title: Laparoscopic versus open colorectal resections in patients with symptomatic stage IV colorectal cancer.
abstract: BACKGROUND
  The purpose of this study was to evaluate short-term and oncologic outcomes of laparoscopic resection (LR) for patients with symptomatic stage IV colorectal cancer compared with open resection (OR).
  
  
  METHODS
  This study is a retrospective analysis of a prospective database. Patients with a minimum follow-up of 12 months after LR or OR for metastatic colorectal cancer were included. All analyses were performed on an "intention-to-treat" basis.
  
  
  RESULTS
  A total of 162 consecutive patients submitted to LR and 127 submitted to OR were included. In the LR group, conversion rate was 26.5 %, mostly due to locally advanced disease (88.4 %). A greater risk of conversion was observed among patients with a tumor size greater than 5 cm regardless the tumor site (P = 0.07). Early postoperative outcome was significantly better for LR group, with a shorter hospital stay (P = 0.008), earlier onset of adjuvant treatment, and similar postoperative complications (P = 0.853) and mortality rates (P = 0.958). LR for rectal cancer was associated with a higher morbidity compared with colon cancer (P = 0.058). During a median follow-up time of 72 months, there was no significant difference in overall survival between the two groups (P = 0.622).
  
  
  CONCLUSIONS
  LR for symptomatic metastatic CRC is safe and, compared with OR, is associated with a shorter hospital stay and with similar survival rates. Concerns remain about LR of bulky tumors and rectal cancers due to the increased risk of conversion and postoperative complications.
authors.affiliation: Digestive and Colorectal Surgery and Centre for Minimal Invasive Surgery, University of Turin, Corso A. M. Dogliotti, 14, 10126 Turin, Italy.
authors.forename: Marco Ettore
authors.initials: ME
authors.lastname: Allaix
authors.forename: Maurizio
authors.initials: M
authors.lastname: Degiuli
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Giraudo
authors.forename: Alessandra
authors.initials: A
authors.lastname: Marano
authors.forename: Mario
authors.initials: M
authors.lastname: Morino
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003082:Colectomy; D015179:Colorectal Neoplasms / Q000473:pathology* / Q000601:surgery*; D005260:Female; D006801:Humans; D010535:Laparoscopy; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D012189:Retrospective Studies; D013997:Time Factors; D016896:Treatment Outcome