title: Laparoscopic Colorectal Cancer Resection in High-Volume Surgical Centers: Long-Term Outcomes from the LAPCOLON Group Trial.
abstract: BACKGROUND
  Strong evidence has confirmed the benefit of laparoscopy in colorectal cancer resection but remains a challenging procedure. It is not clear that such promising results in selected patients translate into a favorable risk-benefit balance in real practice. We conducted a multicenter national observational registry to assess operative and oncologic long-term outcomes following laparoscopic colorectal cancer resection.
  
  
  METHODS
  All patients with laparoscopic colorectal cancer resection between 2001 and 2004 were included. Data were extracted from the prospective Italian national database of 10 high-volume centers (≥40 colorectal cancer laparoscopic resections per year). Surgical technique and follow-up were standardized. Survivals were analyzed by Kaplan-Meier method.
  
  
  RESULTS
  We reported 1832 patients with colon (58.5%) and rectal cancer (41.5%). TNM stage was 0-I-II in 1044 patients (57%) and III-IV in 788 patients (43%). Surgery included a totally laparoscopic procedure in 1820 patients (99.3%). Conversion was 10.5%. Postoperative morbidity and 30-day mortality rates were 17 and 1.2%, respectively. Clinical anastomotic leakage rate was 8.3% (n=152). R0 resection was 95%. With a median follow-up of 54.2 months, cancer recurrence rate was 13.3%. At 5 years, cancer-free survival was 86.7%. Upon multivariate analysis, age (P=0.001) and TNM stage (P<0.001) were associated with cancer-free survival. Predictive factors of cancer recurrence were gender (P=0.029) and TNM stage (P<0.001).
  
  
  CONCLUSIONS
  In high-volume centers and non-selective patients, laparoscopic colorectal resection for cancer achieves good operative results with satisfactory long-term oncologic results. Even in the laparoscopy era, age, gender, and TNM stage remain the most powerful predictor of oncologic outcomes.
authors.affiliation: Oncologic Surgery, Ospedale Rummo, Benevento, Italy.
authors.forename: Cristiano G S
authors.initials: CG
authors.lastname: Huscher
authors.forename: Frederic
authors.initials: F
authors.lastname: Bretagnol
authors.forename: Francesco
authors.initials: F
authors.lastname: Corcione
mesh_terms: D000368:Aged; D057868:Anastomotic Leak / Q000453:epidemiology*; D003082:Colectomy / Q000379:methods*; D003110:Colonic Neoplasms / Q000601:surgery; D015179:Colorectal Neoplasms / Q000601:surgery*; D061887:Conversion to Open Surgery / Q000706:statistics & numerical data; D018572:Disease-Free Survival; D005260:Female; D061847:Hospitals, High-Volume; D006801:Humans; D007558:Italy / Q000453:epidemiology; D010535:Laparoscopy / Q000379:methods; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local; D011183:Postoperative Complications; D011446:Prospective Studies; D012004:Rectal Neoplasms / Q000601:surgery; D012042:Registries; D013997:Time Factors; D016896:Treatment Outcome
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