Minimally invasive surgery for T4 colon cancer is associated with better outcomes compared to open surgery in the National Cancer Database

El-Sharkawy, Farah; Gushchin, Vadim; Plerhoples, Timothy A.; Liu, Chang; Emery, Erica; Collins, Devon T.; Bijelić, Lana

doi:10.1016/j.ejso.2020.09.003

Cited by 12 publications

(13 citation statements)

References 32 publications

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“…Regardless of the approach, the resection must follow essential oncological principles including central ligation of the primary vessel, proper mesocolic excision, an adequate resection margin and a surgical specimen containing a minimum of 12 lymph nodes [5][6][7][8][9] . It can be technically challenging to perform laparoscopically for T4 tumours although recent meta-analyses and register studies have indicated that LAP is safe and possibly even superior with regard to oncological outcomes when compared to OPEN even for T4 tumours [10][11][12] .…”

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confidence: 99%

“…Results from randomized controlled trials and single institutions studies tend to reflect the surgical expertise available at specialized centres. Data on short-term morbidity and mortality from high quality population-based studies reflecting standard care have indicated potential favourable short-term morbidity and mortality after laparoscopic surgery 7,11,[13][14][15] . However, few of these population-based studies have been able to control for elective and emergency surgery or adjust for risk-factors such as comorbidities and BMI.…”

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confidence: 99%

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Short term results in a population based study indicate advantage for laparoscopic colon cancer surgery versus open

Petersson

Matthiessen

Jadid

et al. 2023

Sci Rep

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The aim of this study was to compare LAP with OPEN regarding short-term mortality, morbidity and completeness of the cancer resection for colon cancer in a routine health care setting using population based register data. All 13,683 patients who were diagnosed 2012–2018 and underwent elective surgery for right-sided or sigmoid colon cancer were included from the Swedish Colorectal Cancer Registry and the National Patient Registry. Primary outcome was 30-day mortality. Secondary outcomes were 90-day mortality, length of hospital stay, reoperation, readmission and positive resection margin (R1). Weighted and unweighted multi regression analyses were performed. There were no difference in 30-day mortality: LAP (0.9%) and OPEN (1.3%) (OR 0.89, 95% CI 0.62–1.29, P = 0.545). The weighted analyses showed an increased 90-day mortality following OPEN, P < 0.001. Re-operations and re-admission were more frequent after OPEN and length of hospital stay was 2.9 days shorter following LAP (P < 0.001). R1 resections were significantly more common in the OPEN group in the unweighted and weighted analysis with P = 0.004 and P < 0.001 respectively. Therefore, the favourable short-term outcomes following elective LAP versus OPEN resection for colon cancer in routine health care indicate an advantage of laparoscopic surgery.

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confidence: 99%

mentioning

confidence: 99%

Short term results in a population based study indicate advantage for laparoscopic colon cancer surgery versus open

Petersson

Matthiessen

Jadid

et al. 2023

Sci Rep

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“…A recent analysis of the NCDB demonstrated that T4 colon cancer treated with MIS approach had improved 30‐day mortality and overall survival 29 . The authors concluded that MIS for locally advanced colorectal cancer can be considered for well selected patient populations.…”

Section: Discussionmentioning

confidence: 99%

“…A recent analysis of the NCDB demonstrated that T4 colon cancer treated with MIS approach had improved 30-day mortality and overall survival. 29 The authors concluded that MIS for locally advanced colorectal cancer can be considered for well selected patient populations. In the present study we conduct a similar propensity-score matched analysis and similarly find that, MC is associated with better short-and long-term oncologic outcomes compared to OC in T4 colon cancer patients.…”

Section: Discussionmentioning

confidence: 99%

Tumor extent impacts survival benefit in minimally invasive colectomy for T4 colon cancer: A propensity matched national cohort analysis

Malhotra

Lafaro

Konstantinidis

et al. 2022

Journal of Surgical Oncology

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Background: T4 colon cancers have been underrepresented in randomized trials comparing minimally invasive colectomy (MC) versus open colectomy (OC).Retrospective studies suggest improved survival with MC versus OC, but have not addressed the impact of tumor extent.Methods: Using the National Cancer Database (NCDB), we analyzed patients undergoing colectomy for T4 colon adenocarcinoma from 2010 to 2014. Propensity score matching was performed between MC and OC patients. Tumor extent was defined by zones based on adjacent organ involvement.Results: Of the 19 178 eligible patients, 6564 (34%) underwent MC. After matching, MC was associated with improved overall survival (hazard ratios: 0.71, 95% confidence interval: 0.67−0.76; median OS 59 vs. 42 months, p < 0.001). Compared to MC patients, those undergoing OC had: a higher margin positive rate (p = 0.009); lower median nodes examined (p < 0.001); a lower rate of adjuvant chemotherapy (p < 0.001); and a longer median time to chemotherapy (p < 0.001). Stratified survival analyses demonstrated that MC was associated with improved overall survival compared to OC in all zones except zone 3 and 4.Conclusions: Compared to OC, MC for T4 colon cancer is associated with improved oncologic outcomes when performed for zone 0−2 tumors. For, zone 3 and 4 tumors MC and OC have similar oncologic outcomes and patients should be cautiously selected.

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“…In Table 1, I think the following factors need to be included in the study because they may be related to postoperative complications. [2][3][4][5] Second, in Table 1, I think the preoperative diseases of two groups need to be included in the study, such as lung disease, cardiovascular disease, and diabetes. Patients with chronic obstructive pulmonary disease are prone to respiratory depression during and after the operation, which can increase the risk of postoperative pulmonary infection.…”

Section: To the Editorsmentioning

confidence: 99%

What are the factors predictive of postoperative complications in patients with colorectal cancer undergoing stenting as a bridge to surgery?

Sun²,

Yang³

2022

Journal of Surgical Oncology

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Minimally invasive surgery for T4 colon cancer is associated with better outcomes compared to open surgery in the National Cancer Database

Cited by 12 publications

References 32 publications

Short term results in a population based study indicate advantage for laparoscopic colon cancer surgery versus open

Short term results in a population based study indicate advantage for laparoscopic colon cancer surgery versus open

Tumor extent impacts survival benefit in minimally invasive colectomy for T4 colon cancer: A propensity matched national cohort analysis

What are the factors predictive of postoperative complications in patients with colorectal cancer undergoing stenting as a bridge to surgery?

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