Differences in effectiveness and use of laparoscopic surgery in locally advanced colon cancer patients

Abstract Patients with locally advanced colon cancer have worse outcomes. Guidelines of various organizations are conflicting about the use of laparoscopic colectomy (LC) in locally advanced colon cancer. We determined whether patient outcomes of LC and open colectomy (OC) for locally advanced (T4)...

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Autores principales:	M. Schootman, Matthew Mutch, T. Loux, J. M. Eberth, N. O. Davidson
Formato:	article
Lenguaje:	EN
Publicado:	Nature Portfolio 2021
Materias:	Medicine R Science Q
Acceso en línea:	https://doaj.org/article/5bda58cd8fd145c2b3c288cbd2f2c085
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spelling	oai:doaj.org-article:5bda58cd8fd145c2b3c288cbd2f2c0852021-12-02T17:02:05ZDifferences in effectiveness and use of laparoscopic surgery in locally advanced colon cancer patients10.1038/s41598-021-89554-02045-2322https://doaj.org/article/5bda58cd8fd145c2b3c288cbd2f2c0852021-05-01T00:00:00Zhttps://doi.org/10.1038/s41598-021-89554-0https://doaj.org/toc/2045-2322Abstract Patients with locally advanced colon cancer have worse outcomes. Guidelines of various organizations are conflicting about the use of laparoscopic colectomy (LC) in locally advanced colon cancer. We determined whether patient outcomes of LC and open colectomy (OC) for locally advanced (T4) colon cancer are comparable in all colon cancer patients, T4a versus T4b patients, obese versus non-obese patients, and tumors located in the ascending, descending, and transverse colon. We used data from the 2013–2015 American College of Surgeons’ National Surgical Quality Improvement Program. Patients were diagnosed with nonmetastatic pT4 colon cancer, with or without obstruction, and underwent LC (n = 563) or OC (n = 807). We used a composite outcome score (mortality, readmission, re-operation, wound infection, bleeding transfusion, and prolonged postoperative ileus); length of stay; and length of operation. Patients undergoing LC exhibited a composite outcome score that was 9.5% lower (95% CI − 15.4; − 3.5) versus those undergoing OC. LC patients experienced a 11.3% reduction in postoperative ileus (95% CI − 16.0; − 6.5) and an average of 2 days shorter length of stay (95% CI − 2.9; − 1.0). Patients undergoing LC were in the operating room an average of 13.5 min longer (95% CI 1.5; 25.6). We found no evidence for treatment heterogeneity across subgroups (p > 0.05). Patients with locally advanced colon cancer who receive LC had better overall outcomes and shorter lengths of stay compared with OC patients. LC was equally effective in obese/nonobese patients, in T4a/T4b patients, and regardless of the location of the tumor.M. SchootmanMatthew MutchT. LouxJ. M. EberthN. O. DavidsonNature PortfolioarticleMedicineRScienceQENScientific Reports, Vol 11, Iss 1, Pp 1-8 (2021)
institution	DOAJ
collection	DOAJ
language	EN
topic	Medicine R Science Q
spellingShingle	Medicine R Science Q M. Schootman Matthew Mutch T. Loux J. M. Eberth N. O. Davidson Differences in effectiveness and use of laparoscopic surgery in locally advanced colon cancer patients
description	Abstract Patients with locally advanced colon cancer have worse outcomes. Guidelines of various organizations are conflicting about the use of laparoscopic colectomy (LC) in locally advanced colon cancer. We determined whether patient outcomes of LC and open colectomy (OC) for locally advanced (T4) colon cancer are comparable in all colon cancer patients, T4a versus T4b patients, obese versus non-obese patients, and tumors located in the ascending, descending, and transverse colon. We used data from the 2013–2015 American College of Surgeons’ National Surgical Quality Improvement Program. Patients were diagnosed with nonmetastatic pT4 colon cancer, with or without obstruction, and underwent LC (n = 563) or OC (n = 807). We used a composite outcome score (mortality, readmission, re-operation, wound infection, bleeding transfusion, and prolonged postoperative ileus); length of stay; and length of operation. Patients undergoing LC exhibited a composite outcome score that was 9.5% lower (95% CI − 15.4; − 3.5) versus those undergoing OC. LC patients experienced a 11.3% reduction in postoperative ileus (95% CI − 16.0; − 6.5) and an average of 2 days shorter length of stay (95% CI − 2.9; − 1.0). Patients undergoing LC were in the operating room an average of 13.5 min longer (95% CI 1.5; 25.6). We found no evidence for treatment heterogeneity across subgroups (p > 0.05). Patients with locally advanced colon cancer who receive LC had better overall outcomes and shorter lengths of stay compared with OC patients. LC was equally effective in obese/nonobese patients, in T4a/T4b patients, and regardless of the location of the tumor.
format	article
author	M. Schootman Matthew Mutch T. Loux J. M. Eberth N. O. Davidson
author_facet	M. Schootman Matthew Mutch T. Loux J. M. Eberth N. O. Davidson
author_sort	M. Schootman
title	Differences in effectiveness and use of laparoscopic surgery in locally advanced colon cancer patients
title_short	Differences in effectiveness and use of laparoscopic surgery in locally advanced colon cancer patients
title_full	Differences in effectiveness and use of laparoscopic surgery in locally advanced colon cancer patients
title_fullStr	Differences in effectiveness and use of laparoscopic surgery in locally advanced colon cancer patients
title_full_unstemmed	Differences in effectiveness and use of laparoscopic surgery in locally advanced colon cancer patients
title_sort	differences in effectiveness and use of laparoscopic surgery in locally advanced colon cancer patients
publisher	Nature Portfolio
publishDate	2021
url	https://doaj.org/article/5bda58cd8fd145c2b3c288cbd2f2c085
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Differences in effectiveness and use of laparoscopic surgery in locally advanced colon cancer patients

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