• Ann. Surg. Oncol. · Aug 2014

    Comparative Study

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

    • Hirotoshi Hasegawa, Koji Okabayashi, Masahiko Watanabe, Hutan Ashrafian, Leanne Harling, Yoshiyuki Ishii, Daisuke Sugiyama, Ryo Seishima, Ara Darzi, Thanos Athanasiou, and Yuko Kitagawa.
    • Department of Surgery, School of Medicine, Keio University, Tokyo, Japan, hasegawa@z8.keio.jp.
    • Ann. Surg. Oncol. 2014 Aug 1;21(8):2627-35.

    BackgroundVariability 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.MethodsWe 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.ResultsLaparoscopic 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.ConclusionOur 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.

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