Comparison Between Laparoscopic And Open Surgery For Synchronous Multiple Primary Colorectal Cancers:A Case-matched Study

BackgroundColorectal Cancer(CRC)is one of the most common malignant gastrointestinal tumors,with morbidity ranking third and mortality ranking second.With the development of science and technology,the accumulation of cases and the prolonging of survival,the incidence of Multiple Primary Colorectal Cancer(MPCC)increases gradually.Currently,excision is the most recognized treatment for CRC.Leading the minimally invasive surgery,laparoscopy has been favored by more and more surgeons ever since 21st century.Previous studies have shown the feasibility of laparoscopy for synchronous MPCC(SMPCC).Up to now,there is still no consensus on the surgical treatment of SMPCC.Therefore,our study aimed to retrospect the application of laparoscopy and traditional open surgery in SMPCC as well as explore the efficacy and safety of two groups,based on the propensity score matching(PSM).MethodsThis study was conducted on Nanfang Hospital of Southern Medical University,Fujian Provincial Cancer Hospital and Fujian Provincial Hospital.Clinical data were collected and analyzed retrospectively from SMPCC patients undergoing surgical treatment in the above three hospitals from March 2008 to March 2018.Finally,75 SMPCC patients received laparoscopic surgery(Laparoscopic Group,LG)and 40 received open surgery(Open Group,OG).Preoperative,intraoperative and postoperative data were compared before PSM.Thirty pairs of cases were successfully matched after PSM of age,sex,BMI,ASA score,tumor location,clinical stage,hospital,CEA and CA199.No significant difference was found on preoperative data between two groups.Intraoperative and postoperative data were then compared to explore the efficacy and safety.ResultsSMPCC mostly happens in the elderly,the male,the rectum and sigmoid colon,and the predominant pathological type is moderately differentiated adenocarcinoma.Differences were found on intraoperative and postoperative data after PSM.Compared with OG,the length of incision(5.8±1.9 vs 19.8±4.4 cm,p<0.001)and time to first flow(2.7±1.2 days vs.3.5±1.4 days,p=0.005)and the postoperative hospitalization(11.4±8.4 vs 15.2±10.5,p=0.001)was shorter and the postoperative complications(13.3%vs 60%,p=0.003)were less in LG;while the operating time,intraoperative blood loss and number of captured lymph nodes showed no difference.No significant difference was found in the 3-year and 5-year overall survival rate and disease-free survival rate were between both groups.High CEA and lymphatic metastasis were associated with worse SMPCC prognoses.ConclusionsLaparoscopy is safe and effective in the treatment of SMPCC.Compared with open surgery,laparoscopic surgery has the advantages of less trauma,faster recovery of intestinal function and fewer postoperative complications in the short term;while no significant difference exists in the long-term overall survival and disease-free survival.