Applicability of minimally invasive surgery for clinically T4 colorectal cancer

Area of Science:

• Oncology
• Surgical Oncology
• Gastroenterology

Background:

• The efficacy of minimally invasive surgery (MIS) for clinically T4 (cT4) colorectal cancer (CRC) is not well-established.
• Further research is needed to clarify the role of MIS in managing advanced CRC stages.

Purpose of the Study:

• To evaluate the safety and oncological outcomes of MIS in patients with cT4 CRC.
• To assess the feasibility of achieving R0 resection and long-term survival through MIS for cT4 CRC.

Main Methods:

• A retrospective cohort study analyzed 128 patients with cT4 CRC undergoing MIS between 2006 and 2019.
• Data collected included patient demographics, clinicopathology, surgical outcomes, complications (Clavien-Dindo ≥II), and oncological results.
• Follow-up averaged 33.8 months, focusing on R0 resection rates and survival data.

Main Results:

• The median recovery time to soft diet was 6 days, with a median postoperative hospitalization of 11 days.
• Conversion and complication rates were 7.8% and 27.3%, respectively, with a 30-day mortality of 0.78%.
• R0 resection rates were high (92.2% for cT4M0, 88.6% for pT4M0), and 3-year survival rates varied by stage (e.g., 86.8% for stage II, 17.8% for stage IV).

Conclusions:

• MIS is a viable option for selected cT4 CRC patients, demonstrating acceptable safety profiles.
• Satisfactory R0 resection rates and favorable oncological outcomes can be achieved with MIS in this patient group.
• MIS should be considered for treating cT4 CRC, warranting further investigation into patient selection criteria.