title: Time to Initiation of Adjuvant Chemotherapy in Colon Cancer: Comparison of Open, Laparoscopic, and Robotic Surgery.
abstract: BACKGROUND
  The time to initiation of adjuvant chemotherapy (TIC) can be used as a recovery parameter after surgery. The effect of laparoscopic or robotic surgery on TIC has not been thoroughly studied. This study aimed to compare the impact of open, laparoscopic, and robot-assisted surgery on TIC after colon cancer surgery.
  
  
  METHODS
  Patients who underwent curative resection for stage II or III colon cancer between January 2007 and June 2013 and who received adjuvant chemotherapy from surgeons capable of performing open, laparoscopic, and robotic surgeries were included in this study. Patient demographics, clinicopathologic variables, and TIC were compared among the three groups. Univariate and multivariate analyses were performed to identify factors affecting TIC.
  
  
  RESULTS
  Of the 252 patients, 40, 161, and 51 patients underwent open, laparoscopic, and robotic colectomy, respectively. The postoperative complication rate was lower in the laparoscopic and robotic groups compared to the open group (P = .002). The length of hospital stay was shorter in the laparoscopic group compared with the open and robotic groups (P < .001). Multivariate analysis revealed that the operation method was the only factor affecting TIC, with laparoscopic and robotic surgery being favorable (regression coefficient -5.1, 95% confidence interval -7.6 to -2.6; P < .001). However, there was no difference in TIC between the laparoscopic and robotic group.
  
  
  CONCLUSIONS
  Laparoscopic and robotic surgeries were associated with shorter TIC. This study demonstrates another benefit of minimally invasive surgery with regard to early initiation of adjuvant chemotherapy.
authors: 1 Department of Surgery, Yonsei University College of Medicine , Seoul, South Korea .
authors: Yoon Bin
authors: YB
authors: Jung
authors: 1 Department of Surgery, Yonsei University College of Medicine , Seoul, South Korea .
authors: Jeonghyun
authors: J
authors: Kang
authors: 2 Division of Colon and Rectal Surgery, Department of Surgery, Ajou University School of Medicine , Suwon, South Korea .
authors: Eun Jung
authors: EJ
authors: Park
authors: 1 Department of Surgery, Yonsei University College of Medicine , Seoul, South Korea .
authors: Seung Hyuk
authors: SH
authors: Baik
authors: 1 Department of Surgery, Yonsei University College of Medicine , Seoul, South Korea .
authors: Kang Young
authors: KY
authors: Lee
mesh_terms: D000368:Aged; D000970:Antineoplastic Agents / Q000008:administration & dosage*; D017024:Chemotherapy, Adjuvant; D003082:Colectomy / Q000379:methods*; D003110:Colonic Neoplasms / Q000188:drug therapy* / Q000601:surgery*; D005260:Female; D006801:Humans; D010535:Laparoscopy / Q000009:adverse effects; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D061646:Operative Time; D011183:Postoperative Complications / Q000209:etiology; D012189:Retrospective Studies; D065287:Robotic Surgical Procedures / Q000009:adverse effects; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D000970:Antineoplastic Agents
keywords: adjuvant chemotherapy; colonic neoplasm; laparoscopy; time to initiation of chemotherapy