T4 colorectal cancer: is laparoscopic resection contraindicated?

Bretagnol, F.; Dedieu, A.; Zappa, Magaly; Guedj, Nathalie; Ferron, Marianne; Panís, Yves

doi:10.1111/j.1463-1318.2010.02380.x

Cited by 81 publications

(71 citation statements)

References 21 publications

(37 reference statements)

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“…Previous studies of laparoscopic multivisceral resection have reported that the morbidity ranged from 21 to 33% (7-9), and our series was comparable with those of the previous studies. The incidence of complications in the MPS group in the present study was higher compared with that of other reports (7)(8)(9). Even minor complications that might have little or no influence on postoperative hospital stay or mortality were counted.…”

Section: Discussioncontrasting

confidence: 53%

“…Because of increased the experience with laparoscopic approach for locally advanced colon cancer, the opportunities for adopting laparoscopic surgery for advanced colon cancer invading or adhering to neighboring organs or structures are considered to be increasing. Several studies have demonstrated that laparoscopic multivisceral resection for advanced colorectal cancer was safe and feasible in selected patients (7)(8)(9).…”

Section: Introductionmentioning

confidence: 99%

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Safety and feasibility of single‑port laparoscopic multivisceral resection for locally advanced left colon cancer

et al. 2018

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Abstract. The aim of the present study was to evaluate the safety and feasibility of single-port laparoscopic multivisceral resection (S-MVR) for locally advanced left colon cancer. S-MVR is a challenging technique and to the best of our knowledge this is the first report of S-MVR for left colon cancer invading or adhering to neighboring organs. A retrospective review was conducted of patients who underwent laparoscopic multivisceral resection for locally advanced left colon cancer invading or adhering to neighboring organs from January 2008 to December 2014. Short-term and long-term outcomes were analyzed between groups of patients who underwent S-MVR and multi-port laparoscopic multivisceral resection (M-MVR) retrospectively. A total of 14 patients underwent S-MVR and 15 patients underwent M-MVR. There were no significant differences between groups in terms of operative factors and postoperative complications. The length of hospital stay was significantly shorter in the S-MVR group compared with the M-MVR group (P=0.048). Three-year overall survival was 61.9% in the S-MVR group (n=14). In patients with stage II (P=0.600) and III (P=0714) disease the three-year overall and disease-free survival was 81.8 and 58.3% in the S-MVR group and 80.0 and 70% in the M-MVR groups over a median follow-up of 34 months. In conclusion, S-MVR for locally advanced left colon cancer is safe and feasible in selected patients.

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Section: Discussioncontrasting

confidence: 53%

Section: Introductionmentioning

confidence: 99%

Safety and feasibility of single‑port laparoscopic multivisceral resection for locally advanced left colon cancer

et al. 2018

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“…This surgical strategy avoids excessive tumor handling or incorrect oncologic dissection by the laparoscopic approach, thus reducing the risk of tumor cell spillage and potentially adverse oncologic outcomes. Recently, some retrospective studies have specifically investigated oncologic outcomes in T4 colorectal cancer patients after laparoscopic resection [37][38][39], concluding that a laparoscopic approach to T4 colorectal cancer is safe and does not affect oncologic outcomes compared with the open approach. However, RCTs are needed to confirm these suggestions.…”

Section: Discussionmentioning

confidence: 99%

Does conversion affect short-term and oncologic outcomes after laparoscopy for colorectal cancer?

et al. 2013

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Background Conversion of laparoscopic colorectal resection (LCR) for cancer has been associated with adverse short-term and oncologic outcomes. However, most studies have had small sample sizes and short follow-up periods. This study aimed to evaluate the impact of conversion to open surgery on early postoperative outcomes and survival among patients undergoing LCR for nonmetastatic colorectal cancer. Methods A prospective database of consecutive LCRs for nonmetastatic colorectal cancer was reviewed. Patients who required conversion (CONV group) were compared with those who had completed laparoscopic resection (LAP group). Only patients with a minimum 5-year follow-up period were included in the oncologic analysis. Kaplan-Meier curves were compared to analyze survival. A multivariate analysis was performed to identify predictors of poor survival. Results The conversion rate was 10.9 %. The most common reason for conversion was a locally advanced tumor (48.4 %). Conversion was associated with a significantly longer operative time and a greater blood loss. No differences were observed in terms of postoperative morbidity, mortality, or hospital stay between the CONV and LAP patients. During a median follow-up period of 120 months (range, 60-180 months), the CONV group had a significantly worse 5-year overall survival (OS) (79.4 vs 87.4 %; p = 0.016) and disease-free survival (DFS) (65.4 vs 79.6 %; p = 0.013). Univariate analysis showed that conversion to open surgery, postoperative complications, anastomotic leakage, pT4 cancer, stage 3 disease, and adjuvant chemotherapy were significant risk factors for OS and DFS. On multivariate analysis, pT4 cancer and a lymph node ratio (LNR) of 0.25 or greater were the only independent predictors of DFS and OS, whereas a LNR of 0.01 to 0.24 showed a trend that did not reach statistical significance. Recent large RCTs [5,6] as well as a systematic review and metaanalysis of the literature [7] have reported similar advantages of laparoscopic rectal resection and total mesorectal excision (TME) compared with open surgery for extraperitoneal rectal cancer. Evidence from the literature also has shown comparable outcomes in terms of oncologic clearance and long-term survival between laparoscopic and open resection for colon [1,[8][9][10] and rectal cancer [10][11][12]. The rates for conversion of laparoscopic colon resection to open surgery reported in the largest multicenter RCTs range from 17 to 25 % [2-4], whereas the conversion rates for laparoscopic rectal resection vary between 0.6 and 32.4 % [7]. With the exception of the conventional versus laparoscopic-associated surgery in colorectal cancer (CLASICC) trial, all RCTs have analyzed converted patients in the laparoscopic group on an "intention-to-treat" basis. A few nonrandomized studies have examined the short-term outcomes for converted cancer patients. Some studies have reported higher morbidity and mortality rates and a longer postoperative hospital stay [3,[13][14][15][16][17][18], whereas others did not find si...

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“…If the base of seminal vesicle is involved, the ureters are usually spared. One of the initial reports on laparoscopic multi visceral resection comes from Bretagnol et al [21] . In this study, there were 12 locally advanced rectal cancers with adjacent organ involvement.…”

Section: Extended Resectionmentioning

confidence: 99%

“…Bretagnol et al [21] assessed feasibility and oncological outcomes of laparoscopic surgery for cT4 colorectal cancer and suggested that locally advanced rectal cancer cannot be considered as absolute contraindication. A multicenter propensity score-matched analysis of laparoscopic surgery vs. open surgery for T4 rectal cancer by de' Angelis et al [22] suggested that laparoscopic surgery can achieve good pathological and oncological outcomes similar to open surgery with faster recovery and shorter hospital stay, despite the risk of conversion.…”

Section: Introductionmentioning

confidence: 99%

Minimal invasive approach for beyond total mesorectal excision/extended resections in rectal cancer

Kumar¹,

Kammar²,

Saklani³

2018

MIS

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Minimal invasive surgery (MIS) is an accepted modality of treatment for rectal cancer. The indications for MIS have gradually been extended to locally advanced and locally recurrent rectal cancer as a result of technological advances in instrumentation, advances in surgical techniques, increased surgeon experience, and high volume center. However, safety and feasibility of laparoscopic surgery and robotic surgery in beyond total mesorectal excision (b-TME) and extended TME (e-TME) are not well established. This review summarizes the current evidence for MIS approach for b-TME/extended resections in rectal cancer. A systematic search was carried out in PubMed. Studies available in English related to MIS approach in b-TME/e-TME in rectal cancers were identified and evaluated. This review concludes MIS is feasible with good perioperative outcomes in b-TME/e-TME in carefully selected patients. Laparoscopic surgery has considerable learning curve and should be performed by experienced surgical teams. Robotic surgery is feasible and beneficial in complex resection in pelvis. However, evidence for long-term oncological outcomes of MIS in b-TME/e-TME is low and needs to be studied further by randomized controlled trial once enough numbers are possible in institutes with high volume rate.

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T4 colorectal cancer: is laparoscopic resection contraindicated?

Abstract: This study suggests that laparoscopic surgery is feasible for colorectal T4 cancer resection. Laparoscopy cannot therefore be considered an absolute contraindication for T4 colorectal cancer.

Cited by 81 publications

References 21 publications

Safety and feasibility of single‑port laparoscopic multivisceral resection for locally advanced left colon cancer

Safety and feasibility of single‑port laparoscopic multivisceral resection for locally advanced left colon cancer

Does conversion affect short-term and oncologic outcomes after laparoscopy for colorectal cancer?

Minimal invasive approach for beyond total mesorectal excision/extended resections in rectal cancer

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