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. 2017 Jun;13(6):4953-4958.
doi: 10.3892/ol.2017.6035. Epub 2017 Apr 13.

Comparison of hand-assisted laparoscopic surgery (HALS) and conventional laparotomy in patients with colorectal cancer: Final results from a single center

Takayuki Tajima  1 , Masaya Mukai  2 , Daiki Yokoyama  2 , Shigeo Higami  2 , Shuji Uda  2 , Sayuri Hasegawa  1 , Eiji Nomura  2 , Sotaro Sadahiro  1 , Seiei Yasuda  1 , Hiroyasu Makuuchi  1   2
Affiliations

Comparison of hand-assisted laparoscopic surgery (HALS) and conventional laparotomy in patients with colorectal cancer: Final results from a single center

Takayuki Tajima et al. Oncol Lett. 2017 Jun.

Abstract

In recent years, the use of laparoscopic surgery has been expanded to include radical curative resection. In a previous study, 212 patients with primary colorectal cancer (stages I-III) underwent radical curative resection by hand-assisted laparoscopic surgery (HALS) (n=98) or conventional laparotomy (CL) (n=114) and were compared with respect to 3-year relapse-free survival (3Y-RFS) and 3-year overall survival (3Y-OS). The study included 210/212 patients who were followed up to 5 years, including 96 patients who underwent HALS and 114 treated with CL. The two groups were matched for stage, clinical background, and postoperative management. Patient characteristics were compared and the 5Y-RFS and 5Y-OS were determined. The 5-year follow-up rate was 97.6%. In stage I-III patients, 5Y-RFS and 5Y-OS showed no significant differences between HALS and CL. The patients with stage I disease accounted for 41.7% (40/96) of the patients undergoing HALS, while stage I patients only accounted for 23.7% (27/114) of the patients undergoing CL, and the difference was significant (P=0.005). Stage II patients undergoing CL were older than those treated with HALS (P=0.017). However, there were no differences in the characteristics of stage III patients undergoing HALS or CL. In conclusion, HALS achieved a similar survival to CL in patients with stage I to III colorectal cancer. Compared with CL, HALS was performed more safely and achieved superior cosmetic results.

Keywords: colorectal cancer; conventional laparotomy; hand-assisted laparoscopic surgery; laparoscopic surgery; laparoscopy-assisted colorectal surgery.

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Figures

Figure 1.
Figure 1.
(A) The 5-year relapse-free survival rate (5Y-RFS) and (B) 5-year overall survival rate (5Y-OS) of stage I patients in the hand-assisted laparoscopic surgery (HALS) and conventional laparotomy (CL) groups. The Kaplan-Meier method was employed, followed by comparison with the log-rank test and hazard ratio (HR) [95% confidence interval (CI)].
Figure 2.
Figure 2.
(A) 5-year relapse-free survival rate (5Y-RFS) and (B) 5-year overall survival rate (5Y-OS) of stage II patients in the hand-assisted laparoscopic surgery (HALS) and conventional laparotomy (CL) groups. The Kaplan-Meier method was employed, followed by comparison with the log-rank test and and hazard ratio (HR) [95% confidence interval (CI)].
Figure 3.
Figure 3.
(A) The 5-year relapse-free survival rate (5Y-RFS) and (B) 5-year overall survival rate (5Y-OS) of stage III patients in the hand-assisted laparoscopic surgery (HALS) and conventional laparotomy (CL) groups. The Kaplan-Meier method was employed, followed by comparison with the log-rank test and hazard ratio (HR) [95% confidence interval (CI)].
Figure 4.
Figure 4.
(A) The 5-year relapse-free survival rate (5Y-RFS) and (B) 5-year overall survival rate (5Y-OS) of all the patients (stages I/II/III) in the hand-assisted laparoscopic surgery (HALS) and conventional laparotomy (CL) groups. The Kaplan-Meier method was employed, followed by comparison with the log-rank test and hazard ratio (HR) [95% confidence interval (CI)].
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