Comparison of minimally invasive and open colon surgery for the treatment of T4 colon cancer in a tertiary care institution using propensity score matching analysis

Abstract

Aim: Despite the increasing popularity of minimally invasive surgery (MIS) in recent years, its efficacy in treating T4 colon cancer remains a subject of ongoing debate. This study aimed to assess the perioperative and oncological outcomes of MIS for T4 colon cancer in comparison with open surgery (OP). Method: We conducted a retrospective cohort analysis on 181 consecutive patients who underwent a T4 colon cancer resection through either MIS or OP between December 2014 and September 2021. Converted patients were evaluated in the MIS group according to the intention-to-treat principle. Propensity score matching (PSM) was employed based on age, gender, American Society of Anesthesiologists score, and the T-stage subgroup (T4a and T4b) to control for potentially confounding factors. Demographics short-term and long-term oncological outcomes were evaluated and compared between the two groups. Results: Post-PSM resulted in 49 patients in each group. Both groups were comparable in terms of patient demographics, clinical stage at diagnosis, and postoperative morbidity. The median operative time was longer in the MIS group (167 vs. 132 minutes, p<0.01). The lymph node yield and the quality of complete mesocolic excision did not differ significantly between the two groups. The conversion rate was 8.2%. The 5-year overall survival (85.0% for the MIS group vs. 88.5% for the OP group, p=0.7) and the disease-free survival (62.5% for the MIS group vs. 70.0% for the OP group, p=0.33) rates were comparable between the groups. Conclusion: MIS is a safe approach for treating T4 colon cancer, demonstrating satisfactory outcomes. The method offers oncologically acceptable results, reinforcing its potential advantages.