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.
腹腔镜手术在浆膜外露结直肠癌治疗中的应用已引发关注。本研究旨在探讨腹腔镜手术是否会增加浆膜外露结肠癌切除患者术后复发风险。研究对2006年至2015年间在峨山医学中心接受根治性切除、经病理证实为T4a期无远处转移结肠癌的315例患者进行回顾性分析。根据手术方式将患者分为腹腔镜手术组（微创组）与开腹手术组（开放组）。采用多变量分析确定与总生存期（OS）和无病生存期（DFS）相关的风险因素。微创组纳入148例患者，开放组纳入167例患者。全队列中106例患者（33.7%）在随访期间出现复发。两组在复发率、复发模式和复发时间方面均无显著差异。在复发部位中，微创组腹膜转移率（55.8%）高于开放组（44.4%），但差异无统计学意义（p=0.85）。开放组与微创组的五年总生存率（73.5% vs. 78.4%；p=0.374）和无病生存率（62.0% vs. 64.6%；p=0.61）均无显著差异。年龄和病理N分期与总生存期独立相关，而病理N分期是无病生存期的唯一相关风险因素。腹腔镜手术治疗浆膜外露结肠癌未损害无病生存期和总生存期。本研究证实，尽管腹膜种植是浆膜外露结肠癌最常见的治疗失败类型，但腹腔镜手术不会影响T4a期结肠癌患者的肿瘤学结局。
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