TY - JOUR

T1 - Combined endoscopic and laparoscopic surgery (CELS) for early colon cancer in high-risk patients

AU - Hartwig, Morten F.S.

AU - Bulut, Mustafa

AU - Ravn-Eriksen, Jens

AU - Hansen, Lasse B.

AU - Bojesen, Rasmus D.

AU - Klein, Mads Falk

AU - Jakobsen, Henrik L.

AU - Rasmussen, Morten

AU - Rud, Bo

AU - Eriksen, Jens Ole

AU - Eiholm, Susanne

AU - Fiehn, Anne Marie K.

AU - Quirke, Phil

AU - Gögenur, Ismail

N1 - Publisher Copyright: © 2023, The Author(s).

PY - 2023

Y1 - 2023

N2 - Background: Local excision of early colon cancers could be an option in selected patients with high risk of complications and no sign of lymph node metastasis (LNM). The primary aim was to assess feasibility in high-risk patients with early colon cancer treated with Combined Endoscopic and Laparoscopic Surgery (CELS). Methods: A non-randomized prospective feasibility study including 25 patients with Performance Status score ≥ 1 and/or American Society of Anesthesiologists score ≥ 3, and clinical Union of International Cancer Control stage-1 colon cancer suitable for CELS resection. The primary outcome was failure of CELS resection, defined as either: Incomplete resection (R1/R2), local recurrence within 3 months, complication related to CELS within 30 days (Clavien–Dindo grade ≥ 3), death within 30 days or death within 90 days due to complications to surgery. Results: Fifteen patients with clinical T1 (cT1) and ten with clinical T2 (cT2) colon cancer and without suspicion of metastases were included. Failure occurred in two patients due to incomplete resections. Histopathological examination classified seven patients as having pT1, nine as pT2, six as pT3 adenocarcinomas, and three as non-invasive tumors. In three patients, the surgical strategy was changed intraoperatively to conventional colectomy due to tumor location or size. Median length of stay was 1 day. Seven patients had completion colectomy performed due to histological high-risk factors. None had LNM. Conclusions: In selected patients, CELS resection was feasible, and could spare some patients large bowel resection.

AB - Background: Local excision of early colon cancers could be an option in selected patients with high risk of complications and no sign of lymph node metastasis (LNM). The primary aim was to assess feasibility in high-risk patients with early colon cancer treated with Combined Endoscopic and Laparoscopic Surgery (CELS). Methods: A non-randomized prospective feasibility study including 25 patients with Performance Status score ≥ 1 and/or American Society of Anesthesiologists score ≥ 3, and clinical Union of International Cancer Control stage-1 colon cancer suitable for CELS resection. The primary outcome was failure of CELS resection, defined as either: Incomplete resection (R1/R2), local recurrence within 3 months, complication related to CELS within 30 days (Clavien–Dindo grade ≥ 3), death within 30 days or death within 90 days due to complications to surgery. Results: Fifteen patients with clinical T1 (cT1) and ten with clinical T2 (cT2) colon cancer and without suspicion of metastases were included. Failure occurred in two patients due to incomplete resections. Histopathological examination classified seven patients as having pT1, nine as pT2, six as pT3 adenocarcinomas, and three as non-invasive tumors. In three patients, the surgical strategy was changed intraoperatively to conventional colectomy due to tumor location or size. Median length of stay was 1 day. Seven patients had completion colectomy performed due to histological high-risk factors. None had LNM. Conclusions: In selected patients, CELS resection was feasible, and could spare some patients large bowel resection.

KW - Colon cancer

KW - Combined endoscopy and laparoscopy

KW - Early cancer

U2 - 10.1007/s00464-023-10385-3

DO - 10.1007/s00464-023-10385-3

M3 - Journal article

C2 - 37770605

AN - SCOPUS:85172877895

VL - 37

SP - 8511

EP - 8521

JO - Surgical Endoscopy and Other Interventional Techniques

JF - Surgical Endoscopy and Other Interventional Techniques

SN - 0930-2794

IS - 11

ER -