Does pathological T factor affect the long-term prognosis of locally advanced colorectal cancer treated with Laparoscopic multi-visceral resection?

Abstract Purpose: Local advanced colorectal cancer (LACC) has poor long-term outcomes. Our hypothesis was that the depth of pathological findings would affect postoperative outcomes in patients who underwent multivisceral resection (MVR) resulting in clear margins (R0). The aim of this study was to analyze short- and long-term outcomes in patients who underwent MVR for LACC between T3 and T4 stages.Methods: This was a propensity score-matched (PSM) retrospective study. All 8,764 consecutive patients who underwent surgery for colorectal cancer between April-2007 and January- 2021 at the Saitama Medical University International Medical Center were screened. 572 underwent MVR for LACC. We compared the T3 and T4 groups to evaluate outcomes.Results: The 5-year disease-free survival (DFS) rates did not significantly differ between the two groups (HR 1.344 95% CI (0.638–-2.907), P=0.33). The 5-year overall survival (OS) rates were significantly worse for the T4 group than for the T3 group (HR 3.162 95% CI (1.077–-11.44), P=0.037).To determine the association between American Society of Anesthesiologists (ASA) score, transfusion, pathological T and OS, we performed univariate and multivariate analyses. ASA, transfusion, and pathological T were associated with worse OS in univariate analysis (T3 vs. T4, respectively).Conclusion: Our study showed that the postoperative complications and DFS of the T4 group were similar to those of the T3 group. However, OS was worse in the T4 group compared with T3 group. Multivariate risk factors were ASA>2, transfusion, and, T4.