Minimally invasive surgery is underutilized for colon cancer.
ABSTRACT The Clinical Outcomes of Surgical Therapy Group (COST) trial published in 2004 demonstrated that minimally invasive surgery (MIS) for colorectal cancer provided equivalent oncologic results and better short-term outcomes when compared to open surgery. Before this, MIS comprised approximately 3% of colorectal cancer cases. We hypothesized that there would be a dramatic increase in the use of MIS for colon cancer after this publication.
The National Inpatient Sample database was used to retrospectively review MIS and open colon resections from 2005 through 2007. ICD-9-specific procedure codes were used to identify open and MIS colon cancer resections. Statistical analyses performed included Pearson χ(2) tests and dependent t tests, and Cramer's V was used to measure the strength of association.
A total of 240,446 colon resections were performed between 2005 and 2007. The percentage of resections performed laparoscopically increased from 4.7% in 2005 to 6.7% in 2007 for colon cancer and remained relatively unchanged for benign disease (25.2% in 2005 vs. 27.4% in 2007, P < 0.007). Patients undergoing laparoscopic colectomy were younger, had lower comorbidity scores, had lower rates of complications (20.1 vs. 25.1%, P < 0.001), had shorter lengths of stay (7.2 vs. 9.6 days, P < 0.001), and had lower mortality (1.5 vs. 3.0%, P < 0.001). Furthermore, when evaluating adoption trends, urban teaching hospitals adopted laparoscopy more rapidly than rural nonteaching centers.
Adoption of MIS for the treatment of colorectal cancer has been slow. Additional studies to evaluate barriers in the adoption of MIS for colon cancer resection are warranted.
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ABSTRACT: 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. 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. 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. 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. © The Author 2015. Published by Oxford University Press. All rights reserved. For Permissions, please e-mail: email@example.com.JNCI Journal of the National Cancer Institute 03/2015; 107(3). DOI:10.1093/jnci/dju491 · 15.16 Impact Factor
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ABSTRACT: Purpose The role of minimally invasive colorectal resection for patients undergoing a simultaneous resection for synchronous liver metastases had not been established. This study compared the short- and long-term outcomes between minimally invasive and open colorectal resection for patients undergoing simultaneous resection for liver metastases. Methods This study reviewed 101 consecutive patients undergoing simultaneous colorectal resection and R0 resection of synchronous liver metastases between January 2008 and December 2012. In the study, 36 consecutive patients who underwent minimally invasive colorectal resection were matched with 36 patients who had an open approach by propensity scoring. The analyzed variables included patient and tumor characteristics and short-term and long-term outcomes. Results After propensity score matching, the two groups had similar clinicopathologic variables. No patient undergoing the minimally invasive procedure experienced conversion to the open technique. No postoperative mortality occurred in either group. In the minimally invasive group, the estimated blood loss (P P P P P = 0.794) and disease-free survival rate (38 vs. 27 %; P = 0.860). Conclusion Minimally invasive colorectal resection with simultaneous resection of liver metastases has an outcome similar to open approach but some short-term advantages.International Journal of Colorectal Disease 12/2014; 30(3). DOI:10.1007/s00384-014-2089-2 · 2.42 Impact Factor
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ABSTRACT: After the widespread application of minimally invasive surgery for benign diseases and given its proven safety and efficacy, minimally invasive surgery for gastrointestinal cancer has gained substantial attention in the past several years. Despite the large number of publications on the topic and level I evidence to support its use in colon cancer, minimally invasive surgery for most gastrointestinal malignancies is still underused. We explore some of the challenges that face the fusion of minimally invasive surgery technology in the management of gastrointestinal malignancies and propose solutions that may help increase the utilization in the future. These solutions are based on extensive literature review, observation of current trends and practices in this field, and discussion made with experts in the field. We propose 4 different solutions to increase the use of minimally invasive surgery in the treatment of gastrointestinal malignancies: collaboration between surgical oncologists/hepatopancreatobiliary surgeons and minimally invasive surgeons at the same institution; a single surgeon performing 2 fellowships in surgical oncology/hepatopancreatobiliary surgery and minimally invasive surgery; establishing centers of excellence in minimally invasive gastrointestinal cancer management; and finally, using robotic technology to help with complex laparoscopic skills. Multiple studies have confirmed the utility of minimally invasive surgery techniques in dealing with patients with gastrointestinal malignancies. However, training continues to be the most important challenge that faces the use of minimally invasive surgery in the management of gastrointestinal malignancy; implementation of our proposed solutions may help increase the rate of adoption in the future.JSLS: Journal of the Society of Laparoendoscopic Surgeons / Society of Laparoendoscopic Surgeons 10/2014; 18(4). DOI:10.4293/JSLS.2014.00134 · 0.79 Impact Factor