ORIGINAL ARTICLE   

Minerva Chirurgica 2017 December;72(6):483-90

DOI: 10.23736/S0026-4733.17.07378-3

Copyright © 2017 EDIZIONI MINERVA MEDICA

language: English

Is T4 colon cancer still an absolute contraindication to laparoscopic surgery?

Gabriele BELLIO ✉, Andrea LO CICERO, Vittoria BARBIERI, Paola TARCHI, Biagio CASAGRANDA, Nicolò DE MANZINI

General Surgery Unit, Department of Medical, Surgical and Health Sciences, Cattinara University Hospital, Azienda Sanitaria Universitaria Integrata di Trieste, Trieste, Italy

BACKGROUND: Laparoscopic surgery is widely accepted for colon cancer resection. However, T4 colon cancers have been considered an absolute contraindication to laparoscopic resection. The aim of this study is to evaluate if laparoscopy should still be considered an absolute contraindication to T4 colon cancer, based on a monocenter series recorded in a prospective database.
METHODS: Of 77 patients undergoing elective resection for T4 colon cancer between 2004 and 2015, 39 were performed laparoscopically and were compared to 38 having undergone open resection.
RESULTS: Patient age and American Society of Anesthesiologists score were comparable. Eleven patients initially treated laparoscopically were converted to an open approach (28.2%). There were no statistically significant differences between laparoscopy vs. open concerning tumor stage, R0 resections, operative time, metastatic rate, local recurrence rate or hospital stay. Laparoscopic surgery was associated with less postoperative complications than open surgery (25.6% vs. 52.6%; P=0.020). No statistically significant difference was found with regards to the 3-year overall, tumor-specific and disease-free survivals.
CONCLUSIONS: As there were less postoperative complications, while tumor stage, operative time, hospital stay, R0 resection and survival rates after laparoscopic resection for T4 colonic cancer were not statistically significantly different compared to open surgery, T4 colon cancers are no longer an absolute contraindication to laparoscopic resection in our hospital.

KEY WORDS: Colonic neoplasms - Laparoscopy - Operative surgical procedures - Conversion to open surgery