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Surgical Endoscopy

Published in:

01-02-2015

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

Authors: Gerald A. Gantt Jr., Jean Ashburn, Ravi P. Kiran, Alok A. Khorana, Matthew F. Kalady

Published in: Surgical Endoscopy | Issue 2/2015

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.

Jessup JM, Stewart A, Greene FL, Minsky BD (2005) Adjuvant chemotherapy for stage III colon cancer: implications of race/ethnicity, age, and differentiation. JAMA 294:2703–2711. doi:10.1001/jama.294.21.2703 PubMedCrossRef

Benson AB III, Schrag D, Somerfield MR, Cohen AM, Figueredo AT, Flynn PJ, Krzyzanowska MK, Maroun J, McAllister P, Van Cutsem E, Brouwers M, Charette M, Haller DG (2004) American Society of Clinical Oncology recommendations on adjuvant chemotherapy for stage II colon cancer. J Clin Oncol 22:3408–3419. doi:10.1200/JCO.2004.05.063 PubMedCrossRef

Moertel CG, Fleming TR, Macdonald JS, Haller DG, Laurie JA, Goodman PJ, Ungerleider JS, Emerson WA, Tormey DC, Glick JH (1990) Levamisole and fluorouracil for adjuvant therapy of resected colon carcinoma. N Engl J Med 322:352–358. doi:10.1056/NEJM199002083220602 PubMedCrossRef

Quasar Collaborative Group, Gray R, Barnwell J, McConkey C, Hills RK, Williams NS, Kerr DJ (2007) Adjuvant chemotherapy versus observation in patients with colorectal cancer: a randomised study. Lancet 370:2020–2029. doi:10.1016/S0140-6736(07)61866-2 PubMedCrossRef

Bayraktar UD, Chen E, Bayraktar S, Sands LR, Marchetti F, Montero AJ, Rocha-Lima CM (2010) Does delay of adjuvant chemotherapy impact survival in patients with resected stage II and III colon adenocarcinoma? Cancer. doi:10.1002/cncr.25720 PubMed

Hershman D, Hall MJ, Wang X, Jacobson JS, McBride R, Grann VR, Neugut AI (2006) Timing of adjuvant chemotherapy initiation after surgery for stage III colon cancer. Cancer 107:2581–2588. doi:10.1002/cncr.22316 PubMedCrossRef

Czaykowski PM, Gill S, Kennecke HF, Gordon VL, Turner D (2011) Adjuvant chemotherapy for stage III colon cancer: does timing matter? Dis Colon Rectum 54:1082–1089. doi:10.1097/DCR.0b013e318223c3d6 PubMedCrossRef

Biagi JJ, Raphael MJ, Mackillop WJ, Kong W, King WD, Booth CM (2011) Association between time to initiation of adjuvant chemotherapy and survival in colorectal cancer: a systematic review and meta-analysis. JAMA 305:2335–2342. doi:10.1001/jama.2011.749 PubMedCrossRef

Des Guetz G, Nicolas P, Perret GY, Morere JF, Uzzan B (2010) Does delaying adjuvant chemotherapy after curative surgery for colorectal cancer impair survival? A meta-analysis. Eur J Cancer 46:1049–1055. doi:10.1016/j.ejca.2010.01.020 PubMedCrossRef

10.

Cheung WY, Neville BA, Earle CC (2009) Etiology of delays in the initiation of adjuvant chemotherapy and their impact on outcomes for stage II and III rectal cancer. Dis Colon Rectum 52:1054–1063; discussion 1064. doi:10.1007/DCR.0b013e3181a51173

11.

Clinical Outcomes of Surgical Therapy Study Group (2004) A comparison of laparoscopically assisted and open colectomy for colon cancer. N Engl J Med 350:2050–2059. doi:10.1056/NEJMoa032651 CrossRef

12.

Colon Cancer Laparoscopic or Open Resection Study Group, Buunen M, Veldkamp R, Hop WC, Kuhry E, Jeekel J, Haglind E, Pahlman L, Cuesta MA, Msika S, Morino M, Lacy A, Bonjer HJ (2009) Survival after laparoscopic surgery versus open surgery for colon cancer: long-term outcome of a randomised clinical trial. Lancet Oncol 10:44–52. doi:10.1016/S1470-2045(08)70310-3 PubMedCrossRef

13.

Milsom JW, Bohm B, Hammerhofer KA, Fazio V, Steiger E, Elson P (1998) A prospective, randomized trial comparing laparoscopic versus conventional techniques in colorectal cancer surgery: a preliminary report. J Am Coll Surg 187:46–54; discussion 54–5

14.

Abraham NS, Young JM, Solomon MJ (2004) Meta-analysis of short-term outcomes after laparoscopic resection for colorectal cancer. Br J Surg 91:1111–1124. doi:10.1002/bjs.4640 PubMedCrossRef

15.

Braga M, Vignali A, Gianotti L, Zuliani W, Radaelli G, Gruarin P, Dellabona P, Di Carlo V (2002) Laparoscopic versus open colorectal surgery: a randomized trial on short-term outcome. Ann Surg 236:759–766; disscussion 767. doi:10.1097/01.SLA.0000036269.60340.AE

16.

Lima IS, Yasui Y, Scarfe A, Winget M (2011) Association between receipt and timing of adjuvant chemotherapy and survival for patients with stage III colon cancer in Alberta, Canada. Cancer 117:3833–3840. doi:10.1002/cncr.25954 PubMedCrossRef

17.

Tevis SE, Kohlnhofer BM, Stringfield S, Foley EF, Harms BA, Heise CP, Kennedy GD (2013) Postoperative complications in patients with rectal cancer are associated with delays in chemotherapy that lead to worse disease-free and overall survival. Dis Colon Rectum 56:1339–1348. doi:10.1097/DCR.0b013e3182a857eb PubMedCrossRef

18.

Berglund A, Cedermark B, Glimelius B (2008) Is it deleterious to delay the start of adjuvant chemotherapy in colon cancer stage III? Ann Oncol 19:400–402. doi:10.1093/annonc/mdm582 PubMedCrossRef

19.

Hemandas AK, Abdelrahman T, Flashman KG, Skull AJ, Senapati A, O’Leary DP, Parvaiz A (2010) Laparoscopic colorectal surgery produces better outcomes for high risk cancer patients compared to open surgery. Ann Surg 252:84–89. doi:10.1097/SLA.0b013e3181e45b66 PubMedCrossRef

20.

Harmon GD, Senagore AJ, Kilbride MJ, Warzynski MJ (1994) Interleukin-6 response to laparoscopic and open colectomy. Dis Colon Rectum 37:754–759PubMedCrossRef

21.

Whelan RL, Franklin M, Holubar SD, Donahue J, Fowler R, Munger C, Doorman J, Balli JE, Glass J, Gonzalez JJ, Bessler M, Xie H, Treat M (2003) Postoperative cell mediated immune response is better preserved after laparoscopic vs open colorectal resection in humans. Surg Endosc 17:972–978. doi:10.1007/s00464-001-8263-y PubMedCrossRef

22.

Allendorf JD, Bessler M, Horvath KD, Marvin MR, Laird DA, Whelan RL (1999) Increased tumor establishment and growth after open vs laparoscopic surgery in mice may be related to differences in postoperative T-cell function. Surg Endosc 13:233–235PubMedCrossRef

Title: Laparoscopy mitigates adverse oncological effects of delayed adjuvant chemotherapy for colon cancer
Authors: Gerald A. Gantt Jr.
Jean Ashburn
Ravi P. Kiran
Alok A. Khorana
Matthew F. Kalady
Publication date: 01-02-2015
Publisher: Springer US
Published in: Surgical Endoscopy / Issue 2/2015
Print ISSN: 0930-2794
Electronic ISSN: 1432-2218
DOI: https://doi.org/10.1007/s00464-014-3697-1

At a glance: The STEP trials

Springer Medicine

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

Abstract

Background

Methods

Results

Conclusions

At a glance: The STEP trials

Springer Medicine

Abstract

Background

Methods

Results

Conclusions

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