title: Comparative effectiveness of laparoscopy vs open colectomy among nonmetastatic colon cancer patients: an analysis using the National Cancer Data Base.
abstract: BACKGROUND
  Randomized clinical trials showed that laparoscopic colectomy (LC) is superior to open colectomy (OC) in short-term surgical outcomes; however, the generalizability among real-world patients is not clear.
  
  
  METHODS
  The National Cancer Data Base was used to identify stage I-III colon cancer patients age 18 to 84 years in 2010 and 2011. A propensity score analysis with 1:1 matching (PS) was used to avoid the effect of treatment selection bias. Patients were clustered at the hospital level for multilevel regression analyses. The main outcomes measured were 30-day mortality, unplanned readmissions, length of stay (LOS), and initiation of adjuvant chemotherapy among stage III patients. All statistical tests were two-sided.
  
  
  RESULTS
  A total of 45 876 patients were analyzed, 18 717 (41%) LC and 27 159 (59%) OC. After PS matching, there were 18 230 patients in both groups and they were well balanced on their covariables. Compared with OC, LC showed consistent benefits in 30-day mortality (1.3% vs 2.3 %, odds ratio [OR] = 0.59, 95% confidence interval [CI] = 0.49 to 0.69, P < .001) and LOS (median 5 vs 6 days, incident rate ratio = 0.83, 95% CI = 0.8 to 0.84, P < .001). LC was also associated with a higher rate of adjuvant chemotherapy use in stage III patients (72.3% vs 67.0%, P < .001). LC was more likely to be performed by high-volume surgeons in high-volume hospitals, but there was no significant effect of the hospital/surgeon volume on short-term outcomes.
  
  
  CONCLUSIONS
  In routine clinical practice, laparoscopic colectomy is associated with lower 30-day mortality, shorter length of stay, and greater likelihood of adjuvant chemotherapy initiation among stage III colon cancer patients when compared with open colectomy.
authors: Surveillance and Health Services Research Program, Department of Intramural Research, American Cancer Society, Atlanta, GA (ZZ, AJ, CCL); Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX (CYH, GJC); Alliance for Clinical Trials in Oncology Network and American College of Surgeons Clinical Research Program, Chicago, IL (GJC); Alliance for Clinical Trials in Oncology Network and American College of Surgeons Clinical Research Program, Chicago, IL (GJC). jason.zheng@cancer.org.
authors: Zhiyuan
authors: Z
authors: Zheng
authors: Surveillance and Health Services Research Program, Department of Intramural Research, American Cancer Society, Atlanta, GA (ZZ, AJ, CCL); Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX (CYH, GJC); Alliance for Clinical Trials in Oncology Network and American College of Surgeons Clinical Research Program, Chicago, IL (GJC); Alliance for Clinical Trials in Oncology Network and American College of Surgeons Clinical Research Program, Chicago, IL (GJC).
authors: Ahmedin
authors: A
authors: Jemal
authors: Surveillance and Health Services Research Program, Department of Intramural Research, American Cancer Society, Atlanta, GA (ZZ, AJ, CCL); Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX (CYH, GJC); Alliance for Clinical Trials in Oncology Network and American College of Surgeons Clinical Research Program, Chicago, IL (GJC); Alliance for Clinical Trials in Oncology Network and American College of Surgeons Clinical Research Program, Chicago, IL (GJC).
authors: Chun Chieh
authors: CC
authors: Lin
authors: Surveillance and Health Services Research Program, Department of Intramural Research, American Cancer Society, Atlanta, GA (ZZ, AJ, CCL); Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX (CYH, GJC); Alliance for Clinical Trials in Oncology Network and American College of Surgeons Clinical Research Program, Chicago, IL (GJC); Alliance for Clinical Trials in Oncology Network and American College of Surgeons Clinical Research Program, Chicago, IL (GJC).
authors: Chung-Yuan
authors: CY
authors: Hu
authors: Surveillance and Health Services Research Program, Department of Intramural Research, American Cancer Society, Atlanta, GA (ZZ, AJ, CCL); Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX (CYH, GJC); Alliance for Clinical Trials in Oncology Network and American College of Surgeons Clinical Research Program, Chicago, IL (GJC); Alliance for Clinical Trials in Oncology Network and American College of Surgeons Clinical Research Program, Chicago, IL (GJC).
authors: George J
authors: GJ
authors: Chang
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D017024:Chemotherapy, Adjuvant / Q000706:statistics & numerical data*; D003082:Colectomy / Q000379:methods*; D003110:Colonic Neoplasms / Q000401:mortality* / Q000473:pathology / Q000601:surgery*; D057186:Comparative Effectiveness Research; D016208:Databases, Factual; D005260:Female; D006801:Humans; D010535:Laparoscopy; D007902:Length of Stay / Q000706:statistics & numerical data*; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D010359:Patient Readmission / Q000706:statistics & numerical data; D057216:Propensity Score; D012189:Retrospective Studies; D014481:United States