RT Journal
A1 Bilimoria KY, Bentrem DJ, Nelson H, et al
T1 USe and outcomes of laparoscopic-assisted colectomy for cancer in the united states
JF Archives of Surgery
JO Archives of Surgery
YR 2008
FD September 15
VO 143
IS 9
SP 832
OP 840
DO 10.1001/archsurg.143.9.832
UL http://dx.doi.org/10.1001/archsurg.143.9.832
AB Background 
    Laparoscopic-assisted colectomy (LAC) has gained acceptance for the treatment of colon cancer. However, long-term outcomes of LAC have not been examined at the national level outside of experienced centers.Objective 
    To compare use and outcomes of LAC and open colectomy (OC).Design 
    Retrospective cohort study.Setting 
    National Cancer Data Base.Patients 
    Patients who underwent LAC (n = 11 038) and OC (n = 231 381) for nonmetastatic colon cancer (1998-2002).Main Outcome Measures 
    Regression methods were used to assess use and outcomes of LAC compared with OC.Results 
    Laparoscopic-assisted colectomy use increased from 3.8% in 1998 to 5.2% in 2002 (P < .001). Patients were significantly more likely to undergo LAC if they were younger than 75 years, had private insurance, lived in higher-income areas, had stage I cancer, had descending and/or sigmoid cancers, or were treated at National Cancer Institute–designated hospitals. Compared with those undergoing OC, patents undergoing LAC had 12 or more nodes examined less frequently (P < .001), similar perioperative mortality and recurrence rates, and higher 5-year survival rates (64.1% vs 58.5%, P < .001). After adjusting for patient, tumor, treatment, and hospital factors, 5-year survival was significantly better after LAC compared with OC for stage I and II but not for stage III cancer. Highest-volume centers had comparable short- and long-term LAC outcomes compared with lowest-volume hospitals, except highest-volume centers had significantly higher lymph node counts (median, 12 vs 8 nodes; P < .001).Conclusions 
    Laparoscopic-assisted colectomy and OC outcomes are generally comparable in the population. However, survival was better after an LAC than after an OC in select patients.