Identification of patient subgroups with unfavorable long‐term outcomes associated with laparoscopic surgery in a randomized controlled trial comparing open and laparoscopic surgery for colon cancer (Japan Clinical Oncology Group Study JCOG0404)

Annals of Gastroenterological Surgery

the Colorectal Cancer Study Group of Japan Clinical Oncology Group¹  Masaaki Ito²  Yukihide Kanemitsu³  Hiroyuki Bando⁴  Masayoshi Yasui⁵  Yukihito Kokuba⁶  Masafumi Inomata⁷  Tomonori Akagi⁷  Yusuke Kinugasa⁸  Hiroyuki Egi⁹  Kentaro Nakajima^1,10  Yasuhiro Munakata^1,11  Seiichiro Yamamoto^1,12  Dai Shida^1,13  Masataka Ikeda^1,14  Shuji Saito^1,15  Masashi Wakabayashi^1,16  Hiroshi Katayama^1,16  Seigo Kitano^1,17 

[1] ;Department of Colorectal Surgery National Cancer Center Hospital East Chiba Japan;Department of Colorectal Surgery National Cancer Center Hospital Tokyo Japan;Department of Gastroenterological Surgery Ishikawa Prefectural Central Hospital Kanazawa Japan;Department of Gastroenterological Surgery Osaka International Cancer Institute Osaka Japan;Department of Gastroenterological Surgery St. Marianna University Yokohama Seibu Hospital Yokohama Japan;Department of Gastroenterological and Pediatric Surgery Oita University Faculty of Medicine Oita Japan;Department of Gastrointestinal Surgery Tokyo Medical and Dental University Tokyo Japan;Department of Gastrointestinal Surgery and Surgical Oncology Ehime University Graduate School of Medicine Ehime Japan;Department of Surgery NTT Medical Center Tokyo Japan;Department of Surgery Nagano Municipal Hospital Nagano Japan;Department of Surgery Tokai University School of Medicine Kanagawa Japan;Division of Frontier Surgery The Institute of Medical ScienceThe University of Tokyo Tokyo Japan;Division of Lower Gastrointestinal Surgery, Department of Gastroenterological Surgery Hyogo College of Medicine Nishinomiya Japan;Division of Surgery Gastrointestinal Center Yokohama Shin‐Midori General Hospital Yokohama Japan;Japan Clinical Oncology Group Data Center/Operations Office National Cancer Center Hospital Tokyo Japan;Oita University Oita Japan;

关键词: colon cancer;    laparoscopic surgery;    long‐term outcome;    randomized controlled trial;    subgroup analysis;   

DOI  :  10.1002/ags3.12475

来源: DOAJ

【 摘 要 】

Abstract Background Previously, we conducted a randomized controlled trial (JCOG0404) for stage II/III colon cancer patients and reported that the long‐term survival after open surgery (OP) and laparoscopic surgery (LAP) were almost identical; however, JCOG0404 suggested that survival of patients after LAP with tumors located in the rectosigmoid colon, cT4 or cN2 tumors, and high body mass index (BMI) might be unfavorable. Aim To identify the patient subgroups associated with poor long‐term survival in the LAP arm compared with the OP arm. Methods Patients aged 20–75, clinical T3 or deeper lesion without involvement of other organs, clinical N0‐2 and M0 were included. The patients with pathological stage IV and R2 resection were excluded from the current analysis. In each subgroup, the hazard ratio for LAP (vs. OP) in overall survival (OS) from surgery was estimated using a multivariable Cox regression model adjusted for the clinical and pathological factors. Results In total, 1025 patients (OP, 511 and LAP, 514) were included in the current analysis. Adjusted hazards ratios for OS of patients with high BMI (>25 kg/m2), pT4, and pN2 in LAP were 3.37 (95% confidence interval [CI], 1.24–9.19), 1.33 (0.73–2.41), and 1.74 (0.76–3.97), respectively. In contrast, that of rectosigmoid colon tumors was 0.98 (0.46–2.09). Conclusions Although LAP is an acceptable optional treatment for stage II/III colon cancer, the present subgroup analysis suggests that high BMI (>25 kg/m2), pT4, and pN2 except for RS were factors associated with unfavorable long‐term outcomes of LAP in patients with colon cancer who underwent curative resection. (JCOG 0404: NCT00147134/UMIN‐CTR: C000000105.)

【 授权许可】

Unknown