Outcomes of Laparoscopic-Assisted Surgery for pSM Colorectal Cancer

Abstract

Objective: This study was performed to evaluate short-term surgical outcomes and oncologic efficacy of laparoscopic-assisted colectomy (LAC) for colorectal cancer with pathological submucosal invasion (pSM). Patients and methods: Consecutive patients who underwent elective LAC for pSM colorectal cancer at one institution between October 1994 and December 2006 were enrolled in the study. Data collection included the patients' general characteristics, and the surgical, pathological and oncological results. Results: A total of 120 patients with pSM colorectal cancer underwent LAC during the study period. The group included 40 males and 80 females, and had an average age of 59 years old (range, 31-80). The surgeries included 28 partial colectomies, 8 ileocecal colectomies, 10 right hemicolectomies, 40 sigmoid colectomies, 16 anterior resections, 17 low anterior resections, and 1 abdominoperineal resection. The mean surgical duration was 227 min (range, 147-535 min) and the mean blood loss volume was 33ml (range, 2-910ml). There were no major intraoperative complications. Conversion to open surgery was required in 3 cases (2.5%). There were no deaths during surgery or within the first 30days postoperatively. Anastomotic leak occurred in 2 cases (1.7%), ileus in 6 (5%), and wound infection in 4 (3.3%). The reoperation rate was 3.3%. An average of 11 lymph nodes were harvested (range, 3-40), and in 106 cases (88%), there were no detectable lymph node metastases, 11 (9.5%) had metastasis in 1 lymph node, 1 (0.8%) had metastases in 2 lymph nodes, and 2 (1.7%) had metastases in 3 lymph nodes. The number of harvested lymph nodes correlated with the category of lymph node dissection. However, the category of lymph node dissection did not correlate with intraoperative blood loss or surgical duration, and extensive lymph node dissection did not significantly increase the incidence of intraoperative or postoperative complications. The mean follow-up period was 4.8years, during which there was no local recurrence or port site metastasis. Distant metastasis was observed in 3 patients (2.5%) and lung metastasis was apparent in all of these patients. The 3-year disease-free survival rate was 99.2% (119/120). Conclusion: Laparoscopic-assisted colorectal resection for SM colorectal cancer is safe and effective. LAC with extensive lymph node dissection for SM colorectal cancer does not compromise the short-term surgical outcome.