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Background <p>pT4 colon tumors are associated with worse oncologic prognosis. Although minimally invasive surgery (MIS) improves postoperative recovery, concerns remain regarding its long‑term oncologic safety.</p> Methods <p>This 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.</p> Results <p>A 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, <i>p</i> &lt; 0.01). The mean number of resected lymph nodes and margin involvement were similar between groups. After a median follow‑up of 42.1&#xa0;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, <i>p</i> = 0.018) and OS (HR 1.3, <i>p</i> = 0.024) after adjustment.</p> Conclusions <p>MIS 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.</p>

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Is minimally invasive surgery safe and effective for pT4 colon cancer? Results from a national retrospective cohort study

  • 期刊论文

  • 发表日期：

    2026年4月20日

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  • Óscar Cano-Valderrama,
  • Carlos Cerdán-Santacruz,
  • Mireia Amillo-Zaragüeta,
  • Orlando Aurazo,
  • Cristina González-Prado,
  • Guillermo Cabriada-García,
  • María Conde-Rodríguez,
  • Laura Ramírez-Ruiz,
  • José Manuel Richart-Aznar,
  • Nuria Peris-Tomás,
  • Ángel Serrano del Moral,
  • Fernando Pereira-Pérez,
  • Blas Flor-Lorente,
  • Sebastiano Biondo,
  • Cristina Rihuete Caro,
  • Santos Jiménez de los Galanes Marchán,
  • Fernando Fernández López,
  • Manuel Paz Novo,
  • Francisco Blanco Antona,
  • José Francisco Noguera Aguilar,
  • María Taboada Ameneiro,
  • Enrique Moncada Iribarren,
  • Inés Aldrey Cao,
  • Sandra Nuñez Fernández,
  • Pedro Villarejo,
  • Héctor Guadalajara Labajo,
  • Natalia Uribe Quintana,
  • Zutoia Balciscueta Coltell,
  • Juan Beltrán de Heredia,
  • Beatriz de Andrés Asenjo,
  • Christian Nuño Iglesias,
  • Paola Lora Cumplido,
  • Jesús Bollo Rodríguez,
  • Marta Pascual Damieta,
  • Ane Etxart Lopetegi,
  • David Ambrona Zafra,
  • Silvia Pérez Farré,
  • Mercedes Estaire Gómez,
  • Esther García Santos,
  • Alicia Calero Amaro,
  • Luis Sánchez Guillén,
  • Virginia Jiménez Carneros,
  • Ainhoa Valle Rubio,
  • Rosángela Obregón Reina,
  • Paula Dujovne Lindenbaum,
  • Eduardo de San Pio Carvajal,
  • Elena Sagarra Cebolla,
  • Ricardo Frago Montanuy,
  • Araceli Mayol Oltra,
  • Enrique Boldó Roda,
  • Joaquín Carrasco Campos,
  • Alberto Titos García,
  • Estrella Turienzo Santos,
  • Isabel Cifrián Canales,
  • Arancha Prada,
  • María Carmona Agúndez,
  • Manuel Artiles Armas,
  • Beatriz Arencibia Pérez,
  • Lara Blanco Terés,
  • Álvaro Gancedo Quintana,
  • José Antonio Rueda Orgaz,
  • Federico Ochando Cerdán,
  • Manuel Díez Alonso,
  • Remedios Gómez Sanz,
  • Juan Ocaña Jiménez,
  • Julio Galindo Álvarez,
  • María del Mar Luna Díaz,
  • Enrique Asensio Díaz,
  • Fernando Labarga Rodríguez,
  • Marta Allué,
  • Alejandra Utrilla Fornals,
  • Inmaculada Segura Jiménez,
  • Raquel Conde Muíño,
  • Tamara Fernández Miguel,
  • Irune Vicente Rodríguez,
  • Beatriz Moreno Flores,
  • Cristina Camacho Dorado,
  • Juan Torres Melero,
  • Miguel Lorenzo Liñán,
  • María Labalde Martínez,
  • Francisco Javier García Borda,
  • Eduardo Álvarez Sarrado,
  • Vanessa Concepción Martín,
  • Carmen Díaz López,
  • Pedro A. Parra Baños,
  • Emilio Peña Ros,
  • David Alías Jiménez,
  • Rocío Franco Herrera,
  • Antonio Ramos Bonilla,
  • Marta Pérez González,
  • Asunción Pérez Sánchez,
  • Javier Valdés Hernández,
  • Laura González Sánchez,
  • Eudaldo López-Tomasetti Fernández,
  • Carlos Fernández Mancilla

摘要

Background

pT4 colon tumors are associated with worse oncologic prognosis. Although minimally invasive surgery (MIS) improves postoperative recovery, concerns remain regarding its long‑term oncologic safety.

Methods

This 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.

Results

A 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.

Conclusions

MIS 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.