Use and outcomes of Laparoscopic-assisted colectomy for cancer in the United States

Karl Y. Bilimoria, David J. Bentrem, Heidi Nelson, Steven J. Stryker, Andrew K. Stewart, Nathaniel J. Soper, Thomas R. Russell, Clifford Y. Ko

Research output: Contribution to journalArticle

83 Citations (Scopus)

Abstract

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: Lo 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.

Original languageEnglish (US)
Pages (from-to)832-840
Number of pages9
JournalArchives of Surgery
Volume143
Issue number9
DOIs
StatePublished - Sep 2008

Fingerprint

Colectomy
Neoplasms
Colonic Neoplasms
Low-Volume Hospitals
Sigmoid Neoplasms
Patents
Survival
National Cancer Institute (U.S.)

ASJC Scopus subject areas

  • Surgery

Cite this

Bilimoria, K. Y., Bentrem, D. J., Nelson, H., Stryker, S. J., Stewart, A. K., Soper, N. J., ... Ko, C. Y. (2008). Use and outcomes of Laparoscopic-assisted colectomy for cancer in the United States. Archives of Surgery, 143(9), 832-840. https://doi.org/10.1001/archsurg.143.9.832

Use and outcomes of Laparoscopic-assisted colectomy for cancer in the United States. / Bilimoria, Karl Y.; Bentrem, David J.; Nelson, Heidi; Stryker, Steven J.; Stewart, Andrew K.; Soper, Nathaniel J.; Russell, Thomas R.; Ko, Clifford Y.

In: Archives of Surgery, Vol. 143, No. 9, 09.2008, p. 832-840.

Research output: Contribution to journalArticle

Bilimoria, KY, Bentrem, DJ, Nelson, H, Stryker, SJ, Stewart, AK, Soper, NJ, Russell, TR & Ko, CY 2008, 'Use and outcomes of Laparoscopic-assisted colectomy for cancer in the United States', Archives of Surgery, vol. 143, no. 9, pp. 832-840. https://doi.org/10.1001/archsurg.143.9.832
Bilimoria, Karl Y. ; Bentrem, David J. ; Nelson, Heidi ; Stryker, Steven J. ; Stewart, Andrew K. ; Soper, Nathaniel J. ; Russell, Thomas R. ; Ko, Clifford Y. / Use and outcomes of Laparoscopic-assisted colectomy for cancer in the United States. In: Archives of Surgery. 2008 ; Vol. 143, No. 9. pp. 832-840.
@article{2da5f922cb1244698a6ae9c82b6b9b50,
title = "Use and outcomes of Laparoscopic-assisted colectomy for cancer in the United States",
abstract = "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: Lo 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.",
author = "Bilimoria, {Karl Y.} and Bentrem, {David J.} and Heidi Nelson and Stryker, {Steven J.} and Stewart, {Andrew K.} and Soper, {Nathaniel J.} and Russell, {Thomas R.} and Ko, {Clifford Y.}",
year = "2008",
month = "9",
doi = "10.1001/archsurg.143.9.832",
language = "English (US)",
volume = "143",
pages = "832--840",
journal = "JAMA Surgery",
issn = "2168-6254",
publisher = "American Medical Association",
number = "9",

}

TY - JOUR

T1 - Use and outcomes of Laparoscopic-assisted colectomy for cancer in the United States

AU - Bilimoria, Karl Y.

AU - Bentrem, David J.

AU - Nelson, Heidi

AU - Stryker, Steven J.

AU - Stewart, Andrew K.

AU - Soper, Nathaniel J.

AU - Russell, Thomas R.

AU - Ko, Clifford Y.

PY - 2008/9

Y1 - 2008/9

N2 - 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: Lo 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.

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: Lo 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.

UR - http://www.scopus.com/inward/record.url?scp=52249089214&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=52249089214&partnerID=8YFLogxK

U2 - 10.1001/archsurg.143.9.832

DO - 10.1001/archsurg.143.9.832

M3 - Article

C2 - 18794419

AN - SCOPUS:52249089214

VL - 143

SP - 832

EP - 840

JO - JAMA Surgery

JF - JAMA Surgery

SN - 2168-6254

IS - 9

ER -