Department of Surgical Oncology, Mercy Medical Center, Baltimore, MD, USA.
Department of Surgery, Inova Fairfax Medical Campus, Falls Church, VA, USA.
Eur J Surg Oncol. 2021 Apr;47(4):818-827. doi: 10.1016/j.ejso.2020.09.003. Epub 2020 Sep 10.
Minimally invasive surgery (MIS) is favored for T1-T3 colon cancer resection due to improved short and long-term outcomes. Recommendations regarding T4 cancers remain controversial due to a paucity of clinical trials or large datasets assessing outcomes. We aim to compare outcomes for pT4 colon cancer patients treated with MIS or open surgery (OS) in the National Cancer Database (NCDB). We analyzed adults having MIS or OS for stage II or III pT4 colon cancers between 2010 and 2014 using propensity-score matching, Cox and logistic regression modeling. Of 21 998 T4 patients, 7532 (34.2%) underwent MIS, 14 466 (65.8%) OS and 22.3% were MIS converted to OS. After propensity score matching, 5624 patients in each cohort were included. MIS was associated with improved postoperative mortality (3.4 vs. 7.2%, p > .001), surgical margins, optimal lymph node harvest, adjuvant chemotherapy use and 5-year survival (46% vs. 41%, P < .001). MIS was associated with improved short and long term outcomes for T4 colon cancers compared to OS on multivariate analysis. Based on these findings, well selected pT4 colon cancers can be considered appropriate for MIS however, prospective clinical trials are needed to better define the role of MIS in T4b colon cancer.
微创手术 (MIS) 由于改善了短期和长期结果而受到 T1-T3 结肠癌切除术的青睐。由于缺乏评估结果的临床试验或大型数据集，对于 T4 癌症的建议仍然存在争议。我们旨在比较在国家癌症数据库 (NCDB) 中接受 MIS 或开放性手术 (OS) 治疗的 pT4 结肠癌患者的结果。我们使用倾向评分匹配、Cox 和逻辑回归模型分析了 2010 年至 2014 年间接受 II 期或 III 期 pT4 结肠癌 MIS 或 OS 治疗的成年人。在 21998 例 T4 患者中，7532 例 (34.2%) 接受 MIS 治疗，14466 例 (65.8%) 接受 OS 治疗，22.3% 的患者从 MIS 转为 OS。在进行倾向评分匹配后，每个队列中均纳入了 5624 例患者。MIS 与术后死亡率降低相关 (3.4% vs. 7.2%，p>.001)、手术切缘、最佳淋巴结采集、辅助化疗使用和 5 年生存率 (46% vs. 41%，P<.001)。与 OS 相比，MIS 与 T4 结肠癌的短期和长期结果改善相关。基于这些发现，经过精心选择的 pT4 结肠癌可以被认为适合 MIS，然而，需要前瞻性临床试验来更好地定义 MIS 在 T4b 结肠癌中的作用。
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