1
|
Voron T, Karoui M, Lo Dico R, Malicot KL, Espin E, Cianchi F, Jürgen W, Buggenhout A, Bruzzi M, Denimal F, Cazelles A, Douard R, Lepage C, Taieb J. Impact of laparoscopy on oncological outcomes after colectomy for stage III colon cancer: A post-hoc multivariate analysis from PETACC8 European randomized clinical trial. Dig Liver Dis 2021; 53:1034-1040. [PMID: 34112615 DOI: 10.1016/j.dld.2021.05.012] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2021] [Revised: 05/11/2021] [Accepted: 05/14/2021] [Indexed: 12/11/2022]
Abstract
BACKGROUND In colon cancer (CC), surgery remains the mainstay of treatment with curative intent. Despite several clinical trials comparing open and laparoscopic approaches, data on long-term outcomes for stage III CC are lacking. METHODS This post-hoc analysis of the European PETACC8 randomized phase 3 trial included patients from 340 sites between December 2005 and November 2009, with long follow-up (median 7.56 years). Patients were randomly assigned to FOLFOX or FOLFOX+cetuximab after colonic resection. The surgical approach was left to the referring surgeon's discretion. RESULTS Among 2555 patients included, 1796 (70.29%) were operated on by open surgery and 759 (29.71%) by laparoscopy. The 5-year OS rate was better after laparoscopic resection (85.4%, 95%CI 82.5-87.7) than after open surgery (80.2%, 95%CI 78.2-82.0; p = 0.002). The 5-year DFS rate was also better after laparoscopy (p = 0.016). However, in multivariate analysis using a propensity matching, the surgical approach was not found to be an independent prognostic factor for OS or DFS. OS (p = 0.0243) and DFS (p = 0.035) were increased after laparoscopic surgery in KRAS/BRAF WT sub-group CONCLUSION: We showed that laparoscopic resection has comparable long-term outcomes to open surgery in patients with stage III CC. For those with RAS and BRAF WT CC, laparoscopic colectomy may favorably impact survival.
Collapse
Affiliation(s)
- Thibault Voron
- Sorbonne Université, Department of Digestive and General Surgery, Saint Antoine Hospital, Paris, France
| | - Mehdi Karoui
- Université de Paris, Department of General and Digestive Surgery, Georges Pompidou European Hospital, AP-HP, Paris, France.
| | - Réa Lo Dico
- Université de Paris, Department of Digestive Surgery, Saint Louis Hospital, AP-HP, Paris, France
| | - Karine Le Malicot
- Fédération Francophone de Cancérologie Digestive, Faculty of Medecine, Dijon, France; EPICAD INSERM UMR LNC 1231, University of Burgundy Franche Comté, Dijon France
| | - Eloy Espin
- Department of General Surgery, Hospital Valle de Hebron, Universitat Autonoma de Barcelona, Barcelona, Spain
| | - Fabio Cianchi
- Department of Surgery and Translational Medicine, University of Florence, Florence, Italy
| | - Weitz Jürgen
- Department of Visceral, Thoracic and Vascular surgery, University Hospital Carl Gustav Carus of the Technical University Dresden, Germany
| | - Alexis Buggenhout
- Department of surgical gastroenterology, Erasme Hospital, Université Libre de Bruxelles, Brussels, Belgium
| | - Matthieu Bruzzi
- Université de Paris, Department of General and Digestive Surgery, Georges Pompidou European Hospital, AP-HP, Paris, France
| | - Fabrice Denimal
- Department of Digestive Surgery, Centre Hospitalier Départemental Vendée, La Roche sur Yon, France
| | - Antoine Cazelles
- Université de Paris, Department of General and Digestive Surgery, Georges Pompidou European Hospital, AP-HP, Paris, France
| | - Richard Douard
- Université de Paris, Department of General and Digestive Surgery, Georges Pompidou European Hospital, AP-HP, Paris, France
| | - Come Lepage
- EPICAD INSERM UMR LNC 1231, University of Burgundy Franche Comté, Dijon France; HepatoGastroenterology and Digestive oncology department, University hospital Dijon, University of Burgundy and Franche Comté, FFCD, EPICAD INSERM LNC-UMR 1231, Dijon, France
| | - Julien Taieb
- Université de Paris, Department of Digestive Oncology, Georges Pompidou European Hospital, AP-HP, Paris, France
| |
Collapse
|