title: Safety and feasibility of laparoscopic multivisceral resection for surgical T4b colon cancers: Retrospective analyses.
abstract: BACKGROUND
  Laparoscopic (Lap) surgery has not been established as a standard procedure for locally advanced colon cancers. Here, we evaluated the safety and feasibility of Lap multivisceral resection (MVR) for tumors that had invaded adjacent organs (T4b).
  
  
  METHODS
  We performed retrospective analyses using a single institutional database. Eighty-four patients who underwent Lap or open MVR for surgical T4b primary colon cancers satisfied the inclusion criteria.
  
  
  RESULTS
  Among the 84 patients, 48 underwent Lap MVR and 36 underwent open MVR. More patients in the open group were clinical T4b and were receiving neoadjuvant chemotherapy. Patients in the open group had worse performance status (P = 0.037) and tumors of greater diameter. Lap completion was achieved in 42 cases (87.5%); the conversion rate was highest in cases involving the urinary tract (40.0%). Lap reconstruction of the bladder or ureter was extremely challenging, and therefore, adjacent organ reconstruction influenced Lap completion. Regarding perioperative outcomes, Lap was superior to open surgery in terms of intraoperative blood loss, morbidity, and postoperative hospital stay. Conversion was required in six cases; five were strategic conversions, and conversion was not associated with severe morbidity. The microscopic positive surgical margin rate was not higher in the Lap group than in the open group. Kaplan-Meier analyses of overall and disease-free survival were comparable between the groups. Cox regression analyses revealed that the operative approach did not have a significant adverse effect on long-term outcomes.
  
  
  CONCLUSIONS
  The Lap approach could be considered for surgical T4b cancers, except for urinary tract invasion cases that require complicated reconstruction.
authors.affiliation: Department of Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan.
authors.forename: Ryo
authors.initials: R
authors.lastname: Takahashi
authors.affiliation: Department of Gastroenterological Surgery, Faculty of Medicine, Fukuoka University, Fukuoka, Japan.
authors.forename: Suguru
authors.initials: S
authors.lastname: Hasegawa
authors.affiliation: Department of Surgery, Otsu Municipal Hospital, Shiga, Japan.
authors.forename: Kenjiro
authors.initials: K
authors.lastname: Hirai
authors.affiliation: Department of Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan.
authors.forename: Shigeo
authors.initials: S
authors.lastname: Hisamori
authors.affiliation: Department of Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan.
authors.forename: Koya
authors.initials: K
authors.lastname: Hida
authors.affiliation: Department of Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan.
authors.forename: Kenji
authors.initials: K
authors.lastname: Kawada
authors.affiliation: Department of Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan.
authors.forename: Yoshiharu
authors.initials: Y
authors.lastname: Sakai
mesh_terms: D000230:Adenocarcinoma / Q000401:mortality / Q000473:pathology* / Q000601:surgery*; D000368:Aged; D000369:Aged, 80 and over; D003110:Colonic Neoplasms / Q000401:mortality / Q000473:pathology* / Q000601:surgery*; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D010535:Laparoscopy; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D012189:Retrospective Studies; D016896:Treatment Outcome; D014781:Viscera / Q000601:surgery
keywords: Colon cancer; laparoscopic surgery; multivisceral resection