Current status of endoscopic resection strategy for large, early colorectal neoplasia in Japan
included the points that the groups were small (37 LC vs. 36 OC stage III patients), that there was a disparity in the number who received postoperative chemotherapy, and that this was a subset analysis and not based on an a priori hypothesis, the finding stimulated interest in the laparoscopic approach. In the COST study (3) the median follow-up was 4.4 years, with a recurrence rate of 17.8% for LC and 19.3% for OC. The OS rate at 3 years was 86% for LC and 85% for OC (P = 0.50). The diseasefree survival (DFS) rate (118 events in the LC group and 117 events in the OC group, P = 0.70) was similar for the two arms. These findings were consistent with any stage of cancer. There was no difference in the incidence of incisional recurrence, with two in the LC group (0.5%) and one in the OC (0.2%; P = 0.5). The authors concluded that LC for cancer was safe, but they emphasized surgeons’ experience. The median overall follow-up in the Taiwan trial (6) was 40 months. The estimated cumulative recurrence rate was similar (P = 0.362). In stage II disease, the rate was 13.2% for LC vs. 17.2% for OC, and in stage III disease, 20.9% vs. 25.7%, respectively. The Transatlantic Laparoscopically Assisted vs. Open Colectomy Trials Study Group performed a meta-analysis of data from the Barcelona, COST, COLOR, and CLASICC trials (8). Only patients randomized before 1 March 2000 were included. Data from 1,536 patients were analyzed: 208, 640, 520, and 168 patients, respectively. DFS (P = 0.83) and OS (P = 0.56) for all stages combined did not differ between LAC and OC. Three-year DFS was 75.8% for LAC and 75.3% for OC, and OS rates were 82.2% and 83.5%, respectively. Data for DFS and OS were stratified by trial, adjusting for sex, age, and tumor stage, and revealed no differences. The authors concluded that LC for cancer is safe.