Laparoscopic resection of t4 XXXX : is it feasible?

@entity1 @entity5 @entity12605 @entity3 @entity694
BACKGROUND: Laparoscopic surgical treatment of @entity5 remains a concern that is mostly associated with technical feasibility, high conversion rate, inadequate oncologic clearance, and surgical outcome. OBJECTIVE: The purpose of this work was to evaluate the short- and long-term clinical and oncologic outcomes after laparoscopic and open surgeries for T4 @entity694 . DESIGN: This was a retrospective study of @entity1 with T4 @entity694 without @entity3 (M0) who had laparoscopic or open surgery from 2003 to 2011. SETTING: The study was conducted at a single institution. @entity1 : A total of 83 @entity1 with pT4 @entity694 were included. MAIN OUTCOME MEASURES: R0 resection rate, morbidity and mortality within 30 postoperative days, overall survival, and disease-free survival were measured. RESULTS: Laparoscopic surgery was performed on 61 and open surgery on 22 @entity1 . The groups were similar in overall staging (p = 0.461), with 35 (42%) of the @entity1 at stage 2 and 48 (58%) at stage 3. A complete R0 resection was achieved in 61 (100%) of the @entity1 who underwent laparoscopic surgery and in 21 (96%) of the @entity1 who underwent open surgery (p = 0.265). The average number of lymph nodes harvested was 21 in the laparoscopic group and 24 in the open group (p = 0.202). Thirty-day morbidity rate was similar between the groups (p = 0.467), and the mortality rate was 0. The length of hospital and postsurgical stay was significantly shorter in the laparoscopic group (p = 0.002 and p = 0.008). The 3-year overall survival rates between the groups were 82% (range, 71%-93%) for @entity1 who underwent laparoscopic surgery and 81% (range, 61%-100%) for those who underwent open surgery (p = 0.525), and disease-free survival was 67% (range, 54%-79%) for laparoscopic surgery and 64% (range, 43%-86%) for open surgery (p = 0.848). The follow-up time was 40    25 in months in the laparoscopic group and 34    26 months in the open surgery group (p = 0.325). LIMITATIONS: This was a retrospective study at a single institution. CONCLUSIONS: The study shows that laparoscopic surgery is feasible in T4 @entity694 . With comparable clinical and oncologic outcomes, this study suggests that laparoscopy may be considered as an alternative approach for T4 @entity694 with the advantage of faster recovery (see Video, @entity12605 , http://links.lww.com/DCR/A156).
