title: The short-term and oncologic outcomes of laparoscopic versus open surgery for T4 colon cancer.
abstract: OBJECTIVE
  To compare R0 resection rates and short-term and oncologic outcomes between laparoscopy and open surgery for T4 colon cancer.
  
  
  METHODS
  Patients with non-metastatic T4 colon cancer (n = 117) underwent treatment either through laparoscopy (n = 51) or open surgery (n = 66). Conversion to open surgery occurred in seven cases (13.7%).
  
  
  RESULTS
  History of abdominal surgery (2.0 vs. 12.1%) and emergency operation (2.1 vs. 24.2%) were less frequent in the laparoscopy group. Conversion to open surgery occurred in seven cases (13.7%). Resection of adjacent organs was less frequently performed in the laparoscopy group (27.5 vs. 53.0%, p = .005). The mean operative time (189 vs. 210 min) and rate of 30-day postoperative complications (12 vs. 24%) were similar between the two groups. Shorter time to soft diet (7 vs. 9 days, p = .018) and hospital stay (14 vs. 18 days, p = .044) were observed in the laparoscopy group. T4b tumor was also less frequent in the laparoscopy group (3.9 vs. 18.2%, p = .018), while R0 resection rates were similar between the laparoscopy (96.1%) and open surgery group (95.5%). The mean number of lymph nodes was 22 in the laparoscopy group and 27 in the open surgery group (p = .021). No differences in 3-year overall survival rate (82.5 vs. 75.7%), recurrence-free survival rate (61.9 vs. 63.5%), and local recurrence-free survival rate (89.8 vs. 88.5%) were observed between the groups. Operation time, blood loss, 30-day complication rate, time to diet, duration of hospital stay, R0 resection rate, 3-year overall and local recurrence-free survival rates showed no difference between the converted and open surgery groups.
  
  
  CONCLUSIONS
  Our results indicate that laparoscopy is a surgically safe and oncologically acceptable approach and thus could be considered for well-selected patients with T4 colon cancer in order to allow faster short-term recovery.
authors.affiliation: Division of Gastrointestinal Surgery, Department of Surgery, Yonsei University Wonju College of Medicine, 20 Ilsan-ro, Wonju-si, Wonju, Gangwon-do, 220-701, Korea.
authors.forename: Ik Yong
authors.initials: IY
authors.lastname: Kim
authors.affiliation: Division of Gastroenterology, Department of Internal Medicine, Yonsei University Wonju College of Medicine, Wonju, Korea.
authors.forename: Bo Ra
authors.initials: BR
authors.lastname: Kim
authors.affiliation: Division of Gastrointestinal Surgery, Department of Surgery, Yonsei University Wonju College of Medicine, 20 Ilsan-ro, Wonju-si, Wonju, Gangwon-do, 220-701, Korea. youngwkim@yonsei.ac.kr.
authors.forename: Young Wan
authors.initials: YW
authors.lastname: Kim
mesh_terms: D000368:Aged; D015331:Cohort Studies; D003082:Colectomy / Q000379:methods*; D003110:Colonic Neoplasms / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D061887:Conversion to Open Surgery / Q000706:statistics & numerical data; D005260:Female; D006801:Humans; D010535:Laparoscopy; D007902:Length of Stay / Q000706:statistics & numerical data; D008197:Lymph Node Excision; D008297:Male; D061646:Operative Time; D012189:Retrospective Studies
keywords: Colon neoplasms; Laparoscopy; Neoplasm staging; Survival rate