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).
1
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.
2
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.To read this article in full you will need to make a payment
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References
- Laparoscopic versus open resection in patients with locally advanced colon cancer.Surgery. 2021; 170: 1610-1615
- Prediction of metachronous peritoneal metastases after radical surgery for colon cancer: a scoring system obtained from an international multicenter cohort.Ann Surg Oncol. 2022; 29: 7896-7906
- Laparoscopic surgery for T4 colon cancer: a risk factor for peritoneal recurrences?.Surgery. 2020; 168: 119-124
- Laparoscopic colectomy: a risk factor for postoperative peritoneal metastasis.Clin Colorectal Cancer. 2022; 21: e205-e212
- The impact of an open or laparoscopic approach on the development of metachronous peritoneal metastases after primary resection of colorectal cancer: results from a population-based cohort study.Surg Endosc. 2022; 36: 6551-6557
- Does laparoscopy increase the risk of peritoneal recurrence after resection for pT4 colon cancer? Results of a propensity score-matched analysis from an international cohort.Eur J Surg Oncol. 2022; 48: 1823-1830
Article info
Publication history
Published online: December 17, 2022
Accepted:
November 15,
2022
Publication stage
In Press Corrected ProofIdentification
Copyright
© 2022 Elsevier Inc. All rights reserved.
