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Should we reconsider laparoscopic approach for T4 colon cancer?

Published:December 17, 2022DOI:https://doi.org/10.1016/j.surg.2022.11.020
      We read with interest the article by Huynh et al published in Surgery in 2021. The authors conducted a retrospective analysis of a Canadian population-based database over a 10-year timeframe. They analyzed 1,328 pT4 colon cancers (CC) and concluded that laparoscopy is burdened by an outstanding increase in incidence of peritoneal recurrence (PR) (16.6% vs 9.8%; P < .001).
      • Huynh C.
      • Minkova S.
      • Kim D.
      • Stuart H.
      • Hamilton T.D.
      Laparoscopic versus open resection in patients with locally advanced colon cancer.
      This result raised great concern for us, as it questions ours, as well as most centers’, current practice. Indeed, when oncological principles are respected, minimally invasive surgery allows less surgical stress, less immunological depression, early functional recovery, and early integration with adjuvant treatments. However, looking at this publication, all of these benefits would be overridden by the higher risk of PR related to laparoscopy in pT4 CCs. Although the overall risk of PR in CC is <5%, it raises up to 15% to 20% in pT4 and may even double in patients with several high-risk features.
      • Pedrazzani C.
      • Turri G.
      • Marrelli D.
      • et al.
      Prediction of metachronous peritoneal metastases after radical surgery for colon cancer: a scoring system obtained from an international multicenter cohort.
      Peritoneal recurrence associates with very unfavorable prognosis; therefore, its prevention should be among a surgeon’s priorities. Unfortunately, preoperative staging is unreliable in diagnosing serosal infiltration, making preoperative patients’ selection impossible.
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      References

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        • Minkova S.
        • Kim D.
        • Stuart H.
        • Hamilton T.D.
        Laparoscopic versus open resection in patients with locally advanced colon cancer.
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