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Original Article |
1 Department of Surgery, National Taiwan University Hospital and College of Medicine, Taipei, Taiwan
2 Department of Family Medicine, National Taiwan University Hospital and College of Medicine, Taipei, Taiwan
3 Department of Pathology, National Taiwan University Hospital and College of Medicine, Taipei, Taiwan
4 Division of Colorectal Surgery, Department of Surgery, National Taiwan University Hospital, Taipei, Taiwan, R.O.C.
Correspondence: Address correspondence and reprint requests to: Jin-Tung Liang, MD, PhD, Division of Colorectal Surgery, Department of Surgery, National Taiwan University Hospital, No. 7, Chung-Shan South Road, Taipei, Taiwan, R.O.C.; E-mail: jintung{at}ha.mc.ntu.edu.tw
Introduction: Minimal invasive surgical approach can achieve quick functional recovery. However, the oncologic outcome for cancer is still a concern. This study aims to compare the oncologic outcome between laparoscopic and open methods in the curative resection of Stage II or III left-sided colon cancers.
Methods: In consideration of statistical power up to 90%, 286 eligible patients with curable left-sided colon cancer (Tumor-Node-Metastasis Stage II and Stage III disease) requiring the takedown of colonic splenic flexure to facilitate a curative left hemicolectomy were recruited randomly and equally allocated to the laparoscopic and open group. The primary endpoint was time-to-recurrence of tumor. Data was analyzed according to intention-to-treat principle.
Results: Postrandomization exclusion occurred because of metastatic disease detected intraoperatively occurred in 13 patients and because of patient withdrawal from trial in 4. Therefore, 135 and 134 patients actually comprised the laparoscopic and open group, respectively. The median follow-up of patient was 40 months (range: 18–72 months). The oncologic results were similar (P = 0.362, one-sided log-rank test) in laparoscopic and open group of patients, with the estimated cumulative recurrence rate of 13.2% (9/68) versus 17.2% (11/64) in Stage II disease and 20.9% (14/67) versus 25.7% (18/70) in Stage III disease, respectively. The recurrence patterns were similar between the two groups. Both open and laparoscopic groups were comparable in the number of dissected lymph node (15.6 ± 3.0 vs. 16.0 ± 6.0, P = 0.489), various demographic and clinicopathologic parameters.
Conclusions: The estimated cumulative recurrence rate for the surgery of Stage II or III left-sided colon cancers was the same between laparoscopic and open methods.
Key Words: Laparoscopic surgery • Left colon cancer • Randomized trial • Laparoscopic left hemicolectomy for cancer
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