title: Nationwide implementation of laparoscopic surgery for colon cancer: short-term outcomes and long-term survival in a population-based cohort.
abstract: Randomized trials show similar outcomes after open surgery and laparoscopy for colon cancer, and confirmation of outcomes after implementation in routine practice is important. While some studies have reported long-term outcomes after laparoscopic surgery from single institutions, data from large patient cohorts are sparse. We investigated short- and long-term outcomes of laparoscopic and open surgery for treating colon cancer in a large national cohort.
  
  
  
  We retrieved data from the Norwegian Colorectal Cancer Registry for all colon cancer resections performed in 2007-2010. Five-year relative survival rates following laparoscopic and open surgeries were calculated, including excess mortality rates associated with potential predictors of death.
  
  
  
  Among 8707 patients with colon cancer that underwent major resections, 16 % and 36 % received laparoscopic procedures in 2007 and 2010, respectively. Laparoscopic procedures were most common in elective surgeries for treating stages I-III, right colon, or sigmoid tumours. The conversion rate of laparoscopic procedures was 14.5 %. Among all patients, laparoscopy provided higher 5-year relative survival rates (70 %) than open surgery (62 %) (P = 0.040), but among the largest group of patients electively treated for stages I-III disease, the approaches provided similar relative survival rates (78 vs. 81 %; P = 0.535). Excess mortality at 2 years post-surgery was lower after laparoscopy than after open surgery (excess hazard ratio, 0.7; P = 0.013), but similar between groups during the last 3 years of follow-up. Major predictors of death were stage IV disease, tumour class pN+, age > 80 years, and emergency procedures (excess hazard ratios were 5.3, 2.4, 2.1, and 2.0, respectively; P < 0.001).
  
  
  
  Nationwide implementation of laparoscopic colectomy for colon cancer was safe and achieved results comparable to those from previous randomized trials.
authors.affiliation: Department of Gastrointestinal Surgery, Stavanger University Hospital, P.O. Box 8100, 4068, Stavanger, Norway.|Department of Clinical Medicine, University of Bergen, Bergen, Norway.
authors.forename: Kjartan
authors.initials: K
authors.lastname: Stormark
authors.affiliation: Department of Gastrointestinal Surgery, Stavanger University Hospital, P.O. Box 8100, 4068, Stavanger, Norway.|Department of Clinical Medicine, University of Bergen, Bergen, Norway.
authors.forename: Kjetil
authors.initials: K
authors.lastname: Søreide
authors.affiliation: Department of Gastrointestinal Surgery, Stavanger University Hospital, P.O. Box 8100, 4068, Stavanger, Norway.|Department of Clinical Medicine, University of Bergen, Bergen, Norway.
authors.forename: Jon Arne
authors.initials: JA
authors.lastname: Søreide
authors.affiliation: Department of Mathematics and Natural Sciences, University of Stavanger, Stavanger, Norway.|Research Department, Stavanger University Hospital, Stavanger, Norway.
authors.forename: Jan Terje
authors.initials: JT
authors.lastname: Kvaløy
authors.affiliation: Department of Clinical Medicine, University of Bergen, Bergen, Norway.|Department of Gastrointestinal and Acute Surgery, Haukeland University Hospital, Bergen, Norway.
authors.forename: Frank
authors.initials: F
authors.lastname: Pfeffer
authors.affiliation: Department of Gastrointestinal Surgery, Oslo University Hospital, Oslo, Norway.
authors.forename: Morten T
authors.initials: MT
authors.lastname: Eriksen
authors.affiliation: Department of Gastrointestinal Surgery, Stavanger University Hospital, P.O. Box 8100, 4068, Stavanger, Norway.
authors.forename: Bjørn S
authors.initials: BS
authors.lastname: Nedrebø
authors.affiliation: Department of Gastrointestinal Surgery, Stavanger University Hospital, P.O. Box 8100, 4068, Stavanger, Norway. hartwig.korner@uib.no.|Department of Clinical Medicine, University of Bergen, Bergen, Norway. hartwig.korner@uib.no.
authors.forename: Hartwig
authors.initials: H
authors.lastname: Kørner
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D057868:Anastomotic Leak / Q000453:epidemiology; D003082:Colectomy / Q000379:methods*; D003110:Colonic Neoplasms / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D017558:Elective Surgical Procedures; D005260:Female; D061847:Hospitals, High-Volume; D061846:Hospitals, Low-Volume; D006784:Hospitals, Teaching; D006801:Humans; D010535:Laparoscopy / Q000379:methods*; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000453:epidemiology; D009367:Neoplasm Staging; D009664:Norway / Q000453:epidemiology; D011183:Postoperative Complications / Q000453:epidemiology*; D016016:Proportional Hazards Models; D012811:Sigmoid Neoplasms / Q000401:mortality / Q000473:pathology / Q000601:surgery; D015996:Survival Rate; D016896:Treatment Outcome; D047368:Tumor Burden
keywords: Colon cancer; Implementation; Laparoscopy; Relative survival; Surgery