The impact of an open or laparoscopic approach on the development of metachronous peritoneal metastases after primary resection of colorectal cancer: results from a population-based cohort study

R.J. Lurvink, A. Rijken, C. Bakkers, V.E. Lemmens, P.R. de Reuver, J.B. Tuynman, N.F. Kok, S.W. Nienhuijs, F.N. van Erning, I.H.J.T. de Hingh*

*Corresponding author for this work

Research output: Contribution to journalArticleAcademicpeer-review

Abstract

Background This study aimed to assess the impact of open or laparoscopic resection of primary colorectal cancer (CRC) on the development of metachronous colorectal peritoneal metastases (CPM) in a population-based cohort. Materials and methods This was a retrospective, population-based study of CRC patients who underwent open or laparoscopic resection of the primary tumour in the Netherlands between January 1st and June 30th 2015. Patients with synchronous metastases were excluded. CPM were considered metachronous if diagnosed >= 90 days after resection of primary CRC. Multivariable cox regression analysis was performed to correct for tumour location, histology, differentiation, and stage, nodal stage, tumour perforation, primary surgery type, and unclear resection margins. Results In total, 1516 CRC patients underwent open resection and 3236 CRC patients underwent laparoscopic resection, with a 3-year cumulative incidence of metachronous CPM of 7.3% and 3.7%, respectively (p < 0.001), after median follow-up of 42 months. Open surgical approach was significantly associated with the development of metachronous CPM: HR 1.4 [95%CI 1.1-1.8]. Other prognostic factors were mucinous adenocarcinoma histology (HR 1.6, 95%CI 1.0-2.5), T4 stage (HR 3.2, 95%CI 2.3-4.5), N1 stage (HR 2.9, 95%CI 2.1-4.0), and N2 stage (HR 4.2, 95%CI 2.9-6.1). Conclusions Patients treated with open resection had a significantly higher risk to develop metachronous CPM than patients treated with laparoscopic resection. The mechanisms underlying this phenomenon remain unknown but might be related to differences in per-operative specimen handling, tumour spill, surgical trauma and pro-inflammatory response. This finding might imply the need for a personalized follow-up after primary resection of CRC.
Original languageEnglish
Pages (from-to)6551-6557
Number of pages7
JournalSurgical endoscopy and other interventional techniques
Volume36
Issue number9
Early online date20 Jan 2022
DOIs
Publication statusPublished - Sept 2022

Keywords

  • Colorectal cancer
  • Peritoneal metastases
  • Surgical approach
  • Open surgery
  • Laparoscopic surgery
  • HYPERTHERMIC INTRAPERITONEAL CHEMOTHERAPY
  • OPEN SURGERY
  • SYSTEMIC CHEMOTHERAPY
  • RANDOMIZED-TRIAL
  • COLON-CANCER
  • FOLLOW-UP
  • CARCINOMATOSIS
  • CYTOREDUCTION
  • SURVIVAL
  • RISK

Fingerprint

Dive into the research topics of 'The impact of an open or laparoscopic approach on the development of metachronous peritoneal metastases after primary resection of colorectal cancer: results from a population-based cohort study'. Together they form a unique fingerprint.

Cite this