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.
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.
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
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.
To read this article in full you will need to make a payment
Purchase one-time access:Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
One-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:Subscribe to Digestive and Liver Disease
Already a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
- The global burden of cancer 2013.JAMA Oncol. 2015; 1 ([Internet]Available from:): 505
- Disease-free survival after complete mesocolic excision compared with conventional colon cancer surgery: a retrospective, population-based study.Lancet Oncol. 2015; 16: 161-168
- Three versus 6 months of oxaliplatin-based adjuvant chemotherapy for patients with stage III colon cancer: disease-free survival results from a randomized, open-label, International Duration Evaluation of Adjuvant (IDEA) France, phase III trial.J Clin Oncol. 2018; 36: 1469-1477
- Localised colon cancer: ESMO clinical practice guidelines for diagnosis, treatment and follow-up†.Ann Oncol. 2020; 31 ([Internet]Available from:): 1291-1305https://doi.org/10.1016/j.annonc.2020.06.022
- Effect of duration of adjuvant chemotherapy for patients with stage III colon cancer (IDEA collaboration): final results from a prospective, pooled analysis of six randomised, phase 3 trials.Lancet Oncol. 2020; 21: 1620-1629
- A prospective, randomized trial comparing laparoscopic versus conventional techniques in colorectal cancer surgery: a preliminary report.J Am Coll Surg. 1998; 187: 46-54
- Impact of laparoscopic versus open surgery on hospital costs for colon cancer: a population-based retrospective cohort study.BMJ Open. 2016; 6 ([Internet]Available from:)e012977
The COlon cancer Laparoscopic or Open Resection Study Group. Laparoscopic surgery versus open surgery for colon cancer: short-term outcomes of a randomised trial. Lancet Oncol[Internet] 2005;6:477–484. Available from: http://linkinghub.elsevier.com/retrieve/pii/S1470204505702217
- Randomized trial of laparoscopic-assisted resection of colorectal carcinoma: 3-year results of the UK MRC clasicc trial group.J Clin Oncol. 2007; 25: 3061-3068
- Survival after laparoscopic surgery versus open surgery for colon cancer: long-term outcome of a randomised clinical trial.Lancet Oncol. 2009; 10 ([Internet]Available from:): 44-52https://doi.org/10.1016/S1470-2045(08)70310-3
- Short-term endpoints of conventional versus laparoscopic- assisted surgery in patients with colorectal cancer ( MRC CLASICC trial ): multicentre, randomised controlled trial.Lancet North Am Ed. 2005; 365: 1718-1726
- The clinical outcomes of surgical therapy study group. A comparison of laparoscopically assisted and open colectomy for colon cancer.New Engl J Med. 2004; 350 ([Internet]Available from:): 2050-2059
- Five-year follow-up of the Medical Research Council CLASICC trial of laparoscopically assisted versus open surgery for colorectal cancer.Br J Surg. 2010; 97: 1638-1645
- 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
- Short-term outcomes of the australasian randomized clinical study comparing laparoscopic and conventional open surgical treatments for colon cancer: the ALCCaS trial.Ann Surg. 2008; 248: 728-738
- Long-term outcomes of the australasian randomized clinical trial comparing laparoscopic and conventional open surgical treatments for colon cancer: The australasian laparoscopic colon cancer study trial.Ann Surg. 2012; 256: 915-919
- Short-term outcomes from a prospective randomized trial comparing laparoscopic and open surgery for colorectal cancer.Br J Surg. 2009; 96: 1458-1467
- Ten-year outcomes of a randomised trial of laparoscopic versus open surgery for colon cancer.Surg Endosc. 2017; 31 ([Internet]Available from:): 2607-2615
- Survival outcomes following laparoscopic versus open D3 dissection for stage II or III colon cancer (JCOG0404): a phase 3, randomised controlled trial.Lancet Gastroenterol Hepatol. 2017; 2 ([Internet]Available from:): 261-268
- Oxaliplatin, fluorouracil, and leucovorin with or without cetuximab in patients with resected stage III colon cancer (PETACC-8): An open-label, randomised phase 3 trial.Lancet Oncol. 2014; 15: 862-873
- Adjuvant FOLFOX +/- cetuximab in full RAS and BRAF wildtype stage III colon cancer patients.Ann Oncol. 2017; 28: 824-830
- The central role of the propensity score in observational studies for causal effects.Biometrika. 1983; 70: 41-55
- Propensity score methods for bias reduction in the comparison of a treatment to a non-randomized control group.Stat Med. 1998; 7: 2265-2281
- The long-term results of a randomized clinical trial of laparoscopy-assisted versus open surgery for colon cancer.Ann Surg. 2008; 248: 1-7
- Improved overall survival with oxaliplatin, fluorouracil, and leucovorin as adjuvant treatment in stage II or III colon cancer in the MOSAIC trial.J Clin Oncol. 2009; 27: 3109-3116
- Association of prognostic value of primary tumor location in stage III colon cancer WithRAS andBRAF mutational status.JAMA Oncol. 2018; 4: 1-8
- Refining adjuvant therapy for non-metastatic colon cancer, new standards and perspectives.Cancer Treat Rev. 2019; 75 ([Internet]Available from:): 1-11https://doi.org/10.1016/j.ctrv.2019.02.002
- Is adjuvant chemotherapy necessary for obstructing stage II colon cancer? Results from a propensity score analysis of the French surgical association database.Ann Surg. 2020; (Publish Ahead of Print:1–8)
- Prediction of overall survival in stage II and III colon cancer beyond TNM system: a retrospective, pooled biomarker study.Ann Oncol. 2017; 28 ([Internet]Available from:): 1023-1031
- Prognostic value of BRAF and KRAS mutations in MSI and MSS stage III colon cancer.J Natl Cancer Inst. 2017; 109: 1-12
- The perioperative period is an underutilized window of therapeutic opportunity in patients with colorectal cancer.Ann Surg. 2009; 249: 727-734
Published online: June 08, 2021
Accepted: May 14, 2021
Received: February 20, 2021
© 2021 Editrice Gastroenterologica Italiana S.r.l. Published by Elsevier Ltd. All rights reserved.
ScienceDirectAccess this article on ScienceDirect
- Laparoscopy and survival in colon cancer: A further step beyond the non-inferiority?Digestive and Liver DiseaseVol. 53Issue 8
- PreviewIn the last two decades, several evidences have suggested safety and short-term advantages of laparoscopic approach for colon cancer surgery. However, in randomized clinical trials its benefits in terms of long-term survival have never gone beyond the mere non-inferiority in comparison with open surgery. The COST multi-institutional trial randomly assigned 872 patients affected by colon cancer to open and laparoscopic surgery and demonstrated similar disease-free survivals between groups (HR 0.86, 95%CI 0.63–1.17) .