Division of General and Hepatobiliary Surgery, Department of Surgical Sciences, Dentistry, Gynecology and Pediatrics, University of Verona, Verona, Italy.
Colorectal Cancer Centre, Kyungpook National University Medical Centre, School of Medicine, Kyungpook National University, Daegu, South Korea.
Eur J Surg Oncol. 2022 Aug;48(8):1823-1830. doi: 10.1016/j.ejso.2022.04.015. Epub 2022 Apr 22.
Peritoneal metastases (PM) occur in 15-20% of surgically resected pT4 colon cancer (CC) and strongly affect prognosis. Since no standard treatment has been established, efforts should be addressed toward its prevention. Some literature suggests a detrimental effect of laparoscopy in pT4 CC, hence we aimed to determine its impact on the development of PM after potentially curative resection.
International multicenter retrospective cohort study including consecutive patients undergoing surgery for pT4a and pT4b CC (2014-2018) at 5 referral centers. The inclusion criteria were absence of distant metastasis, elective surgery, curative-intent resection (R0-1), and a minimum follow-up of 24 months (median, IQR: 35, 25.8-50.5 months).
276 patients fulfilled the inclusion criteria and were selected for analysis. After 1:1 propensity score matching (PSM), 63 patients in the laparoscopic group (LapGroup) were compared with 63 patients in the open surgery group (OpenGroup). The two groups were comparable in terms of demographic and clinical parameters, operative data, and specimen characteristics. The OpenGroup presented a higher estimated intraoperative blood loss (P < .001) and postoperative length of stay (P < .001). Overall survival, cancer-specific survival, and disease-free survival resulted comparable. The 5-year probability of developing PM was 16.2% after laparoscopy and 19.5% after open surgery (P = .686). Multivariate analysis confirmed laparoscopy not to be an independent risk factor for PM.
Elective laparoscopic surgery for pT4 CC does not seem to increase the risk of metachronous PM after potentially curative surgery. Long-term outcomes after laparoscopy are not inferior to conventional open resections.
腹膜转移（PM）发生在 15-20%手术切除的 T4 期结肠癌（CC）患者中，强烈影响预后。由于尚未确立标准治疗方法，因此应努力预防其发生。一些文献表明腹腔镜在 T4 期 CC 中具有不利影响，因此我们旨在确定其对潜在可治愈性切除后 PM 发展的影响。
这是一项国际多中心回顾性队列研究，纳入了 5 个转诊中心于 2014-2018 年接受 T4a 和 T4b CC 手术的连续患者。纳入标准为无远处转移、择期手术、治愈性切除（R0-1）以及至少 24 个月的随访（中位数，IQR：35，25.8-50.5 个月）。
276 例患者符合纳入标准并被选入分析。经过 1:1 倾向评分匹配（PSM）后，腹腔镜组（LapGroup）的 63 例患者与开放手术组（OpenGroup）的 63 例患者进行了比较。两组在人口统计学和临床参数、手术数据和标本特征方面具有可比性。OpenGroup 术中估计出血量较高（P < 0.001）和术后住院时间较长（P < 0.001）。总生存率、癌症特异性生存率和无病生存率结果相当。腹腔镜组和开放手术组的 5 年 PM 发生率分别为 16.2%和 19.5%（P = 0.686）。多变量分析证实腹腔镜不是 PM 的独立危险因素。
对于 T4 期 CC，选择性腹腔镜手术似乎不会增加潜在可治愈手术后发生腹膜转移的风险。腹腔镜手术后的长期结果并不劣于传统的开放切除。
