Prevention of peritoneal recurrence in high‐risk colorectal cancer and evidence of T4 status as a potential risk factor

Kyang, Lee S.; Valle, Sarah J.; Alzahrani, Nayef; Morris, David L.

doi:10.1111/ans.14428

Cited by 9 publications

(7 citation statements)

References 46 publications

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“…Similarly, Kyang et al [29] have reported that T4a tumors were prognostically worse in terms of peritoneal metastasis than T4b tumors. Thus, we ascertained that tumor cell spillage might develop more frequently in T4a tumor than in T4b tumor.…”

Section: Discussionmentioning

confidence: 86%

Outcomes of laparoscopic surgery for pathological T4 colon cancer

Aoki

Matsuda

Hasegawa

et al. 2019

Int J Colorectal Dis

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The surgical indication of laparoscopic surgery for pT4 colon cancer remains to be established because only a few studies have investigated the short-and long-term outcomes of laparoscopic surgery for them to date. Therefore, we aimed to elucidate the validity of laparoscopic surgery for them. Methods: We retrospectively analyzed 81 patients with pT4 colon cancer who underwent surgical resection with a curative intent at Kobe University Hospital from January 2007 to December 2015. The short-and long-term outcomes were compared between the propensity score-matched patients who underwent laparoscopic colectomy (LAP group, n = 25) and those who underwent open colectomy (OP group, n = 25).Results: Intraoperative blood loss was significantly less in the LAP group than in the OP group (p = 0.029).Operative time, R0 resection rate, and morbidity did not significantly differ between the two groups. The 5-year overall survival (OS) and the 5-year recurrence-free survival (RFS) did not significantly differ between the propensity score-matched groups. Univariate and multivariate analysis of entire cohort showed the surgical approach (LAP vs OP) selected was not a significant prognostic factor for OS or RFS. Conclusions:The short and the long-term outcomes were similar between the LAP and OP groups. Laparoscopic surgery might be safe and feasible option for pT4 colon cancer patients.

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Section: Discussionmentioning

confidence: 86%

Outcomes of laparoscopic surgery for pathological T4 colon cancer

Aoki

Matsuda

Hasegawa

et al. 2019

Int J Colorectal Dis

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“…The proportion of peritoneal metastases increases with higher N stage over time 17–19 . In this study, pN1 (HR, 2.50 [95% CI, 1.13–5.56]; P = 0.02) and pN2 (HR, 4.45 [95% CI, 1.77–11.17]; P = 0.02) were independent risk factors for postoperative peritoneal metastasis.…”

Section: Discussionmentioning

confidence: 49%

“…The proportion of peritoneal metastases increases with higher N stage over time. [17][18][19] In this study, pN1 (HR, 2.50 [95% CI, ; P = 0.02) were independent risk factors for postoperative peritoneal metastasis. The median peritoneal metastasis-free survival time of the nonadenocarcinoma group was 62 months, which was significantly shorter than that of the adenocarcinoma group.…”

Section: Discussionmentioning

confidence: 50%

Development of a Nomogram to Predict Postoperative Peritoneal Metastasis of Colon Cancer

Dai

Wang

et al. 2023

J Comput Assist Tomogr

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Objective The aim of this study was to determine the clinicopathological and radiological risk factors for postoperative peritoneal metastasis and develop a prediction model for the early detection of peritoneal metastasis in patients with colon cancer. Methods We included 174 patients with colon cancer. The clinicopathological and radiological data were retrospectively analyzed. A Cox proportional hazards regression model was used to identify risk factors for postoperative peritoneal metastasis. Based on these risk factors, a nomogram was developed. Results At a median follow-up of 63 months, 43 (24.7%) patients developed peritoneal metastasis. Six independent risk factors (hazards ratio [95% confidence interval]) were identified for postoperative peritoneal metastasis: abdominopelvic fluid (2.12 [1.02–4.40]; P = 0.04), longer maximum tumor length (1.02 [1.00–1.03]; P = 0.02), pN1 (2.50 [1.13–5.56]; P = 0.02), pN2 (4.45 [1.77–11.17]; P = 0.02), nonadenocarcinoma (2.75 [1.18–6.38]; P = 0.02), and preoperative carcinoembryonic antigen levels ≥5 ng/mL (3.08 [1.50–6.30]; P < 0.01). A clinicopathological-radiological model was developed based on these factors. The model showed good discrimination (concordance index, 0.798 [0.723–0.876]; P < 0.001) and was well-calibrated. Conclusions The developed clinicopathological-radiological nomogram may assist clinicians in identifying patients at high risk of postoperative peritoneal metastasis.

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“…Notably, pivotal clinical trials and many previously reported clinical studies that have investigated the oncologic safety of laparoscopic surgery for colon cancer have consistently excluded patients with pathologic T4 tumors from their analyses, leaving a critical gap in our understanding of the suitability of this minimally invasive approach for this particular subset of patients [2,5]. Higher T stage is a risk factor for developing peritoneal disease due to direct seeding of malignant cells [12,13]. The apprehension surrounding laparoscopic surgery in serosa-exposed colon cancer arises from the potential dissemination of cancer cells, although mechanism is not clearly established, which could theoretically compromise long-term oncologic outcomes [8][9][10]14].…”

Section: Introductionmentioning

confidence: 99%

Do Laparoscopic Approaches Ensure Oncological Safety and Prognosis for Serosa-Exposed Colon Cancer? A Comparative Study against the Open Approach

Seo,

Park

2023

Cancers

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The adoption of laparoscopic surgery in the management of serosa-exposed colorectal cancer has raised concerns. This study aimed to investigate whether laparoscopic surgery is associated with an increased risk of postoperative recurrence in patients undergoing resection for serosa-exposed colon cancer. A retrospective analysis was conducted on a cohort of 315 patients who underwent curative resection for pathologically confirmed T4a colon cancer without distant metastases at the Asan Medical Center between 2006 and 2015. Patients were categorized according to the surgical approach method: laparoscopic surgery (MIS group) versus open surgery (Open group). Multivariate analysis was employed to identify risk factors associated with overall survival (OS) and disease-free survival (DFS). The MIS group included 148 patients and the Open group had 167 patients. Of the total cohort, 106 patients (33.7%) experienced recurrence during the follow-up period. Rates, patterns, and time to recurrence were not different between groups. The MIS group (55.8%) showed more peritoneal metastasis compared to the Open group (44.4%) among recurrence sites, but it was not significant (p = 0.85). There was no significant difference in the five-year OS (73.5% vs. 78.4% p = 0.374) or DFS (62.0% vs. 64.6%; p = 0.61) between the Open and MIS groups. Age and the pathologic N stage were independently associated with OS, and the pathologic N stage was the only associated risk factor for DFS. The laparoscopic approach for serosa-exposed colon cancer did not compromise the DFS and OS. This study provides evidence that laparoscopic surgery does not compromise oncologic outcomes of patients with T4a colon cancer although peritoneal seeding is the most common type of disease failure of serosa-exposed colon cancer.

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Prevention of peritoneal recurrence in high‐risk colorectal cancer and evidence of T4 status as a potential risk factor

Cited by 9 publications

References 46 publications

Outcomes of laparoscopic surgery for pathological T4 colon cancer

Outcomes of laparoscopic surgery for pathological T4 colon cancer

Development of a Nomogram to Predict Postoperative Peritoneal Metastasis of Colon Cancer

Do Laparoscopic Approaches Ensure Oncological Safety and Prognosis for Serosa-Exposed Colon Cancer? A Comparative Study against the Open Approach

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