TY - JOUR
T1 - Comparative effectiveness of laparoscopy vs open colectomy among nonmetastatic colon cancer patients
T2 - An analysis using the national cancer data base
AU - Zheng, Zhiyuan
AU - Jemal, Ahmedin
AU - Lin, Chun Chieh
AU - Hu, Chung Yuan
AU - Chang, George J.
N1 - Publisher Copyright:
© 2015 The Author.
PY - 2015/3/1
Y1 - 2015/3/1
N2 - 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. Conclusion: 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.
AB - 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. Conclusion: 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.
UR - http://www.scopus.com/inward/record.url?scp=84927170518&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=84927170518&partnerID=8YFLogxK
U2 - 10.1093/jnci/dju491
DO - 10.1093/jnci/dju491
M3 - Article
C2 - 25663688
AN - SCOPUS:84927170518
SN - 0027-8874
VL - 107
JO - Journal of the National Cancer Institute
JF - Journal of the National Cancer Institute
IS - 3
ER -