title: Laparoscopic versus open resection for transverse and descending colon cancer: Short-term and long-term outcomes of a multicenter retrospective study of 1830 patients.
abstract: BACKGROUND
  Previous randomized controlled trials demonstrated similar oncological outcomes between laparoscopic and open colectomies, except for cases involving transverse colon and splenic flexure colon cancer. The objective of this study was to confirm the oncological safety and advantages of the short-term results of laparoscopic surgery for transverse and descending colon cancer in comparison with open surgery.
  
  
  METHODS
  The study data were retrospectively collected from the databases of 45 hospitals. Patients with transverse or descending colon cancer who underwent laparoscopic or open R0 resection were registered. The primary end-points were the 3-year overall survival and relapse-free survival rates according to pathological stage. The secondary end-points were the short-term results, including blood loss, operative time, diet intake, hospital stay, and postoperative complications.
  
  
  RESULTS
  Of the 1830 eligible patients, 872 underwent open colectomy and 958 underwent laparoscopic colectomy. The median follow-up period was 38.4 months. The conversion rate to open resection was 4.5%. The 3-year overall survival rate of the laparoscopic group was significantly higher than that of the open group for stage I patients (96.2% vs 99.2%; P = 0.04); it was also higher for stage II (94.0% vs 95.5%) and stage III (87.4% vs 90.2%) patients, but there were no significant differences. The 3-year relapse-free survival rate of the laparoscopic group was significantly higher than that of the open group for stage I patients; there were no differences between the open and laparoscopic groups among the stage II and III patients. In the multivariate analyses, laparoscopic resection was a significant factor in relapse-free survival. Laparoscopic patients had significantly lower blood loss and a significantly longer operative time than the open groups. Also, postoperative hospital stay was significantly shorter and postoperative morbidity was significantly lower in the laparoscopic group.
  
  
  CONCLUSIONS
  Although this retrospective study has limitations, we can conclude that laparoscopic surgery for transverse and descending colon cancer is oncologically safe and yields better short-term results than open surgery.
authors.affiliation: Department of Gastroenterological Surgery, Saitama Medical University International Medical Center, Hidaka, Japan.
authors.forename: Shigeki
authors.initials: S
authors.lastname: Yamaguchi
authors.affiliation: Department of Gastroenterological Surgery, Saitama Medical University International Medical Center, Hidaka, Japan.
authors.forename: Jo
authors.initials: J
authors.lastname: Tashiro
authors.affiliation: Community Health Science Center, Saitama Medical University, Moroyama, Japan.
authors.forename: Ryuichiro
authors.initials: R
authors.lastname: Araki
authors.affiliation: Department of General and Gastroenterological Surgery, Osaka Medical College, Takatsuki, Japan.
authors.forename: Junji
authors.initials: J
authors.lastname: Okuda
authors.affiliation: Department of Colorectal Surgery, Fujita Health University, Toyoake, Japan.
authors.forename: Tsunekazu
authors.initials: T
authors.lastname: Hanai
authors.affiliation: Department of Surgery, Iwate Medical University, Morioka, Japan.
authors.forename: Koki
authors.initials: K
authors.lastname: Otsuka
authors.affiliation: Department of Surgery, National Hospital Organization Yokohama Medical Center, Yokohama, Japan.|Department of Surgery, Yokohama Shin-Midori General Hospital, Yokohama, Japan.
authors.forename: Shuji
authors.initials: S
authors.lastname: Saito
authors.affiliation: Department of Surgery, Kitasato University Hospital, Sagamihara, Japan.
authors.forename: Masahiko
authors.initials: M
authors.lastname: Watanabe
authors.affiliation: Department of Surgery, Tokyo Medical and Dental University Hospital, Tokyo, Japan.
authors.forename: Kenichi
authors.initials: K
authors.lastname: Sugihara
mesh_terms: D000230:Adenocarcinoma / Q000401:mortality / Q000601:surgery*; D000328:Adult; D000368:Aged; D003082:Colectomy / Q000379:methods*; D044683:Colon, Descending / Q000601:surgery*; D003110:Colonic Neoplasms / Q000401:mortality / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D010535:Laparoscopy; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D016019:Survival Analysis; D016896:Treatment Outcome
keywords: Descending colon cancer; laparoscopic surgery; transverse colon cancer