title: Propensity score-matched study of laparoscopic and open surgery for colorectal cancer in rural hospitals.
abstract: OBJECTIVE
  Various randomized clinical studies have suggested that short- and long-term outcomes of laparoscopic surgery (LAP) for colorectal cancer are comparable with those of open surgery (OP). However, these studies were performed in high-volume hospitals. The aim of the present study was to compare the outcomes of LAP versus OP for colorectal cancer in rural hospitals.
  
  
  METHODS
  This was a multicenter retrospective propensity score-matched case-control study of patients who underwent colorectal surgery from January 2004 to April 2009 in 10 hospitals in Japan. All patients underwent curative surgery for pathologically diagnosed stage II or III colorectal cancer. The primary end point was 5-year overall survival (OS). The secondary end points were disease-free survival (DFS) and postoperative complications.
  
  
  RESULTS
  In total, 319 patients who underwent LAP and 1020 patients who underwent OP were balanced to 261 pairs. There was no significant difference in the OS and DFS between two groups. The operation time was significantly shorter for OP than for LAP. Blood loss was significantly lower in LAP than in OP. There was no difference in intraoperative morbidity between the two groups. The postoperative morbidity was significantly lower in LAP than in OP. The hospital stay was significantly shorter in LAP than in OP. There was no significant difference in 90-day postoperative mortality.
  
  
  CONCLUSIONS
  Laparoscopic surgery may be a feasible option for colorectal cancer in rural hospitals.
authors.affiliation: Department of Surgery, The University of Tokushima, Tokushima, Japan. nakao.toshihiro@tokushima-u.ac.jp.
authors.forename: Toshihiro
authors.initials: T
authors.lastname: Nakao
authors.affiliation: Department of Surgery, The University of Tokushima, Tokushima, Japan.
authors.forename: Mitsuo
authors.initials: M
authors.lastname: Shimada
authors.affiliation: Department of Surgery, The University of Tokushima, Tokushima, Japan.
authors.forename: Kozo
authors.initials: K
authors.lastname: Yoshikawa
authors.affiliation: Department of Surgery, The University of Tokushima, Tokushima, Japan.
authors.forename: Jun
authors.initials: J
authors.lastname: Higashijima
authors.affiliation: Department of Surgery, The University of Tokushima, Tokushima, Japan.
authors.forename: Takuya
authors.initials: T
authors.lastname: Tokunaga
authors.affiliation: Department of Surgery, The University of Tokushima, Tokushima, Japan.
authors.forename: Masaaki
authors.initials: M
authors.lastname: Nishi
authors.affiliation: Department of Surgery, The University of Tokushima, Tokushima, Japan.
authors.forename: Chie
authors.initials: C
authors.lastname: Takasu
authors.affiliation: Department of Surgery, The University of Tokushima, Tokushima, Japan.
authors.forename: Hideya
authors.initials: H
authors.lastname: Kashihara
authors.affiliation: Department of Surgery, Kagawa Prefectural Central Hospital, Kagawa, Japan.
authors.forename: Ichio
authors.initials: I
authors.lastname: Suzuka
authors.affiliation: Department of Surgery, Matsuyama Red Cross Hospital, Matsuyama, Japan.
authors.forename: Takashi
authors.initials: T
authors.lastname: Nishizaki
authors.affiliation: Department of Surgery, Tokushima Red Cross Hospital, Tokushima, Japan.
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Okitsu
authors.affiliation: Department of Surgery, Tokushima Prefectural Central Hospital, Tokushima, Japan.
authors.forename: Toshiyuki
authors.initials: T
authors.lastname: Yagi
authors.affiliation: Department of Surgery, Tokushima Municipal Hospital, Tokushima, Japan.
authors.forename: Hidenori
authors.initials: H
authors.lastname: Miyake
authors.affiliation: Department of Surgery, Yoshinogawa Medical Center, Yoshinogawa, Japan.
authors.forename: Murato
authors.initials: M
authors.lastname: Miura
authors.affiliation: Department of Surgery, National Hospital Organization Kochi National Hospital, Kochi, Japan.
authors.forename: Mitsutoshi
authors.initials: M
authors.lastname: Fukuyama
authors.affiliation: Department of Surgery, Takamatsu Municipal Hospital, Takamatsu, Japan.
authors.forename: Daisuke
authors.initials: D
authors.lastname: Wada
authors.affiliation: Department of Surgery, Tokushima Prefecture Naruto Hospital, Tokushima, Japan.
authors.forename: Yoshiaki
authors.initials: Y
authors.lastname: Bando
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003082:Colectomy / Q000009:adverse effects / Q000379:methods*; D015179:Colorectal Neoplasms / Q000473:pathology / Q000601:surgery*; D005240:Feasibility Studies; D005260:Female; D006780:Hospitals, Rural; D006801:Humans; D010535:Laparoscopy / Q000009:adverse effects / Q000379:methods*; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D060787:Neoplasm Grading; D009367:Neoplasm Staging; D057216:Propensity Score; D012189:Retrospective Studies; D016019:Survival Analysis; D016896:Treatment Outcome
keywords: colorectal cancer; laparoscopic surgery; propensity score; rural