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Minimally invasive surgery for stage III colon adenocarcinoma is associated with less delay to initiation of adjuvant systemic therapy and improved survival

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Abstract

Background

Minimally invasive surgery (MIS) may improve surgical recovery and reduce time to adjuvant systemic therapy after colon cancer resection. The objective of this study was to determine the effect of MIS on the initiation of adjuvant systemic therapy and survival in patients with stage III colon cancer.

Methods

The 2010–2014 National Cancer Database was queried for patients with resected stage III colon adenocarcinoma, and divided into MIS, which included laparoscopic and robotic approaches, and open surgery. Propensity-score matching was used to balanced open and MIS groups. The main outcome measures were delayed initiation of adjuvant systemic therapy (defined as > 8 weeks after surgery) and 5-year overall survival (OS). Multiple Cox regression was performed to identify independent predictors for 5-year OS, including an interaction between delayed systemic therapy and MIS, and adjusted for clustering at the hospital level.

Results

There were 86,680 patients that were included in this study. Overall, 45% (38,713) underwent MIS colectomy, of which 93% underwent laparoscopic and 7% robotic surgery. After matching, 33,183 open patients were balanced to 33,183 MIS patients. Patient, tumor, and facility characteristics were similar in the matched cohort. More patients in the MIS group received adjuvant therapy within 8 weeks of surgery (49% vs. 42%, p < 0.001), and fewer MIS patients did not receive any systemic therapy (30% vs. 35%, p < 0.001). Delayed initiation of systemic therapy > 8 weeks was associated with worse 5-year OS (HR 1.27, 95%CI 1.19–1.36). MIS was independently associated with improved survival (HR 0.92, 95%CI 0.86–0.97). This relationship remained even if 90-day mortality was excluded.

Conclusions

MIS approaches are associated with less delay to the initiation of adjuvant systemic therapy and improved survival in patients with stage III colon adenocarcinoma. Surgeons should favor MIS approaches for the treatment of stage III colon adenocarcinoma whenever possible.

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Authors and Affiliations

  1. Center for Colon and Rectal Surgery, Florida Hospital, Orlando, FL, USA

    Lawrence Lee, Justin J. Kelly, George J. Nassif, Matthew R. Albert & John R. T. Monson

  2. Department of Surgery, McGill University Health Centre, Montreal, QC, Canada

    Lawrence Lee & Nathalie Wong-Chong

  3. Colon and Rectal Surgery, McGill University Health Centre, 1001 Decarie Blvd, DS1-3310, Montreal, QC, H4A 3J1, Canada

    Lawrence Lee & Nathalie Wong-Chong

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  1. Lawrence Lee
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Correspondence to Lawrence Lee.

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Disclosure

Dr. Albert reports consultant’s fees from Applied Medical, Stryker, and Conmed, and stock options from Applied Medical. Drs. Lee, Wong-Chong Kelly, Nassif, and Monson have no conflicts of interest or financial ties to disclose.

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Lee, L., Wong-Chong, N., Kelly, J.J. et al. Minimally invasive surgery for stage III colon adenocarcinoma is associated with less delay to initiation of adjuvant systemic therapy and improved survival. Surg Endosc 33, 460–470 (2019). https://doi.org/10.1007/s00464-018-6319-5

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  • DOI: https://doi.org/10.1007/s00464-018-6319-5

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