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Life sciences · Journal article
World Journal of Gastroenterology · September 18, 2026
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T4 colon cancer is associated with a poor prognosis.Pathological assessment may underdiagnose the distinction between T3 and T4 disease, potentially impacting treatment decisions for some patients with T4 colon cancer.While generally less precise than pathological staging, both imaging and intraoperative staging offer potential to address this diagnostic gap, particularly in differentiating T3 from T4 disease.Neoadjuvant therapy is safe and effective for locally advanced colon cancer, significantly reducing local recurrence rates and conferring survival benefits.Neoadjuvant chemotherapy should be avoided when possible in locally advanced colon cancers with deficient mismatch repair, as most are unresponsive to conventional chemotherapy.This patient subset is more suitable for neoadjuvant immunotherapy, which can yield significant pathological responses and improved survival outcomes.Universal upfront testing for mismatch repair status is crucial for stratifying patients and determining appropriate neoadjuvant treatment strategies.Overdiagnosis based on imaging may limit the application of neoadjuvant therapy, as approximately 25% of patients with clinical T3-4 disease on computed tomography are ultimately classified as low-risk stage II disease.Accurately identifying high-risk patients represents a major challenge in advancing comprehensive treatment strategies for locally advanced colon cancer.Prophylactic hyperthermic intraperitoneal chemotherapy may represent one of the most effective strategies to control postoperative peritoneal metastases in locally advanced colon cancer, yet its efficacy, optimal drug regimen, timing, and duration remain subjects of extensive debate.