi MD, FACS, PhD#; Sakai, Yoshiharu MD, FACS, PhD*; Watanabe, Masahiko MD, FACS, PhD**; the Japan Society of Laparoscopic Colorectal Surgery

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Objective: To investigate the hypothesis that laparoscopic primary tumor resection is safe and effective when compared with the open approach for colorectal cancer patients with incurable metastases.

Background: There are only a few reports with small numbers of patients on laparoscopic tumor resection for stage IV colorectal cancer.

Methods: Data from consecutive patients who underwent palliative primary tumor resection for stage IV colorectal cancer between January 2006 and December 2007 were collected retrospectively from 41 institutions. Short- and long-term outcomes were compared between patients who underwent laparoscopic or open resection.

Results: A total of 904 patients (laparoscopic group: 226, open group: 678) with a median age of 64 years (range: 22–95) were included in the analysis. Conversion was required in 28 patients (12.4%) and the most common reasons for conversion (23/28: 82%) were bulky or invasive tumors. There was no 30-day postoperative mortality in either group. The complication rate (NCI-CTCAE grade 2–4) after laparoscopic surgery (17%) was significantly lower than that after open surgery (24%) (P = 0.02), and the difference was greater (4% vs 12%; P < 0.001) when we limited the analysis to severe (≥grade 3) complications. The median length of postoperative hospital stay in the laparoscopic group was significantly shorter than that in the open group (14 vs 17 days; P = 0.002). In univariate analysis, overall survival for the laparoscopic group was significantly better than that for open surgery (median survival time: 25.9 vs 22.3 months, P = 0.04), although no difference was apparent in multivariate analysis.

Conclusions: Compared with open surgery, laparoscopic primary tumor resection has advantages in the short term and no disadvantages in the long term. It is a reasonable treatment option for certain stage IV colorectal cancer patients with incurable disease.

© 2012 Lippincott Williams & Wilkins, Inc.


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