Laparoscopic versus open resection for colon cancer: 10-year outcomes of a prospective clinical trial

Abstract

Background: Laparoscopic resection (LR) and open resection (OR) for colon cancer have similar oncologic outcomes at 5-year follow-up. However, results from studies with longer follow-up are limited. This study aimed to compare 10-year oncologic outcomes of LR and OR for non-metastatic colon cancer.

Methods: A prospective non-randomized trial comparing patients undergoing LR or OR for non-metastatic colon cancer at a single institution was conducted. Statistical analyses were performed on an ''intention-to-treat'' basis and by actual treatment. Kaplan-Meier curves were compared to analyze overall survival (OS) and disease-free survival (DFS). A multivariate analysis was performed to identify predictors of poor survival.

Results: The study included 304 colon cancer patients: 154 patients underwent LR and 150 underwent OR. Fifteen (9.7 %) had LR converted to OR. During a median follow-up period of 138 (range, 120-220) months, no significant differences were observed between LR and OR patients in 10-year OS and DFS rates: 87.2 % versus 78.7 % (P = 0.182) and 80.9 % versus 76.8 % (P = 0.444), respectively. Conversion to open surgery was associated with a non-significant reduction in OS and DFS. Stage-by-stage comparison showed no significant differences between the two groups. Both OS and DFS were similar between right colon and left-sided colon cancer patients. On multivariate analysis, pT4 cancer and a lymph node ratio of 0.20 or more were the only independent predictors of both OS and DFS.

Conclusions: The 10-year follow-up results confirm the oncological effectiveness of the laparoscopic approach to non-metastatic colon cancer.