Should we reconsider laparoscopic approach for T4 colon cancer?

We read with interest the article by Huynh et al published in Surgery in 2021. The authors conducted a retrospective analysis of a Canadian population-based database over a 10-year timeframe. They analyzed 1,328 pT4 colon cancers (CC) and concluded that laparoscopy is burdened by an outstanding increase in incidence of peritoneal recurrence (PR) (16.6% vs 9.8%; P < .001). 1 Huynh C. Minkova S. Kim D. Stuart H. Hamilton T.D. Laparoscopic versus open resection in patients with locally advanced colon cancer. Surgery. 2021; 170: 1610-1615 Abstract Full Text Full Text PDF PubMed Scopus (13) Google Scholar This result raised great concern for us, as it questions ours, as well as most centers’, current practice. Indeed, when oncological principles are respected, minimally invasive surgery allows less surgical stress, less immunological depression, early functional recovery, and early integration with adjuvant treatments. However, looking at this publication, all of these benefits would be overridden by the higher risk of PR related to laparoscopy in pT4 CCs. Although the overall risk of PR in CC is <5%, it raises up to 15% to 20% in pT4 and may even double in patients with several high-risk features. 2 Pedrazzani C. Turri G. Marrelli D. et al. Prediction of metachronous peritoneal metastases after radical surgery for colon cancer: a scoring system obtained from an international multicenter cohort. Ann Surg Oncol. 2022; 29: 7896-7906 Crossref PubMed Scopus (4) Google Scholar Peritoneal recurrence associates with very unfavorable prognosis; therefore, its prevention should be among a surgeon’s priorities. Unfortunately, preoperative staging is unreliable in diagnosing serosal infiltration, making preoperative patients’ selection impossible. Laparoscopic versus open resection in patients with locally advanced colon cancerSurgeryVol. 170Issue 6PreviewSurgical resection of locally advanced colon cancer (LACC) is challenging due to tumor size and the frequent need for multivisceral resection. The role of laparoscopic resection in LACC is controversial. This study aims to compare outcomes for laparoscopic versus open surgery in LACC. Full-Text PDF