Minimally invasive surgery for locally advanced colon cancer (pT4): short-term outcomes from a consecutive real-world cohort

Abstract

Abstract Background The role of minimally invasive surgery (MIS) in pathological T4 colon cancer remains controversial because of the technical complexity of multivisceral resections and concerns regarding oncological adequacy. This study aimed to compare short-term postoperative outcomes following minimally invasive and open colectomy in patients with locally advanced (pT4) colon cancer. Methods We conducted a retrospective single-centre cohort study including consecutive patients who underwent surgical resection for pathological T4 colon cancer between May 2018 and September 2025. Patients were stratified according to surgical approach (minimally invasive vs open) and pathological substage (T4a vs T4b). The primary endpoint was the occurrence of any postoperative complication within 30 days. Secondary endpoints included severe postoperative complications (Clavien–Dindo grade ≥ III) and conversion to open surgery. Multivariable and Firth-penalised logistic regression analyses were performed to identify independent predictors of postoperative morbidity. Results A total of 114 patients with pathological T4 colon cancer were included, of whom 79 (69.3%) underwent minimally invasive surgery and 35 (30.7%) underwent primary open surgery. Overall postoperative complications occurred more frequently after open surgery. Multivariable analysis identified surgical approach as an independent predictor of postoperative morbidity (OR 2.72, p = 0.032). Severe complications were independently associated with increasing age (OR 1.06, p = 0.010). Compared with T4a tumours, T4b lesions were associated with greater operative complexity, lower use of minimally invasive surgery, and higher postoperative complication rates. Exploratory analyses also suggested that preoperative bowel obstruction and altered bowel habits may be associated with an increased risk of conversion. Conclusions In experienced colorectal centres, minimally invasive colectomy appears to be a safe and feasible option for carefully selected patients with pathological T4 colon cancer. In this consecutive real-world cohort, minimally invasive surgery was associated with lower short-term postoperative morbidity than primary open surgery. These findings should be interpreted in light of the observational study design and the potential for residual selection bias. Larger prospective multicentre studies with long-term oncological follow-up are warranted. Trial Registration This study was registered with the Research Registry (researchregistry11844).