Minimally invasive surgery for T4 colon cancer is associated with better outcomes compared to open surgery in the National Cancer Database
Menée aux Etats-Unis à partir des données de la base nationale des cancers portant sur 21 998 patients atteints d'un cancer du côlon de stade II ou III p T4 diagnostiqué entre 2010 et 2014, cette étude compare l'intérêt, du point de vue de la qualité des marges de résection, du prélèvement de ganglions lymphatiques, de la mortalité postopératoire et de la nécessité d'ajouter une chimiothérapie adjuvante, d'une chirurgie mini-invasive et d'un traitement chirurgical par voie ouverte
Minimally invasive surgery (MIS) is favored for T1-T3 colon cancer resection due to improved short and long-term outcomes. Recommendations regarding T4 cancers remain controversial due to a paucity of clinical trials or large datasets assessing outcomes. We aim to compare outcomes for pT4 colon cancer patients treated with MIS or open surgery (OS) in the National Cancer Database (NCDB). We analyzed adults having MIS or OS for stage II or III pT4 colon cancers between 2010 and 2014 using propensity-score matching, Cox and logistic regression modeling. Of 21 998 T4 patients, 7532 (34.2%) underwent MIS, 14 466 (65.8%) OS and 22.3% were MIS converted to OS. After propensity score matching, 5624 patients in each cohort were included. MIS was associated with improved postoperative mortality (3.4 vs. 7.2%, p > .001), surgical margins, optimal lymph node harvest, adjuvant chemotherapy use and 5-year survival (46% vs. 41%, P < .001). MIS was associated with improved short and long term outcomes for T4 colon cancers compared to OS on multivariate analysis. Based on these findings, well selected pT4 colon cancers can be considered appropriate for MIS however, prospective clinical trials are needed to better define the role of MIS in T4b colon cancer.