Comparison of short- and long-term outcomes between laparoscopic and open multivisceral resection for clinical T4b colorectal cancer: A multicentre retrospective cohort study in China

Laparoscopic surgery is associated with increased risk of postoperative peritoneal metastases in T4 colon cancer: a propensity score analysis

BACKGROUND

This study aims to evaluate the postoperative safety, long-term survival, and postoperative peritoneal metastases (PPM) rate associated with laparoscopic surgery (LS) for T4 colon cancer.

MATERIALS AND METHODS

After propensity score matching, there were 68 patients in each of the LS and Open surgery groups. The primary outcomes were the 3-year OS, DFS, and PPM rates.

RESULTS

After matching, 68 patients in each of the groups. The LS group had a higher cumulative 3-year peritoneal metastasis rate (19.8% vs. 6.7%, P = .036), while the 3-year OS (82.3% vs. 83.8%, P = .750) and 2-year DFS (69.0% vs. 75.7%, P = .310) showed no significant difference, compared to the open surgery group. The LS group had a significantly longer operation time (201 ± 85.7 min vs. 164 ± 65.9 min, P = .008) but less postoperative complications (P = .036). Additionally, patients in the LS group removed gastric tube more quickly (1.91 ± 1.18 days vs. 2.69 ± 2.41 days, P = .048). The multivariate analysis revealed that LS (HR = 3.496, 95% CI = 1.108-11.030, P = .033), underweight (HR = 11.650, 95% CI = 2.155-62.990, P = .004), and lymphovascular invasion (HR = 3.123, 95% CI = 1.010-9.664, P = .048) were all predictive factors of PPM. For the pN + subgroup, the 3-year cumulative PPM rate was 29.6% in the LS group, significantly higher than 15.3% in the open group (P = .029), but there was no significant difference after PSM (P = .100).

CONCLUSION

LS offers faster postoperative recovery and comparable long-term survival outcomes. Therefore, it should remain a viable option for locally advanced T4 colon cancer. However, it is crucial to fully recognize the potential risk of increased PPM associated with LS, especially in patients with preoperative suspicion of positive lymph nodes. Further multicenter prospective studies are necessary to validate the potential risks of LS and gain insight into treatment efficacy in different patient populations. In addition, future studies should assess prognosis based on the grade and extent of peritoneal dissemination to provide a more nuanced understanding.

Minimally invasive versus open multivisceral resection for rectal cancer clinically invading adjacent organs: a propensity score-matched analysis

BACKGROUND

Minimally invasive surgery (MIS), such as laparoscopic and robotic surgery for rectal cancer, is performed worldwide. However, limited information is available on the advantages of MIS over open surgery for multivisceral resection for cases clinically invading adjacent organs.

PATIENTS AND METHODS

This was a retrospective propensity score-matching study of consecutive clinical T4b rectal cancer patients who underwent curative intent surgery between 2006 and 2021 at the University of Tokyo Hospital.

RESULTS

Sixty-nine patients who underwent multivisceral resection were analyzed. Thirty-three patients underwent MIS (the MIS group), while 36 underwent open surgery (the open group). Twenty-three patients were matched to each group. Conversion was required in 2 patients who underwent MIS (8.7%). R0 resection was achieved in 87.0% and 91.3% of patients in the MIS and open groups, respectively. The MIS group had significantly less blood loss (170 vs. 1130 mL; p < 0.0001), fewer Clavien-Dindo grade ≥ 2 postoperative complications (30.4% vs. 65.2%; p = 0.0170), and a shorter postoperative hospital stay (20 vs. 26 days; p = 0.0269) than the open group. The 3-year cancer-specific survival rate, relapse-free survival rate, and cumulative incidence of local recurrence were 75.7, 35.9, and 13.9%, respectively, in the MIS group and 84.5, 45.4, and 27.1%, respectively, in the open group, which were not significantly different (p = 0.8462, 0.4344, and 0.2976, respectively).

CONCLUSION

MIS had several short-term advantages over open surgery, such as lower complication rates, faster recovery, and a shorter hospital stay, in rectal cancer patients who underwent multivisceral resection.