Abstract
For patients with T4a colon cancer, the risk of peritoneal dissemination after surgery remains unclear. Seven hundred and eleven patients with T3 or T4a colon cancer, 80 years of age or younger, underwent curative resection (open surgery in 512 and laparoscopic surgery in 199) at the four Jikei University hospitals between 2006 and 2012. Their risk factors for peritoneal dissemination after surgery were evaluated retrospectively. Number of lymph node metastases, postoperative liver metastases and postoperative peritoneal dissemination events in the T4a group were significantly greater than the number in the T3 group. Peritoneal dissemination after surgery developed in four patients (0.7%) in the T3 group and in six patients (5%) in the T4a group. Risk factors for peritoneal dissemination consisted of macroscopic type (P = 0.016), serosal invasion (P = 0.017) and number of lymph node metastases (P = 0.009) according to the Cox proportional hazards regression model. However, tumor diameter and surgical approach (laparoscopic vs open) were not significant factors for peritoneal dissemination. There were no significant differences between the postoperative relapse‐free survival rates for each surgical approach within the T3 or T4a group. Because of comparable postoperative peritoneal dissemination in T3 and T4a colon cancer by the surgical approach (laparoscopic or open), laparoscopic surgery for patients with T4a colon cancer seems justified.
Highlights
In the early 1990s, laparoscopic surgery for early-stage cancer was considered feasible in Japan, but it was not known whether an adequate extent of lymph node dissection for more advanced cases could be achieved by laparoscopic procedures.[1]
According to the national survey conducted by the Japanese Society of Endoscopic Surgery (JSES),[3] the percentage of more advanced cancers (T2 or higher) accounting for the procedure has increased to over 50% of the total cases
Between patients with T3 who received open surgery and laparoscopic surgery, no significant differences were identified in age, gender, macroscopic type of tumor, pathological type, lymph node metastasis and postoperative recurrence rates or sites, whereas significant differences were achieved in tumor location, operation time, intraoperative bleeding, tumor diameter, and pathological type (Table 2)
Summary
In the early 1990s, laparoscopic surgery for early-stage cancer was considered feasible in Japan, but it was not known whether an adequate extent of lymph node dissection for more advanced cases could be achieved by laparoscopic procedures.[1]. Many patients with T4 colon cancer are included in those cases, the risk of peritoneal dissemination after surgery remains unclear. The aim of this retrospective study was to evaluate the validity of laparoscopic surgery for patients with T4a colon cancer.
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