Laparoscopic vs Open Colectomy for Colon Cancer: Results from a Large Nationwide Population-based Analysis
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Laparoscopic colectomy has only recently become an accepted technique for the treatment of colon cancer. We sought to analyze factors that affect the type of resection performed and associated outcomes from a large nationwide database.
All admissions with a primary diagnosis of colon cancer undergoing elective resection were selected from the 2003 and 2004 Nationwide Inpatient Samples. Multiple linear and logistic regression analyses were used to compare outcome measures and identify independent predictors of a laparoscopic approach.
We identified 98,923 admissions (mean age 69.2 years). They were predominately Caucasian (81%), had localized disease (63%), had private insurance (56%), and had surgery performed in urban hospitals (87%). Laparoscopic resection was performed in 3,296 cases (3.3%) and was associated with a lower complication rate (18% vs 22%), shorter length of stay (6 vs 7.6 days), decreased need for skilled aftercare (5% vs 11%), and lower mortality (0.6% vs 1.4%, all P < 0.01). There was no significant difference in the total hospital charges between the groups ($34,685 vs $34,178, P = 0.19). Independent predictors of undergoing laparoscopic resection were age < 70 (odds ratio [OR] = 1.2, P < 0.01), national region (Midwest OR = 1.9, West OR = 2.0, P < 0.01), and lower disease stage (OR = 2.5, P < 0.01). Ethnic category and insurance status showed no significant association with operative method (P > 0.05).
Laparoscopy for colon cancer is associated with improved outcomes in unadjusted analysis and similar charges compared to open resection. We found no influence of race or payer status on the utilization of a laparoscopic approach.
KeywordsLaparoscopy Colon cancer NIS Colectomy
No outside financial support or provision of supplies was solicited or received in connection with this work.
Disclosure and Proprietary Statement
This is an original work by the above authors. The opinions expressed are the authors’ and authors’ alone. They do not necessarily reflect the opinion of the United States Government, the US Department of Defense or the Madigan Army Medical Center. The manuscript has been seen and approved by all authors and is previously unpublished. It was presented as a podium presentation at the June 2007 American Society of Colorectal Surgeons Meeting.
- 1.American Cancer Society. Cancer prevention and early detection: facts and figures, 2007. Available at http://www.cancer.org Accessed April 2007.
- 7.Vertruyen M, Cadiere GB, Himpens J, Bruyn SJ, Lemper JC, Urbain D. Laparoscopic colectomy for cancer (abstract). Surg Endosc 1996;10:558.Google Scholar
- 8.Ramos JM, Gupta S, Anthone GJ, Ortega AE, Simons AJ, Beart RW. Laparoscopic colon cancer. Is the port site at risk? A preliminary report. Arch Surg 1994;127:897–900.Google Scholar
- 19.HCUP. Overview of the Nationwide Inpatient Sample. http://www.hcup-us.ahrq.gov/nisoverview.jsp.
- 50.Carter JJ, Feingold DL, Kirman DL, Kirman I, Oh A, Wildbrett P, Asi Z, Fowler R, Huang E, Whelan RL. Laparoscopic-assisted cecectomy is associated with decreased formation of postoperative pulmonary metastases compared with open cecectomy in a murine model. Surgery 2003;134:432–436.PubMedCrossRefGoogle Scholar
- 54.American Society of Colon and Rectal Surgeons Position Statement. Laparoscopic colectomy for curable cancer. Available at http://www.fascrs.org.