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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

doi: 10.1097/SLA.0b013e31824a99e4
Original Articles

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.

Short- and long-term outcomes of laparoscopic and open resection for incurable stage IV colorectal cancer were examined in a large cohort study. The effectiveness of laparoscopic surgery was clarified.

*Department of Surgery, Kyoto University Hospital, Kyoto

Translational Research Center, Kyoto University Hospital

Department of Gastroenterological Surgery, Oita University Faculty of Medicine

§Department of Colorectal & Pelvic Surgery, National Cancer Hospital East

Gastroenterological Center, Department of Gastroenterological Surgery, Cancer Institute ARIAKE Hospital

Department of Gastroenterological Surgery, Osaka Red Cross Hospital

#Department of Surgery, Fukuyama Municipal Hospital

**Department of Surgery, Kitasato University School of Medicine

††Department of Surgery, Nishi-Kobe Medical Center, Japan.

Reprints: Koya Hida, MD, PhD, Division of Gastrointestinal Surgery, Department of Surgery, Kyoto University Hospital, 54 Shogoin Kawahara-cho, Sakyo-ku, Kyoto 606–8507, Japan. E-mail:

Disclosure: The authors declare no conflict of interest. Support for this study was received from the Japan Society of Laparoscopic Colorectal Surgery and the Japanese Society for Cancer of the Colon and Rectum.

© 2012 Lippincott Williams & Wilkins, Inc.