專題討論22：Early Diagnosis and Minimal-invasive Therapy for GI Neoplasms

S22-5
Minimal-invasive Surgery for Colon Cancer
Jin-Tung, Liang, MD, PhD
Chief, Division of Colorectal Surgery
Professor, Department of Surgery
National Taiwan University Hospital and College of Medicine,
No.7 Chung-Shan South Rd, Taipei, Taiwan 100
ABSTRACT
INTRODUCTION: Minimal invasive surgical approach can achieve quick functional recovery. However, the oncologic outcome for cancer is still a concern. This study aims to compare the oncologic outcome between laparoscopic and open methods in the curative resection of Stage Ⅱ or Ⅲ left-sided colon cancers.

METHODS: In consideration of statistical power up to 90%, 286 eligible patients with curable left-sided colon cancer ( Tumor-Node-Metastasis StageⅡ and Stage Ⅲ disease) requiring the takedown of colonic splenic flexure to facilitate a curative left hemicolectomy were recruited, randomly and equally allocated to the laparoscopic and open group. The primary endpoint was time-to-recurrence of tumor. Data was analyzed according to intention-to-treat principle.
RESULTS: Post-randomization exclusion occurred because of metastatic disease detected intra-operatively occurred in 13 patients and because of patient withdrawal from trial in 4. Therefore, 135 and 134 patients actually comprised the laparoscopic and open group, respectively. The median follow-up of patient was 40 months (range: 18-72 months). The oncologic results were similar (p=0.362, one-sided log-rank test) in laparoscopic and open group of patients, with the estimated cumulative recurrence rate of 13.2% (9/68) versus 17.2% (11/64) in Stage Ⅱdisease and 20.9% (14/67) versus 25.7% (18/70) in Stage Ⅲ disease, respectively. The recurrence patterns were similar between the two groups. Both open and laparoscopic groups were comparable in the number of dissected lymph node (15.6±3.0 vs. 16.0±6.0, p=0.489), various demographic and clinicopathologic parameters.
CONCLUSIONS: The estimated cumulative recurrence rate for the surgery of Stage Ⅱ or Ⅲ left-sided colon cancers was the same between laparoscopic and open methods.