Laparoscopic-assisted colectomy has gained acceptance for the treatment of colon cancer.
Long-term outcomes of laparoscopic-assisted colectomy have not been examined at the national level outside of experienced centers.
Dr Karl Bilimoria and colleagues from California, USA compared the use and outcomes of laparoscopic-assisted colectomy and open colectomy.
The team assessed 11,038 patients who underwent laparoscopic-assisted colostomy, and 231,381 open colectomy for nonmetastatic colon cancer between 1998 and 2002.
Regression methods were used to assess use and outcomes of laparoscopic-assisted colectomy compared with open colectomy.
|5-year survival rates in patients undergoing open colostomy was 59%|
|Archives of Surgery|
The researchers found laparoscopic-assisted colectomy use increased from 4% in 1998 to 5% in 2002.
Patients were significantly more likely to undergo laparoscopic-assisted colectomy if they were younger than 75 years, and had private insurance.
The team noted that patients were more likely to live in higher-income areas, have stage I cancer, have descending and/or sigmoid cancers, or were treated at National Cancer Institute–designated hospitals.
Compared with those undergoing open colectomy, patents undergoing laparoscopic-assisted colectomy had 12 or more nodes examined less frequently.
The team observed similar perioperative mortality and recurrence rates in patients undergoing laparoscopic-assisted or open colectomy.
The team noted that the 5-year survival rates in patients undergoing open colostomy was 59% vs 64% in those undergoing laparoscopic-assisted colostomy.
After adjusting for patient, tumor, treatment, and hospital factors, 5-year survival was significantly better after laparoscopic-assisted colectomy compared with open colectomy for stage 1 and 2 but not for stage 3 cancer.
Highest-volume centers had comparable short- and long-term laparoscopic-assisted colectomy outcomes compared with lowest-volume hospitals, except highest-volume centers had higher lymph node counts.
Dr Bilimoria’s team concluded, “Laparoscopic-assisted colectomy and open colectomy outcomes are generally comparable in the population.”
“However, survival was better after an laparoscopic-assisted colectomy than after an open colectomy in select patients.”