Laparoscopic Colectomy: A Risk Factor for Postoperative Peritoneal Metastasis.

Area of Science:

• Oncology
• Surgical Oncology
• Gastrointestinal Surgery

Background:

• Oncologic outcomes are generally considered equivalent between laparoscopic colectomy (LC) and open colectomy (OC).
• A prior single-center study indicated a higher risk of postoperative peritoneal metastasis (PM) after LC than OC in pathological T4a (pT4a) colon cancer patients.
• This multicenter study investigated the association between surgical approach and PM risk in pT4a colon cancer.

Purpose of the Study:

• To determine if laparoscopic colectomy (LC) increases the risk of peritoneal metastasis (PM) compared to open colectomy (OC) in patients with pathological T4a (pT4a) colon cancer.
• To provide robust evidence from a multicenter study to clarify the safety of LC in this patient population.

Main Methods:

• Utilized a multicenter database from the Japanese Study Group for Postoperative Follow-up of Colorectal Cancer (1997-2012).
• Included 17,323 patients with pathological stage I-III colon cancer, with a specific focus on 2380 patients with pT4a disease.
• Compared the cumulative incidence and risk factors for PM between LC and OC groups, employing multivariable and propensity score analyses.

Main Results:

• The cumulative incidence of PM was significantly higher in the LC group (13.0%) compared to the OC group (7.7%) for pT4a colon cancer patients (P = .001).
• Multivariable analyses identified LC as a significant risk factor for PM (HR: 1.36, 95% CI: 1.04-1.78, P = .023).
• Propensity score analyses confirmed LC as an independent risk factor for PM (HR: 1.36, 95% CI: 1.04-1.78, P = .024).

Conclusions:

• This multicenter study demonstrates a significant increase in the risk of peritoneal metastasis (PM) following laparoscopic colectomy (LC) compared to open colectomy (OC) in patients with pathological T4a colon cancer.
• The findings suggest that the surgical approach may influence the risk of PM in this specific patient group, warranting further investigation and consideration in clinical practice.