Do Laparoscopic Approaches Ensure Oncological Safety and Prognosis for Serosa-Exposed Colon Cancer? A Comparative Study against the Open Approach

SIMPLE SUMMARY: This study examined whether laparoscopic surgery increases the risk of cancer recurrence in patients with T4a colon cancer. A total of 315 patients were analyzed, with 148 in the laparoscopic group and 167 in the open surgery group. Recurrence rates, patterns, and times were similar between the groups. While there was a slightly higher rate of peritoneal metastasis in the laparoscopic group, it was not statistically significant. The five-year overall survival (OS) and disease-free survival (DFS) were not significantly different between the two groups. Age and the pathologic N stage were associated with OS, and only the pathologic N stage was a risk factor for DFS. In conclusion, laparoscopic surgery does not compromise oncologic outcomes in T4a colon cancer patients, despite peritoneal seeding being a common type of recurrence. ABSTRACT: The adoption of laparoscopic surgery in the management of serosa-exposed colorectal cancer has raised concerns. This study aimed to investigate whether laparoscopic surgery is associated with an increased risk of postoperative recurrence in patients undergoing resection for serosa-exposed colon cancer. A retrospective analysis was conducted on a cohort of 315 patients who underwent curative resection for pathologically confirmed T4a colon cancer without distant metastases at the Asan Medical Center between 2006 and 2015. Patients were categorized according to the surgical approach method: laparoscopic surgery (MIS group) versus open surgery (Open group). Multivariate analysis was employed to identify risk factors associated with overall survival (OS) and disease-free survival (DFS). The MIS group included 148 patients and the Open group had 167 patients. Of the total cohort, 106 patients (33.7%) experienced recurrence during the follow-up period. Rates, patterns, and time to recurrence were not different between groups. The MIS group (55.8%) showed more peritoneal metastasis compared to the Open group (44.4%) among recurrence sites, but it was not significant (p = 0.85). There was no significant difference in the five-year OS (73.5% vs. 78.4% p = 0.374) or DFS (62.0% vs. 64.6%; p = 0.61) between the Open and MIS groups. Age and the pathologic N stage were independently associated with OS, and the pathologic N stage was the only associated risk factor for DFS. The laparoscopic approach for serosa-exposed colon cancer did not compromise the DFS and OS. This study provides evidence that laparoscopic surgery does not compromise oncologic outcomes of patients with T4a colon cancer although peritoneal seeding is the most common type of disease failure of serosa-exposed colon cancer.