title: Selection for laparoscopic resection confers a survival benefit in colorectal cancer surgery in England.
abstract: Laparoscopic surgery is being increasingly used in colorectal cancer resections. The aim of this national study was to determine whether laparoscopy confers a long-term survival advantage in colorectal cancer.
  
  
  
  A national administrative data set (Hospital Episode Statistics-HES) encompassing all elective hospital admissions in England between 2001 and 2011 was analysed. All patients that had a colorectal cancer resection (open or laparoscopic) were identified. Cox hazard regression was used to determine differences in overall survival (10 year) between the open and laparoscopy groups.
  
  
  
  A total of 141,682 patients underwent elective surgery for colorectal cancer, of which 20.9 % (n = 29,550) had a laparoscopic procedure. The median 5-year survival in the open group was 36.1 months compared with 46.1 months in the laparoscopic group (p = <0.001). Survival analysis demonstrated laparoscopy to be an independent predictor of survival. Patients who underwent laparoscopic resection were 18 % less likely to die than patients who had an open CRC resection (HR 0.82, CI 0.79-0.83, p < 0.001). This survival benefit persisted even when initial post-operative mortality (90 day) was excluded (HR 0.87, CI 0.85-0.90, p < 0.001). Subgroup analysis, exploring the effect of CRC laparoscopic surgery on survival in the elderly (>79 years old), demonstrated similar survival benefit amongst patients treated using laparoscopy (HR 0.90, CI 0.86-0.94, p < 0.001). Patients not undergoing adjuvant chemotherapy were more likely to survive if they underwent laparoscopic resection (HR 0.81, CI 0.78-0.83, p < 0.001). Similarly, patients undergoing adjuvant chemotherapy demonstrated a survival benefit if a minimal access surgical approach was utilised (HR 0.86, CI 0.81-0.91, p < 0.001).
  
  
  
  Laparoscopy confers a survival benefit, irrespective of age and administration of adjuvant chemotherapy, beyond the initial post-operative period in patients selected for elective colorectal cancer resection.
authors.affiliation: Surgical Epidemiology, Trials and Outcome Centre (SETOC), St Mark's Hospital, Imperial College London, Harrow, Middlesex, HA1 3UJ, UK. alan.askari@nhs.net.
authors.forename: Alan
authors.identifier: 0000-0001-5993-7613
authors.initials: A
authors.lastname: Askari
authors.affiliation: Surgical Epidemiology, Trials and Outcome Centre (SETOC), St Mark's Hospital, Imperial College London, Harrow, Middlesex, HA1 3UJ, UK.
authors.forename: Subramanian
authors.initials: S
authors.lastname: Nachiappan
authors.affiliation: Surgical Epidemiology, Trials and Outcome Centre (SETOC), St Mark's Hospital, Imperial College London, Harrow, Middlesex, HA1 3UJ, UK.
authors.forename: Andrew
authors.initials: A
authors.lastname: Currie
authors.affiliation: Faculty of Medicine, School of Public Health, Dr Foster Unit, Imperial College London, London, UK.
authors.forename: Alex
authors.initials: A
authors.lastname: Bottle
authors.affiliation: Department of Surgery and Cancer, Faculty of Medicine, St Mary's Hospital, Praed Street, London, W2 1NY, UK.
authors.forename: Thanos
authors.initials: T
authors.lastname: Athanasiou
authors.affiliation: Surgical Epidemiology, Trials and Outcome Centre (SETOC), St Mark's Hospital, Imperial College London, Harrow, Middlesex, HA1 3UJ, UK.|Department of Surgery and Cancer, Faculty of Medicine, St Mary's Hospital, Praed Street, London, W2 1NY, UK.
authors.forename: Omar
authors.initials: O
authors.lastname: Faiz
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D001803:Blood Transfusion; D017024:Chemotherapy, Adjuvant; D003082:Colectomy / Q000379:methods; D015179:Colorectal Neoplasms / Q000401:mortality* / Q000601:surgery*; D004739:England / Q000453:epidemiology; D005260:Female; D006801:Humans; D010535:Laparoscopy; D008297:Male; D008875:Middle Aged; D018579:Patient Selection; D016016:Proportional Hazards Models; D055815:Young Adult
keywords: Colorectal cancer; Laparoscopy; Surgery; Survival