Use and outcomes of laparoscopic-assisted colectomy for cancer in the United States.
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).


METHODS
Retrospective cohort study.


METHODS
National Cancer Data Base.


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


METHODS
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.
Bilimoria
Karl Y
KY
Department of Surgery, Feinberg School of Medicine, Northwestern University, and Cancer Programs, American College of Surgeons, Chicago, Illinois 60611, USA. kbilimoria@facs.org
Bentrem
David J
DJ
Nelson
Heidi
H
Stryker
Steven J
SJ
Stewart
Andrew K
AK
Soper
Nathaniel J
NJ
Russell
Thomas R
TR
Ko
Clifford Y
CY
D000230:Adenocarcinoma / Q000601:surgery*; D000368:Aged; D003082:Colectomy / Q000191:economics / Q000379:methods* / Q000706:statistics & numerical data; D003110:Colonic Neoplasms / Q000601:surgery*; D005260:Female; D006801:Humans; D010535:Laparoscopy / Q000191:economics / Q000706:statistics & numerical data; D008198:Lymph Nodes / Q000473:pathology; D008297:Male; D008875:Middle Aged; D017063:Outcome Assessment, Health Care; D018579:Patient Selection; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D013503:Surgery Department, Hospital / Q000706:statistics & numerical data; D014481:United States