The impact of laparoscopic vs open primary colon resection on long-term outcomes after subsequent cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) for metachronous peritoneal metastasis.

BACKGROUND

Several factors have been known to correlate with the early and long-term outcomes of patients undergoing CRS/HIPEC. However, the relation between surgical approach (open vs laparoscopic colectomy) at the index colectomy and oncological outcomes following CRS/HIPEC have not been studied.

METHODS

Patients who underwent CRS/HIPEC after previous colectomy for colorectal cancer with peritoneal metastases from 2015 to 2022 were identified from a prospectively maintained database of peritoneal surface malignancies and were divided into two groups according to the primary colectomy approach open or laparoscopic colectomy. Operative and 30-day outcomes were compared between groups, as well as survival outcomes.

RESULTS

A total of 159 patients met inclusion criteria, of those 101 patients were in the open group and 58 patients were in the laparoscopic group. Both groups had similar demographics and comorbidities. TNM staging at index colectomy was similar between the groups as well as peritoneal cancer index (PCI) score for CRS/HIPEC surgery; however, there was more upper jejunal disease involvement in the laparoscopic group compared with the open group (45.5% vs. 22%, p = 0.004) and shorter mean duration of surgery (4.1 vs. 4.69 [hour], p = 0.004). For the laparoscopic and open colectomy groups, respectively, estimated median disease-free survival (DFS) was 25.9 months (95%CI 0-68.1) vs. 9.9 months (95%CI 1.4-12.6) (p < 0.001). In a multivariable analysis the surgical approach of the index colectomy was independently associated with DFS.

CONCLUSION

Performing CRS HIPEC for metachronous peritoneal metastasis following laparoscopic colectomy may be associated with favorable perioperative and survival outcomes.