Minimally invasive surgery in locally advanced colon cancer contributes to textbook outcome achievement and the long-term outcome

Minimally invasive surgery (MIS) has improved the management of colorectal cancer (CRC), offering reduced morbidity without compromising the oncological outcomes. However, its role in locally advanced colon cancer and its impact on the Textbook Outcome (TO)—a metric integrating key surgical success parameters— remain unclear.

This retrospective study analyzed the data of 459 patients with T3/T4 colon cancer who underwent elective resection at Keio University Hospital between 2012 and 2020. TO was defined as R0 resection, ≥ 12 lymph nodes harvested, no severe complications, no unplanned stoma, and timely surgery. Multivariate regression was used to identify the factors influencing TO and overall survival (OS).

TO was achieved in 59.0% of patients, with higher rates in MIS than in open surgery (64.3% vs. 28.4%, p < 0.001), particularly for right-sided tumors. The predictors of TO non-achievement included a high Controlling Nutritional Status (CONUT) score, advanced stage, and left-sided tumors. Patients achieving TO had a significantly improved 5-year OS (p < 0.001) after a median follow-up of 49.3 months.

MIS reliably achieves TO, especially in right-sided colon cancer, emphasizing the importance of multidisciplinary preoperative planning. TO is a valuable metric for assessing surgical quality while also correlating with an improved long-term survival in locally advanced CRC.