Nationwide implementation of laparoscopic surgery for colon cancer: short-term outcomes and long-term survival in a population-based cohort

Lee

et al. 2020

Sci Rep

the role of laparoscopic surgery for left-sided colon cancer has been supported by the results of randomized controlled trials. However, its benefits and disadvantages in the real world setting should be further assessed with population-based studies.the hospitalization data of patients undergoing open or laparoscopic surgery for left-sided colon cancer were sourced from the taiwan national Health insurance Research Database. patient and hospital characteristics and perioperative outcomes including length of hospital stay, operation time, opioid use, blood transfusion, intensive care unit (ICU) admission, and use of mechanical ventilation were compared. The overall survival was also assessed. patients undergoing laparoscopic surgery had shorter hospital stay (p < 0.0001) and less demand for opioid analgesia (p = 0.0005). Further logistic regression revealed that patients undergoing open surgery were 1.70, 2.89, and 3.00 times more likely to have blood transfusion, to be admitted to ICU, and to use mechanical ventilation than patients undergoing laparoscopic surgery. Operations performed in medical centers were also associated with less adverse events. the overall survival was comparable between the 2 groups.With adequate hospital quality and volume, laparoscopic surgery for left-sided colon cancer was associated with improved perioperative outcomes. the long-term survival was not compromised.Colorectal cancer is a worldwide health problem. It is the 3rd most commonly diagnosed malignancy in the world and is also one of leading causes of cancer death 1 . Laparoscopic colectomy was introduced in 1991 2 . Initially, it was not widely accepted for cancer treatment because of technical difficulties such as working in multiple intra-abdominal quadrants, ligation of vessels and re-establishment of intestinal continuity as well as oncological concerns including retrieval of lymph nodes, surgical resection margin and survival results 3 . These controversies gradually settled with the accumulation of experience and advance in technology. Through medial-to-lateral approach, the difficulty of multi-quadrant working was lessened. New energy devices such as bipolar sealers and ultrasonic shears made ligation of vessels easier. For oncologic concerns, laparoscopic colectomy was accepted as an alternative surgical approach for colon cancer after positive outcomes from several multi-center prospective randomized trials (RCTs) 4-8 . Since then, further evidence has accumulated to support the feasibility, safety, and benefits of the laparoscopic surgery for colorectal cancer 9-11 .

mentioning

confidence: 99%

Comparison of clinical outcomes between laparoscopic and open surgery for left-sided colon cancer: a nationwide population-based study

Lee

et al. 2020

Sci Rep

European Journal of Surgical Oncology

“…As documented in the Figure, we could observe the rate of MIS increased over the years in all countries. However, in Europe is currently still sub-optimal since it ranges 20.0e35.6 Italy [10,51], Spain and Norway [42,48,49,53]. Opposite, this rate is significantly lower in Sweden e about 7.0% [42] -and higher in the Netherlands e (53.0%) and in the UK [40,52].…”

Section: Resultsmentioning

confidence: 99%

Achieving high quality standards in laparoscopic colon resection for cancer: A Delphi consensus-based position paper

Lorenzon

Biondi

Carus

et al. 2018

“…Data on tumour stage are not included in this registry (NoRGast). In a Norwegian national cohort of colon cancer resections from 2007 to 2010, 11.7% presented as T4-tumours, of which 84.3% were removed by open access [38]. Although the limitations of laparoscopic technique have gradually reclined, there is a possibility of a higher proportion of largesized and T4 tumours in the open access group.…”

Section: Discussionmentioning

confidence: 99%

Short-term outcomes after elective colon cancer surgery: an observational study from the Norwegian registry for gastrointestinal and HPB surgery, NoRGast

et al. 2018

Background To describe the real burden of major complications after elective surgery for colon cancer in Norway, and to assess which predictors that are significantly associated with the short-term outcome. Methods An observational, multi-centre analysis of prospectively registered colon resections registered into the Norwegian Registry for Gastrointestinal Surgery, NoRGast, between January 2014 and December 2016. A propensity score-adjusted subgroup analysis for surgical access groups was attempted, with laparoscopic resections grouped as intention-to-treat. Results Out of 1812 resections, 14.0% of patients experienced a major complication within 30 days following surgery. The overall reoperation rate was 8.7%, and rate of reoperation for anastomotic leak was 3.8%. Twenty patients (1.1%) died within 30 days after surgery. Higher age was not a significant predictor of major complications, including 30-day mortality. After correction for all co-variables, open access surgery was associated with higher rates of major complications (OR 1.67 (CI 1.22-2.29), p = 0.002), higher 30-day mortality (OR 4.39 (CI 1.19-16.13) p = 0.026) and longer length-of-stay (HR 0.58 (CI 0.52-0.65) p < 0.001). Conclusions Our results indicate a low complication burden and high rate of uneventful patient journeys after elective surgery for colon cancer in Norway. Age was not associated with higher morbidity or mortality rates. Open access surgery was associated with an inferior short-term outcome. Keywords Short-term outcomes • Colon cancer • Elective surgery • Laparoscopy In 2012, Norway reported the world's 6th highest incidence of colorectal cancer [1], and the incidence has for the past decades been steadily increasing [2]. The prognosis following surgical treatment is excellent, with a 5-year relative survival rate of 84% after resection for non-metastatic disease [3]. Even the oldest and most frail patients will often be offered surgery with curative intent. While the potential gain from uneventful surgery is large, the consequences of major complications may be devastating with loss of function and impaired quality of life that are at best temporary.