R. H. Kim1, Q. D. Chu1, G. C. Caldito2 1Louisiana State University Health Sciences Center – Shreveport,Surgical Oncology,Shreveport, LA, USA 2Louisiana State University Health Sciences Center – Shreveport,Neurology,Shreveport, LA, USA
Introduction: Laparoscopic surgery for colon cancer has been demonstrated in clinical trials to have short term benefits, including shorter hospital stay and recovery period, when compared to the open surgical approach. NCCN guidelines recommend that patients with stage III or high risk stage II colon cancer undergo adjuvant chemotherapy. We hypothesized that laparoscopic colectomy is associated with increased compliance to recommendations for chemotherapy, shorter time to start of chemotherapy, and increased overall survival.
Methods: The National Cancer Data Base was queried to identify patients with stage III or high risk stage II (T4, positive margins, LN<12, or high tumor grade) colon adenocarcinoma diagnosed between 2010 and 2012. Patients were divided into laparoscopic colectomy (LC) and open colectomy (OC) groups based on the surgical approach used for their definitive surgery. Intent-to-treat analysis was used, with converted cases included in the LC group. Rates of receiving adjuvant chemotherapy, time from diagnosis and surgery to start of chemotherapy, and overall survival were compared. Chi-square test, two-sample t-test and Kaplan-Meier method were used for statistical analysis.
Results: A total of 48,257 patients were included for analysis. 18,801 patients underwent LC and 29,456 underwent OC. LC patients received adjuvant chemotherapy at a higher rate than OC (66.2% vs 59.4%, p<0.01). Among patients who received chemotherapy, time to start of chemotherapy after definitive surgery was shorter for LC than OC (p<0.01). Two-year overall survival was higher for LC than OC (81.9% vs 73.2%, p<0.01).
Conclusion: Laparoscopic colectomy is associated with higher rates of compliance with NCCN guidelines for adjuvant chemotherapy for stage III and high risk stage II colon cancer, as well as a shorter time to start of chemotherapy and improved overall survival, compared to open colectomy.
