Certainly, in our center, we prefer laparoscopic surgery where possible. If we have a choice, that’s what we recommend and what we do.
—Brian Englum, MD
Data from the National Cancer Data Bank (2010–2011) suggest that 30% of patients with colorectal cancer who are eligible for adjuvant chemotherapy fail to receive it, but their odds increase by 30% when surgery is performed by laparoscopy, rather than laparotomy.1 “In this large national database of almost 20,000 patients, we found that the use of evidence-based adjuvant chemotherapy after resection of node-positive colon cancer is disturbingly low, with over 30% of patients not receiving therapy,” said Brian Englum, MD, of Duke University. Dr. Englum and colleagues presented their findings at Digestive Disease Week 2014.
Adjuvant chemotherapy is recommended within 2 to 3 months of surgery for patients with lymph node-positive disease. Laparoscopy is a safe alternative to laparotomy for colon cancer resection, however, its benefits in achieving higher rates of appropriate adjuvant chemotherapy use have not been established.
Dr. Englum and colleagues examined the National Cancer Data Bank, which captures 70% of newly diagnosed cancer cases from 1,500 U.S. centers, for patients treated in 2010 and 2011. They identified 19,531 patients with N1-2 disease and no distant metastasis, which made them eligible for chemotherapy, ideally within 90 days of surgery. The patients had 12,088 open procedures and 7,443 laparoscopies.
Patients who underwent an open procedure were found to be older and to have larger tumors. There was no evidence for an oncologic benefit for one type of surgery over the other.
Chemotherapy Not Delivered to One-Third of Candidates
The overall rate of receiving adjuvant chemotherapy was only 65%, but this rose higher in patients having laparoscopies. The rates for adjuvant chemotherapy at 60 and 90 days postoperatively were 53% and 62% after laparoscopy compared to 44% and 54% after laparotomy, Dr. Englum reported.
“Laparoscopic colon resection is associated with a nearly 30% higher odds (OR = 1.27; P < .001) of undergoing appropriately timed adjuvant chemotherapy,” he indicated.
Predictors of failure to receive adjuvant chemotherapy included older age, increased comorbidities, racial minority status, nonprivate insurance, prolonged hospital stay (≥10 days), and unplanned readmission.
“Our thought is that patients who have complications are much less likely to receive adjuvant chemotherapy. They develop complications after surgery and have difficulty recovering from them. When they continue to have problems, the window for chemotherapy often closes. They may never get to the point where they are robust enough to tolerate chemotherapy,” Dr. Englum observed.
“We know from other studies that the complication rates after laparoscopic surgery are significantly less than with open procedures, so it makes sense more of these patients received adjuvant chemotherapy in our study,” he said. “Certainly, in our center, we prefer laparoscopic surgery where possible. If we have a choice, that’s what we recommend and what we do.” ■
Disclosure: Dr. Englum reported no potential conflicts of interest.
1. Englum BR, Speicher PJ, Ganapathi AM, et al: Optimizing the utilization of adjuvant chemotherapy following surgical resection of colon cancer: A comparison of laparoscopic vs open approach. Digestive Disease Week 2014. Abstract Mo1072. Presented May 5, 2014.