Highlights
- •The oncologic outcomes are generally considered equivalent for both laparoscopic and open surgery.
- •However, some studies suggested a greater risk of postoperative peritoneal metastasis after laparoscopic than after open approach in patients with colon cancer.
- •This multicenter study included 17,323 patients with pathological stage I–III colon cancer to clarify the risk of peritoneal metastasis after the two approaches.
- •Multivariable analyses showed laparoscopic approach was a significant risk factor for peritoneal recurrence.
- •The finding above was confirmed by propensity score analyses.
- •This study demonstrated a significant increase in the risk of peritoneal recurrence after minimally invasive surgery.
Abstract
Background
The oncologic outcomes are generally considered equivalent for both laparoscopic and
open surgery. However, our previous single-center study found a greater risk of postoperative
peritoneal metastasis (PM) after laparoscopic colectomy (LC) than after open colectomy
(OC) in patients with pathological T4a (pT4a) colon cancer. This multicenter study
aimed to clarify if the risk of PM was increased after LC.
Methods
This study used the multicenter database of the Japanese Study Group for Postoperative
Follow-up of Colorectal Cancer, which included patients with colorectal cancer treated
between 1997 and 2012 in 24 referral hospitals across Japan. The analysis included
17,323 patients with pathological stage I–III colon cancer, including 2380 patients
with pT4a disease. The risk of PM was compared between the LC and OC groups.
Results
The cumulative incidence of PM was significantly higher after LC in patients with
pT4a colon cancer (13.0% vs. 7.7%; P = .001). Multivariable analyses showed LC was a significant risk factor for PM (hazard
ratio [HR]: 1.36, 95% confidence interval [CI]: 1.04–1.78, P = .023), which was confirmed by propensity score analyses (HR: 1.36, 95% CI: 1.04–1.78,
P = .024).
Conclusion
This study demonstrated a significant increase in the risk of PM after LC than after
OC.
Keywords
To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to Clinical Colorectal CancerAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- Oncologic outcomes following laparoscopic versus open resection of pT4 colon cancer: a systematic review and meta-analysis.Dis Colon Rectum. 2017; 60: 116-125
- Laparoscopic surgery for T4 colon cancer: a systematic review and meta-analysis.Surg Endosc. 2017; 31: 4902-4912
- Laparoscopic resection of t4 colon cancers: is it feasible?.Dis Colon Rectum. 2015; 58: 25-31
- Survival outcomes following laparoscopic versus open D3 dissection for stage II or III colon cancer (JCOG0404): a phase 3, randomised controlled trial. The lancet.Gastroenterology & hepatology. 2017; 2: 261-268
- What is the effect of laparoscopic colectomy on pattern of colon cancer recurrence? A propensity score and competing risk analysis compared with open colectomy.Ann Surg Oncol. 2014; 21: 2627-2635
- Laparoscopic surgery for T4 colon cancer: a risk factor for peritoneal recurrences?.Surgery. 2020; 168: 119-124
- Prognosis of patients with peritoneal metastatic colorectal cancer given systemic therapy: an analysis of individual patient data from prospective randomised trials from the Analysis and Research in Cancers of the Digestive System (ARCAD) database.Lancet Oncol. 2016; 17: 1709-1719
- Japanese Society for Cancer of the Colon and Rectum (JSCCR) guidelines 2019 for the treatment of colorectal cancer.Int J Clin Oncol. 2020; 25: 1-42
- Mucinous and signet-ring cell colorectal cancers differ from classical adenocarcinomas in tumor biology and prognosis.Annals of surgery. 2013; 258: 775-783
- Alternative approaches for confounding adjustment in observational studies using weighting based on the propensity score: a primer for practitioners.BMJ (Clinical research ed.). 2019; 367: l5657
- Strengthening the Reporting of Observational Studies in Epidemiology (STROBE): explanation and elaboration.Epidemiology. 2007; 18: 805-835
- Survival and prognostic factors for metachronous peritoneal metastasis in patients with colon cancer.Ann Surg Oncol. 2017; 24: 1269-1280
- Development and validation of a prediction model for postoperative peritoneal metastasis after curative resection of colon cancer.Ann Surg Oncol. 2018; 25: 1366-1373
- HIPEC in T4a colon cancer: a defendable treatment to improve oncologic outcome?.Ann Oncol. 2012; 23: 3123-3129
- Prognostic impact of pT stage and peritoneal invasion in locally advanced colon cancer.Dis Colon Rectum. 2019; 62: 684-693
- General oncologic effects of the laparoscopic surgical approach. 1997 Frankfurt international meeting of animal laparoscopic researchers.Surg Endosc. 1998; 12: 1092-1095
- Humidified gas prevents hypothermia induced by laparoscopic insufflation: a randomized controlled study in a pig model.Surg Endosc. 1999; 13: 101-105
- Pneumoperitoneum and peritoneal surface changes: a review.Surg Endosc. 2004; 18: 1316-1322
- Peritoneal changes due to laparoscopic surgery.Surg Endosc. 2011; 25: 1-9
- The influence of pneumoperitoneum used in laparoscopic surgery on an intraabdominal tumor growth.Cancer. 1999; 86: 770-774
- Multicentre study of laparoscopic or open assessment of the peritoneal cancer index (BIG-RENAPE).Br J Surg. 2018; 105: 663-667
- Diagnostic Accuracy of CT for Local Staging of Colon Cancer: A Systematic Review and Meta-Analysis.AJR Am J Roentgenol. 2016; 207: 984-995
- MRI for local staging of colon cancer: can mri become the optimal staging modality for patients with colon cancer?.Dis Colon Rectum. 2017; 60: 385-392
- Diagnostic precision of CT in local staging of colon cancers: a meta-analysis.Clinical radiology. 2010; 65: 708-719
- Prognostic value of preoperative radiological staging assessed by computed tomography in patients with nonmetastatic colon cancer.Ann Oncol. 2012; 23:: 1198-1206
- Feasibility of preoperative chemotherapy for locally advanced, operable colon cancer: the pilot phase of a randomised controlled trial.The Lancet. Oncology. 2012; 13: 1152-1160
- Neoadjuvant chemotherapy in locally advanced colon cancer. A phase II trial.Acta oncologica (Stockholm, Sweden). 2015; 54: 1747-1753
- Laparoscopic colectomy for cancer: improved compliance with guidelines for chemotherapy and survival.Surgery. 2017; 161: 1633-1641
- Patterns of metachronous metastases after curative treatment of colorectal cancer.Cancer Epidemiol. 2014; 38: 448-454
- Patterns of recurrence after curative resection of carcinoma of the colon and rectum.Surg Gynecol Obstet. 1992; 174: 27-32
- Complete cytoreductive surgery plus intraperitoneal chemohyperthermia with oxaliplatin for peritoneal carcinomatosis of colorectal origin.J Clin Oncol. 2009; 27: 681-685
- Adjuvant hyperthermic intraperitoneal chemotherapy in patients with locally advanced colon cancer (COLOPEC): a multicentre, open-label, randomised trial. The lancet.Gastroenterology & hepatology. 2019; 4: 761-770
- HIPECT4: multicentre, randomized clinical trial to evaluate safety and efficacy of Hyperthermic intra-peritoneal chemotherapy (HIPEC) with Mitomycin C used during surgery for treatment of locally advanced colorectal carcinoma.BMC Cancer. 2018; 18: 183
- Metastatic colorectal cancer to the peritoneum: current treatment options.Curr Treat Options Oncol. 2018; 19: 49
- Diagnostic performance of imaging for the detection of peritoneal metastases: a meta-analysis.Eur Radiol. 2020; 30: 3101-3112
- Diagnostic accuracy of (18)F-FDG PET/CT for detection of peritoneal carcinomatosis; a systematic review and meta-analysis.Br J Radiol. 2018; 9120170519
Article info
Publication history
Published online: May 18, 2022
Accepted:
May 15,
2022
Received in revised form:
May 12,
2022
Received:
April 2,
2022
Identification
Copyright
© 2022 Elsevier Inc. All rights reserved.