Lower 30-Day Mortality, Increased Likelihood of Adjuvant Chemotherapy With Laparoscopic vs Open Colectomy for Stage III Colon Cancer

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“In routine clinical practice, laparoscopic colectomy is associated with a 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,” according to an analysis of data from the National Cancer Data Base. The results were reported in the Journal of the National Cancer Institute by Zhiyuan Zheng, PhD, of the American Cancer Society, and colleagues from the University of Texas MD Anderson Cancer Center in Houston and the Alliance for Clinical Trials in Oncology Network and American College of Surgeons Clinical Research Program.

“Randomized clinical trials showed that laparoscopic colectomy is superior to open colectomy in short-term surgical outcomes,” and “meta-analysis studies confirmed these findings,” the authors noted. They undertook the current study to investigate whether the findings could be generalized to patients outside clinical trials.

Using the National Cancer Data Base, the investigators identified stage I to III colon cancer patients aged 18 to 84 years in 2010 and 2011. “Patients were limited to those who had adenocarcinoma and underwent either curative laparoscopic colectomy or open colectomy as their first course of treatment within 90 days after diagnoses,” the authors explained.

Among 45,876 patients analyzed, 18,717 (41%) had laparoscopic colectomy and 27,159 (59%) had open colectomy. After propensity score matching to avoid the effect of treatment selection bias, both groups had 18,230 patients well balanced on their covariables.

Patients who had laparoscopic colectomy had consistently lower 30-day mortality, 1.3% vs 2.3 % for patients with open colectomy (odds ratio [OR] = 0.59, 95% confidence interval [CI] = 0.49–0.69, P < .001). The median length of stay was 5 days with laparoscopic colectomy vs 6 days with open colectomy (incident rate ratio = 0.83, 95% CI = 0.8–0.84, P < .001). “Laparoscopic colectomy was also associated with a higher rate of adjuvant chemotherapy use in stage III patients (72.3% vs 67.0%, P < .001)” and receiving chemotherapy without delay, the researchers reported.

Laparoscopic colectomy was performed “at a wide variety of facility types and among both low- and high-volume hospitals and surgeons, with more than 64% of laparoscopic colectomy cases performed in community hospitals and more than 70% performed by low-volume surgeons, demonstrating the widespread availability of the laparoscopic approach,” the researchers stated. “Laparoscopic colectomy was more likely to be performed by high-volume surgeons in high-volume hospitals, but there was no significant effect of the hospital/surgeon volume on short-term outcomes,” the authors added.

“We have demonstrated the generalizability of the benefits of laparoscopic colectomy found in randomized clinical trials among real-world patients where the majority of colectomies were performed in community cancer programs. However, more than half of patients still undergo open resection,” the investigators noted. “Wider diffusion of laparoscopy at the population level with incentives to improve laparoscopic skills acquisition through training and monitoring of outcomes, particularly among current high-volume surgeons who perform only open colectomy, may benefit patients and improve the efficiency of colon cancer care throughout the health-care system.” ■

Zheng Z, et al: J Natl Cancer Inst 107:dju491, 2015.




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