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Laparoscopic-assisted colectomy may confer survival advantage over open colectomy in select patients with colon cancer, new study suggests

Friday, September 26 2008 | Comments

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What's This? Laparoscopic-assisted colectomy (LAC) provides comparable outcomes to open colectomy (OC) for treating patients with colon cancer, according to a recent study. However, survival appears to be better after an LAC than after an OC in select patients.

The use of LAC is becoming more common in the surgical management of colon cancer, having increased from 3.8% of all colectomies in 1998 to 5.2% (P<.001) in 2002. However, few national-level studies have been conducted to determine the long-term outcomes of this method.

To address this need, a retrospective review of the National Cancer Data Base was conducted comparing perioperative and long-term results of 11,038 patients with nonmetastatic colon cancer who underwent LAC with 231,381 similar patients who underwent OC. Patients operated on between 1998 and 2002 were included in the study. Regression methods were used to assess functionality and outcomes between the 2 surgeries. Median patient age was 72 years for those undergoing LAC and 73 years for those having OC.

Of the patients who had LAC, 36.9% had stage I cancer, 33.7% had stage II, and 29.4% had stage IV. Among these subjects, surgery was performed in National Cancer Institute designated hospitals in only 4% of cases. The remaining surgeries were performed at other academic hospitals, Veterans Affairs facilities, and community hospitals.

Male patients were significantly more likely than female patients to undergo LAC. In addition, LAC was more common in patients aged <75 years, in black or Hispanic individuals, in those living in areas with higher median incomes, in patients with private insurance, and in cases where the tumor was located in the sigmoid colon or if the disease was classified as stage I.

Perioperative mortality was lower after LAC compared with OC (2.4% vs 3.0%; P=.001). However, when the data were adjusted for patient, tumor, and hospital factors, there was no difference in 30-day perioperative mortality. Although fewer regional lymph nodes were examined during LAC, the overall margin-positive resection rate was similar for both techniques (3.0% for LAC and 2.9% for OC; P=.39).

Median follow-up was 45 months. For survival analyses, the researchers focused on patients who had received a diagnosis from 1998 to 2000 since they had >=5 years follow-up data available. Observed 5-year survival was 64.1% in the LAC group compared with 58.5% in the OC group, a statistically significant difference (P<.001). This long-term survival was significantly better for patients in both procedure groups with stage I (observed, 77.0% vs 71.1%, respectively; P<.001) or stage II (63.2% vs 60.1%; P=.01) cancers, but there was no significant difference in survival for stage III cancers, irrespective of the surgical method performed.

As hospitals are increasingly using LAC as part of colectomy for colon cancer surgery, the researchers indicated it is important for nonspecialists, hospitals, and surgeons to compare their results with those of other institutions as well as to track their outcomes using cancer registries.

"LAC could be the procedure of choice in select patients. Larger cooperative trials may be warranted to determine whether LAC is superior in certain patient subsets," the authors stressed. (Bilimoria KY, et al. Arch Surg 2008;143:832-840.)

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