Improved Outcome and Greater Use of Adjuvant Chemotherapy With Laparoscopic vs Open Colectomy in Nonmetastatic Colon Cancer
In a National Cancer Data Base analysis reported in the Journal of the National Cancer Institute, Zheng et al found that laparoscopic colectomy was associated with lower 30-day mortality, shorter length of stay, and, in patients with stage III disease, greater use of adjuvant chemotherapy vs open colectomy in patients with nonmetastatic colon cancer.
Study Details
The study included 45,876 patients with stage I to III colon cancer treated in 2010 and 2011. Of them, 18,717 (41%) underwent laparoscopic colectomy and 27,159 underwent open colectomy. The laparoscopic to open colectomy conversion rate was 5.7%. A propensity score analysis with 1:1 matching included 18,230 patients in each group.
Outcomes
In the unmatched analysis, laparoscopic colectomy was associated with lower 30-day mortality (1.30% vs 2.82%, odds ratio [OR] = 0.54, P < .001), lower 30-day readmission rate (4.80% vs 5.52%, OR = 0.87, P = .003), and shorter length of stay (median 5 vs 6 days, OR = 0.82, P < .001). In propensity score–matched analysis, laparoscopy was associated with lower 30-day mortality (1.33% vs 2.30%, OR = 0.59, P < .001) and shorter length of stay (median 5 vs 6 days, OR = 0.83, P <.001). In unmatched analysis among 6,450 laparoscopy patients and 10,529 open colectomy patients with stage III disease, adjuvant chemotherapy was used in 72.4% vs 64.9% (P < .001); in propensity score–matched analysis in 6,395 and 6,454 patients, adjuvant chemotherapy was used in 72.3% vs 67.0% (P < .001).
Laparoscopic colectomy was more likely to be performed by high-volume surgeons in high-volume hospitals, and high surgeon volume was associated with lower 30-day mortality and shorter length of stay. However, the improvements in these outcomes associated with laparoscopic colectomy were observed across all hospital and surgeon volume strata in both unmatched and propensity score–matched analyses.
The investigators concluded: “In routine clinical practice, laparoscopic colectomy is associated with lower 30-day mortality, shorter length of stay, and greater likelihood of adjuvant chemotherapy initiation among stage III colon cancer patients when compared with open colectomy.”
Zhiyuan Zheng, PhD, of the American Cancer Society, is the corresponding author of the Journal of the National Cancer Institute article.
The study was supported by the American Cancer Society and the National Cancer Institute.
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