The short-term and oncologic outcomes of laparoscopic versus open surgery for T4 colon cancer

Purpose: To compare R0 resection rates and short-term and oncologic outcomes between laparoscopy and open surgery for T4 colon cancer. Methods: Patients with non-metastatic T4 colon cancer (n = 117) underwent treatment either through laparoscopy (n = 51) or open surgery (n = 66). Conversion to open surgery occurred in seven cases (13.7 %). Results: History of abdominal surgery (2.0 vs. 12.1 %) and emergency operation (2.1 vs. 24.2 %) were less frequent in the laparoscopy group. Conversion to open surgery occurred in seven cases (13.7 %). Resection of adjacent organs was less frequently performed in the laparoscopy group (27.5 vs. 53.0 %, p = .005). The mean operative time (189 vs. 210 min) and rate of 30-day postoperative complications (12 vs. 24 %) were similar between the two groups. Shorter time to soft diet (7 vs. 9 days, p = .018) and hospital stay (14 vs. 18 days, p = .044) were observed in the laparoscopy group. T4b tumor was also less frequent in the laparoscopy group (3.9 vs. 18.2 %, p = .018), while R0 resection rates were similar between the laparoscopy (96.1 %) and open surgery group (95.5 %). The mean number of lymph nodes was 22 in the laparoscopy group and 27 in the open surgery group (p = .021). No differences in 3-year overall survival rate (82.5 vs. 75.7 %), recurrence-free survival rate (61.9 vs. 63.5 %), and local recurrence-free survival rate (89.8 vs. 88.5 %) were observed between the groups. Operation time, blood loss, 30-day complication rate, time to diet, duration of hospital stay, R0 resection rate, 3-year overall and local recurrence-free survival rates showed no difference between the converted and open surgery groups. Conclusions: Our results indicate that laparoscopy is a surgically safe and oncologically acceptable approach and thus could be considered for well-selected patients with T4 colon cancer in order to allow faster short-term recovery.