Laparoscopic surgery is associated with increased risk of postoperative peritoneal metastases in T4 colon cancer: a propensity score analysis.

IF 2.3 3区医学 Q2 GASTROENTEROLOGY & HEPATOLOGY International Journal of Colorectal Disease Pub Date : 2025-01-02 DOI:10.1007/s00384-024-04773-x

Shu-Yuan Li, Ye-Wang, Cheng-Xin, Li-Qiang Ji, Shi-Hao Li, Wen-Di Jiang, Chen-Ming Zhang, Wei Zhang, Zheng Lou

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Abstract

Background: This study aims to evaluate the postoperative safety, long-term survival, and postoperative peritoneal metastases (PPM) rate associated with laparoscopic surgery (LS) for T4 colon cancer.

Materials and methods: After propensity score matching, there were 68 patients in each of the LS and Open surgery groups. The primary outcomes were the 3-year OS, DFS, and PPM rates.

Results: After matching, 68 patients in each of the groups. The LS group had a higher cumulative 3-year peritoneal metastasis rate (19.8% vs. 6.7%, P = .036), while the 3-year OS (82.3% vs. 83.8%, P = .750) and 2-year DFS (69.0% vs. 75.7%, P = .310) showed no significant difference, compared to the open surgery group. The LS group had a significantly longer operation time (201 ± 85.7 min vs. 164 ± 65.9 min, P = .008) but less postoperative complications (P = .036). Additionally, patients in the LS group removed gastric tube more quickly (1.91 ± 1.18 days vs. 2.69 ± 2.41 days, P = .048). The multivariate analysis revealed that LS (HR = 3.496, 95% CI = 1.108-11.030, P = .033), underweight (HR = 11.650, 95% CI = 2.155-62.990, P = .004), and lymphovascular invasion (HR = 3.123, 95% CI = 1.010-9.664, P = .048) were all predictive factors of PPM. For the pN + subgroup, the 3-year cumulative PPM rate was 29.6% in the LS group, significantly higher than 15.3% in the open group (P = .029), but there was no significant difference after PSM (P = .100).

Conclusion: LS offers faster postoperative recovery and comparable long-term survival outcomes. Therefore, it should remain a viable option for locally advanced T4 colon cancer. However, it is crucial to fully recognize the potential risk of increased PPM associated with LS, especially in patients with preoperative suspicion of positive lymph nodes. Further multicenter prospective studies are necessary to validate the potential risks of LS and gain insight into treatment efficacy in different patient populations. In addition, future studies should assess prognosis based on the grade and extent of peritoneal dissemination to provide a more nuanced understanding.

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腹腔镜手术与T4结肠癌术后腹膜转移风险增加相关：倾向评分分析

背景：本研究旨在评估腹腔镜手术（LS）治疗T4结肠癌的术后安全性、长期生存率和术后腹膜转移（PPM）率。材料与方法：经倾向评分匹配后，LS组和开放手术组各68例。主要结果为3年OS、DFS和PPM率。结果：经配对后，两组各68例。LS组累积3年腹膜转移率较高（19.8% vs. 6.7%, P = 0.036），而3年OS （82.3% vs. 83.8%, P = 0.750）和2年DFS （69.0% vs. 75.7%, P = 0.310）与开放手术组比较无显著差异。LS组手术时间（201±85.7 min vs 164±65.9 min, P = 0.008）明显长于手术组（P = 0.036），但术后并发症较少（P = 0.036）。此外，LS组患者的胃管拔除速度更快（1.91±1.18天vs 2.69±2.41天，P = 0.048）。多因素分析显示，LS （HR = 3.496, 95% CI = 1.108 ~ 11.030, P = 0.033）、体重过轻（HR = 11.650, 95% CI = 2.155 ~ 62.990, P = 0.004）、淋巴血管浸润（HR = 3.123, 95% CI = 1.010 ~ 9.664, P = 0.048）均为PPM的预测因素。对于pN +亚组，LS组的3年累积PPM率为29.6%，显著高于开放组的15.3% (P = 0.029)，而PSM后无显著差异（P = 0.100）。结论：LS具有更快的术后恢复和相当的长期生存结果。因此，对于局部晚期T4结肠癌，它仍然是一个可行的选择。然而，充分认识到与LS相关的PPM升高的潜在风险是至关重要的，尤其是术前怀疑淋巴结阳性的患者。需要进一步的多中心前瞻性研究来验证LS的潜在风险，并深入了解不同患者群体的治疗效果。此外，未来的研究应基于腹膜播散的分级和程度来评估预后，以提供更细致的了解。

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来源期刊

International Journal of Colorectal Disease 医学-外科

CiteScore

4.90

自引率

3.60%

发文量

206

审稿时长

3-8 weeks

期刊介绍： The International Journal of Colorectal Disease, Clinical and Molecular Gastroenterology and Surgery aims to publish novel and state-of-the-art papers which deal with the physiology and pathophysiology of diseases involving the entire gastrointestinal tract. In addition to original research articles, the following categories will be included: reviews (usually commissioned but may also be submitted), case reports, letters to the editor, and protocols on clinical studies. The journal offers its readers an interdisciplinary forum for clinical science and molecular research related to gastrointestinal disease.