Laparoscopic Surgery is Associated with Increased Risk of Postoperative Peritoneal Metastases in T4 Colon Cancer: A Propensity Score Analysis

Background This study aims to evaluate the postoperative safety, long-term survival, and postoperative peritoneal metastases (PPM) rate associated with laparoscopic surgery (LS) for T4 colon cancer. Materials and methods After propensity score matching, there were 85 patients in each of the LS and Open surgery groups. The primary outcomes were the 2-year OS, DFS, and PPM rates. Results After matching, 85 patients in each of the groups. The LS group had a higher cumulative 2-year peritoneal metastasis rate (13.9% vs. 3.9%, P  = .029), while the 2-year OS (83.0% vs. 84.2%, P  = .860) and 2-year DFS (70.9% vs. 74.4%, P  = .540) showed no significant difference, compared to the open surgery group. The time to resume diet and the postoperative hospitalization in the LS group were shorter. There were no significant difference harvested lymph nodes, time to remove the drainage and gastric tube, and postoperative complications. The multivariate analysis revealed that LS (HR = 10.783, P  = .002), postoperative complications (HR = 17.181, P  < .001), and pN stage (N1: HR = 5.786, P  = .045; N2: HR = 8.579, P  = .027, respectively) were all independent risk factors for PPM. Conclusion For non-metastatic T4 colon cancer, the LS does not affect postoperative safety and long-term survival. Therefore, it should not be considered an contraindication for locally advanced T4 colon cancer. However, it is crucial to fully recognize the potential risk of increased PPM associated with LS.