title: Long-term follow-up and individual item analysis of quality of life assessments related to laparoscopic-assisted colectomy in the COST trial 93-46-53 (INT 0146).
abstract: BACKGROUND
  Postoperative outcomes of patients undergoing laparoscopic-assisted colectomy (LAC) have shown modest improvements in recovery but only minimal differences in quality of life (QOL) compared with open colectomy. We therefore sought to assess the effect of LAC on QOL in the short and long term, using individual item analysis of multi-item QOL assessments.
  
  
  METHODS
  QOL variables were analyzed in 449 randomized patients from the COST trial 93-46-53 (INT 0146). Both cross-sectional single-time and change from baseline assessments were run at day 2, week 2, month 2, and month 18 postoperatively in an intention-to-treat analysis using Wilcoxon rank-sum tests. Stepwise regression models were used to determine predictors of QOL.
  
  
  RESULTS
  Of 449 colon cancer patients, 230 underwent LAC and 219 underwent open colectomy. Subdomain analysis revealed a clinically moderate improvement from baseline for LAC in total QOL index at 18 months (P = 0.02) as well as other small symptomatic improvements. Poor preoperative QOL as indicated by a rating scale of ≤ 50 was an independent predictor of poor QOL at 2 months postoperatively. QOL variables related to survival were baseline support (P = 0.001) and baseline outlook (P = 0.01).
  
  
  CONCLUSIONS
  Eighteen months after surgery, any differences in quality of life between patients randomized to LAC or open colectomy favored LAC. However, the magnitude of the benefits was small. Patients with poor preoperative QOL appear to be at higher risk for difficult postoperative courses, and may be candidates for enhanced ancillary services to address their particular needs.
authors: Department of Surgery, Mayo Clinic Arizona, Phoenix, AZ, USA.
authors: Chee-Chee H
authors: CC
authors: Stucky
authors: Barbara A
authors: BA
authors: Pockaj
authors: Paul J
authors: PJ
authors: Novotny
authors: Jeff A
authors: JA
authors: Sloan
authors: Daniel J
authors: DJ
authors: Sargent
authors: Michael J
authors: MJ
authors: O'Connell
authors: Robert W
authors: RW
authors: Beart
authors: John M
authors: JM
authors: Skibber
authors: Heidi
authors: H
authors: Nelson
authors: Jane C
authors: JC
authors: Weeks
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003082:Colectomy; D003110:Colonic Neoplasms / Q000473:pathology / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D010535:Laparoscopy; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000473:pathology / Q000601:surgery*; D009367:Neoplasm Staging; D011184:Postoperative Period; D011788:Quality of Life; D015996:Survival Rate; D013997:Time Factors; D016896:Treatment Outcome