COMPARATIVE EFFECTIVENESS, SAFETY AND CLINICAL OUTCOMES OF LAPAROSCOPIC VERSUS OPEN SURGERY FOR COLORECTAL CANCER.
Main Article Content
Keywords
Colorectal cancer, Epidemiology, Laparoscopic surgery, Open surgery.
Abstract
Background: Colorectal cancer represents one of the leading cause of death worldwide. Despite the theoretical advantages of laparoscopic surgery, it is still not considered the standard treatment for colorectal cancer patients because of criticism concerning oncologic stability. The aim of this study was to evaluate the short term follow-up, clinical outcomes, oncologic safety, potential advantages and effectiveness of laparoscopic surgery versus open surgery for colorectal cancer. This prospective study was carried out in patients who underwent surgery for stage I–III colorectal cancer from March 2023 to July 2025 at the Department of General Surgery, DR. KNS-MIMS, Barabanki,UP, India. A total of 200 patients, 100 in each group (Lap=A Vs Open=B surgery), who underwent the laparoscopic-assisted procedure showed a significantly faster recovery than those who underwent open surgery, namely, less time to first passing flatus , time of first bowel motion , time to resume normal diet , and time to walk independently . Laparoscopic colorectal surgery caused less pain for patients, leading to lower need of analgesic and less hospital recovery time and stay as compared with the patients who underwent open surgery. No differences were found in 3 months, 6 months 12 months and 18 months overall and disease-free survival rates. The study was concluded as the laparoscopic approach was as safe as the open alternative. Laparoscopic-assisted surgery has been shown to be a favorable surgical option with better short-term outcomes and safe, effective oncological control as compared to open resection. Large sample size and long term follow up, up to 5 to 8 years are required to establish Laparoscopic-assisted surgery for colorectal cancer in rural population of India.
References
1. Guillou PJ, Quirke P, Thorpe H, Walker J, Jayne DG, Smith AM, Heath RM, Brown JM. Short-term endpoints of conventional versus laparoscopic-assisted surgery in patients with colorectal cancer (MRC CLASICC trial): Multicentre, randomised controlled trial. Lancet. 2005;365:1718–1726.
2. Laurent C, Leblanc F, Wütrich P, Scheffler M, Rullier E. Laparoscopic ver- sus open surgery for rectal cancer: long- term oncologic results. Ann Surg. 2009; 250:54-61.
3. Jeong SY, Park JW, Nam BH, et al. Open versus laparoscopic surgery for mid- rectal or low-rectal cancer after neoadju- vant chemoradiotherapy (COREAN trial): survival outcomes of an open-label, non- inferiority, randomised controlled trial. Lancet Oncol. 2014;15:767-74
4. Kang SB, Park JW, Jeong SY, et al. Open versus laparoscopic surgery for mid or low rectal cancer after neoadjuvant chemoradiotherapy (COREAN trial): short- term outcomes of an open-label ran- domised controlled trial. Lancet Oncol. 2010;11:637-45.
5. Marr R, Birbeck K, Garvican J, et al. The modern abdominoperineal excision: the next challenge after total mesorectal excision. Ann Surg. 2005;242:74-82.
6. International Agency for Research on Cancer, ‘Cancer Today’, Global Cancer Observatory (GLOBOCAN). 2022. https://gco. iarc.who.int/today/en. Accessed 2024.
7. Bray F, Colombet M, Aitken JF, et al. Cancer incidence in five continents, Vol. XII (IARC CancerBase No. 19). Lyon: International Agency for Research on Cancer. 2023. https://ci5.iarc.who. int. Accessed 2024.
8. Bopanna S, Kedia S, Das P, et al. Long-term follow-up reveals high incidence of colorectal cancer in Indian patients with inflammatory bowel disease. United European Gastroenterol. J. 2017;5:708–14.
9. Patel G, Patil P. Worrisome trends in young-onset colorectal cancer: Now is the time for action. Indian J Surg Oncol. 2022;13:446–52.
10. Khanna D, Sharma P, Budukh A, et al. Rural-urban disparity in cancer burden and care: findings from an Indian cancer registry. BMC Cancer. 2024;24:308.
11. Indian Council of Medical Research-National Centre for Disease Informatics and Research, ‘Clinicopathological Profile of Cancers in India: A Report of the Hospital Based Cancer Registries. 2021. https://ncdirindia.org/All_Reports/HBCR_2021/Default. aspx. Accessed 2024.
12. Brenner DR, Ruan Y, Shaw E, De P, Heitman SJ, Hilsden RJ. Increasing colorectal cancer incidence trends among younger adults in Canada. Prev Med. 2017;105:345–9.
13. Holm T, Ljung A, Häggmark T, Jurell G, Lagergren J. Extended abdominoperi- neal resection with gluteus maximus flap reconstruction of the pelvic floor for rec- tal cancer. Br J Surg. 2007;94:232-8.
14. Bouvy ND, Marquet RL, Jeekel J, Bon- jer HJ. Laparoscopic surgery is associated with less tumour growth stimulation than conventional surgery: an experimental study. Br J Surg. 1997;84:358-61.
15. Veenhof AA, Vlug MS, van der Pas MH, et al. Surgical stress response and postoperative immune function after lap- aroscopy or open surgery with fast track or standard perioperative care: a random- ized trial. Ann Surg. 2012;255:216-21.
16. Harrysson IJ, Cook J, Sirimanna P, Feldman LS, Darzi A, Aggarwal R. System- atic review of learning curves for mini- mally invasive abdominal surgery: a review of the methodology of data collection, depiction of outcomes, and statistical analysis. Ann Surg. 2014;260:37-45.
17. Milsom JW, de Oliveira O Jr, Trencheva KI, Pandey S, Lee SW, Sonoda T. Long- term outcomes of patients undergoing curative laparoscopic surgery for mid and low rectal cancer. Dis Colon Rectum 2009; 52:1215-22.
18. Veldkamp R, Kuhry E, Hop WC, et al. Laparoscopic surgery versus open surgery for colon cancer: short-term outcomes of a randomised trial. Lancet Oncol. 2005;6: 477-84.
19. Berends FJ, Kazemier G, Bonjer HJ, Lange JF. Subcutaneous metastases after laparoscopic colectomy. Lancet 1994;344: 58.
20. Cirocco WC, Schwartzman A, Golub RW. Abdominal wall recurrence after laparoscopic colectomy for colon cancer. Surgery. 1994;116:842-6.
21. Colon Cancer Laparoscopic or Open Resection Study Group. Survival after laparoscopic surgery versus open surgery for colon cancer: long-term outcome of a randomised clinical trial. Lancet Oncol. 2009;10:44-52.
22. Lacy AM, García-Valdecasas JC, Del- gado S, et al. Laparoscopy-assisted colectomy versus open colectomy for treatment of non-metastatic colon cancer: a randomised trial. Lancet. 2002;359:2224-9.
23. van der Pas MH, Haglind E, Cuesta MA, et al. Laparoscopic versus open sur- gery for rectal cancer (COLOR II): short- term outcomes of a randomised, phase 3 trial. Lancet Oncol. 2013;14:210-8.
24. Ohtani H, Tamamori Y, Arimoto Y, H. Zemon, and G. DeNoto. A Meta- Analysis of the Short- and Long-Term Results of Randomized Controlled Trials That Compared Laparoscopy-Assisted and Conventional Open Surgery for Colorectal Cancer . J Cancer. 2011; 2: 425– 434.
25. Mandic M, Li H, Safizadeh F, et al. Is the association of overweight and obesity with colorectal cancer underestimated? An umbrella review of systematic reviews and meta-analyses. Eur J Epidemiol. 2023;38:135–44.
26. Deijen CL, Vasmel JE, de Lange-de Klerk ESM, et al. Ten-year outcomes of a randomised trial of laparoscopic versus open surgery for colon cancer. Surg Endosc. 2017;31:2607–15.
27. Singh A, Muthukumarasamy G, Pawa N, et al. Laparoscopic colorectal cancer surgery in obese patients. Colorectal Dis 2011;13:878–83.
28. Fung A, Trabulsi N, Morris M, et al. Laparoscopic colorectal cancer resections in the obese: a systematic review. Surg Endosc. 2017;31:2072–88.
29. Bell S, Kong JC, Carne PWG, et al. Oncological safety of laparoscopic versus open colorectal cancer surgery in obesity: a systematic review and meta-analysis. ANZ J Surg. 2019;89:1549–55.
30. Zhang Q, Liu Q, Chen J, et al. Short-term outcomes for laparoscopic surgery for BMI > / = 30 patients with rectal cancer. Asian Pac J Cancer Prev. 2021;22:3705–9.
31. Mao D, Flynn DE, Yerkovich S, et al. Effect of obesity on post-operative outcomes following colorectal cancer surgery. World J Gastrointest Oncol. 2022;14:1324–36.
32. Numata M, Sawazaki S, Morita J, et al. Comparison of laparoscopic and open surgery for colorectal cancer in patients with severe comorbidities. Anticancer Res. 2018;38:963–7.
33. Yu YL, Hsu YJ, Liao CK, et al. Advantage of laparoscopic surgery in patients with generalized obesity operated for colorectal malignancy: a retrospective cohort study. Front Surg 2022;9: 1062746.
34. Bizzoca C, Zupo R, Aquilino F, et al. Video-laparoscopic versus open surgery in obese patients with colorectal cancer: a propensity score matching study. Cancers (Basel). 2021;13:1844.
35. Hardiman K, Chang ET, Diggs BS, et al. Laparoscopic colectomy reduces morbidity and mortality in obese patients. Surg Endosc. 2013;27: 2907–10.
36. Cai Y, Zhou Y, Li Z, et al. Surgical outcome of laparoscopic colectomy for colorectal cancer in obese patients: a comparative study with open colectomy. Oncol Lett. 2013;6:1057–62.
37. Kazama K, Numata M, Aoyama T, et al. Laparoscopic vs. open surgery for stage II/III colon cancer patients with body mass index > 25 kg/m(2). In Vivo. 2020;34:2079–85.
38. Kethman WC, Harris AHS, Morris AM, et al. Oncologic and perio- perative outcomes of laparoscopic, open, and robotic approaches for rectal cancer resection: a multicenter, propensity score-weighted cohort study. Dis Colon Rectum. 2020;63:46–52.
39. O’Brien WJ, Schweizer ML, Strymish J, et al. Propensity score-weighted analysis of postoperative infection in patients with and without pre- operative urine culture. JAMA Netw Open. 2024;7:e240900.
40. Austin PC. The use of propensity score methods with survival or time-to- event outcomes: reporting measures of effect similar to those used in randomized experiments. Stat Med. 2014;33:1242–58.
41. Austin PC, Schuster T. The performance of different propensity score methods for estimating absolute effects of treatments on survival out- comes: a simulation study. Stat Methods Med Res. 2016;25:2214–37.
42. Hashiguchi Y, Muro K, Saito Y, et al. Japanese Society for Cancer of the Colon and Rectum (JSCCR) guidelines 2019 for the treatment of color- ectal cancer. Int J Clin Oncol. 2020;25:1–42.
43. Damadi AA, Julien L, Arrangoiz R, et al. Does obesity influence lymph node harvest among patients undergoing colectomy for colon cancer? The American Surgeon. 2008;74:1073–7.
44. Linebarger JH, Mathiason MA, Kallies KJ, et al. Does obesity impact lymph node retrieval in colon cancer surgery? Am J Surg. 2010;200:478–82.
45. Cheong JY, Young CJ, Byrne C. Does the body mass index impact lymph node yield for colorectal cancer resection, and does operative approach influence this: a review of bi-national colorectal cancer audit database. ANZ J Surg. 2021;91:2707–13.
46. Hu DP, Zhu XL, Wang H, Liu WH, Lv YC, Shi XL, et al. Robotic-assisted versus conventional laparoscopic surgery for colorectal cancer: Short-term outcomes at a single center. Indian J Cancer. 2021; 58:225–31.
47. 19. Farah E, Abreu AA, Rail B, Salgado J, Karagkounis G, Zeh HJ, et al. Perioperative outcomes of robotic and laparoscopic surgery for colorectal cancer: a propensity score-matched analysis. World J Surg Oncol. 2023; 21:272.
48. Park JS, Lee SM, Choi GS, Park SY, Kim HJ, Song SH, et al. Comparison of laparoscopic versus robot-assisted surgery for rectal cancers: the COLRAR randomized controlled trial. Ann Surg. 2023; 278:31–8.
49. Yang T, Wei M, He Y, et al. Impact of visceral obesity on outcomes of laparoscopic colorectal surgery: a meta-analysis. ANZ J Surg. 2015;85: 507–13.
50. Son, I.T.; Kim, J.Y.; Kim, M.J.; Kim, B.C.; Kang, B.M.; Kim, J.W. Clinical and oncologic outcomes of laparoscopic versus open surgery in elderly patients with colorectal cancer: A retrospective multicenter study. Int. J. Clin. Oncol. 2021, 26: 2237–2245.
51. Arnold, M.; Sierra, M.S.; Laversanne, M.; Soerjomataram, I.; Jemal, A.; Bray, F. Global patterns and trends in colorectal cancer incidence and mortality. Gut 2017, 66, 683–961.
52. Turrentine, F.E.; Wang, H.; Simpson, V.B.; Jones, R.S. Surgical risk factors, morbidity, and mortality in elderly patients. J. Am. Coll. Surg. 2006, 203, 865–877.
53. González-Senac, N.M.; Mayordomo-Cava, J.; Macías-Valle, A.; Aldama-Marín, P.; Majuelos González, S.; Cruz Arnés, M.L.; Jiménez-Gómez, L.M.; Vidán-Astiz, M.T.; Serra-Rexach, J.A. Colorectal Cancer in Elderly Patients with Surgical Indication: State of the Art, Current Management, Role of Frailty and Benefits of a Geriatric Liaison. Int. J. Environ. Res. Public Health 2021; 18, 6072.
54. Zhou, S.; Wang, X.; Zhao, C.; Liu, Q.; Zhou, H.; Zheng, Z.; Zhou, Z.; Wang, X.; Liang, J. Laparoscopic vs. open colorectal cancer surgery in elderly patients: Short- and long-term outcomes and predictors for overall and disease-free survival. BMC Surg. 2019; 19: 137.
55. Hinoi, T.; Kawaguchi, Y.; Hattori, M.; Okajima, M.; Ohdan, H.; Yamamoto, S.; Hasegawa, H.; Horie, H.; Murata, K.; Yamaguchi, S.; et al. Laparoscopic versus open surgery for colorectal cancer in elderly patients: A multicenter matched case-control study. Ann. Surg. Oncol. 2015; 22: 2040–2050.
56. Miguchi, M.; Yoshimitsu, M.; Shimomura, M.; Kohashi, T.; Egi, H.; Ohdan, H.; Hirabayashi, N. Long-term outcomes of laparoscopic surgery in elderly patients with colorectal cancer: A single institutional matched case-control study. Asian J. Endosc. Surg. 2021; 14: 200–206.
57. Luo, W.; Wu, M.; Chen, Y. Laparoscopic versus open surgery for elderly patients with colorectal cancer: A systematic review and meta-analysis of matched studies. ANZ J. Surg. 2022; 92: 2003–2017.
58. Utsumi, M.; Matsuda, T.; Yamashita, K.; Hasegawa, H.; Agawa, K.; Urakawa, N.; Kanaji, S.; Oshikiri, T.; Nakamura, T.; Kakeji, Y. Short-term and long-term outcomes after laparoscopic surgery for elderly patients with colorectal cancer aged over 80 years: A propensity score matching analysis. Int. J. Color. Dis. 2021; 36: 2519–2528
59. Chern YJ, You JF, Cheng CC, et al. Decreasing postoperative pulmonary complication following laparoscopic surgery in elderly individuals with colorectal cancer: a competing risk analysis in a propensity score- weighted cohort study. Cancers (Basel). 2021;14:131.
60. Braga M, Vignali A, Gianotti L Zuliani W, Radaelli G, Gruarin P, Dellabona P and Di Carlo V. Laparoscopic versus open colorectal surgery: a randomized trial on short- term outcome. Ann Surg. 2002; 236:759 –767.
61. Gandy CP, Kipling RM and Kennedy RH. Laparoscopic colorectal surgery .In: Recent advances in Surgery 27. Johnson C. and Taylor L (Eds). Pbl. Royal Society of Medicine press, London, 2004; pp. 123-136.
62. Künzli BM, Friess H and Shrikhande SV. Is laparoscopic colorectal cancer surgery equal to open surgery? An evidence based perspective. World J Gastrointest Surg. 2010; 2 (4): 101-108.
63. Lacy AM, Delgado S, Castells A, Prins HA, Arroyo V, Ibarzabal A and Pique JM. The long-term results of a randomized clinical trial of laparoscopy-assisted versus open surgery for colon cancer. Ann Surg.2008; 248: 1-7.
64. Sun J, Jiang T, Qiu Z, Cen G, Cao J, Huang K, Pu Y, Liang H, Huang R, Chen S. Short-term and medium-term clinical outcomes of laparoscopic-assisted and open surgery for colorectal cancer: A single center retrospective case-control study. BMC Gastroenterol. 2011;11:85.
65. Clinical Outcomes of Surgical Therapy Study Group. A comparison of laparoscopically assisted and open colectomy for colon cancer. N Engl J Med 2004;350:2050–2059.
66. Buunen M, Veldkamp R, Hop WC, Kuhry E, Jeekel J, Haglind E, Pahlman L, Cuesta MA, Msika S, Morino M, Lacy A, Bonjer HJ. Survival after laparoscopic surgery versus open surgery for colon cancer: Long-term outcome of a randomised clinical trial. Lancet Oncol. 2009;10:44–52.
67. Lee JE, Joh YG, Yoo SH, Jeong GY, Kim SH, Chung CS, Lee DG, Kim SH. Long-term outcomes of laparoscopic surgery for colorectal cancer. J Korean Soc Coloproctol. 2011;27: 64–70.
68. Fleshman J, Sargent DJ, Green E, Anvari M, Stryker SJ, Beart RW Jr, Hellinger M, Flanagan R Jr, Peters W, Nelson H. Laparoscopic colectomy for cancer is not inferior to open surgery based on 5-year data from the COST Study Group trial. Ann Surg. 2007;246:655–662.
69. Kim HJ, Lee IK, Lee YS, Kang WK, Park JK, Oh ST, Kim JG, Kim YH. A comparative study on the short-term clinicopathologic outcomes of laparoscopic surgery versus conventional open surgery for transverse colon cancer. Surg Endosc. 2009;23:1812–1817.
70. Li JC, Leung KL, Ng SS, Liu SY, Lee JF, Hon SS. Laparoscopic-assisted versus open resection of right-sided colonic cancer—A prospective randomized controlled trial. Int J Colorectal Dis. 2012;27:95–102.
71. Veldkamp R, Kuhry E, Hop WC, Jeekel J, Kazemier G, Bonjer HJ, Haglind E, Pahlman L, Cuesta MA, Msika S, Morino M, Lacy AM. Laparoscopic surgery versus open surgery for colon cancer: Short-term outcomes of a randomised trial. Lancet Oncol 2005;6:477–484.
72. Park IK, Kim YH, Joh YG, Hahn KY. Recurrence pattern after laparoscopic resection for colorectal cancer: Analysis according to timing of recurrence and location of primary tumor. J Korean Soc Coloproctol 2007;23:110–115.
2. Laurent C, Leblanc F, Wütrich P, Scheffler M, Rullier E. Laparoscopic ver- sus open surgery for rectal cancer: long- term oncologic results. Ann Surg. 2009; 250:54-61.
3. Jeong SY, Park JW, Nam BH, et al. Open versus laparoscopic surgery for mid- rectal or low-rectal cancer after neoadju- vant chemoradiotherapy (COREAN trial): survival outcomes of an open-label, non- inferiority, randomised controlled trial. Lancet Oncol. 2014;15:767-74
4. Kang SB, Park JW, Jeong SY, et al. Open versus laparoscopic surgery for mid or low rectal cancer after neoadjuvant chemoradiotherapy (COREAN trial): short- term outcomes of an open-label ran- domised controlled trial. Lancet Oncol. 2010;11:637-45.
5. Marr R, Birbeck K, Garvican J, et al. The modern abdominoperineal excision: the next challenge after total mesorectal excision. Ann Surg. 2005;242:74-82.
6. International Agency for Research on Cancer, ‘Cancer Today’, Global Cancer Observatory (GLOBOCAN). 2022. https://gco. iarc.who.int/today/en. Accessed 2024.
7. Bray F, Colombet M, Aitken JF, et al. Cancer incidence in five continents, Vol. XII (IARC CancerBase No. 19). Lyon: International Agency for Research on Cancer. 2023. https://ci5.iarc.who. int. Accessed 2024.
8. Bopanna S, Kedia S, Das P, et al. Long-term follow-up reveals high incidence of colorectal cancer in Indian patients with inflammatory bowel disease. United European Gastroenterol. J. 2017;5:708–14.
9. Patel G, Patil P. Worrisome trends in young-onset colorectal cancer: Now is the time for action. Indian J Surg Oncol. 2022;13:446–52.
10. Khanna D, Sharma P, Budukh A, et al. Rural-urban disparity in cancer burden and care: findings from an Indian cancer registry. BMC Cancer. 2024;24:308.
11. Indian Council of Medical Research-National Centre for Disease Informatics and Research, ‘Clinicopathological Profile of Cancers in India: A Report of the Hospital Based Cancer Registries. 2021. https://ncdirindia.org/All_Reports/HBCR_2021/Default. aspx. Accessed 2024.
12. Brenner DR, Ruan Y, Shaw E, De P, Heitman SJ, Hilsden RJ. Increasing colorectal cancer incidence trends among younger adults in Canada. Prev Med. 2017;105:345–9.
13. Holm T, Ljung A, Häggmark T, Jurell G, Lagergren J. Extended abdominoperi- neal resection with gluteus maximus flap reconstruction of the pelvic floor for rec- tal cancer. Br J Surg. 2007;94:232-8.
14. Bouvy ND, Marquet RL, Jeekel J, Bon- jer HJ. Laparoscopic surgery is associated with less tumour growth stimulation than conventional surgery: an experimental study. Br J Surg. 1997;84:358-61.
15. Veenhof AA, Vlug MS, van der Pas MH, et al. Surgical stress response and postoperative immune function after lap- aroscopy or open surgery with fast track or standard perioperative care: a random- ized trial. Ann Surg. 2012;255:216-21.
16. Harrysson IJ, Cook J, Sirimanna P, Feldman LS, Darzi A, Aggarwal R. System- atic review of learning curves for mini- mally invasive abdominal surgery: a review of the methodology of data collection, depiction of outcomes, and statistical analysis. Ann Surg. 2014;260:37-45.
17. Milsom JW, de Oliveira O Jr, Trencheva KI, Pandey S, Lee SW, Sonoda T. Long- term outcomes of patients undergoing curative laparoscopic surgery for mid and low rectal cancer. Dis Colon Rectum 2009; 52:1215-22.
18. Veldkamp R, Kuhry E, Hop WC, et al. Laparoscopic surgery versus open surgery for colon cancer: short-term outcomes of a randomised trial. Lancet Oncol. 2005;6: 477-84.
19. Berends FJ, Kazemier G, Bonjer HJ, Lange JF. Subcutaneous metastases after laparoscopic colectomy. Lancet 1994;344: 58.
20. Cirocco WC, Schwartzman A, Golub RW. Abdominal wall recurrence after laparoscopic colectomy for colon cancer. Surgery. 1994;116:842-6.
21. Colon Cancer Laparoscopic or Open Resection Study Group. Survival after laparoscopic surgery versus open surgery for colon cancer: long-term outcome of a randomised clinical trial. Lancet Oncol. 2009;10:44-52.
22. Lacy AM, García-Valdecasas JC, Del- gado S, et al. Laparoscopy-assisted colectomy versus open colectomy for treatment of non-metastatic colon cancer: a randomised trial. Lancet. 2002;359:2224-9.
23. van der Pas MH, Haglind E, Cuesta MA, et al. Laparoscopic versus open sur- gery for rectal cancer (COLOR II): short- term outcomes of a randomised, phase 3 trial. Lancet Oncol. 2013;14:210-8.
24. Ohtani H, Tamamori Y, Arimoto Y, H. Zemon, and G. DeNoto. A Meta- Analysis of the Short- and Long-Term Results of Randomized Controlled Trials That Compared Laparoscopy-Assisted and Conventional Open Surgery for Colorectal Cancer . J Cancer. 2011; 2: 425– 434.
25. Mandic M, Li H, Safizadeh F, et al. Is the association of overweight and obesity with colorectal cancer underestimated? An umbrella review of systematic reviews and meta-analyses. Eur J Epidemiol. 2023;38:135–44.
26. Deijen CL, Vasmel JE, de Lange-de Klerk ESM, et al. Ten-year outcomes of a randomised trial of laparoscopic versus open surgery for colon cancer. Surg Endosc. 2017;31:2607–15.
27. Singh A, Muthukumarasamy G, Pawa N, et al. Laparoscopic colorectal cancer surgery in obese patients. Colorectal Dis 2011;13:878–83.
28. Fung A, Trabulsi N, Morris M, et al. Laparoscopic colorectal cancer resections in the obese: a systematic review. Surg Endosc. 2017;31:2072–88.
29. Bell S, Kong JC, Carne PWG, et al. Oncological safety of laparoscopic versus open colorectal cancer surgery in obesity: a systematic review and meta-analysis. ANZ J Surg. 2019;89:1549–55.
30. Zhang Q, Liu Q, Chen J, et al. Short-term outcomes for laparoscopic surgery for BMI > / = 30 patients with rectal cancer. Asian Pac J Cancer Prev. 2021;22:3705–9.
31. Mao D, Flynn DE, Yerkovich S, et al. Effect of obesity on post-operative outcomes following colorectal cancer surgery. World J Gastrointest Oncol. 2022;14:1324–36.
32. Numata M, Sawazaki S, Morita J, et al. Comparison of laparoscopic and open surgery for colorectal cancer in patients with severe comorbidities. Anticancer Res. 2018;38:963–7.
33. Yu YL, Hsu YJ, Liao CK, et al. Advantage of laparoscopic surgery in patients with generalized obesity operated for colorectal malignancy: a retrospective cohort study. Front Surg 2022;9: 1062746.
34. Bizzoca C, Zupo R, Aquilino F, et al. Video-laparoscopic versus open surgery in obese patients with colorectal cancer: a propensity score matching study. Cancers (Basel). 2021;13:1844.
35. Hardiman K, Chang ET, Diggs BS, et al. Laparoscopic colectomy reduces morbidity and mortality in obese patients. Surg Endosc. 2013;27: 2907–10.
36. Cai Y, Zhou Y, Li Z, et al. Surgical outcome of laparoscopic colectomy for colorectal cancer in obese patients: a comparative study with open colectomy. Oncol Lett. 2013;6:1057–62.
37. Kazama K, Numata M, Aoyama T, et al. Laparoscopic vs. open surgery for stage II/III colon cancer patients with body mass index > 25 kg/m(2). In Vivo. 2020;34:2079–85.
38. Kethman WC, Harris AHS, Morris AM, et al. Oncologic and perio- perative outcomes of laparoscopic, open, and robotic approaches for rectal cancer resection: a multicenter, propensity score-weighted cohort study. Dis Colon Rectum. 2020;63:46–52.
39. O’Brien WJ, Schweizer ML, Strymish J, et al. Propensity score-weighted analysis of postoperative infection in patients with and without pre- operative urine culture. JAMA Netw Open. 2024;7:e240900.
40. Austin PC. The use of propensity score methods with survival or time-to- event outcomes: reporting measures of effect similar to those used in randomized experiments. Stat Med. 2014;33:1242–58.
41. Austin PC, Schuster T. The performance of different propensity score methods for estimating absolute effects of treatments on survival out- comes: a simulation study. Stat Methods Med Res. 2016;25:2214–37.
42. Hashiguchi Y, Muro K, Saito Y, et al. Japanese Society for Cancer of the Colon and Rectum (JSCCR) guidelines 2019 for the treatment of color- ectal cancer. Int J Clin Oncol. 2020;25:1–42.
43. Damadi AA, Julien L, Arrangoiz R, et al. Does obesity influence lymph node harvest among patients undergoing colectomy for colon cancer? The American Surgeon. 2008;74:1073–7.
44. Linebarger JH, Mathiason MA, Kallies KJ, et al. Does obesity impact lymph node retrieval in colon cancer surgery? Am J Surg. 2010;200:478–82.
45. Cheong JY, Young CJ, Byrne C. Does the body mass index impact lymph node yield for colorectal cancer resection, and does operative approach influence this: a review of bi-national colorectal cancer audit database. ANZ J Surg. 2021;91:2707–13.
46. Hu DP, Zhu XL, Wang H, Liu WH, Lv YC, Shi XL, et al. Robotic-assisted versus conventional laparoscopic surgery for colorectal cancer: Short-term outcomes at a single center. Indian J Cancer. 2021; 58:225–31.
47. 19. Farah E, Abreu AA, Rail B, Salgado J, Karagkounis G, Zeh HJ, et al. Perioperative outcomes of robotic and laparoscopic surgery for colorectal cancer: a propensity score-matched analysis. World J Surg Oncol. 2023; 21:272.
48. Park JS, Lee SM, Choi GS, Park SY, Kim HJ, Song SH, et al. Comparison of laparoscopic versus robot-assisted surgery for rectal cancers: the COLRAR randomized controlled trial. Ann Surg. 2023; 278:31–8.
49. Yang T, Wei M, He Y, et al. Impact of visceral obesity on outcomes of laparoscopic colorectal surgery: a meta-analysis. ANZ J Surg. 2015;85: 507–13.
50. Son, I.T.; Kim, J.Y.; Kim, M.J.; Kim, B.C.; Kang, B.M.; Kim, J.W. Clinical and oncologic outcomes of laparoscopic versus open surgery in elderly patients with colorectal cancer: A retrospective multicenter study. Int. J. Clin. Oncol. 2021, 26: 2237–2245.
51. Arnold, M.; Sierra, M.S.; Laversanne, M.; Soerjomataram, I.; Jemal, A.; Bray, F. Global patterns and trends in colorectal cancer incidence and mortality. Gut 2017, 66, 683–961.
52. Turrentine, F.E.; Wang, H.; Simpson, V.B.; Jones, R.S. Surgical risk factors, morbidity, and mortality in elderly patients. J. Am. Coll. Surg. 2006, 203, 865–877.
53. González-Senac, N.M.; Mayordomo-Cava, J.; Macías-Valle, A.; Aldama-Marín, P.; Majuelos González, S.; Cruz Arnés, M.L.; Jiménez-Gómez, L.M.; Vidán-Astiz, M.T.; Serra-Rexach, J.A. Colorectal Cancer in Elderly Patients with Surgical Indication: State of the Art, Current Management, Role of Frailty and Benefits of a Geriatric Liaison. Int. J. Environ. Res. Public Health 2021; 18, 6072.
54. Zhou, S.; Wang, X.; Zhao, C.; Liu, Q.; Zhou, H.; Zheng, Z.; Zhou, Z.; Wang, X.; Liang, J. Laparoscopic vs. open colorectal cancer surgery in elderly patients: Short- and long-term outcomes and predictors for overall and disease-free survival. BMC Surg. 2019; 19: 137.
55. Hinoi, T.; Kawaguchi, Y.; Hattori, M.; Okajima, M.; Ohdan, H.; Yamamoto, S.; Hasegawa, H.; Horie, H.; Murata, K.; Yamaguchi, S.; et al. Laparoscopic versus open surgery for colorectal cancer in elderly patients: A multicenter matched case-control study. Ann. Surg. Oncol. 2015; 22: 2040–2050.
56. Miguchi, M.; Yoshimitsu, M.; Shimomura, M.; Kohashi, T.; Egi, H.; Ohdan, H.; Hirabayashi, N. Long-term outcomes of laparoscopic surgery in elderly patients with colorectal cancer: A single institutional matched case-control study. Asian J. Endosc. Surg. 2021; 14: 200–206.
57. Luo, W.; Wu, M.; Chen, Y. Laparoscopic versus open surgery for elderly patients with colorectal cancer: A systematic review and meta-analysis of matched studies. ANZ J. Surg. 2022; 92: 2003–2017.
58. Utsumi, M.; Matsuda, T.; Yamashita, K.; Hasegawa, H.; Agawa, K.; Urakawa, N.; Kanaji, S.; Oshikiri, T.; Nakamura, T.; Kakeji, Y. Short-term and long-term outcomes after laparoscopic surgery for elderly patients with colorectal cancer aged over 80 years: A propensity score matching analysis. Int. J. Color. Dis. 2021; 36: 2519–2528
59. Chern YJ, You JF, Cheng CC, et al. Decreasing postoperative pulmonary complication following laparoscopic surgery in elderly individuals with colorectal cancer: a competing risk analysis in a propensity score- weighted cohort study. Cancers (Basel). 2021;14:131.
60. Braga M, Vignali A, Gianotti L Zuliani W, Radaelli G, Gruarin P, Dellabona P and Di Carlo V. Laparoscopic versus open colorectal surgery: a randomized trial on short- term outcome. Ann Surg. 2002; 236:759 –767.
61. Gandy CP, Kipling RM and Kennedy RH. Laparoscopic colorectal surgery .In: Recent advances in Surgery 27. Johnson C. and Taylor L (Eds). Pbl. Royal Society of Medicine press, London, 2004; pp. 123-136.
62. Künzli BM, Friess H and Shrikhande SV. Is laparoscopic colorectal cancer surgery equal to open surgery? An evidence based perspective. World J Gastrointest Surg. 2010; 2 (4): 101-108.
63. Lacy AM, Delgado S, Castells A, Prins HA, Arroyo V, Ibarzabal A and Pique JM. The long-term results of a randomized clinical trial of laparoscopy-assisted versus open surgery for colon cancer. Ann Surg.2008; 248: 1-7.
64. Sun J, Jiang T, Qiu Z, Cen G, Cao J, Huang K, Pu Y, Liang H, Huang R, Chen S. Short-term and medium-term clinical outcomes of laparoscopic-assisted and open surgery for colorectal cancer: A single center retrospective case-control study. BMC Gastroenterol. 2011;11:85.
65. Clinical Outcomes of Surgical Therapy Study Group. A comparison of laparoscopically assisted and open colectomy for colon cancer. N Engl J Med 2004;350:2050–2059.
66. Buunen M, Veldkamp R, Hop WC, Kuhry E, Jeekel J, Haglind E, Pahlman L, Cuesta MA, Msika S, Morino M, Lacy A, Bonjer HJ. Survival after laparoscopic surgery versus open surgery for colon cancer: Long-term outcome of a randomised clinical trial. Lancet Oncol. 2009;10:44–52.
67. Lee JE, Joh YG, Yoo SH, Jeong GY, Kim SH, Chung CS, Lee DG, Kim SH. Long-term outcomes of laparoscopic surgery for colorectal cancer. J Korean Soc Coloproctol. 2011;27: 64–70.
68. Fleshman J, Sargent DJ, Green E, Anvari M, Stryker SJ, Beart RW Jr, Hellinger M, Flanagan R Jr, Peters W, Nelson H. Laparoscopic colectomy for cancer is not inferior to open surgery based on 5-year data from the COST Study Group trial. Ann Surg. 2007;246:655–662.
69. Kim HJ, Lee IK, Lee YS, Kang WK, Park JK, Oh ST, Kim JG, Kim YH. A comparative study on the short-term clinicopathologic outcomes of laparoscopic surgery versus conventional open surgery for transverse colon cancer. Surg Endosc. 2009;23:1812–1817.
70. Li JC, Leung KL, Ng SS, Liu SY, Lee JF, Hon SS. Laparoscopic-assisted versus open resection of right-sided colonic cancer—A prospective randomized controlled trial. Int J Colorectal Dis. 2012;27:95–102.
71. Veldkamp R, Kuhry E, Hop WC, Jeekel J, Kazemier G, Bonjer HJ, Haglind E, Pahlman L, Cuesta MA, Msika S, Morino M, Lacy AM. Laparoscopic surgery versus open surgery for colon cancer: Short-term outcomes of a randomised trial. Lancet Oncol 2005;6:477–484.
72. Park IK, Kim YH, Joh YG, Hahn KY. Recurrence pattern after laparoscopic resection for colorectal cancer: Analysis according to timing of recurrence and location of primary tumor. J Korean Soc Coloproctol 2007;23:110–115.
Article Sidebar
Published
Aug 13, 2025
Article Details
How to Cite
Dr Ajay Gabbulal Gupta, Dr Pankaja Kumar, & Dr Ravi Sinha. (2025). COMPARATIVE EFFECTIVENESS, SAFETY AND CLINICAL OUTCOMES OF LAPAROSCOPIC VERSUS OPEN SURGERY FOR COLORECTAL CANCER. Journal of Population Therapeutics and Clinical Pharmacology, 32(7), 511-530. https://doi.org/10.53555/mchdzd67
Section
Articles
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
All articles published in JPTCP are licensed under Copyright Creative Commons Attribution-NonCommercial 4.0 International License.
Author Biographies
Dr Ajay Gabbulal Gupta
Pg Resident-3, Department Of General Surgery, DR. KNSMIMS, Gadia, Barabanki,Up, India.
Dr Pankaja Kumar
Associate Professor, Department Of General Surgery, DR. KNSMIMS, Gadia, Barabanki,Up, India.
Dr Ravi Sinha
Professor & HOd, Department Of General Surgery, DR. KNSMIMS, Gadia, Barabanki,Up, India.
How to Cite
Dr Ajay Gabbulal Gupta, Dr Pankaja Kumar, & Dr Ravi Sinha. (2025). COMPARATIVE EFFECTIVENESS, SAFETY AND CLINICAL OUTCOMES OF LAPAROSCOPIC VERSUS OPEN SURGERY FOR COLORECTAL CANCER. Journal of Population Therapeutics and Clinical Pharmacology, 32(7), 511-530. https://doi.org/10.53555/mchdzd67