講演情報
[JKS2-3]Minimally Invasive Surgery for T4 Colon Cancer: Is It Safe?
*Byung Soh Min1 (1. Yonsei University College of Medicine, Korea)
Background: T4 colon cancer carries a high risk of recurrence, particularly peritoneal metastasis (PM). The oncological safety of minimally invasive surgery (MIS) remains controversial.
Methods and Results: Recurrence rates in T4 colon cancer are 32%, 34%, and 63% for N0, N1, and N2 disease, respectively. Several retrospective studies reported higher PM rates after laparoscopic surgery. A Japanese multicenter study of 2,380 patients with pT4a cancer found higher PM incidence after laparoscopic than open surgery (13.0% vs. 7.7%, P = 0.001). However, pooled randomized trial data showed no significant difference. Preventive hyperthermic intraperitoneal chemotherapy (HIPEC) has yielded conflicting results: COLOPEC showed no significant benefit, whereas HIPECT4 improved locoregional control. Neoadjuvant chemotherapy in the FOXTROT trial improved tumor downstaging and R0 resection rates while reducing recurrence risk.
Conclusion: Laparoscopic colectomy may be appropriate for carefully selected patients with T4 colon cancer, although its impact on PM remains uncertain. Individualized patient selection, meticulous surgical technique, and multidisciplinary strategies are essential. Further prospective studies are needed to clarify oncological safety and establish selection criteria.
Methods and Results: Recurrence rates in T4 colon cancer are 32%, 34%, and 63% for N0, N1, and N2 disease, respectively. Several retrospective studies reported higher PM rates after laparoscopic surgery. A Japanese multicenter study of 2,380 patients with pT4a cancer found higher PM incidence after laparoscopic than open surgery (13.0% vs. 7.7%, P = 0.001). However, pooled randomized trial data showed no significant difference. Preventive hyperthermic intraperitoneal chemotherapy (HIPEC) has yielded conflicting results: COLOPEC showed no significant benefit, whereas HIPECT4 improved locoregional control. Neoadjuvant chemotherapy in the FOXTROT trial improved tumor downstaging and R0 resection rates while reducing recurrence risk.
Conclusion: Laparoscopic colectomy may be appropriate for carefully selected patients with T4 colon cancer, although its impact on PM remains uncertain. Individualized patient selection, meticulous surgical technique, and multidisciplinary strategies are essential. Further prospective studies are needed to clarify oncological safety and establish selection criteria.