Laparoscopic colectomy for colon adenocarcinoma: an 11-year retrospective review with 5-year survival rates.
BACKGROUND
Laparoscopic colectomy for the management of colon cancer remains a controversial therapeutic option, especially when the outcomes are compared with the historically accepted survival data and recurrence rates after open surgery. The purpose of this study was to evaluate the 5-year overall and disease-free survival rates after laparoscopic colon resection for invasive colon adenocarcinoma.


METHODS
A total of 129 patients underwent consecutive laparoscopic colectomies for colon adenocarcinoma (between April 1992 and 2004 January) by a single surgeon at a single institution. Records were analyzed retrospectively and follow-up data was obtained. The Student t-test, Cox regression analysis, and Kaplan-Meier survival data were used for statistical analysis.


RESULTS
After patients with noninvasive disease on final pathology were excluded, the study population comprised 88 patients who underwent laparoscopic colectomies for invasive colon cancer with > 2 years of follow-up. Of these cases, 81 (93%) were amenable for complete follow-up at 11years (41 women and 40 men; mean age, 76 years). Mean follow-up was 61 months. There was one perioperative death (1.2%), and the overall postoperative morbidity rate was 13.6%. The average number of lymph nodes harvested was 10.1 (+/-6). There were no port site recurrences. The Kaplan-Meier survival data were as follows for 5-year overall survival and 5-year disease-free survival, respectively stage I (n = 34) 89% and 89%; stage II (n = 22), 65% and 59%; stage III (n = 19), 72% and 67%; stages I-III combined, (n = 75), 77% and 73%.


CONCLUSIONS
For this specific cohort of patients undergoing curative laparoscopic colectomies for invasive colon adenocarcinoma, the mean follow-up was > 5 years. Overall survival and disease-free survival for stage I, II, and III colon cancer as well as for stages I-III combined are favorable and comparable to historically acceptable open colectomy survival rates. Overall survival and disease-free survival after laparoscopic colectomy for invasive colon cancer is no worse, and perhaps better than, the previously reported rates for the same procedure done by an open technique.
Jacob
B P
BP
Department of Laparoscopic Surgery, Mount Sinai School of Medicine, 5 East 98th Street, New York, NY 10029, USA.
Salky
B
B
D000230:Adenocarcinoma / Q000401:mortality / Q000556:secondary / Q000601:surgery*; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015331:Cohort Studies; D003082:Colectomy / Q000379:methods* / Q000706:statistics & numerical data; D003110:Colonic Neoplasms / Q000401:mortality / Q000601:surgery*; D018572:Disease-Free Survival; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D010535:Laparoscopy / Q000379:methods* / Q000706:statistics & numerical data; D015993:Life Tables; D008113:Liver Neoplasms / Q000556:secondary; D008197:Lymph Node Excision / Q000706:statistics & numerical data; D008207:Lymphatic Metastasis; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local; D011183:Postoperative Complications / Q000453:epidemiology; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D016019:Survival Analysis; D015996:Survival Rate; D016896:Treatment Outcome