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Laparoscopic technique: can we improve the surgical treatment strategy for metastatic colon cancer?

Background: Nowadays the colorectal cancer still one of the most common oncological disease in the World. Asymptomatic illness – this is a reason for the high incidence of advanced disease. Every third (29.4%) patient with colon cancer in Russia after initial examination had distant metastases. Primary tumor removal helps to avoid the complications (bowel obstruction, bleeding, perforation etc.), optimize the subsequent chemotherapy and significantly increase two-year survival (18.2% vs. 4.7%) in comparison with symptomatic procedures (colostomy or bypass). The laparoscopic primary tumor removal could minimize the surgical trauma, reduce postoperative rehabilitation, percentage of complications and also speed up the launching of chemotherapy.

Aim: to compare the results of cytoreductive surgery by laparoscopic technique and laparotomy approach for patients with colon cancer and synchronous distant metastases.

Materials and methods: prospective randomize trial. Since 2010 to 2012yy. 89 patients with colon cancer and synchronous distant metastases (T1–4a Nany M1a-b) underwent primary tumor removal (44 by laparoscopic technique- main group and 45– laparotomy access-screening group). The groups were similar by the gender, age, stage, tumor and metastases localization.

Results: simultaneous R-0 resection (primary tumor and all metastases) underwent 4 patients (in 2 at each group), staged R-0 resection-11(29.6%) vs. 9(24.4%), p=0.05 respectively. Mean time: 230.1±51.3min- in group with laparoscopic procedure vs. 130.6±38.6min -open access group, р<0.05; primary colon anastomosis performed in 40(90.9%) vs. 37(82.2%), p=0.05 patients respectively. Average intraoperative blood loss: 134.1±31.4 vs. 753.3±46.1 ml respectively, р<0.05. Postoperative complications: 3(6.8%) vs. 8(17.8%); reoperation: 2 and 3 respectively, p=0.11. Bowel motility restoration: 1.2±0.7 vs. 2.5±1.2 days, p<0.05; first stool: 2.4±1.3 vs. 3.8±1.4 days, p=0.63; time to patients activation: 1.2±1.1 vs. 3.9±0.9 days, p<0.05; first food taken: 2.0±0.7 vs. 4.0±1.3 days, p<0.05; duration of analgesia: 2.3±1.4 vs. 4.4±1.4 days, average hospital stay: 9.3±3.9 vs. 13.4±3.4, p<0.05 respectively. Time to start adjuvant chemotherapy after surgical treatment: 19.7±3.4 vs. 27.5±4.1 days respectively. The Kaplan-Meier overall 2-year survival: 69.5% in patients, who underwent laparoscopic procedure and 61.6%-in open access group, p=0.96.

Conclusions: the laparoscopic precision technique could minimize the surgical trauma, improve the postoperative patient restoration, reduce time to chemotherapy treatment and we also have a tendency to improve the percentages of postoperative complications and 2-year overall survival. These advantages are especially important in the treatment strategy of patients with metastatic colon cancer.

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