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Laparoscopy mitigates adverse oncological effects of delayed adjuvant chemotherapy for colon cancer

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Abstract

Background

Delaying initiation of adjuvant chemotherapy more than 8 weeks after surgical resection for colorectal cancer adversely affects overall patient survival. The effect of a laparoscopic surgical approach on initiation of chemotherapy has not been studied. The goal of this study was to determine if a laparoscopic approach to colon cancer resection affects the timing of adjuvant chemotherapy and outcomes.

Methods

Patients who underwent curative surgery for stage II or III colon cancer and received adjuvant chemotherapy between 2003 and 2010 were identified from a prospectively maintained database. Patients were categorized according to surgical approach: open or laparoscopic. Patient demographics, clinicopathologic variables, postoperative complications, time from surgery to initiation of chemotherapy, and long-term oncologic outcomes were compared.

Results

Age, gender, ASA class, BMI, tumor stage, and postoperative complications were similar for laparoscopic and open cases, while length of stay was 2 days shorter for laparoscopic cases (5.4 vs 7.6 days, p < 0.01). The proportion of patients who received adjuvant chemotherapy more than 8 weeks after surgery did not differ between the groups (35.6 % open vs 38.7 % laparoscopic, p = 0.77). In the open group, delay in chemotherapy after surgery was associated with decreased disease-free and overall survival (p = 0.01, 0.01, respectively). However, delay in chemotherapy more than 8 weeks did not affect disease-free or overall survival in the laparoscopy group (p = 0.93, 0.51, respectively).

Conclusions

The benefits of quicker recovery after laparoscopic surgery did not translate into earlier initiation of adjuvant chemotherapy in this retrospective study. However, a laparoscopic approach negated the inferior oncologic outcomes of patients who received delayed initiation of chemotherapy.

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Acknowledgments

The authors would like to acknowledge Jeff Hammel for his statistical analysis. MFK is the Krause-Lieberman Chair in Colorectal Surgery. AAK is the Sondra and Stephen Hardis Chair in Oncology Research.

Disclosures

Gerald A Gantt, M.D., Jean Ashburn, M.D., Ravi P. Kiran, M.B.B.S., Alok A. Khorana, M.D., and Matthew F. Kalady, M.D. have no relevant conflict of interests or financial ties to disclose.

Funding

Krause-Lieberman Endowed Chair of Colorectal Surgery.

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Authors and Affiliations

  1. Department of Colorectal Surgery, Digestive Disease Institute, Cleveland Clinic Foundation, 9500 Euclid Ave A30, Cleveland, OH, 44195, USA

    Gerald A. Gantt Jr., Jean Ashburn, Ravi P. Kiran & Matthew F. Kalady

  2. Department of Solid Tumor Oncology, Taussig Cancer Institute, Cleveland Clinic Foundation, Cleveland, OH, USA

    Alok A. Khorana

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  1. Gerald A. Gantt Jr.
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  2. Jean Ashburn
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Correspondence to Gerald A. Gantt Jr..

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Gantt, G.A., Ashburn, J., Kiran, R.P. et al. Laparoscopy mitigates adverse oncological effects of delayed adjuvant chemotherapy for colon cancer. Surg Endosc 29, 493–499 (2015). https://doi.org/10.1007/s00464-014-3697-1

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  • DOI: https://doi.org/10.1007/s00464-014-3697-1

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