title: Differences in clinical features between laparoscopy and open resection for primary tumor in patients with stage IV colorectal cancer.
abstract: OBJECTIVE
  To identify differences in clinical features between laparoscopy and open resection for primary tumor in patients with stage IV colorectal cancer. We also evaluated short-term and oncologic outcomes after laparoscopy and open surgery.
  
  
  METHODS
  A total of 100 consecutive stage IV patients undergoing open (n=61) or laparoscopic (n=39) major resection were analyzed. There were four cases (10%) of conversion to laparotomy in the laparoscopy group.
  
  
  RESULTS
  Pathological T4 tumors (56% vs 26%), primary colon cancers (74% vs 51%), and larger tumor diameter (6 vs 5 cm) were more commonly managed with open surgery. Right colectomy was more common in the open surgery group (39%) and low anterior resection was more common in the laparoscopy group (39%, P=0.002). Hepatic metastases in segments II, III, IVb, V, and VI were more frequently resected with laparoscopy (100%) than with open surgery (56%), although the difference was not statistically significant. In colon and rectal cancers, mean operative time and 30-day complication rates of laparoscopy and open surgery did not differ. In both cancers, mean time to soft diet and length of hospital stay were shorter in the laparoscopy group. Mean time from surgery to chemotherapy commencement was significantly shorter with laparoscopy than with open surgery. In colon and rectal cancers, 2-year cancer-specific and progression-free survival rates were similar between the laparoscopy and open surgery groups.
  
  
  CONCLUSIONS
  Based on our findings, laparoscopy can be selected as an initial approach in patients with a primary tumor without adjacent organ invasion and patients without primary tumor-related symptoms. In selected stage IV patients, tumor factors such as primary rectal tumor, peritoneal carcinomatosis, or liver metastasis may not be absolute contraindications for a laparoscopic approach.
authors.affiliation: Department of Surgery, Division of Colorectal Surgery, Yonsei University Wonju College of Medicine, Wonju, Gangwon-do, Korea.
authors.forename: Ik Yong
authors.initials: IY
authors.lastname: Kim
authors.affiliation: Department of Internal Medicine, Division of Gastroenterology, Yonsei University Wonju College of Medicine, Wonju, Gangwon-do, Korea.
authors.forename: Bo Ra
authors.initials: BR
authors.lastname: Kim
authors.affiliation: Department of Internal Medicine, Division of Gastroenterology, Yonsei University Wonju College of Medicine, Wonju, Gangwon-do, Korea.
authors.forename: Hyun Soo
authors.initials: HS
authors.lastname: Kim
authors.affiliation: Department of Surgery, Division of Colorectal Surgery, Yonsei University Wonju College of Medicine, Wonju, Gangwon-do, Korea.
authors.forename: Young Wan
authors.initials: YW
authors.lastname: Kim
keywords: colorectal neoplasms; laparoscopy; neoplasm metastasis