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Surgical Endoscopy
Published in: Surgical Endoscopy 11/2016

01-11-2016

Nationwide implementation of laparoscopic surgery for colon cancer: short-term outcomes and long-term survival in a population-based cohort

Authors: Kjartan Stormark, Kjetil Søreide, Jon Arne Søreide, Jan Terje Kvaløy, Frank Pfeffer, Morten T. Eriksen, Bjørn S. Nedrebø, Hartwig Kørner

Published in: Surgical Endoscopy | Issue 11/2016

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Abstract

Background

Randomized trials show similar outcomes after open surgery and laparoscopy for colon cancer, and confirmation of outcomes after implementation in routine practice is important. While some studies have reported long-term outcomes after laparoscopic surgery from single institutions, data from large patient cohorts are sparse. We investigated short- and long-term outcomes of laparoscopic and open surgery for treating colon cancer in a large national cohort.

Methods

We retrieved data from the Norwegian Colorectal Cancer Registry for all colon cancer resections performed in 2007–2010. Five-year relative survival rates following laparoscopic and open surgeries were calculated, including excess mortality rates associated with potential predictors of death.

Results

Among 8707 patients with colon cancer that underwent major resections, 16 % and 36 % received laparoscopic procedures in 2007 and 2010, respectively. Laparoscopic procedures were most common in elective surgeries for treating stages I–III, right colon, or sigmoid tumours. The conversion rate of laparoscopic procedures was 14.5 %. Among all patients, laparoscopy provided higher 5-year relative survival rates (70 %) than open surgery (62 %) (P = 0.040), but among the largest group of patients electively treated for stages I–III disease, the approaches provided similar relative survival rates (78 vs. 81 %; P = 0.535). Excess mortality at 2 years post-surgery was lower after laparoscopy than after open surgery (excess hazard ratio, 0.7; P = 0.013), but similar between groups during the last 3 years of follow-up. Major predictors of death were stage IV disease, tumour class pN+, age > 80 years, and emergency procedures (excess hazard ratios were 5.3, 2.4, 2.1, and 2.0, respectively; P < 0.001).

Conclusion

Nationwide implementation of laparoscopic colectomy for colon cancer was safe and achieved results comparable to those from previous randomized trials.
Appendix
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Metadata
Title
Nationwide implementation of laparoscopic surgery for colon cancer: short-term outcomes and long-term survival in a population-based cohort
Authors
Kjartan Stormark
Kjetil Søreide
Jon Arne Søreide
Jan Terje Kvaløy
Frank Pfeffer
Morten T. Eriksen
Bjørn S. Nedrebø
Hartwig Kørner
Publication date
01-11-2016
Publisher
Springer US
Published in
Surgical Endoscopy / Issue 11/2016
Print ISSN: 0930-2794
Electronic ISSN: 1432-2218
DOI
https://doi.org/10.1007/s00464-016-4819-8

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