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Despite clinical success, laparoscopic colectomy underused in colon cancer treatment
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Laparoscopic colectomy has shown superiority in clinical trials to open colectomy, but most physicians still choose open resection as the standard of surgical care for colon cancer, according to study results.
Many randomized clinical trials in the past decade have shown patients who undergo laparoscopic colectomies experience better short-term outcomes than those who undergo open colectomy. These benefits include better 30-day mortality, fewer unplanned readmissions and shorter lengths of stay.
Clinical trial results have shown long-term outcomes between the two groups are comparable.
Zhiyuan Zheng
Yet, when researchers used the National Cancer Data Base to determine the generalizability of trial data to real-world settings, they determined laparoscopic colectomy was underutilized.
“The benefits of laparoscopic colectomy are realized across the diverse spectrum of cancer programs and surgeons,” Zhiyuan Zheng, PhD, senior health services researcher for the American Cancer Society, and colleagues wrote. “However, close to half of all surgeons still performed only open colectomy, and more than half of high-volume surgeons performed open colectomy more frequently than laparoscopic colectomy in their routine clinical practice.”
The analysis included 45,876 patients with stage I to stage III colon cancer aged 18 to 84 years who underwent one of the two surgical procedures in 2010 or 2011. From that group, 41% underwent laparoscopic colectomy and 59% underwent open colectomy.
The investigators used a 1:1 propensity score analysis to avoid the effect of treatment selection bias, and they matched 18,230 patients in both groups.
Consistent with the results of prior clinical trials, Zheng and colleagues determined laparoscopic colectomy was associated with a significant reduction in 30-day mortality compared with open colectomy (1.3% vs. 2.3%; OR = 0.59; 95% CI, 0.49-0.69).
Patients who underwent laparoscopic colectomy experienced a lower rate of unplanned readmissions (4.8% vs. 5.1%; OR = 0.9; 95% CI, 0.81-1) and a shorter median length of stay (5 days vs. 6 days; incident rate ratio = 0.83; 95% CI, 0.8-0.84).
Among 8,414 individual surgeons identified, 44.4% performed open colectomy only. Among the 954 surgeons deemed “high volume,” 51.5% performed open surgery more frequently than laparoscopic surgery.
Finally, researchers determined laparoscopic colectomies were associated with a higher rate of initiation of adjuvant chemotherapy for patients with stage III disease (72.3% vs. 67%; P < .001).
“In order for more patients to realize benefits associated with laparoscopic colectomy at the national level, policies should create incentives within the health care system to expand the capability to perform laparoscopic colectomy through education and training,” Zheng and colleagues wrote. – by Anthony SanFilippo
Disclosure: The researchers report no relevant financial disclosures.
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