What is the effect of laparoscopic colectomy on pattern of colon cancer recurrence? A propensity score and competing risk analysis compared with open colectomy

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Title: What is the effect of laparoscopic colectomy on pattern of colon cancer recurrence? A propensity score and competing risk analysis compared with open colectomy
Authors: Hasegawa, H
Okabayashi, K
Watanabe, M
Ashrafian, H
Harling, L
Ishii, Y
Sugiyama, D
Seishima, R
Darzi, A
Athanasiou, T
Kitagawa, Y
Item Type: Journal Article
Abstract: Background Variability in colon cancer recurrence after laparoscopic colectomy (LAC) remains poorly understood. The aim of our study was to quantify the influence of LAC on colon cancer recurrence patterns. Methods We included 986 patients undergoing curative colectomy at our institution between 1992 and 2008. Kaplan–Meier, multivariable Cox regression, propensity score adjustment, and competing risks modeling were used to evaluate the influence of laparoscopic surgery on the site of colon cancer recurrence, including the following: liver metastasis, lung metastasis, local recurrence, peritoneal dissemination, other, and multiple sites. We estimated the risk factors for each recurrence site. Results Laparoscopic surgery was used in 419 (42.5 %) of 986 patients, with an overall median follow-up time of 5.0 years (interquartile range 3.5). The overall 5-year disease-free survival rate was 86.1 % (open surgery 81.8 % vs. laparoscopic surgery 92.0 %; p < 0.001). However, after covariates and propensity score adjustment, laparoscopic surgery was not a significant risk factor for each type of recurrence: liver hazard ratio (HR) 0.93 (95 % CI 0.45–1.89), p = 0.84; lung HR 0.67 (95 % CI 0.26–1.70), p = 0.39; local HR 0.56 (95 % CI 0.12–2.63), p = 0.46; peritoneal HR 2.49 (95 % CI 0.75–8.27), p = 0.14; others HR 0.47 (95 % CI 0.04–5.13), p = 0.53; multiple HR 0.88 (95 % CI 0.25–3.14), p = 0.84. The risk factors for each type of recurrence were variable and characterized by specific clinicopathological features. Conclusion Our study reveals that LAC and open colectomy demonstrate comparable overall colon cancer recurrence rates and recurrence sites. Specific clinicopathological characteristics may have a stronger influence on colon cancer recurrence site compared with the surgical technique.
Issue Date: 1-Aug-2014
Date of Acceptance: 1-Mar-2014
URI: http://hdl.handle.net/10044/1/60482
DOI: https://dx.doi.org/10.1245/s10434-014-3613-x
ISSN: 1068-9265
Publisher: Springer Verlag
Start Page: 2627
End Page: 2635
Journal / Book Title: Annals of Surgical Oncology
Volume: 21
Issue: 8
Copyright Statement: © 2014 Society of Surgical Oncology. The final publication is available at Springer via https://dx.doi.org/10.1245/s10434-014-3613-x
Sponsor/Funder: National Institute for Health Research
Funder's Grant Number: NF-SI-0510-10186
Keywords: Science & Technology
Life Sciences & Biomedicine
Oncology
Surgery
COMPLETE MESOCOLIC EXCISION
COLORECTAL SURGERY
TUMOR-GROWTH
TRIAL
RESECTION
SURVIVAL
MODEL
PNEUMOPERITONEUM
ADJUSTMENT
CARCINOMA
Aged
Colectomy
Colonic Neoplasms
Female
Follow-Up Studies
Humans
Laparoscopy
Liver Neoplasms
Lung Neoplasms
Lymphatic Metastasis
Male
Middle Aged
Neoplasm Invasiveness
Neoplasm Recurrence, Local
Neoplasm Staging
Peritoneal Neoplasms
Postoperative Complications
Prognosis
Propensity Score
Retrospective Studies
Risk Assessment
Survival Rate
1112 Oncology And Carcinogenesis
Oncology & Carcinogenesis
Publication Status: Published
Online Publication Date: 2014-03-11
Appears in Collections:Division of Surgery
Faculty of Medicine



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