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Exploration of the advantages of minimally invasive surgery for clinical T4 colorectal cancer compared with open surgery : A matched-pair analysis
| Title: | Exploration of the advantages of minimally invasive surgery for clinical T4 colorectal cancer compared with open surgery : A matched-pair analysis |
| Authors: | Imaizumi, Ken Browse this author | | Homma, Shigenori Browse this author →KAKEN DB | | Miyaoka, Yoichi Browse this author | | Matsui, Hiroki Browse this author | | Ichikawa, Nobuki Browse this author | | Yoshida, Tadashi Browse this author | | Takahashi, Norihiko Browse this author | | Taketomi, Akinobu Browse this author →KAKEN DB |
| Keywords: | chemotherapy | | clinical T4 | | colorectal cancer | | minimally invasive surgery | | primary tumor resection |
| Issue Date: | 12-Aug-2022 |
| Publisher: | Lippincott Williams & Wilkins (LWW) |
| Journal Title: | Medicine |
| Volume: | 101 |
| Issue: | 32 |
| Start Page: | e29869 |
| Publisher DOI: | 10.1097/MD.0000000000029869 |
| Abstract: | The indications of minimally invasive surgery (MIS) for T4 colorectal cancer are controversial because the advantages of MIS are unclear. Therefore, we compared overall survival (OS) and recurrence-free survival (RFS) as the primary endpoint, and short-term outcome, alteration in perioperative laboratory data, and the interval of postoperative chemotherapy from operation as secondary endpoints, between MIS and open surgery (OPEN) using a matched-pair analysis. We explored the advantages of MIS for T4 colorectal cancer. In this retrospective single-institution study, we included 125 patients with clinical T4 colorectal cancer who underwent curative-intent surgery of the primary tumor between October 2010 and September 2019. Conversion cases were excluded. MIS patients were matched to OPEN patients (ratio of 1:2) according to tumor location, clinical T stage, and preoperative treatment. We identified 25 and 50 patients who underwent OPEN and MIS, respectively, including 31 with distant metastasis. Both groups had similar background characteristics. The rate of major morbidities (Clavien-Dindo grade > III) was comparable between the 2 groups (P = .597), and there was no mortality in either group. MIS tended to result in shorter postoperative hospitalization than OPEN (P = .073). Perioperative alterations in laboratory data revealed that MIS suppressed surgical invasiveness better compared to OPEN. Postoperative chemotherapy, especially for patients with distant metastasis who underwent primary tumor resection, tended to be started earlier in the MIS group than in the OPEN group (P = .075). OS and RFS were comparable between the 2 groups (P = .996 and .870, respectively). In the multivariate analyses, MIS was not a significant prognostic factor for poor OS and RFS. MIS was surgically safe and showed similar oncological outcomes to OPEN-with the potential of reduced invasiveness and enhanced recovery from surgery. Therefore, patients undergoing MIS might receive subsequent postoperative treatments earlier. |
| Type: | article |
| URI: | http://hdl.handle.net/2115/86976 |
| Appears in Collections: | 医学院・医学研究院 (Graduate School of Medicine / Faculty of Medicine) > 雑誌発表論文等 (Peer-reviewed Journal Articles, etc)
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