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Laparoscopic surgery in patients with colon cancer: a population-based analysis

Surgical Endoscopy volume 31, pages 2586–2595 (2017)Cite this article

Abstract

Background

The long-term outcomes after laparoscopic surgery for colon cancer remain debatable, as randomized trials have reported similar outcomes for open and laparoscopic surgery but population-based data are scarce. Thus, it is unclear whether, outside of clinical trials, laparoscopic surgery that is performed as a standard clinical treatment has detrimental effects on patients’ long-term survival.

Methods

This study examined a unified database of 30 German regional cancer registries for patients with colorectal cancer who were diagnosed between 2003 and 2011. Among 216,682 patients with colorectal carcinoma, we identified 37,068 patients with Union for International Cancer Control stage I–III colon carcinoma (>12 cm from the anal verge), including 3825 patients (10.38 %) who underwent laparoscopic surgery. Multivariate Cox regression analyses were also used to evaluate factors that influenced the likelihood of a patient undergoing laparoscopic surgery. Kaplan–Meier analysis with the log-rank test was used to analyse differences in short- and long-term survival outcomes after open or laparoscopic surgery.

Results

Younger age, lower T-stage, and left-sided surgery were independent predictors of the patient undergoing laparoscopic surgery (all, p < 0001). The 30-day mortality rate was significantly lower for patients who underwent laparoscopic surgery for left-sided tumours (odds ratio [OR] 0.49; 95 % confidence interval [CI] 0.33–0.77). Compared to open surgery, laparoscopic surgery was a significant and independent predictor of prolonged long-term survival for right- and left-sided surgeries (right-side, OR 0.67; 95 % CI 0.56–0.82; left-sided, OR 0.70; 95 % CI 0.62–0.78).

Conclusion

Our results indicate that laparoscopic surgery provides favourable outcomes even when used outside controlled trials and should be considered as a standard treatment for patients with colon cancer.

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Acknowledgments

The authors thank all participating registries for their cooperation.

Author information

Affiliations

  1. Klinik für Allgemeine-Viszeral- und Kinderchirurgie, Kliniken Böblingen, Bunsenstr. 120, 71032, Böblingen, Germany

    Stefan Benz

  2. Arbeitsgemeinschaft Deutscher Tumorzentren e.V, Kuno-Fischer-Strasse 8, 14057, Berlin, Germany

    Hagen Barlag & Monika Klinkhammer-Schalke

  3. Tumourzentrum Regensburg e.V, Josef-Engert-Str. 9, 93053, Regensburg, Germany

    Michael Gerken

  4. Caritas-Krankenhaus St. Josef, Klinik für Chirurgie Landshuter Strasse 65, 93053, Regensburg, Germany

    Alois Fürst

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  1. Stefan Benz
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  2. Hagen Barlag
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  3. Michael Gerken
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  4. Alois Fürst
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Correspondence to Stefan Benz.

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Disclosures

Drs. Stefan Benz, Hagen Barlag, Michael Gerken, Alois Fuerst and Monika Klinkhammer-Schalke have no conflicts of interest or financial ties to disclose.

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Benz, S., Barlag, H., Gerken, M. et al. Laparoscopic surgery in patients with colon cancer: a population-based analysis. Surg Endosc 31, 2586–2595 (2017). https://doi.org/10.1007/s00464-016-5266-2

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  • DOI: https://doi.org/10.1007/s00464-016-5266-2

Keywords

  • Minimal invasive surgery
  • Laparoscopic surgery
  • Colon cancer
  • Cancer registry
  • Long-term survival