title: Open versus laparoscopic resection of primary tumor for incurable stage IV colorectal cancer: a large multicenter consecutive patients cohort study.
abstract: OBJECTIVE
  To investigate the hypothesis that laparoscopic primary tumor resection is safe and effective when compared with the open approach for colorectal cancer patients with incurable metastases.
  
  
  BACKGROUND
  There are only a few reports with small numbers of patients on laparoscopic tumor resection for stage IV colorectal cancer.
  
  
  METHODS
  Data from consecutive patients who underwent palliative primary tumor resection for stage IV colorectal cancer between January 2006 and December 2007 were collected retrospectively from 41 institutions. Short- and long-term outcomes were compared between patients who underwent laparoscopic or open resection.
  
  
  RESULTS
  A total of 904 patients (laparoscopic group: 226, open group: 678) with a median age of 64 years (range: 22-95) were included in the analysis. Conversion was required in 28 patients (12.4%) and the most common reasons for conversion (23/28: 82%) were bulky or invasive tumors. There was no 30-day postoperative mortality in either group. The complication rate (NCI-CTCAE grade 2-4) after laparoscopic surgery (17%) was significantly lower than that after open surgery (24%) (P = 0.02), and the difference was greater (4% vs 12%; P < 0.001) when we limited the analysis to severe (≥grade 3) complications. The median length of postoperative hospital stay in the laparoscopic group was significantly shorter than that in the open group (14 vs 17 days; P = 0.002). In univariate analysis, overall survival for the laparoscopic group was significantly better than that for open surgery (median survival time: 25.9 vs 22.3 months, P = 0.04), although no difference was apparent in multivariate analysis.
  
  
  CONCLUSIONS
  Compared with open surgery, laparoscopic primary tumor resection has advantages in the short term and no disadvantages in the long term. It is a reasonable treatment option for certain stage IV colorectal cancer patients with incurable disease.
authors.affiliation: Division of Gastrointestinal Surgery, Department of Surgery, Kyoto University Hospital, Kyoto, Japan. hidakoya@kuhp.kyoto-u.ac.jp
authors.forename: Koya
authors.initials: K
authors.lastname: Hida
authors.forename: Suguru
authors.initials: S
authors.lastname: Hasegawa
authors.forename: Yousuke
authors.initials: Y
authors.lastname: Kinjo
authors.forename: Kenichi
authors.initials: K
authors.lastname: Yoshimura
authors.forename: Masafumi
authors.initials: M
authors.lastname: Inomata
authors.forename: Masaaki
authors.initials: M
authors.lastname: Ito
authors.forename: Yosuke
authors.initials: Y
authors.lastname: Fukunaga
authors.forename: Akiyoshi
authors.initials: A
authors.lastname: Kanazawa
authors.forename: Hitoshi
authors.initials: H
authors.lastname: Idani
authors.forename: Yoshiharu
authors.initials: Y
authors.lastname: Sakai
authors.forename: Masahiko
authors.initials: M
authors.lastname: Watanabe
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015179:Colorectal Neoplasms / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D005260:Female; D006801:Humans; D010535:Laparoscopy; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D016019:Survival Analysis; D055815:Young Adult