• Zhiyuan Zheng, Ahmedin Jemal, Chun Chieh Lin, Chung-Yuan Hu, and George J Chang.
• Surveillance and Health Services Research Program, Department of Intramural Research, American Cancer Society, Atlanta, GA (ZZ, AJ, CCL); Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX (CYH, GJC); Alliance for Clinical Trials in Oncology Network and American College of Surgeons Clinical Research Program, Chicago, IL (GJC); Alliance for Clinical Trials in Oncology Network and American College of Surgeons Clinical Research Program, Chicago, IL (GJC). jason.zheng@cancer.org.
• J. Natl. Cancer Inst. 2015 Mar 1; 107 (3).

BackgroundRandomized clinical trials showed that laparoscopic colectomy (LC) is superior to open colectomy (OC) in short-term surgical outcomes; however, the generalizability among real-world patients is not clear.MethodsThe National Cancer Data Base was used to identify stage I-III colon cancer patients age 18 to 84 years in 2010 and 2011. A propensity score analysis with 1:1 matching (PS) was used to avoid the effect of treatment selection bias. Patients were clustered at the hospital level for multilevel regression analyses. The main outcomes measured were 30-day mortality, unplanned readmissions, length of stay (LOS), and initiation of adjuvant chemotherapy among stage III patients. All statistical tests were two-sided.ResultsA total of 45 876 patients were analyzed, 18 717 (41%) LC and 27 159 (59%) OC. After PS matching, there were 18 230 patients in both groups and they were well balanced on their covariables. Compared with OC, LC showed consistent benefits in 30-day mortality (1.3% vs 2.3 %, odds ratio [OR] = 0.59, 95% confidence interval [CI] = 0.49 to 0.69, P < .001) and LOS (median 5 vs 6 days, incident rate ratio = 0.83, 95% CI = 0.8 to 0.84, P < .001). LC was also associated with a higher rate of adjuvant chemotherapy use in stage III patients (72.3% vs 67.0%, P < .001). LC was more likely to be performed by high-volume surgeons in high-volume hospitals, but there was no significant effect of the hospital/surgeon volume on short-term outcomes.ConclusionIn routine clinical practice, laparoscopic colectomy is associated with lower 30-day mortality, shorter length of stay, and greater likelihood of adjuvant chemotherapy initiation among stage III colon cancer patients when compared with open colectomy.© The Author 2015. Published by Oxford University Press. All rights reserved. For Permissions, please e-mail: journals.permissions@oup.com.

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