Successful and safe introduction of laparoscopic colorectal cancer surgery in Dutch hospitals.
OBJECTIVE
To investigate the safety of laparoscopic colorectal cancer resections in a nationwide population-based study.


BACKGROUND
Although laparoscopic techniques are increasingly used in colorectal cancer surgery, little is known on results outside trials. With the fast introduction of laparoscopic resection (LR), questions were raised about safety.


METHODS
Of all patients who underwent an elective colorectal cancer resection in 2010 in the Netherlands, 93% were included in the Dutch Surgical Colorectal Audit. Short-term outcome after LR, open resection (OR), and converted LR were compared in a generalized linear mixed model. We further explored hospital differences in LR and conversion rates.


RESULTS
A total of 7350 patients, treated in 90 hospitals, were included. LR rate was 41% with a conversion rate of 15%. After adjustment for differences in case-mix, LR was associated with a lower risk of mortality (odds ratio 0.63, P < 0.01), major morbidity (odds ratio 0.72, P < 0.01), any complications (odds ratio 0.74, P < 0.01), hospital stay more than 14 days (odds ratio 0.71, P < 0.01), and irradical resections (odds ratio 0.68, P < 0.01), compared to OR. Outcome after conversion was similar to OR (P > 0.05). A large variation in LR and conversion rates among hospitals was found; however, the difference in outcome associated with operative techniques was not influenced by hospital of treatment.


CONCLUSIONS
Use of laparoscopic techniques in colorectal cancer surgery in the Netherlands is safe and results are better in short-term outcome than open surgery, irrespective of the hospital of treatment. Outcome after conversion was similar to OR.
Department of Surgery †Medical Decision Making, Leiden University Medical Center, The Netherlands.
Nikki E
NE
Kolfschoten
Nicoline J
NJ
van Leersum
Gea A
GA
Gooiker
Perla J
PJ
Marang van de Mheen
Eric-Hans
EH
Eddes
Job
J
Kievit
Ronald
R
Brand
Pieter J
PJ
Tanis
Willem A
WA
Bemelman
Rob A E M
RA
Tollenaar
Jeroen
J
Meijerink
Michel W J M
MW
Wouters
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003082:Colectomy / Q000379:methods* / Q000401:mortality / Q000706:statistics & numerical data; D015179:Colorectal Neoplasms / Q000401:mortality / Q000601:surgery*; D061887:Conversion to Open Surgery / Q000706:statistics & numerical data; D017558:Elective Surgical Procedures / Q000379:methods* / Q000401:mortality / Q000706:statistics & numerical data; D005260:Female; D006801:Humans; D010535:Laparoscopy / Q000401:mortality / Q000706:statistics & numerical data; D007902:Length of Stay / Q000706:statistics & numerical data; D016014:Linear Models; D016015:Logistic Models; D008297:Male; D008485:Medical Audit; D008875:Middle Aged; D015999:Multivariate Analysis; D009426:Netherlands; D011183:Postoperative Complications / Q000453:epidemiology; D012007:Rectum / Q000601:surgery*; D012042:Registries; D016896:Treatment Outcome