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Published on: March 24, 2023
Laparoscopic surgery should be a viable option for T4 colon cancer: evidence from a propensity score matching
Xiaomei Jiang1, Hang Zhou1,2, Zhaoyang Zheng1
1Division of Gastrointestinal Surgery, Department of General Surgery, West China Hospital of Sichuan University, No.37 Guoxue Lane, Wuhou District, Chengdu, 610041, Sichuan, China.
Purpose:
The suitability of laparoscopy for T4 colon cancer (CC) remains controversial. This study aims to compare the short-term and long-term oncological outcomes specifically for T4 CC.
Method:
This observational study included patients who underwent either laparoscopic resection (LR) or open resection (OR) for T4 CC (2015-2023). Propensity score matching (PSM) was used to balance covariates (age, sex, BMI, ASA classification and tumor staging). Primary outcomes were 3-year overall survival (OS) and disease-free survival (DFS). Secondary endpoints included postoperative outcomes and recurrence rates. Prognostic factors for OS and DFS were also analyzed and results of the logistic regression analyses were presented as hazard ratios (HR) with 95 confidence intervals (CI).
Result:
A total of 176 patients were enrolled, with 75 well-balanced pairs after PSM. The LR group demonstrated comparable major complication rates to the OR group (8.0% vs. 5.3%, P = 0.734). During a mean follow-up of 44.1 ± 28.1 months after LR versus 40.8 ± 23.6 months after OR (P = 0.960), postoperative recurrence rates were similar (LR: 24.0% vs. OR: 17.3%, P = 0.550). The 3-year OS rates were 76.8% and 81.9% in LR and OR respectively (P = 0.292), and 3-year DFS rates were 68.6% and 71.7% in LR and OR, respectively (P = 0.312). Multivariate cox regression analysis determined significant independent predictors for OS included age > 75 years (HR = 11.03, 95%CI 5.29-22.98, P < 0.001), adjuvant therapy (HR = 0.45, 95%CI 0.23-0.87, P = 0.017) and positive lymph nodes (HR = 1.12 per node, 95%CI 1.01-1.25, P = 0.035). Key determinants including age > 75 years (HR = 7.25, 95%CI 3.70-14.20, P < 0.001), adjuvant therapy (HR = 0.29, 95%CI 0.16-0.53, P < 0.001), AJCC staging (III vs. Ⅱ: HR = 2.56, 95%CI 1.07-6.12, P = 0.034) and excised lymph nodes (HR = 1.05 per node, 95%CI 1.02-1.07, P = 0.001) were indepently associated with DFS.
Conclusion:
LR demonstrates comparable short-term and long-term oncological outcomes to OR and it should be considered as a safe and feasible option for T4 CC.
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