Abstract
BackgroundLaparoscopic colectomy for colon cancer has been compared with open colectomy in randomized controlled trials, but these studies may not be generalizable because of strict enrollment and exclusion criteria which may explicitly or inadvertently exclude older individuals due to associated comorbidities. Previous studies of older patients undergoing laparoscopic colectomy have generally focused on short-term outcomes. The goals of this cohort study were to identify predictors of laparoscopic colectomy in an older population in the United States and to compare short-term and long-term outcomes.MethodsPatients aged 65 years or older with incident colorectal cancer diagnosed 1996-2002 who underwent colectomy within 6 months of cancer diagnosis were identified from the linked Surveillance, Epidemiology, and End Results-Medicare database. Laparoscopic and open colectomy patients were compared with respect to length of stay, blood transfusion requirements, intensive care unit monitoring, complications, 30-day mortality, and long-term survival. We adjusted for potential selection bias in surgical approach with propensity score matching.ResultsLaparoscopic colectomy cases were associated with left-sided tumors; areas with higher population density, income, and education level; areas in the western United States; and National Cancer Institute-designated cancer centers. Laparoscopic colectomy cases had shorter length of stay and less intensive care unit monitoring. Although laparoscopic colectomy patients (n = 424) had fewer complications (21.5% versus 26.3%), lower 30-day mortality (3.3% versus 5.8%), and longer median survival (6.6 versus 4.8 years) compared with open colectomy patients (n = 27,012), after propensity score matching these differences disappeared.ConclusionsIn this older population, laparoscopic colectomy practice patterns were associated with factors which likely correlate with tertiary referral centers. Although short-term and long-term survival are comparable, laparoscopic colectomy offers shorter hospitalizations and less intensive care.
Highlights
Laparoscopic colectomy for colon cancer has been compared with open colectomy in randomized controlled trials, but these studies may not be generalizable because of strict enrollment and exclusion criteria which may explicitly or inadvertently exclude older individuals due to associated comorbidities
Our study aimed to identify factors associated with laparoscopic colectomy in older patients and to compare both short-term and long-term outcomes
Except for incorporation of hospital characteristics, this analysis did not account for clustering of LC cases in a subset of hospitals. In this analysis of older individuals with colon cancer, laparoscopic colectomy was associated with factors that probably correlate with tertiary care practice patterns
Summary
Laparoscopic colectomy for colon cancer has been compared with open colectomy in randomized controlled trials, but these studies may not be generalizable because of strict enrollment and exclusion criteria which may explicitly or inadvertently exclude older individuals due to associated comorbidities. Randomized controlled trials (RCT) have shown no long-term survival difference between LC and OC [5,7,8,9] or, in one single-center trial, better cancerrelated survival with LC [10]. These studies may not be generalizable because of strict inclusion or exclusion criteria which may explicitly or inadvertently exclude older individuals due to associated comorbidities. Whilst older patients might benefit most from the less invasive approach offered by laparoscopic colectomy because of limited functional reserve [13], some surgeons still have concerns that they may be disadvantaged by the longer operative times usually described with this approach
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