title: Laparoscopic colectomy decreases the time to administration of chemotherapy compared with open colectomy.
abstract: BACKGROUND
  Minimally invasive colon surgery (MIS) has been shown to minimize pain and decrease overall recovery time. No studies have shown a clear oncologic benefit. Some literature suggests that the time to administration of chemotherapy can be important to improve outcomes for advanced colon cancer. The goal of this study is to evaluate the effect of minimally invasive surgery on the timing of chemotherapy administration.
  
  
  METHODS
  This was a retrospective review of all patients undergoing surgery for colon cancer at a tertiary institution between 2004 and 2013.
  
  
  RESULTS
  A total of 668 partial colectomies for cancer were performed; 241 were stage III and above and deemed appropriate for chemotherapy. Eighty-five patients did not receive chemotherapy (patient's wishes, age/comorbidities or lost to follow-up). Of the 156 patients who received chemotherapy, 57 underwent MIS and 99 had open colectomy. Average time to chemotherapy after MIS colectomy was 42.9 versus 60.3 days for open surgery (p < 0.001). In the open group, 52 (53 %) people had postoperative complications and readmissions versus 24 (39 %) in the MIS group. Postoperative complications increased the time to chemotherapy for all patients. However, among patients with complications, patients in the MIS group were still able to start chemotherapy earlier (p < 0.05) than open colectomy patients. Multivariate analysis revealed the MIS approach as the only factor lowering time between surgery and chemotherapy.
  
  
  CONCLUSIONS
  Laparoscopic colectomy decreases the time interval from surgery to the start of chemotherapy compared with open colectomy. Postoperative complications increase the time to chemotherapy for both open and MIS surgery.
authors.affiliation: Colon & Rectal Surgery, Beth Israel Deaconess Medical Center, Boston, MA, USA, vpoylin@bidmc.harvard.edu.
authors.forename: Vitaliy
authors.initials: V
authors.lastname: Poylin
authors.forename: Thomas
authors.initials: T
authors.lastname: Curran
authors.forename: Eliza
authors.initials: E
authors.lastname: Lee
authors.forename: Deborah
authors.initials: D
authors.lastname: Nagle
mesh_terms: D000971:Antineoplastic Combined Chemotherapy Protocols / Q000008:administration & dosage*; D003082:Colectomy; D003110:Colonic Neoplasms / Q000473:pathology / Q000601:surgery*; D003131:Combined Modality Therapy; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D010535:Laparoscopy; D008297:Male; D008875:Middle Aged; D019060:Minimally Invasive Surgical Procedures; D009367:Neoplasm Staging; D011183:Postoperative Complications; D011379:Prognosis; D011446:Prospective Studies; D012189:Retrospective Studies; D013997:Time Factors