Laparoscopic surgery for palliative resection of the primary tumor in incurable stage IV colorectal cancer.
BACKGROUND
The purpose of the study was to evaluate the feasibility and efficacy of laparoscopic palliative resection in patients with incurable stage IV colorectal cancer.


METHODS
We reviewed 100 patients with incurable stage IV colorectal cancer who underwent palliative resection of the primary tumor between 2002 and 2009 at National Cancer Center Hospital East (NCCHE). Outcomes and postoperative course were compared between patients who underwent open and laparoscopic surgery.


RESULTS
Of the 100 patients, 22 were treated with a laparoscopic procedure and 78 underwent an open surgical procedure. There was no difference in the preoperative characteristics of the two groups. In the laparoscopic group, the mean operation time was significantly longer (177 vs. 148 min, p = 0.007) and the amount of blood loss was significantly lower (166 vs. 361 ml, p = 0.002). Postoperative complications occurred in 5 patients (22.7 %) after laparoscopic surgery and in 21 patients (26.9 %) after open surgery, with no significant difference between the two groups. Time to flatus, time to start of food intake, and hospital stay were all shorter after laparoscopic surgery (3.0 vs. 3.8 days, p = 0.003; 3.6 vs. 5.0 days, p < 0.001; and 12.0 vs. 15.0 days, p = 0.005; respectively). Significantly more patients in the laparoscopic group had >15 % lymphocytes on postoperative day 7 (p = 0.049). Overall survival rates were 73.7 and 75.5 % at 1 year after laparoscopic surgery and open surgery, respectively (p = 0.344).


CONCLUSIONS
A laparoscopic procedure should be considered for palliative resection of the primary tumor for incurable stage IV colorectal cancer, because the results of this study indicate that the procedure is safe and effective.
Colorectal and Pelvic Surgery Division, Department of Surgical Oncology, National Cancer Center Hospital East, Kashiwanoha 6-5-1, Kashiwa, Chiba, 277-8577, Japan. hnishigo@east.ncc.go.jp
Hideaki
H
Nishigori
Masaaki
M
Ito
Yuji
Y
Nishizawa
Atsushi
A
Kohyama
Takamaru
T
Koda
Kentaro
K
Nakajima
Yusuke
Y
Nishizawa
Akihiro
A
Kobayashi
Masanori
M
Sugito
Norio
N
Saito
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015179:Colorectal Neoplasms / Q000473:pathology / Q000601:surgery*; D005260:Female; D006801:Humans; D010535:Laparoscopy; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D010166:Palliative Care; D012189:Retrospective Studies