ArticleSurgical endoscopy2026
Is minimally invasive surgery safe and effective for pT4 colon cancer? Results from a national retrospective cohort study.
Article in Surgical endoscopy, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
backgroundpT4 colon tumors are associated with worse oncologic prognosis. Although minimally invasive surgery (MIS) improves postoperative recovery, concerns remain regarding its long‑term oncologic safety.
methodsThis is a secondary analysis of a retrospective, multicenter national cohort including patients with pT4 colon cancer treated with curative intent in 50 hospitals. We compared oncologic outcomes (local, peritoneal and systemic recurrence, disease‑free survival [DFS] and overall survival [OS]) between open surgery and MIS. Variables associated with surgical approach were incorporated into a propensity score (PS) to adjust outcomes.
resultsA total of 1850 patients were analyzed: 725 (39.2%) underwent MIS and 1125 (60.8%) open surgery. Patients selected for MIS more frequently had favorable clinical and tumor characteristics. After PS adjustment, MIS was associated with fewer postoperative complications, including fewer major complications (OR 2.4, p < 0.01). The mean number of resected lymph nodes and margin involvement were similar between groups. After a median follow‑up of 42.1 months, overall recurrence rates did not differ between MIS and open surgery, including peritoneal and systemic metastases. Although overall mortality was lower in the MIS group, cancer‑specific mortality was similar. MIS was associated with better DFS (HR 1.2, p = 0.018) and OS (HR 1.3, p = 0.024) after adjustment.
conclusionsMIS can be safely performed in well-selected patients with T4 colon cancer-specifically those with ASA I-II, screen-detected disease, right-sided tumors, elective surgery, tumors not adherent to adjacent structures, no need for extended resection, absence of tumor perforation, pT4a stage, and low-grade histology-reducing postoperative complications without compromising oncological outcomes.
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