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Karl Y. Bilimoria, MD, MS; David J. Bentrem, MD; Heidi Nelson, MD; Steven J. Stryker, MD; Andrew K. Stewart, MA; Nathaniel J. Soper, MD; Thomas R. Russell, MD; Clifford Y. Ko, MD, MSHS

Arch Surg. 2008;143(9):832-840.

Background  Laparoscopic-assisted colectomy (LAC) has gained acceptance for the treatment of colon cancer. However, long-term outcomes of LAC have not been examined at the national level outside of experienced centers.

Objective  To compare use and outcomes of LAC and open colectomy (OC).

Design  Retrospective cohort study.

Setting  National Cancer Data Base.

Patients  Patients who underwent LAC (n = 11 038) and OC (n = 231 381) for nonmetastatic colon cancer (1998-2002).

Main Outcome Measures  Regression methods were used to assess use and outcomes of LAC compared with OC.

Results  Laparoscopic-assisted colectomy use increased from 3.8% in 1998 to 5.2% in 2002 (P < .001). Patients were significantly more likely to undergo LAC if they were younger than 75 years, had private insurance, lived in higher-income areas, had stage I cancer, had descending and/or sigmoid cancers, or were treated at National Cancer Institute–designated hospitals. Compared with those undergoing OC, patents undergoing LAC had 12 or more nodes examined less frequently (P < .001), similar perioperative mortality and recurrence rates, and higher 5-year survival rates (64.1% vs 58.5%, P < .001). After adjusting for patient, tumor, treatment, and hospital factors, 5-year survival was significantly better after LAC compared with OC for stage I and II but not for stage III cancer. Highest-volume centers had comparable short- and long-term LAC outcomes compared with lowest-volume hospitals, except highest-volume centers had significantly higher lymph node counts (median, 12 vs 8 nodes; P < .001).

Conclusions  Laparoscopic-assisted colectomy and OC outcomes are generally comparable in the population. However, survival was better after an LAC than after an OC in select patients.

Author Affiliations: Department of Surgery, Feinberg School of Medicine, Northwestern University (Drs Bilimoria, Bentrem, Stryker, and Soper), and Cancer Programs, American College of Surgeons (Drs Bilimoria, Russell, and Ko and Mr Stewart), Chicago, Illinois; Department of Surgery, Mayo Clinic, Rochester, Minnesota (Dr Nelson); and Department of Surgery, University of California, Los Angeles, and VA Greater Los Angeles Healthcare System, Los Angeles, California (Dr Ko).

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RELATED LETTERS

Is Laparoscopic Colectomy a Good Operation for Colon Cancer?
Fadi F. Attiyeh
Arch Surg. 2009;144(3):290-291.
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Arch Surg. 2009;144(3):291.
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