Survival after laparoscopic and open surgery for colon cancer: a comparative, single-institution study

Abstract

BackgroundSome recent studies have suggested that laparoscopic surgery for colorectal cancer may provide a potential survival advantage when compared with open surgery. This study aimed to compare cancer-related survivals of patients who underwent laparoscopic or open resection of colon cancer in the same, high volume tertiary center.MethodsPatients who had undergone elective open or laparoscopic surgery for colon cancer between January 2002 and December 2010 were analyzed. A clinical database was prospectively compiled. Survival analysis was calculated by using the Kaplan-Meier method.ResultsA total of 460 resections were performed. There were no significant differences between the laparoscopic (n = 227) and the open group (n = 233) apart from tumor stage: stage I tumors were more frequent in the laparoscopic group whereas stage II tumors were more frequent in the open group. The mean number of harvested lymph nodes was significantly higher in the laparoscopic than in the open group (20.0 ± 0.7 vs 14.2 ± 0.5, P < 0.01). The 5-year cancer-related survival for patients undergoing laparoscopic resection was significantly higher than that following open resections (83.1% vs 68.5%, P = 0.01). By performing a stage-to-stage comparison, we found that the improvement in survival in the laparoscopic group occurred mainly in patients with stage II tumors.ConclusionsOur study shows a survival advantage for patients who had undergone laparoscopic surgery for stage II colon cancer. This may be correlated with a higher number of harvested lymph nodes and thus a better stage stratification of these patients.

Comparison of Oncologic Outcomes in Laparoscopic versus Open Surgery for Non-Metastatic Colorectal Cancer: Personal Experience in a Single Institution

“…Previously randomized controlled studies demonstrated that LR benefits favorable operative outcomes with less pain, quick recovery of the gastrointestinal tract, a shorter hospital stay and better cosmetics when compared with OR [19,20].…”

“…Laparoscopy provides a better visualization of intra-abdominal conditions [27], including a wider, clearer and brighter image to allow surgeons to perform a more radical and precise resection of the mesocolon and mesorectum, while facilitating an accurate and complete lymphadenectomy [28,29]. Complete lymphadenectomy for colorectal cancer is essential for the patient's oncological prognosis due to reduced risk of residual nodal disease, and accurate nodal staging (achieving a better stratification of tumor staging) [19]. We noted no statistical difference in lymph node retrieval number between our two groups.…”

Short- and long-term outcomes of laparoscopic-assisted surgery, mini-laparotomy and conventional laparotomy in patients with Stage I-III colorectal cancer

“…The favourable post-operative complication rate following laparoscopic resection for CRC has been well documented over the past decade. [ 2 5 6 7 8 9 10 11 13 14 15 16 27 28 29 ] However, only a few studies have compared the morbidity outcome following ML and CL approaches for CRC. The present study demonstrated a superior morbidity profile after ML compared with that after CL.…”

Factors influencing lymph node skip metastasis in colorectal cancer: a retrospective study

“…Moreover, the number of patients included in this study was relatively small. The patients who underwent or were converted to open surgery were excluded because the numbers of LNs retrieved are different, which would result in bias . In addition, only about 10% ( n = 35 during the study period) of the patients undergo open surgery for CRC at our centre, which would result in a subgroup too small for reliable statistical analysis.…”

“…Patients with rectal cancer located below the peritoneal reflection were excluded from this study because of the complicated pattern of metastases to the lateral pelvic nodes. Patients with fewer than 12 retrieved LNs, open surgery (because of significant differences in the numbers of harvested lymph nodes between open surgery and laparoscopy), synchronous tumours, neoadjuvant treatment and familial adenomatous polyposis (FAP) were also excluded from the present study. This study was reviewed and approved by the ethics committee of Mianyang Central Hospital.…”