Reevaluation of laparoscopic surgery's value in pathological T4 colon cancer with comparison to open surgery: A retrospective and propensity score-matched study

Introduction: Neoadjuvant chemotherapy (CT) for locally advanced colon cancer (LACC) could potentially lead to tumor shrinkage, eradication of micrometastases, and prevention of tumor cell shedding during surgery. This retrospective study investigates the surgical and oncological outcomes of preoperative CT for LACC. Methods: Using the Netherlands Cancer Registry, data of patients with stage II or III colon cancer, diagnosed between 2008 and 2016 was collected. A propensity score matching (PSM; 1:2) was performed and compared patients with clinical tumor (cT) 4 colon cancer who were treated with neoadjuvant CT to patients with cT4 colon cancer treated with adjuvant CT (Fig. 1). Results: A total of 192 patients treated with neoadjuvant CT were compared to 1,954 patients that received adjuvant CT. After PSM, 149 patients in the neoadjuvant group were compared to 298 patients in the control group. No significant differences were found in baseline characteristics after PSM. After neoadjuvant CT, a significant response was observed in 13 (9%) patients with 5 (4%) patients showing a complete response. Complete resection margins (R0) were achieved in 77% in the neoadjuvant group versus 86% in the adjuvant treated group (p = 0.037). Significantly less tumor positive lymph nodes were found in the neoadjuvant group (median 0 vs. 2, p < 0.001). Major complication rates and 5-year overall survival did not differ between both groups (67–65%, p = 0.87). Conclusion: Neoadjuvant CT seems safe and feasible with similar long-term survival compared to patients who are treated with adjuvant CT.

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Reply to: Letter to editor- “Minimally invasive surgery for T4 colon cancer is associated with better outcomes than open surgery in national cancer database”

European Journal of Surgical Oncology ◽

10.1016/j.ejso.2020.11.141 ◽

2020 ◽

Author(s):

Vadim Gushchin ◽

Timothy Plerhoples ◽

Lana Bijelic

Keyword(s):

Colon Cancer ◽

Minimally Invasive Surgery ◽

Minimally Invasive ◽

Invasive Surgery ◽

Open Surgery ◽

National Cancer Database ◽

T4 Colon Cancer

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Survival benefit of lymph node dissection in surgery for colon cancer in elderly patients: A multicenter propensity score-matched study in Japan

Asian Journal of Endoscopic Surgery ◽

10.1111/ases.12474 ◽

2018 ◽

Vol 11 (4) ◽

pp. 346-354

Author(s):

Makoto Takahashi ◽

Hiroaki Niitsu ◽

Kazuhiro Sakamoto ◽

Takao Hinoi ◽

Minoru Hattori ◽

...

Keyword(s):

Colon Cancer ◽

Lymph Node ◽

Propensity Score ◽

Elderly Patients ◽

Lymph Node Dissection ◽

Survival Benefit ◽

Node Dissection ◽

Matched Study

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Favorable short-term oncologic outcomes following laparoscopic surgery for small T4 colon cancer: a multicenter comparative study

World Journal of Surgical Oncology ◽

10.1186/s12957-020-02074-5 ◽

2020 ◽

Vol 18 (1) ◽

Author(s):

Sung Sil Park ◽

◽

Joon Sang Lee ◽

Hyoung-Chul Park ◽

Sung Chan Park ◽

...

Keyword(s):

Colon Cancer ◽

Laparoscopic Surgery ◽

Open Surgery ◽

Disease Free Survival ◽

Laparoscopic Group ◽

Oncologic Outcomes ◽

Short Term ◽

Free Survival ◽

T4 Colon Cancer ◽

Disease Free

Abstract Background Laparoscopic surgery for T4 colon cancer may be safe in selected patients. We hypothesized that small tumor size might preoperatively predict a good laparoscopic surgery outcome. Herein, we compared the clinicopathologic and oncologic outcomes of laparoscopic and open surgery in small T4 colon cancer. Methods In a retrospective multicenter study, we reviewed the data of 449 patients, including 117 patients with tumors ≤ 4.0 cm who underwent surgery for T4 colon cancer between January 2014 and December 2017. We compared the clinicopathologic and 3-year oncologic outcomes between the laparoscopic and open groups. Survival curves were estimated using the Kaplan–Meier method and compared using the log-rank test. Univariate and multivariate analyses were performed using the Cox proportional hazards model. A p < 0.05 was considered statistically significant. Results Blood loss, length of hospital stay, and postoperative morbidity were lower in the laparoscopic group than in the open group (median [range], 50 [0–700] vs. 100 [0–4000] mL, p < 0.001; 8 vs. 10 days, p < 0.001; and 18.0 vs. 29.5%, p = 0.005, respectively). There were no intergroup differences in 3-year overall survival or disease-free survival (86.6 vs. 83.2%, p = 0.180, and 71.7 vs. 75.1%, p = 0.720, respectively). Among patients with tumor size ≤ 4.0 cm, blood loss was significantly lower in the laparoscopic group than in the open group (median [range], 50 [0–530] vs. 50 [0–1000] mL, p = 0.003). Despite no statistical difference observed in the 3-year overall survival rate (83.3 vs. 78.7%, p = 0.538), the laparoscopic group had a significantly higher 3-year disease-free survival rate (79.2 vs. 53.2%, p = 0.012). Conclusions Laparoscopic surgery showed similar outcomes to open surgery in T4 colon cancer patients and may have favorable short-term oncologic outcomes in patients with tumors ≤ 4.0 cm.

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