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 21 May 2018

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News

Laparoscopic-assisted colectomy for cancer in the USA

A study in the most recent issue of the Archives of Surgery examines the use and outcomes of laparoscopic-assisted colectomy for cancer in the United States.

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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.”

 

 

 

 

 

 

Arch Surg 2008: 143(9): 832-40


19 September 2008

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