Feasibility of Laparoscopic Resection with D3 Lymph Node Dissection for Primary Tumors in Stage IV Colorectal Cancer (Originals)

Introduction : The feasibility and prognostic effect of laparoscopic primary tumor resection with D3 lymph node dissection for stage IV colorectal cancer remain unknown. Methods : Patients who had undergone laparoscopic D3 lymph node dissection for colorectal cancers of stage IV (11 patients) or stage IIIb (8 patients) at Kashiwa Hospital from January 2001 through December 2010 were retrospectively studied. The medical records of all patients were reviewed. Results : Between patients with stage IV or IIIb disease there was no significant difference in operative duration, intraoperative blood loss, postoperative hospital stay, or postoperative complications. Although tumor diameter, depth of tumor invasion, and pathological type did not differ significantly between the patient groups, the number of lymph node metastases was significantly greater in patients with stage IIIb disease. After primary tumor resection 3 patients with stage IV disease underwent conversion hepatectomy. The 5-year survival rates were 85.7% for patients with stage IIIb disease and 27.2% for those with stage IV disease. For more than 4 years after surgery postoperative local recurrence has not been observed in either group. Conclusion : Laparoscopic primary tumor resection with D3 lymph node dissection for stage IV colorectal cancer is oncologically acceptable and may allow metastatic lesions to be treated after colorectal primary resection. (Jikeikai Med J 2015 ; 62 : 63-7)