Department of Surgical Oncology, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan.
Department of Surgery, National Hospital Organization Ureshino Medical Center, Ureshino, Japan.
Asian J Endosc Surg. 2023 Jul;16(3):400-408. doi: 10.1111/ases.13171. Epub 2023 Feb 17.
We aimed to assess mid-term outcomes after laparoscopic surgery (LAP) vs open surgery (OP) for pathological T4 (pT4) and/or N2 (pN2) colon cancer.
We retrospectively reviewed 255 primary tumor resections for pT4 and/or pN2 colon cancer performed from 2015 to 2020 at six hospitals, divided into LAP (n = 204) and OP groups (n = 51). After propensity score matching to minimize selection bias, 47 matched patients per group were assessed.
Before matching, the rate of males (53.9% vs. 37.3%, P = .042), left sided colon cancer (53.9% vs 37.3%, P = .042), D3 lymph node dissection (90.7% vs 68.6%, P < .001) and body mass index (kg/m ) (22.3 vs 21.8, P = .039) were significantly greater in the LAP group. The rate of pT4b (7.8% vs 40.4%, P < .001) was lower and pN2 was higher (57.4% vs 37.3%, P = .012) in the LAP group. After matching, preoperative characteristics and pathologic status were equivalent between the groups. The LAP and OP groups showed comparable overall survival (OS) (2-year OS, 84.5% vs 76.8%, P = .055) and recurrence-free survival (RFS) (2-year RFS, 73.9% vs 52.8%, P = .359). In the patients with pT4, OS (2-year OS, 79.4% vs 75.7%, P = .359) and RFS (2-year RFS, 71.3% vs 58.7%) were comparable. In the patients with pN2, OS (2-year OS, 83.4% vs 76.3%) and RFS (2-year RFS, 69.6% vs 36.2%) were also comparable.
LAP for pT4 and/or pN2 colon cancer showed comparable mid-term outcomes compared with OP. LAP was an acceptable surgical approach in this cohort.
我们旨在评估腹腔镜手术（LAP）与开腹手术（OP）治疗病理性 T4（pT4）和/或 N2（pN2）结肠癌的中期结果。
我们回顾性分析了 2015 年至 2020 年在六家医院进行的 255 例原发性肿瘤切除治疗 pT4 和/或 pN2 结肠癌患者，分为 LAP（n=204）和 OP 组（n=51）。为了最小化选择偏倚，对每组进行了倾向评分匹配，每组匹配了 47 例患者。
在匹配之前，LAP 组的男性比例（53.9%比 37.3%，P=0.042）、左半结肠癌（53.9%比 37.3%，P=0.042）、D3 淋巴结清扫（90.7%比 68.6%，P < 0.001）和体质指数（kg/m）（22.3 比 21.8，P=0.039）明显更高。LAP 组 pT4b 的比例（7.8%比 40.4%，P < 0.001）较低，而 pN2 的比例较高（57.4%比 37.3%，P=0.012）。匹配后，两组的术前特征和病理状况相当。LAP 组和 OP 组的总生存（OS）（2 年 OS，84.5%比 76.8%，P=0.055）和无复发生存（RFS）（2 年 RFS，73.9%比 52.8%，P=0.359）相当。在 pT4 患者中，OS（2 年 OS，79.4%比 75.7%，P=0.359）和 RFS（2 年 RFS，71.3%比 58.7%）相当。在 pN2 患者中，OS（2 年 OS，83.4%比 76.3%）和 RFS（2 年 RFS，69.6%比 36.2%）也相当。
LAP 治疗 pT4 和/或 pN2 结肠癌的中期结果与 OP 相当。在这一组中，LAP 是一种可以接受的手术方法。
